Esophageal Replacement by Colonic Interposition for the Surgical Management of Acute Necrotic Gastric Volvulus: A Case Report.

Acute gastric volvulus, a condition where the stomach rotates around itself, is a rare clinical entity that requires prompt identification and immediate intervention to prevent life-threatening complications. Upon diagnosis, an emergent exploratory laparotomy is the procedure of choice, especially if complications, such as obstruction, ischemia, or perforation, are present. Management techniques and surgical corrections vary depending on the degree of obstruction, the consequent damage to surrounding structures, and the functional reservoir. We present a case of acute gastric volvulus with extensive esophageal and gastric necrosis requiring total gastrectomy and partial esophagectomy. We discuss the patient's operative management requiring colonic interposition with esophagocolonic anastomosis to reconnect this patient's gastrointestinal tract.

Optimal timing and outcomes among COVID-19 patients undergoing tracheostomy.

BACKGROUND: Patients who require mechanical ventilation secondary to severe COVID-19 infection have poor survival. It is unknown if the benefit of tracheostomy extends to COVID-19 patients. If so, what is the optimal timing? METHODS: Retrospective cohort study within a large hospital system in the United States. The population included patients with COVID-19 from January 1, 2020 to September 30, 2020. In total, 93,918 cases were identified. They were excluded if no intubation or tracheostomy, underwent tracheostomy before intubation, <18 years old, hospice patients before admission, and bacterial pneumonia. In total, 5,911 patients met the criteria. Outcomes between patients who underwent endotracheal intubation only versus tracheostomy were compared. The primary outcome was inpatient mortality. All patients who underwent tracheostomy versus intubation only were compared. Three cohort analysis compared early (<10 days) versus late (>10 days) tracheostomy versus control. Eight cohort analysis compared days 0-2, days 3-6, days 7-10, days 11-14, days 15-18, days 19-22, and days 23+ to tracheostomy versus control. RESULTS: There was an overall inpatient mortality rate of 37.5% in the tracheostomy cohort compared to 54.4% in the control group (P < .0001). There was an early tracheostomy group inpatient mortality rate of 44.7% (adjusted odds ratio 0.73, 95% confidence interval 0.52-1.01) compared to 33.1% (adjusted odds ratio 0.44, 95% confidence interval 0.34-0.58) in the late tracheostomy group. CONCLUSION: COVID-19 patients with tracheostomy had a significantly lower mortality rate compared to intubated only. Optimal timing for tracheostomy placement for COVID-19 patients is 11 days or later. Future studies should focus on early tracheostomy patients.

Challenges in Managing Acute Myocardial Infarction Associated With Infective Endocarditis: A Case Report.

Acute myocardial infarction (AMI) is a rare but recognized and potentially serious complication of infective endocarditis (IE). This case describes the challenges surrounding the management of AMI in the setting of septic coronary embolism, brain, spleen, and kidney infarcts due to septic emboli from native mitral valve IE.