A 14-year-old girl presented with symptoms of abdominal pain and vomiting for 3 hours. However, she was a healthy child, otherwise. Her vitals were stable and her family history was insignificant. Based on her presentation, doctors diagnosed her with a case of gastroenteritis. She received symptomatic treatment and was discharged on the improvement of her condition.
Return of the Symptoms
Despite symptomatic treatment, the patient presented again with seemingly severer symptoms just after two days. She reported having continuous intermittent vomiting and severe abdominal pain. Her blood pressure had dropped and she was tachycardic.
On examination, doctors noticed diffuse tenderness in the abdomen on both superficial and deep palpation. Moreover, the patient displayed rebound tenderness and guarding reflexes, indicating peritonitis.
Initially, doctors managed the patient with IV fluids. However, to be sure of the underlying pathology, they conducted an abdominal CT. لعبة قمار The patient’s vitals were stable before the scan. But her heartbeat increased and her blood pressure dropped following the scan. On deterioration of her condition, doctors arranged a quick exploratory laparotomy.
Laparotomy Reveals Gastric Perforation
Doctors found a perforated anterior wall of the stomach. They removed the ischemic segments and sutured back the remaining parts performing a partial gastrectomy.
Post-operatively, doctors kept the patient on antibiotics to prevent any infection. Moreover, they inserted a jejunostomy tube to feed the patient. موقع مراهنات المباريات They also sent the resected specimen for histopathological assay. Furthermore, the patient’s hyperextensible skin and marfanoid limbs together with a variant COL5A1 gene detected on DNA sampling suggested a case of classical Ehlers Danlos Syndrome (EDS).
EDS and Gastric Perforation
EDS is an inherited disorder that involves defective connective tissue synthesis (due to lack of collagen). Its classic form, also called the vascular EDS, often presents with perforations in the GI tract. Although it usually attacks the colon or the small intestine. In addition, a tear in the gastric wall is a highly rare presentation. طريقة لعبة القمار