scholarly journals Repeated Duodenal Stump Perforation Using a Stapling Device Following Subtotal Gastrectomy With Roux-en-Y Reconstruction for Advanced Gastric Cancer: Lessons From a Rare Case

2015 ◽  
Vol 100 (4) ◽  
pp. 726-732
Author(s):  
Tadashi Furihata ◽  
Makoto Furihata ◽  
Naoki Satoh ◽  
Masato Kosaka ◽  
Kunibumi Ishikawa ◽  
...  
Keyword(s):  
Subtotal Gastrectomy ◽  
Lessons Learned ◽  
Wall Thickening ◽  
Duodenal Stump ◽  
Stapling Device ◽  
Life Saving ◽  
Life Threatening ◽  
History Of ◽  
Considerable Morbidity ◽  
Reconstruction After Gastrectomy

Closure of the duodenal stump using a stapling device is commonly applied in Roux-en-Y reconstruction after gastrectomy. However, serious and possibly fatal duodenal stump perforation can develop in extremely rare cases. We describe a case of subtotal gastrectomy with Roux-en-Y reconstruction followed by repeated duodenal stump perforations. A 79-year-old man with a long history of diabetes and hypertension was admitted to our institution with epigastralgia and right hypochondralgia. Computed tomography and an upper gastrointestinal imaging series revealed remarkable wall thickening of the gastric antrum and corpus. Upper endoscopy also showed a giant ulcerative lesion in the same area. The lesion was confirmed by histology to be poorly differentiated adenocarcinoma. The patient underwent open subtotal gastrectomy with Roux-en-Y reconstruction. However, duodenal stump perforation occurred repeatedly on postoperative days 1, 3, and 19, which caused peritonitis. The patient was kept alive through duodenal stump repair, an additional resection using a stapling device, and repeated drainage treatments; but he suffered considerable morbidity due to these complications. We report a case of a life-threatening duodenal stump perforation after subtotal gastrectomy, highlighting lessons learned from the profile and clinical course. Abdominal surgeons should be aware of the possibility of this serious complication of duodenal stump perforation, and be able to perform immediate interventions, including life-saving reoperation.

scholarly journals Exclusive Phlebosclerosis of Submucosal Veins Leading to Ischemic Necrosis and Perforation of the Large Bowel: First European Case

2018 ◽  
Vol 12 (1) ◽  
pp. 137-142 ◽  
Author(s):  
Sebastian Klein ◽  
Denise Buchner ◽  
De-hua Chang ◽  
Reinhard Büttner ◽  
Uta Drebber ◽  
...  
Keyword(s):  
Wall Thickening ◽  
Caucasian Woman ◽  
Ischemic Necrosis ◽  
Colonic Wall ◽  
Asian Patients ◽  
Life Threatening ◽  
History Of ◽  
Mesenteric Vessels ◽  
The Right ◽  
European Woman

Phlebosclerotic colitis (PC) is a rare, potentially life-threatening disease of unclear pathogenesis almost exclusively reported in Asian patients of both genders. A fibrous degeneration of venous walls leads to threadlike calcifications along mesenteric vessels and colonic wall thickening, detectable by CT. This causes disturbed blood drainage and hemorrhagic infarction of the right-sided colonic wall. This is a report of PC in a Caucasian woman in Europe without Asian background and no history of herbal medications, a suspected cause in Asian patients. CT revealed no calcification of the mesenteric vein or its tributaries. Instead, submucosal veins of the left-sided colonic wall were calcified, leading to subsequent transmural necrosis. Clinically, the patient developed a paralytic ileus and sigmoidal perforation during a 2-week hospitalization due to a bleeding cerebral vascular aneurysm. This case of a European woman with PC is unique in its course as well as its radiologic, clinical, and pathologic presentation.

scholarly journals Broken metallic tracheostomy tube migrating into the tracheobronchial tree

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Nilam U. Sathe ◽  
Ratna Priya ◽  
Sheetal Shelke ◽  
Kartik Krishnan
Keyword(s):  
Foreign Body ◽  
Tracheostomy Tube ◽  
Main Bronchus ◽  
Tracheobronchial Tree ◽  
Life Saving ◽  
Wear And Tear ◽  
Life Threatening ◽  
History Of ◽  
The Right ◽  
Periodic Replacement

Foreign body aspiration can be a life-threatening emergency. Broken tracheostomy tube in tracheobronchial tree is one of the rarest types of foreign body reported. Here we report two cases of fracture of metallic tracheostomy tube, leading to foreign body in tracheobronchial tree. A 14-year-old girl presented to our Emergency Department with history of respiratory distress and violent bouts of cough since 2 days. Chest X-ray showed that the broken part of the tube was lodged in the right main bronchus. The presence of Parkinson’s disease in the patient and restricted neck flexion offered a challenge both for the anaesthetist and the surgeon. We were successful in removing the broken tube in 13 small pieces. Check bronchoscopy was clear and the procedure went uneventful. We would like to conclude that broken tracheostomy tube presenting as foreign body bronchus is infrequent but it is a preventable complication of tarcheostomy. The patient must be kept on regular follow up to check for signs of wear and tear. Timely and periodic replacement of tracehostomy tube should also be done, otherwise such life-saving surgery can become lifethreatening.

scholarly journals The Challenge of the Non-Compliant Patient: A Case of Caesarean Section Scar Ectopic Pregnancy

2021 ◽  
pp. 1-3
Author(s):  
Jessica Audet ◽  
Brittany Noel Robles ◽  
Nicolle M Arroyo Lluberas ◽  
Jessica Audet ◽  
Daniel Faustin ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Emergency Laparotomy ◽  
Pharmacological Management ◽  
Compliant Patient ◽  
Life Saving ◽  
Close Observation ◽  
Life Threatening ◽  
History Of ◽  
Ruptured Uterus

Ectopic pregnancy is a quite common and life-threatening pregnancy. The most common site of ectopic implantation of a fertilized embryo is the fallopian tube. In extremely rare situations, the embryo can implant in other locations, which makes the diagnosis and management even more complex. Although close observation of a new pregnancy is key in the diagnosis and treatment of an ectopic pregnancy, there is still a major risk of life-threatening outcomes. This is a case report of a 31-year-old patient with a history of multiple pregnancies who presented to a community hospital in the spring of 2021 with an ectopic caesarean scar pregnancy. A diagnosis of ectopic pregnancy was on a timely basis, and surgical management was advised. Upon refusal of treatment and admission, pharmacological management was initiated, but patient compliance challenged the success of the therapy. Patient non-compliance to close follow-up resulted in a ruptured uterus. Emergency laparotomy with supracervical hysterectomy was performed as a life-saving procedure.

Safety of allergen immunotherapy in North America from 2008-2017: Lessons learned from the ACAAI/AAAAI National Surveillance Study of adverse reactions to allergen immunotherapy

2020 ◽  
Vol 41 (2) ◽  
pp. 108-111 ◽  
Author(s):  
David I. Bernstein ◽  
Tolly E.G. Epstein
Keyword(s):  
Allergen Immunotherapy ◽  
Lessons Learned ◽  
Subcutaneous Immunotherapy ◽  
Uncontrolled Asthma ◽  
Sublingual Tablet ◽  
Life Threatening ◽  
History Of ◽  
Allergen Extracts ◽  
Systemic Infections ◽  
Observation Period

In 2004, it was estimated that one fatal anaphylactic reaction (FR) occurred in every 2.4 million subcutaneous immunotherapy (SCIT) injection visits. Uncontrolled asthma was the most commonly cited factor that contributed to FRs. Results of the annual American College of Allergy, Asthma, and Immunology/American Academy of Allergy, Asthma and Immunology sponsored survey conducted among practicing allergists suggest that one nonfatal systemic reactions (SR) occurred in 0.15% of injection visits and in 0.7% of patients who were treated. Analysis of recent data indicated that FRs are 3.75-fold less frequent. Life-threatening grade 4 anaphylactic reactions are estimated to occur in 0.005% of patients who receive SCIT (or 1/160,000 injection visits). Analysis of data from annual surveys identified the following possible risk factors for SRs: a history of SRs to SCIT, the administration of injections in patients with uncontrolled asthma, use of accelerated buildup regimens, and never adjusting doses during the height of the allergy season. Delayed-onset SRs beginning >30 minutes after injections represented 15% of all SRs in clinics with 30-minute observation periods. The safety profile of sublingual immunotherapy is favorable, with no FRs yet identified for sublingual tablet or liquid formulations. Risk management should focus mainly on patients with uncontrolled asthma by withholding injections in such patients, with recent worsening in asthma symptoms and lung function (e.g., peak expiratory flow rate). Because nearly all FRs and SRs occur within 30 minutes of injections, a 30-minute observation period is recommended. Routinely prescribing epinephrine for all patients did not prevent severe SRs, likely due to poor adherence when SRs occurred. Also, no local or systemic infections were identified in 2.3 million patients attending 24.5 million injection visits, which allayed concerns over infections associated with compounding of allergen extracts by practicing allergists.

scholarly journals DEVASTATING RESULTS OF UNMET NEEDS OF TERMINATION OF PREGNANCY

2021 ◽  
pp. 40-41
Author(s):  
Ashwini N Hotkar ◽  
Prashant Bhingare ◽  
Shrinivas Gadappa
Keyword(s):  
Surgical Intervention ◽  
Colon Perforation ◽  
Uterine Perforation ◽  
Mortality And Morbidity ◽  
Dilation And Curettage ◽  
Life Saving ◽  
Life Threatening ◽  
History Of ◽  
Sigmoid Colon Perforation ◽  
Saving Measure

Uterine perforation is a rare life threatening complication due to unsafe abortion by unqualified or untrained person. CASE: A 20 year old primigravida with 6 months ANC was referred to our hospital with the USG of uterine rupture and with a history of Dilation and curettage i/v/o anomalous baby, was in septic shock. There was also evidence of Sigmoid colon perforation. As a life saving measure Obstetric hysterectomy with colostomy done. Unsafe CONCLUSION: abortions are still in practice which has led to increased rate of mortality and morbidity. surgical intervention on a uterus of more than 20 weeks can be hazardous and should be terminated wisely.

scholarly journals Aerobiology in South Africa: A new hope!

2020 ◽  
Vol 116 (7/8) ◽  
Author(s):  
Linus Ajikah ◽  
Frank H. Neumann ◽  
Dilys Berman ◽  
Jonny Peter
Keyword(s):  
South Africa ◽  
Health Care Providers ◽  
Fungal Spores ◽  
Care Providers ◽  
Online Data ◽  
Fungal Allergens ◽  
Life Threatening ◽  
History Of ◽  
Considerable Morbidity ◽  
Effective Diagnosis

Pollen and fungal spores (aerospora) are the major atmospheric bioaerosols. Aerospora occurrence and concentration vary by geographical region and blossoming period, and with meteorological factors. Allergic respiratory diseases affect about 20 million South Africans, with pollen and fungal allergens amongst the leading triggers. Asthma triggered by aerospora can be life threatening; allergic rhinitis causes considerable morbidity and carries financial implications for individuals and health systems. Thus, knowledge about geographical variation, seasonal timing and intensity, as well as annual aerospora fluctuations in South Africa, where climate and vegetation are exceptionally diverse, is essential for effective diagnosis and treatment of allergies. Unfortunately, there is a lack of continuous aeropalynological data from South Africa. The longest annual monitoring exists for Cape Town (~20 years), with almost no data out of the Cape since the 1990s, and many parts of South Africa have never been monitored. In this brief review, we highlight the cross-disciplinary need for strengthened and expanded continuous aeropalynological study in South Africa, the history of efforts to date, and the introduction of the interdisciplinary South African Pollen Network (SAPNET). SAPNET was launched in seven major cities in August 2019 in order to monitor weekly variations of aerospora, and provide online data for allergy sufferers and health-care providers (www.pollencount.co.za) with the aim to establish regional pollen calendars.

scholarly journals Az Eurotransplant-csatlakozás első öt éve Magyarországon

2018 ◽  
Vol 159 (42) ◽  
pp. 1695-1699 ◽  
Author(s):  
Róbert Langer
Keyword(s):  
Living Donor ◽  
Lessons Learned ◽  
Donor Kidney ◽  
Life Saving ◽  
History Of ◽  
Brain Dead ◽  
Kidney Transplantations ◽  
End Stage ◽  
Stepwise Evolution ◽  
Living Donor Kidney

Abstract: The author concludes lessons learned from Hungary joining Eurotransplant five years ago through the more than half a century history of the Hungarian organ transplantation. The result of the stepwise evolution is that today’s transplantation activity can be measured by a European benchmark. In comparison to the era before the membership, there are 40% more transplantations in the country. First the numbers of the living donor kidney transplantations significantly raised, followed by the organs transplanted from brain-dead donors: kidney, heart, pancreas, then liver and finally also lung. The ratio of the multiorgan donors changed from about 40% to more than 70%. A reassuring solution was found for the high urgent cases, for the paediatric transplants and for the highly immunized patients, who would have been in a desperate situation without Eurotransplant, but now every Hungarian end-stage organ failure patient has similar chances for getting a potential life-saving organ as their former luckier West-European counterparts. Orv Hetil. 2018; 159(42): 1695–1699.

scholarly journals Adult-diagnosed Chronic Granulomatous Disease: The Need to Increase Awareness

2021 ◽  
Author(s):  
Joseph Baxter ◽  
Derek Smith ◽  
Charles Webb
Keyword(s):  
Chronic Granulomatous Disease ◽  
Lupus Erythematosus ◽  
Fungal Infections ◽  
Genetic Disorder ◽  
Immunosuppressive Drugs ◽  
Granulomatous Disease ◽  
Multiple Systems ◽  
Life Saving ◽  
Life Threatening ◽  
History Of

ABSTRACT Chronic granulomatous disease is genetic disorder characterized by the inability of phagocytes to produce sufficient oxidative burst needed to kill intracellular organisms. Patients have recurrent, life-threatening infections involving multiple systems including the lungs, skin, lymph nodes, and liver. The majority of patients with chronic granulomatous disease are diagnosed in childhood although some may present in adulthood due to a milder phenotype. Unfortunately, these patients may also present with concomitant autoimmune diseases. We describe a 48-year-old woman with a history of immune thrombocytopenia and systemic lupus erythematosus on immunosuppressive therapy. She developed subsequent bacterial and fungal infections initially attributed to immunosuppressive drugs. Further evaluation revealed the diagnosis of chronic granulomatous disease. We review the diagnosis and treatment of chronic granulomatous disease in hopes to increase awareness of this disease in adulthood in order to initiate potential life-saving prophylactic antibiotics.

scholarly journals Spontaneous Rupture of a Leiomyoma Causing Life-Threatening Intra-Abdominal Hemorrhage

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Melissa Schwartz ◽  
Kristin Powell
Keyword(s):  
Uterine Fibroid ◽  
Hypovolemic Shock ◽  
Clinical Manifestations ◽  
Uterine Fibroids ◽  
Acute Onset ◽  
Benign Tumors ◽  
Free Fluid ◽  
Life Saving ◽  
Life Threatening ◽  
History Of

Background. Uterine fibroids are common benign tumors in women. Clinical manifestations are well known. Acute complications necessitating emergent surgical intervention are rare. Case. We report a case of a 53-year-old woman with a history of uterine fibroids presenting with acute-onset severe abdominal pain. Imaging indicated massive free fluid and a large partially solid uterine mass. Vitals were consistent with hypovolemic shock. Examination revealed a surgical abdomen. She underwent an emergent laparotomy and total hysterectomy. Surgery revealed 4.5 L of hemoperitoneum and a 15 cm degenerated uterine fibroid with active bleeding. Pathology was consistent with intraoperative findings. She required transfusion of numerous blood products perioperatively. Her postoperative course was uncomplicated. Conclusion. It is rare for a uterine fibroid to spontaneously rupture. However, prompt recognition of this severe complication is critical for expeditious, life-saving surgical management.

scholarly journals Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 205
Author(s):  
Nicola Tarantino ◽  
Domenico G. Della Rocca ◽  
Nicole S. De Leon De La Cruz ◽  
Eric D. Manheimer ◽  
Michele Magnocavallo ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Individual Factors ◽  
Substantial Part ◽  
Arrhythmogenic Substrate ◽  
Life Threatening ◽  
History Of ◽  
Anatomic Distribution ◽  
Artery Disease ◽  
Surveillance Analysis

A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.

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