scholarly journals Blunt abdominal trauma with duodenal dissection: A case report

2021 ◽  
Vol 5 (2) ◽  
pp. 023-026
Author(s):  
Essola Basile ◽  
Boumsong Batamag Jean Baptiste ◽  
Engbang Jean Paul ◽  
Djomo Dominique ◽  
Ngaroua Esdras ◽  
...  
Keyword(s):  
Emergency Situation ◽  
Exploratory Laparotomy ◽  
Hemodynamic Instability ◽  
Duodenal Stump ◽  
Transverse Mesocolon ◽  
Jejunal Segment ◽  
Humanitarian Mission ◽  
Complete Transection ◽  
Complete Section ◽  
Specialized Center

We describe a new case of duodenal wound with complete transection in a 22-year-old patient following a motorcycle accident. He presented to the emergency room of the rural Regional Hospital of Edéa in Cameroon with a clinical picture of acute abdomen and post-trauma hemodynamic instability. A peritoneal puncture brought back an incoagulable blood. An exploratory laparotomy revealed a large hemoperitoneum mixed with food debris. A tear of the omentum and transverse mesocolon and a complete section of the third duodenum at the beginning of its free portion were observed. The surgeon performed emergency closure of both duodenal stumps and performed an isoperistaltic lateral gastrojejunal bypass. A transfer to a specialized center for a more anatomical continuity was considered, but the imminence of a humanitarian mission in the hospital prompted the surgeon to seize the opportunity of this mission for the reoperation. This surgical revision was performed on the fifth postoperative day. A resection of the distal duodenal stump and the adjacent jejunal segment including the anastomosis was performed. Continuity was restored by a mechanical duodenal-jejunal anastomosis. The patient was discharged on the 18th postoperative day. This type of lesion is difficult to manage in an emergency situation in a structure with limited technical resources. Unfortunately, surgeons treating polytraumatized civilians are encountering an increasing number of blunt duodenal wounds requiring laborious management.

scholarly journals Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis

2016 ◽  
Vol 98 (8) ◽  
pp. e197-e199 ◽  
Author(s):  
P Das ◽  
R Mukherjee ◽  
D Pathak ◽  
A Gangopadhyay ◽  
S Halder ◽  
...  
Keyword(s):  
Rare Complication ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Hemodynamic Instability ◽  
Gangrenous Appendicitis ◽  
Free Air ◽  
Tension Pneumoperitoneum ◽  
Emergency Measure ◽  
Intraperitoneal Free Air ◽  
Needle Decompression

Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumoperitoneum was confirmed by computed tomography, which showed compression of the intra-abdominal viscera and liver (saddlebag sign) by a large volume of intraperitoneal free air. Urgent needle decompression was done as an emergency measure. Exploratory laparotomy, planned due to persistent peritonitis, revealed gangrenous appendicitis with perforation near its base. Appendicectomy with excision of gangrenous portion of caecum was performed. The purpose of the reporting this case is to highlight that the tension pneumoperitoneum can be, very rarely, associated with gangrenous appendicitis and timely diagnosis is very important for the emergency management of this deadly condition.

Transcatheter arterial embolization for hemorrhage after gynecologic hysterectomy: a multicenter study

2021 ◽  
pp. 028418512110103
Author(s):  
Cheng Shi Chen ◽  
Young-Jong Cho ◽  
Ji Hoon Shin ◽  
Jeong Ho Kim ◽  
Suyoung Park ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Exploratory Laparotomy ◽  
Hemodynamic Instability ◽  
Active Bleeding ◽  
Success Rates ◽  
Contrast Extravasation ◽  
Anterior Division

Background Transcatheter arterial embolization (TAE) is not common for hemorrhagic complications after gynecologic hysterectomy. Purpose To evaluate the effectiveness and safety of TAE for hemorrhage after hysterectomy for gynecologic diseases. Material and Methods This is a retrospective, multicenter study, which investigated 11 patients (median age = 45 years) who underwent TAE for hemorrhage after gynecologic hysterectomy between 2004 and 2020. Results The median interval between surgery and angiography was one day (range = 0–82 days). Hemodynamic instability and massive transfusion were present in 6 (54.5%) and 4 (36.4%) patients, respectively. CT scans (n = 7) showed contrast extravasation (n = 5), pseudoaneurysm (n = 1), or both (n = 1). On angiography, the bleeding arteries were the anterior division branches of the internal iliac artery (IIA) (n = 6), posterior division branch (lateral sacral artery, n = 1), and inferior epigastric artery (n = 1) in eight patients with active bleeding. In the remaining three patients, angiographic staining without active bleeding foci was observed at the vaginal stump, and the feeders for staining were all anterior division branches of the IIA. Technical and clinical success rates were 100% and 90.9% (10/11), respectively. In one patient, active bleeding focus was successfully embolized on angiography, but surgical hemostasis was performed for suspected bleeding on exploratory laparotomy. Postembolization syndrome occurred in one patient. Conclusions TAE is effective and safe for hemorrhage after hysterectomy for gynecologic diseases. Angiographic findings are primarily active bleeding, but angiographic staining is not uncommon. A bleeding focus is possible in any branch of the IIA, as well as the arteries supplying the abdominal wall.

Vitamin K1-Induced Anaphylactic Shock

1996 ◽  
Vol 12 (5) ◽  
pp. 214-216 ◽  
Author(s):  
Noorizan Abdul Aziz ◽  
Zaitun Kamaruddin ◽  
Yahaya Hassan ◽  
Kamarudin Jaalam
Keyword(s):  
Vitamin K ◽  
Intravenous Administration ◽  
Anaphylactic Shock ◽  
Emergency Situation ◽  
Hemodynamic Instability ◽  
Activated Partial Thromboplastin Time ◽  
Critically Ill Patient ◽  
Severe Reaction ◽  
Case Summary ◽  
Macular Rash

Objective: To report a case of anaphylactic shock induced by the rapid intravenous administration of vitamin K1 in a patient in the intensive care unit (ICU). Case Summary: A 9-year-old Malay girl was admitted to the ICU and was diagnosed with Guillain-Barré syndrome. She developed an allergy to atropine that was manifested by a symmetric generalized transient macular rash over the trunk; it subsided 10 minutes after the drug was stopped. About 7 hours later, vitamin K1 10 mg iv was administered over 3 minutes due to the slight prolongation of prothrombin time and activated partial thromboplastin time. Immediately after the drug was administered, the patient developed a generalized transient macular rash, cyanosis, and shock. Her blood pressure and heart rate could not be detected. She responded well, however, after resuscitation. Discussion: Anaphylactic shock in this patient was most probably caused by the intravenous administration of vitamin K1, because this event occurred immediately after its administration. There have also been a few reported cases of severe reaction and death associated with intravenous administration of vitamin K1. The likelihood that the incident was drug-related could be classified as “probable” based on Naranjo's causal relationship algorithm. Conclusions: Rapid intravenous administration of vitamin K1 may induce anaphylactic shock in a critically ill patient with hemodynamic instability. If vitamin K1 is required, oral administration is preferred because it is rarely associated with severe reactions. Intravenous administration of vitamin K1 should be considered only in an emergency situation and the rate of administration should not exceed 1 mg/min.

Long-Term Follow-Up after Division of a Pharyngeal Flap for Severe Nasal Obstruction

1992 ◽  
Vol 29 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Louise Caouette-Laberge ◽  
E. Patricia Egerszegi ◽  
Anne-Marie De Remont ◽  
Ilse Ottenseyer
Keyword(s):  
Nasal Obstruction ◽  
Soft Palate ◽  
Nasal Breathing ◽  
Complete Transection ◽  
Velopharyngeal Incompetence ◽  
Complete Section ◽  
Long Term Follow Up ◽  
Pharyngeal Flap ◽  
Velopharyngeal Function

Between 1965 and 1986, nine patients were noticed to have significant nasal airway obstruction following surgery for velopharyngeal incompetence (VPI). All had a superiorly based pharyngeal flap. Division of the flap was recommended to correct the posterior obstruction. A complete section of the flap was done in seven cases and lateral port enlargement was done in the remaining two. The interval between flap elevation and transection ranged from 5 months to 5 years. Three patients required more than one operation to fully correct the obstruction. All the patients were evaluated 2 to 14 years later to assess nasal breathing and speech and to document velopharyngeal function by nasoendoscopy and videofluoroscopy. One patient presented major symptoms of nasal obstruction at follow-up, while others reported snoring and occasional mouth breathing, although their nasal respiration appeared subjectively adequate. Four patients had normal speech, three were mildly hyponasal, one was moderately hyponasal, and the other was severely hyponasal. Intelligibility was good in all cases but one, although three patients had some articulation errors: two with persistent errors related to early VPI and one from dental malocclusion and tongue protrusion. Videofluoroscopy and nasoendoscopy showed that despite complete transection at the base of the flap in eight cases, five still had evidence of residual tethering. In one patient, the obstruction was almost complete and repeat division of the flap was recommended. Seven patients showed increased thickness of the soft palate in the midline where the flap had been anchored. Velopharyngeal closure was adequate in five cases, marginal in three, and obstructed in one. The review of our cases showed that the velopharyngeal opening in these patients is not large and incompetent, but rather is contracted and the flap often reattaches posteriorly after division. We recommend a closure of all raw surfaces to be done when the flap is sectioned, adding Z-plasties when needed to prevent further V-P obstruction. Even in the presence of recurrent obstruction, the resection of the extra tissue contributed by the flap on the soft palate is not felt to be indicated.

Mesenteric vein thrombosis in a dog

1998 ◽  
Vol 34 (5) ◽  
pp. 431-433 ◽  
Author(s):  
R Shahar ◽  
S Harrus ◽  
B Yakobson
Keyword(s):  
Abdominal Pain ◽  
Abdominal Mass ◽  
Exploratory Laparotomy ◽  
Cocker Spaniel ◽  
Jejunal Segment ◽  
Mesenteric Vein Thrombosis ◽  
Mesenteric Vein ◽  
Vein Thrombosis

A four-year-old, male cocker spaniel was presented for vomiting and anorexia of two days' duration. An elongated abdominal mass was palpated, and abdominal pain was noted. On exploratory laparotomy, a jejunal segment was found to be infarcted transmurally. Histopathology confirmed the diagnosis of mesenteric vein thrombosis. The dog recovered uneventfully following resection of the affected bowel.

scholarly journals Survival abdominal gunshot injury: a rare case

2018 ◽  
Vol 5 (5) ◽  
pp. 1935
Author(s):  
Ashok S. Gajbhiye ◽  
M. N. Deshmukh ◽  
Parag Jaipuriya ◽  
Parag Jaipuriya ◽  
P. Mehata ◽  
...  
Keyword(s):  
Foreign Body ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Exploratory Laparotomy ◽  
Abdominal Radiograph ◽  
Jejunal Segment ◽  
Firearm Injury ◽  
Single Entry ◽  
Restricted Use ◽  
Operative Recovery

A 55 years old male patient came to the casualty of a medical college and hospital with alleged history of assault with firearm injury on his back. Patient was conscious with GCS 15/15, his pulse rate was 133 beats per min, blood pressure was 100/60 mmHg, SpO2 was 95% and pallor was present. On local examination there was single entry wound at lower back on left side of size 1 cm X 1 cm with no exit wound. Generalized abdominal tenderness and guarding was present. Patient was immediately resuscitated. Blood grouping, cross match were sent immediately. Abdominal radiograph did not show any gas under the diaphragm but a foreign body (a bullet) was seen. Ultrasonography and computerized tomography scan of the abdomen was suggestive of hemoperitonium and a foreign body bullet in abdomen. Exploratory laparotomy showed moderate hemoperitonium of about 1000 ml which was sucked out completely. Evidence of retroperitoneal rent of size approximately 1 cm X 1 cm seen with oozing through it which was closed in layers. A bullet was seen in the anterior abdominal wall but skin was intact. Five jejunal perforations distal to 20 cm from the duodenojejunal flexure were seen and the bullet was removed from the anterior abdominal wall.  Resection of the jejunal segment with jejuno-jejunal anastomosis was done. Jejunal mesenteric rents were closed. Abdominal wall closed in layers. Post-operative recovery was uneventful. Patient was discharged on the 10th post-operative day. Early diagnosis and treatment in the golden hours can save the life of the patients. A mass education on the dangers of these guns and the harm they can cause as well as legal regulations for their restricted use seem to be necessary.

scholarly journals Perforated Jejunal Diverticulum - an Unusual Presentation

2015 ◽  
Vol 1 (1) ◽  
pp. 43-45
Author(s):  
Kamal Koirala ◽  
Mahesh Khakurel ◽  
Reeta Barai
Keyword(s):  
Abdominal Pain ◽  
Histopathological Examination ◽  
Primary Anastomosis ◽  
Exploratory Laparotomy ◽  
Health Sciences ◽  
Unusual Presentation ◽  
Jejunal Segment ◽  
Acute Peritonitis ◽  
Jejunal Diverticulum ◽  
Acute Complications

Jejunal diverticula are rare and usually asymptomatic. Acute complications may include haemorrhage, diverticulitis, obstruction, abscess formation and perforation. Here we report a case of 61 years lady who presented with generalized abdominal pain, vomiting and fever. There were features of acute peritonitis on examination. Exploratory laparotomy revealed a perforated jejunal diverticulum. Resection of the jejunal segment containing the perforated diverticulum and primary anastomosis was done. Histopathological examination revealed jejunal diverticulum with pinhole perforation. DOI: http://dx.doi.org/10.3126/jpahs.v1i1.13016   Journal of Patan Academy of Health Sciences. 2014 Jun;1(1):43-45

scholarly journals Isolated complete transection of common hepatic artery in a fall accident: a case report

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Aghyad Kudra Danial ◽  
Mario Bedon ◽  
Nour Kalaji ◽  
Nasri Nasra ◽  
Hayat Khalil
Keyword(s):  
Hepatic Artery ◽  
Unusual Case ◽  
Exploratory Laparotomy ◽  
Common Hepatic Artery ◽  
Successful Management ◽  
Complete Transection ◽  
Abdominal Organs ◽  
Isolated Injury ◽  
The Common ◽  
External Injury

Abstract Blunt abdominal trauma is the most frequent external injury to the abdomen, which is rarely due to falling. However, not often does a blunt trauma cause injury to the common hepatic artery. Isolated injury of the common hepatic artery has rarely been reported in the literature. This report describes an unusual case of a falling accident from a height of 5 meters that results in complete transection of the common hepatic artery, yet all other abdominal organs are normal. The case was initially diagnosed by a Focused Assessment with Sonography in Trauma exam and confirmed with an exploratory laparotomy. The successful management would be an end-to-end anastomosis of the dissected artery. We hope we would raise awareness of such injury in order to facilitate its diagnosis and management and improve its outcome.

scholarly journals Diagnostic and Therapeutic Challenges in The Management of Acute Massive Overt Bleeding of Jejunal Gastrointestinal Stromal Tumours: Case Series

2021 ◽  
Author(s):  
SATISH SUBBIAH NAGARAJ ◽  
Sriram Deivasigamani ◽  
Amresh Aruni ◽  
Hemanth Kumar ◽  
Anurag Sachan ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Exploratory Laparotomy ◽  
Hemodynamic Instability ◽  
Computed Tomographic Angiography ◽  
Single Step ◽  
Resection Margins ◽  
Diagnostic Features

Abstract Introduction: Jejunal Gastro-Intestinal Stromal Tumours (GIST) are rare mesenchymal tumours. Acute massive overt bleeding from jejunal GIST are very rare and poses both diagnostic and therapeutic challenges in emergent conditions. Methods A case series with retrospective analysis of prospectively maintained database of patients presenting with acute massive overt bleeding secondary to histologically proven jejunal GIST was done. Clinical characteristics, endoscopic and imaging diagnostic features, histological findings, surgical procedures and outcomes in these patients were studied. Results Three patients were included in this case series. Mean age of presentation was 49.0 years with two male and one female patient. All three patients presented with melena and hemodynamic instability, resuscitated with adequate blood transfusions. Routine endoscopic assessment were inconclusive. Multiphasic Computed Tomographic Angiography (CTA) revealed hypodense hypervascular mass in jejunum in all three patients. One patient was unresponsive to blood transfusion and underwent emergency exploratory laparotomy. One patient underwent laparoscopic resection and reconstruction. Mean length of hospital stay was 5.3 days. Histopathological examination confirmed Jejunal GIST in all three patients with microscopically negative resection margins. Two patients were disease free till 18 months follow up and the one patient lost to follow up after 1 year. Conclusion Multiphasic CTA is a single step diagnostic tool for localisation of bleed and assessment of tumour characteristics in emergent conditions. Surgical resection is the mainstay of treatment for both control of bleed and to provide oncologically clear resection margins.

scholarly journals Small Bowel Volvulus as Delayed Presentation of Undiagnosed Crohn’s Disease: A Case Report

2021 ◽  
Vol 5 (4) ◽  
pp. 455-458
Author(s):  
Minh Thu Nguyen ◽  
Amir Ali ◽  
Ryan Bodkin
Keyword(s):  
Crohn’S Disease ◽  
Case Report ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Exploratory Laparotomy ◽  
Hemodynamic Instability ◽  
Delayed Presentation ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Inflammatory Bowel

Introduction: Emergency department (ED) visits related to flare-ups of inflammatory bowel disease (IBD) are becoming more prevalent. There are many potentially dangerous complications and sequelae of uncontrolled IBD. Case Report: We report a case of a middle-aged woman who presented with a few hours of severe abdominal pain, nausea, and vomiting. Given her hemodynamic instability, she was sent urgently for computed tomography, which showed an incomplete small bowel malrotation, mesenteric volvulus, and high-grade small bowel obstruction with evolving ischemia. The patient underwent exploratory laparotomy to resect most of her small intestines. Biopsies later revealed active Crohn’s disease. Conclusion: Patients with flare-ups of IBD are common in the ED, but very few present with a midgut volvulus later in life. Our case is unique and adds to the literature due to the dramatic consequences of undiagnosed Crohn’s disease in a patient with intermittent symptoms and extensive workup spanning over two decades.

Sign in / Sign up

Export Citation Format

Share Document