scholarly journals Sentinel Bleeding as a Sign of Gastroaortic Fistula Formation after Oesophageal Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
M. Uittenbogaart ◽  
M. N. Sosef ◽  
J. van Bastelaar
Keyword(s):  
Epigastric Pain ◽  
Blood Clot ◽  
Rare Complication ◽  
Neoadjuvant Chemoradiation ◽  
Sudden Onset ◽  
Warning Signs ◽  
Fistula Formation ◽  
Oesophageal Wall ◽  
Patient Reported ◽  
Oesophageal Surgery

Gastroaortic fistula formation is a very rare complication following oesophageal resection and, in most cases, leads to sudden death. We report the case of a 65-year-old male with an adenocarcinoma of the oesophagus who underwent neoadjuvant chemoradiation followed by a minimally invasive transthoracic oesophagectomy with gastric tube reconstruction and intrathoracic anastomosis. After an uneventful postoperative course and hospital discharge, the patient reported blood regurgitation on postoperative day 23. Endoscopy revealed an adherent blood clot on the oesophageal wall, which after dislocation caused exsanguination. Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula. The sudden onset of haemorrhage makes this condition particularly difficult to treat. Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.

scholarly journals The Management of Multi-Site, Bleeding, Visceral Artery Pseudoaneurysms, Secondary to Necrotising Pancreatitis

2009 ◽  
Vol 91 (3) ◽  
pp. 255-258 ◽  
Author(s):  
J Skipworth ◽  
D Raptis ◽  
D Brennand ◽  
C Imber ◽  
A Shankar
Keyword(s):  
Acute Pancreatitis ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Enterocutaneous Fistula ◽  
Fistula Formation ◽  
Visceral Artery ◽  
Haemodynamic Instability ◽  
Successful Recovery ◽  
Necrotising Pancreatitis ◽  
Tomographic Angiography

We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the necessity for multidisciplinary involvement in the management of pseudoaneurysms, an approach that is often most successfully achieved in a tertiary setting.

scholarly journals Gastrosplenic Fistula and Coeliac Artery Occlusion

2020 ◽  
pp. 1-3
Author(s):  
Wen Jye Wong ◽  
Tze Yang Chin ◽  
Wen Jye Wong
Keyword(s):  
Functional Status ◽  
Ct Angiography ◽  
Epigastric Pain ◽  
Case Reports ◽  
Rare Complication ◽  
Arterial Disease ◽  
Fistula Formation ◽  
Arterial Tree ◽  
Coeliac Artery ◽  
Poor Functional Status

Gastrosplenic fistula (GSF) is a very rare complication of several disease processes and can lead to catastrophic bleeding, necessitating emergent treatment. Splenic or gastric lymphomas are the predominant causes, with trauma and gastric surgery also implicated in several case reports. We present a case of a gastrosplenic fistula resulting from occlusion of the coeliac artery. To our knowledge, this is the first reported case of a GSF resulting from severe intra-abdominal arterial disease. A 60-year-old male initially presented to the emergency department with epigastric pain. He had an extensive medical history, including dialysis-dependent end-stage renal failure, atrial fibrillation, coronary artery disease, and multiple previous abdominal surgeries. Investigation with CT angiography revealed calcified occlusion of the coeliac artery as well as extensive calcification throughout his aorta and arterial tree. A diagnosis of mesenteric angina was made, but due to his poor functional status, he was not suitable for surgical or transcatheter interventions. He was treated symptomatically, but a month later developed sudden worsening of his epigastric pain, followed by large volume haematemesis. CT angiography showed a GSF with extensive gastric necrosis. Due to his poor functional status and rapid deterioration, he opted for palliation and passed away two days later. It has been postulated that GSF develops from the invasion of malignant tissue from the stomach to the spleen or vice versa, and subsequent necrosis of this tissue results in fistula formation. This case demonstrates that the invasion of an adjacent organ may not be necessary; necrosis itself can cause erosion that ultimately results in fistula formation.

scholarly journals A dangerous pleural effusion

2010 ◽  
Vol 92 (5) ◽  
pp. e53-e54 ◽  
Author(s):  
Somprakas Basu ◽  
Shilpi Bhadani ◽  
Vijay K Shukla
Keyword(s):  
Rare Complication ◽  
Sudden Onset ◽  
Biliary Surgery ◽  
Biliary Leak ◽  
X Ray ◽  
Delay In Diagnosis ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Life Threatening ◽  
Chest X Ray

Bilothorax is a rare complication of biliary peritonitis and, if not treated promptly, can be life-threatening. We report a case of a middle-aged woman who had undergone a bilio-enteric bypass and subsequently a biliary leak developed, which finally led to intra-abdominal biliary collection and spontaneous bilothorax. The clinical course was rapid and mimicked venous thromboembolism, myocardial infarction and pulmonary oedema, which led to a delay in diagnosis and management and finally death. We high-light the fact that bilothorax, although a rare complication of biliary surgery, should always be considered as a probable cause of massive effusion and sudden-onset respiratory and cardiovascular collapse in the postoperative period. A chest X-ray and a diagnostic pleural tap can confirm the diagnosis. Once detected, an aggressive management should be instituted to prevent organ failure and death.

scholarly journals A Case of Massive Hepatic Infarction in a Patient with HELLP Syndrome

2019 ◽  
Vol 09 (01) ◽  
pp. e84-e87
Author(s):  
Jessica Morgan ◽  
Micaela Della Torre ◽  
Anna Whelan ◽  
Sophia Rodriguez ◽  
Laura DiGiovanni
Keyword(s):  
Liver Enzymes ◽  
Epigastric Pain ◽  
Early Recognition ◽  
Rare Complication ◽  
Liver Function Tests ◽  
True Incidence ◽  
Hepatic Infarction ◽  
Elevated Liver Enzymes ◽  
Blood Pressures ◽  
The Right

Background Hepatic infarction is an exceedingly rare complication of hemolysis, elevated liver enzymes, and low platelets syndrome. Few cases have been described in the medical literature and the true incidence remains unknown. It can lead to fulminant liver failure, liver transplant, or death if not promptly addressed. Case Report A 22-year-old primigravida presented with right upper quadrant and epigastric pain at 28 weeks' gestation. She had severely elevated blood pressures requiring intravenous antihypertensives as well as proteinuria, thrombocytopenia, and mild transaminitis. Within 6 hours of admission, her rapidly rising liver function tests (LFTs) necessitated urgent delivery by primary cesarean section. Her liver enzymes continued to rapidly worsen postoperatively and immediate postpartum computed tomography of the abdomen and pelvis revealed massive hepatic infarction, 11 × 10 × 15 cm, of the right lobe of the liver. Her transaminases peaked at alanine transferase of 2,863 IU/L and aspartate transferase of 2,732 IU/L. She received supportive multidisciplinary intensive care, and LFTs returned to normal by postoperative day 20. Conclusion Hepatic infarction is an extraordinarily rare complication of pre-eclampsia. Early recognition and prompt multidisciplinary management are vital to prevent catastrophic bleeding, hepatic failure, and death.

scholarly journals Proximal peroneal artery traumatic pseudoaneurysm following a compound proximal tibial shaft fracture managed with an external fixator: A case report

2019 ◽  
Vol 27 (1) ◽  
pp. 89-92
Author(s):  
Malinda Rasith Ileperuma ◽  
Badra Hewavithana
Keyword(s):  
External Fixator ◽  
Rare Complication ◽  
Shaft Fracture ◽  
Sudden Onset ◽  
Peroneal Artery ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Artery Pseudoaneurysm ◽  
Initial Injury ◽  
High Index Of Suspicion

A case of post-traumatic proximal peroneal artery pseudoaneurysm following a proximal tibial shaft fracture, complicated by acute compartment syndrome, fixed using an external fixator, in a 22-year-old female is presented. She was investigated for sudden-onset bleeding from the external fixator pin site, 6 weeks after the initial injury, was anaemic and diagnosed with a pseudoaneurysm at lower limb angiography. Contrast leak from the site of pseudoaneurysm was noted and open surgery with ligation of the pseudoaneurysm was performed. This rare complication of a proximal tibial shaft fracture has to be considered in patients presenting with acute bleeding from the surgical site or from pin sites after a significant lag period and requires a high index of suspicion.

scholarly journals Delayed diaphragmatic rupture presenting with acute gastric volvulus

2014 ◽  
Vol 96 (7) ◽  
pp. e17-e19 ◽  
Author(s):  
JML Williamson ◽  
R Macleod ◽  
A Hollowood
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Gastric Volvulus ◽  
Diaphragmatic Rupture ◽  
Motorcycle Accident ◽  
Thoracic Computed Tomography ◽  
Acute Gastric Volvulus ◽  
Hospital Cardiac Arrest

Gastric volvulus is a rare complication of diaphragmatic rupture. We report the case of an 82-year-old man who presented following an out-of-hospital cardiac arrest. Chest radiography and thoracic computed tomography revealed an acute gastric volvulus and a chronic diaphragmatic hernia containing transverse colon and abdominal viscera. He had complained of retching and associated epigastric pain prior to collapse, and had sustained a motorcycle accident approximately 60 years earlier. Insertion of a nasogastric tube was unsuccessful (completing Borchardt’s diagnostic triad) and his condition prevented both operative and endoscopic reduction of his volvulus. He died soon afterwards.

Catamenial Synkinetic Retroauricular Pain

Cephalalgia ◽  
2003 ◽  
Vol 23 (3) ◽  
pp. 214-217 ◽  
Author(s):  
DE Jacome
Keyword(s):  
White Matter Hyperintensities ◽  
Rare Complication ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Bell’S Palsy ◽  
Bell's Palsy ◽  
Patient Reported ◽  
Magnetic Resonance Imaging Mri ◽  
Eye Closure ◽  
Facial Synkinesis

A report of two female patients with persistent unilateral retroauricular pain and cranial synkinesis following Bell's palsy. Pain occurred during menses in the first patient and was exacerbated by menses in the second patient. Retroauricular pain often precedes or follows Bell's palsy. Pain normally disappears within 2 weeks from the onset of paralysis. Neurological examination, brain magnetic resonance imaging (MRI), computed tomography of the head and cranial electrophysiological testing were performed. The first patient had severe right retroauricular pain during her menses for several years following Bell's palsy. Her brain MRI showed non-specific T2 white matter hyperintensities. On her electromyogram she had facial synkinesis with tonic motor unit discharges on her right orbicularis oris and mentalis muscles during sustained eye closure. The second patient reported hearing a sound over her left ear when she blinked or protruded her jaw after Bell's palsy. She had ipsilateral retroauricular pain, exacerbated during menses. Her brain MRI was normal. Electromyogram showed facial synkinesis. Chronic retroauricular pain, occurring or exacerbated during menses, may be a rare complication of Bell's palsy. It can be associated with facial subclinical synkinetic dystonia and trigemino-facial synkinesis.

scholarly journals Aortic Dissection Presenting as Acute Pancreatitis: Suspecting the Unexpected

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Adam Hafeez ◽  
Dillon Karmo ◽  
Adrian Mercado-Alamo ◽  
Alexandra Halalau
Keyword(s):  
Blood Pressure ◽  
Acute Pancreatitis ◽  
Aortic Dissection ◽  
Epigastric Pain ◽  
Pressure Control ◽  
Sudden Onset ◽  
Medical Emergency ◽  
Threatening Condition ◽  
Life Threatening ◽  
Normal Triglyceride

Aortic dissection is a life-threatening condition in which the inner layer of the aorta tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). It is considered a medical emergency. We report a case of a healthy 56-year-old male who presented to the emergency room with sudden onset of epigastric pain radiating to his back. His blood pressure was 167/91 mmHg, equal in both arms. His lipase was elevated at 1258 U/L, and he was clinically diagnosed with acute pancreatitis (AP). He denied any alcohol consumption, had no evidence for gallstones, and had normal triglyceride level. Two days later, he endorsed new suprapubic tenderness radiating to his scrotum, along with worsening epigastric pain. A MRCP demonstrated evidence of an aortic dissection (AD). CT angiography demonstrated a Stanford type B AD extending into the proximal common iliac arteries. His aortic dissection was managed medically with rapid blood pressure control. The patient had excellent recovery and was discharged home without any surgical intervention.

scholarly journals Rare complication of milk-alkali ingestion: severe pancreatitis and acute kidney injury in a chronic hypocalcaemic patient with DiGeorge’s syndrome

2019 ◽  
Vol 12 (3) ◽  
pp. e226761 ◽  
Author(s):  
Rajarshi Bhadra ◽  
Fareeha Ahmed Khan ◽  
Mona Soliman ◽  
Meyappan Somasundaram ◽  
Daniel V Iltchev ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Renal Dysfunction ◽  
Epigastric Pain ◽  
Calcium Supplementation ◽  
Rare Complication ◽  
Biliary Duct ◽  
Thiazide Diuretics ◽  
Prolonged Stay ◽  
Calcium Supplements ◽  
Severe Renal Dysfunction

Injudicious use of over-the-counter calcium supplements has resulted in increased incidences of hypercalcaemia and related complications. We present a case of acute pancreatitis in a chronic hypocalcaemic patient of DiGeorge’s syndrome. The patient came into the ED with sepsis syndrome, right upper quadrant and epigastric pain and no obvious source of infection. Lab results and imaging were indicative of acute pancreatitis. There was severe renal dysfunction. The patient needed haemodialysis and had a prolonged stay in intensive care. The medical history was negative for biliary duct pathology or alcohol use. The patient had vomiting and diarrhoea in the nursing home for about a week, but she continued to receive her regular medications that included the calcium supplements and thiazide diuretics. It is likely that a complex interplay between calcium supplementation, dehydration and thiazide diuretics resulted in the development of acute pancreatitis and severe renal dysfunction in a chronic hypocalcaemic patient.

Sign in / Sign up

Export Citation Format

Share Document