scholarly journals Spontaneous gastric perforation: is it really common?

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Imran Hashim ◽  
Nabila Talat ◽  
Asif Iqbal ◽  
Muhammad Saleem Choudhary ◽  
Naveed Haider ◽  
...  
Keyword(s):  
Gastric Perforation ◽  
Early Recognition ◽  
Exploratory Laparotomy ◽  
Burst Abdomen ◽  
Feeding Jejunostomy ◽  
Neonatal Gastric Perforation ◽  
Threatening Condition ◽  
Life Threatening ◽  
Greater Curvature ◽  
Lesser Curvature

Abstract Background Neonatal gastric perforation (NGP) is a rare, serious, and life-threatening condition which needs early recognition with prompt intervention for better prognosis. Its etiology is not yet well established, but multiple speculations have been put forth for its etiopathogenesis. Few most considered are traumatic, spontaneous, or secondary to inflammatory process like necrotizing enterocolitis. This study describes the etiological and prognostic factors for patients with NGP in our experience at a single center. Results A total of 46 neonates were included. Male gender predominated with M:F being 1.7:1. Most (n=36) neonates presented within 10 days of life whereas 8 neonates presented within 15 days. At presentation, gas under diaphragm was the most common radiologic finding in 25 (54.3%) neonates. On exploratory laparotomy, it was found that greater curvature was involved in maximum number of cases (n=27), followed by lesser curvature and anterior and posterior walls of the stomach. Most of perforations were within 1–5 cm in size. Gastrorrhaphy was done in all cases, and in two cases, feeding jejunostomy was done along with repair for feeding purpose. Finally, spontaneous NGP was diagnosed in 30 (60.8%), and NEC patches on other parts of the intestine were seen in 11 patients. Postoperatively, 28 neonates developed complications in the form of sepsis (n=13), wound infection (n=10), and burst abdomen (n=5). Regarding clinical outcome, 27 (58.7%) were discharged from the hospital whereas 19 (39.3%) patients died. Conclusion Our results show that spontaneous NGP is most commonly associated with NEC in our population, usually affecting the greater curvature. We observed a high mortality rate; however, good ICU care may improve the survival.

Alcohol Related Non-traumatic Rhabdomyolysis and Compartment Syndrome

2007 ◽  
Vol 6 (1) ◽  
pp. 33-34
Author(s):  
JPL Ong ◽  
◽  
LA Thomas ◽  
Keyword(s):  
Skeletal Muscle ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Lower Extremity ◽  
Compartment Syndrome ◽  
Early Recognition ◽  
Clinical Entity ◽  
Threatening Condition ◽  
Life Threatening ◽  
Renal Support

Rhabdomyolysis is a serious and life-threatening condition in which skeletal muscle is damaged, commonly resulting in acute renal failure. The causes of this clinical entity can be traumatic and non-traumatic. In the latter group, alcohol is the commonest cause. This report describes the case of a 25 year old man who presented with rhabdomyolysis leading to acute renal failure after an alcohol binge. He presented with painful legs and lower extremity compartment syndrome. The patient recovered with surgical fasciotomy and renal support. This case illustrates the importance of early recognition and treatment of alcohol related non-traumatic rhabdomyolysis and compartment syndrome.

Assessment and care of the patient with sepsis

2020 ◽  
pp. 225-257
Author(s):  
Kevin Barrett
Keyword(s):  
Septic Shock ◽  
Early Recognition ◽  
Scoring Systems ◽  
Cardiovascular Responses ◽  
Physiological Changes ◽  
Assessment Framework ◽  
Threatening Condition ◽  
Life Threatening ◽  
Support Mechanisms ◽  
Sepsis And Septic Shock

There has been considerable recent focus on sepsis in both the clinical arena and within the general public to raise awareness of the importance of early recognition of this potentially life-threatening condition. The early recognition of sepsis by ward nurses can both reduce progression of this lethal disease and improve survival for patients in hospital. This chapter focuses on definitions of sepsis and septic shock, physiological changes associated with inflammatory and cardiovascular responses to sepsis, and a clinical assessment framework to guide practice. There is also a discussion of the use of scoring systems and how to escalate support mechanisms for patients with sepsis and septic shock.

scholarly journals Thoracic aortic aneurysm causing aorto-esophageal fistula—our experience with a rare disease

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Aakriti Yadav ◽  
Uttam Krishna Shrestha ◽  
Kajan Raj Shrestha ◽  
Dinesh Gurung
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Sudden Onset ◽  
Massive Hemoptysis ◽  
Esophageal Fistula ◽  
Feeding Jejunostomy ◽  
Intravenous Antibiotics ◽  
Threatening Condition ◽  
Life Threatening ◽  
Upper Gastrointestinal

Abstract Aorto-esophageal fistula is a life-threatening condition, accounting for a small number of cases of upper gastrointestinal bleeding where patients present with one or more features of Chiari’s triad. We present the case of a 43-year-old woman, referred to us with symptoms of central chest pain, sudden onset dysphagia followed by massive hemoptysis. She was diagnosed with an aorto-esophageal fistula due to a ruptured thoracic aortic aneurysm and rushed for an emergency endovascular thoracic aortic stent and feeding jejunostomy with intravenous antibiotics and supportive care. After 6 weeks of surgery, the patient was re-evaluated to plan for an esophageal stent if required. The purpose of this presentation is to make the surgical fraternity aware of the gravity of this disease and novel techniques to manage it.

scholarly journals Acute Aortic Dissection Mimicking STEMI in the Catheterization Laboratory: Early Recognition Is Mandatory

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Alessio Arrivi ◽  
Gaetano Tanzilli ◽  
Paolo Emilio Puddu ◽  
Giovanni Truscelli ◽  
Marcello Dominici ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Early Recognition ◽  
Type A ◽  
Type A Aortic Dissection ◽  
Catheterization Laboratory ◽  
Arterial Complication ◽  
Threatening Condition ◽  
Life Threatening ◽  
Previously Treated ◽  
Pathophysiologic Mechanisms

Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery.

scholarly journals Maternal and foetal outcome of eclampsia in a referral hospital

2017 ◽  
Vol 6 (3) ◽  
pp. 1021
Author(s):  
Mousumi Das Ghosh ◽  
Vinita Singh ◽  
Alokananda Ray
Keyword(s):  
Antenatal Care ◽  
Early Recognition ◽  
Mode Of Delivery ◽  
Ventilatory Support ◽  
Adequate Treatment ◽  
Mortality And Morbidity ◽  
Foetal Mortality ◽  
Threatening Condition ◽  
Life Threatening ◽  
Foetal Outcome

Background: Eclampsia is a life-threatening condition, common in developing countries with high fatality rate. It is a cause of maternal and foetal mortality and morbidity. The aim of the study is to determine the maternal and foetal outcome in Tata Main Hospital, Jamshedpur, Jharkhand, India.Methods: All cases of eclampsia were analysed from January 2012 to December 2014 from admission to discharge or death of the patient.  Age, parity, antenatal care, interval between attack and admission, blood pressure on admission, gestational age and mode of delivery were  taken into account. There were 135 cases of eclampsia out of 14572 deliveries. Only singleton pregnancies were analysed.Results: The incidence of antepartum eclampsia was 84.4%, intrapartum 3% and postpartum 12.5 %. 83% patients were primigravida, 33% less than 20 yrs,42% had no antenatal checkup and 45% had < 4 visits. Only 15% patients received magnesium sulphate before referral to the hospital. There were four maternal deaths and twenty-one perinatal deaths. Eleven patients needed ventilatory support, four developed pulmonary oedema,  two patients had respiratory depression and three patients had renal failure.Conclusions: Hypertensive disease in pregnancy requires proper antenatal care, early recognition and referral, adequate treatment and timely delivery.

Atraumatic splenic rupture in chronic pancreatitis with successful embolization

2020 ◽  
Vol 21 (2) ◽  
pp. 58-68
Author(s):  
Anooja Abdul Salam ◽  
Ben Pearch ◽  
Lisa Sorger
Keyword(s):  
Chronic Pancreatitis ◽  
Splenic Artery ◽  
Splenic Rupture ◽  
Early Recognition ◽  
Hypovolemic Shock ◽  
Artery Embolization ◽  
Splenic Artery Embolization ◽  
Threatening Condition ◽  
Life Threatening ◽  
Atraumatic Splenic Rupture

Atraumatic splenic rupture is uncommon but it is a life threatening condition because of hypovolemic shock. Early recognition and treatment are the keys to asuccessful outcome. We report a case of atraumatic splenic rupture secondary to chronic pancreatitis treated successfully by splenic artery embolization.

scholarly journals Colonic Volvulus in Children: Surgical Management of a Challenging Condition

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 982
Author(s):  
Francesca Destro ◽  
Luciano Maestri ◽  
Milena Meroni ◽  
Alessandro Campari ◽  
Federica Pederiva ◽  
...  
Keyword(s):  
Early Recognition ◽  
Significant Risk ◽  
Intestinal Resection ◽  
Significant Risk Factor ◽  
Colonic Volvulus ◽  
Presenting Symptoms ◽  
Threatening Condition ◽  
Life Threatening ◽  
Intestinal Pseudo Obstruction

Colonic volvulus (CV) is a rare but potentially life-threatening condition with unclear etiopathogenesis. To date, less than 80 pediatric cases have been described. Hirschsprung’s disease (HD) is associated with CV in 17% of cases, representing a significant risk factor. Non-HD CV is an even more complex entity. The aim of this study is to describe a series of patients with CV to accentuate some peculiar aspects of this disease. We performed a retrospective study (period: 2012–2021) collecting information of patients with CV. Data analyzed included: demographics, medical history, presenting symptoms and radiological and surgical details. Eleven patients (12.5 ± 2.8 years; 7F/4M) had CV (eight sigmoid, two transverse colon, one total colon). Five patients had associated anomalies and three had HD. A two-step approach with volvulus endoscopic/radiological detorsion followed by intestinal resection was attempted in eight cases (one endoscopic approach failed). Three patients required surgery at admission. At follow-up, two patients developed recurrent intestinal obstruction, one of whom also had anastomotic stenosis. Colonic volvulus is a challenging condition that requires prompt patient care. A missed diagnosis could lead to severe complications. The evaluation of the patient should include a careful histological examination (searching for HD and alpha-actin deficiency), immunologic and metabolic screening, neurological tests and detection of chronic intestinal pseudo-obstruction (CIPO). Lifelong follow-up is mandatory for the early recognition and treatment of progressive diseases involving the proximal gastrointestinal tract.

scholarly journals Atraumatic splenic rupture in chronic pancreatitis with successful embolization

2020 ◽  
pp. 58-68
Author(s):  
Anooja Abdul Salam ◽  
Ben Pearch ◽  
Lisa Sorger
Keyword(s):  
Chronic Pancreatitis ◽  
Splenic Artery ◽  
Splenic Rupture ◽  
Early Recognition ◽  
Hypovolemic Shock ◽  
Artery Embolization ◽  
Splenic Artery Embolization ◽  
Threatening Condition ◽  
Life Threatening ◽  
Atraumatic Splenic Rupture

Atraumatic splenic rupture is uncommon but it is a life threatening condition because of hypovolemic shock. Early recognition and treatment are the keys to asuccessful outcome. We report a case of atraumatic splenic rupture secondary to chronic pancreatitis treated successfully by splenic artery embolization.

scholarly journals Neonatal Gastric Perforation: Smallest Baby Ever Operated and Survived: A Case Report

2018 ◽  
Vol 7 (2) ◽  
pp. 24
Author(s):  
Nikhilesh Nain ◽  
Sunil Janged
Keyword(s):  
Gastric Perforation ◽  
Partial Gastrectomy ◽  
Abdominal Distension ◽  
Operative Management ◽  
Invasive Ventilation ◽  
X Ray ◽  
Neonatal Gastric Perforation ◽  
Gastric Decompression ◽  
Greater Curvature ◽  
Prompt Diagnosis

Neonatal gastric perforation is a rare surgical emergency with no certain etiology. Due to its high mortality prompt diagnosis and emergency exploration surgery is mandatory. Hereby, we report a case of neonatal gastric perforation in a 4-day-old extreme low birth weight baby (645 g) born at 29 weeks who presented with complaints of abdominal distension, lethargy, and respiratory distress. X-ray abdomen revealed free gas under the diaphragm. Emergency surgery was performed. On exploration, a tear was seen along the greater curvature of the stomach with necrotic walls. Partial gastrectomy was done and perforation closed. Postoperatively baby was managed with invasive ventilation, IV antibiotics, parenteral nutrition, and continuous gastric decompression by nasogastric tube. Baby survived with intensive post-operative management and was discharged after 90 days of NICU stay. As far as literature is concerned this is the case of a smallest baby ever operated and survived after neonatal gastric perforation.

scholarly journals SAT-492 Impending Thyroid Storm Induced by Checkpoint Inhibitors

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ya Zhou ◽  
Kathryn Jobbins ◽  
Raju Panta
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Disease ◽  
Checkpoint Inhibitors ◽  
Early Recognition ◽  
Nodular Goiter ◽  
Thyroid Storm ◽  
Prior History ◽  
Free T4 ◽  
Threatening Condition ◽  
Life Threatening

Abstract Introduction: Thyroid storm is a rare but life threatening condition due to thyroid hormone excess and is usually caused by Graves disease, toxic nodular goiter or rarely due to thyroiditis. Immune checkpoint inhibitors (ICI) are a novel choice for treating cancers, and carry a risk for development of endocrinopathies. We report a case of impending thyroid storm 5 weeks after initiation of ICI. Case Presentation: 81-year-old Caucasian male with metastatic renal cell carcinoma presented with generalized weakness and fatigue 5 weeks after ipilimumab and nivolumab were started. He had no prior history of thyroid disease and had normal thyroid functions before the treatment. He complained of palpitations, heat intolerance and loose stools on admission. On examination he was disoriented, tachycardic (128bpm) with new onset atrial fibrillation, had moist skin and brisk reflexes. He had non-tender thyroid, no thyromegaly, and no nodules palpated. Burch-Wartofsky score was 35, suggesting impending thyroid storm. Laboratory investigation showed elevated free T4 (&gt;7.77), elevated free T3 (8.6) with a suppressed TSH (&lt; 0.02). He had positive anti-TPO but Thyrotropin receptor antibody was negative. He was treated with propranolol 40 mg three times daily, prednisone 40 daily, methimazole 30mg three times a day with significant improvement in free T4 (5.67) within first 48 hours. Discussion: Imipimumab and nivolumab are monoclonal antibodies against cytotoxic T-lymphocyte associated protein 4 (CTLA-4) and programmed death receptor-1 (PD-1) respectively. The reported incidence of thyroid dysfunction after combined imipimumab and nivolumab therapy can be as high as 22%1. Thyroiditis could present as early as 2-6 weeks 2 after treatment, and hypothyroidism tends to present between 5 months and 3 years3. According to a current consensus4, baseline TSH and FT4 should be drawn prior to initiating ICI. Thyroid storm is a clinical diagnosis and Burch-Wartofsky score can help in diagnosis. A high degree of suspicion and prompt diagnosis of thyroid storm and treatment is of utmost importance especially in this patient population. Rapid improvements in thyroid hormone levels suggest thyroiditis as a potential cause for thyrotoxicosis. Conclusion: ICI induced thyroid disease is not an uncommon condition. It could present as either thyrotoxicosis or hypothyroidism. Both patient and clinician should be aware of potential signs and symptoms of thyroid storm for early recognition and timely treatment of this life-threatening condition. [1] Byun DJ et al.Nat Rev Endocrinol. 2017 Apr;13(4):195-207 [2] Iyer PC et al. Thyroid. 2018 Oct;28(10):1243-1251 [3] Endocr Relat Cancer. 2014 Mar 7;21(2):371-81 [4] Puzanov et al. Journal for ImmunoTherapy of Cancer (2017) 5:95

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