scholarly journals Wilkie's syndrome in an adolescent female patient

2020 ◽  
Vol 6 (11) ◽  
pp. 456
Author(s):  
Bandar Idrees A. Ali ◽  
Khuloud Omar Bukhari ◽  
Abdullah Saeed Alzahrani
Keyword(s):  
Laparoscopic Approach ◽  
Fat Pad ◽  
Radiological Investigation ◽  
Wilkie’S Syndrome ◽  
Life Threatening ◽  
Failed Surgery ◽  
Clinical Conditions ◽  
Definitive Management ◽  
Upper Gastrointestinal ◽  
Epigastric Abdominal Pain

<p>One of the rare cases of the upper gastrointestinal tract obstruction is superior mesenteric artery syndrome (SMAS) but potentially life-threatening if not recognized early. It is due to loss of fat pad between the aorta and SMA which will lead to a compression of the third portion of the duodenum. It has a different angle which will lead to different presentations as well as severity. We are reporting the 15 year-old (y/o) female who is medically free, presented to the emergency department (ED) complaining of severe colicky epigastric abdominal pain for the last 5 days in the epigastric area. The diagnosis of SMAS was made after clinical and radiological investigation. After proper supportive resuscitative measures, definitive management of the surgery was done by laparoscopic approach (duodenojejunostomy). The diagnosis of SMA syndrome is considered challenging due to many presentations and might be confused with other clinical conditions. Unless early diagnosed and treated, the outcome might be catastrophic. Medical treatment is attempted first in many cases depending on the severity and presentation but if failed, surgery will be the best option.</p>

Management of Pleural Effusions in the Emergency Department.

2020 ◽  
Vol 15 ◽  
Author(s):  
MT Congedo ◽  
GM Ferretti ◽  
D Nachira ◽  
MA Pennisi
Keyword(s):  
Emergency Department ◽  
Systematic Approach ◽  
Acute Chest Pain ◽  
Pleural Effusions ◽  
Therapeutic Approaches ◽  
Massive Pleural Effusion ◽  
Emergency Department Setting ◽  
Clinical Conditions ◽  
Definitive Management

Background: In symptomatic patients, admitted in emergency department for acute chest pain and dyspnea, who require an urgent treatment, a rapid diagnosis and prompt management of massive pleural effusion or hemothorax can be lifesaving. The aim of this review was to summarize the current diagnostic and therapeutic approaches for the management of the main types of pleural effusions that physicians can have in an emergency department setting. Methods: Current literature about the topic was reviewed and critically reported, adding the experience of the authors in the management of pleural effusions in emergency settings. Results: The paper analyzed the main types of pleural effusions that physicians can have to treat. It illustrated the diagnostic steps by the principal radiological instruments, with a particular emphasis to the role of ultrasonography, in facilitating diagnosis and guiding invasive procedures. Then, the principal procedures, like thoracentesis and insertion of small and large bore chest drains, are indicated and illustrated according to the characteristics and the amount of the effusion and patient clinical conditions. Conclusion: The emergency physician must have a systematic approach that allows rapid recognition, clinical cause identification and definitive management of potential urgent pleural effusions.

scholarly journals Endotherapy for Nonvariceal Upper Gastrointestinal Hemorrhage

2021 ◽  
Vol 12 (02) ◽  
pp. 078-092
Author(s):  
Chhagan L. Birda ◽  
Antriksh Kumar ◽  
Jayanta Samanta
Keyword(s):  
Gastrointestinal Hemorrhage ◽  
Surgical Intervention ◽  
Thermal Therapy ◽  
Upper Gastrointestinal Hemorrhage ◽  
Transfusion Strategy ◽  
Related Factors ◽  
Primary Hemostasis ◽  
Mechanical Therapy ◽  
Definitive Management ◽  
Upper Gastrointestinal

AbstractNonvariceal upper gastrointestinal hemorrhage (NVUGIH) is a common GI emergency with significant morbidity and mortality. Triaging cases on the basis of patient-related factors, restrictive blood transfusion strategy, and hemodynamic stabilization are key initial steps for the management of patients with NVUGIH. Endoscopy remains a vital step for both diagnosis and definitive management. Multiple studies and guidelines have now defined the optimum timing for performing the endoscopy after hospitalization, to better the outcome. Conventional methods for achieving endoscopic hemostasis, such as injection therapy, contact, and noncontact thermal therapy, and mechanical therapy, such as through-the-scope clips, have reported to have 76 to 90% efficacy for primary hemostasis. Newer modalities to enhance hemostasis rates have come in vogue. Many of these modalities, such as cap-mounted clips, coagulation forceps, and hemostatic powders have proved to be efficacious in multiple studies. Thus, the newer modalities are recommended not only for management of persistent bleed and recurrent bleed after failed initial hemostasis, using conventional modalities but also now being advocated for primary hemostasis. Failure of endotherapy would warrant radiological or surgical intervention. Some newer tools to optimize endotherapy, such as endoscopic Doppler probes, for determining flow in visible or underlying vessels in ulcer bleed are now being evaluated. This review is focused on the technical aspects and efficacy of various endoscopic modalities, both conventional and new. A synopsis of the various studies describing and comparing the modalities have been outlined. Postendoscopic management including Helicobacter pylori therapy and starting of anticoagulants and antiplatelets have also been outlined.

scholarly journals 709 Covid-19 Pandemic: Audit on The Management of Acute Cholecystitis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Asarbakhsh ◽  
N Lazarus ◽  
P Lykoudis
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Readmission Rate ◽  
Adverse Outcomes ◽  
Management Option ◽  
Management Guidelines ◽  
Theatre Staff ◽  
The Impact ◽  
Definitive Management ◽  
Upper Gastrointestinal

Abstract Background The definitive management of acute cholecystitis is laparoscopic cholecystectomy on the same admission if the patient is fit. As the Covid-19 pandemic emerged, evidence suggested adverse outcomes for asymptomatic Covid positive patients undergoing surgery, including increased mortality risk. Risks to theatre staff were also highlighted. This prompted changes in acute cholecystitis management guidelines. Method The audit aim was to assess the impact of guideline change on clinical outcomes and readmission rate for acute cholecystitis. The revised Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) guidelines were the gold standard. All inpatient admissions for acute cholecystitis during the 4-week peak of the pandemic (17/04/2020 – 14/05/2020) were included. Result 24 patients were admitted with acute cholecystitis. 10 patients (41.7%) were managed with antibiotics alone, 4 patients (16.6%) underwent cholecystostomy. 12 patients (50%) were discharged within 3 days. Lack of clinical progress/ongoing symptoms was the indication for laparoscopic cholecystectomy in 5 cases (20.8%). 5 conservatively managed patients (20.8%) were readmitted with ongoing cholecystitis or pancreatitis. Conclusions 19 patients (80%) were managed non-surgically in accordance with AUGIS guidelines. However conservative management was not always appropriate. We recommend that laparoscopic cholecystectomy should remain a management option for acute cholecystitis during the ongoing Covid-19 pandemic.

Painless spontaneous haemoperitoneum secondary to a uterine leiomyoma/fibroid: unusual presentation of a life-threatening differential

2021 ◽  
Vol 14 (10) ◽  
pp. e243465
Author(s):  
Chiamaka Maduanusi ◽  
Sathiyaa Balachandran ◽  
Sahathevan Sathiyathasan ◽  
Kazal Omar
Keyword(s):  
Uterine Leiomyoma ◽  
Rare Complication ◽  
Abdominal Mass ◽  
Uterine Fibroids ◽  
Reproductive Age ◽  
Haemodynamic Instability ◽  
Hypovolaemic Shock ◽  
Important Differential Diagnosis ◽  
Life Threatening ◽  
Definitive Management

This is a case of a 47-year-old woman with a spontaneous haemoperitoneum secondary to uterine leiomyomas (fibroids), an important differential diagnosis in patients with uterine fibroids and hypovolaemic shock. Uterine fibroids are very common in women of reproductive age, yet little is taught about their potential to cause hypovolaemic shock. Although it is a rare complication, given the prevalence of fibroids, it is important to bear this life-threatening differential in mind to optimise the care for these women. Presentation typically involves abdominal pain, syncope, haemodynamic instability and an intra-abdominal mass. CT of the abdomen and pelvis can be helpful in identifying the source of the haemoperitoneum, but should not delay surgery, which is the definitive management.

scholarly journals Spontaneous rupture of an unscarred uterus in early pregnancy: a rare but life-threatening emergency

2019 ◽  
Vol 12 (5) ◽  
pp. e228493 ◽  
Author(s):  
Bedayah Amro ◽  
Ghassan Lotfi
Keyword(s):  
Early Pregnancy ◽  
Uterine Rupture ◽  
Laparoscopic Approach ◽  
First Trimester ◽  
Rare Occurrence ◽  
Spontaneous Uterine Rupture ◽  
First Case ◽  
Life Threatening ◽  
First Trimester Of Pregnancy ◽  
Underlying Risk

Spontaneous uterine rupture during early pregnancy is an extremely rare occurrence and may vary in presentation and course of events, hence the clinical diagnosis is often challenging. We present our experience with two such cases of spontaneous uterine rupture in the first trimester of pregnancy without any identifiable underlying risk factors. The first case was at 12 weeks of gestation and the second case was at 6 weeks gestational age (GA). Both cases were diagnosed and managed by the laparoscopic approach. We are reporting the earliest documented GA in which spontaneous uterine rupture occurred. So far, the earliest GA reported in the literature according to our knowledge was at 7+3 weeks. Access to a laparoscopic facility is crucial in the early definitive diagnosis and prompt management of these cases, since this may significantly reduce the risk of severe morbidity and mortality.

scholarly journals Lactobacillus acidophilus-Induced Endocarditis and Associated Splenic Abscess

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Muhammet Ozer ◽  
Suleyman Yasin Goksu ◽  
Ali Shahverdiani ◽  
Muhammad Mustafa
Keyword(s):  
Lactobacillus Acidophilus ◽  
Splenic Abscess ◽  
Normal Flora ◽  
Positive Bacterium ◽  
Delay In Diagnosis ◽  
Causative Microorganism ◽  
Hematogenous Seeding ◽  
Life Threatening ◽  
Clinical Conditions ◽  
Timely Treatment

Lactobacillus acidophilus is a rod-shaped, Gram-positive bacterium generally found in the normal flora of the oropharynx, gastrointestinal, and genitourinary tracts. It is commonly known as nonpathogen in the human body. Endocarditis due to Lactobacillus is rarely encountered and associated with impaired immunity. Splenic abscess is also an uncommon infection that classically results from endocarditis or another source of hematogenous seeding. Here, we present the case of bioprosthetic aortic valve endocarditis and associated splenic abscess caused by Lactobacillus acidophilus. The source of the Lactobacillus bacteremia should be investigated because of the risk of life-threatening conditions. Most of the time, identifying Lactobacillus species is challenging and can cause a delay in diagnosis and timely treatment. Especially in patients who have significant underlying clinical conditions, physicians should consider Lactobacillus species as a causative microorganism.

scholarly journals Aorto-esophageal fistula: successful open surgical management of two cases

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Siddharth Pahwa ◽  
Susmit Bhattacharya ◽  
Siddhartha Mukhopadhyay ◽  
Ashok Verma
Keyword(s):  
Surgical Management ◽  
Surgical Repair ◽  
Hemodynamic Instability ◽  
Esophageal Fistula ◽  
Long Term Follow Up ◽  
Life Threatening ◽  
Dacron Patch ◽  
Upper Gastrointestinal

Abstract An aorto-esophageal fistula (AEF) is a rare yet life-threatening cause of upper gastrointestinal bleeding. We report our experience with open surgical management of two cases of AEF. Both cases presented with almost identical presentations: hematemesis and hemodynamic instability. The aorta in the first patient was normal; the defect was small and was repaired with a Dacron patch. The second patient had an aneurysmal aorta, which was replaced with a Dacron graft. Both cases were performed under partial bypass. The esophageal rent in both patients was debrided, primarily closed and buttressed with a vascularized intercostal pedicle. Nonavailability of endovascular personnel and equipment along with hemodynamic instability of the patient influenced our surgical strategy. Long-term follow-up of these patients is necessary to analyze the outcomes of our surgical repair.

Gastric Mucormycosis as a Cause of Life-Threatening Upper Gastrointestinal Bleeding in a Trauma Patient

2010 ◽  
Vol 76 (7) ◽  
pp. 76-77 ◽  
Author(s):  
Chad B. Johnson ◽  
Mentor Ahmeti ◽  
Alan H. Tyroch ◽  
Marc J. Zuckerman ◽  
M. Nawar Hakim
Keyword(s):  
Gastrointestinal Bleeding ◽  
Trauma Patient ◽  
Upper Gastrointestinal Bleeding ◽  
Life Threatening ◽  
Upper Gastrointestinal

Life-Threatening Upper Gastrointestinal Bleeding Secondary to Aortoenteric Fistula

2008 ◽  
Vol 2 ◽  
pp. CCRPM.S376
Author(s):  
Tasbirul Islam ◽  
George Hines ◽  
Douglas S. Katz ◽  
William Purtil ◽  
Francis Castiller
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Gastrointestinal Bleeding ◽  
Surgical Repair ◽  
Upper Gastrointestinal Bleeding ◽  
Aortoduodenal Fistula ◽  
Open Surgical Repair ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Upper Gastrointestinal

We present a patient with gastrointestinal bleeding secondary to an aortoduodenal fistula. The patient had undergone an open surgical repair of an abdominal aortic aneurysm five years prior to admission.

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