Presenter of 2 Presentations
MAL PERFORANTE PLANTAR / ISCHEMIC FOOT ULCER
Abstract
Abstract Body
Background and Purpose:
Peripheral neuropathy usually affects the extremities and the most frequent cause is diabetic peripheral neuropathy. Other causes include shingles (post-herpetic neuralgia), B12 deficiency, alcoholism, etc. Most neuropathic ulcerations occur on the lower extremities and affect prominent different areas of the feet such as the heel and metatarsal heads, or areas of high friction that are prone to callus formation.
Methods: Case report
Results:
An alcoholic 55 year-old male with lower-limb alcoholic neuropathy went to the primary care center on numerous occasions due to an ulcer on the right foot-sole. The patient was being treated with antibiotics, cleaning of the wound and the use of medical insole. However, the ulcer did not improve and evolved to produce intense pain and a strong smell. During the conservative treatment with diferent antibiotics and analgesia, the evolution was bad and the ulcer developed in osteomielitis.
The patient was referred to different departments (dermatology, traumatology, internal medicine) to obtain a proper diagnosis. After biopsies, computerized axial tomography and magnetic resonance, the patient was diagnosed of Neuropathic Ulcer. A surgical procedure together with a stronger antibiotic regime was required to close the ulcer, which has not relapsed until now.
Conclusion:
A neuropathic ulcer has a high probability to evolve to osteomyelitis if it is not properly treated. General practitioners must not underestimate the chance of a non-diabetic person to suffer from severe pathologies usually associated to diabetes, as these need a very early diagnosis and treatment to enable their survival and recovery.
HIDDEN BLEEDING
Abstract
Abstract Body
Background and Purpose:
Meckel's diverticulum (MD) is the most common gastrointestinal malformation. Meckel's diverticulum is a vestigial remnant of the omphalomesenteric duct that in most cases (53%) is diagnosed in the first two years of life. Although anecdotally, adult patients may present suffer from MD and its symptoms seems to be different, with reported predominance of non-bleeding-related presentations.
Methods: Case report
Results:
An 18 year-old male without any previous pathologies arrived to the emergency department after observing blood in his faeces. Active bleeding was discarded (hemoglobin 13 g/dl) and the patient was sent home with a diagnosis of hemorrhoids. Bleeding continued and the patient suffered from hallucinations and fainted. Blood tests showed that the patient was anemic (hemoglobin 7 g/dl and elevated urea levels). Moreover, melenas were observed after a digital rectal examination.
The patient was admitted to the heavy-bleeding patient unit due a suspected lower gastrointestinal bleeding. After a colonoscopy and endoscopy the origin of the bleeding was not found. Finally, a video capsule endoscopy allowed to observe the diverticulum. The patient was intervened and he evolved positively.
Conclusion:
Meckel's diverticulum commonly occurs in children and therefore, the reports in older populations are very rare. General practitioners should have an open mind about pathologies happening mostly during the pediatric age, as it is possible to observe them exceptionally in adults. In addition, video-capsule endoscopy has an important value in detecting small intestine diseases, specifically those affecting the jejunum and ileum, especially in children with lower gastrointestinal hemorrhage.