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Shehata M, Abdelrahman Dafalla H, Singh Y. Successful Retrieval of 35 Razors From the Stomach via Upper Gastrointestinal (GI) Endoscopy: A Case Report. Cureus 2024; 16:e52856. [PMID: 38268993 PMCID: PMC10807475 DOI: 10.7759/cureus.52856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 01/26/2024] Open
Abstract
Adult ingestion of foreign bodies in the digestive system is a common clinical challenge, often involving mentally impaired individuals, criminals, and drug dealers or occurring accidentally. Encounters with multiple sharp foreign bodies are infrequent and pose significant risks, including gastrointestinal (GI) bleeding, perforation, internal fistulas, and infection. The choice between endoscopy and emergency surgery for removal is contentious, with the less invasive endoscopy typically favored as the first line of management, depending on the foreign body's location and endoscopic accessibility. The current literature on the treatment of numerous sharp foreign bodies is sparse. This case report illustrates the successful endoscopic removal of a large quantity of sharp foreign bodies (35 half blades) from the upper GI tract, utilizing various extraction tools. It also aims to contribute to the existing literature regarding management strategies for ingested sharp foreign bodies. A comprehensive account is provided of the clinical presentation, imaging studies, consultations, and endoscopic procedures performed, culminating in the patient's safe discharge from our facility.
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Affiliation(s)
- Mostafa Shehata
- Gastroenterology, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
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Oyania F, Mugarura R, Newton odongo C, Commander SJ, Situma M. Esophageal foreign body retrieved by cervical esophagotomy four years after ingestion. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Sekar R, Raja K, Ganesan S, Alexander A, Saxena SK. Migrated Foreign Body of Upper Digestive Tract-A Ten-Year Institutional Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:5577-5583. [PMID: 36742716 PMCID: PMC9895525 DOI: 10.1007/s12070-021-02890-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/26/2021] [Indexed: 02/07/2023] Open
Abstract
The ingested foreign body is one of the commonest emergencies encountered by otolaryngologists Depending on the shape and duration of impaction, a small number of foreign bodies (1-2%) can perforate the wall of the gastrointestinal Tract. A migrated foreign body may remain quiescent or cause life-threatening suppurative and vascular complications. Data were collected retrospectively from the hospital records in a tertiary care hospital in South India from 2010 to 2020. Fifteen patients diagnosed with migrated foreign body and who underwent neck exploration were included in the study. Demographic details, mode of presentation, clinical and radiological findings, rigid esophagoscopy findings, neck exploration techniques employed were noted. The mean age of the patients was 37.66 years. All patients had a history of dysphagia, odynophagia, and point tenderness. All the patients underwent a lateral neck radiograph, and it was positive in 12 patients (80%), while in 3 patients (20%), it was negative. All the patients had a positive finding in Contrast-Enhanced Computed Tomography. Esophagoscopy was done prior to neck exploration to identify the site of injury and the probable site of migration. All the patients underwent lateral neck exploration, and foreign body was removed. Migrated foreign body can cause significant morbidity and mortality if not diagnosed and managed early. Strong suspicion and a systematic approach are needed for the diagnosis and management.
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Affiliation(s)
- Raghul Sekar
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006 India
| | - Kalaiarasi Raja
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006 India
| | - Sivaraman Ganesan
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006 India
| | - Arun Alexander
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006 India
| | - Sunil Kumar Saxena
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006 India
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Zanchetta M, Monti E, Latham L, Costa J, Marzorati A, Odeh M, Colombo EM, Ietto G, Inversini D, Iovino D, Maffioli MP, Festi LF, Carcano G. Dental Prosthesis in Esophagus: A Right Cervicotomic Approach. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081170. [PMID: 36013349 PMCID: PMC9409762 DOI: 10.3390/life12081170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
Foreign body ingestion in the upper digestive tract is a relatively common emergency. Less than 1% have to be treated surgically. We report the case of a 68-year-old man who ingested a dental prosthesis, probably during a seizure, and thus unknowingly, and presented two days later to the emergency department complaining of a mild dysphagia. A chest radiograph showed the presence of a removable dental prosthesis in the upper esophageal tract. The patient was brought to the operating room where a multidisciplinary equipe was assembled. Two attempts of retrieval with a flexible and a rigid endoscope failed because the removable dental prosthesis was stuck in the right pyriform sinus. Therefore, the surgeon performed an uncommon right cervicotomy and retrieved the foreign body through a right-side esophagotomy. The surgical approach depends on the nature and location of the foreign body. Urgent treatment is required whenever the patient develops dyspnea or dysphagia because of the high risk of inhalation and asphyxia. Removal of any esophageal foreign body has to be performed within 12-24 h. Repeated attempts to retrieve large dental prosthesis using an endoscope may result in esophageal perforation therefore when such risk of complication is too high, a surgical approach becomes inevitable. In our opinion, surgery remains the extrema ratio after a failed endoscopic retrieval attempt but can be lifesaving despite high risk of complications.
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Affiliation(s)
- Matteo Zanchetta
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Correspondence:
| | - Elisa Monti
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
| | - Lorenzo Latham
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Jessica Costa
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
| | - Alessandro Marzorati
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Murad Odeh
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Elisabetta Marta Colombo
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Giuseppe Ietto
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Davide Inversini
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Domenico Iovino
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Marco Paolo Maffioli
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Otorinolaringoiatria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy
| | - Luigi Fiorenzo Festi
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
| | - Giulio Carcano
- Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy; (E.M.); (J.C.); (G.I.); (D.I.); (M.P.M.); (G.C.)
- Chirurgia Generale d’Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy; (L.L.); (A.M.); (M.O.); (E.M.C.); (D.I.); (L.F.F.)
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Pavone G, Tartaglia N, Pacilli M, Maddalena F, Petruzzelli F, Ambrosi A. Leak after sleeve gastrectomy with positive intraoperative indocyanine green test: Avoidable scenario? Int J Surg Case Rep 2022; 95:107168. [PMID: 35567877 PMCID: PMC9111972 DOI: 10.1016/j.ijscr.2022.107168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background The staple line gastric leak (GL) is estimated to be the most serious complication of the sleeve gastrectomy. The use of indocyanine green (ICG) has been introduced in minimally invasive surgery to show the vascularization of the stomach in real time and its application to the gastroesophageal junction (GE) during Laparoscopic Sleeve Gastrectomy (LSG) seems very promising. Case presentation We present the case of a 40-year-old female underwent laparoscopic sleeve gastrectomy. Intraoperative indocyanine green test showed a small dark area in the proximal third of the staple line reinforced with fibrin glue. Two weeks later the patient presented to the emergency room (ED) with abdominal pain, fever, vomiting, intolerance to oral intake and the evidence of a leak on the abdomen Computer Tomography (CT). The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05337644 for the Organization UFoggia. Conclusions This case report shows that intraoperative ICG test can be helpful in determining which patients are at greater risk of the leak and, more importantly, the cause of the leak but further tests are needed to determine if the ICG predicts leak due to ischemia. Fistulas after sleeve gastrectomy are complex and have multifactorial origins. Indocyanine Green (ICG) is a liquid that can be injected into the human bloodstream without adverse effects. This is a case report of a 40-year-old female with a positive intraoperative indocyanine green test as a prediction of the leak after sleeve gastrectomy.
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Affiliation(s)
- Giovanna Pavone
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
| | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
| | - Mario Pacilli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
| | - Francesca Maddalena
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
| | - Fabio Petruzzelli
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 71122 Foggia, Italy.
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6
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Pavone G, Tartaglia N, Porfido A, Panzera P, Pacilli M, Ambrosi A. The new onset of GERD after sleeve gastrectomy: A systematic review. Ann Med Surg (Lond) 2022; 77:103584. [PMID: 35432994 PMCID: PMC9006745 DOI: 10.1016/j.amsu.2022.103584] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 02/07/2023] Open
Abstract
Background The main adverse effect is gastroesophageal reflux disease (GERD), with concern on the development of Barrett's esophagus and esophageal adenocarcinoma in the long term. However, the relationship between SG and GERD is complex. The aim of this study is to systematically evaluate all published data existing in the literature to evaluate the effect of sleeve gastrectomy on GERD, esophagitis, BE in order to clarify the long-term clinical sequelae of this procedure. Materials and methods This systematic review was conducted in accordance with the guidelines for Preferred Reporting Items for Systematic Review. The work has been reported in line with the PRISMA criteria [19]. We evaluated the quality and risk of bias of this Systematic Review using AMSTAR 2 checklist [20]. Published studies that contained outcome data for primary sleeve gastrectomy associated with the primary and secondary outcomes listed below were included. The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05178446 for the Organization UFoggia. Results 49 articles were eligible for inclusion that met the following criteria: publications dealing with patients undergoing laparoscopic SG, publications describing pre- and postoperative GERD symptoms and/or esophageal function tests, articles in English, human studies and text complete available. Conclusions We have controversial data on LSG and GERD in the literature as there is a multifactorial relationship between LSG and GERD. The most recent studies have shown satisfactory control of postoperative reflux in most patients and low rates of de novo GERD. These data are leading to wider acceptance of LSG as a bariatric procedure even in obese patients with GERD. The aim of this study is to evaluate the effect of sleeve gastrectomy on GERD. In the literature there are controversial results on the onset of GERD after LSG. Satisfactory control of postoperative reflux in most patients and low rates of de novo GERD. These data are leading to wider acceptance of LSG as a bariatric procedure even in obese patients with GERD.
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Giordano D, Botti C, Iotti V, Ghidini A. Foreign Body in the Cervical Oesophagus: A Case Report. Curr Med Imaging 2022; 18:1117-1119. [PMID: 35379156 DOI: 10.2174/1573405618666220404110751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Foreign bodies in the upper aerodigestive tract represent an uncommon cause of visits to emergency departments. In the majority of cases, foreign bodies do not go beyond the pharynx. They cause dyspnoea or pneumonia if they reach the tracheo-bronchial tree. If ingested, they will pass spontaneously through the gastrointestinal canal in the majority of cases. Nevertheless, especially in case of sharp-pointed or large objects, the foreign bodies can stop in the oesophagus. In case of dysphagia, stinging sensation and/or odynophagia occurring after eating a meal, a foreign body in the upper aerodigestive tract should be suspected. If not clinically visible, imaging is required. CASE PRESENTATION A 72-year-old woman presented to the Emergency Department with pharyngodynia, odynophagia, stinging, dysphagia, and sialorrhea for 12 hours. Her symptoms started after eating a meal with meat. The patient underwent a standard two-projection radiogram of the neck. The antero-posterior projection radiogram was unremarkable. The lateral projection radiogram showed 16 millimetres in maximum length radiopaque foreign body within the cervical oesophagus. The patient underwent transoral flexible oesophagoscopy under general anaesthesia, with successful removal of the foreign body (bony fragment). Her symptoms improved rapidly after the procedure, and the patient was discharged after 48 hours in good health. CONCLUSION A foreign body in the cervical oesophagus may lead to visceral perforation. Once suspected, every effort should be made to identify and remove the foreign body to avoid potentially catastrophic consequences. In some cases, imaging could be necessary to detect the foreign body.
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Affiliation(s)
- Davide Giordano
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Iotti
- Radiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Successful removal of multiple sharp-pointed foreign body (metallic cap) impacted in the esophagus. Eur J Gastroenterol Hepatol 2021; 33:1332-1334. [PMID: 34581690 DOI: 10.1097/meg.0000000000002023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Chen L, Jia L. Endoscopic management of multiple broken scalpel blades in the gastrointestinal tract: a case report. J Int Med Res 2021; 49:300060520982697. [PMID: 33459108 PMCID: PMC7816537 DOI: 10.1177/0300060520982697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The entry of multiple broken scalpel blades into the gastrointestinal tract with involvement of the stomach, ileum, and colon is rare; no such cases have been reported to date. Whether management of multiple sharp foreign bodies is more effective by endoscopy or surgery remains controversial in clinical practice. We herein describe a 23-year-old man with depression who was admitted to our department 36 hours after swallowing multiple scalpel blades. The patient reported abdominal pain and bloody vomit. A radiograph revealed irregular blade-shaped foreign bodies in the abdomen, and computed tomography confirmed foreign bodies in the stomach, mid-distal segment of the ileum, proximal segment of the ascending colon, liver area of the transverse colon, and lumen of the sigmoid colon. Surgery was immediately suggested as the first-choice treatment, but endoscopy was instead performed after a thorough multidisciplinary discussion. All broken scalpel blades were successfully removed with combined gastroscopy and colonoscopy, and the patient’s postoperative recovery was uneventful. This case demonstrates the vital importance of multidisciplinary management and endoscopy as an appropriate treatment approach even for multiple sharp foreign bodies in patients without perforation or peritonitis.
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Affiliation(s)
- Lisheng Chen
- Department of Gastrointestinal Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lingwei Jia
- Department of Gastrointestinal Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Savioli G, Ceresa IF, Caneva L, Gerosa S, Ricevuti G. Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes. MEDICINES (BASEL, SWITZERLAND) 2021; 8:16. [PMID: 33805197 PMCID: PMC8064317 DOI: 10.3390/medicines8040016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/15/2021] [Accepted: 03/07/2021] [Indexed: 12/17/2022]
Abstract
Coagulopathy induced by major trauma is common, affecting approximately one-third of patients after trauma. It develops independently of iatrogenic, hypothermic, and dilutive causes (such as iatrogenic cause in case of fluid administration), which instead have a pejorative aspect on coagulopathy. Notwithstanding the continuous research conducted over the past decade on Trauma-Induced Coagulopathy (TIC), it remains a life-threatening condition with a significant impact on trauma mortality. We reviewed the current evidence regarding TIC diagnosis and pathophysiological mechanisms and summarized the different iterations of optimal TIC management strategies among which product resuscitation, potential drug administrations, and hemostatis-focused approaches. We have identified areas of ongoing investigation and controversy in TIC management.
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Affiliation(s)
- Gabriele Savioli
- Emergency Department, IRCCS Policlinico San Matteo, PhD University of Pavia, 27100 Pavia, Italy; (I.F.C.); (S.G.)
| | - Iride Francesca Ceresa
- Emergency Department, IRCCS Policlinico San Matteo, PhD University of Pavia, 27100 Pavia, Italy; (I.F.C.); (S.G.)
| | - Luca Caneva
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Sebastiano Gerosa
- Emergency Department, IRCCS Policlinico San Matteo, PhD University of Pavia, 27100 Pavia, Italy; (I.F.C.); (S.G.)
| | - Giovanni Ricevuti
- Department of Drug Science, University of Pavia, 27100 Pavia, Italy;
- Saint Camillus International University of Health Sciences, 00152 Rome, Italy
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Bhardwaj R, Preet Tuli I, PK MS, Gupta A, Makkar S. Cricoid Ossification Mimicking an Esophageal Foreign Body: A Victim of Overdiagnosis. DUBAI MEDICAL JOURNAL 2021. [DOI: 10.1159/000510599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Laryngeal cartilages undergo ossification, usually after the third decade of life. Variations exist in the extent and age of onset of ossification. Radiologically, these ossified cartilages may mimic an aerodigestive tract foreign body. We present an unusual case where the ossified cricoid cartilage masqueraded as a fish bone in the aerodigestive tract. A 48-year-old male patient presented to us with a foreign body sensation and throat pain after consuming fish. We found no fish bone on endoscopic laryngopharyngeal assessment but noted a linear opacity against the C-6 vertebral body in the aerodigestive tract on a lateral X-ray film of the neck. Rigid esophagoscopy also did not reveal any foreign object, but a computed tomography (CT) scan showed a linear hyperdensity in the wall of the aerodigestive tract, against the C-6 vertebral body, due to linear ossification in the midline of the cricoid lamina posteriorly. The patient’s symptoms improved within 1 week of anti-reflux medications, and he remains asymptomatic. It is possible to encounter such rare cases of cartilage ossification while dealing with foreign body aerodigestive tract in adult patients in clinical practice. Proper assessment using CT scan prevents unnecessary procedures and anxiety to the patient.
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12
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Brown KM. A tolerable alternative for removal of a fish bone to the pharynx: A case report. Clin Case Rep 2021; 9:1598-1600. [PMID: 33768897 PMCID: PMC7981766 DOI: 10.1002/ccr3.3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 11/12/2022] Open
Abstract
Aerodigestive tract fish bones are common and often utilize significant hospital resources. Some pharyngeal fish bones can be retrieved with basic equipment thus clinicians should exhaust all simple techniques including that described in this paper.
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13
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Energy Based Vessel Sealing Devices in Thyroid Surgery: A Systematic Review to Clarify the Relationship with Recurrent Laryngeal Nerve Injuries. MEDICINA-LITHUANIA 2020; 56:medicina56120651. [PMID: 33260912 PMCID: PMC7760641 DOI: 10.3390/medicina56120651] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/05/2022]
Abstract
Background and objectives: The principal complications associated with thyroid surgery consist in postoperative recurrent laryngeal nerve (RLN) palsy, hypoparathyroidism, intra-operative and post-operative hemorrhage. In this paper, structured as a literature review, we describe the current knowledge and the technical improvements currently employed in the field of thyroid surgery, focusing on the contribution of energy based devices in relation with the reduction of the operating time and the odds of possible complication. Materials and methods: a relevant systematic literature search on Pubmed was carried out including works from 2004 through 2019, selecting studies providing information on the energy based devices employed in surgeries and statistic data concerning RNL (transient and permanent) injury and operative time. Results: Nineteen studies were reviewed, dealing with 4468 patients in total. The operative variables considered in this study are: employed device, number of patients, pathological conditions affecting the patients, surgical treatment, RNL injury percentage and the operating time, offering an insight on different patient conditions and their relative operative outcomes. A total of 1843 patients, accounting to the 41.2% of the total pool, underwent the traditional technique operation, while 2605 patients (58.3%) were treated employing the energy based devices techniques. Thyroidectomy performed by approaches different from traditional (for example robotic, MIVAT (Mini Invasive Video Assisted thyroidectomy)) were excluded from this study. Conclusions: The energy-based vessel sealing devices in study, represent a safe and efficient alternative to the traditional clamp-and-tie hand technique in the thyroidal surgery scenario, granting a reduction in operating time while not increasing RNL injury rates. According to this information, a preference for energy based devices techniques might be expressed, furthermore, a progressively higher usage rate for these devices is expected in the near future.
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Savioli G, Ceresa IF, Macedonio S, Gerosa S, Belliato M, Iotti GA, Luzzi S, Del Maestro M, Mezzini G, Giotta Lucifero A, Lafe E, Simoncelli A, Manzoni F, Cobianchi L, Mosconi M, Cuzzocrea F, Benazzo F, Ricevuti G, Bressan MA. Trauma Coagulopathy and Its Outcomes. ACTA ACUST UNITED AC 2020; 56:medicina56040205. [PMID: 32344710 PMCID: PMC7230692 DOI: 10.3390/medicina56040205] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/16/2022]
Abstract
Background and Objectives: Trauma coagulopathy begins at the moment of trauma. This study investigated whether coagulopathy upon arrival in the emergency room (ER) is correlated with increased hemotransfusion requirement, more hemodynamic instability, more severe anatomical damage, a greater need for hospitalization, and hospitalization in the intensive care unit (ICU). We also analyzed whether trauma coagulopathy is correlated with unfavorable indices, such as acidemia, lactate increase, and base excess (BE) increase. Material and Methods: We conducted a prospective, monocentric, observational study of all patients (n = 503) referred to the Department of Emergency and Acceptance, IRCCS Fondazione Policlinico San Matteo, Pavia, for major trauma from 1 January 2018 to 30 January 2019. Results: Of the 503 patients, 204 had trauma coagulopathy (group 1), whereas 299 patients (group 2) did not. Group 1 had a higher hemotransfusion rate than group 2. In group 1, 15% of patients showed hemodynamic instability compared with only 8% of group 2. The shock index (SI) distribution was worse in group 1 than in group 2. Group 1 was more often hypotensive, tachycardic, and with low oxygen saturation, and had a more severe injury severity score than group 2. In addition, 47% of group 1 had three or more body districts involved compared with 23% of group 2. The hospitalization rate was higher in group 1 than in group 2 (76% vs. 58%). The length of hospitalization was >10 days for 45% of group 1 compared with 28% of group 2. The hospitalization rate in the ICU was higher in group 1 than in group 2 (22% vs. 14.8%). The average duration of ICU hospitalization was longer in group 1 than in group 2 (12.5 vs. 9.78 days). Mortality was higher in group 1 than in group 2 (3.92% vs. 0.98%). Group 1 more often had acidemia and high lactates than group 2. Group 1 also more often had BE <−6. Conclusions: Trauma coagulopathy patients, upon arrival in the ER, have greater hemotransfusion (p = 0.016) requirements and need hospitalization (p = 0.032) more frequently than patients without trauma coagulopathy. Trauma coagulopathy seems to be more present in patients with a higher injury severity score (ISS) (p = 0.000) and a greater number of anatomical districts involved (p = 0.000). Head trauma (p = 0.000) and abdominal trauma (p = 0.057) seem related to the development of trauma coagulopathy. Males seem more exposed than females in developing trauma coagulopathy (p = 0.018). Upon arrival in the ER, the presence of tachycardia or alteration of SI and its derivatives can allow early detection of patients with trauma coagulopathy.
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Affiliation(s)
- Gabriele Savioli
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (S.M.); (S.G.); (M.A.B.)
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Correspondence:
| | - Iride Francesca Ceresa
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (S.M.); (S.G.); (M.A.B.)
| | - Sarah Macedonio
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (S.M.); (S.G.); (M.A.B.)
| | - Sebastiano Gerosa
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (S.M.); (S.G.); (M.A.B.)
| | - Mirko Belliato
- Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.B.); (G.A.I.)
| | - Giorgio Antonio Iotti
- Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.B.); (G.A.I.)
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (G.M.); (A.G.L.)
| | - Mattia Del Maestro
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Gianluca Mezzini
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (G.M.); (A.G.L.)
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (G.M.); (A.G.L.)
| | - Elvis Lafe
- Neuro Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.L.); (A.S.)
| | - Anna Simoncelli
- Neuro Radiodiagnostic Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (E.L.); (A.S.)
| | - Federica Manzoni
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Lorenzo Cobianchi
- General Surgery Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Mario Mosconi
- Orthopedics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.M.); (F.C.); (F.B.)
| | - Fabrizio Cuzzocrea
- Orthopedics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.M.); (F.C.); (F.B.)
| | - Francesco Benazzo
- Orthopedics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.M.); (F.C.); (F.B.)
| | - Giovanni Ricevuti
- Department of Internal Medicine and Therapeutics, Cellular Pathophysiology and Clinical immunology Laboratory, University of Pavia, 27100 Pavia, Italy;
| | - Maria Antonietta Bressan
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (S.M.); (S.G.); (M.A.B.)
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