Bowel Perforation Caused by Peritoneal Shunt Catheters:Diagnosis and Treatment

2006 ◽  
Vol 58 (suppl_1) ◽  
pp. ONS-76-ONS-82 ◽  
Author(s):  
Matthieu Vinchon ◽  
Marc Baroncini ◽  
Thines Laurent ◽  
Dhellemmes Patrick
Keyword(s):  
Bowel Perforation ◽  
Multiorgan Failure ◽  
Correct Diagnosis ◽  
Previous History ◽  
Signs And Symptoms ◽  
Shunt Revision ◽  
Peritoneal Catheter ◽  
History Of ◽  
Shunt Removal ◽  
Spastic Tetraparesis

Abstract OBJECTIVE: The peritoneum is the preferred site for insertion of shunts used for the treatment of hydrocephalus. Bowel perforation by peritoneal catheters (BPPC) is a rare but devastating complication. Its pathophysiology, diagnosis, and treatment are debated. METHODS: Retrospective review of cases of BPPC in a series of 1956 patients having a peritoneal catheter followed up for a mean duration of 10.0 years. RESULTS: Nineteen observations of BPPC, representing 1.0% of the total series. Nine of 19 patients were nonambulatory, and nine of 19 had a previous history of meningeal infection. At the time of diagnosis, only three of the 19 patients had anal extrusion of the catheter, 14 had fever, nine had abdominal signs and symptoms, and six had cutaneous signs of infection. Radiological investigations were often negative or inconclusive. In seven of the patients, the initial diagnosis was shunt failure, and BPPC was diagnosed only during shunt revision. Once the correct diagnosis was made, the treatment was total shunt removal, external drainage, and antibiotic therapy for 2 weeks. Three patients, all severely impaired before BPPC, died, one of meningeal sepsis, the others of multiorgan failure related to spastic tetraparesis. Three were considered shunt-independent, two had a ventriculoatrial shunt, and the others had a new shunt with a peritoneal catheter without complication. CONCLUSION: BPPC is a neurosurgical emergency. Anal extrusion is present in only a minority of patients; the diagnosis of BPPC is often difficult, delayed, and its incidence is likely underestimated. The majority of patients can be treated with a new peritoneal shunt after cure of the infection.

scholarly journals Extraoral Sinus Tracts of Odontogenic Origin: A Case Series

2020 ◽  
Author(s):  
Ellahe Azizlou ◽  
Mohsen AminSobhani ◽  
Sholeh Ghabraei ◽  
Mehrfam Khoshkhounejad ◽  
Abdollah Ghorbanzadeh ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Case Series ◽  
Signs And Symptoms ◽  
Complete Recovery ◽  
Cutaneous Lesions ◽  
Odontogenic Origin ◽  
The Face ◽  
History Of ◽  
Relationship Of ◽  
Dental Infections

Extraoral sinus tracts of odontogenic origin often develop as the result of misdiagnosis of persistent dental infections due to trauma, caries, or periodontal disease. Due to these lesions' imitation from cutaneous lesions, misdiagnosis, and mismanagement, which we frequently encounter, this article aims to describe four cases with manifestations in different parts of the face and the neck. Patients were referred to an endodontist with a history of several surgical procedures and/or antibiotic therapy due to misdiagnosis. After comprehensive examinations, root canal treatment was performed. The resolution of signs and symptoms during the follow-up period confirmed the correct diagnosis. Dermatologists and other physicians should be aware of the possibility of the relationship of extraoral sinus tracts with dental infections. Precise examination and taking a comprehensive history can aid to prevent unnecessary and incorrect therapeutic and/or pharmaceutical interventions. Elimination of dental infection leads to complete recovery in such patients.

scholarly journals Eagle’s Syndrome: Transoral Styloidectomy a Technique Modification Case Report

2020 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Correct Diagnosis ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Styloid Process ◽  
Unknown Etiology ◽  
Eagle’S Syndrome ◽  
Anatomical Structures ◽  
History Of ◽  
Eagle Syndrome ◽  
Sixth Decade

Eagle’s Syndrome is a rare condition with unknown etiology that mainly affects female patients between the third and sixth decade of life. It was first described in 1937 by Dr. Watt W. Eagle, in a study carried out in a group of patients whose main symptom was cervicopharyngeal pain caused by elongation of the styloid process and/or calcification of the stylohyoid ligament [1]. The diagnosis of this pathology is based on the anamnesis and physical examination together with imaging exams of the patients. Cervicofacial pain, palpation of the styloid process in the tonsillar fossa and limitation in neck mobility are the most classic signs and symptoms of this disease [2]. Due to the nonspecific symptoms present in these patients, this disease is usually underdiagnosed and confused with temporomandibular disorders, cervical myalgias, and even being diagnosed as atypical trigeminal neuralgias [3]. For this reason, clinical examination and imaging exams, are indispensable for the correct diagnosis and evaluation of anatomical structures [3]. We present a case of a woman with a history of eagle syndrome which was diagnosed and treated at the Hospital clinico metropolitano El Carmen Santiago, Chile.

Pemetrexed and carboplatin plus bevacizumab for advanced non-squamous non-small cell lung cancer (NSCLC): Preliminary results

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7601-7601 ◽  
Author(s):  
J. D. Patel ◽  
T. A. Hensing ◽  
V. Villafor ◽  
E. Hart ◽  
P. Bonomi
Keyword(s):  
Bowel Perforation ◽  
Previous History ◽  
Median Number ◽  
Hematological Toxicity ◽  
Prior History ◽  
Toxicity Profile ◽  
Common Grade ◽  
History Of ◽  
Grade 3 ◽  
Number Of Cycles

7601 Background: Pemetrexed in combination with carboplatin has been shown to have promising activity and favorable toxicity profile in NSCLC. Bevacizumab has been shown to improve response rates and survival in pts with advanced non-squamous NSCLC when combined with carboplatin and paclitaxel. This study of pemetrexed and carboplatin plus bevacizumab was designed to evaluate the toxicity profile and to estimate the activity of the regimen in this pt population. Methods: Eligibility required that pts were chemotherapy-naive, had stage IIIB (effusion)/IV non-squamous NSCLC, PS 0–1, with no evidence of CNS metastases. Pts received pemetrexed 500 mg/m2 over 10 minutes, carboplatin AUC 6 over 30 minutes, and bevacizumab 15 mg/kg over 30–90 minutes on a 21-day cycle for 6 cycles. Pts with SD or PR received pemetrexed 500 mg/m2 and bevacizumab 15 mg/kg every 21 days until disease progression or toxicity. All pts received folic acid, vitamin B12 and steroid prophylaxis. Results: From 8/05 to 9/06, 39 pts (of planned 50) were enrolled: 20 M/19 F; median age 64 (range 41 - 80). One pt enrolled and subsequently refused treatment. Median number of cycles was 6 (range 1–22), and 25/38 (66%) completed at least 6 cycles of therapy. There was no grade 4 hematological toxicity. Grade 3 hematological toxicities were anemia (5%, N=2) and thrombocytopenia (3%, N=1). The most common grade 3/4 non-hematological toxicities included proteinuria (3%, N=1, gr 3), venous thrombosis (3%, N=1, gr 3), infection (3%, N=1, gr 4), and diverticulitis (11%: 8%, N=3, gr 3/3%, N=1, gr 4). 1 pt with diverticulitis experienced bowel perforation that required surgical intervention. The trial was temporally suspended and the group of pts with diverticulitis was analyzed separately. The only risk factor identified was previous history of diverticulitis. One CR, 20 PRs were observed for an overall response rate of 55% (95%, CI 43–75%). Conclusions: Treatment with pemetrexed and carboplatin plus bevacizumab in pts with advanced non-squamous NSCLC is feasible with an acceptable toxicity profile. The encouraging activity justifies further development of this regimen. However, pts with a prior history of diverticulitis should be excluded until this observation can be investigated further. No significant financial relationships to disclose.

Risk Factors for Isolated Pulmonary Embolism Are Opposite to Those for DVT-Associated PE: Results of the 7532-Patients Prospective OPTIMEV Cohort Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3977-3977
Author(s):  
Jean Luc Bosson ◽  
Marie Antoinette Sevestre ◽  
Jose Labarere ◽  
Joel Constans ◽  
Isabelle Quere ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Cohort Study ◽  
Diagnostic Tests ◽  
Previous History ◽  
Signs And Symptoms ◽  
Routine Practice ◽  
Early Presentation ◽  
Mortality And Morbidity ◽  
History Of

Abstract Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common clinical problem, associated with a significant mortality and morbidity. Hence, accurate diagnosis and appropriate treatment are essential for patients presenting with suspected VTE. Unfortunately, the diagnosis of VTE is challenging in routine practice because of the nonspecific signs and symptoms of this disease. A large number of epidemiologic studies have focused on VTE, contributing to better understanding of this disease and improving its management. Demonstrated risk factors for VTE have been included into clinical prediction rules derived to help physician identify patients that should be referred for objective diagnostic tests. Over the past decade, the extensive use of diagnostic tests combined with the recent advances in imaging technology have resulted in more frequent diagnosis and treatment of early presentation of VTE, including isolated distal DVT or isolated PE. However the clinical signification of various VTE presentations remains unclear, and knowledge on epidemiology of VTE needs to be improve. Therefore we prospectively investigated the relative frequency and risk factors of isolated distal DVT, proximal DVT, PE with DVT and without DVT. Between November 2004 and January 2006, all patients over 18 years old who were referred to 359 french board certified vascular physicians for a clinical suspicion of VTE were included. VTE presentations were categorized using validated clinical decision rules and objective tests including ultrasonography, lung scan and helical CT scan. Subjects without an objectively confirmed diagnosis of VTE were used as controls. We performed multivariate analysis of risk factors for each type of VTE. 8256 patients entered the study, among which 7532 were analysed. The median age for all patients was 65 years (49–77 years), 2923 (39%) were men, 2925 were inpatients (39%), and 1884 (25%) had a previous history of VTE. 933 had isolated distal DVT (12%), 710 proximal DVT (9.4%), 426 PE with DVT (5.7%), 148 PE without DVT (2.0%) and 5315 had no VTE (70.6%). Classically risk factors were comparable for all different types of DVT (distal, proximal, or associated with PE). Curiously, risk factors for isolated pulmonary embolism are opposite to those for DVT-associated PE. Specially isolated PE was not associated with age (> 75y, OR 1.2 [0.7–2.1, p 0.58), family history of VTE (OR 0.7 [0.4–1.3, p 0.26, bed confinement (OR 0.6[0.4–1.1, p 0.1),plaster (OR 0.3 [0.04–2.5, p 0.28), or acute respiratory or cardiac failure (OR 1.8 [0.9–3.3], p 0.07). Only personnal history of VTE (OR 1.7 [1.1–2.6], recent surgery (OR 1.7 [1.0–3.0], cancer [OR 1.7 [1.1–2.7, p 0.02) and contraceptive use (OR 6.3 [2.5–15.6] p< 0.01) were shwon as risk factors for isolated PE. So this multicenter prospective cohort study shows heterogeneity in the risk factor profile between different forms of VTE encountered in daily practice, providing new insight in the epidemiology of this disease. Specifically, our study underlines the specific risk factors profile of isolated PE comparing to DVT-associated PE.

scholarly journals Postoperative Bowel Perforation due to Heterotopic Ossification (Myositis Ossificans Traumatica): A Case Report and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Victoria Valinluck Lao ◽  
Oliver B. Lao ◽  
Edgar Figueredo
Keyword(s):  
Heterotopic Ossification ◽  
Surgical Planning ◽  
Myositis Ossificans ◽  
Bowel Perforation ◽  
Traumatic Injury ◽  
Previous History ◽  
Midline Incision ◽  
Abdominal Tumor ◽  
History Of ◽  
Accurate Reporting

Heterotopic ossification (HO) is the ectopic development of normal bone within soft tissue that can occur after traumatic injury. It is uncommon and may be missed or misdiagnosed, which can lead to complications. We report the case of an 84-year-old male with a previous history of a laparotomy who underwent resection of an intra-abdominal tumor through a midline incision. On postoperative day six, the patient was taken to the operating room, as succus was draining from the incision. Upon re-exploration, sharp bone-like material was found in the wound directly adjacent to an enterotomy. Pathology confirmed mature lamellar bone and the diagnosis of HO. This is the first report of postoperative intestinal perforation secondary to HO in a midline wound. We report this case to encourage accurate reporting of HO and its morbidity and complications for the benefit of appropriate surgical planning and epidemiologic tracking of outcomes.

scholarly journals Idiopathic Hypoparathyroidism: Still a Diagnostic Conundrum – A Tertiary Centre Experience

2020 ◽  
Vol 52 (10) ◽  
pp. 708-711
Author(s):  
Rujul Jain ◽  
S. K. Singh ◽  
N. K. Agrawal
Keyword(s):  
Antiepileptic Drugs ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Common Indication ◽  
Delay In Diagnosis ◽  
Tertiary Centre ◽  
History Of ◽  
Lag Period ◽  
Carpopedal Spasm

AbstractIdiopathic hypoparathyroidism leads to hypocalcemia and hyperphosphatasemia and usually has a genetic aetiology. The variable but often subtle signs and symptoms usually lead to a misdiagnosis of hypoparathyroidism. Case records of 32 patients of idiopathic hypoparathyroidism admitted over a period of five years were analysed. There was a lag period of 5.94 years from the onset of symptoms to the diagnosis. Carpopedal spasm was the most common indication for admission to the hospital. Trivial symptoms such as fatigue (84%) and paresthesia (62.5%) were the most common reported symptoms. A sum of 46.5% of the patients were on antiepileptic drugs before the correct diagnosis of hypoparathyroidism was made. This observation emphasized that Calcium profile should be obtained in patients with history of paresthesia and seizure to avoid the long delay in diagnosis of hypoparathyroidism.

scholarly journals Constrictive Pericarditis: A Challenging Diagnosis in Paediatrics

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Mariana Faustino ◽  
Inês Carmo Mendes ◽  
Rui Anjos
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Constrictive Pericarditis ◽  
Correct Diagnosis ◽  
Previous History ◽  
Right Heart Failure ◽  
Right Heart ◽  
Noninvasive Cardiac Imaging ◽  
Uncommon Disease ◽  
History Of

Constrictive pericarditis is an uncommon disease in children, usually difficult to diagnose. We present the case of a 14-year-old boy with a previous history of tuberculosis and right heart failure, in whom constrictive pericarditis was diagnosed. The case highlights the need to integrate all information, including clinical data, noninvasive cardiac imaging, and even invasive hemodynamic evaluation when required, in order to establish the correct diagnosis and proceed to surgical treatment.

Psychiatric Manifestations of Frontal Lobe Tumours

1989 ◽  
Vol 155 (6) ◽  
pp. 735-738 ◽  
Author(s):  
M. A. Ron
Keyword(s):  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Correct Diagnosis ◽  
Previous History ◽  
Memory Loss ◽  
Psychiatric Disease ◽  
Surgical Removal ◽  
History Of ◽  
Psychiatric Manifestations ◽  
Made In

In a recent article in the British Medical Journal Maurice-Williams & Dunwoody (1988) reported two patients with frontal meningiomas who presented initially to psychiatrists. The correct diagnosis was made in one of them after prolonged, perhaps unnecessary, psychiatric treatment. In the other the diagnosis was made at autopsy. In this case psychiatrists were only briefly involved and neurosurgical referral had been made promptly. The authors, who treat these reports as a cautionary tale, conclude by warning psychiatrists to pay special attention to a number of features in the history and examination of psychiatric patients. In particular we are told that suspicion should arise in the presence of gradual non-remitting symptoms such as irritability, memory loss, self-neglect, dysphasia or incontinence in patients without a previous history of psychiatric disease or clear precipitating factors. They also suggest that we pay attention to the views of relatives when they feel the patient suffers from a physical rather than a psychiatric illness, and emphasise that early diagnosis leads to easier surgical removal and better outcome.

scholarly journals Multiloculated peritoneal inclusion cyst: a case report

2020 ◽  
Vol 8 (1) ◽  
pp. 388
Author(s):  
Sunita Prakash Jain ◽  
Arun C. M. ◽  
Doreswamy K. ◽  
Amasa Vishwanath Reddy
Keyword(s):  
Histopathological Examination ◽  
Previous History ◽  
Pelvic Mass ◽  
Signs And Symptoms ◽  
Emergency Laparotomy ◽  
Inclusion Cyst ◽  
Peritoneal Inclusion Cyst ◽  
Healthy Female ◽  
Perimenopausal Women ◽  
History Of

Multiloculated peritoneal inclusion cysts (MPIC) are uncommon abdominopelvic cysts seen in perimenopausal women. We describe a perimenopausal woman presenting with pelvic mass. This patient presented to us with all signs and symptoms involving abdomen and the pelvis. On emergency laparotomy, it was seen that multioculated cyst occupied the whole of abdomen arising from the peritoneum. The condition was successfully treated with surgery. Histopathological examination (HPE) report proved it to be multi loculated peritoneal inclusion cyst. This case is presented for its rarity in itself, presenting as intestinal obstruction, in a healthy female, that too without previous history of any surgery.

Use of lumboperitoneal shunts with the Strata NSC valve: a single-center experience

2010 ◽  
Vol 113 (6) ◽  
pp. 1304-1308 ◽  
Author(s):  
Ahmed K. Toma ◽  
Muhammad Dherijha ◽  
Neil D. Kitchen ◽  
Laurence D. Watkins
Keyword(s):  
Signs And Symptoms ◽  
Pseudotumor Cerebri ◽  
Shunt Revision ◽  
Peritoneal Catheter ◽  
Shunt System ◽  
Shunt Insertion ◽  
Single Center Experience ◽  
Distal Obstruction ◽  
Clinical Records ◽  
Visual Complaints

Object The lumboperitoneal (LP) shunt with the adjustable PS Medical Strata NSC LP valve and small lumen peritoneal catheter was introduced in the authors' unit in 2007. The object of this study was to audit the unit's experience with this new shunt system. Methods The authors performed a retrospective review of the clinical records of patients who underwent Strata NSC LP shunt insertion. Demographic and clinical data as well as information about complications and revisions were reported. Results Between August 2007 and November 2009, 20 patients underwent placement of an LP shunt with an adjustable Strata NSC valve and small lumen peritoneal catheter at the authors' institution. Their mean age was 40.3 years and the mean duration of follow-up was 12 months. Preoperatively, 18 patients had headache and 15 patients had visual signs and symptoms. Fourteen of the 18 patients with preoperative headache did not complain of headache postoperatively, and 4 had headache that was found not to be related to shunt function. Two of the patients with preoperative visual complaints had ongoing visual problems postoperatively. None of the patients had infection or subdural hematoma. The only overdrainage symptoms occurred in association with spontaneous readjustment of the valve and resolved when the valve was reset. Thirteen patients (65%) did not require shunt revision. Seven patients (35%) required 13 shunt exploration or revision procedures, mainly due to distal obstruction. Placement of an LP shunt failed to completely resolve the raised intracranial pressure problem in 2 patients. Conclusions The use of the Strata NSC valve and small lumen peritoneal catheter is effective in treating pseudotumor cerebri and is beneficial in terms of markedly reducing overdrainage complications compared with other reported series of cases in which an LP shunt has been placed. However, the use of the Strata NSC valve and small lumen peritoneal catheter did not have a marked impact on other causes of shunt failure, particularly distal obstruction.

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