Pneumomediastinum as a cause of acute chest pain postpartum.

Pneumomediastinum can easily be mistaken for a pulmonary embolus or myocardial infarction. We describe herein a case of pneumomediastinum postpartum. A primigravida complained five-hours postpartum of acute chest pain and mild dyspnea. The initial (working) diagnosis was pulmonary embolus and the patient was treated with antithrombotic therapy. A CT scan revealed the real cause of the chest pain: pneumomediastinum. The patient was given adequate analgesia and two days later was able to leave the hospital in good clinical condition. We suggest that in the case of acute chest pain during or shortly following labor, pneumomediastinum should be considered.

Endoscopic tattoo of the colon might be standardized to locate tumors intraoperatively.

BACKGROUND: Small colonic lesions which are identified during endoscopy are usually difficult to locate intra-operatively. Endoscopic tattoo of the colon seems the most efficient method, however it does fail in some cases to identify the lesion peroperatively. We studied this method to evaluate its efficacy. METHODS: Nineteen patients were tattooed during colonoscopy with "India ink" (drawing ink Rotring ). These patients had lesions in which difficulties were anticipated when retracing them again during colorectal surgery. Seventeen patients underwent colonic surgery. One patient underwent laparoscopic polypectomy and the other TEM (Transanal Endoscopic Microsurgery). RESULTS: The visibility of the "India ink" peroperatively and afterwards during histological examination were evaluated. The tattoos were visible in 68.4 % patients intraoperatively. Histopathological macroscopic examination of the specimens showed ink in 73.6 % patients. In 31.5 % patients the tattoo could not be recognised peroperatively. CONCLUSIONS: Endoscopy assisted tattooing of the colon has been reported to be a safe method to landmark lesions in the colon. In the majority of our patients the tattoo was obvious during surgery. Endoscopic tattoo seems an efficient technique in identifying small colonic lesions intraoperatively.