Paradoxical refractory hypotension following adrenaline administration in a patient taking clozapine

2021 ◽  
Vol 14 (11) ◽  
pp. e243363
Author(s):  
Anand Alagappan ◽  
Rosaleen Baruah ◽  
Alastair Cockburn ◽  
Euan A Sandilands
Keyword(s):  
Adverse Effects ◽  
Intestinal Obstruction ◽  
Paralytic Ileus ◽  
Surgical Intervention ◽  
Psychiatric Inpatient ◽  
Agonist Activity ◽  
Epinephrine Administration ◽  
Refractory Hypotension ◽  
Adrenaline Administration

Clozapine is a potent antipsychotic commonly used for refractory schizophrenia. Adverse effects are well recognised including constipation, intestinal obstruction, agranulocytosis and cardiomyopathy. We present a case of paradoxical refractory hypotension following epinephrine administration in a patient taking clozapine. A psychiatric inpatient who had been taking clozapine for many years developed paralytic ileus and obstruction requiring surgical intervention. Following initiation of epinephrine administration intraoperatively he developed refractory hypotension which improved only when epinephrine was weaned off. This effect is likely due to uninterrupted β2-agonist activity in the presence of clozapine-induced α-blockade. Clinicians need to have greater awareness of this serious interaction and avoid the use of epinephrine in patients taking clozapine.

Surgical intervention, adverse effects and radiotherapy: A retrospective single center study

2018 ◽  
Vol 17 (12) ◽  
pp. e2673
Author(s):  
P. Stelmach ◽  
P. Rajwa ◽  
G. Rempega ◽  
M. Kępiński ◽  
J. Ryszawy ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Surgical Intervention ◽  
Single Center ◽  
Single Center Study ◽  
Center Study

scholarly journals SMALL BOWEL OBSTRUCTION SECONDARY TO OBTURATOR HERNIA: A PRE-OPERATIVE DIAGNOSIS AT COMPUTED TOMOGRAPHY

2021 ◽  
Vol 6 (1) ◽  
pp. 46-49
Author(s):  
Marlina Tanty Ramli ◽  
Mohd Shukry Mohd Khalid ◽  
Kartini Rahmat
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Elderly Patients ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Obturator Hernia ◽  
Uneventful Recovery ◽  
Presenting Symptoms

Obturator hernia is rare, but it must be considered in elderly patients who present with small bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as the presenting symptoms and signs are usually non-specific. Presence of positive Howship-Romberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We report a case of a 93-year-old female patient who was admitted to our surgical department with symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative. Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy post-CT where the incarcerated bowel loop was released and the obstructed bowel was decompressed without any complication. The hernial defect was close with a mesh and the patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of obturator hernia must always be considered in elderly patients who present with intestinal obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids inappropriate surgical intervention planning which is crucial in optimising the outcome.

scholarly journals Neonatal intestinal obstruction: report

2000 ◽  
Vol 6 (1) ◽  
pp. 187-193
Author(s):  
G. A. Nasir ◽  
S. Rahma ◽  
A. H. Kadim
Keyword(s):  
Mortality Rate ◽  
Conservative Treatment ◽  
Intestinal Obstruction ◽  
Imperforate Anus ◽  
Surgical Intervention ◽  
Duodenal Atresia ◽  
Colonic Atresia ◽  
Neonatal Intestinal Obstruction ◽  
Age Range ◽  
Surgical Unit

We reviewed 36 cases of neonatal intestinal obstruction admitted to our surgical unit over a 10-year period, 1986-1996, for surgical intervention following the failure of conservative treatment. There were more males than females and the age range was 12 hours-26 days. Imperforate anus was the main cause of the obstruction [27.8%] followed by duodenal atresia [13.9%] and colonic atresia and meconium ileus [11.1% each]. There were 8 deaths following surgery [22% mortality rate], the main causes being aspiration pneumonia, septicaemia and hypothermia

scholarly journals TOURNIQUET APPENDIX: RARE ETIOLOGY OF ORGANIC ACUTE INTESTINAL OBSTRUCTION

2021 ◽  
Vol 9 (08) ◽  
pp. 834-836
Author(s):  
Bicane Ma. ◽  
◽  
Malaaynine Mf. ◽  
Rabbani K. ◽  
Louzi A. ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Intestinal Obstruction ◽  
Bowel Obstruction ◽  
Paralytic Ileus ◽  
Rare Case ◽  
Acute Intestinal Obstruction ◽  
Ileal Loop ◽  
Surgical Emergency ◽  
Mechanical Bowel Obstruction

Acute appendicitis is the most common surgical emergency. A bowel obstruction due to the appendicitis is in most cases functional with a paralytic ileus mechanical bowel obstructions are rare or exceptional. We describe a rare case of a mechanical bowel obstruction due to a strangulation of the last ileal loop by the appendix.

Surgical Ascariasis in Children in Kashmir

1997 ◽  
Vol 27 (1) ◽  
pp. 13-14 ◽  
Author(s):  
Satish Kumar Pandit ◽  
Habib Ullah Zarger
Keyword(s):  
Retrospective Study ◽  
Intestinal Obstruction ◽  
Endemic Area ◽  
Surgical Intervention ◽  
Ileal Perforation ◽  
Biliary Ascariasis ◽  
High Incidence ◽  
Surgical Conditions

A retrospective study of 85 children aged 3–12 years revealed 25 cases who needed surgical intervention due to ascariasis. The surgical conditions found at laparotomy were intestinal obstruction (18) appendicitis (3), ileal perforation (2), biliary ascariasis (2). The study highlights the high incidence of surgical ascariasis among children with abdominal complaints in an endemic area.

ACUTE INTESTINAL OBSTRUCTION DUE TO MIGRATED INGUINAL HERNIOPLASTY MESH-A CASE REPORT

2021 ◽  
pp. 60-61
Author(s):  
Parth Manek ◽  
Parth Patel ◽  
Kishor Jain ◽  
Sharvari Pujari ◽  
Ramkrishna Prabhu ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Gold Standard ◽  
Rare Case ◽  
Surgical Intervention ◽  
Acute Intestinal Obstruction ◽  
Inguinal Hernioplasty ◽  
Elderly Male ◽  
Mesh Migration ◽  
Mechanical Bowel Obstruction ◽  
Mesh Hernioplasty

Mesh Hernioplasty is the gold standard for Inguinal hernia.However, it is not free of complications. Mesh migration causing intestinal obstruction, albeit rare, is a serious and complications. Timely surgical intervention is very important in the management of this condition. We report a rare case of an elderly male patient with mechanical bowel obstruction due to mesh migration 9 years after a right inguinal hernia meshplasty.

scholarly journals A study of forty eight patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome

2020 ◽  
Vol 7 (8) ◽  
pp. 2563
Author(s):  
Himanshu Gupta ◽  
Sumikesh Anand
Keyword(s):  
Intestinal Obstruction ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Secondary Data ◽  
Hand Surgery ◽  
Abdominal Distension ◽  
Favourable Outcome ◽  
Unfavorable Outcome ◽  
Presenting Symptoms ◽  
Adequate Care

Background: Intestinal obstruction is defined as obstruction of the passage of the intestine for its contents. Successful conservative treatment may leave adhesions that could cause recurrence; on the other hand, surgery may be the source of new adhesions like any other abdominal surgery. Hence, the present study was undertaken for assessing the 48 patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome.Methods: Of a total of 48 patients with ilecoceacal masses who presented with intestinal obstruction and underwent surgical intervention for the same. Surgical management outcome was classified as “favorable” or “unfavorable” outcome according to the retrospective secondary data extracted from their medical records. Unfavorable outcome was considered if the patient died or has one or more postoperative complications. Favorable outcome was considered if the patient was discharged alive and does not have any history of postoperative complications.Results: Abdominal pain, abdominal distension, vomiting and failure to pass faeces were the prominent presenting symptoms among intestinal obstruction patients.  Favourable outcome was seen in 76 percent of the patients while unfavourable outcome was seen in 24 percent of the patients. Mortality occurred in 6 patients. Prolonged ileus was found to be present in 1 patient. Failure to wean from ventilator for more than 48 hours was seen in 2 patients.  Conclusions: Surgical management had high efficacy of more than 75 percent in managing patients with intestinal obstructions. With precise technique and adequate care, complication rate can be reduced.

scholarly journals Prevalence and Updated Management of Paralytic Ileus: A Simple Review

2021 ◽  
pp. 61-66
Author(s):  
Ali Mohammed A. Alahmari ◽  
Abdullah Hassan F. Alsuayri ◽  
Hdinan Mohammed J. Alsadi ◽  
Basem Khaled G. Alshahrani ◽  
Fahad Mohammed Abdullah Alyahya ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Paralytic Ileus ◽  
Preventive Measures ◽  
Clinical Manifestations ◽  
Tube Placement ◽  
Pelvic Surgery ◽  
Pharmacologic Therapy ◽  
Shortness Of Breath ◽  
Opioid Use ◽  
Gastric Stasis

The study aims to summarize the updated evidence regards, epidemiology, causes, clinical manifestations, and management of paralytic ileus. Lower abdominal surgical procedure, particularly big open cuts and increased bowel operations, is linked with an increased hazard of bowel obstruction. Though, numerous risk issues have been revealed to upsurge the probability and resistance of intestinal obstruction, such as prolonged abdominal / pelvic surgery, lower gastrointestinal (GI) surgery, open surgery, retroperitoneal spine surgery, opioid use, cancer peritoneal, intra-abdominal inflammation (sepsis / peritonitis), delayed enteral nutrition or nasogastric (NG) tube placement, and hypokalemia. Signs of intestinal obstruction are tachycardia caused by any interruption of movement, absence of abdominal pain, abdominal distention and tenderness, shortness of breath, and hypovolemia. Bowel sounds disappear and flatulence is not discharged, leading to gastric stasis, which can cause hiccups, discomfort, and easy vomiting. Preventive measures include avoiding unnecessary exposure and over-processing of the intestine or traction of the mesentery. Treatment is conservative, as this condition is mostly self-limited. Pharmacologic Therapy have little place, but there are some exceptions of adequate values.

scholarly journals Mesenteric lipoma: a rare cause of acute small bowel obstruction

2021 ◽  
Vol 8 (10) ◽  
pp. 3214
Author(s):  
Debarghya Chattarjee ◽  
Vijay Raina ◽  
Rajeev Sharma
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Human Body ◽  
Surgical Intervention ◽  
Acute Intestinal Obstruction ◽  
Abdominal Symptoms ◽  
Clinical Literature ◽  
Multiple Imaging ◽  
Acute Small Bowel Obstruction ◽  
Mesenteric Lipoma

Lipomas, also known as universal tumors, can be found almost anywhere in the human body. However mesenteric lipomas are rare entities, with less than 100 cases reported in clinical literature. Patients may present with chronic non-specific abdominal symptoms, or rarely acute intestinal obstruction. Multiple imaging modalities are available for pre-operative diagnosis. Surgical intervention is required for treatment of symptomatic mesenteric lipomas.

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