scholarly journals Recurrent trichobezoar in a patient with Rapunzel syndrome

2021 ◽  
Vol 17 (1) ◽  
pp. 64-66
Author(s):  
Joanna Godlewska ◽  
◽  
Justyna Orpiszewska ◽  
Wojciech Górecki ◽  
◽  
...  
Keyword(s):  
Emergency Department ◽  
Foreign Body ◽  
Psychiatric Treatment ◽  
Psychological Care ◽  
Invasive Treatment ◽  
Rapunzel Syndrome ◽  
Postoperative Course ◽  
Proximal Small Intestine ◽  
Proximal Intestine

Rapunzel syndrome is a condition where a trichobezoar is formed in the stomach and proximal intestine due to hair ingestion. A 6-year-old girl presented to emergency department with abdominal pain, vomiting and a palpable epigastric mass. Laparotomy was performed for gastric foreign body; a trichobezoar that filled the stomach, duodenum and proximal small intestine was removed. Postoperative course was uncomplicated; the patient was discharged for further out-patient follow-up and psychological care. After 7 months, the girl presented with a recurrence. A recurrent trichobezoar was removed via laparotomy. The girl was started on psychiatric treatment and iron substitution for anaemia. Ten weeks after discharge, follow-up gastroscopy was negative for gastric foreign body. There are no guidelines for follow-up after trichobezoar removal. Since the disease may be recurrent, follow-up endoscopy should be considered in order to enable an early diagnosis and less invasive treatment.

Generalised urticaria following ingestion of a nickel-plated coin in a 4-year-old girl

2020 ◽  
Vol 13 (9) ◽  
pp. e234601 ◽  
Author(s):  
Isabelle Duchesnay ◽  
Michael H Livingston ◽  
Lisa VanHouwelingen ◽  
J Mark Walton
Keyword(s):  
Emergency Department ◽  
Foreign Body ◽  
Nickel Content ◽  
Endoscopic Removal ◽  
Nickel Plating ◽  
Postoperative Course ◽  
Abdominal Radiographs

We report the case of a 4-year-old girl who presented to the emergency department after ingestion of a nickel-plated coin. Abdominal radiographs confirmed the presence of a coin in her stomach but she was otherwise asymptomatic. She was discharged with assurances that the foreign body would pass spontaneously. The patient developed significant generalised urticaria the next day, which became progressively more severe. Her symptoms prompted endoscopic removal of the nickel-plated coin and a postoperative course of corticosteroids and antihistamine therapy. This is the first reported case of generalised urticaria secondary to ingestion of a coin with nickel plating only (2% nickel content overall). A review of similar cases is provided.

scholarly journals Minimally invasive treatment of iatrogenic complete left ureter obstruction after hysterectomy

2012 ◽  
Vol 2 (2) ◽  
pp. 144-147
Author(s):  
Yigit Akin ◽  
Isil Basara ◽  
Aliseydi Bozkurt
Keyword(s):  
Emergency Department ◽  
Treatment Options ◽  
Ureteral Injury ◽  
Invasive Treatment ◽  
Ureter Injury ◽  
Left Ureter ◽  
Ureter Obstruction ◽  
Chief Complaints ◽  
Treatment Prognosis

The iatrogenic ureter injuries are rare complications and may have serious consequences. The treatment options depend on situations. Pelvic surgeons, keep in mind that this kinds of complications, is very important for diagnosis and treatment, during the surgery. This report presents a case of a patient with iatrogenic left ureteral injury during hysterectomy. The patient visited emergency department of our hospital with the chief complaints of left lomber pain on the 17th day of hysterectomy. After evaluation in emergency clinic, the patient had an endoscopic treatment for iatrogenic ureter injury. The patient is still in follow-up period. We also review the literature and discuss diagnose, treatment, prognosis of iatrogenic ureter injuries. The treatmentoptions are still developing by technology.

scholarly journals A case report of retrograde intussusception 3 years post Roux-en-Y gastric bypass

2019 ◽  
Vol 2019 (8) ◽  
Author(s):  
Fahad Okal ◽  
Jawad Allarakia ◽  
Amer Alghamdi ◽  
Zahid Alqurashi ◽  
Ghaleb Aboalsamh ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Gastric Bypass ◽  
Severe Pain ◽  
Surgical Intervention ◽  
Rare Complication ◽  
Postoperative Course ◽  
Retrograde Intussusception ◽  
Small Bowel Segment

Abstract Retrograde jejuno-jejunal intussusception is a rare complication of bariatric surgeries. It causes acute sudden symptoms that require immediate surgical intervention. We report a case of a 46-year-old female who underwent Roux-en-Y gastric bypass (REYGP) 3 years prior. The patient presented to the emergency department with acute sudden abdominal pain, nausea and vomiting. Laparoscopically, intussuscepting small bowel segment was found gangrenous, and it was resected and end-to-end anastomoses were fashioned. The postoperative course was uneventful, and the patient remained asymptomatic for the 12 months of follow-up. Patients with retrograde intussusception experience an intolerable severe pain that necessitates surgical intervention. The etiology of intussusception as a complication after REYGP is unclear, yet theoretically some possible etiologies exist. The initial diagnosis of retrograde intussusception is made based on abdominal computed tomography. Early intervention significantly reduces morbidity and mortality.

Learning Curve of Upper Aerodigestive Tract Foreign Body Management for Otorhinolaryngology Residents

ORL ◽  
2021 ◽  
pp. 1-7
Author(s):  
Ching-Ching Chiu ◽  
Chien-Yu Huang ◽  
Keng-Ming Chang ◽  
Sheng-Chiao Lin ◽  
Yu-Hsi Liu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Foreign Body ◽  
Learning Curve ◽  
Foreign Bodies ◽  
Aerodigestive Tract ◽  
Deep Neck Infection ◽  
Upper Aerodigestive Tract ◽  
Negative Finding ◽  
Neck Infection

<b><i>Introduction:</i></b> Foreign body ingestion is the most common reason for otolaryngology specialist consultations in emergency departments. Among the different types of foreign bodies, fish bones are the most common, particularly in Asian populations. In Taiwan, upper aerodigestive tract foreign bodies (UADT-FBs) are mostly managed by residents in the otorhinolaryngology (ORL) department. Considering the learning curve required for all procedures, different management types between residents, and possible resulting safety issues, this study explored the outcomes of UADT-FB management by residents in different years of ORL training. <b><i>Materials and Methods:</i></b> The medical records of 2,283 patients who visited Kaohsiung Veterans General Hospital’s Emergency Department for UADT-FB during June 2013–August 2019 were retrospectively reviewed. The reviewed data included the demographic data of enrolled patients, outcomes of foreign body management, and follow-up chart records of the patients. <b><i>Results:</i></b> Among the 2,283 patients, 1,324 (58%) were found to be negative for foreign bodies, and foreign bodies in 951 (41.7%) were removed immediately. In the negative finding (NF) group, 2 (4.9%) patients were later found to be positive for foreign bodies during follow-up in the outpatient department. One (2.4%) patient developed a deep neck infection and esophageal perforation. The percentage of NFs decreased from 62.58% in residents in the first half of their first year (R1a) to 54% for third-year residents (R3). Comparing R1a with R3, the number needed to harm for retained UADT-FBs after patients visited the emergency department was 12.2. <b><i>Discussion/Conclusion:</i></b> This study provides data from 1 referral center regarding the management of UADT-FBs. With increasing resident training, the percentage of NFs declined from 62.58 to 54%. Young residents, especially those in the first 6 months of their training, should have senior residents perform a second examination if UADT-FBs are not found in suspected cases.

Emergency Department Admission and Mortality Rate for Suicidal Behavior

Crisis ◽  
2014 ◽  
Vol 35 (6) ◽  
pp. 406-414 ◽  
Author(s):  
Raimondo Maria Pavarin ◽  
Angelo Fioritti ◽  
Francesca Fontana ◽  
Silvia Marani ◽  
Alessandra Paparelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Metropolitan Area ◽  
Suicidal Behavior ◽  
Mortality Risk ◽  
Illicit Drugs ◽  
Attempted Suicide ◽  
Cox Model ◽  
Emergency Department Admission ◽  
Completed Suicide

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

Pneumopericardium after Foreign Body Aspiration: A Case Report

2020 ◽  
Vol 1 (1) ◽  
pp. 4-6
Author(s):  
Abdelgalil Ragab ◽  
Tarek Al Salhani ◽  
Sallam Taha ◽  
Eyad Darraj ◽  
Kamal Moustafa
Keyword(s):  
Case Report ◽  
Foreign Body ◽  
Foreign Body Aspiration ◽  
Sharp Foreign Body

A case of spontaneous pneumopericardium occurred in the patient after the aspiration of no sharp foreign body. The patient was sent to Operation Theater (OT), bronchoscopic extraction of the foreign body was performed, and the patient was stable postoperatively. Serial follow up X-rayswere done and showed resolving of the pneumopericardium.

scholarly journals A life-threatening spontaneous ascending aortic rupture due to a small penetrating aortic ulcer

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110377
Author(s):  
Yasuhito Nakamura ◽  
Kiyoshi Doi ◽  
Syojiro Yamaguchi ◽  
Etsuji Umeda ◽  
Osamu Sakai ◽  
...  
Keyword(s):  
Rare Case ◽  
Aortic Wall ◽  
Aortic Rupture ◽  
Ascending Aorta ◽  
Bleeding Site ◽  
Penetrating Aortic Ulcer ◽  
Postoperative Course ◽  
Life Threatening ◽  
Aortic Dissections

We reported a rare case of spontaneous frank rupture of a small (4 mm) penetrating aortic ulcer in the ascending aorta resulted in catastrophic bleeding. The ulcer only created a pinhole wound in the adventitia without saccular aneurysms, intramural hematomas, or aortic dissections. Notably, the wound could be directly closed because the aortic wall was intact only 5 mm away from the bleeding site. The postoperative course was uneventful, and the patient was discharged on the 11th postoperative day. After 8 months, follow-up computed tomography showed no abnormality of the aortic wall at the repair site.

scholarly journals Prospective study to assess the tissue response to HPC-coated p48 flow diverter stents compared to uncoated devices in the rabbit carotid artery model

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Tim Lenz-Habijan ◽  
Pervinder Bhogal ◽  
Catrin Bannewitz ◽  
Ralf Hannes ◽  
Hermann Monstadt ◽  
...  
Keyword(s):  
Foreign Body ◽  
Flow Diverter ◽  
Foreign Body Response ◽  
Tissue Response ◽  
Acute Setting ◽  
Significant Difference ◽  
And Performance ◽  
Surface Modified ◽  
Common Carotid Arteries

Abstract Background Flow diverters (FDs) are widely used in the treatment of intracranial aneurysms, but the required medication increases the risk of haemorrhagic complications and limits their use in the acute setting. Surface modified FDs may limit the need for dual antiplatelet therapy (DAPT). Hydrophilic polymer coating (HPC) may reduce the need of medication. Methods This explorative study, approved by the local authorities and the local welfare committee, compared stent behaviour and overall tissue response between HPC-coated FDs and uncoated FDs, both implanted into the common carotid arteries of eight New Zealand white rabbits. Endothelialisation, inflammatory response, and performance during implantation were assessed. Angiographic follow-up was performed to observe the patency of the devices after implantation and after 30 days. Histological examinations were performed at 30 days to assess foreign body reaction and endothelialisation. Kruskal-Wallis and Wilcoxon tests were used to compare non-parametric variables. Results Angiography showed that both coated and uncoated FDs performed well during implantation. All devices remained patent during immediate follow-up and after 30 days. Histopathology showed no significant difference in inflammation within the vessel wall between the two cohorts (2.12 ± 0.75 vs. 1.96 ± 0.79, p = 0.7072). Complete endothelialisation of the stent struts was seen with very similar (0.04 ± 0.02 mm vs. 0.04 ± 0.03 mm, p = 0.892) neoendothelial thickness between the two cohorts after 30 days. Conclusion Taking into account the limitation in sample size, non-significant differences between the HPC-coated and uncoated FDs regarding implantation, foreign body response, and endothelialisation were found.

scholarly journals 986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S521-S522
Author(s):  
Jennifer R Silva-Nash ◽  
Stacie Bordelon ◽  
Ryan K Dare ◽  
Sherrie Searcy
Keyword(s):  
Emergency Department ◽  
Sexual Assault ◽  
Hiv Transmission ◽  
Post Exposure Prophylaxis ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Exposure ◽  
Assault Victims ◽  
Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P&lt; 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P&lt; 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P&lt; 0.001), pregnancy (39.0% vs 79.6%; P&lt; 0.001), syphilis (3.4% vs 89.8%; P&lt; 0.001), hepatitis B (15.3% vs 95.5%; P&lt; 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

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