A Rare Case of Mediastinitis Following a Routine Dental Procedure in a Patient with History of Cardiac Surgery

Duodenal adenocarcinoma constitutes 0.4% of gastrointestinal malignancies. Achalasia incidence rate is 0.5-1.2 per 100000. The combination is rare. This is a report of a 68-year-old male from Nepal with history of five years abdominal pain, dysphasia and weight loss. Duodenoscopy could confirm ulcero-proliferative growth at D1-D2. Barium meal depicted features of achalasia cardia. No similar case report suggests that occurrence of duodenal carcinoma and achalasia cardia is merely co- incidental. Discussion: No similar case report suggests that occurrence of duodenal carcinoma and achalasia cardia is merely co- incidental. Consent: Informed consent was obtained from the patient for publication of this case report .

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A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

10.31487/j.jscr.2020.01.03 ◽

2020 ◽

pp. 1-3

Author(s):

Jinping Xu ◽

Ruth Wei ◽

Salieha Zaheer

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Femoral Hernia ◽

Rare Case ◽

Hernia Recurrence ◽

High Morbidity ◽

Diagnostic Challenge ◽

Abdominal Ct ◽

Abdominal Ct Scan ◽

History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

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A case of sigmoid volvulus in an unexpected demographic

Surgical Case Reports ◽

10.1186/s40792-020-01105-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Mohammad Saba ◽

Joshua Rosenberg ◽

Gregory Wu ◽

Gudata Hinika

Keyword(s):

Abdominal Pain ◽

Severe Pain ◽

Rare Case ◽

Young Female ◽

Sigmoid Volvulus ◽

Case Presentation ◽

Operative Complications ◽

History Of ◽

Male Sex ◽

Emergent Laparotomy

Abstract Background A sigmoid volvulus occurs when a segment of the colon twists upon its mesentery. This infliction is associated with old age, multiple co-morbidities, and the male sex. We present a rare case of sigmoid volvulus that occurred in a healthy young female. Case presentation A 28-year-old female presented with a one week history of constipation and abdominal pain. Her symptoms suddenly worsened and became associated with vomiting and severe pain. A focused history taking and physical examination showed peritoneal signs that led to timely diagnostic imaging to be implemented. Computed tomography (CT) of the abdomen was consistent with sigmoid volvulus. Our patient underwent emergent laparotomy with a sigmoidectomy and recovered with no post-operative complications. Conclusion This case report emphasizes the importance of clinicians maintaining a sigmoid volvulus as a rare, yet important differential when approaching abdominal pain in young healthy patients.

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Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

The Surgery Journal ◽

10.1055/s-0041-1731443 ◽

2021 ◽

Vol 07 (03) ◽

pp. e124-e126

Author(s):

Mark Portelli ◽

Mark Bugeja ◽

Charles Cini

Keyword(s):

Computed Tomography ◽

Young Adult ◽

Rare Case ◽

Surgical Repair ◽

Bochdalek Hernia ◽

Case Presentation ◽

Atypical Case ◽

Accident And Emergency ◽

History Of ◽

Accident And Emergency Department

Abstract Purpose Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring secondary to a defect in the posterior attachment of diaphragm. This condition commonly presents with respiratory insufficiency in infants. To date, there are less than 100 cases of Bochdalek's hernia presenting in adults published in the literature. The mainstay treatment of Bochdalek's hernia involves reduction of hernial contents back into the peritoneal cavity with a tensionless graft repair closing the diaphragmatic defect. Case Presentation We present an atypical case of the Bochdalek hernia presenting in a previously healthy 16-year-old male who presented to the Accident and Emergency department with a 2-day history of dysphagia and loss of breath. The Bochdalek hernia was confirmed on computed tomography (CT) imaging and the patient underwent surgical repair with Gore-Tex mesh. Conclusion The report shows a rare case of the Bochdalek hernia in a young adult, successfully managed with a laparotomy.

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Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02842-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

T. M. Skipina ◽

S. Macbeth ◽

E. L. Cummer ◽

O. L. Wells ◽

S. Kalathoor

Keyword(s):

Emergency Department ◽

Metabolic Acidosis ◽

Mental Status ◽

Rare Case ◽

Liver Function Tests ◽

Altered Mental Status ◽

Potassium Citrate ◽

Metabolic Encephalopathy ◽

History Of ◽

Normal Urine

Abstract Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.

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PEER-REVIEW OF “A History of Cardiac Surgery: an Adventurous Voyage From Antiquity to the Artificial Heart”

Cardiovascular Pathology ◽

10.1016/j.carpath.2021.107330 ◽

2021 ◽

pp. 107330

Author(s):

Gaetano Thiene

Keyword(s):

Cardiac Surgery ◽

Peer Review ◽

Artificial Heart ◽

History Of

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Surveillance and control of M. chimaera infections in the Tuscany Region, Italy

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.705 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

B Casini ◽

B Tuvo ◽

M Totaro ◽

A Baggiani ◽

G Privitera

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Water Sample ◽

Case Finding ◽

Microbial Count ◽

Clinical Specimens ◽

Open Chest ◽

Microbiological Parameters ◽

History Of ◽

And Control

Abstract Background Disseminated M. chimaera infections among patients who underwent open-chest surgery with cardiopulmonary bypass have been associated with the contamination of heater-cooler devices (HCDs). The Tuscany region in the Decree 3822/2019 issued recommendations for the surveillance and control of M. chimaera infections. Methods In three Tuscan cardiac surgery centers, the case finding was carried out through evaluation and testing of patients with a history of HCD exposure (past 6 years) was performed. Water and aerosol samples were analyzed from each HCDs to determine the microbiological parameters required by the Directive 98/83/CE and to assess the presence of non-tuberculous mycobacteria (NTMs), according to the regional protocol. Results M. chimaera infection was not found in any patient and all clinical specimens tested negative. 22 HCDs were sampled (n.12 LivaNova, n.1 Terumo and n.9 Maquet) for a total of 114 samples (45, 8, 2 and 59 respectively). All the microbiological parameters were compliant, excepted for total microbial count at 36 °C that exceeded 100 CFU/ml in 50% (57/114) of samples and for the presence of P.aeruginosa in 10% (12/114). NTMs were detected in 16% (18/114) of HCDs: M. chimaera was identified in 11% (13/114) of samples and in 4% (5/114) M. gordonae. All aerosol samples were negative for NTMs, but in the HCDs Maquet, B.cereus were detected in 7% (4/59) of the samples, K.oxytoca in 2% (1/59), B.ursincola in 2% (1/59) and S. paucimobilis in 3% (2/59). Only S. paucimobilis was isolated also in the same HCD water sample. Conclusions The implementation of maintenance and disinfection procedures of HCDs was able to reduce the risk of contamination and aerosolization by NTMs but not of other microorganisms. Key messages Further strategies should be put in place for the cases finding. Moreover, reliable decontamination and identification of agents that can disrupt biofilms and increase chlorine susceptibility of mycobacteria are required.

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