Meningocele tourniquet syndrome
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CASE REPORT
Meningocele tourniquet syndrome Akhilesh Kumar 1 & Nitin Pant 1 & Anand Pandey 1 & Ashish Wakhlu 1 Received: 19 December 2019 / Accepted: 27 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Tourniquet syndrome is a rare condition where a tourniquet applied to an appendage leads to an obstructed blood flow and subsequent ischemic injury. Meningomyelocele and meningocele are common birth defects, and involvement of meningocele in tourniquet syndrome is never mentioned in the literature. We managed a 10-day-old male child presenting with infected lumber meningocele with a tourniquet tied at its base. It is being presented with review of relevant literature. Keywords Tourniquet syndrome . Meningocele . Neural tube defect
Introduction Tourniquet syndrome (TS) is a rare condition where a tourniquet is applied on a body part. It may lead to obstructed blood flow and subsequent ischemic injury [1]. Common sites reported for TS are the finger, toes, and external genitalia [2]. Meningomyelocele and meningocele are common birth defects in the spectrum of neural tube defects. We treated a newborn patient of lumbar meningocele in whom a nursing staff applied tourniquet at its base. Being an extremely rare presentation of TS, it is being reported with review of relevant literature.
Case report A 10-day-old, full term, male neonate was referred from pediatric outpatient department (OPD) for lumbar meningocele. He also had high grade fever for last 5 days. On examination, the baby was lethargic. He was febrile and heart rate was 140/ min. There was a midline swelling in the lumbar region measuring 8 cm × 6 cm. The overlying skin was intact; however, the swelling was edematous with some slough near its base.
* Nitin Pant [email protected] 1
Department of Pediatric Surgery, King George’s Medical University, Lucknow 226003, India
There was no clinical evidence of associated hydrocephalus, bladder or bowel, or lower limb involvement. The parents informed that the edematous appearance of the swelling was for last 4 days. The child was admitted and was administered intravenous antibiotics along with daily cleaning and dressing. Blood culture did not reveal any bacterial growth. Culture from the removed dressing reported Staphylococcus aureus sensitive to vancomycin. His condition improved and subsequently a magnetic resonance imaging (MRI) of the whole spine and brain was conducted. MRI revealed a lumbar meningocele at L3 level without any hydrocephalus (Fig. 1). After 7 days of antibiotics course, it was observed that although the slough disappeared, the edema persisted. He was posted for surgery on the eighth day of admission. At surgery, we identified a silk thread, which was embedded in the meningocele near its base (Fig. 2).The thread had eroded through the skin and subcutaneous tissue. This made clear the findings of edema in the baby. The tourniquet was removed, and we proceeded with the repair. Postoperatively, an enquiry about the tourniquet was made. The parents reveale
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