P-BN30 Retroperitoneal biloma: a case report of spontaneous retroperitoneal bike leak and collection

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Robert Bickerton ◽  
Amy Godden ◽  
Georgios Bointas ◽  
Marize Bakhet ◽  
George Bingham ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Rare Complication ◽  
Gallstone Disease ◽  
Bile Leak ◽  
Liver Function Tests ◽  
Interesting Case ◽  
Gallbladder Perforation ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Cbd Stone

Abstract Background Retroperitoneal biloma is a rare complication of gallstone disease. Only a handful of cases have been reported in the literature with various mechanisms postulated.  Here, we report a case of spontaneous retroperitoneal biloma arising from gallbladder perforation. Methods An 87-year-old female patient presented with right upper quadrant pain in the context of known gallstone disease. Inflammatory markers and liver function tests were deranged. Cross sectional imaging found acute cholecystitis and a gallbadder neck perforation with an impacted 2cm proximal common bile duct (CBD) stone.   A cholecystostomy was placed and she improved clinically. However, inflammatory markers remained high, and a subsequent computed tomography (CT) found a large collection in the retroperitoneum.   Results The retroperitoneal collection measured 14cm x 7cm, and there had been evidence on prior CT scans of retroperitoneal inflammation. It was urgently drained under ultrasound guidance and found to contain bilious content.  Subsequent endoscopic retrograde cholangiopancreatography (ERCP) was unable to retrieve the CBD stone, but left stents either side of the stone. The patient clinically and biochemically improved. She was discharged and had an elective ERCP, which successfully retrieved the stone, with a plan for urgent elective laparoscopic cholecystectomy.  Conclusions Here, we report an interesting case of retroperitoneal biloma successfully managed with ultrasound-guided drainage. Perforation of the distal CBD can result in retroperitoneal bile leak, but the proximal CBD stone in this case would have likely prevented passage of bile. A more likely cause is adhesion of the gallbladder neck to the posterior parietal peritoneum due to chronic inflammation, with subsequent perforation and release of bile into the retroperitoneum. This has previously been described in the literature. Regardless of mechanism, knowledge of the potential for this rare complication is important for anticipating and appropriately managing complications of gallbladder perforation. 

Point-of-care contrast enhanced lung ultrasound and COVID-19

Ultrasound ◽  
2021 ◽  
pp. 1742271X2110479
Author(s):  
Alice Tee ◽  
Gibran Timothy Yusuf ◽  
Adrian Wong ◽  
Deepak Rao ◽  
Sa Tran ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Contrast Enhanced Ultrasound ◽  
Cross Sectional ◽  
Patient Demographics ◽  
Pulmonary Angiogram ◽  
Contrast Enhanced ◽  
Cross Sectional Imaging ◽  
Ct Pulmonary Angiogram

Objectives Bedside lung ultrasound has been indispensable during the coronavirus disease 2019 (COVID-19) pandemic, allowing us to rapidly assess critically unwell patients. We demonstrate the unique application of contrast-enhanced ultrasound with the aim of further understanding this disease. Methods Patient demographics were recorded alongside recent cross-sectional imaging and inflammatory markers. Ultrasound was conducted by experienced operators in a portable setting. Conventional six-point lung ultrasound method was used to evaluate B-lines, small (subpleural) consolidation and the pleura. Areas of small consolidation were targeted after intravenous administration of ultrasound contrast. Results The areas of small consolidations, a potential sign of pneumonia on B-mode lung ultrasound, usually enhance on contrast-enhanced ultrasound. Our study revealed these areas to be avascular, indicating an underlying thrombotic/infarction process. Findings were present in 100% of the patients we examined. We have also shown that the degree of infarction correlates with CT severity (r = 0.4) and inflammatory markers, and that these areas improve as patients recover. Conclusions We confirmed the theory of immune thrombus by identifying the presence of microthrombi in the lungs of 100% of our patients, despite 79% having had a recent negative CT pulmonary angiogram study. contrast-enhanced ultrasound can be utilised to add confidence to an uncertain COVID-19 diagnosis and for prognosticating and monitoring progress in confirmed COVID-19 patients. Contrast-enhanced ultrasound is clearly very different to CT, the gold standard, and while there are specific pathologies that can only be detected on CT, contrast-enhanced ultrasound has many advantages, most notability the ability to pick up microthrombi at the periphery of the lungs.

Spontaneous cholecystocutaneous fistula: an uncommon complication of acute cholecystitis

2020 ◽  
Vol 13 (12) ◽  
pp. e238063
Author(s):  
Philipp Kasper ◽  
Julia Kaminiorz ◽  
Christoph Schramm ◽  
Tobias Goeser
Keyword(s):  
Rare Complication ◽  
Gallstone Disease ◽  
Acalculous Cholecystitis ◽  
Abdominal Ultrasound ◽  
Gallbladder Perforation ◽  
Ct Guided ◽  
Acute Calculous Cholecystitis ◽  
Hypochondriac Region ◽  
Pericholecystic Abscess ◽  
The Right

A 78-year-old man presented to the hospital with acute right upper quadrant pain, fever and nausea. A focused abdominal ultrasound and abdominal CT scan were performed demonstrating an acute calculous cholecystitis with gallbladder perforation. Although a CT-guided cholecystostomy was performed and a pericholecystic abscess was relieved promptly, the patient developed a cholecystocutaneous fistula in the right hypochondriac region. A cholecystocutaneous fistula is an extremely rare complication that may occur in patients with acute calculous or acalculous cholecystitis, chronic gallstone disease, gallbladder carcinoma or prior hepatobiliary surgery.

scholarly journals EP.TH.49The Use of MRCP to Investigate Bile Duct Stones

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jennifer Ma ◽  
Paras Jethwa
Keyword(s):  
High Risk ◽  
Bile Duct ◽  
Risk Group ◽  
Gallstone Disease ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Liver Function Tests ◽  
High Risk Group ◽  
Low Risk ◽  
Intermediate Risk ◽  
Cbd Stone

Abstract Aim Association of Upper Gastrointestinal Surgeons (AUGIS) latest guideline advocates stratification of patients with gallstone disease to determine their risks of common bile duct (CBD) stone and to perform Magnetic resonance cholangiopancreatography (MRCP) for those at intermediate risk. The study assessed the appropriateness of our local hospital's MRCP requests in accordance to the AUGIS standard. Method Inpatient MRCP requests for suspected ductal gallstones between June and December 2019 were identified retrospectively. Admission history, ultrasound, MRCP findings and liver function tests were collected from hospital electronic records. Patients with previous cholecystectomy were excluded. Patients were categorized into ‘low risk’, ‘intermediate risk’ and ‘high risk’. Results 67 patients were included in the study and 24 patients were discovered to have CBD stones on MRCP. The majority of patients (54%) were considered ‘intermediate risk’, whilst the ‘low risk’ group consisted of 13% of the MRCP requests and ‘high risk’ group comprised of 33%. Amongst those in the ‘low risk’ group, only 1 of 9 patients (11%) had cbd stone identified on MRCP. 19% patients in the intermediate group were found to have CBD stone, whilst 73% patients in the high risk group were identified to have CBD stone. On average, patients underwent MRCP within a day of request. Conclusion A high proportion of patients at high risk for CBD stone were referred for MRCP, contrary to AUGIS guideline. Inpatient MRCP referrals should be considered carefully in this category as it potentially increases length of stay without change in clinical management.

scholarly journals A rare case of COVID-19 vaccine-induced thrombotic thrombocytopaenia (VITT) involving the veno-splanchnic and pulmonary arterial circulation, from a UK district general hospital

2021 ◽  
Vol 14 (9) ◽  
pp. e244223
Author(s):  
Huma Asmat ◽  
Folusho Fayeye ◽  
Hameed Alshakaty ◽  
Jay Patel
Keyword(s):  
District General Hospital ◽  
Liver Function Tests ◽  
Intravenous Immunoglobulins ◽  
Cross Sectional ◽  
Vein Thrombosis ◽  
Arterial Circulation ◽  
Acute Medical Unit ◽  
Cross Sectional Imaging ◽  
Low Platelet Count ◽  
Spread Of Infection

A 47-year-old woman presented with a headache to the acute medical unit, 10 days after receiving AstraZeneca vaccination for COVID-19. Brain imaging was normal, but her blood tests showed a remarkably low platelet count, mildly deranged liver function tests and a high D-dimer. Further within her hospital admission, she developed right-sided abdominal pain and chest pain, and subsequent cross-sectional imaging confirmed a small segmental pulmonary embolism, and an acute portal vein thrombosis extending to the splenic and superior mesenteric veins. On the basis of her investigations, she was diagnosed as a case of vaccine-induced thrombotic thrombocytopenia and was treated with intravenous immunoglobulins. In a time where there is a strategic goal to vaccinate the global population from COVID-19 to inhibit the spread of infection and reduce hospitalisation, this particular clinical scenario emphasises the need of all clinicians to remain vigilant for rare complications of the COVID-19 vaccination.

scholarly journals Occult spontaneous lateral intrasphenoidal encephalocele: A rare presentation

2013 ◽  
Vol 04 (S 01) ◽  
pp. S109-S111 ◽  
Author(s):  
Shahina Bano ◽  
Vikas Chaudhary ◽  
Sachchida N Yadav ◽  
Umesh C Garga
Keyword(s):  
Congenital Malformations ◽  
Interesting Case ◽  
Bony Defect ◽  
Resonance Imaging ◽  
Rare Presentation ◽  
Cross Sectional ◽  
Basal Encephalocele ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Intrasphenoidal Encephalocele

ABSTRACTBasal encephaloceles are extremely rare congenital malformations. Advanced cross-sectional imaging modalities like computed tomography and magnetic resonance imaging are necessary for diagnosing the asymptomatic, occult basal encephalocele and planning the surgical approach. We present an interesting case of clinically silent right-sided lateral intrasphenoidal encephalocele through a large bony defect.

Oculostapedial synkinesis following idiopathic facial palsy: something to listen out for

2018 ◽  
Vol 132 (8) ◽  
pp. 757-758
Author(s):  
T Williams ◽  
B Tungland ◽  
N Stobbs ◽  
G Watson
Keyword(s):  
Facial Palsy ◽  
Complete Resolution ◽  
Rare Case ◽  
Surgical Intervention ◽  
Rare Complication ◽  
Facial Movement ◽  
Cross Sectional ◽  
Team Members ◽  
Cross Sectional Imaging ◽  
Idiopathic Facial Palsy

AbstractObjectiveThis paper presents a rare case of oculostapedial synkinesis.Case reportAfter partial resolution of an idiopathic facial palsy, a male patient presented with persistent distortion of hearing when blinking and closing his eye. Audiometry findings were unremarkable, and cross-sectional imaging of the facial nerve revealed no abnormalities apart from an incidental contralateral meningioma. Initial conservative management, with referral to a specialist physiotherapist, failed to resolve the symptoms. The patient subsequently opted for surgical intervention, and underwent a transmeatal tympanotomy and transection of the stapedial tendon. Following this, he had complete resolution of symptoms.ConclusionOculostapedial synkinesis is a rare complication of facial palsy, but is recognised in the literature. Given its unusual presentation, it can be overlooked, especially by more junior team members. This case highlights the need to pay careful attention to patients' symptoms and listen out for the description of hearing distortion on facial movement.

scholarly journals Cardiac Pseudotumor Simulated by Ascitic Pseudocyst: Cross-sectional Imaging Findings of a Rare Complication of Peritoneovenous Shunting

2020 ◽  
Vol 2 (5) ◽  
pp. e200311
Author(s):  
Jose Arimateia B. Araujo-Filho ◽  
William Dinsfriend ◽  
Darragh Halpenny ◽  
Jonathan W. Weinsaft
Keyword(s):  
Rare Complication ◽  
Imaging Findings ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

760 Unilateral Isolated Hypoglossal Nerve Palsy After Shoulder Surgery: A Case Report

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Wei ◽  
D Karunaratne ◽  
C Sivaji
Keyword(s):  
Nerve Injury ◽  
Nerve Palsy ◽  
Hypoglossal Nerve ◽  
Rare Complication ◽  
Humeral Fracture ◽  
Complete Recovery ◽  
Cross Sectional ◽  
Hypoglossal Nerve Palsy ◽  
Cross Sectional Imaging ◽  
High Index Of Suspicion

Abstract Aim Hypoglossal nerve injury is a rare complication in anaesthetic and surgical practice with only a few cases worldwide. This report describes the pathophysiology of this condition and highlights the key managements steps and expected outcomes for clinicians and patients. Case An open reduction and internal fixation of a left humeral fracture was performed on a healthy female patient in her mid-fifties under general anaesthesia. Two hours post-operatively, she developed left sided tongue swelling and deviation with dysphagia and dysarthria. Urgent CT head and MRA scans showed no abnormalities, leading to a diagnosis of isolated left hypoglossal nerve injury. Neurology and SALT were both involved in her care, but she ultimately made a full functional recovery after six months without any specific intervention. Conclusions A clear history, examination and high index of suspicion are crucial in the diagnosis of a hypoglossal nerve palsy. Cross sectional imaging is necessary to exclude any intracranial lesions, but intervention is rarely required, and patients should expect a slow but complete recovery over a period of months.

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