The Pierced Colon: When Biliary Stents Go the Wrong Way.

Bowel perforation of biliary stents is a rare complication of biliary stenting. We report the successful endoscopic treatment of a 78-year-old man with a straight biliary plastic stent perforating the ascending colon without underlying structural abnormality in the affected segment. Perforation was detected incidentally during computed tomography; the patient had been under continued antibiotic therapy for liver abscess. Stent extraction was performed by using an endoscopic snare; the site of perforation was closed with through-the-scope clips. The patient remained asymptomatic. In addition, we reviewed published cases of perforated biliary stents and outlined that most perforations are caused by straight plastic stents.

Prevalence and risk factors for post-traumatic stress disorder in relatives of out-of-hospital cardiac arrest patients.

AIM: Prognostic uncertainty and surrogate decision-making demands associated with prolonged unconsciousness in out-of hospital cardiac arrest (OHCA) patients in the intensive care unit (ICU) may increase post-traumatic stress disorder (PTSD) risk in their relatives. Our aim was to study PTSD frequency and risk factors in relatives of OHCA patients. METHODS: In this observational study 101 consecutive eligible adult relatives of OHCA patients were interviewed using validated questionnaires, the "Impact of Event Scale-Revised" to detect PTSD and the "Family-Satisfaction with Care in the ICU" to assess potential PTSD risk factors. RESULTS: PTSD was detected in 40/101 relatives (40%). Multivariate logistic regression identified three significant PTSD predictors [odds ratio, 95% confidence interval]: female gender [3.30, 1.08-10.11], history of depression [3.63, 1.02-12.96], family perception of the patient's therapy as insufficient [18.40, 1.52-224.22]. Three other predictors were not significantly associated with PTSD (hypothermia treatment of the patient [2.86, 0.96-8.48]), delayed delivery of prognostic information by ICU staff [2.11, 0.83-5.38], family-ICU staff conflict [3.61, 0.71-18.40]). A prediction rule including six factors (p<0.15 each) showed high discrimination (area under the receiver-operating characteristic curve 0.74) with a stepwise increase in risk for PTSD from 0% (no risk factor) to 63% (≥3 risk factors). There was no evidence for effect modification either by survival status or neurological outcome. CONCLUSION: Relatives of OHCA patients treated in the ICU are at increased risk of PTSD, which can be predicted based on six factors, three ICU-related and potentially at least partly modifiable. Further research is needed to validate our findings and to develop strategies to prevent PTSD in OHCA patients' relatives.