scholarly journals The Challenge of the Non-Compliant Patient: A Case of Caesarean Section Scar Ectopic Pregnancy

2021 ◽  
pp. 1-3
Author(s):  
Jessica Audet ◽  
Brittany Noel Robles ◽  
Nicolle M Arroyo Lluberas ◽  
Jessica Audet ◽  
Daniel Faustin ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Emergency Laparotomy ◽  
Pharmacological Management ◽  
Compliant Patient ◽  
Life Saving ◽  
Close Observation ◽  
Life Threatening ◽  
History Of ◽  
Ruptured Uterus

Ectopic pregnancy is a quite common and life-threatening pregnancy. The most common site of ectopic implantation of a fertilized embryo is the fallopian tube. In extremely rare situations, the embryo can implant in other locations, which makes the diagnosis and management even more complex. Although close observation of a new pregnancy is key in the diagnosis and treatment of an ectopic pregnancy, there is still a major risk of life-threatening outcomes. This is a case report of a 31-year-old patient with a history of multiple pregnancies who presented to a community hospital in the spring of 2021 with an ectopic caesarean scar pregnancy. A diagnosis of ectopic pregnancy was on a timely basis, and surgical management was advised. Upon refusal of treatment and admission, pharmacological management was initiated, but patient compliance challenged the success of the therapy. Patient non-compliance to close follow-up resulted in a ruptured uterus. Emergency laparotomy with supracervical hysterectomy was performed as a life-saving procedure.

scholarly journals Ruptured cornual ectopic pregnancy: a case report

2020 ◽  
Vol 9 (8) ◽  
pp. 3483
Author(s):  
Arti Sharma ◽  
Dipika Singh ◽  
Sarika Verma
Keyword(s):  
Case Report ◽  
Ectopic Pregnancy ◽  
Multidisciplinary Approach ◽  
Hemodynamic Instability ◽  
Emergency Laparotomy ◽  
New Delhi ◽  
Life Saving ◽  
Life Threatening ◽  
Ectopic Pregnancies ◽  
Labour Room

A cornual gestation is one of the most hazardous and life-threatening type of ectopic pregnancy with a mortality rate of 2-5 times higher than other ectopic pregnancies. Because of the myometrium stretch ability, they usually present late around 7-12 weeks of gestation. Thus, the diagnosis and treatment of such cases become challenging. In the case of ruptured cornual ectopic pregnancy, the patient usually presents with hemodynamic instability. Presenting a case report of a 28-year-old female who presented to the labour room of ESI hospital, Okhla, New Delhi at 12 weeks of pregnancy in a state of shock. A provisional diagnosis of ruptured cornual ectopic was made based on clinical examination and ultrasound report. Resuscitation followed by emergency laparotomy done as a life-saving procedure for the patient. Ruptured cornual ectopic needs urgent intervention and multidisciplinary approach. However, with the advancement and expertise in the field of radiology and early diagnosis can be made which can contribute towards more conservative management of such cases.

Coeliac crisis mimicking nephrotic syndrome in a post-partum patient

2019 ◽  
Vol 64 (3) ◽  
pp. 116-118
Author(s):  
Özant Helvacı ◽  
Seyma Yıldız ◽  
Berfu Korucu ◽  
Ulver Derici ◽  
Turgay Arinsoy
Keyword(s):  
Nephrotic Syndrome ◽  
Coeliac Disease ◽  
Post Partum ◽  
Lower Extremity Weakness ◽  
Case Presentation ◽  
Multisystem Involvement ◽  
Life Threatening ◽  
History Of ◽  
Rare Occasion

Background Coeliac crisis is a life-threatening presentation of coeliac disease. Severe diarrhoea, weight loss, electrolyte imbalances and malnutrition are prominent features. Although mainly a disease of childhood, it can on the rare occasion be diagnosed in adults. Case presentation A 25-year-old female with severe generalised oedema, lower extremity weakness, hypokalemia and profound hypoalbuminemia was referred with an initial diagnosis of nephrotic syndrome. Three months previously she had given birth to a healthy child following an uneventful pregnancy. She did not have proteinuria. She had a history of diarrhoea with gluten-containing food since childhood but lacked a formal diagnosis of coeliac disease. A duodenal biopsy confirmed the suspected diagnosis. Coeliac crisis was diagnosed with life-threatening multisystem involvement. Introduction of a gluten-free diet abolished all disease symptoms and ameliorated laboratory parameters at six months’ follow-up. Conclusion Coeliac crisis is a rare, yet dangerous presentation of coeliac disease in adults. As this case suggests, it can present with generalised oedema and hypoalbuminemia mimicking nephrotic syndrome. Rapid diagnosis is the key to successful treatment.

1175Structural progression increases the risk of ventricular arrhythmias in patients with arrhythmogenic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Chivulescu ◽  
Ø.H Lie ◽  
H Skulstad ◽  
B A Popescu ◽  
R O Jurcut ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Arrhythmias ◽  
Arrhythmogenic Cardiomyopathy ◽  
Cardioverter Defibrillator ◽  
Structural Progression ◽  
Life Threatening ◽  
Arrhythmic Event ◽  
History Of ◽  
Structural Disease

Abstract Background Arrhythmogenic cardiomyopathy (AC) is an inheritable cardiomyopathy with incomplete penetrance, variable phenotype severity and poorly described disease progression. It is characterized by high risk of life-threatening ventricular arrhythmias and sudden cardiac death in young individuals. Risk stratification and selection of patients presenting without history of life-threatening arrhythmic events for cardioverter-defibrillator implantation in primary prevention remains challenging. Purpose We aimed to assess the impact of disease progression on arrhythmic outcomes in AC patients. Methods We included consecutive AC probands and mutation-positive family members with at least one complete follow-up evaluation. Echocardiographic and electrical parameters were defined according to the 2010 Revised Task Force criteria at inclusion and at last follow-up. Structural progression was defined as development of new echocardiographic diagnostic criteria. Electrical progression was defined as the development of new diagnostic depolarization, repolarization and/or premature ventricular complex count criteria during follow-up. Non-sustained ventricular tachycardia or ventricular tachycardia occurring during follow-up defined incident ventricular arrhythmic events. Results We included a total of 144 patients (48% female, 47% probands, 40±16 years old). At inclusion, 54 patients (37%) had a history of arrhythmic events, 30 patients (21%) had overt structural disease and 114 (79%) had no or minor structural disease. During 7.0 (IQR: 4.5 to 9.4) years of follow-up, 49 patients (43%) with no or minor structural disease at inclusion developed new structural criteria being defined as progressors. Among 80 participants with no or minor structural disease and no arrhythmic history at inclusion, a first arrhythmic event occurred in 14 (17%). The incidence of arrhythmic events was higher in progressors (11/27, 41%) than in non-progressors (3/53, 6%) (p<0.001) (Figure). Structural progression was associated with higher risk of first arrhythmic events during follow-up when adjusted for sex, age at inclusion and follow-up duration, independent of electrical progression (7.6, 95% CI [1.5, 37.2], P=0.01). Incident arrhythmic events distribution Conclusion Almost half of patients without overt structural cardiac disease at genetic diagnosis develop new structural criteria during 7 years follow-up and 17% experienced their first ventricular arrhythmic event. Structural progression was independently associated with ventricular arrhythmic events during follow-up. These findings highlight the increased risk of arrhythmias when structural abnormalities are detected. Their finding may initiate the evaluation for primary prevention cardioverter-defibrillator implantation.

scholarly journals Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy

2020 ◽  
Vol 13 (1) ◽  
pp. e232904
Author(s):  
Robert Lyons ◽  
Granit Ismaili ◽  
Michael Devine ◽  
Haroon Malik
Keyword(s):  
Ct Scan ◽  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Rapunzel Syndrome ◽  
History Of

A 16-year-old girl with a background of childhood trichophagia presented with a 2-day history of epigastric pain and associated anorexia with vomiting. An epigastric mass was palpable on examination. A CT scan revealed an intragastric trichobezoar, extending into the duodenum consistent with Rapunzel syndrome with evidence of partial gastric outlet obstruction and a possible perforation. The patient underwent an urgent laparotomy and extraction of the trichobezoar. The bezoar was removed without complication and no intraoperative evidence of perforation was detected. After an uncomplicated postoperative recovery, she was discharged home with psychiatric follow-up.

The EMDR DeTUR protocol for the treatment of self-injury in a patient with severe personality disorder: a case report

2019 ◽  
Vol 5 (1) ◽  
pp. 27-38
Author(s):  
Phyllis Annesley ◽  
Adedayo Alabi ◽  
Laura Longdon
Keyword(s):  
Case Report ◽  
Factitious Disorder ◽  
Content Type ◽  
Self Injury ◽  
Life Threatening ◽  
History Of ◽  
Mental Health Difficulties ◽  
Healthcare Interventions ◽  
Therapy Sessions

Purpose The purpose of this paper is to describe the Eye movement desensitisation and reprocessing (EMDR) treatment of an adult female patient detained within a high secure hospital with complex mental health difficulties, including complex trauma, factitious disorder, self-injury and a history of offending. The EMDR treatment addressed the patient’s urges to engage in severe and sometimes life-threatening self-injury, a primary motive of which was to access physical healthcare interventions within a general hospital. The paper describes the wide-ranging benefits of the treatment and incorporates feedback from the patient and clinicians within her multi-disciplinary team (MDT). Design/methodology/approach Four triggers for self-injury were processed during the therapy using the DeTUR Protocol (Popky, 2005, 2009) and the Constant Installation of Present Orientation and Safety (CIPOS, Knipe, 2009a) method. In total, 18 one hour therapy sessions were delivered plus three follow-up sessions to continue to offer support and complete the post-treatment evaluation. Findings The level of urge for each trigger was reduced to 0 which the patient defined as “no urge to self-injure”. Benefits went well beyond self-injury with reported positive impacts on mood, thinking, sleep, concentration, memory and experience of flashbacks. Practical implications This case report demonstrates that the EMDR DeTUR Protocol together with the CIPOS method can be extremely valuable in the treatment of patients who self-injure. Originality/value The case report offers an important contribution to an area that requires much further research.

scholarly journals Broken metallic tracheostomy tube migrating into the tracheobronchial tree

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Nilam U. Sathe ◽  
Ratna Priya ◽  
Sheetal Shelke ◽  
Kartik Krishnan
Keyword(s):  
Foreign Body ◽  
Tracheostomy Tube ◽  
Main Bronchus ◽  
Tracheobronchial Tree ◽  
Life Saving ◽  
Wear And Tear ◽  
Life Threatening ◽  
History Of ◽  
The Right ◽  
Periodic Replacement

Foreign body aspiration can be a life-threatening emergency. Broken tracheostomy tube in tracheobronchial tree is one of the rarest types of foreign body reported. Here we report two cases of fracture of metallic tracheostomy tube, leading to foreign body in tracheobronchial tree. A 14-year-old girl presented to our Emergency Department with history of respiratory distress and violent bouts of cough since 2 days. Chest X-ray showed that the broken part of the tube was lodged in the right main bronchus. The presence of Parkinson’s disease in the patient and restricted neck flexion offered a challenge both for the anaesthetist and the surgeon. We were successful in removing the broken tube in 13 small pieces. Check bronchoscopy was clear and the procedure went uneventful. We would like to conclude that broken tracheostomy tube presenting as foreign body bronchus is infrequent but it is a preventable complication of tarcheostomy. The patient must be kept on regular follow up to check for signs of wear and tear. Timely and periodic replacement of tracehostomy tube should also be done, otherwise such life-saving surgery can become lifethreatening.

scholarly journals Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oluwatobi Onafowokan ◽  
Dabanjan Bandyopadhyay ◽  
Dale Johnson ◽  
Hugo J. R. Bonatti
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Late Complication ◽  
Abdominal Hernia ◽  
Emergency Laparotomy ◽  
Incisional Hernias ◽  
History Of ◽  
The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

scholarly journals Non-occlusive mesenteric ischaemia associated with anorexia nervosa

2019 ◽  
Vol 12 (5) ◽  
pp. e229703
Author(s):  
Takashi Sakamoto ◽  
Alan Kawarai Lefor ◽  
Tadao Kubota
Keyword(s):  
Anorexia Nervosa ◽  
Distal Ileum ◽  
Interdisciplinary Management ◽  
Emergency Laparotomy ◽  
Diffuse Peritonitis ◽  
Chronic Haemodialysis ◽  
Mesenteric Ischaemia ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of

Non-occlusive mesenteric ischaemia (NOMI) is a life-threatening condition that requires emergent intervention and anorexia nervosa is a chronic eating disorder that requires careful medical and nutritional management. A 54-year-old woman with a history of anorexia nervosa and undergoing chronic haemodialysis developed abdominal pain and called an ambulance. On arrival, she was in shock and abdominal examination was consistent with diffuse peritonitis. Computed tomography scan suggested ischaemia from the distal ileum to the ascending colon. Emergency laparotomy revealed NOMI from the distal ileum to the transverse colon. The treatment strategy included staged operations and careful medical management to optimise nutritional support and electrolyte management with survival of the patient. NOMI and anorexia nervosa are both difficult to manage. Meticulous interdisciplinary management can result in a good outcome.

scholarly journals Retroperitoneal Ectopic Pregnancy: Diagnosis and Therapeutic Challenges

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Salma Ouassour ◽  
Abdelhai Adib Filali ◽  
Mohamed Raiss ◽  
Rachid Bezad ◽  
Zakia Tazi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Ectopic Pregnancy ◽  
Management Strategy ◽  
Clinical Signs ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Life Threatening ◽  
History Of ◽  
Ectopic Pregnancies

Background. Retroperitoneal ectopic pregnancy is extremely rare. This unusual location represents a great challenge for clinicians due to the difficulties of diagnosis and high risk of life-threatening complications. Case Report. We report the case of a spontaneous early pregnancy of undetermined location in a patient with a history of previous laparoscopic surgery. Diagnosis steps using clinical examination, ultrasound, and magnetic resonance imaging led to the localization of the pregnancy, in the left side of the para-aortic region, in the retroperitoneal space. Conclusion. Retroperitoneal ectopic pregnancy is an uncommon entity with rather complex pathogenesis. Clinicians should carefully interpret clinical signs, biological findings, and imaging features and be aware of unusual locations such as the retroperitoneum for ectopic pregnancies. Early diagnosis and appropriate management strategy are conditio sine qua non for successful treatment outcomes.

scholarly journals Caesarean Scar Pregnancy - A Rare Case Report

2016 ◽  
Vol 27 (2) ◽  
pp. 83-86 ◽  
Author(s):  
Razia Sultana ◽  
Saiful Islam ◽  
Nurjahan
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Transvaginal Sonography ◽  
Emergency Laparotomy ◽  
Colour Doppler ◽  
Caesarean Scar ◽  
Incomplete Abortion ◽  
Rare Case Report ◽  
Life Threatening

Objective:The aim is to publish the case report of the rarely occurring and life threatening ectopic pregnancy developing in a Caesarean section scar causing uterine rupture.Methods and Results: This patient was diagnosed initially as a case of incomplete abortion. Other possible diagnoses were molar pregnancy, mass in the cervix. She was admitted in hospital for evacuation and curettage. During the procedure she developed severe pervaginal bleeding leading to hypovolumic shock. So decision was taken for emergency laparotomy. After opening the abdomen rupture was found in the lower uterine segment extending upto upper part of cervix. So hysterectomy was performed and histopathology confirmed the diagnosis of ectopic pregnancy that developed in a Caesarean section scar Analysis of the women’s obstetric history revealed that she had been previously operated because of breech presentation.Conclusion: Heightened awareness of the possibility of pregnancy in caesarean scar and early diagnosis by means of transvaginal sonography along with colour doppler can improve outcome and minimize the need for emergency extended surgeryBangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 83-86

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