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Ullah R, Saeed S, Rafael HA, Nishat N, Rosario-Curcio J, Gul A. Co-occurrence of Tuberculous Meningitis and Intestinal Perforation in Abdominal Tuberculosis (TB): A Report of a Rare Case From Pakistan. Cureus 2024; 16:e55132. [PMID: 38558686 PMCID: PMC10979716 DOI: 10.7759/cureus.55132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Tuberculosis (TB) remains a significant global health concern, with millions affected worldwide each year. Extrapulmonary TB, particularly involving the digestive tract and central nervous system, poses distinctive difficulties in both diagnosis and treatment. We report a case involving a 15-year-old girl with a history of intestinal TB on anti-tuberculous therapy who presented with symptoms suggestive of meningitis, along with abdominal pain and distension. Our initial suspicion was tuberculous meningitis, considering the underlining abdominal TB, which was later supported by cerebrospinal fluid analysis showing lymphocytic-predominant pleocytosis and positive acid-fast bacilli staining. Concurrently, the patient developed hemodynamic instability and severe abdominal pain, which on repeat X-rays of the abdomen showed air under the diaphragms, prompting surgical exploration and revealing multiple ileal perforations. Histopathological examination confirmed TB as the cause of perforation. This case highlights the diagnostic and therapeutic complexities of concurrent tuberculous meningitis and intestinal TB perforation. Early recognition and interdisciplinary management are crucial for optimal patient outcomes.
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Affiliation(s)
- Rizwan Ullah
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Saad Saeed
- Internal Medicine, Nottingham University Hospitals NHS Trust, Nottingham, GBR
| | | | - Nadia Nishat
- Family Medicine, Adichunchanagiri Institute of Medical Sciences, Mandya, IND
| | | | - Aiysha Gul
- Obstetrics and Gynaecology, Mardan Medical Complex, Mardan, PAK
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Branco T, Ávila L, Rodrigues A, Ferreira Á. Cecal Volvulus in an Elderly Woman: A Rare Cause of Bowel Obstruction. Cureus 2024; 16:e53571. [PMID: 38445161 PMCID: PMC10914306 DOI: 10.7759/cureus.53571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Abstract
Cecal volvulus is a rare, life-threatening form of bowel obstruction caused by the entanglement of the bowel around the mesenteric axis, compromising blood supply and leading to obstruction and ischemia. The diagnosis is challenging due to its highly variable clinical presentation and differential diagnoses, which may delay timely intervention. This is a case report of an 89-year-old woman who presented with a two-day history of lower right quadrant abdominal pain, nausea, and a temporary loss of consciousness. She also reported a history of chronic constipation. Clinical examination and imaging were suggestive of bowel obstruction, prompting further investigation. Plain radiography and abdominal CT confirmed bowel obstruction, with suspicion of volvulus. The diagnostic uncertainty between cecal and sigmoid volvulus prompted a colonoscopy, which excluded sigmoid volvulus. Emergency laparotomy revealed cecal volvulus and a distended cecum with ischemic changes but without necrosis. A right hemicolectomy was performed, and the patient recovered well postoperatively. This case report aims to expand the medical knowledge around the topic of cecal volvulus. It underscores the challenges in diagnosing and managing this condition and emphasizes the importance of prompt recognition and surgical intervention to improve patient outcomes.
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Affiliation(s)
- Tiago Branco
- General Surgery, Centro Hospitalar do Oeste, Caldas da Rainha, PRT
| | - Leonor Ávila
- General Surgery, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT
| | - Ana Rodrigues
- General Surgery, Centro Hospitalar do Oeste, Caldas da Rainha, PRT
| | - Ágata Ferreira
- General Surgery, Centro Hospitalar do Oeste, Caldas da Rainha, PRT
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Almouwalld MN. An Idiopathic Case of Sclerosing Encapsulating Peritonitis: A Case Report. Cureus 2024; 16:e53667. [PMID: 38455835 PMCID: PMC10918053 DOI: 10.7759/cureus.53667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Sclerosing encapsulating peritonitis, also known as abdominal cocoon syndrome, is an uncommon disorder where a dense fibrous layer forms around the small intestine, causing blockage and vague abdominal complaints. Despite its infrequency, diagnosing and treating this condition is challenging due to its indistinct symptoms and the complex nature of its treatment. This report discusses a 55-year-old female with no notable medical history who experienced progressive abdominal pain and weight loss. Initial laboratory tests revealed mild normocytic anemia and raised levels of inflammatory markers. A computed tomography (CT) scan demonstrated "cocoon-like" encapsulation of the small intestines. After ruling out infectious, neoplastic, and autoimmune factors, the patient was diagnosed with idiopathic sclerosing encapsulating peritonitis. The treatment strategy began with conservative measures, including total parenteral nutrition and antibiotics, but eventually required surgical intervention due to ongoing symptoms. Postoperatively, the patient recovered well, showing significant symptom relief and weight gain at a six-month checkup. This case emphasizes the need to consider sclerosing encapsulating peritonitis when diagnosing unexplained abdominal symptoms, especially when no typical risk factors are present.
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Sevy JJ, White R, Pyle SM, Aertsens A. Abdominal computed tomography and exploratory laparotomy have high agreement in dogs with surgical disease. J Am Vet Med Assoc 2024; 262:226-231. [PMID: 37944254 DOI: 10.2460/javma.23.08.0458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To compare the results of abdominal CT with exploratory laparotomy in the dog. ANIMALS 100 client-owned dogs from 1 academic institution. METHODS Medical records were searched for dogs that had undergone a preoperative abdominal CT scan read by a board-certified veterinary radiologist followed by an exploratory laparotomy. CT and surgical reports were compared. RESULTS The overall agreement between abdominal CT scan and exploratory laparotomy in all cases was 97%. Overall, there was no evidence that proportion agreement differed on the basis of body condition score, time interval between CT and surgery, or oncologic versus nononcologic disease. CLINICAL RELEVANCE Abdominal CT scan read by a board-certified diplomate is a sensitive presurgical diagnostic tool for surgical abdominal disease in the dog. When performing a specific abdominal surgery, it is acceptable for the surgeon to fully explore the abdomen or forego it for a smaller approach to the organ of interest if an abdominal CT was performed prior.
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Douglass MB, Carpenter SL, Campbell CH, Hoffman C, Hessey J. Benign or by Chance: A Case Report on Incidental Appendectomy Revealing a Neuroendocrine Tumor During Traumatic Exploratory Laparotomy. Cureus 2024; 16:e54527. [PMID: 38516428 PMCID: PMC10955438 DOI: 10.7759/cureus.54527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Incidental appendectomies (IAs) are often performed in laparotomies to prevent future complications caused by the buildup of scar tissue. Although neoplastic findings are rare, all appendectomy specimens should be sent for histopathological analysis. We present the case of a 38-year-old man found to have an appendiceal neuroendocrine tumor (NET) after receiving an IA secondary to a traumatic rectal perforation requiring exploratory laparotomy. Well-differentiated NETs isolated to the appendix have an excellent prognosis. Appendectomies are considered curative for NETs smaller than 2 cm that have not metastasized beyond the appendix. Appendiceal NETs are capable of secreting vasoactive substances and, therefore, causing carcinoid syndrome. However, the progression to carcinoid syndrome generally coincides with metastasis to the liver, indicating a poor prognosis. While histopathological analysis of appendectomy specimens rarely yields atypical findings, this analysis is crucial to ensure that the proper treatment is selected based on tumor progression in an appendectomy specimen staining positive for somatotropin and chromogranin.
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Affiliation(s)
- Megan B Douglass
- Surgery, University of South Carolina School of Medicine, Columbia, USA
| | | | - Cayla H Campbell
- Surgery, University of South Carolina School of Medicine, Columbia, USA
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Meng M, Riera Gonzalez C, Teklu Y, Mosquera Zavaleta J, Singh A. The Efficacy of Intraoperative Esophagogastroduodenoscopy in Localizing Retroperitoneal Bowel Injury: A Case Report. Cureus 2024; 16:e54057. [PMID: 38348203 PMCID: PMC10860371 DOI: 10.7759/cureus.54057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 02/15/2024] Open
Abstract
The efficacy of intraoperative esophagogastroduodenoscopy (EGD) in visualizing a patient's small bowel interior to detect injuries or lesions, or conduct a leak test post-bowel anastomosis, makes it a preferred option among surgeons. However, it is not always available, can carry a risk of morbidity and mortality, or can prolong operative time if not performed by a proficient team. A 21-year-old male patient came to the emergency department with four gunshot wounds to his abdomen, with two on either side of the abdomen. Exploratory laparotomy was performed and through and through injuries were identified in the small bowel and at the junction of the third/fourth portion of the duodenum. It was challenging to gather the patient's past medical history, particularly gastrointestinal bleeding history, due to the underlying medical condition. However, the patient had experienced a retroperitoneal bowel injury in the setting of duodenal hematoma that was not immediately identified at first glance. In this context, intraoperative endoscopy could be a significant adjunct to detect retroperitoneal bowel injury if rapidly available and in a controlled scenario. Moreover, the advantages of intraoperative EGD increase with positive collaboration between a general surgeon and a gastroenterologist.
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Affiliation(s)
- Muzi Meng
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
- General Surgery, BronxCare Health System, Bronx, USA
| | | | - Yonas Teklu
- General Surgery, BronxCare Health System, Bronx, USA
| | | | - Ajit Singh
- General Surgery, BronxCare Health System, Bronx, USA
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Zong B, Xiao X, Deng N, Wang W, Peng L, Fang D, Wang H, Hu S, Li Z, Zhang X. A case report of a giant ileocecal cystic prolapse through the anus and literature review. Front Med (Lausanne) 2024; 10:1324792. [PMID: 38249983 PMCID: PMC10796788 DOI: 10.3389/fmed.2023.1324792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Intussusception refers to the invagination of a proximal loop of the bowel into an adjacent distal segment. This condition is rare in adults, especially when it involves a complete folding of the ileocecal area out of the body cavity. Meanwhile, enterogenous cysts are congenital malformations that are largely identified in childhood following symptoms of bowel obstruction. While surgical treatment is ultimately required for both diseases, deciding on the type of surgery and the right time to operate can be a challenge for clinicians. It is especially difficult to decide on treatment for an adult with the coincidental occurrence of both conditions and no definitive pathologic diagnosis prior to surgery. Here, we present the case study of a 19-year-old female patient who presented with a prolapsed anus due to intussusception caused by a large ileocecal mass. The patient was admitted to the emergency department with a "massive anal mass." She remained symptomatic after receiving conventional conservative treatment and had to undergo emergency surgery after developing an intestinal obstruction. While the patient's intraoperative condition also confirmed the preoperative CT findings, the situation became more complicated during surgery. The postoperative pathological report indicated the presence of an enterogenous cyst. After recovery from surgery, the patient was successfully discharged. Intussusception or intestinal obstruction caused by an intestinal mass is a surgical indication, and removal is the only way to cure the condition. This case study provides a helpful reference for general surgeons, especially anorectal surgeons, imaging physicians, and pathologists, and informs the diagnosis and treatment of this patient population.
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Affiliation(s)
- Beige Zong
- Department of General Surgery, The Fourth People’s Hospital of Chongqing, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Xia Xiao
- Department of General Surgery, The Fourth People’s Hospital of Chongqing, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Nijiao Deng
- Department of General Surgery, The Fourth People’s Hospital of Chongqing, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Wenjing Wang
- Medical Imaging Department, The Fourth People’s Hospital of Chongqing, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Li Peng
- Department of Pathology, The Fourth People’s Hospital of Chongqing, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Dianliang Fang
- Department of Gastroenterology and Hepatology, The Fourth People’s Hospital of Chongqing, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Haoyu Wang
- Department of General Surgery, The Fourth People’s Hospital of Chongqing, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Song Hu
- Department of General Surgery, The Fourth People’s Hospital of Chongqing, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Zhongfu Li
- Department of General Surgery, The Fourth People’s Hospital of Chongqing, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Xin Zhang
- Department of General Surgery, The Fourth People’s Hospital of Chongqing, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
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Yadav KK, Ghimire R, Subedi S, Kandel K, Yadav RK, Ghimire B, Shah JK. Radiolucent foreign body leading to complete small bowel obstruction: a diagnostic dilemma - a case report. Ann Med Surg (Lond) 2023; 85:6144-6147. [PMID: 38098606 PMCID: PMC10718328 DOI: 10.1097/ms9.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/12/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction and importance Foreign body ingestion leading to luminal obstruction in both the small and large bowels is rare, especially in children. The authors present a case of a 7-year-old patient who presented with a small bowel obstruction caused by an ingested radiolucent foreign body. The previous herniotomy surgery 1 year back led to initial diagnostic confusion, highlighting the need for a broad differential diagnosis. Case presentation A 7-year-old child with a history of herniotomy presented with symptoms of small bowel obstruction. Radiological imaging revealed a soft tissue mass mimicking a polyp or cystic lesion. During exploratory laparotomy, a cystic structure was discovered in the terminal ileum. The foreign body, identified as a fluid-filled balloon, was inaccessible to endoscopy and was gently maneuvered into the ascending colon. It was punctured and removed during on-table colonoscopy. Clinical discussion This case underscores the challenges of diagnosing and managing luminal obstruction caused by radiolucent foreign bodies in children. The presence of previous surgery can mislead clinicians, necessitating a broad differential diagnosis. Radiological imaging played a crucial role in identifying the foreign body. Surgical intervention guided by an on-table colonoscopy allowed successful removal. Conclusion Foreign body ingestion leading to luminal obstruction should be considered, even in cases with previous abdominal surgery. Radiological imaging aids in identification, and timely surgical intervention, guided by on-table colonoscopy, facilitates foreign body removal. Awareness of such cases is essential for optimal care in pediatric patients with luminal obstruction caused by foreign body ingestion.
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Affiliation(s)
- Krishna K. Yadav
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
| | - Ranjeet Ghimire
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University
| | - Sudan Subedi
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
| | - Krishna Kandel
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University
| | | | - Bikal Ghimire
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
| | - Jayant K. Shah
- Department of General Surgery, Tribhuvan University Teaching Hospital, Maharajgunj
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Choudhary S, Kose V. A Cystic Surprise: Unearthing Fimbrial Cysts as an Uncommon Source of Abdominal Pain. Cureus 2023; 15:e49885. [PMID: 38174203 PMCID: PMC10762493 DOI: 10.7759/cureus.49885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
Fimbrial cysts also known as paraovarian cysts are small and asymptomatic and are occasionally large resulting in pelvic pain. It is difficult to differentiate a fimbrial cyst from an ovarian cyst by imaging; therefore, they are often recognized intra-operatively during laparotomy. This report presents a rare case of a 48-year-old female who presented with the primary complaints of persistent right lower abdominal pain that was intermittently radiating to the back for one year. Clinical findings reported the possibility of twisted right hydrosalpinx but the tumor biomarkers were found to be within the normal range. In addition to this, ultrasound sonography (USG) and magnetic resonance imaging (MRI) revealed a pelvic mass that was indicative of cystic lesions. As the above-mentioned diagnosis was found to be challenging, exploratory laparotomy as a part of surgical intervention and diagnosis was performed along with histopathological investigations that confirmed the existence of fimbrial end cysts on both sides. Fimbrial end cysts represent a rare yet significant cause of abdominal pain; therefore, early recognition, thorough clinical evaluation, and appropriate diagnostic workup are essential for timely intervention and preventing potential complications associated with fimbrial end cysts.
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Affiliation(s)
- Srishti Choudhary
- Department of Obstetrics and Gynaecology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
| | - Varsha Kose
- Department of Obstetrics and Gynaecology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND
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Verma A, Sharma G, Kashyap M. A Retrospective Analysis of Emergency Obstetric Hysterectomy: A Life-Saving Intervention. Cureus 2023; 15:e46758. [PMID: 37946885 PMCID: PMC10632065 DOI: 10.7759/cureus.46758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
Introduction Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that plays a critical role in managing life-threatening obstetric emergencies. In our study, we sought to evaluate the incidence, indications, risk factors and maternal as well as fetal outcomes associated with EOH. Also, the study was conducted to review the operative experiences and trend of emergency hysterectomies done for various indications over a period of two years in our tertiary care center. Methods The present hospital-based retrospective analytical study was conducted in the Department of Obstetrics and Gynecology, L.L.R.M. Medical College, Meerut, between March 2021 to February 2023. All women who delivered within or outside the institute undergoing obstetric hysterectomy were included in our study. Out of a total of 7743 deliveries, 46 EOH cases were found. The data of these 46 EOH deliveries were collected and analyzed after issuing ethical clearance by the Institutional Ethical Committee of L.L.R.M. Medical College, Meerut. Results During the two-year study period, 46 EOH were performed out of 7743 deliveries making an incidence of 0.504 EOH per 100 deliveries. Most of the cases were of multiparous women in the age group of 25 to 35 years (78%). The majority, 43.5% cases belonged to placenta accreta spectrum (PAS), followed by ruptured uterus (30.5%) and postpartum hemorrhage (PPH) (26%). The most frequent preoperative complication seen in EOH was severe anemia (29, 63%). Intraoperative bladder injury was seen in four cases, along with one case of ureteric injury. Postoperatively, cases were shown to have acute hemorrhagic shock (54.3%), disseminated intravascular coagulation (DIC), septicemia, wound infection, acute renal failure (ARF), hepatic encephalopathy and psychosis. Four maternal mortalities were observed in our study. Conclusion EOH is a necessary operative procedure in many obstetric emergencies including PAS and PPH. Despite intra-operative risk and possible postoperative complications, it remains a potentially life-saving procedure. Thus various surgeries for PAS and PPH should be the integral part of postgraduate trainings to save the lives of mothers and to reduce the maternal mortality.
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Affiliation(s)
- Aruna Verma
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
| | - Garima Sharma
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
| | - Monika Kashyap
- Department of Obstetrics and Gynecology, Lala Lajpat Rai Memorial (LLRM) Medical College, Meerut, IND
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Garg S, Yadav MS, Singhal K. A Clinical Comparative Study of Rectus Sheath Closure Techniques in Emergency Exploratory Laparotomy: Evaluating "Far-Near-Near-Far" vs. Conventional Closure Approach. Cureus 2023; 15:e45655. [PMID: 37868414 PMCID: PMC10589504 DOI: 10.7759/cureus.45655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Midline exploratory laparotomy is essential in emergency surgery, and effective closure of the abdominal wall is crucial for optimal healing and reduced complications. The far-near-near-far technique for rectus sheath closure has gained attention due to potential advantages over conventional closure due to the fact that even if one suture gives way it does not affect the nearby suture and the rectus sheath is still held in place. This study aims to compare these techniques in emergency exploratory laparotomy. METHODS This single-center prospective observational study included all patients undergoing emergency exploratory laparotomy at a tertiary care hospital. Patients were categorized into two groups based on the closure technique used: conventional closure or far-near-near-far technique. Sociodemographic data and comorbidities were collected. Operative time, closure time, and postoperative complications were assessed. Statistical analysis was performed using IBM SPSS Statistics 22.0 (IBM Corp., Armonk, NY). RESULTS The study included patients with a mean age of 42.14 years. Operative and closure times did not significantly differ between the groups. There was no significant difference in comorbidities between the two techniques. The incidence of wound infection, dehiscence, burst abdomen, incisional hernia, and sinus formation did not significantly differ between the groups. Late complications were also similar. CONCLUSION The far-near-near-far technique for rectus sheath closure in emergency exploratory laparotomy showed comparable outcomes to conventional closure methods. No significant differences were found in operative time, closure time, or postoperative complications. This study contributes to the understanding of different closure techniques, allowing surgeons to make informed decisions.
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Affiliation(s)
- Shreyash Garg
- General Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Moorat Singh Yadav
- General Surgery, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Kritika Singhal
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Saada LJM, Erdogan NB, Saada J. Superior Mesenteric Vein Dilatation With Ladd's Band Causing Partial Intestinal Obstruction in a Five-Year-Old Male Child: A Case Report. Cureus 2023; 15:e45895. [PMID: 37885546 PMCID: PMC10598618 DOI: 10.7759/cureus.45895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
Midgut malrotation has a noticeable frequency among congenital anomalies and presents mostly as vomiting. We report a case of a five-year-old boy with recurrent attacks of bilious vomiting and mild epigastric colicky abdominal pain for a year. Midgut malrotation with Ladd's band and superior mesenteric vein (SMV) dilatation causing partial intestinal obstruction were diagnosed based on the clinical presentation, upper gastrointestinal (GI) barium follow-through study, computed tomography (CT) scan with and without IV contrast, and intraoperative findings. In the upper GI barium study, the duodenum was passing anteriorly, and the second and proximal third portions were persistently dilated with recurring to-and-fro type peristalsis, resulting in delayed passage through the third portion. In the abdomen and pelvis CT scan with and without IV contrast, the SMV was dilated, forming a venous collar around the third portion of the duodenum and causing partial obstruction. Exploratory laparotomy revealed a hugely dilated SMV trapped in the Ladd's band. Ladd's procedure was done besides releasing the SMV and widening the root of the mesentery. The postoperative follow-up was smooth, without any relapse of the previous symptoms. Midgut malrotation in the older age group is rare in itself because there are relatively few cases documented in this age range. We determined to present this case to raise awareness of knowledge concerning the diagnosis and timely management of this condition in order to prevent comorbidity. In addition, we realise that SMV dilatation is an uncommon correlation of the known condition, midgut malrotation, and hope to contribute to the literature.
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Affiliation(s)
| | | | - Jamil Saada
- Pediatric Surgery Department, Al Mezan Hospital, Hebron, PSE
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13
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Ho TH, Lin PY. Woman With Hematochezia. J Acute Med 2023; 13:125-128. [PMID: 37841820 PMCID: PMC10568636 DOI: 10.6705/j.jacme.202309_13(3).0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/26/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2023]
Abstract
As a consequence of cirrhosis, portal hypertension causes resistance to blood flow and leads to the formation of varices. However, colonic variceal hemorrhages are rarely reported but could be a lethal cause of lower gastrointestinal hemorrhage. Currently, there is no consensus on the management of colonic variceal hemorrhage. Variceal ligation, injection sclerotherapy, transjugular intrahepatic portosystemic shunt placement, and balloon-occluded retrograde transvenous obliteration or a combination of the above therapies have been reported with inconsistent success rates. We advocate considering colonic variceal bleeding as a crucial differential diagnosis of lower gastrointestinal bleeding in cirrhotic patients and initiating time-sensitive, definite operative treatment or combination therapy as soon as possible in colonic variceal patients with life-threatening bleeding events, which are often refractory to conservative treatment.
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Affiliation(s)
- Tai-Hung Ho
- National Yang Ming Chiao Tung UniversityEmergency Medicine, College of MedicineTaipeiTaiwan
- Taipei Veterans General HospitalDepartment of Emergency MedicineTaipeiTaiwan
| | - Pei-Ying Lin
- National Yang Ming Chiao Tung UniversityEmergency Medicine, College of MedicineTaipeiTaiwan
- Taipei Veterans General HospitalDepartment of Emergency MedicineTaipeiTaiwan
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Shah D, Chaudhary SR, Khan S, Mallik S. Overreliance on Radiological Findings Leading to Misdiagnosed Giant Retroperitoneal Ganglioneuroma: A Case Report and Literature Review. Cureus 2023; 15:e43914. [PMID: 37746449 PMCID: PMC10512760 DOI: 10.7759/cureus.43914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Ganglioneuroma is a rare, benign, well-differentiated neurogenic tumor most commonly located in the posterior mediastinum or retroperitoneum. Giant ganglioneuromas are even less common; this is only the 19th reported case in literature to date. We present a case of a giant retroperitoneal ganglioneuroma in a five-year-old child, which on imaging mimicked a mesenteric cyst and posed various challenges in its management. Histopathology later confirmed our misdiagnosis and revealed the tumor to be a ganglioneuroma. This unique case serves as a lesson for clinicians to not operate before receiving histopathological confirmation of their diagnosis.
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Affiliation(s)
| | | | - Shahin Khan
- General Surgery, Medical College Baroda, Vadodara, IND
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15
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Tiesenga F, Adorno LF, Udoeyop D, Dinh V, Ahmed S, Sharma A, Sharma K. Perforated Marginal Ulcer. Cureus 2023; 15:e38127. [PMID: 37252481 PMCID: PMC10212605 DOI: 10.7759/cureus.38127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Marginal ulcers are a late complication of gastric bypass surgery. A marginal ulcer is a term for ulcers that develop at the margins of a gastrojejunostomy, primarily on the jejunal side. A perforated ulcer involves the entire thickness of an organ, creating an opening on both surfaces. We will present an intriguing case of a 59-year-old Caucasian female who arrived at the emergency department with diffused chest and abdominal pain that began in her left shoulder and went down to the right lower quadrant area. The patient was in visible pain with restlessness, and her abdomen was moderately distended. The computed tomography (CT) showed possible perforation in the gastric bypass surgery area, but the results were inconclusive. The patient had laparoscopic cholecystectomy ten days prior, and the pain began right after surgery. The patient underwent an open abdominal exploratory surgery, with the closure of the perforated marginal ulcer. The fact that the patient had undergone another surgery and had pain immediately afterward also obscured the diagnosis. This case shows the rare presentation of the patientäs diverse signs and symptoms and inconclusive reports that led to the open abdominal exploratory surgery that finally confirmed the diagnosis. This case highlights the importance of a thorough past medical history, including surgical history. The past surgical history led the team to zone in on the gastric bypass area, leading to an accurate differential diagnosis.
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Affiliation(s)
| | - Luis F Adorno
- Surgery, Windsor University School of Medicine, Community First Medical Center, Chicago, USA
| | | | - Victor Dinh
- Surgery, Windsor University School of Medicine, Chicago, USA
| | - Sarosh Ahmed
- Surgery, Windsor University School of Medicine, Chicago, USA
| | - Akash Sharma
- Surgery, Windsor University School of Medicine, Chicago, USA
| | - Karan Sharma
- Surgery, Windsor University School of Medicine, Chicago, USA
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16
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Kaur J, Stoukides G, Amaturo M. Closed-Loop Gastric Outlet Obstruction Secondary to Duodenal Ulcer in a Patient With Esophageal Stricture. Cureus 2023; 15:e36507. [PMID: 37090344 PMCID: PMC10121273 DOI: 10.7759/cureus.36507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Closed-loop gastric outlet obstruction (GOO) is a rare complication that results from a mechanical obstruction in the pylorus or duodenum. In the early 1990s, the common cause of GOO was peptic ulcer disease, accounting for 5% to 10% of hospital admissions. Peptic ulcer disease is the disruption of the mucosal integrity in the stomach and duodenum and can be categorized into gastric ulcers and duodenal ulcers. With the treatment for Helicobacter pylori and the increased use of proton pump inhibitors (PPI), GOO now occurs in fewer than 5% of patients with duodenal ulcer disease and even less in those with gastric ulcer disease. Although the morbidity of duodenal ulcers has been declining in recent years, the incidence of post-bulbar duodenal ulcer (PBDU) remains at a constant 9.33%, primarily due to diagnostic and therapeutic difficulties. Additionally, fewer than 5% of obstructing duodenal ulcers are caused by PBDU, and even fewer are located in the second or third portions of the duodenum. Ulcers located in the distal part of the duodenum raise concern for syndromes associated with hypersecretion of acid, including Zollinger-Ellison syndrome (ZES). The ZES is rare, accounting only for 0.1% of all duodenal ulcers. Here, we present a case where a patient with esophageal stricture developed a rare case of closed-loop GOO secondary to a duodenal ulcer. The patient, initially treated for esophageal perforation, developed an esophageal stricture. The patient was being worked up for ZES and multiple endocrine neoplasia link type 1 (MEN1) syndrome due to his concerning laboratory findings and rare clinical presentation.
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Affiliation(s)
- Jashandeep Kaur
- Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Georgianna Stoukides
- Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Michael Amaturo
- General Surgery, Jamaica Hospital Medical Center, New York, USA
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17
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Merridale-Punter MS, Prutton JSW, Stefanovski D, Worsman FCF, Payne RJ, Wylie CE, Archer DC, Menzies-Gow NJ, Coles L, McGovern KF, Parker RA. Outcome following emergency laparotomy in 33 UK donkeys: A retrospective multicentre study. Equine Vet J 2023; 55:222-229. [PMID: 35478419 DOI: 10.1111/evj.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Emergency laparotomies in donkeys are infrequently performed and there is limited literature on the subject. OBJECTIVES To determine findings and associated outcomes of exploratory laparotomies in donkeys. STUDY DESIGN Descriptive retrospective study. METHODS Donkeys undergoing emergency exploratory laparotomy for investigation and treatment of colic at seven UK referral hospitals between 2005-2017 were included. Data were retrieved from available hospital records. Descriptive statistics and inferential statistical analysis of outcomes of interest was performed in three steps. RESULTS Thirty-three cases fulfilled the inclusion criteria. Clinical signs on presentation were available for 32 donkeys, of which 53.1% (17/32) presented for investigation of colic while in 46.9% (15/32) the presenting complaint was non-specific. Primary lesion location included small intestine (42.4%, 14/33), large colon (39.3%, 13/33), caecum (6.1%, 2/33), stomach (6.1%, 2/33) and 6.1% (2/33) had multiple abnormal findings without a clear primary lesion. Overall survival to discharge was 54.5% (18/33). Five donkeys (15.2%, 5/33) were euthanased at surgery and of those recovering from general anaesthesia a further 35.7% (10/28) were euthanased or died prior to discharge. Six donkeys (21.4%, 6/28) required a second laparotomy of which 4 (66.7%, 4/6) survived. Post-operative complications occurred in 82.1% (23/28) of cases and included hyperlipaemia (42.9%, 12/28), incisional complications (21.4%, 6/28), ileus (21.4%, 6/28) and persistent colic (17.9%, 5/28). When adjusted for other complications, donkeys with primary gastric lesions were less likely to have presented with severe colic compared with those with primary small intestinal lesions (OR: 0.07, 95% CI 0.01-0.95, p = 0.05). Only age was positively associated with death prior to discharge (OR: 1.18, 95% CI 1.03-1.36, p = 0.02). MAIN LIMITATIONS Small sample size and retrospective design. CONCLUSION Donkeys with abdominal lesions may present with a range of signs often not including colic. Surgical findings were diverse and survival to discharge appears to be lower than in horses.
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Affiliation(s)
- Mathilde S Merridale-Punter
- Liphook Equine Hospital, Liphook, UK.,Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, Australia
| | | | - Darko Stefanovski
- University of Pennsylvania, Clinical Studies - New Bolton Center, Kennett Square, Pennsylvania, USA
| | - Francesca C F Worsman
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | | | - Claire E Wylie
- Rossdales Equine Hospital, Exning, UK.,The University of Sydney, Sydney School of Veterinary Sciences, Sydney, New South Wales, Australia
| | - Debra C Archer
- University of Liverpool, Equine Hospital, Leahurst Campus, Neston, UK
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18
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Muacevic A, Adler JR, Ooi G, Sritharan M. Conservative Management of Emphysematous Gastritis With Gastric Mucosal Ischaemia: A Case Report. Cureus 2023; 15:e34656. [PMID: 36755769 PMCID: PMC9902070 DOI: 10.7759/cureus.34656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/07/2023] Open
Abstract
Emphysematous gastritis is a rare condition historically associated with high mortality. It is characterised by gastric mural pneumatosis and portal venous gas, secondary to bacterial or fungal invasion. Given the rarity of the condition, there is little evidence to guide clinical decisions regarding whether a patient requires surgical resection. We describe the case of a 72-year-old male diagnosed with emphysematous gastritis, with endoscopic evidence of gastric fundus mucosal ischaemia. As there was no evidence of ischaemia extending to the serosa on exploratory laparotomy, gastrectomy was not performed, and the patient was managed conservatively. He subsequently made a full recovery, and was discharged without any further complications. This case demonstrates that in the absence of full-thickness gastric ischaemia, patients with emphysematous gastritis may be appropriate for conservative management without surgical resection.
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19
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Muacevic A, Adler JR, Habib Al Abboudi Y. Urinary Bladder Perforation Due to Foley Catheter: A Case Report and Review of Literature. Cureus 2022; 14:e32887. [PMID: 36582418 PMCID: PMC9793804 DOI: 10.7759/cureus.32887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
Urinary bladder perforation is one of the few surgical emergencies prone to misdiagnosis, leading to a high mortality rate. Our case highlights patient management in such cases and reviews similar reports to increase awareness about patients with indwelling catheters and suspicion of bladder perforation. A 73-year-old patient with decompensated heart failure developed severe abdominal pain, abdominal distention, and hematuria following a Foley catheter insertion. Computed tomography (CT) raised suspicion of bladder perforation. Exploratory laparotomy revealed serosanguinous fluid in the abdomen and rupture of the bladder dome. Bladder repair was performed, and the patient was monitored post-operatively under intensive care, with an uneventful recovery before discharge. There are many causes of bladder perforation. It occurs most commonly due to traumatic incidence, iatrogenic instrumentation, or spontaneous rupture. It is a rare complication, accounting for 0.002% of all hospital admissions. According to the Centers for Disease Control (CDC), 12-15% of patients receive a urinary catheter during their hospital stay; therefore, it is important to consider complications of catheterization and their management. Bladder rupture can present with non-specific symptoms leading to delayed management. We recommend clinical attention to patients with urinary catheter insertion presenting with severe abdominal pain, difficulty voiding, or hematuria to rule out the possibility of perforation. Rapid diagnosis and accurate treatment of such cases are crucial for an uneventful recovery.
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20
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Muacevic A, Adler JR, Rani A, Chejara RK, Sharma A, Arora JK, Kalwaniya DS, Tolat A, G P, Singh A. Preoperative Serum Albumin Level as a Predictor of Abdominal Wound-Related Complications After Emergency Exploratory Laparotomy. Cureus 2022; 14:e31980. [PMID: 36589182 PMCID: PMC9797030 DOI: 10.7759/cureus.31980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Serum albumin is generally considered to be a predictor of patients' nutritional status. Previous studies have used serum albumin to assess postoperative morbidity, mortality, and various other surgical outcomes in cardiac surgeries and elective gastrointestinal surgeries. In this study, we used preoperative serum albumin levels to assess postoperative surgical site wound complications in patients who underwent emergency exploratory laparotomy. Methodology Preoperative serum albumin level was observed in 60 patients who underwent emergency exploratory laparotomy due to various pathological conditions and were divided into those with hypoalbuminemia (serum albumin level <3.5 g/dl and >3.5 g/dL). Postoperative surgical site infections, wound dehiscence, and various complications, such as duration of hospital stay, prolonged ileus, the incidence of enterocutaneous fistula, the incidence of anastomotic leak, and 30-day mortality, were assessed. Results In our study, about 65% of the patients had hypoalbuminemia. Among them, 56.4% of the patients had surgical site infections according to the Southampton grade, with a statistically significant p-value of <0.001. Moreover, 87.2% of the patients had wound dehiscence according to the World Union Wound Healing Societies Surgical Wound Dehiscence wound grading, with a statistically significant p-value of <0.001. In addition, statistical significance was noted between preoperative hypoalbuminemia and increased postoperative hospital stay, with a p-value of <0.001. Conclusions Preoperative serum albumin value is a formidable predictor of postoperative surgical site infections, wound dehiscence, and duration of hospital stay in patients who underwent emergency exploratory laparotomy.
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21
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Abstract
A mesenteric cyst is an uncommon ailment that can affect practically any abdominal quadrant in its presentation. They may turn up as an accidental discovery. Although there are a number of hypotheses explaining the genesis of these cysts, the exact etiology is unknown. A 70-year-old female patient came to see us complaining of abdominal pain for a month and had trouble passing stools for 15 days. Contrast-enhanced computed tomography was done for the patient, which revealed a heterogeneously enhancing mass lesion in the abdominal cavity. The patient was then taken for an exploratory laparotomy procedure. To make the procedure thorough and easy, intraoperative partial drainage of the cyst fluid was carried out. We were able to observe the margins of the mesenteric cyst more easily as the partial drainage was carried out. The partial drainage decreased the volume and size of the mesenteric cyst, reducing the pressure effect on the surrounding structures and allowing easy mobilization of the intraabdominal structures during intraoperative examinations. The partial drainage of the cystic fluid also made the dissection process safer. After releasing all adhesions, the cyst was delivered outside and sent for histopathological analysis. The histopathological reports confirmed it to be a mesenteric cyst. The aim of this article is to educate the readers and to make fellow surgeons well aware of this condition. This will not only help fellow clinicians in better diagnosis and treatment but also help in the reduction of the overall burden of the healthcare society by reducing mortality and morbidity.
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22
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Huang X, Li G, Zhang X, Chen Z, Xu M, Sun Y. Natural Course and Treatment of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection with Total True Lumen Occlusion. Vasc Endovascular Surg 2022; 57:41-47. [PMID: 36171181 DOI: 10.1177/15385744221130836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We retrospectively investigated the association between the imaging features of spontaneous isolated superior mesenteric artery dissection (SISMAD) accompanied by total true lumen occlusion and the clinical symptoms to identify the patients at high risk and establish personalized therapeutic options. METHODS Among 261 patients with SISMAD, we selected 37 with Yun's type III dissection; 35 patients underwent successful conservative management and 2 patients underwent exploratory laparotomy. After discharge, all patients were periodically followed up on an outpatient basis. We recorded patients' general condition, symptoms, time until symptom relief, imaging findings and follow-up results. RESULTS All patients experienced acute abdominal pain prior to admission, with an onset time of 29.95 ± 24.66 hours. The mean time until relief of abdominal pain in patients who received conservative treatment was 42.17 ± 38.09 hours. Correlation analysis revealed no correlation between the length of dissection or of the occluded segment and abdominal pain intensity. Pain scores were lower and time until pain relief was shorter in patients with a definite arc of Riolan (AOR) on admission than in those without an AOR. No collateral circulation was observed in the two patients who underwent exploratory laparotomy, and distal intestinal perfusion was poor in these cases. Complete and partial remodeling of the superior mesenteric artery (SMA) was observed in 6 and 16 patients, respectively at the 12-month follow-up. Although the SMA remained occluded in 12 patients, abundant collateral circulation was detected. Three patients were lost to follow-up. CONCLUSION This study highlights that conservative treatment should be attempted as first-line therapy in most patients with Yun's type III SISMAD. Complete AOR can contribute to remission of clinical symptoms during the acute stage. Poor distal blood flow of occluded vessels may serve as an important indicator for identification of patients at high risk of ischemic intestinal necrosis.
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Affiliation(s)
- Xianchen Huang
- Department of Interventional Radiology and Vascular Surgery, 606537Dushu Lake Hospital Affiliated to Soochow University, Soochow, China
| | - Guanqiang Li
- Department of Interventional Radiology and Vascular Surgery, 606537Dushu Lake Hospital Affiliated to Soochow University, Soochow, China
| | - Xicheng Zhang
- Department of Interventional Radiology and Vascular Surgery, 606537Dushu Lake Hospital Affiliated to Soochow University, Soochow, China
| | - Zhaolei Chen
- Department of Vascular Surgery, 370089Yangzhou University Affiliated Northern Jiangsu People's Hospital, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Miao Xu
- Department of Vascular Surgery, 370089Yangzhou University Affiliated Northern Jiangsu People's Hospital, The Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yuan Sun
- Department of Interventional Radiology and Vascular Surgery, 606537Dushu Lake Hospital Affiliated to Soochow University, Soochow, China
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23
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Nashidengo PR, Quayson FW, Abebrese JT, Tjipetekera R, Seibes SS. Twice perforated stump appendicitis: a case report. Pan Afr Med J 2022; 43:43. [PMID: 36523281 PMCID: PMC9733468 DOI: 10.11604/pamj.2022.43.43.37149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 10/03/2023] Open
Abstract
Stump appendicitis is an acute inflammation of the residual appendix and one of the rare complications after appendectomy. Stump appendicitis is an under-reported and poorly defined condition related to obstruction and inflammation of the residual appendix after an appendectomy, usually by a fecolith. It remains a clinical challenge because of delayed diagnosis and subsequent treatment with increased morbidity or mortality. Herein, we describe the case of a 42-year-old male who presented with periumbilical pain with progression to generalized abdominal pain and signs of peritonitis 14 months post appendectomy. An exploratory laparotomy revealed an inflamed, non-gangrenous perforated appendices stump. We discuss the challenges in the diagnosis and management thereof.
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24
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Nakamae Y, Hobbs KJ, Ziegler J, Rivero LA, Kennedy S, Stockler J, Gomez DE. Gastrointestinal foreign bodies in pet pigs: 17 cases. J Vet Intern Med 2022; 36:1185-1189. [PMID: 35481711 PMCID: PMC9151479 DOI: 10.1111/jvim.16429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pigs have an indiscriminate eating behavior placing them at high risk of developing foreign body (FB) obstructions. Objectives Describe the clinical and diagnostic features, treatments, and outcome of pet pigs diagnosed with gastrointestinal (GI) FBs. Medical and surgical treatments, pig outcomes, and post‐mortem findings were also investigated. Animals Seventeen pet pigs. Methods A multicenter retrospective study was conducted. Gastrointestinal FBs were defined as swallowed objects that became lodged within the gastrointestinal tract distal to the cardia identified during exploratory laparotomy. Results Common clinical signs were anorexia/hyporexia, tachypnea, vomiting, dehydration, tachycardia, and ileus. Diagnostic imaging identified the presence of a FB in 4 cases. Upon celiotomy, the FBs were in the stomach and small intestine in 17 cases and large colon in 2 cases. Types of FB included fruit pit, diaper, and metallic objects. Of the 17 pigs, 15 (88%) were discharged from the hospital and 2 (12%) were euthanized. Conclusion and Clinical Importance Clinical signs of GI FB were similar to those reported in obstipated pigs. Diagnostic imaging has limitations for detection of FB. Surgical removal of FBs in pigs carried a good prognosis.
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Affiliation(s)
- Yoko Nakamae
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Kallie J Hobbs
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Jessie Ziegler
- Department of Veterinary Medical Teaching Hospital, University of California School of Veterinary Medicine, Davis, California, USA
| | - Luis A Rivero
- Department of Large Animal Clinical Sciences, University of Missouri College of Veterinary Medicine, Columbia, Missouri, USA
| | - Shari Kennedy
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Jenna Stockler
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, Alabama, USA
| | - Diego E Gomez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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25
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Siddiqui A, Ahmed H, Nazim MH, Soliman B, Obokhare I. Giant Proximal Right Colon Submucosal Hematoma Leading to a Large Bowel Obstruction. Cureus 2022; 14:e24599. [PMID: 35651476 PMCID: PMC9138192 DOI: 10.7759/cureus.24599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/05/2022] Open
Abstract
A 41-year-old female with a previous history of chronic obstructive pulmonary disease (COPD) and polycythemia presented to the emergency department with worsening shortness of breath and cough which progressed to respiratory distress requiring mechanical ventilation. During her hospital stay, she developed abdominal distention followed by a fever and a four-point decrease in hemoglobin. A non-contrasted abdominopelvic CT scan was ordered which showed a very large retroperitoneal hematoma adjacent to the right colon with subtle active bleeding. Selective angioembolization of a distal segment of the right colic artery was performed by Interventional Radiology (IR) to achieve hemostasis and hemodynamic stability. Due to the persistent and worsening abdominal distention, a CT scan with contrast was ordered which clearly showed a submucosal hematoma in the region of the right colon extending from the hepatic flexure to the cecum. The hematoma was completely obstructing the proximal and mid ascending colon leading to a large bowel obstruction. Exploration of the abdomen showed severe bowel dilation, and frank ischemia of the hepatic flexure of the colon. Right hemicolectomy with primary ileocolonic anastomosis to evacuate the right retroperitoneal hematoma was subsequently performed. The patient was discharged on post-operative day 16 with no major complications.
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Affiliation(s)
- Arham Siddiqui
- General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Hijab Ahmed
- General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Muhammad H Nazim
- General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Basem Soliman
- General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Izi Obokhare
- General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
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26
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Lee CK, Wisnik CA, Abdel-Khalek A, Fleites O, Pelenyi SS, Tariq A, Tiesenga F. Peanut-Related Perforated Diverticulitis Before the Age of 60. Cureus 2021; 13:e19767. [PMID: 34950546 PMCID: PMC8686341 DOI: 10.7759/cureus.19767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 11/19/2022] Open
Abstract
We present a case in which a 55-year-old male with a past medical history of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) presented with sharp, worsening right-sided abdominal pain radiating across the entire abdomen after eating peanuts. Computed tomography (CT) imaging showed evidence of acute sigmoid diverticulitis complicated by a walled-off perforation. The patient’s past medical history suggested previous recurrent episodes of diverticulitis. Our patient underwent exploratory laparotomy, sigmoid colon resection with low anterior anastomosis and proctocolectomy, and loop ileostomy. During treatment, the sigmoid colon was found to be very indurated and abnormally going all the way down to the peritoneal reflection. Appropriate identification of the patient’s condition and timely intervention resulted in a successful outcome.
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Affiliation(s)
- Charles K Lee
- Medicine, Saint James School of Medicine, Park Ridge, USA.,Surgery, West Suburban Medical Center, Oak Park, USA
| | - Christopher A Wisnik
- Medicine, Poznan University of Medical Sciences, Poznan, POL.,Surgery, West Suburban Medical Center, Oak Park, USA
| | - Ameen Abdel-Khalek
- Medicine, Saint James School of Medicine, Park Ridge, USA.,Surgery, West Suburban Medical Center, Oak Park, USA
| | - Orlando Fleites
- Medicine, Saint James School of Medicine, Park Ridge, USA.,Surgery, West Suburban Medical Center, Oak Park, USA
| | - Stephanie S Pelenyi
- Anesthesia, Avalon University School of Medicine, Willemstad, CUW.,Surgery, West Suburban Medical Center, Oak Park, USA
| | - Ammarah Tariq
- Medicine, Saint James School of Medicine, Park Ridge, USA.,Surgery, West Suburban Medical Center, Oak Park, USA
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27
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Lee C, Velez V, Patel S, Huynh L, Saddler CJ, Dhillon S, Nguyen J, Tiesenga F. Mesh for Hernia Repair as Cause of Bowel Obstruction. Cureus 2021; 13:e19702. [PMID: 34934571 PMCID: PMC8684331 DOI: 10.7759/cureus.19702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/05/2022] Open
Abstract
Ventral hernia repairs are commonly treated by abdominal wall repair where a prosthetic mesh is placed over the hernia site, to prevent future hernia recurrences. Risks of a ventral hernia repair include urinary retention, seroma, recurrence, and in rare cases, bowel injury or obstruction. Our patient's clinical presentation and history, supported by an abdominal X-ray and CT findings, were consistent with the diagnosis of small bowel obstruction (SBO) due to adhesions between the patient's small bowel and the mesh used for abdominal wall hernia repair. Our patient underwent an exploratory laparotomy due to exquisite abdominal wall tenderness and evidence of SBO. Appropriate identification of the cause of our patient's SBO, careful and meticulous treatment, and appropriate inpatient monitoring all contributed to a successful outcome.
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Affiliation(s)
- Charles Lee
- Medicine, Saint James School of Medicine, Park Ridge, USA.,Medicine, West Suburban Medical Center, Oak Park, USA
| | - Veronica Velez
- Internal Medicine, West Suburban Medical Center, Oak Park, USA.,Internal Medicine, Saint James School of Medicine, Park Ridge, USA
| | - Sundip Patel
- Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Linda Huynh
- Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Carrington J Saddler
- Medicine, Saint James School of Medicine, Park Ridge, USA.,Medicine, West Suburban Medical Center, Oak Park, USA
| | - Sirjana Dhillon
- Medicine, Caribbean Medical University School of Medicine, Willemstad, CUW
| | - Joseph Nguyen
- Internal Medicine, Windsor University School of Medicine, Cayon, KNA
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Harish R, Kazi FN, Sharma JVP. Efficacy of Subcutaneous Closed Suction Drain in Reduction of Postoperative Surgical Site Infection. Surg J (N Y) 2021; 7:e275-e280. [PMID: 34660890 PMCID: PMC8510787 DOI: 10.1055/s-0041-1735900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background
Surgical site infections (SSIs) are the infections of wound after an invasive operative approach. It remains to be a major morbidity for patients undergoing surgeries although there have been tremendous improvements in the surgical techniques.
Different interventions to suppress the selective serotonin reuptake inhibitors have been proposed. Many of them have been routinely used by surgeons like minimizing shaving, hand washing, and preoperative antibiotics and these are well accepted. Drains are used in major abdominal surgeries, hernia repairs, breast surgeries reducing collections in closed areas.
1
Hematoma, serous fluid, and dead space in surgical incision wounds raise the risk of infection as they serve as the platform for microbial growth. Studies have proved that the usage of subcutaneous drains has lowered the chances of infection.
Results
The patients in the case group had lower incidence of SSI compared with the control group. The patients in the case group had subcutaneous drain which drained any collection that developed in the subcutaneous space. When the incidence of SSI was compared between the emergency cases and elective cases, the emergency cases showed higher propensity for SSI and increased rate for patients who had co-morbidities like diabetes mellitus, hypertension, etc. The most common organism isolated from the SSI was found to be
Escherichia coli
. It was also noted that the mean number of days of hospital stay was comparatively higher for the patients who developed SSI compared with patients who did not develop SSI.
Conclusion
Thus the presence of SSI adds morbidity to the patient and the patients who undergo major surgeries are likely to develop SSI postoperatively. The presence of subcutaneous closed suction drain helps in reducing the SSI to a certain extent.
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Affiliation(s)
- R Harish
- Department of General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - Farah Naaz Kazi
- Department of General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
| | - J V Pranav Sharma
- Department of General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
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29
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Mansour M, Hamza A, AlMarzook A, kanbour IM, Alsuliman T, kurdi B. A ruptured cornual pregnancy successfully managed in a patient with a history of oophorectomy and salpingectomy: A rare case report. Clin Case Rep 2021; 9:e04934. [PMID: 34691456 PMCID: PMC8517584 DOI: 10.1002/ccr3.4934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 11/11/2022] Open
Abstract
Cornual pregnancy is a rare condition that accounts for approximately 2-4% of ectopic pregnancies worldwide. Herein, we report an unstable case of a 32-year-old woman with a history of oophorectomy and salpingectomy who was admitted for a ruptured cornual pregnancy in the left cornu, which was successfully managed by laparotomy.
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Affiliation(s)
- Marah Mansour
- Faculty of MedicineTartous UniversityTartousSyrian Arab Republic
| | - Amr Hamza
- Faculty of MedicineAleppo UniversityAleppoSyrian Arab Republic
| | - AlHomam AlMarzook
- Department of NeurosurgeryIbn Al‐Nafees HospitalDamascusSyrian Arab Republic
| | - Ilda moafak kanbour
- Department of Obstetrics and GynecologyMaternity HospitalDamascusSyrian Arab Republic
| | - Tamim Alsuliman
- Hematology and Cell Therapy DepartmentSaint‐Antoine HospitalAP‐HPSorbonne UniversityParisFrance
| | - Bashar kurdi
- Chair of Department of Obstetrics and GynecologyMaternity HospitalDamascusSyrian Arab Republic
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30
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Tasneem B, Fox D, Akhter S. Blunt Abdominal Trauma in the Third Trimester: Eight Departments, Two Patients, One Survivor. Cureus 2021; 13:e16688. [PMID: 34466321 PMCID: PMC8395372 DOI: 10.7759/cureus.16688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/05/2022] Open
Abstract
Blunt abdominal trauma is one of the leading causes of non-obstetrics-related deaths during pregnancy, with motor vehicle collision, falls, and assaults being the most common etiologies. While a trauma team plays a central role in the care of a pregnant trauma patient, a multidisciplinary involvement is vital to ensure the safety of the fetus and the mother. This case study will follow the step-by-step multidisciplinary approach utilized for a 37-year-old female in her third trimester who suffered blunt trauma and arrived at a Level 1 trauma center that led to maternal survival but fetal demise. She was initially evaluated by Emergency Medicine and Obstetrics/Gynecology departments for maternal and fetal trauma, by Orthopedics for several fractures including the pubic ramus and sacral ala fractures, as well as by Neurosurgery for a subarachnoid hemorrhage and a subdural hematoma. Subsequently, the following departments were brought on after the patient suddenly became hypotensive with abdominal tenderness to assess for internal bleeding: Interventional Radiology, Trauma, Surgery, and Urology. Retroperitoneal and pelvic hematomas were found to be the source of bleeding during an emergency laparotomy and the decision was made for an emergency caesarian section. The neonatal intensive care unit ultimately could not start the fetal heart. In the days that followed, the neurosurgery department monitored the worsening intercranial bleeds while Psychiatry and Social Work attended to the patient. A proper systematic approach towards a patient in this situation necessitates expertise from multiple fields, and the success of this interplay greatly affects patient outcomes.
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Affiliation(s)
- Bilal Tasneem
- Emergency Medicine, Richmond University Medical Center, Staten Island, USA
| | - Daniel Fox
- Emergency Medicine, Richmond University Medical Center, Staten Island, USA
| | - Shahnaz Akhter
- Research, Richmond University Medical Center, Staten Island, USA
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31
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Bozzay JD, Walker PF, Schechtman DW, Shaikh F, Stewart L, Carson ML, Tribble DR, Rodriguez CJ, Bradley MJ. Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties. J Trauma Acute Care Surg 2021; 91:S247-S255. [PMID: 33605707 PMCID: PMC8324514 DOI: 10.1097/ta.0000000000003109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are well-recognized complications after exploratory laparotomy for abdominal trauma; however, little is known about SSI development after exploration for battlefield abdominal trauma. We examined SSI risk factors after exploratory laparotomy among combat casualties. METHODS Military personnel with combat injuries sustained in Iraq and Afghanistan (June 2009 to May 2014) who underwent laparotomy and were evacuated to participating US military hospitals were included. Log-binominal regression was used to identify SSI risk factors. RESULTS Of 4,304 combat casualties, 341 patients underwent a total of 1,053 laparotomies. Abdominal SSIs were diagnosed in 49 patients (14.4%): 8% with organ space SSI, 4% with deep incisional SSI, and 4% with superficial SSIs (4 patients had multiple SSIs). Patients with SSIs had more colorectal (p < 0.001), small bowel (p = 0.010), duodenum (p = 0.006), pancreas (p = 0.032), and abdominal vascular injuries (p = 0.040), as well as prolonged open abdomen (p = 0.004) and more infections diagnosed before the SSI (or final exploratory laparotomy) versus non-SSI patients (p < 0.001). Sustaining colorectal injuries (risk ratio [RR], 3.20; 95% confidence interval [CI], 1.58-6.45), duodenum injuries (RR, 6.71; 95% CI, 1.73-25.58), and being diagnosed with prior infections (RR, 10.34; 95% CI, 5.05-21.10) were independently associated with any SSI development. For either organ space or deep incisional SSIs, non-intra-abdominal infections, fecal diversion, and duodenum injuries were independently associated, while being injured via an improvised explosive device was associated with reduced likelihood compared with penetrating nonblast (e.g., gunshot wounds) injuries. Non-intra-abdominal infections and hypotension were independently associated with organ space SSIs development alone, while sustaining blast injuries were associated with reduced likelihood. CONCLUSION Despite severity of injuries and the battlefield environment, the combat casualty laparotomy SSI rate is relatively low at 14%, with similar risk factors and rates reported following severe civilian trauma. LEVEL OF EVIDENCE Epidemiological, level III.
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Affiliation(s)
- Joseph D Bozzay
- From the Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center (J.D.B., P.F.W., M.J.B.), Bethesda, Maryland; Brooke Army Medical Center (D.W.S.), JBSA Fort Sam Houston, Texas; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (D.R.T.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (F.S., L.S., M.L.C.), Bethesda, Maryland; John Peter Smith Hospital (C.J.R.), Fort Worth, Texas, Bethesda, Maryland
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32
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Bensaad A, Habi J, El Aidaoui K, Fadil A, Sair K. A Fatal Case of Strangulated Pericecal Hernia. Cureus 2021; 13:e16097. [PMID: 34367751 PMCID: PMC8330507 DOI: 10.7759/cureus.16097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/05/2022] Open
Abstract
Pericecal hernia, a subtype of internal hernia, is a rare and unusual cause of small-bowel obstruction (SBO). We report the case of a pericecal hernia in an 80-year-old woman who presented to the emergency department with symptoms of SBO. She experienced colicky diffuse abdominal pain associated with vomiting and obstipation for over five days. Abdominal examination showed rebound tenderness in the right iliac fossa without any mass palpation. Computed tomography noted a "sac-like" structure in the right iliac fossa with dilated and ischemic small-bowel loops within. Exploratory laparotomy showed strangulated pericecal hernia and non-viable small bowel loops in the inferior ileocecal recess. Extensive resection and defect repair followed by small-bowel end-to-end primary anastomosis was made. After two days of ICU admission, patient died from septic shock. This case report highlights the need for prompt diagnosis, followed by surgical intervention to lower mortality of SBO of internal hernia origin, especially in cases where no previous surgery is noted.
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Affiliation(s)
- Ahmed Bensaad
- General Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Jihane Habi
- Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Karim El Aidaoui
- Intensive Care Unit, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Abdelaziz Fadil
- Emergency Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Khalid Sair
- General Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
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Gunadi, Damayanti W, Saputra RP, Ramadhita, Ibrohim IS, Lestiono A, Melati D, Permatahati WI, Widowati T, Makhmudi A. Case Report: Complicated Meckel Diverticulum Spectrum in Children. Front Surg 2021; 8:674382. [PMID: 34113646 PMCID: PMC8185063 DOI: 10.3389/fsurg.2021.674382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Meckel diverticulum (MD) is the most common congenital anomaly of the intestines, with an incidence of 2% of the general population. It can present as various clinical features with complications and be life threatening if diagnosis is delayed and treatment late. Case Presentation: We report three pediatric cases with complicated MD: one female presented with small-bowel obstruction, one male with peritonitis, and one female with severe iron-deficiency anemia, without gross gastrointestinal bleeding nor any ectopic gastric mucosa. All patients underwent exploratory laparotomy, segmental small-bowel resection, and primary anastomosis. They successfully recovered and were uneventfully discharged on the fourth, seventh, and 10th postoperative days, respectively. Conclusions: MD can present with various complication spectrums, including small-bowel obstruction, peritonitis, and severe iron-deficiency anemia, which may cause difficulty in definitive diagnosis, particularly in children. Segmental small-bowel resection and primary anastomosis are effective surgical approaches and show good outcomes for MD patients.
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Affiliation(s)
- Gunadi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Wahyu Damayanti
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Robin Perdana Saputra
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ramadhita
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ibnu Sina Ibrohim
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Andi Lestiono
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Devy Melati
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Winda Intan Permatahati
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Titis Widowati
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Akhmad Makhmudi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Kumar N, Anjum R, Mani R, Chezhian S, Gupta A. Retro-Ileal Conduit Small Bowel Internal Herniation After Radical Cystectomy: A Surgical Complication. Cureus 2021; 13:e14142. [PMID: 33927944 PMCID: PMC8075830 DOI: 10.7759/cureus.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Intestinal obstruction is one of the most important cause of acute abdomen. An internal herniation is an uncommon yet relevant clinical entity causing an acute intestinal obstruction that can occur after major bowel surgery. Here, we describe a case of acute intestinal obstruction caused by internal herniation in a patient with muscle-invasive urinary bladder carcinoma who underwent robot-assisted radical cystectomy with an ileal conduit. We also discuss the management of adjuvant chemotherapy-induced leukopenia.
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Affiliation(s)
- Navin Kumar
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Rohik Anjum
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Rishit Mani
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - S Chezhian
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
| | - Amit Gupta
- General Surgery, All India Institute of Medical Sciences, Rishikesh, IND
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35
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Mert A, Mırcık E. Primary Epiploic Appendagitis: A Case Report. Cureus 2021; 13:e14060. [PMID: 33898143 PMCID: PMC8059666 DOI: 10.7759/cureus.14060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary epiploic appendagitis (PEA) is a rather uncommon and self-limiting cause of acute abdomen managed conservatively. Overlapping clinical features with other common causes of acute abdomen usually requiring surgical intervention, and rare occurrences have led to misdiagnosis of the condition and unnecessary surgical intervention. However, with identification of definite characteristic features on imaging (computed tomography [CT] scan) has led to easier diagnosis and avoidance of exploratory laparotomy. Here we present a case of PEA in a 34-year-old otherwise healthy Caucasian male with a chief complaint of acute left-sided abdominal, flank and inguinal pain with diarrhea. Laboratory investigation reports were more or less within normal limits; CT scan confirmed the diagnosis of PEA. The patient was managed successfully with an oral antibiotic and a non-steroidal anti-inflammatory drug. CT scan should be done in cases of acute abdomen (if not absolutely contraindicated) for confirmation of diagnosis, as in our case CT scan helped in confirmation of diagnosis of PEA and thus avoided unnecessary surgical intervention. However, with the current advances in radiological tools, correct diagnosis of acute abdomen has become a lot easier, leading to timely surgical intervention and also at the same time avoidance of unnecessary exploratory laparotomy. Again, with documentation of specific characteristic radiological features of PEA, diagnosis of PEA has become much easier. After careful correlation among clinical, radiological, and laboratory findings, diagnosis of PEA was confirmed. The patient was managed conservatively at home with the advice of plenty of fluid intake and bed rest. Furthermore, he was prescribed an oral antibiotic (ciprofloxacin) and a non-steroidal anti-inflammatory drug (ibuprofen) empirically for seven days to prevent further complications like adhesions, bowel obstruction, intussusception, peritonitis, and local abscess formation. The patient recovered completely (the symptoms and signs resolved clinically) after one week. To conclude, it can be said, although rare in occurrence and lacking in specific presenting features, diagnosis of PEA has become easier with imaging techniques like CT scan and magnetic resonance imaging (MRI); thus, with prior awareness regarding this disease among physicians, unnecessary surgical interventions can be avoided.
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Affiliation(s)
- Alpaslan Mert
- School of Health Sciences, Beykent University, Istanbul, TUR
| | - Emre Mırcık
- Health Management, Private Hurrem Sultan Hospital, Istanbul, TUR
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36
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Lawson AL, Sherlock CE, Ireland JL, Mair TS. Equine nutrition in the post-operative colic: Survey of Diplomates of the American Colleges of Veterinary Internal Medicine and Veterinary Surgeons, and European Colleges of Equine Internal Medicine and Veterinary Surgeons. Equine Vet J 2021; 53:1015-1024. [PMID: 33174212 PMCID: PMC8451781 DOI: 10.1111/evj.13381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 09/30/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
Background Evidence is lacking concerning re‐introduction of feed and water following colic surgery. Objectives To describe current approaches of European and American specialists to re‐introduction of feed and water in adult horses following surgical treatment of common intestinal lesions, assuming an uncomplicated recovery. Study design Cross‐sectional survey. Methods Electronic invitations, with a link to the online survey, were sent to 1,430 large animal specialists, including Diplomates of the ECVS, ACVS, ECEIM and ACVIM colleges. Results The response rate was 12.6% including partial respondent data. Responses for each multiple‐choice question were between 123 and 178. Results are expressed as the percentage of the total number of responses and as a range where specific lesions are grouped together. Respondents reported that horses with large intestinal displacements were offered free choice water (63%‐65%) within 3 hours (55%‐63%), whereas horses with a small intestinal strangulating lesion were offered < 2 L water (64%‐74%) 12‐24 hours (28%‐34%) post‐operatively. Horses with a large colon displacement were offered feed within 3 hours of surgery (16%) with the majority offered feed 6‐12 hours (35%‐36%) post‐operatively. Horses with small intestinal strangulating lesions and small colon lesions were offered feed 24‐48 hours (34%‐42%) after surgery. Following small intestinal, small colon or caecal lesions, horses were re‐introduced feed in handfuls (79%‐93%) and initially with grass (41%‐54%). Horses with large colon displacements were mostly fed handfuls (49%‐50%) of forage initially, but a number of respondents would offer larger quantities such as a small bucket (35%‐37%) and predominantly of hay (50%‐51%). Main limitations Low response rate. This study did not take into account common post‐operative complications that may alter the clinical approach. Conclusions This post‐operative colic nutrition survey is the first to describe current clinical practice. Further research is required to investigate nutritional strategies in post‐operative colic cases.
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Affiliation(s)
- April L Lawson
- Institute of Veterinary Science, University of Liverpool, Neston, UK
| | | | - Jo L Ireland
- Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Tim S Mair
- Bell Equine Veterinary Clinic, Mereworth, UK
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Abstract
A 63-year-old woman was admitted to our hospital with herpes zoster viral infection and intermittent disorder of consciousness. On day 13 of hospitalization for glucocorticoid treatment, the patient experienced seven episodes of hematochezia. She had a 2-year history of systemic lupus erythematosus and had undergone splenectomy at 40 years of age. Computed tomography and electronic endoscopy revealed bleeding and contrast agent leakage into the splenic flexure of the colon. The patient underwent an emergency exploratory laparotomy and left hemicolectomy for suspected active hemorrhaging into the digestive tract. Pathological examination revealed that the bleeding had been caused by a fungal infection. No further hemorrhaging occurred after the surgery, suggesting that intestinal fungal infection might be a potential differential diagnosis for gastrointestinal bleeding in compromised hosts.
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Affiliation(s)
- Jianchun Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ruopeng Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Wanqi Chen
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Beizhan Niu
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
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38
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Hameed T, Kumar A, Sahni S, Bhatia R, Vidhyarthy AK. Emerging Spectrum of Perforation Peritonitis in Developing World. Front Surg 2020; 7:50. [PMID: 33102512 PMCID: PMC7522547 DOI: 10.3389/fsurg.2020.00050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Gastrointestinal perforations constitute a major cause of patients with acute abdomen pain coming to the surgery emergency room. Incidence, site of perforation, and age is different in the developing world and is showing new trends. The etiological spectrum in the developing world is different from the western world. This study was conducted to find out the latest trends in perforation peritonitis in India. Methods: This study was conducted in a single surgical unit of Darbhanga Medical College and Hospital, India. A total of 350 consecutive patients with perforation peritonitis were studied in terms of age, sex, seasonal variation, biochemical parameters, clinical presentation, radiological and intraoperative findings, surgical intervention, and postoperative outcome. Results: The most common cause of perforation peritonitis in our study was a duodenal ulcer (~50%) followed by typhoid (20%), traumatic (14.5%), appendicular (7.4%), and tubercular (3.1%) cases. Males were three times more commonly affected than females. Peak incidence was noted in the 2nd and 3rd decades of life. Peptic ulcer perforations were common in autumn and winter and typhoid perforations were common during the summer and rainy seasons. Conclusion: Spectrum of perforation peritonitis cases in this part of world is different from developed western countries. It is different in respect of younger age at presentation, site of perforation, and etiological factors. Infective pathology makes up to a quarter of total cases in the developing world. The developing world has more perforation peritonitis cases involving the upper gastrointestinal tract, while the western world has a predominance of lower gastrointestinal tract perforations.
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Affiliation(s)
- Tariq Hameed
- Department of Surgery, Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Awadh Kumar
- Department of Surgery, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Shivanand Sahni
- Department of Surgery, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Rahul Bhatia
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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Wolde TG, Huang S, Zhang K, Wu J, Gao W, Li Q, Jiang K, Miao Y, Wei J. Evaluation of Twenty-One Cases of Abdominal Tuberculosis: A Single-Center Experience. Surg Infect (Larchmt) 2020; 22:299-304. [PMID: 32697624 DOI: 10.1089/sur.2020.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Abdominal tuberculosis (TB) remains an issue as it masquerades as many malignant or benign abdominal conditions. Objective: To analyze the clinical and laboratory features of abdominal TB retrospectively and discuss its management. Methods: The data of patients with a histopathologic diagnosis of abdominal TB seen from January 1, 2008, to February 1, 2019 were collected in The First Affiliated Hospital of Nanjing Medical University. Nodal, visceral, peritoneal, and mixed TB cases were included while excluding other forms of extra-pulmonary TB (EPTB). Results: A total of 21 patients presented having a median age of 49 years (interquartile range 33-57 years) with 12 females and 9 males. Ten presented with abdominal pain, whereas four had abdominal pain and distention. Weight loss was present in five and type 2 diabetes mellitus (DM) in three. Every patient received contrast-enhanced computed tomography (CE-CT) with positive results in all the cases. Seven patients received endoscopic ultrasound-guided fine-needle aspiration cytology examination (EUS-FNAC) and five had results positive for TB. Pre-operative diagnosis of abdominal TB was possible in seven; however, the majority (n = 14) underwent exploratory laparotomy, and all obtained a definitive diagnosis of TB. No deaths occurred. Conclusions: Both CE-CT and EUS-FNAC can aid in the timely diagnosis. Laparotomy is an invasive but efficient tool for the final diagnosis of abdominal TB.
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Affiliation(s)
- Tewodross Getu Wolde
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, School of International Education, NMU, Nanjing, People's Republic of China
| | - Shimeng Huang
- Department of General Surgery, The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Kai Zhang
- Department of General Surgery, The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Junli Wu
- Department of General Surgery, The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Wentao Gao
- Department of General Surgery, The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Qiang Li
- Department of General Surgery, The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Kuirong Jiang
- Department of General Surgery, The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yi Miao
- Department of General Surgery, The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jishu Wei
- Department of General Surgery, The Pancreas Center of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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40
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Abstract
Cecal volvulus is a very rare cause of large bowel obstruction (LBO) that develops when a part of the bowel twists around the mesentery. Cases of acute abdomen, regardless of age, race, and ethnicity, should be examined to exclude volvulus from differential diagnoses. Surgery is the only confirmatory method to diagnose and treat this life-threatening condition. Here, we report a case of a 35-year-old female patient who presented with abdominal pain, distension, constipation, and vomiting. Abdominal computed tomography (CT) aided in accurately diagnosing the cecal volvulus, and the patient immediately underwent an exploratory laparotomy.
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Cuevas-Ramos G, Domenech L, Prades M. Small Intestine Ultrasound Findings on Horses Following Exploratory Laparotomy, Can We Predict Postoperative Reflux? Animals (Basel) 2019; 9:ani9121106. [PMID: 31835406 PMCID: PMC6940970 DOI: 10.3390/ani9121106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Postoperative reflux is a well-recognized complication after exploratory laparotomy, particularly in horses that present with small intestine pathology. Even though much has been written about the pathophysiology and management of this postsurgical complication, we could not find a study that describes the monitoring of small intestine appearance after laparotomy via transcutaneous abdominal ultrasound. Therefore, the aim of the study was to provide clinical evidence of ultrasound finds in 58 horses over three days post exploratory laparotomy. The results from these exams were compared to the abdominal ultrasounds of 20 horses undergoing general anesthesia for an elective procedure, which were used as a control group. Differences were found between horses with versus without small intestinal pathology. Horses operated on because of large colon pathology had similar ultrasound findings to the control group during the postoperative period. In contrast, horses that were presented with small intestinal pathology had more visible small intestine loops, increased loop diameter, and wall thickness, before and after surgery, particularly those cases that had undergone a resection and anastomosis. A quick abdominal ultrasound in horses, during the postoperative period after colic surgery, was a useful method to identify horses with abnormal small intestinal parameters, both pre- and post-surgery. Further investigation as to whether these parameters can be used to predict postoperative reflux (POR) in a larger population is warranted. Abstract Postoperative reflux (POR) is a well-recognized complication after colic surgery in horses, particularly when presenting small intestinal pathology. Even though much has been written about the pathophysiology and management of POR, additional clinical studies are needed to better understand and anticipate this complication. The aim of the study was to provide clinical evidence of ultrasound findings in the postoperative period (three days). The study is based on transcutaneous abdominal ultrasounds of the caudoventral abdomen during the postoperative period (three days), in 58 horses, presented for an exploratory laparotomy, and compared to 20 horses that underwent general anesthesia for an elective surgical procedure. Small intestine (SI) images and videos were analyzed for loop number, loop diameter, wall thickness, motility, and echogenic type of loop contents. Ultrasound findings of horses that had a large colon pathology were similar to those of the control group. Interestingly, horses that presented an SI pathology had significantly thicker SI walls, increased loop diameter, slower motility, and hypoechoic contents, particularly in horses that had undergone small intestinal resection and anastomosis. Although the number of horses that developed POR in our study was too small for statistical analysis, they all had the aforementioned ultrasonographic changes. Abdominal ultrasound, during the postoperative period (three days), was a useful method to identify horses with abnormal small intestinal parameters. Further investigation as to whether these parameters can be used to predict POR in a larger population is warranted.
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Affiliation(s)
- Gabriel Cuevas-Ramos
- Large Animal Clinic, Copenhagen University, Agrovej 8, 2630 Taastrup, Denmark
- Correspondence:
| | - Lara Domenech
- Campus UAB, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (L.D.); (M.P.)
| | - Marta Prades
- Campus UAB, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (L.D.); (M.P.)
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Chen L, Wu B, Han Q, Yan J. Clinical analysis of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage. J Int Med Res 2019; 48:300060519879294. [PMID: 31662015 PMCID: PMC7607188 DOI: 10.1177/0300060519879294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study was performed to explore the causes and clinical characteristics
of emergency exploratory laparotomy in patients with intractable postpartum
hemorrhage. Methods This retrospective study was performed from January 2004 to December 2017.
Patients with intractable postpartum hemorrhage were grouped according to
the initial pathogenesis as determined by exploratory laparotomy: uterine
atony, placental factors, coagulation dysfunction, or uterine rupture. Results This study involved 72 patients who underwent emergency exploratory
laparotomy, accounting for 0.04% of total deliveries. Uterine preservation
surgery and hysterectomy were performed in 31 and 41 patients, respectively.
Abnormal events upon returning to the ward were primarily vaginal hemorrhage
and pelvic hematoma. The frequency of uterine artery ligation was lower in
the hysterectomy group than uterine preservation group. The prothrombin
activity level, fibrinogen level, and platelet count before surgery were
lower in the hysterectomy group than uterine preservation group. The
international normalized ratio and activated partial thromboplastin time
were higher in the hysterectomy group than uterine preservation group. In
total, 44 patients developed complications. Conclusion Placental implantation is a primary cause of hysterectomy after emergency
laparotomy. However, the possibility of postpartum hemorrhage caused by
coagulation disorders should not be ignored.
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Affiliation(s)
- Lichun Chen
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Baohua Wu
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Qing Han
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
| | - Jianying Yan
- Obstetrics Department, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian Province, China
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Yang Q, Gao Y. Incarcerated recurrent inguinal hernia as a cause of secondary torsion of the greater omentum: a rare case report and literature review. J Int Med Res 2019; 47:5867-5872. [PMID: 31578894 PMCID: PMC6862910 DOI: 10.1177/0300060519878372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Torsion of the greater omentum is a rare condition with a low incidence. However, secondary torsion of the greater omentum caused by an incarcerated recurrent inguinal hernia is extremely rare. Such torsion is fairly difficult to diagnose preoperatively because the symptoms are not typical and can mimic those of other causes of acute abdominal disease. If only the incarcerated inguinal hernia is treated, associated torsion of the greater omentum may be missed. We herein report a case of secondary torsion of the greater omentum caused by an incarcerated recurrent inguinal hernia. Exploratory laparotomy was performed because the preoperative computed tomography findings suggested torsion of the greater omentum. The diagnosis of torsion of the greater omentum was confirmed intraoperatively. The patient developed no recurrence throughout the 5-year follow-up.
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Affiliation(s)
- Qian Yang
- Department of General Surgery, Chongqing Emergency Medical Center (Central Hospital of Chongqing University), Chongqing, China
| | - Yunhan Gao
- Department of General Surgery, Chongqing Emergency Medical Center (Central Hospital of Chongqing University), Chongqing, China
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Hendriksen BS, Morrell D, Keeney L, Candela X, Oh J, Hollenbeak CS, Arkorful TE, Newton C, Amponsah-Manu F. RISK FACTORS FOR READMISSION AND LENGTH OF INPATIENT STAY IN RURAL GHANA FOLLOWING EXPLORATORY LAPAROTOMY. J West Afr Coll Surg 2018; 8:24-44. [PMID: 33553050 PMCID: PMC7861195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Increased inpatient length of stay (LOS) and readmission represent significant economic burden on patients and families faced with surgical disease in low-middle income countries given limited surgical access, infrastructure, and variable insurance status. STUDY AIM Identify risk factors for readmission and inpatient LOS in postoperative care in the Eastern Regional Hospital, Ghana. STUDY DESIGN Retrospective case series. SETTING Eastern Regional Hospital, Koforidua, Ghana. METHODS Data for exploratory laparotomy procedures were obtained from surgical case logs collected at the regional referral hospital in Koforidua, Eastern Region, Ghana from July 2017 to June 2018. This information was combined with the hospital electronic medical records to collect demographic data, laboratory values, and outcomes. Multivariable analyses were used to model LOS and readmission. RESULTS The study included 346 exploratory laparotomy procedures (286 adult, 60 pediatric) for various surgical diseases. The overall 30-day readmission rate was 9.2%. Average LOS was 12.0±20.4 days for readmitted patients and 6.7±5.5 days for patients without readmission. Readmitted patients were more likely to have had preoperative anemia (p=0.009), surgical site infection (P=0.001), or a re-laparotomy (p=0.005). Preoperative anemia (OR=3.5 [95% CI 1.54-7.96], p=0.003) and surgical site infection (OR=3.68 [95% CI 1.36-10.00], p=0.011) were associated with increased odds of readmission. Preoperative anemia was also associated with about 3.0 additional inpatient days (p=0.001). CONCLUSION Preoperative anemia and surgical site infections represent risk factors for readmission in rural Ghana. Anemia is also associated with longer LOS. Future interventions aimed at treating anemia and preventing surgical site infections may reduce some of the post-operative burden placed on patients and their families.
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Affiliation(s)
- B S Hendriksen
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - D Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - L Keeney
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - X Candela
- Penn State College of Medicine, Hershey, PA, USA
| | - J Oh
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - C S Hollenbeak
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - T E Arkorful
- Department of Surgery, Eastern Regional Hospital, Koforidua, Ghana
| | - C Newton
- Department of Surgery, Eastern Regional Hospital, Koforidua, Ghana
| | - F Amponsah-Manu
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Surgery, Eastern Regional Hospital, Koforidua, Ghana
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Fakhouri F, Ghazal A, Alnaeb H, Hezan R, Araj J. Spinal-epidural Abscess Presenting as an Acute Abdomen in a Child: A Case Report and Review of the Literature. Asian J Neurosurg 2018; 13:1247-1249. [PMID: 30459907 PMCID: PMC6208252 DOI: 10.4103/ajns.ajns_177_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Abdominal presentations in patients with spinal–epidural abscess (SEA) are not uncommon. However, it needs to be continually emphasized that the atypical presentations of these diseases could delay the timely diagnosis and consequently prompt management, which threatens spinal cord, leading to potential to paralysis or even death. We report a case of a young girl who presented with abdominal pain and fever. The diagnosis of SEA was unfortunately so delayed that the patient did not show any functional recovery postoperatively. This report aims to highlight the importance of high level of clinical suspicion to recognize an atypical presentation of the SEA. Moreover, the fully detailed history-taking and physical examination are of paramount importance. Spinal underlying pathologies should always be considered as a cause of abdominal pain, especially in children.
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Affiliation(s)
- Fakhr Fakhouri
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Ahmad Ghazal
- Department of Surgery, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Hasnaa Alnaeb
- Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Rasha Hezan
- Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Joudi Araj
- Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
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Prince S, Busharar HAS, AlZoabi OM. Small bowel stenosis following blunt abdominal trauma: a case report. Clin Case Rep 2017; 5:1865-1867. [PMID: 29152288 PMCID: PMC5676262 DOI: 10.1002/ccr3.1176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/02/2017] [Accepted: 07/08/2017] [Indexed: 11/09/2022] Open
Abstract
Blunt abdominal trauma is a rare case of intestinal obstruction, and only few cases have been reported in the world literature. Stenotic intestinal obstruction following blunt abdominal trauma is a very rare complication. This case highlights the need for clinical suspicion serial clinical assessment and radiological evaluation and the need for early surgery in patients presenting with abdominal symptoms following blunt abdominal trauma.
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Affiliation(s)
- Sheela Prince
- Department of General surgeryRashid HospitalDubaiUAE
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47
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Zhang PH, Liu Z, Ren LC, Zeng JZ, Huang GW, Xiao MZ, Zhou J, Liang PF, Zhang MH, Huang XY. Early laparotomy and timely reconstruction for patients with abdominal electrical injury: Five Case Reports and Literature Review. Medicine (Baltimore) 2017; 96:e7437. [PMID: 28723751 PMCID: PMC5521891 DOI: 10.1097/md.0000000000007437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION High-tension electricity can cause devastating injuries that may result in abdominal wall loss, visceral damage, and sometimes major threat to life. The visceral organ may be exposed after debridement and require flap cover, but the tensile strength of abdominal wall may be lack even if flap transplanted. METHODS From April 2007 through May 2015, 5 patients with severe abdominal electrical injury were treated at our hospital. Exploratory laparotomy was performed based on their clinical manifestations and debridement findings of abdominal wall at early stage, and decision regarding technique for reconstruction of abdominal wall was based on an assessment of the location and extent of the defect. Medical records were reviewed for these data. RESULTS Clinical evaluation and debridement findings of the abdomen revealed 4 patients with suspicious visceral damage. Laparotomy was performed in 4 cases, and revealed obvious lesion in 3 cases, including segmental necrosis of small intestine, partial necrosis of diaphragm, left liver and gastric wall, and greater omentum. Five patients underwent abdominal wall reconstruction using island retrograde latissimus dorsi myocutaneous flap or free/island composite anterolateral thigh myocutaneous flap. All flaps survived, abdominal bulging occurred in 3 cases after follow-up of 12 to 36 months. CONCLUSIONS The clinical manifestations and wound features of abdomen collectively suggest a possible requirement of laparotomy for severe abdominal electrical burns. Retrograde latissimus dorsi myocutaneous flap or composite anterolateral thigh myocutaneous flap is an effective option for reconstruction of abdominal wall loss, the long-term complication of abdominal bulging, however, remains a significant clinical challenge.
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Affiliation(s)
| | - Zan Liu
- Department of Burns and Reconstructive Surgery
| | | | | | | | | | - Jie Zhou
- Department of Burns and Reconstructive Surgery
| | | | | | - Xiao-Yuan Huang
- Institute of Burn Research, Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China
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48
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Abstract
The ingestion of a foreign body is a common occurrence. Psychiatric patients and prisoners may swallow objects on purpose. Occasionally emergent exploratory laparotomy may be indicated if the diagnosis is uncertain, and emergent removal of the foreign body may be needed to prevent substantial risk of serious complications including perforation, fistula, or gastrointestinal bleeding.
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Affiliation(s)
- Wen-Jung Chang
- Division of General Surgery Department of Surgery Kaohsiung Armed Forces General Hospital Kaohsiung Taiwan
| | - Wen-Yi Chiu
- Departments of Family Medicine Kaohsiung Armed Forces General Hospital Kaohsiung Taiwan
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49
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Ma LZ, Liu ZR. [Renal artery embolization with exploratory laparotomy for management of massive colonic hemorrhage after renal biopsy: a case report]. Nan Fang Yi Ke Da Xue Xue Bao 2017; 37:135-137. [PMID: 28109114 PMCID: PMC6765745 DOI: 10.3969/j.issn.1673-4254.2017.01.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Indexed: 06/06/2023]
Abstract
We report a case of massive colonic hemorrhage after renal biopsy managed by renal artery embolization combined with exploratory laparotomy. Clinicians must be alert for such rare anatomical abnormalities as ectopic colon behind the kidney and the risk of colonic hemorrhage following renal biopsy. In this case, artery embolization combined with exploratory laparotomy successfully and quickly stopped the bleeding and avoided possible organ resection.
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Affiliation(s)
- Lian-Zi Ma
- Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.E-mail:
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50
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Kylat RI. Internal Hernia Masquerading As Necrotizing Enterocolitis. Front Pediatr 2017; 5:225. [PMID: 29164078 PMCID: PMC5671485 DOI: 10.3389/fped.2017.00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022] Open
Abstract
In extremely preterm infants, acute abdominal emergencies are fortunately less common with improving care. Spontaneous intestinal perforation and necrotizing enterocolitis are conditions where emergency surgery is most often needed. Conservative medical management and placement of temporary drain are often used in the initial management. Internal hernia (IH) is an uncommon cause of bowel obstruction in neonates, is difficult to diagnose and unfortunately are found only at autopsy. The presentation in preterm infants, distinction between these conditions, and the need for early diagnosis of IH are discussed.
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Affiliation(s)
- Ranjit I Kylat
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, United States
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