Spontaneous Cecal Perforation During Pregnancy.

Spontaneous perforation of the colon is a rare disease defined as sudden perforation of a healthy colon without evidence of trauma or disease. These perforations are typically classified as either stercoral or idiopathic. Cecal perforation during pregnancy is an uncommon and potentially life-threatening condition requiring prompt recognition and surgical intervention. We present a case of a 33-year-old woman at 29 weeks and three days gestation presenting with spontaneous cecal perforation. She presented to the emergency department with diffuse abdominal pain and distention lasting for three days, associated with nausea and vomiting. Following evaluation, she was diagnosed with diffuse peritonitis. The diagnosis of this condition relies on both the clinical presentation and the utilization of radiographic imaging. The patient underwent an emergent explorative laparotomy with prompt surgical intervention to repair the 1.2 x 0.8 cm perforation found on her distended cecum. The surgical repair consisted of the excision of the edges and the primary suture of the perforation with an omental patch. Her post-procedure course was uneventful, and she later delivered a healthy baby at full term. This case highlights the importance of considering uncommon causes of acute abdominal pain in pregnant women to ensure timely diagnosis and management.

Refractory Ischemic Priapism Following Hemodialysis.

Priapism, characterized by prolonged and painful penile erection, is a rare urological emergency with diverse etiologies. We present a case of refractory ischemic priapism following hemodialysis in a 57-year-old male with a history of type II diabetes mellitus, hypertension, and end-stage renal disease. Despite standard conservative management, the patient's condition persisted, necessitating penile distal shunting through an intracorporeal dilatation plus Al-Ghorab corporoglandular shunt. Blood gas analysis of corpus cavernosum blood revealed severe acidosis and hypoxemia, emphasizing the systemic impact of ischemic priapism. The patient's history of erythropoietin injections and the administration of heparin during dialysis emerged as potential contributors to priapism. We discuss the complex interplay between erythropoietin, coagulation cascade, and heparin in the context of priapism development. The case underscores the need for further research to understand the specific mechanisms contributing to priapism in patients undergoing hemodialysis.

Postpartum Spinal Epidural Lipomatosis With Epidural Venous Engorgement.

Spinal epidural lipomatosis (SEL) refers to a condition characterized by the abnormal growth of fatty tissue within the vertebral canal, situated outside the spinal canal itself. This expansion of fat can result in symptoms such as back pain and radiculopathy. The majority of cases remain without noticeable symptoms. However, when SEL does cause symptoms, it is frequently linked to using external steroids. The contributing factors to SEL include obesity and Cushing's syndrome. The presentation of SEL can mimic other spinal disorders such as epidural hematoma, spinal stenosis, and degenerative joint disease. Patients might present with gradually progressing and long-standing complaints of back pain, muscle weakness, numbness, loss of bladder or bowel control, lack of coordination, abnormal reflexes, and, in rare instances, paralysis. We are reporting a case involving a 34-year-old female with obesity, who experienced sudden weakness in her left lower extremity shortly after a recent uncomplicated vaginal delivery using epidural analgesia. A magnetic resonance imaging (MRI) of her thoracic (T) and lumbar spine revealed spinal cord compression secondary to extensive posterior epidural lipomatosis associated with epidural venous engorgement. The patient underwent an immediate laminectomy procedure at the T3, T5, T7, and T9 levels to alleviate the compression. Postoperatively, she underwent a course of physiotherapy and gradually regained her normal muscle strength. She was discharged in stable condition on the sixth day after the surgery.

The potential effect of iopamidol contrast on renal function in patients infected with SARS-CoV-2 virus: A retrospective cohort study.

Background: Many types of computed tomography (CT) scans require the use of contrast. Acute kidney injury (AKI) is a known adverse effect of intravenous contrast administration. To our knowledge, the effects of low-osmolar contrast agents such as iopamidol on renal function in patients infected with the SARS-CoV-2 virus have never been studied. This study investigates the incidence of AKI following iopamidol contrast administration in patients infected with the SARS-CoV-2 virus. Methods: This retrospective cohort study included two groups: patients who received CT pulmonary angiography who were infected with SARS-CoV-2 virus and those who tested negative for SARS-CoV-2. Data were collected from the electronic medical record of a single hospital from January 1, 2020, to September 15, 2020. AKI was defined using the Kidney Disease: Improving Global Outcomes definition: increase in serum creatinine by ≥0.3 mg/dL (≥26.5 mcmol/L) within 48 h, or increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days, or urine volume <0.5 mL/kg/h for 6 h. Results: AKI occurred in 13.51% of patients in the SARS-CoV-2 positive group and 16.92% of patients in the negative group. Using a two-sample test to compare the equality of proportions (with continuity correction factor), we found there is no significant difference in the two proportions (P = 0.3735). Conclusion: There was no significant difference in the incidence of AKI between SARS-CoV-2 positive and negative groups. Given the limitations of this study, further work must be done on this topic.

Cerebral air embolism through a central venous catheter in the absence of intracardiac shunt.

Central venous catheters are routinely placed on medically complex patients for a variety of reasons, including facilitating intravenous access in difficult intravenous (IV) access situations, accurate hemodynamic monitoring, large-volume resuscitation, medication administration, nutritional support, and continuous renal replacement. As with other invasive medical procedures, placement, maintenance, and discontinuation of central venous catheters introduces risk and potential complications. We report a case of bilateral cerebral infarct secondary to air embolism through the right internal jugular vein venous catheter in the absence of intracardiac shunt in a patient with ischemic colitis who underwent total abdominal colectomy.

A Rare Presentation of Penile Calciphylaxis Requiring Partial Penectomy.

Calciphylaxis is a rare disease and carries high morbidity and mortality rates. It's characterized by microvascular calcification and occlusion, which leads to a life-threatening disease characterized by skin necrosis and ulceration. Calciphylaxis is classified as uremic, which occurs in patients with end-stage renal disease and who are non-uremic. Non-uremic calciphylaxis is an even rarer disease that occurs in patients without end-stage renal disease and has a high mortality rate secondary to sepsis. The most common risk factors are diabetes mellitus, hyperparathyroidism, malignant neoplasm, warfarin-based anticoagulation, alcoholic liver disease, and autoimmune disorders. The management includes wound debridement, pain management, and sepsis control. We report a case of penile calciphylaxis in a 36-year-old male with a 15-year history of type II diabetes mellitus and chronic kidney disease. He presented with penile ulceration, which rapidly progressed to necrosis. He also had skin necrosis, characteristic of penile calciphylaxis. The patient has perished of multiorgan failure secondary to severe septic shock.

Subcutaneous Emphysema Following Open Tracheostomy During Tracheostomy Mask Ventilation.

BACKGROUND Tracheostomy is a surgical procedure that is done by creating an ostomy in the anterior wall of the trachea to facilitate airway access and ventilation. It is indicated for acute respiratory failure after prolonged intubation, upper airway obstruction, difficult airway, and extensive secretions. Early perioperative complications include bleeding, pneumothorax/pneumomediastinum from a false tract, subcutaneous emphysema, esophageal perforation, and tracheal ring fractures. CASE REPORT We present the case of a 64-year-old woman with a past medical history of hypertension, asthma, alcohol and cocaine abuse, bipolar, and, right breast cancer that was treated by chemotherapy and total mastectomy. She was diagnosed with adductor spasmodic dysphonia of unknown etiology 6 months ago and has been treated with Botulinum toxin injection, with an incomplete resolution. She was admitted to the Respiratory Intensive Care Unit with acute hypoxic respiratory failure associated with stridor secondary to laryngospasm, which was unresponsive to steroids and racemic epinephrine. She underwent an emergent open tracheostomy with a regular nonfenestrated tracheostomy tube. A few hours after surgery, she was weaned from mechanical ventilation to a tracheostomy mask oxygen and had an episode of strong cough followed by extensive neck and facial subcutaneous emphysema. CONCLUSIONS Subcutaneous emphysema is a rare complication but it can be catastrophic, especially if it is associated with pneumothorax and/or pneumomediastinum. Avoiding tight a tracheostomy tube strap and fenestrated tracheostomy tube is one of the measures that can be used to avoid this complication.

Iatrogenic Acute Aortic Insufficiency Following Mitral Valve Replacement.

Iatrogenic acute aortic insufficiency after heart procedures is rare and it can happen secondary to cusp entrapment, tension, laceration, or perforation. The aortic valve is located anterior and to the right of the mitral valve, which makes it susceptible to damage during mitral valve replacement or repair. We report a 62-year-old male who developed acute aortic valve insufficiency following mitral valve replacement where using an intraoperative transesophageal echocardiogram (TEE) prompted early diagnosis and management. Late diagnosis is usually associated with increased morbidity and mortality. The aortic insufficiency resulted from entrapment of the aortic valve annulus due to suture misplacement at the commissure between the left and noncoronary cusp. This case report shines the light on the importance of a thorough intraoperative TEE during cardiac surgery to early diagnose and treat any complications.

Rare Variant of Left Circumflex Coronary Artery Originating From the Right Coronary Artery.

Coronary artery anomalies are rare in the general population. Many individuals with coronary artery anomalies are asymptomatic. Some individuals with these anomalies have an increased risk of sudden cardiac death (SCD), especially young athletes, and an elevated risk of myocardial ischemia with anginal symptoms, seen in older age groups. We report a 43-year-old male who received coronary artery bypass graft (CABG) surgery for the four-vessel disease after suffering from an anteroseptal myocardial infarction (MI). The patient presented to the hospital emergency department with episodes of chest pain for three days. On coronary angiography, an anomalous origin of the left circumflex coronary artery (ALCx) was visualized. This ALCx was a type I variant originating from a separate ostium from the right coronary artery (RCA) at the right coronary cusp.  It is important to document and describe the different variants of coronary anomalies to provide proper patient management. The anomalous origin of the left circumflex coronary artery from the right coronary cusp of the RCA is considered a benign variant. It may, however, have been instrumental in supplying blood to the left heart in the setting of complete left coronary artery (LCA) occlusion.

Inadvertent Subdural Catheter Placement: A Rare Complication in Obstetric Anesthesia.

Epidural neuraxial analgesia is a standard procedure for pain control during labor and delivery. One rare complication is accidental epidural catheter placement in the subdural space, a potential space between the arachnoid and dura membranes. The incidence of the subdural blockade during neuraxial block is unknown. The subdural block suspicion arises when the clinical signs and symptoms do not fit epidural or subarachnoid local anesthetic injection. The clinical picture includes delayed or gradual onset, extensive sensory block with minimal motor block, hypotension more than an epidural neuraxial block, and less than spinal neuraxial block, and it can rarely track intracranially and causes dyspnea and loss of consciousness. In this article, we report a case of inadvertent subdural catheter placement that was diagnosed clinically with unexpectedly high block involving the upper extremities. No radiological confirmation was used for the diagnosis.

A Case Report of Iatrogenic Bronchial Rupture following Endobronchial Blocker Placement.

Physiologists Eduard Pfluger and Claude Bernard first introduced one lung ventilation (OLV) in 1871. Today, it is now a frequently used technique in open or minimally invasive cardiothoracic surgeries. One key benefit of the use of OLV is improved surgical exposure. Historically, lung isolation catheters used under fluoroscopic guidance or a Fogarty catheter were used to achieve OLV. In present times, endobronchial blockers (EBBs) in conjunction with single lumen endotracheal tubes and double lumen endotracheal tubes (DLTs) are used to achieve intraoperative OLV. Some complications of EBBs include mucosal injury, bleeding, bronchial rupture, pneumothorax, malpositioning-induced respiratory arrest, severe hypoxemia, and dislodgement. The incidence of iatrogenic tracheal rupture with single lumen endotracheal intubation is reported to be approximately 0.005%, and with double lumen ETT, the incidence may be between 0.05 and 0.19%. Mortality associated with tracheal rupture with DLTs is approximately 8.8%. Data on airway injury with endobronchial blockers is limited, and reported cases of bronchial perforations with use of EBBs are rare suggesting that EBBs may be the safer option for OLV. In this case report, we will be discussing a case of iatrogenic endobronchial rupture following endobronchial blocker placement.

Fluoroscopic-guided erector spinae plane block for spine surgery.

Erector spinae plane block (ESPB) is an ultrasound-guided block that can be also done under fluoroscopic guidance, which is usually used to manage postoperative pain of the thoracic and abdominal regions. We describe a successful Fluoroscopic-guided lumbar erector spinae plane block for lower back spinal surgery.

Methamphetamine-Induced Bowel Ischemia in a 50-Year-Old Male.

Methamphetamine intoxication is a known risk factor for nonocclusive mesenteric ischemia (NOMI). We describe a case of a 50-year-old male with a history of polysubstance abuse who presented to the Emergency Department with severe abdominal pain and coffee-ground emesis. Computed tomographic (CT) imaging demonstrated portal venous gas and diffuse colonic wall thickening concerning for ischemic colitis. The patient underwent exploratory laparotomy with resection of the ascending colon as well as a necrotic section of the jejunum. Further embolic workup was negative with a subjective history of amphetamine use prior to presentation. NOMI has a high fatality rate, and we recommend providers include drug-induced bowel infarction on their differential when presented with findings of ischemic bowel of unclear etiology.