Management of Pancreatic Fistulas

Patient complaints of pain abdomen and multiple episodes of vomitting. Patient gave history of significant weight loss. Patient only had undergone few investigations (reports attached) . Pls discuss how to investigate and manage this case

Spot Diagnosis, USG picture of Abdominal scan. Discuss the treatment too.

a20 yr old down's syndrome girl with uncontrolled epilepsy was brought by her family for rapidly progressing neck pain and dysphagia. endoscopy very edematous pharynx and larynx. xray neck showed prevertebral widening with gas formation, straightening of cervical vertebrae and suspected foreign body at post cricoid level. ? large retropharyngl abcess on questioning the parents they give history that she hurriedly had fish a few days ago. As it was a high risk condition she wasn't taken up at many places. it was heart wrenching looking at her , she's unable to understand what's happening to her all that she wasn't able to swallow anything and had excruciating pain. she was taken up for exploration under GA under high risk thanks to my anaesthetist who dared to give her anesthesia. intra op big sharp fish bone was found at post cricoid region anteriorly abutting laryngeal mucosa posteriorly piercing pharyngeal mucosa, after it's removal 20 ml of foul smelling pus evacuated. it was very difficult to make her retain her ryles tube post surgery, with a lot of her mischief we managed to keep it for 4 days and she made a good diet speedy recovery. *parents of MR children should never leave them unattended when they are consuming food with Sharp particles like meat, and small round food items (can cause aspiration). *we have to take calculated risks *retropharyngeal abcess should be managed before they turn into near fatal mediastinitis.

one and half yr old presented with fever for 10days and blackish discolouration of toes since 8days which is increasing. Liver just palpable and 1cm spleen. Pansystolic murmur on mitral area on auscultation. Discuss.

3-year-old male was playing with a lead fishing sinker. His mother was about to attempt to take it away from him when he suddenly began choking. By the time she reached her son, his choking had ceased and he was actively crying. He subsequently arrives at the emergency department asymptomatic. His physical exam is unremarkable, and an X-ray is obtained . Discuss further management?