Early Laparotomy: A Necessity for Postoperative Intraperitoneal Hemorrhage

2019 ◽  
Vol 41 (1) ◽  
pp. 8-14
Author(s):  
Suniti Rawal ◽  
Pooja Paudyal
Keyword(s):  
Diagnostic Laparoscopy ◽  
Distress Syndrome ◽  
Morbidity And Mortality ◽  
Surgical Incision ◽  
Postoperative Haemorrhage ◽  
Intraperitoneal Hemorrhage ◽  
Intraperitoneal Bleeding ◽  
Anesthetic Complications ◽  
The Right ◽  
Subsequent Rise

Introduction: Haemorrhage is considered the dreaded complications following any surgery. “Relaparotomy” is a better described terminology for a repeat case postoperative haemorrhage in gynecological surgeries. With increased awareness and early detection and subsequent rise in gynaecological operations have led additional incidence of relaparotomies and further in morbidity and mortality. Methods: The study was conducted from April 2006 - March 2017 including cases of re/laparotomy for intraperitoneal bleeding at TUTH, Nepal. Results: There were 27 cases of intraperitoneal hemorrhage majorly from 20 abdominal surgeries comprising 12(44.4%) abdominal hysterectomies, 6 (22.2%) laparotomy, 1(3.7%) each of diagnostic laparoscopy and abdomino perineal approach and 7(26%) vaginal hysterectomies. Features of hypovolaemic shock in 14(51.8%), marked abdominal distention in 9(33.3%) and blood loss of 400 to 3000 ml was observed. Five (18.5%) cases of active bleeding from pedicales were secured. Oozing from various sites (10, 37%) cured with haemostatic sutures. Generalised oozing post diagonistic laproroscopy, subtotal hysterectomy was done (1, 3.7%). In 2 (7.4%) cases bleeding from fallopian tube and mesosapinx were sutured. Six (22.2%) hematomas were evacuated and bleeders secured. Dissection of left uterosacrial ligament and tearing of infundibulopelvic ligaments (1, 3.7%) were reinforced and sutured. Sputter in the vault (1, 3.7%) were ligated and isolated rise in PT (1, 3.7%) with FFP transfusion. Two succumbed to death, one following diagnostic laparoscopy from adult respiratory distress syndrome and next from VH with PFR anesthetic complications. Conclusion: Proper closure of surgical incision with the right technique, appropriate ligature, careful tying of the blood vessel, monitoring pulse rate and blood pressure in postoperative cases can minimize the morbidity and mortality.

scholarly journals Intraperitoneal haemorrhage- A call for laparotomy as second intervention

1970 ◽  
Vol 2 (2) ◽  
pp. 63-68
Author(s):  
Suniti Rawal ◽  
Ashma Rana ◽  
Kesang D Bista ◽  
Geeta Gurung ◽  
Ram K Ghimire
Keyword(s):  
Blood Pressure ◽  
Retrospective Study ◽  
Diagnostic Laparoscopy ◽  
Surgical Intervention ◽  
Surgical Incision ◽  
Primary Surgery ◽  
Internal Iliac ◽  
Intraperitoneal Bleeding ◽  
Vaginal Birth After Caesarean ◽  
Intraperitoneal Haemorrhage

Aim: To study laparotomy as second intervention for hemoperitoneum following primary surgery in obstetric and gynecology. Method: Eleven years retrospective study going back from Dec 2006 embracing all the cases of re/laparotomy for intraperitoneal bleeding were carried out in TUTH, Nepal. Results: Of the 24 cases complicated by intraperitoneal hemorrhage for which relaparotomy had been done 12 each were formed by gynaecologic and obstetric cases: 11 were caesareans (CS) and a laparotomy following vaginal birth after caesarean (VBAC). In gynecology the preceding surgeries undertaken were [diagnostic laparoscopy (1), laparotomy (3), hysterectomies 8 (3 being vaginal)] Massive hemoperitoneum occurred in ¼ cases; extensive hematoma in a third having altogether with associated risks factor in 9(37.5%).Source of bleeding were disligated/abraded infundibulopelvic vessel (3), cuff bleeding (4), cardinal ligaments (1), uterine cornua (1), uterine angles (6), vagina (1) and placental bed (1) which were duly managed by 5 obstetrics hysterectomy. Laparotomy >2 times were repeated 4: obstetric 2 [(1) for vault bleeding following hysterectomy done for scar rupture after VBAC and other for slippage of ovarian vessel following hysterectomy and internal iliac ligation] and same number in Gynecology 2 [(1) after vaginal hysterectomy first for laceration of infundibulopelvic vessel and then for generalized ooze and hematoma]. Next was following a diagnostic laparoscopy, complicated by unexplainable intraperitoneal bleeding first devised by internal iliac ligation, then finally by hysterectomy that died. Conclusions: Careful tying of the blood vessel, choosing right technique and appropriate ligature in the first place is as important as proper closure of all the surgical incision/ inflicted cut taking note of the rise in the pulse rate and fall in the blood pressure in overall postoperative cases such that related morbidity and mortality from late diagnosis leading to delayed second surgical intervention can be obviated or minimized. Key Words: Intraperitoneal bleeding, hemoperitoneum, relaparotomy   doi:10.3126/njog.v2i2.1458 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 63 - 68

scholarly journals Proning related bilateral anterior ischaemic optic neuropathy in a patient with COVID-19 related acute respiratory distress syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirsty Michelle Clarke ◽  
Vivi Riga ◽  
Amy-lee Shirodkar ◽  
Joel Meyer
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Visual Field ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Vision Loss ◽  
Prone Positioning ◽  
Disc Oedema ◽  
Ischaemic Optic Neuropathy ◽  
The Right

Abstract Background Non-arteritic ischaemic optic neuropathy (NAION) is a rare but harmful complication of prone positioning. Prone mechanical ventilation is a therapeutic strategy which has been used extensively during the COVID-19 pandemic to treat acutely hypoxemic patients with COVID-19 related acute respiratory distress syndrome (ARDS). Though a small number of cases of unilateral NAION have been reported in patients testing positive for the SARS-CoV-2 virus, we describe what is to our knowledge, the first reported case of bilateral NAION occurring in a patient proned extensively for the treatment of COVID-19 related ARDS. We consider the potential aetiological factors leading to NAION after prone mechanical ventilation in patients with COVID-19 and suggest strategies to protect against its development. Case presentation : We report a case of severe, irreversible, visual impairment secondary to bilateral anterior ION in a fifty-five-year-old male who underwent eight episodes of prone mechanical ventilation to treat COVID-19 related ARDS. Once weaned from his sedation he reported bilateral painless vision loss, and bedside ophthalmological assessment identified a reduced visual acuity of 3/30 unaided in the left eye and counting fingers in the right. Dilated indirect ophthalmoscopy revealed inferotemporal optic disc oedema with splinter haemorrhages in the right eye and mild disc oedema, temporal pallor, and nerve fibre layer haemorrhages inferiorly in the left eye. Humphrey visual field 24 − 2 testing confirmed a severely constricted visual field with macular sparing on the right and depressed inferonasal vision with preserved peripheral vision on the left eye. OCT disc imaging shortly after diagnosis revealed bilateral disc swelling and flame haemorrhages in the right eye. Conclusions NAION is a devastating, but preventable complication of prone positioning, which may pose significant risk of vision loss in patients with COVID-19 related ARDS.

Diverse disease processes of group A Streptococcus infection including severe invasive infections among members of a family

2021 ◽  
Vol 14 (4) ◽  
pp. e241339
Author(s):  
Kaori Amari ◽  
Masaki Tago ◽  
Naoko E Katsuki ◽  
Shu-ichi Yamashita
Keyword(s):  
Septic Shock ◽  
Distress Syndrome ◽  
Clinical Course ◽  
Group A Streptococcus ◽  
Bloody Stool ◽  
Laryngeal Oedema ◽  
Invasive Infections ◽  
Group A ◽  
The Right ◽  
Close Contacts

We herein report three cases of group A Streptococcus (GAS) infection in a family. Patient 1, a 50-year-old woman, was transferred to our hospital in shock with acute respiratory distress syndrome, swelling in the right neck and erythemata on both lower extremities. She required intubation because of laryngeal oedema. At the same time, patient 2, a 48-year-old man, was admitted because of septic shock, pneumonia and a pulmonary abscess. Five days later, patient 3, a 91-year-old woman, visited our clinic with bloody stool. All three patients were cured by antibiotics, and GAS was detected by specimen cultures. During these patients’ clinical course, an 84-year-old woman was found dead at home after having been diagnosed with type A influenza. All four patients lived in the same apartment. The GAS genotypes detected in the first three patients were identical. When treating patients with GAS, appropriate management of close contacts is mandatory.

scholarly journals Right Ventricular Function in Acute Respiratory Distress Syndrome: Impact on Outcome, Respiratory Strategy and Use of Veno-Venous Extracorporeal Membrane Oxygenation

2022 ◽  
Vol 12 ◽  
Author(s):  
Matthieu Petit ◽  
Edouard Jullien ◽  
Antoine Vieillard-Baron
Keyword(s):  
Pulmonary Hypertension ◽  
Extracorporeal Membrane Oxygenation ◽  
Right Ventricle ◽  
Pulmonary Circulation ◽  
Distress Syndrome ◽  
Cor Pulmonale ◽  
Prone Positioning ◽  
Acute Cor Pulmonale ◽  
Membrane Oxygenation ◽  
The Right

Acute respiratory distress syndrome (ARDS) is characterized by protein-rich alveolar edema, reduced lung compliance and severe hypoxemia. Despite some evidence of improvements in mortality over recent decades, ARDS remains a major public health problem with 30% 28-day mortality in recent cohorts. Pulmonary vascular dysfunction is one of the pivot points of the pathophysiology of ARDS, resulting in a certain degree of pulmonary hypertension, higher levels of which are associated with morbidity and mortality. Pulmonary hypertension develops as a result of endothelial dysfunction, pulmonary vascular occlusion, increased vascular tone, extrinsic vessel occlusion, and vascular remodeling. This increase in right ventricular (RV) afterload causes uncoupling between the pulmonary circulation and RV function. Without any contractile reserve, the right ventricle has no adaptive reserve mechanism other than dilatation, which is responsible for left ventricular compression, leading to circulatory failure and worsening of oxygen delivery. This state, also called severe acute cor pulmonale (ACP), is responsible for excess mortality. Strategies designed to protect the pulmonary circulation and the right ventricle in ARDS should be the cornerstones of the care and support of patients with the severest disease, in order to improve prognosis, pending stronger evidence. Acute cor pulmonale is associated with higher driving pressure (≥18 cmH2O), hypercapnia (PaCO2 ≥ 48 mmHg), and hypoxemia (PaO2/FiO2 < 150 mmHg). RV protection should focus on these three preventable factors identified in the last decade. Prone positioning, the setting of positive end-expiratory pressure, and inhaled nitric oxide (INO) can also unload the right ventricle, restore better coupling between the right ventricle and the pulmonary circulation, and correct circulatory failure. When all these strategies are insufficient, extracorporeal membrane oxygenation (ECMO), which improves decarboxylation and oxygenation and enables ultra-protective ventilation by decreasing driving pressure, should be discussed in seeking better control of RV afterload. This review reports the pathophysiology of pulmonary hypertension in ARDS, describes right heart function, and proposes an RV protective approach, ranging from ventilatory settings and prone positioning to INO and selection of patients potentially eligible for veno-venous extracorporeal membrane oxygenation (VV ECMO).

‘Be Me’: I-Vampire/I-Zombie

2016 ◽  
Author(s):  
Stacey Abbott
Keyword(s):  
Point Of View ◽  
The Self ◽  
First Person ◽  
Film And Television ◽  
Cultural Anxiety ◽  
New Meanings ◽  
Byronic Hero ◽  
Narrative Format ◽  
The Right ◽  
Subsequent Rise

This chapter examines the adoption and development of the first person narrative format within vampire, and more recently zombie, film and television. It considers how this trope has contributed to the rise of the sympathetic/romantic vampire figure from the Byronic hero within Polidori’s The Vampyre to Interview with the Vampire and Byzantium and the subsequent rise of the sympathetic zombie. This chapter questions if this first person point of view empties the vampire and zombie of symbolic agency, or manipulates the genre to explore new meanings. It considers how the genres of the vampire and the zombie are increasingly interconnected, moving away from themes of apocalypse and cultural anxiety to explore questions of identity and the self within a changing world, effectively queering the vampire and zombie for new audiences.Case studies include Let the Right One In, Byzantium, Only Lovers Left Alive, Warm Bodies, Colin, and In the Flesh.

scholarly journals Targeting the Heme-Heme Oxygenase System to Prevent Severe Complications Following COVID-19 Infections

Antioxidants ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 540 ◽  
Author(s):  
Frank A. D. T. G. Wagener ◽  
Peter Pickkers ◽  
Stephen J. Peterson ◽  
Stephan Immenschuh ◽  
Nader G. Abraham
Keyword(s):  
Critically Ill ◽  
Heme Oxygenase ◽  
Heme Proteins ◽  
Distress Syndrome ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Proof Of Concept ◽  
Effector Molecules ◽  
Free Heme ◽  
Anti Inflammatory

SARS-CoV-2 is causing a pandemic resulting in high morbidity and mortality. COVID-19 patients suffering from acute respiratory distress syndrome (ARDS) are often critically ill and show lung injury and hemolysis. Heme is a prosthetic moiety crucial for the function of a wide variety of heme-proteins, including hemoglobin and cytochromes. However, injury-derived free heme promotes adhesion molecule expression, leukocyte recruitment, vascular permeabilization, platelet activation, complement activation, thrombosis, and fibrosis. Heme can be degraded by the anti-inflammatory enzyme heme oxygenase (HO) generating biliverdin/bilirubin, iron/ferritin, and carbon monoxide. We therefore postulate that free heme contributes to many of the inflammatory phenomena witnessed in critically ill COVID-19 patients, whilst induction of HO-1 or harnessing heme may provide protection. HO-activity not only degrades injurious heme, but its effector molecules possess also potent salutary anti-oxidative and anti-inflammatory properties. Until a vaccine against SARS-CoV-2 becomes available, we need to explore novel strategies to attenuate the pro-inflammatory, pro-thrombotic, and pro-fibrotic consequences of SARS-CoV-2 leading to morbidity and mortality. The heme-HO system represents an interesting target for novel “proof of concept” studies in the context of COVID-19.

scholarly journals Obesity inducing acute respiratory distress syndrome: we should choose the right population!

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Patrick M. Honore ◽  
Leonel Barreto Gutierrez ◽  
Sebastien Redant ◽  
Keitiane Kaefer ◽  
Andrea Gallerani ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
The Right
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