Spontaneous Pneumothorax Mimicking Perforated Viscus in Covid-19 patient

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
MOHD SHAHIMIN SOAID ◽  
NORSAFARINY AHMAD
Keyword(s):  
Ct Scan ◽  
Multiorgan Failure ◽  
Emergency Laparotomy ◽  
Tube Insertion ◽  
Bilateral Pneumothorax ◽  
Case Presentation ◽  
Perioperative Morbidity ◽  
Post Intubation ◽  
Perforated Viscus ◽  
Rule Out

Case presentation: A 65-year-old female diagnosed with COVID-19 developed worsening respiratory distress requiring invasive ventilation. Chest radiography post-intubation revealed air under the diaphragm, pneumomediastinum and subcutaneous emphysema. The case was referred to the surgical team for emergency laparotomy for suspected perforated viscus. Clinically, her abdomen was distended but there was no sign of peritonism. In view of the high risk of perioperative morbidity and absence of peritonism, a CT scan was done to rule out the cause of pneumoperitoneum. CT scan showed bilateral pneumothorax, presence of air in the extra peritoneum and retroperitoneum. There was no air in the peritoneum and no evidence of perforated viscus. She was treated conservatively with bilateral chest tube insertion. Unfortunately, she developed multiorgan failure and succumbed to death.

scholarly journals Blunt abdominal injury resulting in a belly full of candy after a motocross accident, a case report

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Floris B. Poelmann ◽  
Frank F. A. IJpma
Keyword(s):  
Ct Scan ◽  
Abdominal Cavity ◽  
Delayed Diagnosis ◽  
Abdominal Injury ◽  
Pelvic Cavity ◽  
Emergency Laparotomy ◽  
Case Presentation ◽  
Blunt Abdominal Injury ◽  
Free Air ◽  
Gastric Rupture

Abstract Background Blunt traumatic gastric perforations in children are rare. Delayed diagnosis will lead to abdominal contamination and may result in morbidity and even mortality. We present a case of an adolescent who sustained blunt abdominal injury in a motocross accident and presented with remarkable hyperdense spherical shaped structures on the computed tomography (CT). Case presentation A 15-year-old boy arrived at the emergency room with an acute abdomen after a motocross accident. A CT scan of the abdomen demonstrated free air and hyperdense round structures in the stomach, pelvic cavity and right paracolic gutter. During emergency laparotomy a traumatic gastric perforation was sutured, a splenic rupture was treated with a vicryl mesh and multiple spherical food scraps were removed from the abdomen. After surgery, the boy clarified that he had eaten a whole bag of colorful and spherical shaped candy just before the accident. Conclusions Traumatic gastric rupture in children is rare but physicians should be aware of this diagnosis in case of blunt abdominal trauma with free air on the CT scan. Gastric contents, in this case candy, can present as hyperdense shaped structures in the abdominal cavity on the CT scan.

scholarly journals Faecopneumothorax due to missing diaphragmatic hernia: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Resul Nusretoğlu ◽  
Yunus Dönder
Keyword(s):  
Computed Tomography ◽  
Diaphragmatic Hernia ◽  
Colon Resection ◽  
Emergency Laparotomy ◽  
Hernia Sac ◽  
Case Presentation ◽  
Abdominal Tenderness ◽  
History Of ◽  
Diaphragmatic Hernias ◽  
Tomography Scan

Abstract Background Diaphragmatic hernias may occur as either congenital or acquired. The most important cause of acquired diaphragmatic hernias is trauma, and the trauma can be due to blunt or penetrating injury. Diaphragmatic hernia may rarely be seen after thoracoabdominal trauma. Case presentation A 54-year-old Turkish male patient admitted to the emergency department with abdominal pain and dyspnea ongoing for 2 days. He had general abdominal tenderness in all quadrants. He had a history of a stabbing incident in his left subcostal region 3 months ago without any pathological findings in thoracoabdominal computed tomography scan. New thoracoabdominal computed tomography showed a diaphragmatic hernia and fluid in the hernia sac. Due to respiratory distress and general abdominal tenderness, the decision to perform an emergency laparotomy was made. There was a 6 cm defect in the diaphragm. There were also necrotic fluids and stool in the hernia sac in the thorax colon resection, and an anastomosis was performed. The defect in the diaphragm was sutured. The oral regimen was started, and when it was tolerated, the regimen was gradually increased. The patient was discharged on the postoperative 11th day. Conclusions Acquired diaphragmatic hernia may be asymptomatic or may present with complications leading to sepsis. In this report, acquired diaphragmatic hernia and associated colonic perforation of a patient with a history of stab wounds was presented.

Muscle Tone Assessment under General Anesthesia for Sjögren-Larsson Syndrome and Spasticity

2021 ◽  
Vol 56 (2) ◽  
pp. 163-165
Author(s):  
George Georgoulis ◽  
Argyrios Dinopoulos ◽  
Emmanouil Gkliatis
Keyword(s):  
General Anesthesia ◽  
Muscle Tone ◽  
Muscle Relaxants ◽  
Spastic Diplegia ◽  
Case Presentation ◽  
Neurosurgical Procedure ◽  
Dorsal Rhizotomy ◽  
Severe Spasticity ◽  
Larsson Syndrome ◽  
Rule Out

Introduction: Study of muscle tone in individuals with severe spasticity (Modified Asworth Scale – MAS:3) under general anesthesia can confirm or rule out the eventual necessity of the impending spasticity relieving ablative neurosurgery by observing the hypertonia reduction and passive range of motion expansion. Therefore, what we measure under muscle relaxants is practically a fixed deformity. Case Presentation: The study was performed on a girl with Sjögren-Larsson syndrome, presenting with icthyosis and spastic diplegia. Proposed intervention was Dorsal Rhizotomy. Under general anesthesia, with and without muscle relaxants, hypertonia was significantly reduced (MAS:1), but the angle of motion did not increase much. Conclusion: We decided not to perform such a neurosurgical procedure. In ambiguous situations, the proposed study can help in decision-making for spasticity treatment.

scholarly journals Small intestine duplication cyst with recurrent hematochezia: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhicheng Zhang ◽  
Xiaowei Huang ◽  
Qian Chen ◽  
Demin Li ◽  
Qi Zhou ◽  
...  
Keyword(s):  
Small Intestine ◽  
Case Report ◽  
Literature Review ◽  
Ct Scan ◽  
Duplication Cyst ◽  
Abdominal Ct ◽  
Case Presentation ◽  
Abdominal Ct Scan ◽  
Capsule Endoscopes

Abstract Background Small intestine duplication cysts (SIDCs) are rare congenital anatomical abnormalities of the digestive tract and a rare cause of hematochezia. Case presentation We describe an adult female presented with recurrent hematochezia. The routine gastric endoscope and colonic endoscope showed no positive findings. Abdominal CT scan indicated intussusception due to the "doughnut" sign, but the patient had no typical symptoms. Two subsequent capsule endoscopes revealed a protruding lesion with bleeding in the distal ileum. Surgical resection was performed and revealed a case of SIDC measuring 6 * 2 cm located inside the ileum cavity. The patient remained symptom-free throughout a 7-year follow-up period. Conclusion SIDCs located inside the enteric cavity can easily be misdiagnosed as intussusception by routine radiologic examinations.

503 Clinical Frailty Score (CFS) Vs Antibiotics, Time to Surgery and Time to Computerised Tomography (CT) Scan in An Emergency Surgical Population

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Palaniappan ◽  
R Soiza ◽  
S Moug ◽  
P Myint
Keyword(s):  
Ct Scan ◽  
Emergency Laparotomy ◽  
Antibiotic Administration ◽  
Process Measures ◽  
Time To Surgery ◽  
Performance Time ◽  
Frail Patients ◽  
Management Plans ◽  
Administration Time ◽  
Frailty Score

Abstract Introduction Frail patients have increased mortality after surgery. However, it is not known if pre-operative process measures such as antibiotic administration, time to CT and time to surgery are influenced by patient frailty. Method The Emergency Laparotomy and Laparoscopy Scottish Audit (ELLSA) assessed outcome after emergency surgery across Scottish hospitals (November 2017 – October 2018). Frailty was measured using the 7-point Clinical Frailty Score (CFS). Outcome measures were antibiotic provision for sepsis, admission to CT time, admission to surgery time, CT request to performance time and CT request to surgery time. Results 1302 patients (median age 63 years [IQR 49-74]; 49% male) with complete data were included. Median time from admission to CT and surgery increased between those with CFS 1 to 6/7 from 597 to 1724 minutes (p < 0.0001) and 1556 to 4120 minutes (p < 0.0001) respectively. Time from CT request to surgery also significantly increased with CFS (p < 0.042). There was no significant association between CFS and antibiotic administration or CT request to performance. Conclusions Frail patients have to wait longer for CT scan requests and surgery, but frailty was not associated with antibiotic administration or delays in CT request to performance time. Possible explanations include frailty-related challenges making correct diagnoses and optimal management plans.

scholarly journals Tétanos en un preescolar de 5 años con abandono familiar: Reporte de caso

2019 ◽  
Vol 30 (3) ◽  
Author(s):  
Juan Pablo Guillermo-Durán ◽  
Salvador Gómez-Carro ◽  
Nina Mendez-Dominguez
Keyword(s):  
Foreign Body ◽  
Clinical Findings ◽  
Battered Child Syndrome ◽  
Clostridium Tetani ◽  
Case Presentation ◽  
Battered Child ◽  
Symptomatic Management ◽  
Child Syndrome ◽  
Terapia Intensiva ◽  
Rule Out

Introducción: El tétanos es una enfermedad infecciosa causada por Clostridium tetani, con un cuadro clínico grave y una elevada mortalidad. En Yucatán, la tasa de incidencia es baja (0.09 por 100,000 habitantes), reportándose únicamente dos casos en 2017, por lo que actualmente es una enfermedad de baja sospecha diagnóstica en la región. Caso clínico: Preescolar masculino de 5 años, originario de una comunidad rural de Yucatán y con esquema de inmunización incompleto, quien fue atendido por espasmos musculares generalizados, así como heridas recientes por cuerpo extraño y síndrome del niño maltratado. En la Unidad de Terapia Intensiva, se integró el diagnóstico de tétanos, por lo que recibió manejo etiológico y sintomático, logrando mejoría a su egreso. Discusión: Yucatán es una de las entidades federativas con mayor índice de maltrato infantil. Ante la presencia de dicha problemática social, es importante descartar un esquema de inmunización incompleto, mismos que con la coexistencia de hallazgos clínicos típicos y herida reciente por cuerpo extraño, se debe sospechar tétanos.Background: Tetanus is an infectious disease caused by Clostridium tetani, with severe symptoms and a high mortality rate.  In Yucatan, the incidence rate is low (0.09 per 100,000 population), reporting only two cases in 2017, so it is now a disease of low diagnostic suspicion in the region. Case presentation: A 5-year-old male preschool, from a rural community of Yucatán and with incomplete immunization scheme, who was attended by generalized muscle spasms as well as recent foreign body wounds and battered child syndrome. In the Intensive Care Unit, the diagnosis of tetanus was integrated, for which he received etiological and symptomatic management, achieving improvement at his discharge. Discussion: Yucatan is a state with high child abuse rate of. In the presence of this social problem, it is important to rule out an incomplete immunization scheme, which with the coexistence of typical clinical findings and recent foreign body wound, tetanus should be suspected. 

scholarly journals Endo-buccal mucosal punch biopsy and cervico-facial benign subcutaneous emphysema

2020 ◽  
Vol 26 (3) ◽  
pp. 33
Author(s):  
Thibault Casatuto ◽  
Gauthier Benat ◽  
Sara Laurencin-Dalicieux ◽  
Sarah Cousty
Keyword(s):  
Ct Scan ◽  
Oral Mucosa ◽  
Dental Care ◽  
Subcutaneous Emphysema ◽  
Punch Biopsy ◽  
Cervical Swelling ◽  
Rule Out

Subcutaneous emphysema is a rare feature caused by traumatism (weapons, accidents: crashes, barotrauma, …), dental care and infections. A 48-year-old woman consults for a right oral mucosa lesion and benefits from a biopsy for anatomopathological diagnosis. Within hours of the biopsy, bilateral jugal then cervical swelling has occured without signs of severity. The examination at 48 hours and the CT scan showed a bilateral cervicofacial emphysema with a spontaneous favorable resolution in a few days making the diagnosis of benign subcutaneous emphysema (BSCE). BSE can occurs after an endobuccal biopsy, a close follow up is necessary to rule out gas gangrene.The resolution is spontaneous with the necessity to reassure the patient.

Strangulated Morgagni hernia masquerading as an acute coronary syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e244045
Author(s):  
May Honey Ohn ◽  
Jun Rong Ng ◽  
Theviga Neela Mehan ◽  
Ng Pey Luen
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Surgical Repair ◽  
Bleeding Risk ◽  
Emergency Laparotomy ◽  
Morgagni Hernia ◽  
X Ray ◽  
Coronary Syndrome ◽  
The Right ◽  
Rule Out

Morgagni hernia is the rarest type of congenital diaphragmatic hernia, which can present late in adulthood. Here, we report a case of Morgagni hernia in an elderly woman who presented as an acute coronary syndrome with raised troponin level. X-ray of the chest (CXR) showed air–fluid level in the right lower hemithorax with loss of right diaphragmatic outline and subsequently confirmed strangulated Morgagni hernia with CT. She was treated with emergency laparotomy to reduce the hernia content and surgical repair with mesh done. In conclusion, Troponin can be falsely positive in Morgagni hernia patients, possibly due to strain on the heart by herniated bowel contents. Basic imaging such as a (CXR) is useful in the case of chest pain to rule out the non-cardiac causes. Although ‘time is the myocardium’ in the setting of all cases of chest pain with raised troponin, CXR should be done before treatment that poses bleeding risk and unnecessary delay in laparotomy.

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.

scholarly journals Diaphragmatic hernia: a rare complication of hepatic ablation

2020 ◽  
Vol 65 (3) ◽  
pp. 103-106
Author(s):  
Mark T Macmillan ◽  
Shueh Hao Lim ◽  
Hamish M Ireland
Keyword(s):  
Microwave Ablation ◽  
Rare Complication ◽  
Diaphragmatic Injury ◽  
Diaphragmatic Defect ◽  
Emergency Laparotomy ◽  
Effective Technique ◽  
Case Presentation ◽  
Hepatocellular Carcinomas ◽  
Hepatic Ablation ◽  
Life Threatening

Introduction Ablation has become an effective treatment for small hepatocellular carcinomas (HCC). Whilst ablation is a safe and effective technique, diaphragmatic injury is a rarely associated but significant complication. Case presentation: We present a case of a 67 year old patient who developed a diaphragmatic defect following microwave ablation (MWA) for HCC. The diaphragmatic defect progressed to herniation which was complicated by perforation of intrahernial large bowel. The patient was treated by emergency laparotomy and an extended right hemi-colectomy was performed. Conclusion Our report adds to the current available knowledge on diaphragmatic injury following hepatic ablation and demonstrates the potential for life threatening consequences associated with this complication.

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