Lessons learned from successful autologous gastrointestinal reconstruction in patients with intestinal failure: a case series

Abstract Background Intestinal failure (IF) is a rare but severe form of organ failure. The condition is defined as body’s inability to absorb adequate fluids, macronutrients and minerals for growth and development, so that intravenous supplementation is necessary. A broad spectrum of diseases, trauma and complications of surgery might eventually end up with intestinal failure. Nowadays, intestinal failure patients are preferably cared for in intestinal rehabilitation units (IRU). Autologous gastrointestinal reconstruction (AGIR) refers to non-transplant operative management of IF patients designed to improve enteral tolerance and gut absorptive capacity. Case presentation Herein we present five cases with complications of surgeries due to peptic ulcer bleeding, blunt abdominal trauma, obesity and gastric tumor. The surgeries were complicated by anastomotic leak, peritonitis and fistula formation. By adopting multidisciplinary decisions and special care for each complication, all the five patients were successfully managed and discharged. Discussion and conclusions As presented, re-anastomosis in presence of abdominal contamination will probably fail. In patients with intestinal failure, PN should start as soon as possible to increase the success rate of future surgeries and prevent potential need for intestinal transplantation. We suggest referring patients with complicated outcomes of gastrointestinal surgeries to the IRUs to reduce morbidity and mortality.

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Implementing a REBOA program outside of the ivory tower: initial case series and lessons learned at a community trauma center.

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v2i3.64 ◽

2018 ◽

Vol 2 (3) ◽

Author(s):

Jacob J Glaser ◽

Adam Czerwinski ◽

Ashley Alley ◽

Michael Keyes ◽

Valentino Piacentino ◽

...

Keyword(s):

Acute Care ◽

Trauma Center ◽

Systolic Pressure ◽

Case Series ◽

Lessons Learned ◽

Hospital Environment ◽

Open Approach ◽

Improvement Program ◽

Clinical Series ◽

Community Trauma

Background: REBOA has become an established adjunct to hemorrhage control. Prospective data sets are being collected, primarily from large, high volume trauma centers. There are limited data, and guidelines, to guide implementation and use outside of highly resourced environments. Smaller centers interested in adopting a REBOA program could benefit from closing this knowledge gap. Methods: A clinical series of cases utilizing REBOA from Grand Strand Medical Center, Myrtle Beach, South Carolina were reviewed. This represents early data from a busy community trauma center (ACS Level 2), from January 2017 to May 2018. Seven cases are identified and reported on, including outcomes. Considerations and ‘lessons learned’ from this early institutional experience are commented on. Results: REBOA was performed by trauma and acute care surgeons for hemorrhage and shock (blunt trauma n=3, penetrating trauma n=2, no- trauma n=2). All were placed in Zone 1 (one initially was placed in zone 3 then advanced). Mean (SD) systolic pressure (mmHg) before REBOA was 43 (30); post REBOA pressure was 104 (19). N=4 were placed via an open approach, n=3 percutaneous (n=2 with ultrasound). All with arrest before placement expired (n=3) and all others survived. Complications are described. Conclusions: REBOA can be a feasible adjunct for shock treatment in the community hospital environment, with outcomes comparable to large centers, and can be implemented by acute care and trauma surgeons. A rigorous process improvement program and critical appraisal process are critical in maximizing benefit in these centers.

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Total laparoscopic transabdominal-transdiaphragmatic approach for treating Siewert II tumors: a prospective analysis of a case series

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02136-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Wei Pang ◽

Gang Liu ◽

Yan Zhang ◽

Yun Huang ◽

Xinpu Yuan ◽

...

Keyword(s):

Surgical Approach ◽

Mediastinal Lymph Node ◽

Intraoperative Complications ◽

Case Series ◽

Type Ii ◽

Clinical Trial Registry ◽

Siewert Type ◽

Siewert Type Ii ◽

Estimated Blood Loss ◽

Gastrointestinal Reconstruction

Abstract Background Although the morbidity of gastric cancer has decreased, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing. Furthermore, no consensus exists on which surgical approach should be applied for Siewert type II AEG. The purpose of our study was to evaluate the technical safety and feasibility of a new surgical approach. Methods Sixty patients with Siewert type II AEG underwent laparoscopic total gastrectomy with the total laparoscopic transabdominal-transdiaphragmatic (TLTT) approach, which needs an incision in the diaphragm. Results The median operative time, reconstruction time, and estimated blood loss were 214.8 ± 41.6 min, 29.40 ± 7.1 min, and 209.0 ± 110.3 ml, respectively. All of the patients had negative surgical margins. Conclusion There were no intraoperative complications or conversions to open surgery. Our surgical procedure provides a unique option for the safe application of laparoscopic lower mediastinal lymph node dissection and gastrointestinal reconstruction. Trial registration Chinese Clinical Trial Registry, ChiCTR1800014336. Registered on 31 December 2017 - Prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=23111&htm=4.

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Mass barium carbonate poisoning with fatal outcome, lessons learned: a case series

Cases Journal ◽

10.4076/1757-1626-2-9069 ◽

2009 ◽

Vol 2 (0) ◽

Author(s):

Aniruddha Ghose ◽

Abdullah Abu Sayeed ◽

Amir Hossain ◽

Ridwanur Rahman ◽

Abul Faiz ◽

...

Keyword(s):

Barium Carbonate ◽

Fatal Outcome ◽

Case Series ◽

Lessons Learned

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Lessons learned from volar plate fixation of scaphoid fracture nonunions

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417743636 ◽

2017 ◽

Vol 43 (1) ◽

pp. 57-65 ◽

Cited By ~ 6

Author(s):

Seth D. Dodds ◽

John B. Williams ◽

Max Seiter ◽

Clark Chen

Keyword(s):

Plate Fixation ◽

Scaphoid Fracture ◽

Case Series ◽

Lessons Learned ◽

Wrist Flexion ◽

Level Of Evidence ◽

Computed Tomographic ◽

Volar Aspect ◽

Fracture Nonunions ◽

New Type

Treating scaphoid nonunions presents difficulties particularly when there is bone loss, significant humpback deformity or avascular necrosis. We describe a new type of fixation with a volar scaphoid plate that adds to the methods of internal fixation that are available for the treatment of recalcitrant scaphoid nonunions. We will also discuss ‘lessons learned’ from a cases series. The case series includes 20 consecutive patients treated with volar buttress plating and a pedicled vascularized bone graft from the ipsilateral volar distal radius. There was clinical and radiographic evidence of union in 18 of 20 patients, 13 of which were verified by computed tomographic scan. The range of motion was improved in all patients post-operatively. Four patients with radiographic union experienced intermittent clicking with maximal wrist flexion, believed to be due to the impingement of the plate on the volar aspect of the radioscaphoid articulation and underwent removal at approximately 1 year after the index procedure. Volar scaphoid plating is a useful alternative to headless scaphoid screw fixation in the treatment of unstable scaphoid waist fractures and nonunions. Level of evidence: IV

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Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle

Foot & Ankle International ◽

10.1177/1071100718805076 ◽

2018 ◽

Vol 40 (2) ◽

pp. 145-151 ◽

Cited By ~ 5

Author(s):

Elizabeth A. Harkin ◽

Andrew M. Schneider ◽

Michael Murphy ◽

Adam P. Schiff ◽

Michael S. Pinzur

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Ankle Joint ◽

Chronic Wounds ◽

Surgical Techniques ◽

Case Series ◽

Lessons Learned ◽

Charcot Foot ◽

Operative Correction ◽

Therapeutic Footwear

Background: Deformity associated with Charcot foot arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following operative correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot foot arthropathy involving the ankle joint. Methods: Fifty-six consecutive patients underwent operative reconstruction of Charcot foot deformity involving the ankle joint by a single surgeon over a 14-year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single-stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years. Results: One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty-eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between pre- or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome. Conclusions: Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques. Level of Evidence: Level IV, case series.

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Case Series : Operative vs Non-Operative Management in Grade III Pancreatic Injury

Medicinus ◽

10.19166/med.v7i6.2598 ◽

2020 ◽

Vol 7 (6) ◽

pp. 199

Author(s):

Andry Irawan ◽

Clinton Clinton ◽

Sutanto D ◽

Agustina F

Keyword(s):

Case Series ◽

Operative Management ◽

Pancreatic Injury ◽

Clinical Findings ◽

First Case ◽

Non Operative Management ◽

Left Abdomen ◽

Grade Iii ◽

Selection Of

Introduction: Pancreatic injury is a rare case, caused by blunt or sharp trauma. Difficulty in making diagnose on pancreatic trauma cases are associated with high mortality, and the treatment can be either operative or conservatively. However, It is still unclear which treatment is more favorable.Case: We present 2 cases of Grade III pancreatic injury with stable hemodynamic who suffered bicycle accident. First case, 12-year-old boy complaining severe pain on the upper left abdomen (VAS 9-10) and get worsening by time, with vomiting. The patient underwent distal Pancreatectomy-Splenectomy. Second case, 8-year-old boy complaining of pain on the upper left abdomen (VAS 6-7) without extension on whole abdominal region with vomiting and fever. The patient was treated conservatively. In both cases, patient was discharged with improvement. However, about 3 months later patients who were treated conservatively developed into a pseudocyst.Conclusion: The selection of management in grade III pancreatic injury can be operative or conservative depending on clinical findings such as hemodynamic condition and the quality of abdominal pain. But the occurrence of pseudocysts pancreas is another surgical challenge.

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Operative Outcomes of Grade 3 Turf Toe Injuries in Competitive Football Players

Foot & Ankle International ◽

10.1177/1071100718775967 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1076-1081 ◽

Cited By ~ 5

Author(s):

Kenneth Smith ◽

Norman Waldrop

Keyword(s):

Range Of Motion ◽

Operative Procedure ◽

Case Series ◽

Operative Management ◽

Return To Play ◽

First Metatarsophalangeal Joint ◽

Operative Outcomes ◽

Turf Toe ◽

Grade 3

Background: Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. Methods: We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. Results: The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. Conclusion: Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. Level of Evidence: Level IV, case series

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Pyogenic sacroiliitis: Lessons learned from an atypical case series

Anales de Pediatría (English Edition) ◽

10.1016/j.anpede.2018.07.006 ◽

2019 ◽

Vol 91 (1) ◽

pp. 42-46

Author(s):

Joana Arcângelo ◽

Susana Norte Ramos ◽

Pedro Alves ◽

Delfin Tavares ◽

Catarina Gouveia

Keyword(s):

Case Series ◽

Lessons Learned ◽

Atypical Case ◽

Pyogenic Sacroiliitis

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Operative Technique and Lessons Learned From Surgical Implantation of the NeuroPace Responsive Neurostimulation® System in 57 Consecutive Patients

Operative Neurosurgery ◽

10.1093/ons/opaa300 ◽

2020 ◽

Author(s):

Max O Krucoff ◽

Thomas A Wozny ◽

Anthony T Lee ◽

Vikram R Rao ◽

Edward F Chang

Keyword(s):

Operative Technique ◽

Focal Epilepsy ◽

Intraoperative Imaging ◽

Case Series ◽

Lessons Learned ◽

Seizure Freedom ◽

Operative Techniques ◽

Surgical Positioning ◽

Intracerebral Hemorrhages

Abstract BACKGROUND The Responsive Neurostimulation (RNS)® System (NeuroPace, Inc) is an implantable device designed to improve seizure control in patients with medically refractory focal epilepsy. Because it is relatively new, surgical pearls and operative techniques optimized from experience beyond a small case series have yet to be described. OBJECTIVE To provide a detailed description of our operative technique and surgical pearls learned from implantation of the RNS System in 57 patients at our institution. We describe our method for frame-based placement of amygdalo-hippocampal depth leads, open implantation of cortical strip leads, and open installation of the neurostimulator. METHODS We outline considerations for patient selection, preoperative planning, surgical positioning, incision planning, stereotactic depth lead implantation, cortical strip lead implantation, craniotomy for neurostimulator implantation, device testing, closure, and intraoperative imaging. RESULTS The median reduction in clinical seizure frequency was 60% (standard deviation 63.1) with 27% of patients achieving seizure freedom at last follow up (median 23.1 mo). No infections, intracerebral hemorrhages, or lead migrations were encountered. Two patients experienced lead fractures, and four lead exchanges have been performed. CONCLUSION The techniques set forth here will help with the safe and efficient implantation of these new devices.

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Short bowel syndrome in infancy: recent advances and practical management

Frontline Gastroenterology ◽

10.1136/flgastro-2020-101457 ◽

2020 ◽

pp. flgastro-2020-101457

Author(s):

Elena Cernat ◽

Chloe Corlett ◽

Natalia Iglesias ◽

Nkem Onyeador ◽

Julie Steele ◽

...

Keyword(s):

Parenteral Nutrition ◽

Short Bowel Syndrome ◽

Intestinal Adaptation ◽

Intestinal Failure ◽

Rare Condition ◽

Oral Feeding ◽

Short Bowel ◽

Intestinal Continuity ◽

Gastrointestinal Reconstruction ◽

Lipid Reduction

Short bowel syndrome (SBS) is a rare condition characterised by extensive loss of intestinal mass secondary to congenital or acquired disease. The outcomes are determined by dependency on parenteral nutrition (PN), its possible complications and factors that influence intestinal adaptation. In order to achieve the best results, patients should be managed by a specialised multidisciplinary team with the aims of promoting growth and development, stimulating intestinal adaptation and preventing possible complications. This involves timely surgical management aimed at rescuing maximum bowel length and eventually re-establishing intestinal continuity where appropriate. A combination of enteral and parenteral nutrition needs to be targeted towards maintaining a balance between fulfilling the nutritional and metabolic needs of the child while preventing or at least minimising potential complications. Enteral nutrition and establishment of oral feeding play a fundamental role in stimulating bowel adaptation and promoting enteral autonomy. Other measures to promote enteral autonomy include the chyme recycling in patients where bowel is not in continuity, autologous gastrointestinal reconstruction and pharmacological treatments, including promising new therapies like teduglutide. Strategies such as lipid reduction, changing the type of lipid emulsion and cycling PN are associated with a reduction in the rates of intestinal failure–associated liver disease. Even though vast improvements have been made in the surgical and medical management of SBS, there is still lack of consensus in many aspects and collaboration is essential.

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