Background: Fixed drug eruption (FDE) is a recurrent cutaneous adverse drug reaction, with paracetamol-induced cases being rare and ocular involvement even more uncommon. Case Presentation: We report a 6-year-old male who developed an isolated FDE of the right upper eyelid following paracetamol administration, presenting with erythema, edema, and subsequent hyperpigmentation. This rare presentation, with no systemic involvement, was diagnosed clinically, and management focused on strict avoidance of the offending drug. The patient recovered completely with residual hyperpigmentation after supportive management. Conclusion: Given the limited reports of eyelid involvement in FDE, this case underscores the need for clinical awareness of its atypical manifestations to ensure timely diagnosis and appropriate management. Continue Reading

Background:Pneumatosis portalis and pneumatosis intestinalis, when seen in conjunction, are rare but ominous findings on imaging of the abdomen, frequently indicating severe intra-abdominal disease such as intestinal ischaemia. We present a case of pneumatosis portalis and intestinalis following cardiac surgery without evidence of significant intra-abdominal disease. Case presentation:A 62-year-old male underwent open bioprosthetic aortic valve replacement for severe aortic stenosis. Four days post-operatively, the patient developed severe abdominal pain and distension. Contrast computed tomography (CT) of the abdomen demonstrated a significant degree of gas within the portal venous system and within the intestinal wall. At exploratory laparotomy, no evidence of significant bowel ischaemia or intra-abdominal disease was evident, a finding confirmed after re-look laparotomy 48 hours later. The patient was eventually discharged with no further sequelae noted. Conclusion:This case demonstrates the often pre-terminal finding of pneumatosis portalis and intestinalis, seen in a patient without evidence of any significant abdominal disease.... Continue Reading

Background: Complications from cardiopulmonary Resuscitation (CPR) are common and can add to morbidity and mortality. A pneumoperitoneum after CPR is an uncommon complication. The majority of previously reported cases of gastric perforation after CPR were associated with difficult airway management or positive pressure ventilation in association with chest compressions. Case Presentation: We present a case of a massive pneumoperitoneum in a 53-year-old woman after resuscitation following attempted hanging. During and following basic and advanced life support, a massive swelling of the abdomen due to massive pneumoperitoneum was observed, most likely caused by gastric perforation after bag-valve mask ventilation on an obstructed airway. The pneumoperitoneum resolved after conservative measures and insertion of an intra-abdominal drain; no surgery was necessary. The patient made a good and full recovery. Conclusion: This case emphasizes the importance of maintaining vigilance for gastric perforation with abdominal distention after CPR, in particular when difficult airway management is... Continue Reading

Background: New-onset constipation in middle-aged and older adults can be an early and sometimes the only presenting sign of colorectal malignancy. This risk is particularly relevant in populations with low screening uptake (e.g., in regions where national screening programs are recent or underutilized). Timely recognition of alarm features and appropriate imaging are important to diagnose obstruction and stage the disease. Case presentation: A 54-year-old Saudi man without chronic illnesses presented with a 2-week history of progressive constipation and abdominal distension, and three days of diffuse abdominal pain with recurrent vomiting. He reported no flatus for 2 days and no stool for four days. He denied weight loss or rectal bleeding. Examination showed a markedly distended but soft abdomen with tenderness in the right lower quadrant; bowel sounds were hypoactive. The digital rectal exam was normal. Laboratory tests revealed leukocytosis (white blood cell count 11.4 × 109/l; reference range 4.5-11.0 ×... Continue Reading

Background: Osteomas are benign, slow-growing bony tumors that usually occur as solitary, incidental findings. When multiple craniofacial osteomas are present, Gardner syndrome (GS), an Adenomatous Polyposis Coli-associated hereditary disorder, must be considered. Craniofacial osteomas may precede intestinal polyposis by several years, making them important early diagnostic indicators. However, attenuated GS and sporadic familial osteomas can present with similar features, creating a diagnostic dilemma. Early identification, genetic counselling, and surveillance are therefore essential to exclude delayed gastrointestinal or extracolonic manifestations. Case presentation: We report two first-degree male relatives with multiple craniofacial osteomas but no systemic features. The proband, a 15-year-old boy, presented with mandibular, palatal, and paranasal swellings that were radiologically and histopathologically confirmed as compact osteomas. His 52-year-old father also exhibited multiple craniofacial osteomas, including mandibular and sinus involvement, but remained asymptomatic. Comprehensive systemic evaluation, including colonoscopy, abdominal imaging, dermatologic, and ophthalmologic examinations, was negative for intestinal polyposis or extracolonic... Continue Reading

Background: Giant ameloblastoma is a rare, benign but locally aggressive odontogenic tumor characterized by massive jaw enlargement, accounting for 1% of all jaw tumors, often affecting the mandible. It presents with slow but relentless growth, causing significant facial deformity and functional impairment. Case Presentation: We report two cases of Giant Ameloblastoma. The first patient reported to the outpatient department an expansile swelling involving the mandible crossing the midline, extending approximately from the right side of the angle to the left side angle. 15.2 cm x 10.5 cm x 11 cm. The second case was reported to the outpatient department, with an expansile swelling involving the right mandible and maxillary region, which was 10 cm x 12cm x 7cm. Both patients had an extraoral draining sinus on the lesion, and both had a previous history of surgery in that region, 20 years back and 11 years back, respectively. The pre-operative investigation... Continue Reading

Background:Trichophagia, the compulsive ingestion of hair, is most commonly linked to trichotillomania. However, isolated trichophagia without hair-pulling behavior is extremely rare, especially in children. Case Presentation:We report a nine-year-old girl with isolated tonsillar trichophagia presenting with sore throat and dysphagia. Physical examination revealed dark hair strands embedded in the bilateral tonsillar crypts. Tonsillectomy confirmed localized hair bezoars. The patient’s mother had obsessive–compulsive disorder, and her father had generalized anxiety disorder, suggesting strong familial psychiatric vulnerability. The child underwent cognitive-behavioral therapy and family-based psychoeducation after surgery. Conclusion:This rare case demonstrates that trichophagia may occur independently of trichotillomania and can manifest in unusual locations such as the tonsils. Early psychiatric evaluation combined with surgical management is crucial to prevent recurrence and address underlying psychopathology. Continue Reading

Background: Rarely seen, gastric mucormycosis mostly occurs in people with weakened immune systems. Among whom diabetes mellitus often plays a key role, and rare case reports exist. Case Presentation: We describe a 31-year-old woman with poorly controlled type 1 diabetes mellitus who had abdominal pain with shock with tachycardia leading to Intensive Care Unit admission. The endoscopic exam revealed wide-ranging involvement of the stomach from the fundus to the antrum, and also involving the GE junction and distal esophagus. Such extensive involvement has not been reported yet. Intensive treatment with antifungal drugs and supportive therapy failed to stop the severe sepsis, and the patient passed away after 20 days in the hospital. Conclusion: Extensive gastric mucormycosis is marked by its aggressiveness and difficulty in diagnosis, so health professionals should be especially careful in identifying patients at risk. Different studies on early recognition and effective approaches for management are discussed. Continue Reading