When is CT with rectal contrast indicated in patients suspected with anastomotic leak?

2021 ◽  
Vol 1 (1) ◽  
pp. e31
Author(s):  
Sathyaseelan Arumugam ◽  
Emily Leivers ◽  
Ishmael Chasi
Keyword(s):  
Case Report ◽  
Anastomotic Leak ◽  
Contrast Enema ◽  
Computerised Tomography ◽  
Low Threshold ◽  
No Gold Standard ◽  
Colorectal Resections ◽  
Difficult Cases ◽  
Standard Investigation ◽  
Failure To Progress

There is no clear guidance about the use of intraluminal rectal contrast combined with computerised tomography (CT) scan when assessing for anastomotic leak (AL) following colorectal resections. ALs most commonly manifest after post-operative day 5, presenting with fevers, abdominal pain, tachycardia and rising inflammatory markers. However, some patients with AL also present with subtle symptoms and failure to progress. CT with or without luminal contrast is the most commonly used investigation for diagnosis; however, there is no consensus on the best protocol. This case report highlights a need for having criteria, which include intra- and post-operative pointers when having a luminal contrast may aid diagnosis, in difficult cases. Studies show that routine contrast enema is not recommended, and furthermore, no gold standard investigation is available. This case report explores the need for a low threshold to use rectal contrast in CT in cases of prolonged ileus.

scholarly journals Esophagojejunal anastomotic leak managed with self expandable metallic stent

2013 ◽  
Vol 04 (01) ◽  
pp. 013-015
Author(s):  
Arvind Madurandagam Annapillai ◽  
Biggs Saravanan Ramachandran ◽  
Senthilkumar Ponniah ◽  
Hemamala V. ◽  
Kesavan B. ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Case Report ◽  
Anastomotic Leak ◽  
Total Gastrectomy ◽  
Clinical Situation ◽  
Metallic Stent ◽  
Viable Option ◽  
Expandable Metallic Stent ◽  
Difficult Cases ◽  
Respiratory Embarrassment

ABSTRACTEsophagealjejunal anastomotic leak after gastrectomy is a serious surgical emergency with high mortality. This report describes a 57-year-old male with esophagojejunal anastomotic leak following total gastrectomy for gastric cancer and was managed successfully with self-expandable metallic stent. To our knowledge this is the first such report from India. This case report highlights the need of interdisciplinary coordination in managing this difficult clinical situation. Endotherapy with self-expandable metallic stent (SEM) provided twin benefits of improving respiratory embarrassment and the joy of eating. Therapy of such difficult cases must be individualized; however, and SEM stent usage is a viable option (J Dig Endcsc 2013;4(1):13–15)

scholarly journals Mesenteroaxial Gastric Volvulus: A Case Report

2021 ◽  
Vol 59 (237) ◽  
Author(s):  
Sampanna Pandey ◽  
Madhav Paudel ◽  
Anuj Parajuli ◽  
Roshan Ghimire ◽  
Asmita Neupane
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Primary Repair ◽  
Wedge Resection ◽  
Gastric Volvulus ◽  
Exploratory Laparotomy ◽  
Uneventful Recovery ◽  
Atypical Presentation ◽  
Surgical Exploration ◽  
Low Threshold

Gastric volvulus is defined as an abnormal rotation of the stomach. Classical textbook presentation may not always be present. Meticulous assessment and broadened differential diagnosis are thus crucial. Various types have been described in literature. Low threshold for detection with aggressive resuscitation and immediate surgical exploration on suspected incarceration or perforation are mandatory. We report a case of 16-years-female who had atypical presentation of mesenteroaxial gastric volvulus. Emergency exploratory laparotomy with wedge resection and primary repair of stomach with anterolateral gastropexy was performed. She had uneventful recovery with discharge on fifth postoperative day.

scholarly journals Pneumomediastinum, subcutaneous emphysema and pneumorrhachis following cocaine insufflation: a case report

2020 ◽  
Vol 19 (3) ◽  
pp. 154-158
Author(s):  
Jill Burns ◽  
◽  
Allen Roby ◽  
Tom Jaconelli ◽  
◽  
...  
Keyword(s):  
Case Report ◽  
Subcutaneous Emphysema ◽  
Illicit Drug ◽  
Plain Radiograph ◽  
Posterior Mediastinum ◽  
Valsalva Manoeuvre ◽  
Computerised Tomography ◽  
Coronary Syndrome ◽  
Rapid Absorption ◽  
The Uk

A case report on a 36-year-old male patient presenting to the emergency department (ED) with chest tightness, nasal sounding voice and subcutaneous emphysema 72 hours after the nasal insufflation of approximately 0.5g of cocaine. A plain radiograph of the chest demonstrated an extensive pneumomediastinum with subcutaneous emphysema extending into his neck. A computerised tomography (CT) scan confirmed the above findings, along with a pneumorrhachis of the thoracic spine. He was admitted locally for further investigation and observation. Cocaine is the second most used illicit drug in the UK. The associated complications of cocaine can vary from acute coronary syndrome to acute psychosis. Pulmonological trauma secondary to cocaine misuse is commonly associated with inhalation of cocaine; we present this rare case of subcutaneous emphysema, pneumomediastinum and pneumorrhachis secondary to nasal insufflation. It is believed that deep nasal insufflation of cocaine is followed by forceful Valsalva manoeuvre, which allows for the rapid absorption of the drug and increases the euphoric effect. This forceful inhalation can lead to barotrauma and leakage of air into the posterior mediastinum.

scholarly journals Ataxia and Encephalitis in a Young Adult with EBV Mononucleosis: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Rashid S. Hussain ◽  
Naaz A. Hussain
Keyword(s):  
Case Report ◽  
Neurological Manifestations ◽  
Postconcussion Syndrome ◽  
Neurological Sequelae ◽  
Appropriate Treatment ◽  
Symptomatic Management ◽  
Low Threshold ◽  
Acute Infectious Mononucleosis ◽  
Acute Changes ◽  
Recommended Therapy

Neurological manifestations of mononucleosis are extremely rare, occurring in about 1% of all cases. However, when they occur, appropriate treatment must be undertaken to ensure appropriate symptomatic management and reduce morbidity. We present the case of a 25-year-old graduate student with weeklong complaints of fever, sore throat, fatigue, nausea, and “dizziness.” She later developed increased sleep requirements, ataxia, vertigo, and nystagmus with a positive EBV IgM titer confirming acute infectious mononucleosis. The patient was clinically diagnosed with EBV-associated cerebellitis and encephalitis, displaying neurological and psychiatric impairment commonly seen in postconcussion syndrome. MRI showed no acute changes. She was started on valacyclovir and a prednisone taper, recovering by the end of twelve weeks. Though corticosteroids and acyclovir are not recommended therapy in patients presenting with EBV-associated ataxia, clinicians may want to keep a low threshold to start these medications in case more serious neurological sequelae develop.

Anastomotic Leak Rate after Low Anterior Resection for Rectal Cancer after Chemoradiation Therapy

2010 ◽  
Vol 76 (8) ◽  
pp. 869-871 ◽  
Author(s):  
Benjamin R. Phillips ◽  
Lisa J. Harris ◽  
Pinckney J. Maxwell ◽  
Gerald A Isenberg ◽  
Scott D. Goldstein
Keyword(s):  
Anastomotic Leak ◽  
Rectal Resection ◽  
Colorectal Anastomosis ◽  
Neoadjuvant Chemoradiation ◽  
Contrast Enema ◽  
Chemoradiation Therapy ◽  
Leak Rate ◽  
Stoma Reversal ◽  
Anastomotic Leak Rate ◽  
Preoperative Chemoradiation Therapy

Anastomotic leak may be the most concerning complication after colorectal anastomosis. To compare open with laparoscopic rectal resection, we must have accurate leak rates in patients who have received neoadjuvant chemoradiation therapy to serve as a benchmark for comparison. All patients who had preoperative chemoradiation therapy with rectal resection and low pelvic anastomosis for cancer in a single colorectal practice over a 7-year period were retrospectively reviewed. All patients had proximal diversion and a contrast enema study before stoma reversal. Eighty-seven consecutive patients were included in the study. Average age was 58 years. Fifty-nine per cent of patients were male. Sixty-six per cent were smokers. Pathologic T stage was 5 per cent TO, 16 per cent T1, 28 per cent T2, 47 per cent T3, and 5 per cent T4. Seventy-five per cent of patients were pathologically lymph node-negative. Average time to stoma reversal was 122 days. Total anastomotic leak rate was 10.3 per cent (8% clinical leaks). Five (56%) patients with leak successfully underwent reversal of their diverting stoma (average time to reversal, 290 days). Patients who had the complication of anastomotic leakage had less likelihood of stoma reversal and a significantly prolonged time to stoma reversal.

scholarly journals The role of neuroradiology in intracerebral haemorrhage

2011 ◽  
Vol 2 (1S) ◽  
pp. 31
Author(s):  
Daniele Prosetti ◽  
Francesca Vannozzi ◽  
Fabio Scazzeri
Keyword(s):  
Case Report ◽  
Intracranial Haemorrhage ◽  
Case Reports ◽  
Cerebral Haemorrhage ◽  
Diagnostic Process ◽  
Digital Subtraction ◽  
Computerised Tomography ◽  
Diagnostic Role

The neuroradiologist plays a fundamental role in evaluating cerebral haemorrhage, from the clinical suspect until the final diagnosis.The neuroradiologist’s role consists not only in highlighting the presence of an haemorrhage, but also in specifying its localization and its nature, and in assessing, together with the neurosurgeon, the adequate treatment.With the aid of some case reports, this article underlines the role of neuroradiologist in the diagnostic process. For each case report discussed, computerised tomography (CT) and digital subtraction angiography (DSA) findings are given, to better highlight the diagnostic role of these techniques in the detection and characterization of intracranial haemorrhage.

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