Unusual cause of gas complicating a biloma, postcholecystectomy

2021 ◽  
Vol 14 (4) ◽  
pp. e240437
Author(s):  
Cameron Spence ◽  
Fatima Ahmad ◽  
Louisa Bolton ◽  
Amit Parekh
Keyword(s):  
Emergency Department ◽  
Accurate Diagnosis ◽  
Clinical Team ◽  
Common Complication ◽  
Endoscopic Retrograde ◽  
Correct Treatment ◽  
Complicated Case ◽  
Unusual Appearance ◽  
Gallbladder Fossa ◽  
Elective Cholecystectomy

A 50-year-old man presented to the emergency department with abdominal pain, vomiting and fever. He had been admitted 6 months ago with acute cholecystitis when he underwent endoscopic retrograde cholangiopancreatography (ERCP) to remove ductal gallstones. Elective cholecystectomy was performed 3 days prior to the current admission. CT demonstrated a fluid and gas containing collection in the gallbladder fossa, biliary gas and free intra-abdominal gas. ERCP revealed a retained common bile duct gallstone and leakage from the cystic duct remnant. We postulate that the gas within the collection originated from intrahepatic gas post-ERCP or from a gas forming organism. The free intra-abdominal gas originated from the collection rather than an intraoperative bowel injury. This complicated case highlights an unusual appearance of a common complication. It demonstrates the importance of discussion with the clinical team to ensure that an accurate diagnosis is made and the correct treatment is provided.

The Red Legs RATED tool to improve diagnosis of lower limb cellulitis in the emergency department

2021 ◽  
Vol 30 (12) ◽  
pp. S22-S29
Author(s):  
Gillian O'Brien ◽  
Patricia White
Keyword(s):  
Emergency Department ◽  
Lower Limb ◽  
Treatment Guidelines ◽  
Positive Impact ◽  
Data Gathering ◽  
Pilot Project ◽  
Accurate Diagnosis ◽  
Evidence Based ◽  
Significant Burden ◽  
User Friendly

Background: Lower limb cellulitis poses a significant burden for the Irish healthcare system. Accurate diagnosis is difficult, with a lack of validated evidence-based tools and treatment guidelines, and difficulties distinguishing cellulitis from its imitators. It has been suggested that around 30% of suspected lower limb cellulitis is misdiagnosed. An audit of 132 patients between May 2017 and May 2018 identified a pattern of misdiagnosis in approximately 34% of this cohort. Objective: The aim of this pilot project was to develop a streamlined service for those presenting to the emergency department with red legs/suspected cellulitis, through introduction of the ‘Red Leg RATED’ tool for clinicians. Method: The tool was developed and introduced to emergency department clinicians. Individuals (n=24) presenting with suspected cellulitis over 4 weeks in 2018 were invited to participate in data gathering. Finally, clinician questionnaire feedback regarding the tool was evaluated. Results: Fourteen participants consented, 6 female and 8 male with mean age of 65 years. The tool identified 50% (n=7) as having cellulitis, of those 57% (n=4) required admission, 43% (n=3) were discharged. The remainder who did not have cellulitis (n=7) were discharged. Before introduction of the tool, all would typically have been admitted to hospital for further assessment and management of suspected lower limb cellulitis. Overall, 72% (n=10) of patients who initially presented with suspected cellulitis were discharged, suggesting positive impact of the tool. Clinician feedback suggested all were satisfied with the tool and contents. Conclusion: The Red Leg RATED tool is user friendly and impacts positively on diagnosis treatment and discharge. Further evaluation is warranted.

A COMPREHENSIVE STUDY ON ACUTE NON-TRAUMATIC ABDOMINAL EMERGENCIES

2021 ◽  
pp. 14-16
Author(s):  
Md. Quamar Zubair ◽  
A. K. Jha Suman
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Surgical Intervention ◽  
Age Groups ◽  
Diagnostic Procedures ◽  
Accurate Diagnosis ◽  
Postoperative Patient ◽  
Correct Treatment ◽  
Abdominal Emergencies ◽  
Comprehensive Study

Abdominal pain is one of the most common reasons for visit to the emergency room. Acute appendicitis is the commonest cause. An accurate diagnosis is essential for the correct treatment, which in many cases will prevent the death of the patient. Mainstay of diagnosis is history and physical examination. If this information is inadequate to establish a diagnosis and urgent or immediate operation is unnecessary, the periodic re-examination helps document the progression of the disease and often avoids unnecessary surgical intervention. Today the combination of improved diagnostic procedures, antibiotic and better anaesthesia and preoperative and postoperative patient care has led to a decrease in morbidity and mortality of patients with acute abdomen. The objective of this study was to determine the various causes of nontraumatic acute abdominal emergencies, their incidence, management and mortality in both sexes and all age groups >12 years age.

Candida and Breastfeeding: A Critical Commentary on the Dilemmas Around Diagnosis, Treatment, and Management

2020 ◽  
pp. CLINLACT-D-20-00007
Author(s):  
Denise McGuinness ◽  
Marcelina Szafranska
Keyword(s):  
Healthcare Professionals ◽  
Clinical Skills ◽  
Management Strategies ◽  
Accurate Diagnosis ◽  
Breast Pain ◽  
Correct Treatment ◽  
Diagnosis And Management ◽  
Critical Commentary ◽  
The Usa ◽  
Robust Evidence

ObjectiveThe etiology of nipple pain in breastfeeding women can be challenging for healthcare professionals. The most common cause of nipple pain or damage in breastfeeding women is poor latch and positioning of the baby at the breast (Duncan, 2015). However, when position and attachment is not identified as the cause, controversy exists as to the etiology of the pain with nipple or breast thrush identified as a probable suspect.MethodThe literature was reviewed to explore the diagnosis and management of thrush in breastfeeding women.ResultsThere is a lack of robust evidence in the literature to support an accurate diagnosis of candida as the cause of nipple and/or deep breast pain in breastfeeding women. Diagnosis and management strategies vary between the USA and Europe.ConclusionIt is important that clinicians supporting and working with breastfeeding women are aware of the differential diagnosis for both breast and nipple pain, as well as utilize their clinical skills effectively to offer the correct treatment and management to women presenting with candida like symptoms (Amir et al., 2013, Wilson-Clay and Hoover, 2017). Culture and sensitivity of mothers expressed milk may be supportive of a diagnosis; however, analysis of mothers’ milk is not without its challenges. Breastfeeding women should not be treated for potential candida infection with a traditional clinical examination alone.

scholarly journals Unilateral cyanosis on tongue as an unusual appearance in emergency department: a case report

2020 ◽  
Vol 7 (1) ◽  
pp. 69-70
Author(s):  
Seyed Reza Habibzadeh ◽  
Esmaeal Rayat Dost ◽  
Saeed Barazandehpour ◽  
Mahdi Foroughian
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Unusual Appearance

scholarly journals DIAGNOSTIC ACCURACY OF ULTRASOUND IN THE DETECTION OF PNEUMOTHORAX IN CHEST TRAUMA PATIENTS WITH CT AS THE GOLD STANDARD

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Danquale Vance Kynshikhar ◽  
Chaman Lal Kaushal ◽  
Ashwani Tomar ◽  
Neeti Aggarwal
Keyword(s):  
Emergency Department ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Chest Trauma ◽  
Accurate Diagnosis ◽  
Trauma Patients ◽  
Chest Ultrasound

Background: To study the diagnostic accuracy of ultrasound in the detection of pneumothorax in chest trauma patients with CT as the Gold Standard Methods: The present study was conducted from 31th July 2018 to 30th July 2019. A total of 36 patients were enrolled in the study. Results: By chest ultrasound, pneumothorax was detected in 15 of 24 patients. The sensitivity of chest ultrasound for the diagnosis of pneumothorax was 62.5%, specificity was 100%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 54.14% and accuracy was 75%. Conclusion: Chest ultrasound can play an important role in the emergency department aiding a physician for bedside rapid and accurate diagnosis of pneumothorax without interruption in the resuscitation process and without transferring the patient to the radiology section. Keywords: Ultrasound, CT, Pneumothorax

scholarly journals Ureteric obstruction as an unrecognised cause of acute pancreatitis in the emergency setting

2009 ◽  
Vol 7 (1) ◽  
Author(s):  
Mariolyn Raj ◽  
Spencer Murray
Keyword(s):  
Emergency Department ◽  
Acute Pancreatitis ◽  
Unusual Case ◽  
Accurate Diagnosis ◽  
Emergency Setting ◽  
Severity Assessment ◽  
Ureteric Obstruction ◽  
Acute Setting ◽  
Severe Pancreatitis ◽  
Possible Cause

Introduction Acute severe pancreatitis has a high mortality rate (10 to 30 %) and the aetiology of the pancreatitis itself influences the severity assessment and ultimately the treatment.1 Up to 20% of cases of acute pancreatitis are said to be due to unusual causes such as viral infection, trauma and drugs. However to date, there have been no reports in the literature of ureteric obstruction and infection causing acute pancreatitis. Methods We report on a case of a 77-year-old male who presented to the Emergency Department with acute pancreatitis occurring in the setting of an obstructed and infected right urinary system. Results We outline the pathway to diagnosis and management in this patient and highlight the difficulties associated with reaching an accurate diagnosis in the acute setting. Conclusion We report on this unusual case of acute pancreatitis in the emergency setting. By illustrating this case we aim to promote awareness of and encourage clinicians to consider ureteric obstruction as a possible cause of acute pancreatitis, in their workup of patients in the emergency department.

scholarly journals Plasma Procalcitonin Is Useful for Predicting the Severity of Acute Cholecystitis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Saben Sakalar ◽  
Engin Ozakın ◽  
Arif Alper Cevik ◽  
Nurdan Acar ◽  
Serkan Dogan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Early Diagnosis ◽  
Acute Cholecystitis ◽  
Delayed Diagnosis ◽  
Morbidity And Mortality ◽  
Radiological Diagnosis ◽  
Common Complication ◽  
Tokyo Guidelines ◽  
Grade 3

Background. Acute cholecystitis is a common complication of cholelithiasis. Delayed diagnosis may constitute morbidity and mortality; therefore, early diagnosis and determining the severity of acute cholecystitis are crucial. Objectives. This study aimed to determine the validity of blood procalcitonin (PCT) levels in assessing the severity of acute cholecystitis. Methods. The Emergency Department (ED) patients diagnosed as acute cholecystitis were included in the study. Patients were allocated into three severity grades according to the Tokyo Guidelines 2013. PCT level was measured after the clinical and radiological diagnosis of acute cholecystitis in the ED. Results. Ninety-five patients diagnosed with acute cholecystitis, among them 48 of were male. Forty patients (42.1%) were allocated to grade 1, 19 (20%) to grade 2, and 36 (37.9%) to grade 3. The median values of PCT were 0.104 ng/ml, 0.353 ng/ml, and 1.466 ng/ml for grade 1, 2, and 3 patients, respectively (p<0.001). Conclusion. Blood procalcitonin levels can be used to determine the severity of acute cholecystitis effectively.

scholarly journals Success of elective cholecystectomy treatment plans after emergency department visit

2015 ◽  
Vol 193 (1) ◽  
pp. 95-101 ◽  
Author(s):  
Juliane Bingener ◽  
Kristine M. Thomsen ◽  
Andrea McConico ◽  
Erik P. Hess ◽  
Elizabeth B. Habermann
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Treatment Plans ◽  
Elective Cholecystectomy

scholarly journals Manual Testicular Detorsion under Propofol Sedation

2009 ◽  
Vol 2009 ◽  
pp. 1-2 ◽  
Author(s):  
Martyn Harvey ◽  
Giles Chanwai ◽  
Grant Cave
Keyword(s):  
Emergency Department ◽  
Spermatic Cord ◽  
Testicular Torsion ◽  
Accurate Diagnosis ◽  
Propofol Sedation ◽  
Spermatic Cord Torsion

Acute spermatic cord torsion is a urologic emergency requiring accurate diagnosis and timely intervention to effect testicular salvage. We report a case of adolescent testicular torsion successfully reduced following manual detorsion under sedation at the Emergency Department. Scrotal exploration and bilateral orchidopexy were subsequently performed as a semielective procedure.

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