Gangrene

Introduction.  Entrapment or strangulation of the penis is a rare emergency situation that can lead to a wide range of vascular and mechanical injuries.Aim.  The aim of this article is to present our experience dealing with penile strangulation. A review of the literature is also summarized in this report. Current treatment options and outcomes are also evaluated.Methods.  We performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. These reports were analyzed and the important findings summarized.Results.  Penile strangulation has been first time reported in 1755. Since that time, sporadic reports have appeared in the literature describing a variety of foreign bodies on the penis that have in common only the property of circularity. We noted motives, types of objects, types of strangulation, symptomatology, trauma grades, diagnoses, including psychological involvement, as well as possible treatment options. Furthermore, two cases of penile strangulation from our clinical practice are presented involving different degrees of vascular insult leading to different pathogenesis, clinical presentation, and surgical approach.Conclusion.  Penile strangulation is an unusual clinical condition and the consequences can be severe. Penile strangulation could lead to different degrees of vascular obstruction. Consequently, several clinical syndromes can occur: from mild nonsignificant vascular obstruction that resolves after decompression to severe gangrene of the penis accompanied with impaired renal function. The most common motive associated with foreign bodies on the penis is sexual or erotic in nature. The choice of method for removal depends upon type, size, incarceration time, trauma grade, and availability of the equipment. Prompt diagnosis and early treatment are essential to avoid the potential complications of ischemic necrosis and autoamputation. Ivanovski O, Stankov O, Kuzmanoski M, Saidi S, Banev S, Filipovski V, Lekovski L, and Popov Z. Penile strangulation: Two case reports and review of the literature. J Sex Med 2007;4:1775–1780.

Penetrating diaphragmatic injury rarely occurs in isolation. Diagnosis of traumatic diaphragmatic hernia resulting from penetrating diaphragmatic injury may be delayed or missed with attendant high morbidity and mortality. We reported a 28-year-old man who presented with features of subacute intestinal obstruction which became severe over the last four days. He had a stab injury to his left lower chest wall that was sutured 31/2 years prior to the development of symptoms. Emergency laparotomy with incidental findings of missed diaphragmatic hernia with gangrenous jejunal segment was found. The hernia was reduced, gangrenous segment resected with end to end anastomosis, and repair of diaphragmatic rent done. He had an uneventful recovery and follow up. There is the need to maintain high index of suspicion of Traumatic Diaphragmatic Hernia (TDH) in a patient with recent or previous thoraco-abdominal injury that will reduce the rate of missed or delayed diagnosis.

Ascaris lumbricoides or round worm infestation is quite common in the developing world. It affects all age groups but is more common in children. Most of the cases remain asymptomatic. The usual presentation is an intestinal obstruction. The physicians should be aware of this condition and consider it in the differential diagnosis when faced with such a case. The rare fatal complications include bleeding, perforation and gangrene.

Katupila - Securinega leucopyrus (willd) Muell. is ethnobotanic medicine, whose leaves are proven to exhibit wound healing property through in vitro, in vivo experimental studies and clinical study along with other properties like anti inflammatory, antioxidant etc. Present study was aimed to develop suitable Ayurvedic dosage form which can value add to ethnic practice and outcomes of recent studies on Katupila by utilizing probable potential of its alternate aria plant part; stem. Six batches of Katupila taila were prepared from decoction and bolus of stem of Katupila heated with Sesame oil in prescribed manner of Snehapaka as per Ayurvedic classics till Madhyam Snehapaka. Organoleptic, physicochemical evaluation, test parameters for evaluation of Snehakalpa as per Ayurvedic Pharmacopeia of India (API) were recorded in triplicate along with chromatographic pattern. Average 934.8 g (93.48% yield) of Katupila Taila was obtained from batch size of, 1 l of Tila Taila with 212 g of Kalk...

Tetralogy of Fallot (TOF) carries a higher risk for infective endocarditis (IE) due to associate multiple cardiac lesions. The incidence of IE in operated TOF patients either by corrective or palliative surgery is high (around 18%), however small (around 4%) in non-corrected TOF. Most reported cases of infective endocarditis complicating TOF have been in adults, reports of central embolization complicating infective endocarditis is also rare in African literatures, especially in children with TOF. We therefore report a case of gangrene of the left forearm from central embolization in a 14-month child with TOF who had septicaemia with infective endocarditis and acute renal failure. The incidence of infective endocarditis (IE) in congenital heart disease (CHD) is increasing especially in adults. This may be due to advancement in cardiac surgery and catheter intervention that led to increase in the number of patients with complex congenital heart diseases surviving to adulthood. 1 Infective endocarditis risk in CHD varies from 1% to 9%. 2,3 Tetralogy of fallot (TOF) carries a higher risk for IE due to associate multiple cardiac lesions. 4 The incidence of IE in operated TOF patients either by corrective or palliative surgery is high (around 18%), however small (around 4%) in non-corrected TOF. 3,5 Most reported cases of infective endocarditis complicating TOF have been in older children and adults 6,7 reports of central embolization is also rare in African literatures, especially in children with TOF. We therefore report a case of gangrene of the left forearm from central embolization in a 14-month child with TOF who had septicaemia with infective endocarditis and acute renal failure. CASE REPORT A 14-month-old female toddler presented at our centre with 2 weeks of fever and 3 days of loss of consciousness. Two days before presentation, gangrene of the fingers and left forearm was noticed, the following day, urinary output was observed to be reduced. On examination, she was unconscious and febrile (39.5 o C): She had features of down syndrome, anasarca and low oxygen saturation (94%) on 2 L/min of oxygen via nasal prongs. There was dark discoloration of the left upper limb extending from the fingers to distal two-thirds of the forearm with hyper-emic patches on the medial aspect of the elbow. The fingers were cold, shrunken, in fixed flex-ion deformity and absent radial and brachial pulses. Doppler studies showed that the brachial, radial and ulnar arteries were not audible.

We came across three rare cases of incarcerated hernia, with different presentations. The first case was an elderly female, who presented with an incarcerated incisional hernia on the right lower iliac region diagnosed on contrast enhanced computed tomography (CT); the contents were the small bowel and the perforated tip of the appendix. In the second case of inguinal incarcerated hernia, ultrasonography showed the inflammed appendix in the subcutaneous plane of the hernial sac, which is very rarely diagnosed pre-operatively and was confirmed during surgery. Inflammed appendix with gangrenous tip was found in the inguinal hernial sac. In yet another case of incarcerated inguinal hernia, the contents were a gangrenous part of the ascending colon and transverse colon, with the tip of the inflamed appendix—also only rarely observed. The colon extended to the scrotum in this case. We could find no description within the existing medical literature on either transverse or ascending colon as contents in inguinal hernia although transverse colon alone has been reported in four cases. The surgical options for dealing with the appendix in an Amyand’s hernia depend on the mode of presentation. The presence of a normal appendix does not require an appendicectomy to be performed, but its removal is necessary if inflamed.

Abstract. We describe a case of digital gangrene in a toddler with background disseminated tuberculosis based on non response to antibiotic treatment for twenty four days, lack of BCG immunization, positive contact with adult having chronic cough, favorable epidemiologic and radiologic features of tuberculosis. She presented with fever, cough, vomiting, weight loss and black discolouration of the fingers and toes. Patient was febrile (Temp 39.4°C), pale, had digital gangrene, peripheral lym- phadenopathy and weighed 75% of her expected body weight. She was dyspnoeic, tachypnoec, respiratory rate of 42 cycles per minute with crackles. Her pulse rate was 140 beat/minute (tachycardia), in addition to hepatosplenomegaly. Chest X-ray showed features of consolidation, full blood count revealed packed cell volume of 21%, eosinophilia of 8% and erythrocyte sedimenta- tion rate (ESR) of 130 mm/Hr. Patient remarkably improved with anti-tuberculosis drugs and discharged on follow-ups.
Keywords: Digital gangrene, disseminated tuberculosis, toddler, low health resource country