Pneumoperitoneum After Jejunostomy Tube Placement Managed by Needle Decompression: A Case Report.

Percutaneous endoscopic feeding tube placement is a commonly performed procedure in patients who cannot take food by mouth. While it is considered a safe and effective method of providing nutritional support, like any medical procedure, it can lead to complications. Feeding tube placement, including percutaneous endoscopic jejunostomy (PEJ), is associated with several complications, including bleeding, site infection, aspiration, buried bumper, tube dislodgement, and pneumoperitoneum. We report a case of a 20-year-old male with multiple medical issues who underwent a PEJ that was complicated by bowel distension. The patient developed tension pneumoperitoneum post-procedure, which was treated with a bedside needle decompression. This case report highlights the significance of promptly recognizing and intervening in complications that may arise during a frequently performed medical procedure, PEJ tube placement, to prevent serious consequences, including bowel ischemia.

A Novel Technique Using Ryle's Tube for Colonic Decompression in Acute Colonic Pseudo-Obstruction.

Acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, involves colon dilation without mechanical obstruction. It is conventionally treated with conservative measures such as fasting, nasogastric and rectal tube placement, correction of fluids and electrolytes, and, if necessary, use of neostigmine and colonic decompression through colonoscopy. Surgical intervention may be considered in severe cases. In this report, we present a case of acute colonic pseudo-obstruction where initial conservative management failed. The patient was successfully treated using a novel rectal tube insertion technique.

Extensive Arterial and Venous Thrombosis in a Female With a Known Untreated Polycystic Ovarian Syndrome: A Case Report.

Polycystic ovarian syndrome (PCOS) is a common heterogeneous endocrine disease associated with a twofold higher risk of stroke and venous thromboembolism (VTE). An 18-year-old female presented to the emergency department (ED) with a one-hour history of right-side body weakness, facial asymmetry, and altered mental status. The patient had poor mentation and was unable to protect her airway. She was intubated and admitted to the intensive care unit (ICU). She was diagnosed with polycystic ovarian syndrome three years ago; however, she was not on active treatment at the time of presentation. She received two doses of the BNT162b2 mRNA COVID-19 vaccine, and her last dose was six months before the current presentation. A workup showed that she had extensive arterial and venous thrombosis. Later during investigations, she was found to have a complex atrial septal defect (ASD) with a left-to-right shunt. This case reports a management approach for a young female with untreated polycystic ovarian syndrome that predisposed her to develop deep vein thrombosis (DVT), pulmonary embolism (PE), and ischemic stroke due to atrial septal defect with possible transient shunt reversal.