scholarly journals Transvaginal Management of Vaginal Cuff Dehiscence with Bowel Evisceration following Delayed Diagnosis

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Samantha Bleull ◽  
Hunter Smith ◽  
Robert Shapiro
Keyword(s):  
Ct Scan ◽  
Bowel Obstruction ◽  
Surgical Approach ◽  
Prolonged Exposure ◽  
Bowel Resection ◽  
Delayed Diagnosis ◽  
Vaginal Flora ◽  
Vaginal Cuff ◽  
Vaginal Cuff Dehiscence ◽  
High Index Of Suspicion

One of the most serious complications that can arise from hysterectomy is vaginal cuff dehiscence with subsequent bowel evisceration. Treatment via vaginal approach has been utilized in early cases of vaginal cuff dehiscence where the need for bowel resection is less likely. Our case examines the treatment of vaginal cuff dehiscence through a vaginal approach approximately 36 hours after apparent vaginal dehiscence with subsequent bowel evisceration. In this case, we chose a vaginal approach even in the setting of possible bowel obstruction and a significant leukocytosis. We utilized CT scan findings to help guide our surgical approach. Although the subjective appearance of the bowel protruding through the vaginal cuff was reassuring, this played little role in guiding our decision with regard to surgical approach. Vaginal cuff dehiscence with evisceration can be managed successfully via a vaginal approach even with prolonged exposure of the bowel to vaginal flora. CT scan should be utilized to evaluate bowel integrity when considering a vaginal dehiscence repair. A high index of suspicion is warranted as these cases can present up to many years after hysterectomy.

scholarly journals Small bowel obstruction secondary to obturator hernia in an elderly female

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Aneela Devarakonda ◽  
Aarav Gupta-Kaistha ◽  
Nikhil Kulkarni
Keyword(s):  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Delayed Diagnosis ◽  
Obturator Hernia ◽  
Computed Tomography Imaging ◽  
Rare Type ◽  
Midline Laparotomy ◽  
Mortality And Morbidity ◽  
Tomography Imaging ◽  
High Index Of Suspicion

Abstract Obturator hernia is an extremely rare type of pelvic hernia with relatively high mortality and morbidity due to delayed diagnosis. Most cases present with acute intestinal obstruction and typically affect elderly, emaciated females. A high index of suspicion is required for early diagnosis and timely surgical intervention. We present a rare case of an 81-year-old female who was initially discharged from the emergency department due to nonspecific symptoms. She represented with clinical features of bowel obstruction and was diagnosed preoperatively with computed tomography imaging identifying a left-sided obturator hernia with a loop of bowel extending through the obturator canal. She was taken to theater for lower midline laparotomy and repair of obturator hernia. Although many cases are identified intraoperatively, we will discuss preoperative means of diagnosis of obturator hernia from examination findings to imaging diagnosis.

Presentation of Gall Stone Ileus as Gut Obstruction

JMS SKIMS ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. 117-119
Author(s):  
Munir Ahmad Wani ◽  
Mubarak Ahmad Shan ◽  
Syed Muzamil Andrabi ◽  
Ajaz Ahmad Malik
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Ct Scan ◽  
Bowel Obstruction ◽  
Emergency Surgery ◽  
Gallstone Ileus ◽  
Gall Stone ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Gall Stone Ileus

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case report, we discuss a difficult diagnostic case of gallstone ileus presenting as small gut obstruction with ischemia. A 56-year-old female presented with abdominal pain and vomiting. A CT scan was performed and showed an evolving bowel obstruction with features of gut ischemia with pneumobilia although no frank hyper density suggestive of a gallstone was noted. The patient underwent emergency surgery and a 60 mm obstructing calculus was removed from the patient's jejunum, with a formal tube cholecystostomy. JMS 2018: 21 (2):117-119

scholarly journals Impact of a Revised Cuff Closure Technique on the Rate of Vaginal Cuff Dehiscence with Endoscopic Hysterectomy

2020 ◽  
Vol 27 (7) ◽  
pp. S105
Author(s):  
S. Behbehani ◽  
E. Suarez-Salvador ◽  
H. Kosiorek ◽  
J. Yi ◽  
J.F. Magrina
Keyword(s):  
Vaginal Cuff ◽  
Closure Technique ◽  
Vaginal Cuff Dehiscence

EP.FRI.390 Improving care for patients with acute bowel obstruction: A closed loop audit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Benjamin Clayphan ◽  
Anna Fairclough ◽  
Jeff Lim ◽  
Roderick Alexander
Keyword(s):  
Ct Scan ◽  
Patient Outcomes ◽  
Bowel Obstruction ◽  
Care Pathway ◽  
Imaging Modality ◽  
Ct Scans ◽  
Abdominal Ct ◽  
Retrospective Audit ◽  
Raising Awareness ◽  
Time To Diagnosis

Abstract Aims Acute Bowel Obstruction (ABO) accounts for 10% of emergency surgical admissions and when surgery is required mortality can exceed 10%. Early diagnosis is associated with improved patient outcomes and timely acquisition of abdominal CT scans can help prevent delays. The NCEPOD 2020 report on ABO identified ‘delays in imaging’ as a key area for improvement in the care of these patients, with these delays being exacerbated if an abdominal X-ray (AXR) was performed as well as an abdominal CT. This study looks at ways to expedite the diagnosis of patients presenting with ABO.   Methods A retrospective audit of 77 patients admitted from A&E or SAU with ABO from April 2019 to February 2020 was conducted. Imaging modality, time-to-CT scan and time-to-diagnosis was recorded. Results and recommendations were presented locally and an evidence based ABO care pathway was implemented and publicised. 20 patients were audited prospectively, post care pathway implementation.  Results 70.1% of patients from the initial audit received a CT-scan and 42% of these patients received an AXR before their eventual CT-scan. The average wait for a definitive radiological diagnosis was 27.8hr. After implementation of the pathway only 18% of patients audited received both modes of imaging and the average time to diagnosis has been reduced to 10.7hr.  Conclusions Raising awareness of the appropriate and timely use of CT-scans in the diagnosis of ABO has reduced the number of concomitant AXR for these patients, expediting the making of a definitive diagnosis and improving patient outcomes. 

Granulomatosis with polyangiitis presenting as pancreatic disease

2021 ◽  
Vol 14 (3) ◽  
pp. e241033
Author(s):  
Jessie Jia Tao ◽  
Arnav Agarwal ◽  
Ari Benjamin Cuperfain ◽  
Christian Pagnoux
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Epigastric Pain ◽  
Delayed Diagnosis ◽  
Pancreatic Disease ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Rapid Progression ◽  
Radiographic Evidence ◽  
High Index Of Suspicion ◽  
Parenchymal Lung

Granulomatosis with polyangiitis (GPA) is a rare necrotising small vessel vasculitis typically associated with oronasal, pulmonary and renal manifestations. Pancreatic disease is an exceedingly rare initial presentation and is associated with delayed diagnosis and rapid progression. We discuss a 66-year-old woman presenting with epigastric pain, elevated lipase and radiographic evidence of focal pancreatitis. She had no relevant medical history and no lithiasis seen on imaging. Pertinent findings include strawberry gingivitis, positive proteinase-antineutrophil cytoplasm antibody (98% specificity) and focal nodular parenchymal lung lesions on CT chest—all of which are consistent with a diagnosis of GPA. She was promptly started on high-dose steroids which resulted in significant clinical and biochemical improvement. Cyclophosphamide was added once biopsy confirmed the absence of malignancy. In order to optimise the clinical outcomes of GPA, physicians must keep a wide differential and high index of suspicion in the setting of unexplained pancreatitis with systemic features.

Case of second primary breast cancer in ectopic breast tissue and review of the literature

2021 ◽  
Vol 14 (4) ◽  
pp. e241361
Author(s):  
Jamin Kweku Addae ◽  
Thomas Genuit ◽  
Joseph Colletta ◽  
Kathy Schilling
Keyword(s):  
Breast Cancer ◽  
Primary Breast Cancer ◽  
Breast Tissue ◽  
Delayed Diagnosis ◽  
Left Breast ◽  
Second Primary ◽  
Female Population ◽  
Accessory Breast ◽  
History Of ◽  
High Index Of Suspicion

Accessory breast tissue (ABT) is found in approximately 2%–6% of the female population and are subject to most of the physiological and pathological changes that occur in pectoral breast. Primary breast cancer occurring in ABT is a rare occurrence and a second primary breast cancer occurring in an accessory breast has never been reported. We report the case of a 60-year-old woman with a history of mastectomy for left breast cancer 5 years prior to presentation, who presented with an enlarging right axilla mass found to be a second primary breast cancer in an accessory tissue on biopsy. Many physicians are unfamiliar with the clinical presentation of accessory breast cancer due to the rarity of the condition and this ultimately results in delayed diagnosis and advanced disease at presentation. It is therefore prudent that physicians have a high index of suspicion when patients present with axillary masses.

Four common diseases causing sudden blindness or death in the eye emergency department

2020 ◽  
pp. postgradmedj-2020-138163
Author(s):  
Ana Leonor Rei da Cruz Escaleira ◽  
Dimitrios Kalogeropoulos ◽  
Chris Kalogeropoulos ◽  
Soon Wai Ch’Ng ◽  
Velota C T Sung ◽  
...  
Keyword(s):  
Emergency Department ◽  
Delayed Diagnosis ◽  
Signs And Symptoms ◽  
Ocular Motility ◽  
Ocular Manifestations ◽  
Ischaemic Attack ◽  
High Index Of Suspicion ◽  
Sudden Blindness ◽  
Patient At Risk ◽  
Prompt Diagnosis

Neuro-ophthalmological emergency disorders typically present with symptoms of visual loss, diplopia, ocular motility impairment or anisocoria. The ocular manifestations of these disorders are sometimes indicative of a more serious global neurology disease rather than an isolated ocular disease. The aim of this review is to highlight four important neuro-ophthalmological emergency disorders that must not be missed by an ophthalmologist. These include acute painful Horner’s syndrome, painful cranial nerve III palsy, giant cell arteritis and transient ischaemic attack with amaurosis fugax. The delayed diagnosis of these clinical entities puts the patient at risk of blindness or death. Therefore, prompt diagnosis and management of these conditions are essential. This can be acquired from understanding the main signs and symptoms of the disease presentation together with a high index of suspicion while working at a busy eye emergency department.

Nodular melanoma presenting as an exophytic subungual mass

2018 ◽  
Vol 63 (1) ◽  
pp. 32-34 ◽  
Author(s):  
B Finlay ◽  
T Ramachandren ◽  
K Hussey ◽  
S Parkyn ◽  
K Meyer ◽  
...  
Keyword(s):  
Delayed Diagnosis ◽  
Interesting Case ◽  
High Index ◽  
Nodular Melanoma ◽  
Diagnostic Pitfall ◽  
One Year ◽  
High Index Of Suspicion ◽  
Subungual Melanoma

Despite being recognised and reported in the literature for decades, subungual melanoma of the foot remains a diagnostic pitfall, with it commonly being mistaken for benign conditions. We present an interesting case of delayed diagnosis of subungual melanoma of the hallux that was misdiagnosed in the community for over one year. With melanoma being the fourth most commonly diagnosed cancer in Australia in 2013, this case serves as a reminder to all clinicians about the importance of maintaining a high index of suspicion for melanoma of the foot.

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