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Eventration of the diaphragm
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Colin G. DeLong, Afif N. Kulaylat, Robert E. Cilley
Transdiaphragmatic injury may occur with either open or thoracoscopic techniques. Intra-abdominal injuries, such as gastric or colon perforation, require immediate operative attention. Herniation into the site of the repair can occur. Rare cases of incarcerated diaphragmatic hernia and diaphragmatic rupture have been reported and should be considered in the event of severe clinical decompensation.
Clostridium difficile and Its Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
With C. difficile pancolitis, the aim of therapy is two-fold. First, the drug(s) used should have a high degree of anti-C. difficile activity. Second, these antibodies should achieve therapeutic colon wall levels. High intraluminal levels are of no benefit in a transmural colon wall process. Third, pancolitis is often accompanied by microscopic translocation of colon flora from the wall into the peritoneum, i.e., causing microscopic peritonitis. Furthermore, pancolitis may result in colon perforation or toxic megacolon/perforation [31].
Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Entamoeba dispar may be asymptomatic, or a cause of mild lower gut diarrhoea. It is commonly identified in homosexual men. Conversely, E. histolytica is potentially fatal, causing painful diarrhoea with blood in the stool; this mimics idiopathic inflammatory bowel diseases such as ulcerative colitis and Crohn's disease, and bacterial colitis. This may resolve spontaneously, or persist and progress to more severe mucosal ulceration. If untreated, up to 5% of patients – and especially those who are pregnant or receiving steroids – suffer colon perforation and peritonitis, which has a high mortality.
OverStitch Sx Endoscopic suturing system in minimally invasive endoscopic procedures: overview of its safety and efficacy and comparison to oversticthTM
Published in Expert Review of Medical Devices, 2022
Tara Keihanian, Mohamed O Othman
Endoscopic suturing significantly evolved in the last 12 years. Although Overstictch TM is the most commonly used device, its use is limited, due to the necessity of double channel endoscope from single endoscopy manufacture. Overstich Sx, on the other hand can fit over any single channel endoscope regardless of the brand of the manufacture. This will result in a wider adoption of OverStitch Sx over time. In case of emergency, particularly in esophageal, gastric or left side colon perforation, the device provide immediate assistance, since it can be assembled in the less than 5 minutes over the endoscope. In my experience, teaching the endoscopy staff the correct sequence of system assembly is the key for a successful procedure. For example, aligning the endoscope side by side along the OverStitch Sx is a key step. In addition, endoscopy assistant should be aware that tightening the two straps at the distal end of the OverStitch Sx will result in clockwise movement of the device. Adjusting for this minute clockwise movement, will ensure correct placement of the device over the tip of the endoscope and clear field of view. Removing the golden sheaths around the silicon straps away from the field is extremely important. These golden sheaths are static and can become adherent to the endoscope.
Delayed peaks of acetaminophen in overdose patients with concomitant abdominal trauma
Published in Clinical Toxicology, 2021
Elizabeth M. Crow, Meghan B. Spyres, Sean P. Boley, Michael Levine, Samuel J. Stellpflug
On arrival, her exam revealed wounds to all extremities, abdomen, back and thorax. Vital signs were temperature 36.0 C, heart rate 131 beats/minute, blood pressure 95/60 mmHg, respiratory rate 30 breaths/minute and oxygen saturation 100%. Her Glasgow Coma Scale (GCS) score was 15 on arrival, and her presentation did not support a classic ingestion toxidrome (i.e., anticholinergic or opioid related symptoms). The penetrating trauma resulted in a colon perforation, diaphragmatic injury, and pneumothorax. She demonstrated no signs or symptoms of a particular toxidrome. A chest tube was placed and she was taken to the operating room for a laparotomy. She reported being forced to ingest acetaminophen and methamphetamine and denied ethanol (these claims were supported by laboratory evaluation); the time frame of the ingestion is unknown, but likely within a few hours prior to presentation. The formulation of the acetaminophen was stated as simply “Tylenol”. Initial labs included an acetaminophen concentration of 211.7 mcg/mL and normal aspartate aminotransferase (AST), creatinine, pH, and coagulation studies. Two hours after arrival, 21-hour NAC protocol of 300 mg/kg was started intraoperatively and continued in the intensive care unit (ICU). No gastrointestinal decontamination was given.
Percutaneous thermal ablation of hepatic tumors: local control efficacy and risk factors for artificial ascites failure
Published in International Journal of Hyperthermia, 2021
Bo-wen Zhuang, Xiao-hua Xie, Dao-peng Yang, Man-xia Lin, Wei Wang, Ming-de Lu, Ming Kuang, Xiao-yan Xie
There were no severe electrolyte derangements, peritonitis, peritoneal bleeding or gastrointestinal tract injury events directly associated with the AA technique and there were no cardiopulmonary complications due to volume overload. The AA was partially shifted into the right pleural space in 15 (4.4%) of 341 patients as depicted on ultrasound images one day after ablation, and 6 patients underwent drainage. All patients showed complete absorption of AA and a shifted pleural effusion, as confirmed on 1-month follow-up images. The rate of major complications was 1.1% (three of 281 patients) in the AA success group and 1.7% (one of 60 patients) in the AA failure group. The major complication rates were not significantly different between the two groups (p = 0.541). In the AA success group, three major complications were observed in different patients. One patient developed a liver abscess and underwent percutaneous drainage and intravenous antibiotics. Severe hepatic bleeding occurred in one patient and hemostasis was successfully achieved after percutaneous ablation. One patient experienced acute pulmonary infection and recovered after antibiotic therapy. In the AA failure group, major complications occurred in one patient. The patient experienced colon perforation and recovered after emergency surgery. No AA or ablation related deaths occurred in either group.