A 3-year-old girl was injured in a traffic accident. She suffered traumatic subarachnoid hemorrhage, pneumocephalus and multiple skull fractures including the skull base. Polyuria appeared 8 hours after injury. Urinalysis revealed that osmolarity was 122 mOsmol. The diagnosis of post-traumatic diabetes insipidus was determined, and continuous intravenous infusion of ADH (antidiuretic hormone) was started. Because interruption of ADH infusion resulted in polyuria, administration of ADH continued until the 77th hospital day. She was discharged on the 336th hospital day in a persistent vegetative state. T2-weighted magnetic resonance imaging revealed high intensity with contrast enhancement at the hypothalamus. Endocrine findings revealed hypopituitarism due to insufficient hypothalamus function. With these findings, we concluded that direct injury to hypothalamus resulted in diabetes insipidus.
A case of Anderson type III odontoid fracture was reported. A 56-year-old woman suffered severe trauma from a traffic accident. She reported a short period of unconsciousness, at the time of impact but in the emergency room of our hospital, she was alert, oriented, and cooperative. There was no evidence of any neurological deficit, but she complained of pain in the back of the neck. No fracture or subluxation was identified by cervical X-ray films (standard anteroposterior, lateral, and odontoid views), but cervical computerized tomography (CT) and magnetic resonance imaging (MRI) revealed an Anderson type III odontoid fracture. Fortunately, no intrathecal lesion was found by MRI. Because of minimal signs traceable to the neck, and no cervical dislocation, we chose conservative therapy for this patient. She was doing well, with no neurological deficit, 18 weeks after cervial brace fixation. Odontoid fracture should be considered as a possible complication in traffic trauma patients. We should pay particularly attention to patients with period of unconsciousness or memory disturbance, or with complaint of neck pain. We emphasize the importance of early diagnosis and following appropriate treatment of odontoid fracture to avoid a delayed disability.
A 27-year-old male with rectal gangrene as a result of a hemorrhoid infection complicated by pelvic cellulitis is described. Management initially included an exploratory laparotomy and perirectal space drainage. The patient deteriorated acutely on the 2nd postoperative day and required emergency abdomino-perineal resection. Reviewing the medical literatures, rectal gangrene can occur as a result of variety of etiologies such as occlusion of small arteries, toxication, infection, or trauma, although most of them occur after the abdominal aortic operations. Because clinical deterioration occurs in a matter of hours, a high index of suspicion should be maintained and the emergency operation is always required to save patient's life.