RESUMEN
This is a case of a 70-year-old female with small bowel evisceration through vaginal cuff dehiscence 14 months after hysterectomy. She presented with a loop of ileum herniated through the vagina. The bowel was irreducible and she was taken to the operating room for exploratory laparotomy, reduction of herniated bowel contents, and repair of vaginal cuff. During surgery, the eviscerated bowel had questionable viability and indocyanine green angiography was used to assess perfusion. After the repair of the vaginal cuff, indocyanine green angiography was performed and the bowel was saved from resection. In the discussion, light is shed upon the rarity of vaginal cuff dehiscence and the few cases of small bowel evisceration after a dehiscence. Possible causes of the evisceration, updates to technique, and recommendations for management are also discussed. The ultimate recommendation is for use of indocyanine green angiography in assessment of intestinal viability during surgical exploration for small bowel evisceration.
RESUMEN
Industrial facilities and other sources can emit air pollutants from fugitive leaks, process malfunctions and area sources that can be difficult to understand and to manage. Next generation emissions measurement (NGEM) approaches executed near facilities are enabling new ways to assess these sources and their impacts to nearby populations. This paper describes complementary uses of emerging NGEM systems in a Louisville, KY industrial district (Rubbertown), focusing on an important area air toxic, 1,3-butadiene. Over a one-year deployment starting in September 2017, two-week average passive samplers (PSs) at 11 sites showed both geospatial and temporal trends. At 0.24 ppbv annual average 1,3-butadiene concentration, a group of PSs located near facility fence lines was elevated compared to a PS group located in the community and upwind from facilities (0.07 ppbv average). Two elevated PS periods capturing emission events were examined using time-resolved NGEM approaches as case studies. In one event a 1.18 ppbv PS reading was found to be relatively localized and was caused by a multiday emission from a yet to be identified, non-facility source. In the other event, the airshed was more broadly impacted with PS concentrations ranging from 0.71 ppbv for the near-facility group to 0.46 ppbv for the community group. This case was likely influenced by a known emission event at an industrial facility. For both case studies, air pollutant and wind data from prototype NGEM systems were combined with source location models to inform the emission events. This research illustrates the power of applying NGEM approaches to improve both the understanding of emissions near sources and knowledge of impacts to near-source communities.