scholarly journals Abdominal tuberculosis requiring surgical intervention: A 10-year single-center experience

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Hana Arbab ◽  
Nawal Khan ◽  
Farhana Amanullah ◽  
Lubna Samad
Keyword(s):  
Surgical Intervention ◽  
Early Recognition ◽  
Enterocutaneous Fistula ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
Abdominal Tuberculosis ◽  
High Morbidity ◽  
Single Center Experience ◽  
Threatening Condition ◽  
Emergency Surgical Intervention

Background: Although uncommon in children, abdominal tuberculosis (ATB) can be a life-threatening condition with a subset requiring emergency surgical intervention.  This study aims to determine the presentation, surgical procedures performed, and outcomes in children affected by abdominal tuberculosis. Methods: A retrospective chart review of all children undergoing surgical intervention for ATB from July 2007 to December 2018 was conducted. Data were analyzed using SPSS version 22. Results: Of 340 children with a diagnosis of ATB seen at the Indus Hospital’s TB clinic, 14 (4%) underwent laparotomy. Females were affected more commonly (57%), with a mean age at presentation of 11 years (range 8-14). Nine children required laparotomy for documented perforation, while 5 had an intestinal obstruction. Most children (n=10) had an established diagnosis of ATB before the surgical intervention; 2 children had completed 6–9 months anti-tuberculous treatment (ATT) courses, while 8 children had been on ATT for a mean period of 2.5 months at the time of developing acute surgical symptoms.  Diversion ileostomy was made in 64%.  Postoperative complications included sepsis (n=4), wound infection (n=3), abdominal collection (n=2), enterocutaneous fistula (n=2), and abdominal wound dehiscence requiring formal closure (n=2). There were 4 mortalities (29%); 10 patients were discharged after a median in-hospital stay of 12 days (range 6-35) of which 6 with ileostomies underwent reversal after completion of the ATT course. Conclusion: ATB has high morbidity and mortality. Perforation and obstruction can occur during or after the completion of ATT.  Management requires early recognition and surgical intervention as indicated.

scholarly journals Aortic Dissection and Renal Failure in a Patient with Severe Hypothyroidism

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Valerie Brooke ◽  
Sangeeta Goswami ◽  
Arpan Mohanty ◽  
Pashtoon Murtaza Kasi
Keyword(s):  
Renal Failure ◽  
Aortic Dissection ◽  
Early Recognition ◽  
False Lumen ◽  
Uncontrolled Hypertension ◽  
High Morbidity ◽  
Acute Type ◽  
Type B Dissection ◽  
Threatening Condition ◽  
Life Threatening

Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality. The most important recognized acquired cause that leads to dissection is chronic arterial hypertension. With respect to the anuria and renal failure, aortic dissection is not something that is always considered and is still not a very common presentation unless both renal arteries come off the false lumen of the dissection. However, when present, preoperative renal failure in patients with acute type B dissection has been noted to be an independent predictor of mortality. Early recognition and diagnosis is the key and as noted by previous studies as well, almost a third of these patients are initially worked up for other causes until later when they are diagnosed with aortic dissection. Here we present a case of a patient presenting with severe hypothyroidism, long-standing hypertension, and anuria. Through the case, we highlight the importance of having aortic dissection as an important differential in patients presenting with anuria who have a long standing history of uncontrolled hypertension. Pathophysiology relating to severe hypothyroidism-induced renal dysfunction is also discussed.

FA07.02: ESOPHAGEAL PERFORATION: A RETROSPECTIVE, SINGLE CENTER OUTCOMES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 13-14
Author(s):  
Balazs Kovacs ◽  
Takahiro Masuda ◽  
Ross Bremner ◽  
Michael Smith ◽  
Jasmine Huang ◽  
...  
Keyword(s):  
Esophageal Perforation ◽  
Surgical Intervention ◽  
Conflicts Of Interest ◽  
Retrospective Chart Review ◽  
Esophageal Resection ◽  
High Morbidity ◽  
Single Center ◽  
Tertiary Referral Hospital ◽  
Exclusion Criteria ◽  
Icu Stay

Abstract Background Esophageal perforation (EP) though uncommon has high morbidity and mortality. Aim of this study is to evaluate the outcomes at a tertiary referral hospital. Methods After IRB approval patients with EP between May 2014 and Sept 2017 were identified. Retrospective chart review was done to collect data. Exclusion criteria were: age under 18, leak following esophageal resection and esophageal stenting in previous year. Pittsburgh esophageal perforation severity score (PS) was calculated for each patient. Results During study period 56 patients (70% men) with EP met inclusion and exclusion criteria with a mean age and BMI of 60 Yrs. 27.1 kg/m2 respectively. Most common causes were iatrogenic (43%) and Boerhaave's (21%). Nearly 3/4th patients presented to the hospital within 24h of onset. The site of perforation was thoracic (67.9%), cervical (16.1%) and abdominal (16.1%). Overall mortality within 1 month was 5.7% (3 cases) compared to predicted (5.8 cases, 10.4%) based on Pittsburgh score (P > 0.05). See Table 1 for PS at presentation, management and ICU stay. Conclusion In our single center experience the leading cause of EP are iatrogenic injury and Boerhaave's syndrome. PS correlated well with need for aggressive surgical intervention and length of ICU stay. Use of endoluminal stents was higher than previously reported. Stents with or without additional surgical intervention can be a viable option in a subset of patients. Disclosure All authors have declared no conflicts of interest.

Stump Resections Resulting from Incomplete Operations

2007 ◽  
Vol 73 (1) ◽  
pp. 75-78
Author(s):  
Taner Yigit ◽  
Oner Mentes ◽  
Mehmet Eryilmaz ◽  
Mujdat Balkan ◽  
Ali Ihsan Uzar ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Surgical Intervention ◽  
Enterocutaneous Fistula ◽  
Delayed Diagnosis ◽  
Clinical Event ◽  
Incomplete Resection ◽  
Abdominal Symptoms ◽  
Abdominal Exploration ◽  
History Of ◽  
Emergency Surgical Intervention

Stump viscera caused by an incomplete operation can present the same symptoms as before the first operation. Furthermore, as an acute clinical event, these incomplete resections may sometimes cause acute abdomen and may need emergency surgical intervention. A 34-year-old woman with a history of laparoscopic cholecystectomy 5 days before was admitted with acute abdominal symptoms. Abdominal exploration revealed that she had undergone incomplete resection of the gallbladder. Another patient, a 21-year-old man, was admitted with complaints of fluid drainage from his appendectomy incision scar. He was diagnosed as having enterocutaneous fistula. Abdominal exploration revealed a stump appendix fistulizing to the abdominal wall. The third patient was a 32-year-old man with an appendectomy scar who was admitted with complaints of acute appendicitis. The patient was diagnosed as having acute appendicitis and underwent an appendectomy. A stump appendix was removed during the operation. Surgeons should be aware of stump pathologies and keep in mind a possible incomplete operation to prevent delayed diagnosis and treatment.

Fascicular torsions of the anterior and posterior interosseous nerve in 4 cases: neuroimaging methods to improve diagnosis

2020 ◽  
Vol 132 (6) ◽  
pp. 1925-1929 ◽  
Author(s):  
Jennifer Kollmer ◽  
Paul Preisser ◽  
Martin Bendszus ◽  
Henrich Kele
Keyword(s):  
Magnetic Resonance ◽  
Surgical Intervention ◽  
Case Series ◽  
Diagnostic Methods ◽  
Posterior Interosseous Nerve ◽  
Nerve Ultrasound ◽  
Magnetic Resonance Neurography ◽  
Surgical Exploration ◽  
Hyperintense Signal ◽  
Emergency Surgical Intervention

Diagnosis of spontaneous fascicular nerve torsions is difficult and often delayed until surgical exploration is performed. This case series raises awareness of peripheral nerve torsions and will facilitate an earlier diagnosis by using nerve ultrasound (NUS) and magnetic resonance neurography (MRN). Four patients with previously ambiguous upper-extremity mononeuropathies underwent NUS and 3T MRN. Neuroimaging detected proximal torsions of the anterior and posterior interosseous nerve fascicles within median or radial nerve trunks in all patients. In NUS, most cases presented with a thickening of affected nerve fascicles, followed by an abrupt caliber decrease, leading to the pathognomonic sausage-like configuration. MRN showed T2-weighted hyperintense signal alterations of fascicles at and distal to the torsion site, and directly visualized the distorted nerves. Three patients had favorable outcomes after being transferred to emergency surgical intervention, while 1 patient with existing chronic muscle atrophy was no longer eligible for surgery. NUS and MRN are complementary diagnostic methods, and both can detect nerve torsions on a fascicular level. Neuroimaging is indispensable for diagnosing fascicular nerve torsions, and should be applied in all unclear cases of mononeuropathy to determine the diagnosis and if necessary, to guide surgical therapies, as only timely interventions enable favorable outcomes.

scholarly journals Heterotopic caval valve implantation for the management of severe tricuspid regurgitation: a case series

2020 ◽  
Author(s):  
Aidan Sharkey ◽  
Ronny Munoz Acuna ◽  
Kiran Belani ◽  
Ravi K Sharma ◽  
Omar Chaudhary ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Tricuspid Regurgitation ◽  
Surgical Intervention ◽  
Symptom Relief ◽  
Vena Cava ◽  
Case Series ◽  
High Morbidity ◽  
Severe Tricuspid Regurgitation ◽  
Maximal Medical Therapy ◽  
Valve Implantation

Abstract Background Severe tricuspid regurgitation (TR) is a complex condition that can be difficult to treat medically, and often surgical intervention is prohibited due to the high morbidity and mortality associated with this intervention. In patients who have failed maximal medical therapy and have progressive symptoms related to their severe TR, heterotopic caval valve implantation (CAVI) offers potential for symptom relief for these patients. Case summary We present two cases of patients with severe TR with symptoms of heart failure that were refractory to medical therapy. Due to extensive comorbidities in these patient’s surgical intervention was deemed unsuitable and the decision was made to proceed with heterotopic CAVI in order to try and control their symptoms. Both patients successfully underwent the procedure and had an Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) implanted in the inferior vena cava/right atrium junction. In both patients, there was improvement in the postoperative haemodynamics as measured by invasive and non-invasive methods. Successful discharge was achieved in both patients with improvement in their symptoms. Discussion Selective use of heterotopic CAVI to treat symptomatic severe TR that is refractory to medical therapy may be a viable option to improve symptoms in those patients that are unsuitable for surgical intervention.

EMERGENCY SURGERY DURING COVID 19 AT K.A.P.V GOVERNMENT MEDICAL COLLEGE AND MGMGH , TRICHY

2021 ◽  
pp. 6-9
Author(s):  
Sumathi Ravikumar ◽  
Yeganathan Rajappan ◽  
Durairajan Vaithiyanathan ◽  
Catherine Sindhuja
Keyword(s):  
Surgical Intervention ◽  
District General Hospital ◽  
Favourable Outcome ◽  
Emergency General Surgery ◽  
Emergency Admissions ◽  
Medical College ◽  
Prolonged Duration ◽  
Current Impact ◽  
Emergency Surgical Intervention ◽  
The Impact

COVID 19 pandemic was declared by WHO as public health emergency on January 30,2020. Health system was reorganised with the aim to cope with the new disease and maintain essential health service. Many patients suffered from ARDS which lead to the modication of clinical and surgical activity. Current impact of COVID 19 outbreak on emergency surgical practice is still not developed. Varied presentation, diagnostic uncertainity, lack of guidelines present challenges to surgeons. AIM: The aim of our study was to evaluate the impact of the COVID-19 pandemic on emergency general surgery admissions and operations in our institution METHODS: We conducted a retrospective study in K.A.P.V.G.M.C. and M.G.M.G.H., Trichy from march 2020 to December 2020. All general surgical emergency admissions to KAPVGMC and MGMGH, district general hospital were included from march to December 2020.The details of diagnosis and subsequent management were retrieved from records. CONCLUSION: It was observed thatclinical decisions were made based on urgency of each case while simultaneously evaluating their COVID 19 status. The number of surgicalcases during COVID 19 period were signicantly reduced. Recognising asymptomatic carriers and need of emergency surgical intervention were the challenges faced by the surgeons. Effective communication between microbiologist, radiologist, anaesthetist and surgeon was necessary to attain a favourable outcome. .Inspite of challenges faced 80% had postoperative uneventful period other than prolonged duration of stay and were discharged and followed up. Covid 19 pneumonia and ARDS attributed to majority of death among the 20 % of deceased , other than septicemia

177Lu-dotatate use in chronic kidney disease patients: A single center experience

2021 ◽  
Vol 5 (3) ◽  
pp. 162-171
Author(s):  
Sandhya Manohar ◽  
Panagiotis Kompotiatis ◽  
Thorvardur R Halfdanarson ◽  
Timothy J Hobday ◽  
Matthew Thorpe ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Peptide Receptor Radionuclide Therapy ◽  
Retrospective Chart Review ◽  
Drug Dose ◽  
Hematological Toxicity ◽  
Close Monitoring ◽  
Novel Therapy ◽  
Single Center Experience ◽  
Safety Studies ◽  
Long Term Impact

Background: Peptide receptor radionuclide therapy with 177Lu-dotatate is a novel therapy for metastatic neuroendocrine cancers. It undergoes reabsorption at the proximal tubule; after the breakdown of the peptide fragment, 177Lu is retained and continues its decay process exposing the nephron to continuous low dose radiation. Pivotal NETTER-1 trial did not include patients with eGFR <50 and so its effects in CKD patients is not known. Methods: We performed a retrospective chart review of all consecutive adult patients that received 177Lu-dotatate over 1 year at Mayo Clinic, Rochester. We analyzed renal and hematological laboratory data obtained prior to each of four treatment cycles and at 3- and 6-month post completion of all treatment. We defined CKD as eGFR <60 ml/min and AKI as creatinine increase of ⩾0.3 from baseline by AKIN criteria. Results: Overall 86 patients were included in the study with 39 (45%) with known CKD. About three patients had CKD, four with eGFR of 20–30 ml/min. About 4 (4.6%) patients had AKI and the predominant cause being hypotension. Among the CKD patients the average eGFR improved after the first cycle of PRRT therapy from baseline of 49 (13) to 53.5 (17) ml/min ( p = 0.01) with no significant decline of renal function noted at 3- and 6-months post treatment follow up. Rate of thrombocytopenia and leukopenia were significantly more in the CKD patients starting even after single treatment. No drug dose correlation was noted. Conclusion: Patients with CKD are at a higher risk of hematological toxicity especially with thrombocytopenia and require close monitoring and ongoing dose adjustment. Ongoing safety studies to assess the long-term impact of 177Lu-dotatate on the kidney are needed.

Timing of Surgical Intervention in Patients with Pituitary Apoplexy and Cranial Nerves Deficits: Single-Center Experience

2021 ◽  
Author(s):  
Mohammad Alahmari ◽  
Shaun Kilty ◽  
Andrea Lasso ◽  
Fatmahalzahra Banaz ◽  
Sepideh Mohajeri ◽  
...  
Keyword(s):  
Pituitary Apoplexy ◽  
Surgical Intervention ◽  
Cranial Nerves ◽  
Single Center ◽  
Single Center Experience

scholarly journals Emergency Surgical Intervention by Mobile Surgical Team in the NICU

2014 ◽  
Vol 04 (02) ◽  
pp. 162-168
Author(s):  
R.-B. Trobs ◽  
A. Stein ◽  
U. Felderhoff ◽  
L. Hanssler
Keyword(s):  
Surgical Intervention ◽  
Surgical Team ◽  
Emergency Surgical Intervention

scholarly journals A prospective study on appendicular mass

2021 ◽  
Vol 8 (4) ◽  
pp. 1114
Author(s):  
K. Ravichandran ◽  
R. Jayaraman ◽  
K. Nithya
Keyword(s):  
Prospective Study ◽  
Conservative Management ◽  
Enterocutaneous Fistula ◽  
Wound Dehiscence ◽  
Final Diagnosis ◽  
College Hospital ◽  
Duration Of Surgery ◽  
Interval Appendicectomy ◽  
A Prospective Study ◽  
Appendicular Mass

Background: The immediate management of appendicular mass have always been controversial. Early appendicectomy (within 72 hours of presentation) is preferred in some cases, while in others non operative conservative management is advocated. Usually successful conservative management (Ochsner Sherren regimen) is followed by interval appendicectomy (6-8 weeks later). This study determines the outcome of different modalities of intervention in patients with appendicular mass.Methods: A prospective study was conducted in Rajah Muthiah medical college hospital in department of general surgery from June 2018 to December 2020, in cases diagnosed to have appendicular mass. A total of 116 patients were included. After taking detailed history and clinical examination, relevant blood and radiological investigations, were done to achieve the final diagnosis. Presentation, examination findings, investigations, type of surgery, duration of surgery, post-operative complications and duration of hospital stay were studied. Data was collected, compiled, tabulated and analysed.Results: Conservative management followed by interval appendicectomy had lesser incidence of complications like Intraoperative adhesions, surgical site infection, wound dehiscence and enterocutaneous fistula. It also had relatively lesser operative time and lesser period of hospital stay.Conclusions: On comparing the different modalities of intervention, conservative management followed by interval appendicectomy is quite effective and safe method of treatment, with less operative difficulties and better outcome.

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