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Baishya N, Dua R, Singh R, Padmanabhan AK. Rare case of high amylase pleural effusion without pancreatitis, oesophageal rupture or malignancy. BMJ Case Rep 2022; 15:e251160. [PMID: 36343981 PMCID: PMC9644303 DOI: 10.1136/bcr-2022-251160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
High amylase pleural effusion remains an entity which includes a wide variety of differentials, with pancreatitis, oesophageal rupture or malignant pleural effusion being most commonly encountered in clinical practice. Keeping the clinical picture (suggestive of pain in abdomen preceding any respiratory complaints) and differentials at hand, the case was evaluated with contrast-enhanced CT of the thorax and abdomen which revealed normal pancreatic architecture and no abnormal communication was noted between the pancreas and pleural space. A contrast oesophagogram, done when pancreatitis was ruled out, showed no evidence of any leak. The patient underwent upper gastrointestinal endoscopy which was suggestive of an ulcer with fistulous communication with the pleural space. Following nasojejunal feeding and clipping of the fistulous tract the patient's symptoms improved.
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Affiliation(s)
- Nyrvan Baishya
- Pulmonary, Critical care and Sleep medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Ruchi Dua
- Pulmonary, Critical care and Sleep medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Randeep Singh
- Pulmonary, Critical care and Sleep medicine, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
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Turco LC, Ferrandina G, Vargiu V, Cappuccio S, Fagotti A, Sallustio G, Scambia G, Cosentino F. Extreme complications related to bevacizumab use in the treatment of ovarian cancer: a case series from a III level referral centre and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1687. [PMID: 33490199 PMCID: PMC7812204 DOI: 10.21037/atm-20-4448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In patients undergoing debulking surgery for ovarian cancer (OC), bevacizumab-combined chemotherapy has been reported to be associated with an increased incidence of adverse events (AEs). Reports in the literature have noted the overall morbidity of bevacizumab to be between 3.7% and 9%. The aim of this study is to report uncommon and unusual manifestations of morbidity in surgical cases performed at our third level referral centers for gynecologic oncology. Additionally, we review the rare and severe bevacizumab-related complications that have been described in the literature. We defined as "extreme", the particularly rare and/or severe complications up to determining a life-threatening condition or death, which are related to the use of bevacizumab. A case-series of extreme complications registered at our institutions were reported. In addition, a literature search of the PubMed, MEDLINE and EMBASE electronic databases was performed for this review. The studies collected included: 8 randomized controlled trials (RCT) and 5 prospective observational, 1 prospective phase-IV, 10 prospective phase-II, 2 prospective phase-I, and 20 retrospective studies, as well as 9 case reports. Bevacizumab was administered as primary treatment in adjuvant and neo-adjuvant setting in 16 and 5 studies respectively, as treatment for recurrence in 36 trials, and for secondary cytoreductive surgery (SCS) in 3 studies. The overall population administered with bevacizumab numbered 7,096 women. Extreme complications were observed in 591 patients, with a morbidity rate of the 8.3%. Overall, central nervous system (CNS), cardiovascular, gastrointestinal (GI) and primary infectious complications were seen in 22 patients (0.3%), 261 patients (3.7%), 159 patients (2.2%), and 8 patients (0.13%), respectively. Hemorrhagic and wound complications occurred in 18 women (0.25%), and 112 women (1.6%), respectively. Extreme complications related to the use of bevacizumab are rare, and often go unrecognized. The recognition and immediate management of such rare and life-threatening complications in patients treated at third level referral centers could significantly improve patient survival.
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Affiliation(s)
- Luigi Carlo Turco
- Mater Olbia Hospital, Gynaecology and Breast Unit, Olbia.,Division of Gynecologic Oncology, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
| | - Gabriella Ferrandina
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Virginia Vargiu
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Serena Cappuccio
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Anna Fagotti
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Giuseppina Sallustio
- Università Cattolica del Sacro Cuore, Roma, Italia.,Department of Radiology and Diagnostic Imaging, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
| | - Giovanni Scambia
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesco Cosentino
- Division of Gynecologic Oncology, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
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Iqbal SM, Zhi C, Masud M, Aslam HM, Qadir MA. Gastropleural Fistula: A Rare Complication of a Common Procedure. Cureus 2019; 11:e4136. [PMID: 31058019 PMCID: PMC6485830 DOI: 10.7759/cureus.4136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Weight loss surgeries are evident to be highly beneficial in patients with morbid obesity (body mass index (BMI) ≥40.0 kg/m2) and severe obesity (BMI between 35.0 and 39.9 kg/m2 with co-morbidities). While this results in significant mortality benefit, there is always the possible risk of postsurgical complications. Gastrobronchial and gastropleural fistulas are two rare, post-operative pulmonary complications associated with these surgeries. Our patient is a 54-year-old female who underwent a biliopancreatic diversion with a duodenal switch. A few weeks later, she started developing a cough, fever, and shortness of breath. Computed tomography (CT) chest showed the presence of a loculated right sided hydropneumothorax. A gastrointestinal fluoroscopic contrast study performed showed a large fistula originating from the distal end of the stomach and ending towards the right pleural cavity. The fistula was successfully closed with the endoscopic fulguration of fistulous opening with argon beam coagulation and orthoscopic clipping, resulting in complete obliteration of the fistula tract. The right-sided hydropneumothorax was initially treated conservatively with antibiotics and chest tube drains followed by video-assisted thoracoscopic decortication with chest tube placement. Gastropleural fistula formation is rare but is nonetheless a serious postoperative complication of bariatric procedures and mimics pneumonia clinically. It is, therefore, essential to obtain detailed imaging work-up to rule out fistula formation, which, in turn, can be timely treated without causing further devastating results to the patient.
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Affiliation(s)
- Shumaila M Iqbal
- Internal Medicine, University at Buffalo / Sisters of Charity Hospital, Buffalo, USA
| | - Cassandra Zhi
- Internal Medicine, Drexel University College of Medicine, Philadelphia, USA
| | - Mawra Masud
- Internal Medicine, University at Buffalo / Sisters of Charity Hospital, Buffalo, USA
| | - Hafiz M Aslam
- Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Trenton, USA
| | - Madiha A Qadir
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
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Al-Shurafa H, Alghamdi S, Albenmousa A, Alolayan H, Al-Shurafa Z. Gastropleural fistula after single anastomosis gastric bypass. A case report and review of the literature. Int J Surg Case Rep 2017; 35:82-86. [PMID: 28458144 PMCID: PMC5412257 DOI: 10.1016/j.ijscr.2017.03.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/22/2017] [Accepted: 03/25/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Pulmonary complications after bariatric surgeries are rare but usually serious. They often occur early after surgery but the presentation might be delayed for several months. Gastropleural fistula after bariatric surgery is extremely rare and has been reported in a very small number of patients post sleeve gastrectomy and gastric bypass. CASE PRESENTATION A 37-year-old lady presented with left sided pleural effusion and empyema 2 years post single anastomosis gastric bypass surgery. She was found to have a large gastropleural fistula and was managed by surgical repair of the fistula with conversion to gastric bypass and decortication of the affected pleura. That resulted in significant clinical improvement and resolution of the empyema. CONCLUSION Gastropleural fistula is a very rare complication of bariatric surgeries and should be considered in patients who present with chronic or recurrent pulmonary infections.
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Affiliation(s)
- Haider Al-Shurafa
- Department of Surgery, Prince Sultan Military Medical City, Saudi Arabia.
| | - Saleh Alghamdi
- Department of Surgery, Prince Sultan Military Medical City, Saudi Arabia
| | - Ali Albenmousa
- Department of Gastroenterology, Prince Sultan Military Medical City, Saudi Arabia
| | - Haifa Alolayan
- Department of Surgery, Prince Sultan Military Medical City, Saudi Arabia
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Luo RB, Liu S, DeLong JC, Jacobsen GR, Sandler BJ, Horgan S. Laparoscopic Gastropleural Fistula Repair: A Minimally Invasive Solution for a Complex Problem. J Laparoendosc Adv Surg Tech A 2017; 27:416-419. [PMID: 28080207 DOI: 10.1089/lap.2016.0569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Gastropleural fistula (GPF) is a complex pathology that can present as a result of surgery, trauma, peptic ulcer disease, malignancies, radiation, or chemotherapy. Management typically includes endoscopic or surgical intervention along with intraabdominal or intrathoracic drainage of pre-existing infection. Traditionally, surgical approaches have been through exploratory laparotomy or thoracotomy, subjecting already ill patients to additional morbidity. CASE REPORT We describe and demonstrate a laparoscopic minimally invasive approach to the management of a GPF with a wedge resection of the stomach, along with a review of the current literature regarding GPF treatment. CONCLUSION GPF repair can be performed through laparoscopy and may lead to improved patient outcomes and faster recovery.
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Affiliation(s)
- Ran B Luo
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
| | - Shanglei Liu
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
| | - Jonathan C DeLong
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
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Abstract
Gastropleural fistula is a rare condition, most frequently reported as a result of trauma, peptic ulcer disease or malignancy. We report a case of gastropleural fistula in a patient with metastatic ovarian cancer who presented with hydropneumothorax and mediastinal shift. She was successfully managed with an open partial gastrectomy, repair of diaphragmatic defect, and thoracoscopic washout and decortication. Based on our case and review of the literature, surgical repair of gastropleural fistula should be considered as a palliative procedure even in patients with end-stage cancer.
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