BMJ case reports
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De Garengeot hernia is a rare clinical entity defined as the presence of a vermiform appendix within a femoral hernia sac. A 50-year-old woman presented to the emergency department with a painful lump over her right groin region. A bedside ultrasound was performed and soft tissue lesion was suspected. ⋯ Although it is usually an incidental finding during hernioplasty, De Garengeot hernia should be considered in the differential diagnosis of patients with an incarcerated femoral hernia. Mesh repair can be performed depending on the clinical situation. We report a rare case of incarcerated femoral hernia with acute appendicitis that required early surgical management to avoid associated complications.
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Hemiarthroplasty of the hip is a commonly performed procedure for subcapital neck of femur fractures. Dislocation of the hemiarthroplasty is a recognised but uncommon complication. ⋯ Dissociations are rare and require open reduction. We present a case of a patient with a hip hemiarthroplasty dislocation and dissociation subsequent to a fall.
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A 60-year-old man was diagnosed with severe sepsis caused by pyelonephritis. During transfer to the hospital room, he suddenly developed ventricular fibrillation and the patient recovered after electrical defibrillation. After this cardiac event, his haemodynamics collapsed despite administration of crystalloid fluid. ⋯ As a result of these combined therapies, the patient was successfully resuscitated. From this clinical course, we finally diagnosed that the severe sepsis was concomitant with myocardial depression. Introduction of mechanical support, including extracorporeal cardiopulmonary resuscitation may be recommendable in cases of severe sepsis with myocardial depression resulting in haemodynamic collapse, however, the option of introduction of an invasive approach needs further examination.
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Epidermolysis bullosa acquisita is a rare, acquired, autoimmune subepidermal blistering disease of the skin, characterised by blisters and erosions, especially in trauma-prone sites and extensor skin surface, scarring with formation of milia, skin fragility and nail dystrophy. Epidermolysis bullosa acquisita is extremely rare in childhood and it has been reported to be frequently associated with Crohn's disease. ⋯ We report a case of a 17-year-old boy affected by Crohn's disease who presented with milia on infiltrated erythematous plaques over the back of the hands. The diagnosis of epidermolysis bullosa acquisita was confirmed by histopathology, direct and indirect immunofluorescence analysis and ELISA.
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Tuberculosis caused by Mycobacterium tuberculosis presents a major health challenge in endemic countries and spares no organ in the human body. This infection is a mimicker of various disease processes such as metastasis, lymphoproliferative diseases, and other granulomatous conditions such as sarcoidosis and fungal infections. The most challenging and important differential is metastasis, especially in the disseminated form of tuberculosis. We present a histopathologically proven case of isolated hepatosplenic tuberculosis that was provisionally diagnosed as lymphoma due to its unusual, restricted involvement of the liver and spleen.