BMJ case reports
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Foreign body (FB) ingestion is a common problem in children. Up to 90% of these FBs pass spontaneously. ⋯ We present a case of a 9-year boy who accidentally ingested a long paper pin, which spontaneously passed in 26 h. This case is being reported to highlight the successful spontaneous passage of a 4 cm long sharp foreign body in a child.
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Case Reports
Spinal epidural abscess and meningitis following short-term epidural catheterisation for postoperative analgaesia.
We present a case of a patient with a spinal epidural abscess (SEA) and meningitis following short-term epidural catheterisation for postoperative pain relief after a laparoscopic sigmoid resection. On the fifth postoperative day, 2 days after removal of the epidural catheter, the patient developed high fever, leucocytosis and elevated C reactive protein. Blood cultures showed a methicillin-sensitive Staphylococcus aureus infection. ⋯ A gadolinium-enhanced MRI showed a SEA that was localised at the epidural catheter insertion site. Conservative management with intravenous flucloxacillin was initiated, as no neurological deficits were seen. At last follow-up, 8 weeks postoperatively, the patient showed complete recovery.
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Cerebral fat embolism (CFE) is a rare but potentially lethal complication of long bone fractures. Many cases of CFE occur as subclinical events and remain undiagnosed. ⋯ CT of the head was normal. MRI of the head confirmed the diagnosis with lesions markedly conspicuous and most widespread on susceptibility-weighted imaging as compared to all other sequences including diffusion-weighted imaging.
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Case Reports
High renal regional oxygen saturation in femoral arteriovenous fistula after neonatal cardiac surgery.
The use of an indwelling arterial catheter is standard practice in the postoperative monitoring of paediatric cardiac surgery patients. Arteriovenous fistula related to this procedure can be difficult to diagnose. Regional haemoglobin oxygen saturation (rSO2) using near-infrared spectroscopy and central venous oxygen saturation (ScvO2) are monitored to follow the balance between oxygen consumption and delivery. ⋯ High rSO2 and high ScvO2 are less frequently described. We report the discovery of an iatrogenic arteriovenous fistula in a neonate after cardiac surgery who had unexpectedly high values of renal rSO2 and femoral ScvO2. High renal rSO2 after femoral instrumentation should alert the physician to the possibility of arteriovenous fistula.
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Arthralgia is a rare but recognised complication of meningococcal septicaemia. We report a case of a 29-year-old man presenting with a 24 h history of fever, joint swelling and subsequent development of a non-blanching, petechial rash. He was treated for probable meningococcal septicaemia and the causative pathogen was later identified as Neisseria meningitidis. He was treated with ceftriaxone and after 10 days the pain and swelling in his joints improved.