scholarly journals Massive Hematochezia from a Large Bleeding Duodenal Diverticulum

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Marcus Juan Esteban ◽  
Amit Sureen ◽  
Daniel Herlihy ◽  
Sherif Elhanafi ◽  
Marc J. Zuckerman
Keyword(s):  
Duodenal Diverticulum ◽  
Common Finding ◽  
Upper Endoscopy ◽  
Gi Tract ◽  
Case Presentation ◽  
Epinephrine Injection ◽  
Duodenal Diverticula ◽  
Life Threatening ◽  
Possible Cause ◽  
Prompt Diagnosis

Background. Duodenal diverticula are a rare cause of gastrointestinal (GI) bleeding despite being a common finding in the GI tract. We present a case of a patient who had massive hematochezia due to a complex duodenal diverticulum. Case Presentation. A 74-year-old Hispanic female presented initially with generalized weakness. During admission, the patient had an episode of a large amount of hematochezia and had to be transferred to the intensive care unit (ICU). Upper endoscopy was done using a forward-viewing endoscope which revealed a bleeding complex duodenal diverticulum. Successful hemostasis was achieved through epinephrine injection followed by placement of hemostatic clips. Conclusion. Although rare, gastroenterologists need to be aware of duodenal diverticulum as a possible cause of gastrointestinal bleed. It could be life-threatening, and thus, prompt diagnosis and management is necessary.

scholarly journals Endoscopic negative pressure therapy as stand-alone treatment for perforated duodenal diverticulum: presentation of two cases

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dörte Wichmann ◽  
Kai Tobias Jansen ◽  
Flurina Onken ◽  
Dietmar Stüker ◽  
Emanuel Zerabruck ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Treatment Method ◽  
Interventional Therapy ◽  
Duodenal Diverticulum ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Case Presentation ◽  
Treatment Start ◽  
Duodenal Diverticula ◽  
Life Threatening

Abstract Background Endoscopic negative pressure therapy is a novel and successful treatment method for a variety of gastrointestinal leaks. This therapy mode has been frequently described for rectal and esophageal leakages. Duodenal diverticular perforations are rare but life-threatening events. The early diagnosis of duodenal diverticular perforation is often complicated by inconclusive symptoms. This is the first report about endoscopic negative pressure therapy in patients with perforated duodenal diverticula. Case presentation We present two cases of duodenal diverticula perforations treated with endoscopic negative pressure therapy as stand-alone treatment. Start of symptoms varied from one to three days before hospital admission. Early sectional imaging led to the diagnosis of duodenal diverticular perforation. Both patients were treated with endoluminal endoscopic negative pressure therapy with simultaneous feeding option. Three respective changes of the suction device were performed. Both patients were treated with antibiotics and antimycotics during their hospital stay and be discharged from hospital after 20 days. Conclusions This is the first description of successful stand-alone treatment by endoscopic negative pressure therapy in two patients with perforated duodenal diverticulum. We thus strongly recommend to attempt interventional therapy with endoluminal endoscopic negative pressure therapy in patients with duodenal diverticular perforations upfront to surgery.

scholarly journals Surgical procedure of segmentectomy as a possible cause of postoperative cerebral embolism: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Peirui Chen ◽  
Qiusha Qing ◽  
Mingqiang Diao ◽  
Xiaokang Sun ◽  
Junrong Yang ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Surgical Procedure ◽  
Mechanical Thrombectomy ◽  
Early Postoperative Period ◽  
Cerebral Embolism ◽  
Case Presentation ◽  
Early Symptom ◽  
Life Threatening ◽  
Pulmonary Vein Stump ◽  
Possible Cause

Abstract Background Cerebral embolism after lobectomy is a life-threatening complication during the early postoperative period. However, it is unclear if cerebral embolism can develop after segmentectomy. Case presentation We experienced a case of a 37-year-old man who demonstrated early symptom of acute ischemic stroke in early postoperative period after right upper posterior segmentectomy and performed intra-arterial mechanical thrombectomy (IAMT) successfully. Conclusions Long and irregular pulmonary vein stump (PVS) and endothelial injury caused by surgical procedure may lead to cerebral embolism after segmentectomy. We believe that doing preoperative pulmonary vascular assessment and using appropriate surgical procedure may reduce the rate of cerebral embolism.

scholarly journals Cardiac Fibroelastoma versus Thrombus: Echocardiographic Evidence Can Be Misleading

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
John P. O’Laughlin ◽  
Gautam Verma ◽  
Iosif Gulkarov
Keyword(s):  
Young Female ◽  
Common Finding ◽  
Unique Case ◽  
Case Presentation ◽  
Aortic Thrombus ◽  
Life Threatening ◽  
Work Up ◽  
Cardiac Masses ◽  
Echocardiographic Findings ◽  
Echocardiographic Evidence

We present a case of a young female with stroke symptoms who underwent valve sparing resection of a presumed fibroelastoma based on echocardiographic findings. After confirming embolic stroke, she underwent excision of the lesion, which on pathology revealed a nonbacterial thrombus. Ultimately, this led to a more extensive work-up leading to the discovery of a papillary serous ovarian carcinoma, the underlying cause of her hypercoagulable state. The initial echocardiographic findings painted the clear picture of a papillary tumor on the aortic valve which was likely the source of the emboli resulting in ischemic stroke. This unique case presentation illustrates that imaging, including echocardiography, may not always coincide with the clinical diagnosis. Thus, understanding the differential diagnoses of cardiac masses is of vital clinical significance. The distinction of fibroelastoma versus the much less common finding of aortic thrombus may lead to early diagnosis of malignancy and prevention of life threatening events due to stroke or undiagnosed disease.

scholarly journals Surgical Procedure of Segmentectomy as a Possible Cause of Postoperative Cerebral embolism: A Case Report

2020 ◽  
Author(s):  
Peirui Chen ◽  
Qiushan Qing ◽  
Mingqiang Diao ◽  
Xiaokang Sun ◽  
Junrong Yang ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Surgical Procedure ◽  
Mechanical Thrombectomy ◽  
Early Postoperative Period ◽  
Cerebral Embolism ◽  
Case Presentation ◽  
Early Symptom ◽  
Life Threatening ◽  
Pulmonary Vein Stump ◽  
Possible Cause

Abstract Background: Cerebral embolism after lobectomy is a life-threatening complication during the early postoperative period. However, it is unclear if cerebral embolism can develop after segmentectomy. Case Presentation: We experienced a case of a 37-year-old man who demonstrated early symptom of acute ischemic stroke in early postoperative period after right upper posterior segmentectomy and performed intra-arterial mechanical thrombectomy (IAMT) successfully.Conclusions: long and irregular pulmonary vein stump (PVS) and endothelial injury caused by surgical procedure may lead to cerebral embolism after segmentectomy. We believe that doing preoperative pulmonary vascular assessment and using appropriate surgical procedure may reduce the rate of cerebral embolism.

scholarly journals The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Moysis Moysidis ◽  
Daniel Paramythiotis ◽  
Anestis Karakatsanis ◽  
Evropi Amanatidou ◽  
Elisavet Psoma ◽  
...  
Keyword(s):  
Incidental Findings ◽  
Duodenal Diverticulum ◽  
Common Site ◽  
Case Presentation ◽  
Postoperative Course ◽  
First Case ◽  
Intravenous Antibiotics ◽  
Therapeutic Decisions ◽  
Duodenal Diverticula ◽  
Bowel Rest

Abstract Background The duodenum is a common site for diverticulum formation. Most of the duodenal diverticula are asymptomatic, incidental findings. Perforation is a rare but potentially lethal complication of duodenal diverticular disease. Surgery remains the mainstay of treatment for perforated duodenal diverticula. In recent years, a few cases were successfully managed either conservatively or with endoscopy. Case presentation We present two cases of female patients treated in our department for duodenal diverticulum perforation. The first case was treated surgically with a diverticulectomy. The second case was managed conservatively with bowel rest and intravenous antibiotics. Both patients had an uncomplicated postoperative course and were discharged home. Conclusions Both surgical and conservative treatments are viable options for a perforated duodenal diverticulum in selected patients. Patients with a contained duodenal diverticular perforation can be managed conservatively at the outset. Possibly, the introduction of a classification system for duodenal diverticulum perforation may help clinicians in making essential therapeutic decisions.

scholarly journals Anemia That Presented with Desaturation: A Focus on Core Concepts

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Lakshmi Shobhavat ◽  
Antonio D’Costa ◽  
Karthik Shroff
Keyword(s):  
Blood Smear ◽  
Intensive Care Admission ◽  
Case Presentation ◽  
Threatening Condition ◽  
Core Concepts ◽  
Life Threatening ◽  
History Of ◽  
The Common ◽  
Treatable Condition ◽  
Prompt Diagnosis

Background. Methemoglobinemia is a potentially life-threatening condition which presents with cyanosis and characteristic “chocolate-coloured blood.” Although a co-oximetry would give a prompt diagnosis, there have been multiple reports of misdiagnosing this treatable condition—from being diagnosed as sepsis to asthma and even being operated for “ruptured ectopic pregnancy.” Here, we report a case which presented without the classical signs of poisoning and methemoglobinemia—without vomiting, cyanosis, or chocolate-coloured blood. We also discuss the common misconceptions regarding anemia physiology and the pitfalls in diagnosing this condition and warn the reader regarding the reflexive use of antidotes like methylene blue. Case Presentation. A well-grown 3-year old boy presented with an acute history of irritability, cola-coloured urine, and desaturation on examination. The child was pale, with tachypnoea and in failure. Blood smear was suggestive of severe hemolytic anemia. Methemoglobinemia was diagnosed on co-oximetry. By focussing on physiologic principles of management rather than a specific antidote, the child was discharged home, well and active within 3 days of intensive care admission.

Sinusitis as a cause of Insidious headache in a pregnant woman: A case report

2020 ◽  
pp. 1753495X2097009
Author(s):  
Sara Yang ◽  
Jane J Han ◽  
Monica Patadia
Keyword(s):  
Pregnant Woman ◽  
Altered Mental Status ◽  
Clinical Suspicion ◽  
Acute Sinusitis ◽  
Case Presentation ◽  
Subdural Collection ◽  
Odontogenic Origin ◽  
Intracranial Complications ◽  
Possible Cause ◽  
Prompt Diagnosis

Background The incidence of headaches during pregnancy is 35%. Although ruling out pre-eclampsia as a possible cause for headache is important in the pregnant population, acute sinusitis should remain on the differential as it occurs six times more frequently in pregnant women. Untreated disease can lead to rare intracranial complications such as a subdural empyema. Case presentation: 21-year-old female at 33-weeks gestation with recurring headaches was diagnosed with pre-eclampsia with severe features requiring emergent caesarean section. The woman continued to have altered mental status and focal neurologic deficits after delivery. Computerized tomography head imaging demonstrated a subdural collection discovered to be an empyema due to unilateral acute sinusitis of odontogenic origin. Conclusion Maintaining a clinical suspicion for acute sinusitis as a cause of headache in a pregnant woman is important for prompt diagnosis and treatment before it develops into a rare intracranial complication.

scholarly journals Retroperitoneal abscess with pylephlebitis caused by lumbar acupuncture: a case report

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hayemin Lee ◽  
Kiyoung Sung ◽  
Jinbeom Cho
Keyword(s):  
Chronic Back Pain ◽  
Diagnosis And Treatment ◽  
Retroperitoneal Abscess ◽  
Case Presentation ◽  
Complex Anatomy ◽  
Life Threatening ◽  
Operative Findings ◽  
Treatment Procedures ◽  
Possible Cause ◽  
Symptoms And Signs

Abstract Background Retroperitoneal abscess (RA) is an unusual life-threatening disease that has insidious and occult presentations. Although the incidence of this disease is low, diagnosis and treatment are challenging due to its nonspecific presentation and the complex anatomy of the retroperitoneal space. Recently, we experienced one case of a RA with extensive thrombophlebitis of the portal venous system. Case presentation An 80-year-old male presented to the emergency room with symptoms and signs of septic shock; however, the decision making for diagnosis and treatment was difficult, as no clinical and radiological evidence supported key findings regarding the origin of sepsis. Although this patient eventually recovered after surgical drainage, we suggested that more straightforward diagnostic and treatment procedures were required in this patient to avoid possible critical complications. Through a retrospective review of operative findings, patient history, and microbiology, we found that the RA in this patient was caused by lumbar acupuncture, which is usually performed for the management of chronic back pain with long needles. Conclusion Early surgical intervention should be considered for RA whenever the patient does not respond to broad-spectrum antibiotic treatment. Acupuncture is a possible cause of otherwise unexplained soft tissue infections, such as RA, especially in Asian countries.

scholarly journals Surgical Procedure of Segmentectomy as a Possible Cause of Postoperative Cerebral Embolism: A Case Report

2020 ◽  
Author(s):  
Peirui Chen ◽  
Qiushan Qing ◽  
Mingqiang Diao ◽  
Xiaokang Sun ◽  
Junrong Yang ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Surgical Procedure ◽  
Mechanical Thrombectomy ◽  
Early Postoperative Period ◽  
Cerebral Embolism ◽  
Case Presentation ◽  
Early Symptom ◽  
Life Threatening ◽  
Pulmonary Vein Stump ◽  
Possible Cause

Abstract Background: Cerebral embolism after lobectomy is a life-threatening complication during the early postoperative period. However, it is unclear if cerebral embolism can develop after segmentectomy. Case Presentation: We experienced a case of a 37-year-old man who demonstrated early symptom of acute ischemic stroke in early postoperative period after right upper posterior segmentectomy and performed intra-arterial mechanical thrombectomy (IAMT) successfully.Conclusions: long and irregular pulmonary vein stump (PVS) and endothelial injury caused by surgical procedure may lead to cerebral embolism after segmentectomy. We believe that doing preoperative pulmonary vascular assessment and using appropriate surgical procedure may reduce the rate of cerebral embolism.

Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽  
2021 ◽  
pp. 273250162110050
Author(s):  
Samuel Ruiz ◽  
Rizal Lim
Keyword(s):  
Pediatric Population ◽  
Rare Complication ◽  
Disease Process ◽  
Rare Condition ◽  
External Drainage ◽  
Direct Extension ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

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