Traumatic disruption of the subclavian artery and brachial plexus in a patient with Ehlers-Danlos syndrome

A 17-year-old girl with Ehlers-Danlos syndrome underwent simple reduction of a dislocated shoulder that was complicated by disruption of the subclavian artery and brachial plexus. The shoulder dislocation was a recurrent condition that had been treated successfully on several previous occasions without complication. During the relocation process, only minor upper extremity manipulation caused injury to the brachial plexus and subclavian artery. Management of an iatrogenic vascular injury was made difficult by the fragile consistency of the anterial wall that would not hold sutures. Amputation of the patient's arm ultimately was required.

Analysis of techniques and results in 347 consecutive colon anastomoses

We have reported our experience with 347 consecutive colon anastomoses in 321 patients seen over an 8 year period. The overall anastomotic failure, mortality, and complication rates were 1.4, 2, and 10 percent, respectively, for the entire series. The complication and death rates were significantly higher in patients whose anastomoses were completed as part of an emergency procedure. Even though various one- and two-layer inverting techniques, suture materials, and staples were used, we could not identify any one method as being clearly superior in preventing anastomotic complications, although the results do suggest that some caution may be appropriate before mechanical stapling devices are universally applied. The results support that adherence to accepted surgical principles of reducing the solid content and fecal flora of the colon prior to operation, insuring an excellent blood supply to both bowel ends, even approximation of the bowel ends with inverting sutures which include the submucosal layer of the bowel, absence of tension, meticulous hemostasis, and avoidance of anastomosis in the presence of peritonitis are the primary means of avoiding dehiscence of colon anastomoses.

Pericardial tamponade and hemothorax after penetrating injury to the internal mammary artery

Penetrating wounds to the anterior chest wall are associated with injury to the heart and great vessels. If injury to these structures is suspected, early surgical intervention is indicated. The internal mammary artery also can be involved in penetrating trauma and can present a clinical situation similar to heart injury, as in the case reported.

Late complications after gastric reservoir reduction with external wrap

Numerous surgical procedures have been introduced to facilitate weight loss in morbidly obese individuals. Gastric reservoir reduction, wrapping the stomach with an inert fabric, is one such procedure. Nissen fundoplication has been performed in conjunction with this approach to prevent postoperative gastroesophageal reflux. Gastric perforation and functional gastroesophageal obstruction occurring as late as 71 months after this operation represent late complications. Perforation has developed in 14.6% of stomachs wrapped with polypropylene mesh. Nissen fundoplication may contribute to this complication.