scholarly journals An Innovative Technique to Repair Cervical Oesophageal Perforation using Oro-oesophageal Tube and AMBU

2019 ◽  
Vol 27 (2) ◽  
pp. 171-175 ◽  
Author(s):  
Manish Gupta ◽  
Ginni Datta
Keyword(s):  
Primary Closure ◽  
Rare Condition ◽  
Late Presentation ◽  
Morbidity And Mortality ◽  
Oesophageal Perforation ◽  
High Morbidity ◽  
Cervical Oesophagus ◽  
Delay In Diagnosis ◽  
Upper Thoracic ◽  
Thoracic Oesophagus

Introduction Oesophageal perforation is a rare condition and has high morbidity and mortality. Both the morbidity and mortality are directly related to the delay in diagnosis and start of treatment. Primary closure with drainage is recommended if perforation is detected in less than 24 hours. Treatment for delayed or missed rupture of oesophagus is not very clear and is controversial. Case Report We hereby report a case of delayed diagnosed cervical oesophagus rupture following gunshot, which was primarily repaired. Special emphasis is on newer technique of fistula localization using oro-oesophageal tube and AMBU for better closure. The fistula closure was successful and no there were no post-operative complications. Discussion The symptoms and signs on presentation of patient of cervical oesophagus perforation are discussed along with the differing treatment paradigms for early versus late presentation. Surgical repair with primary closure may be undertaken, even in late presentation of oesophagus rupture. This technique of oro-oesophageal tube used along with AMBU, may be useful in cases of both cervical and upper thoracic oesophagus rupture. 

scholarly journals Anesthetic Management and Perioperative Events of Peripartum Cardiomyopathy during Cesarean Delivery a Series of Five Cases

2018 ◽  
Vol 03 (02/03) ◽  
pp. 198-203
Author(s):  
Sree Rama Mellacheruvu ◽  
Kousalya Chakravarthy ◽  
Khaliq Ahmed
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
Case Reports ◽  
Anesthetic Management ◽  
Rare Condition ◽  
Late Pregnancy ◽  
Postoperative Management ◽  
Peripartum Cardiomyopathy ◽  
Morbidity And Mortality ◽  
High Morbidity

AbstractPeripartum cardiomyopathy (PPCM) is a rare idiopathic cardiomyopathy having an incidence of less than 0.1%. PPCM is associated with high morbidity and mortality rates ranging from 5 to 32%. In this review, the authors report a series of five PPCM cases. The case reports included pregnant women with PPCM, admitted in the hospital from October 1, 2017 to June 1, 2018 over a period of 9 months who required cesarean section. The authors aim to discuss the presentation, optimization, anesthetic management, and postoperative care of this rare condition. One of the cases was a booked case. The remaining four pregnant patients were referred in late pregnancy with features of congestive cardiac failure. One patient was in acute pulmonary edema, required intubation, and subsequently had cesarean section under general anesthesia. Four patients were managed with incremental epidural anesthesia. The need for proper preoperative optimization and intra- and postoperative management was discussed. The authors had one maternal mortality in our series. There was no neonatal mortality. Early diagnosis of PPCM, prompt treatment of heart failure, planning the delivery, and postpartum care can decrease maternal morbidity and mortality. Incremental epidural dosing can be used for cesarean section and has the advantage of stable hemodynamic status without the risks associated with general anesthesia.

scholarly journals Presentation and Outcome of Acute Limb Ischaemia

2019 ◽  
Vol 14 (1) ◽  
pp. 59-61
Author(s):  
Md Humayun Kabir ◽  
Munshi Md Mojibur Rahman ◽  
AKM Musa Khan ◽  
Alamgir Rashid Chowdhury ◽  
AT Shahrier Ahmed
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Armed Forces ◽  
Late Presentation ◽  
Morbidity And Mortality ◽  
Military Hospital ◽  
High Morbidity ◽  
Limb Ischaemia ◽  
Acute Limb Ischaemia ◽  
Co Morbidity

Introduction: Outcome of acute limb ischaemia (ALI) is depends on the timely intervention. Delayed reperfusion of acute occlusive limb ischemia causes local and systemic serious consequences and is the main cause of morbidity and mortality in these patients. Objective: To identify the factors impeding the management and outcome of ALI in a tertiary level hospital. Materials and Methods: This cross sectional study evaluated reporting time and management of 42 patients with ALI between Jan 2016 to Jan 2018 in Combined Military Hospital Dhaka. Late presentation of ALI is defined as reporting of patient after 72 hours of symptoms. Time of presentation, Grades of ischemia, co-morbidities, morbidities and mortality were recorded. Results: During the study period, 42 patients were included, 25 female (59.5%) and 17 male (40.5%). Average age was 63 years (30 years – 87 years). 38 (90%) patients with lower limb ischaemia and 4 (10%) patients with upper limb ischaemia. 2 patients (4.7%) reported within 6 hours of symptom, 6 patients (14.3%) presented within 24 hours, 11 patients (26.3%) within 72 hours and 23 patients (54.7%) after 72 hours. On admission, 16 patients had grade III ischemia, 18 had grade IIb, 8 had grade IIa. 12 patients died (28.5%) and 19 (45%) patients had amputation. The risk factors of amputation were grade of ischemia, extremity (lower limb 45% vs. Upper limb 0%), age and co-morbidity. Conclusion: Late presentation of acute occlusive ischemia carries high morbidity and mortality. Lack of awareness and Negligence of symptoms delay the reporting time to hospital. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 59-61

scholarly journals First UK experience of endoscopic vacuum therapy for the management of oesophageal perforations and postoperative leaks

2019 ◽  
Vol 10 (2) ◽  
pp. 200-203 ◽  
Author(s):  
Alaa Alakkari ◽  
Ruchit Sood ◽  
Simon M Everett ◽  
Bjorn J Rembacken ◽  
Jeremy Hayden ◽  
...  
Keyword(s):  
Jejunal Interposition ◽  
The Other ◽  
Morbidity And Mortality ◽  
Oesophageal Perforation ◽  
Vacuum Therapy ◽  
High Morbidity ◽  
Novel Treatment ◽  
Endoscopic Vacuum Therapy ◽  
British Experience ◽  
The Uk

Oesophageal perforations and anastomotic leaks are associated with high morbidity and mortality. Endoscopic vacuum therapy (EVT) is a promising novel treatment that promotes healing and avoids sepsis. There are no data reporting its use in the UK. We report the first British experience of EVT in two elderly frail patients. Two patients were treated in our institution with EVT using Eso-SPONGE®. One patient had spontaneous oesophageal perforation and the other had anastomotic leakage post-Merendino oesophageal reconstruction (oesophagogastric continuity with jejunal interposition anastomosis). Both patients were over 65 years of age. One patient had 13 endoscopic Eso-SPONGE® exchanges over 8 weeks, while the other one had 6 exchanges over 4 weeks. Complete resolution of oesophageal leakage was achieved in both cases. EVT should be considered in the management of patients with oesophageal perforations and postoperative leaks. This novel therapeutic intervention has the potential to significantly reduce morbidity and mortality in these patients.

scholarly journals Medical Management of Cervical Ectopic Pregnancy

2016 ◽  
Vol 22 (2) ◽  
Author(s):  
Wasima Arif ◽  
Farrah Mukhtar ◽  
Iffat Naheed ◽  
Farhat Naz
Keyword(s):  
Ectopic Pregnancy ◽  
Medical Management ◽  
Rare Condition ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Peripheral Hospital ◽  
Endocervical Canal ◽  
Ectopic Pregnancies ◽  
Nulliparous Female ◽  
Cervical Ectopic Pregnancy

Cervical ectopic pregnancy is a rare condition with implantation in the endocervical canal below the closed internal os. It accounts for less than 1% of all ectopic pregnancies. It is associated with high morbidity and mortality. A case of cervical ectopic pregnancy is reported. She was a young nulliparous female, timely referred from peripheral hospital. She was treated successfully with medical management and thus fertility was preserved

scholarly journals Femoral Hernia: Epidemiology and challenges of management in a sub-saharan African Country

2020 ◽  
Vol 11 (6) ◽  
pp. 77-83
Author(s):  
Aloysius Ugwu-Olisa Ogbuanya ◽  
Fabian Ugonna Olisa ◽  
Richard Lawrence Ewah ◽  
Obinna Nweke ◽  
Nonyelum Benedett Ugwu
Keyword(s):  
Femoral Hernia ◽  
African Country ◽  
Late Presentation ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
High Propensity ◽  
Emergency Group ◽  
Missed Diagnosis ◽  
Sub Saharan ◽  
Diagnostic Pitfalls

Background: Femoral hernia is peculiar due to its high propensity towards strangulation, high rates of diagnostic pitfalls and occurrence in older patients with multiple comorbidities. Therefore, an updated record of the clinical characteristics and burden of the disease in our locality should be established. Aims and Objectives: This study aimed to document the challenges of diagnosis and outcome of repair of femoral hernia in southeast Nigeria. Materials and Methods: This was a multi-centre retrospective study of adult patients with femoral hernias repaired surgically over twelveyears period. Tests of statistical significances were done. Results: A total of 128 patients were studied and they represented 3.4% and 2.6% of all patients with groin and abdominal wall hernias respectively. There were 116 females and 12 males. The overall rate of missed diagnosis was 14.8%; majority (84.2%) were in the emergency arm. Eighty-one (63.4%) patients presented emergently while 47 (36.7%) were managed electively. In the emergency group, the vast majority (72, 88.9%) presented beyond 24hours from onset of complications. Still on the emergency group, 72 (88.9%) were strangulated, seven (8.6%) were obstructed and 2 (2.5%) were incarcerated at presentation. Overall resection rate was 39.8%, but in the emergency group, it was 63.0%. Prosthetic meshes were used in only 4 (8.5%) of the 47 elective cases. Recurrence rate was Overall morbidity and mortality rates were 43.0% and 10.9% respectively. Late presentation was an independent predictor of mortality (p=0.000). Conclusion: Thoughfemoral hernias are relatively uncommon, the rate of missed diagnosis is high, majority of which occur in the emergency group. Majority presented in emergency and have high propensity towards strangulation with attendant high morbidity and mortality.

834 ENDOSCOPIC VACUUM THERAPY IN THE MANAGEMENT OF OESOPHAGEAL PERFORATIONS AND POST-OPERATIVE LEAKS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
S Mastoridis ◽  
A Zanna ◽  
R Owen ◽  
S Antonowicz ◽  
B Sgromo
Keyword(s):  
Morbidity And Mortality ◽  
Oesophageal Perforation ◽  
Vacuum Therapy ◽  
High Morbidity ◽  
Reactive Protein ◽  
Video Recordings ◽  
Oesophageal Wall ◽  
Patient Consent ◽  
Endoscopic Vacuum Therapy ◽  
The Uk

Abstract   Oesophageal perforations and post-oesophagectomy anastomotic leaks are associated with high morbidity and mortality. Endoscopic vacuum therapy (EVT) is a novel treatment strategy with the potential to promote healing and ameliorate sepsis. Few instances of the use of EVT have been reported in the UK, wioth only two cases published outside our centre representing a limited aetiological and demographic spectrum. Methods From May 2019 to November 2020 8 patients aged 27–85 years underwent EVT for disparate oesophageal wall defects. Data regarding technical success and feasibility were analysed. Video recordings of procedures were undertaken with patient consent. Results Complete defect resolution was achieved in cases (87%), requiring median of 13 days of treatment (range 6–23), and necessitating 3 replacement procedures (range 1–4). Significant improvement in C-reactive protein was achieved in all patients undergoing treatment (P = 0.015). Over an average follow up of 360 days, no severe complications resulted directly from sponge placement, however 2 individuals (25%) developed oesophageal stricture necessitating endoscopic balloon dilatation, and one died whilst undergoing treatment. Conclusion Here we provide a video demonstration of the application of EVT in patients with oesophageal perforation or post-operative leak. Our data demonstrate this approach to be a safe, valuable tool for the management of a spectrum of oesophageal wall defects, with the potential to reduce associated morbidity and mortality in selected patients. Video Video of safe application of EVT. https://www.dropbox.com/s/rgypt6o1z93iui5/EVT.mp4?dl=0.

Management of oesophageal anastomosis dehiscence after oesophagectomy for oesophageal cancer

2020 ◽  
Vol 99 (5) ◽  
pp. 200-206
Keyword(s):  
Oesophageal Cancer ◽  
Surgical Procedure ◽  
Anastomotic Dehiscence ◽  
Gastric Conduit ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Therapeutic Algorithm

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

Laparoscopic repair of internal hernia with late presentation and primary closure of the mesocolic defect – video correspondence

2021 ◽  
Author(s):  
Roberto Peltrini ◽  
Nello Pirozzi ◽  
Mariangela Ilardi ◽  
Umberto Bracale ◽  
Francesco Corcione
Keyword(s):  
Laparoscopic Repair ◽  
Internal Hernia ◽  
Primary Closure ◽  
Late Presentation

scholarly journals Pneumocephalus Following Self-Inflicted Penetrating Brain Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Che-Fang Ho ◽  
Yuan-Yun Tam ◽  
Chia-Chen Wu
Keyword(s):  
Rare Complication ◽  
Bed Rest ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Adequate Treatment ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Intravenous Antibiotics ◽  
Computed Tomography Scans ◽  
Intravenous Hydration ◽  
Prompt Diagnosis

Objective. Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality. Material and Method. We present the case of a 42-year-old healthy man who injured himself when he stuck a metal stick into his left nasal cavity to relieve prolonged nasal obstruction. Immediate cerebrospinal fluid rhinorrhea and subsequent meningitis and pneumocephalus occurred later. He was presented at our hospital with fever and meningeal signs. Result. Computed tomography scans revealed left rhinosinusitis and air collection in the subarachnoid space. The patient received the conservative treatment of bed rest, intravenous hydration, head elevation, and broad-spectrum intravenous antibiotics. Pneumocephalus and meningitis resolved without any surgery, and he experienced no other sequela or complication. Conclusion. Pneumocephalus is a rare incidence and can lead to high morbidity and mortality. Prompt diagnosis and adequate treatment of pneumocephalus and meningitis proved beneficial for our patient who recovered without any complication or surgery.

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