scholarly journals Endoscopic stent insertion for anastomotic leakage following oesophagectomy

2013 ◽  
Vol 95 (1) ◽  
pp. 43-47 ◽  
Author(s):  
M Schweigert ◽  
N Solymosi ◽  
A Dubecz ◽  
RJ Stadlhuber ◽  
H Muschweck ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Stent Implantation ◽  
Fatal Outcome ◽  
Invasive Procedure ◽  
High Volume ◽  
Primary Treatment ◽  
Stent Insertion ◽  
Endoscopic Stent ◽  
Life Threatening ◽  
Life Threatening Complication

Introduction Intrathoracic anastomotic leakage following oesophagectomy is a crushing condition. Until recently, surgical re-exploration was the preferred way of dealing with this life threatening complication. However, mortality remained significant. We therefore adopted endoscopic stent implantation as the primary treatment option. The aim of this study was to investigate the feasibility and results of endoscopic stent implantation as well as potential hazards and pitfalls. Methods Between January 2004 and December 2011, 292 consecutive patients who underwent an oesophagectomy at a single high volume centre dedicated to oesophageal surgery were included in this retrospective study. Overall, 38 cases with anastomotic leakage were identified and analysed. Results A total of 22 patients received endoscopic stent implantation as primary treatment whereas a rethoracotomy was mandatory in 15 cases. There were no significant differences in age, frequency of neoadjuvant therapy or ASA grade between cases with and without a leak. However, patients with a leak were five times more likely to have a fatal outcome (odds ratio: 5.10, 95% confidence interval: 2.06–12.33, p<0.001). Stent migration occurred but endoscopic reintervention was feasible. In 17 patients (77%) definite closure and healing of the leak was achieved, and the stent was removed subsequently. Two patients died owing to severe sepsis despite sufficient stent placement. Moreover, stent related aortic erosion with consecutive fatal haemorrhage occurred in three cases. Conclusions Stent implantation for intrathoracic oesophageal anastomotic leaks is feasible and compares favourably with surgical re-exploration. It is an easily available, minimally invasive procedure that may reduce leak related mortality. However, it puts the already well-known risk of stent-related vascular erosion on the spot. Awareness of this life threatening complication is therefore mandatory.

scholarly journals Idiopathic Thrombocytopenic Purpura with Intracranial Haemorrhage and Menorrhagia

2017 ◽  
Vol 35 (2) ◽  
pp. 97-99
Author(s):  
Suchanda Das ◽  
Bidhan Roy Chowdhury ◽  
Rokeya Begum
Keyword(s):  
Idiopathic Thrombocytopenic Purpura ◽  
Intracranial Hemorrhage ◽  
Clinical Importance ◽  
Invasive Procedure ◽  
Limited Effect ◽  
Thrombocytopenic Purpura ◽  
Aggressive Management ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
The Individual

A rare and life threatening complication of idiopathic thrombocytopenic purpura is intracranial hemorrhage ( ICH) and is the leading reported cause of death. The other important manifestation of ITP is menorrhagia. There are a variety of different causes of menorrhagia and gynecological evaluation is essential to tailor management to the individual patient to prevent unnecessary invasive procedure which may have limited effect. A 25 years old female para-2+0 presented with menorrhagia,severe excruciating headache,easy bruising, ecchymosis and petechialhemorrhage. After all investigation clinical evaluation it was diagnosed as a case of ITP with intracranial hemorrhage and menorrhagia. An intracranial hemorrhage is the most dreaded complication of ITP it is essential toprecede an early diagnosis, prompt and aggressive management and optimizing the management of acute menorrhagia remains of clinical importance due to life threatening nature of the condition.J Bangladesh Coll Phys Surg 2017; 35(2): 97-99

scholarly journals Neuroendoscopic lavage and continuous drainage of ventricles: Treatment of pyocephalus in a newborn

2019 ◽  
Vol 1 (1) ◽  
pp. 55-59
Author(s):  
Ram Babu Joshi ◽  
Rupendra Bahadur Adhikari ◽  
Amit Thapa
Keyword(s):  
Clinical Cure ◽  
Obstructive Hydrocephalus ◽  
Primary Treatment ◽  
Direct Visualization ◽  
Pyogenic Meningitis ◽  
Continuous Drainage ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Ventriculo Peritoneal Shunt

Pyocephalus/Cerebral ventricular empyema is a serious life threatening complication of acute pyogenic meningitis. The primary treatment of ventriculitis is administration of antibiotics. With recent advances, neuroendoscopic lavage (NEL) of ventricles through direct visualization has helped save lives when multipronged approaches including intravenous (IV) antibiotics, intrathecal antibiotics and continuous drainage of cerebrospinal fluid (CSF) fails. We report a case of a 23-day old neonate who developed pyocephalus as a complication of pyogenic meningitis. He did not respond favorably to initial IV antibiotic treatment for two weeks. NEL of ventricles was performed. Thick pus/flakes inside the ventricles had caused obstructive hydrocephalus. Continuous CSF drainage was done through strategically placed multiple external ventricular drains. Interval ventriculo-peritoneal shunt was done bilaterally after the CSF was macroscopically/ microscopically clear of visible debris, and sterile. Microbiological and clinical cure was achieved and the child survived and is thriving well at last follow-up at the age of 6 months.

scholarly journals Management of anastomotic leakage-induced tracheobronchial fistula following oesophagectomy: the role of endoscopic stent insertion†

2012 ◽  
Vol 41 (5) ◽  
pp. e74-e80 ◽  
Author(s):  
Michael Schweigert ◽  
Attila Dubecz ◽  
Martin Beron ◽  
Herbert Muschweck ◽  
Hubert J. Stein
Keyword(s):  
Anastomotic Leakage ◽  
Stent Insertion ◽  
Endoscopic Stent

Post-operative mediastinitis, pleuritis and pericarditis due to Mycoplasma hominis and Ureaplasma urealyticum with a fatal outcome

2008 ◽  
Vol 57 (5) ◽  
pp. 656-657 ◽  
Author(s):  
Celia García-de-la-Fuente ◽  
Eduardo Miñambres ◽  
Estibaliz Ugalde ◽  
Ana Sáez ◽  
Luis Martinez-Martinez ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pericardial Effusion ◽  
Unusual Case ◽  
Ureaplasma Urealyticum ◽  
Fatal Outcome ◽  
Clinical Manifestations ◽  
Mycoplasma Hominis ◽  
Response To Therapy ◽  
Life Threatening ◽  
Life Threatening Complication

Post-sternotomy mediastinitis, although infrequent, is a potentially life-threatening complication of cardiac surgery. We report an unusual case of Mycoplasma hominis and Ureaplasma urealyticum post-surgical mediastinitis with persistent pleural and pericardial effusion. Clinical manifestations and response to therapy are described, and the difficulties of establishing the diagnosis are discussed.

One Decade of Experience with Endoscopic Stenting for Intrathoracic Anastomotic Leakage after Esophagectomy: Brilliant Breakthrough or Flash in the Pan?

2014 ◽  
Vol 80 (8) ◽  
pp. 736-745 ◽  
Author(s):  
Michael Schweigert ◽  
Norbert Solymosi ◽  
Attila Dubecz ◽  
Maria Posada GonzáLez ◽  
Hubert J. Stein ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Neoadjuvant Therapy ◽  
Anastomotic Leakage ◽  
Fatal Outcome ◽  
Pleural Empyema ◽  
Stent Insertion ◽  
Endoscopic Stenting ◽  
Asa Score ◽  
Significant Difference

Management of intrathoracic anastomotic leakage after esophagectomy by means of endoscopic stent insertion has gained wide acceptance as an alternative to surgical reintervention. Between January 2004 and March 2013 all patients who underwent esophagectomy at a German high-volume center for esophageal surgery were included in this retrospective study. The study comprises 356 patients. Anastomotic leakage occurred in 49 cases. There were no significant differences in age, American Society of Anesthesiologists (ASA) score, or frequency of neoadjuvant therapy between cases with and without leak. However, leak patients sustained significantly more often postoperative pneumonia, pleural empyema, sepsis, and acute renal failure. Moreover, leak victims had higher odds for fatal outcome (16 of 49 vs 33 of 307; odds ratio, 5.94; 95% confidence interval, 2.65 to 13.15; P < 0.0001). The leakage was amendable by endoscopic stenting in 29 cases, whereas rethoracotomy was mandatory in 20 patients. Between stent and rethoracotomy cases, we observed no significant differences in age, ASA score, neoadjuvant therapy, occurrence of pneumonia, pleural empyema, or tracheostomy rate. Rethoracotomy patients sustained more often sepsis (16 of 20 vs 14 of 29; P = 0.04) and acute renal failure (nine of 20 vs four of 29; P = 0.02) as expression of more severe septic disease. Nevertheless, there was no significant difference in mortality (seven of 29 vs nine of 20; P = 0.21). Furthermore, we observed three cases of stent-related aortic erosion with peracute death from exsanguination. Despite being the preferred treatment option, endoscopic stenting was only feasible in approximately 60 per cent of all intrathoracic leaks. The results are marred by the occurrence of deadly vascular erosion. Therefore, individualized strategies should be preferred to a general recommendation for endoscopic stenting.

Endoscopic Stent Insertion versus Primary Operative Management for Spontaneous Rupture of the Esophagus (Boerhaave Syndrome): An International Study Comparing the Outcome

2013 ◽  
Vol 79 (6) ◽  
pp. 634-640 ◽  
Author(s):  
Michael Schweigert ◽  
Rory Beattie ◽  
Norbert Solymosi ◽  
Karen Booth ◽  
Attila Dubecz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Spontaneous Rupture ◽  
Fatal Outcome ◽  
Stent Insertion ◽  
Endoscopic Stenting ◽  
Stent Group ◽  
Endoscopic Stent ◽  
Boerhaave Syndrome

Spontaneous rupture of the esophagus (Boerhaave syndrome) is an extremely rare, life-threatening condition. Traditionally surgery was the treatment of choice. Endoscopic stent insertion offers a promising alternative. The aim of this study was to compare the results of primary surgical therapy with endoscopic stenting. A British and a German high-volume center for esophageal surgery participated in this retrospective study. At the British center, operative therapy (primary repair or surgical drainage) was routinely carried out. Endoscopic stent insertion was the primary treatment option at the German center. Only patients with nonmalignant, spontaneous rupture of the esophagus (Boerhaave syndrome) were included. Demographic characteristics, comorbidity, clinical course, and outcome were analyzed. The study comprises 38 patients with a median age of 60 years. Time between rupture and treatment was less than 24 hours in 22 patients. Overall mortality was four of 38. Diagnosis greater than 24 hours was associated with higher risk for fatal outcome (odds ratio [OR], 4.64; 95% confidence interval [CI], 0.33 to 265.79). The surgery (S) and the endoscopic stent group (E) included 20 and 13 cases, respectively. Esophagectomy was unavoidable in three cases and two were managed conservatively. There were no significant differences in age, time to diagnosis less than 24 hours, intensive care unit days, hospital stay, sepsis, renal failure, slow respiratory weaning, or presence of comorbidity between the two groups. In 11 of 13 in the stent group, operative intervention (video-assisted thoracic surgery, thoracotomy, mediastinotomy) was eventually mandatory and three of 13 even required repeated surgery. The rate of reoperation in the surgery group was six of 20. Mortality was two of 13 (E) versus one of 20 (S). The odds for fatal outcome were 3.3 times higher in the stent group than in the surgery group (OR, 3.32; 95% CI, 0.15 to 213.98). Management of Boerhaave syndrome by means of endoscopic stent insertion offers no advantage regarding morbidity, intensive care unit or hospital stay, and is associated with frequent treatment failure eventually requiring surgical intervention. Furthermore, endoscopic stenting shows a higher risk for fatal outcome than primary surgical therapy.

scholarly journals Evaluating the Efficacy of Primary Treatment for Graves’ Disease Complicated by Thyrotoxic Periodic Paralysis

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Rita Yuk-Kwan Chang ◽  
Brian Hung-Hin Lang ◽  
Ai Chen Chan ◽  
Kai Pun Wong
Keyword(s):  
Radioactive Iodine ◽  
Primary Treatment ◽  
Periodic Paralysis ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Thyrotoxic Periodic Paralysis ◽  
Term Efficacy ◽  
Life Threatening ◽  
Life Threatening Complication

Objective. Thyrotoxic periodic paralysis (TPP) is a potentially life-threatening complication of Graves’ disease (GD). The present study compared the long-term efficacy of antithyroid drugs (ATD), radioactive iodine (RAI), and surgery in GD/TPP.Methods. Sixteen patients with GD/TPP were followed over a 14-year period. ATD was generally prescribed upfront for 12–18 months before RAI or surgery was considered. Outcomes such as thyrotoxic or TPP relapses were compared between the three modalities.Results. Eight (50.0%) patients had ATD alone, 4 (25.0%) had RAI, and 4 (25.0%) had surgery as primary treatment. Despite being able to withdraw ATD in all 8 patients for 37.5 (22–247) months, all subsequently developed thyrotoxic relapses and 4 (50.0%) had ≥1 TPP relapses. Of the four patients who had RAI, two (50%) developed thyrotoxic relapse after 12 and 29 months, respectively, and two (50.0%) became hypothyroid. The median required RAI dose to render hypothyroidism was 550 (350–700) MBq. Of the 4 patients who underwent surgery, none developed relapses but all became hypothyroid.Conclusion. To minimize future relapses, more definitive primary treatment such as RAI or surgery is preferred over ATD alone. If RAI is chosen over surgery, a higher dose (>550 MBq) is recommended.

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

Stapled Surgery for Hemorrhoidal Prolapse: From the Beginning to the Modern Times

2020 ◽  
Vol 15 ◽  
Author(s):  
Alessandro Sturiale ◽  
Bernardina Fabiani ◽  
Claudia Menconi ◽  
Danilo Cafaro ◽  
Felipe Celedon Porzio ◽  
...  
Keyword(s):  
Postoperative Bleeding ◽  
Invasive Procedure ◽  
High Volume ◽  
Normal Mucosa ◽  
Stapled Hemorrhoidopexy ◽  
Wound Complications ◽  
Rectal Intussusception ◽  
Stapler Technique ◽  
History Of ◽  
Hemorrhoidal Prolapse

Introduction: Hemorrhoidal disease is the most common proctologic condition in adults. Among the different surgical procedures, one of the greatest innovations is represented by the stapled hemorrhoidopexy. The history of this technique started with a single stapler use passing thorough a double stapler technique to resect the adequate amount of prolapse, finally arriving to the use of high volume devices. Methods: Nevertheless each device has its own specific feature, the stapler is basically made up with one or more circular lines of titanium staples whose height may be variable. The procedure is based on different steps: Introduction of the CAD, evaluation of the prolapse, fashioning purse string or parachute suture, introduction of the stapler head beyond the suture, pull the wires through the window, close the stapler and keep pulled the wires of the suture held together with a forcep, fire using two hands, open the stapler and remove it and check the staple line and then check the specimen. One of the latest innovations in stapled surgery the Tissue Selective Therapy. It is a minimally invasive procedure in which there is a partial circular stapled hemorrhoidopexy focused on the prolapsing piles with bridges of normal mucosa left. Results: Several studies have reported that SH is a safe and effective procedure to treat the hemorrhoidal prolapse. It is a quicker procedure with a shorter hospital stay and earlier return to work if compared with the conventional treatment. This is due to a less postoperative pain, postoperative bleeding, wound complications and constipation. Furthermore, the first generation devices had worse outcomes if compared with those of the new generation stapler that showed lower postoperative complication rate with better anatomical and symptomatic results. Conclusions: Stapled procedure for the treatment of symptomatic hemorrhoidal prolapse represents one of the most important innovations in proctology of the last century bringing with it the new revolutionary concept of the rectal intussusception as a determining factor involved in the natural history of the disease. Stapled hemorrhoidopexy marked an era in which the surgeon may to offer to the patients a safe, effective treatment with less pain and fast recovery.

Sign in / Sign up

Export Citation Format

Share Document