Parvimonas micra: A Rare Cause of Pleural Empyema With COVID-19 Co-infection.

Parvimonas micra, an oral anaerobe and a known gastrointestinal microbiota, has also been found to be enriched in mucosal tissues of the colon. Our patient presented with chest pain, productive cough, and hypoxia. He was diagnosed with COVID-19 pneumonia with a suspected superimposed bacterial infection. After the initiation of treatment, the patient developed a right hydropneumothorax/loculated pleural effusion on X-ray. Bedside drainage was done, and cross-sectional imaging showed findings of pleural empyema. Cultures obtained after bedside drainage grew P. micra. The patient underwent right posterolateral open thoracotomy, total lung decortication, wedge resection, pneumonolysis, and mechanical pleurodesis. Antimicrobial therapy was adjusted based on culture sensitivities and infectious disease evaluation. Adequate drainage and source control were achieved, COVID-19 infection was resolved, and the patient was discharged on oral antibiotics. This case report highlights a rare and interesting case of pleural empyema caused by a superimposed bacterial infection with P. micra in a patient with COVID-19 pneumonia.

Methods of Surgical Repair for Iatrogenic Sigmoid Colon Perforation Following Colonoscopy: A Case Report and Literature Review.

Iatrogenic colonic perforation is a relatively infrequent yet perilous complication arising from both diagnostic and therapeutic colonoscopies, potentially leading to severe septic complications and increased morbidity or mortality. Given the gravity of potential complications, surgical intervention stands as the principal treatment strategy, with various modalities selected based on clinical discretion. In this context, we present the case of a patient who underwent primary laparoscopic repair following the identification of a sigmoid colon perforation during a routine colonoscopy. Intraoperatively, a Jackson-Pratt drain was placed to facilitate postoperative monitoring and drainage. The patient's hospitalization extended to a total of seven days due to sustained drainage and leukocytosis, highlighting the complexities of managing postoperative complications in such cases. This report underscores the current landscape of published data guiding the surgical management of iatrogenic colonic perforation following colonoscopy and highlights both the existing strengths and gaps within the current body of literature. As colonic perforation remains a critical concern in endoscopic procedures, a comprehensive understanding of optimal surgical interventions is crucial for minimizing patient morbidity and ensuring successful outcomes.

Strangulated Gastric Hernia Following a Missed Traumatic Diaphragmatic Injury: A Case Report.

Traumatic diaphragmatic injuries (TDIs) are rare and can be life-threatening, depending on the size of the injury and the contents herniating through it. They usually result from blunt or penetrating trauma to the thoracoabdominal area, with an incidence of 0.8-5% and up to 30% presenting late. A high index of suspicion should be maintained when evaluating patients with a history of trauma (severe blunt or thoracoabdominal penetrating trauma) and upper abdominal symptoms. We present a case of a missed TDI after a left posterior thoracoabdominal stab injury, which was evaluated with a diagnostic laparoscopy at an outside hospital. He presented to our emergency department (ED) with sudden onset left-sided chest pain and uncontrollable vomiting. A CT scan was obtained and showed a distended stomach herniating through a defect in the left hemidiaphragm. The patient was immediately taken for laparoscopic exploration and repair. There was a 5 cm defect in the left posterolateral diaphragm containing a strangulated stomach (approximately ⅔) and necrotic omentum. Complete reduction was achieved and the diaphragmatic defect was repaired primarily. His postoperative course was uncomplicated. This case illustrates the importance of maintaining a high index of suspicion for TDI, despite reports of previous exploration. Missed TDI can present with herniated intra-abdominal organs, which can become strangulated and increase morbidity and mortality.

A Rare Cause of Popliteal Artery and Vein Transection: A Case Report and Literature Review.

We present a rare occurrence of popliteal vascular injury due to blunt trauma. The patient had an isolated blunt lower extremity trauma. The patient subsequently experienced moderate tenderness and non-expanding hematoma at the popliteal fossa, reduced range of motion at the knee, and diminished distal pulses. X-rays showed a patella dislocation and tibial plateau non-displaced fracture but no knee dislocation. CT angiography showed an abrupt non-opacification of the distal portion of the popliteal artery with an overlying large hematoma. Surgical exploration was performed which revealed a concomitant transection of the popliteal artery and vein with a 5 cm defect. It was repaired with an interposition graft, and a fasciotomy was also performed. Literature has noted that although the overall incidence of popliteal injuries is low, when present due to blunt trauma there is increased morbidity. A high index of suspicion is recommended for vascular injuries in all patients with blunt trauma to the lower extremities. Minimizing time to diagnosis and intervention for limb salvage and improved outcomes.

An Unusual Case of Cecal Perforation: Accidental Ingestion of a Tooth in an Elderly Trauma Patient.

Foreign body ingestion is a common occurrence in the United States, with the majority passing asymptomatically. In cases where complications occur, such as intestinal perforation, it may present as an acute abdomen with diagnostic challenges regarding the etiology. A 70-year-old male was brought to the emergency department (ED) after he jumped from the second floor of a burning building, sustaining 10% second-degree burns to his forearms. He was intubated for concerns of inhalational injury and resuscitated. His intensive care unit (ICU) course included the management of respiratory failure, sepsis, and acute kidney injury. On hospital day 28, imaging showed moderate pneumoperitoneum with ascites. He was taken for abdominal exploration, during which it was noted that there was gross fecal contamination and a 1 cm cecal perforation. After resection of the ileocecum, it was left in discontinuity due to hemodynamic instability and contamination. He was brought for a second-look laparotomy in 48 hours, and an incisor tooth was found in the right pelvis, and an ileocolic (ileum-ascending colon) anastomosis was performed. His post-operative course was complicated by an anastomotic leak and an intra-abdominal collection. Despite attempts at source control with percutaneous drainage, the patient remained septic with a poor prognosis. Goals of care were discussed, and the decision was made to de-escalate care. Although there is literature on foreign body ingestion resulting in intestinal perforation, there is a paucity of literature highlighting the importance of dental exams in elderly trauma patients, the incidence of perforation due to tooth ingestion, and maintaining a high index of suspicion for an acute abdomen in unusual presentations of sepsis.

Traumatic Rupture of Cystic Left Retroperitoneal Mass: An Atypical Presentation of Diffuse Large B-Cell Lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. Though the presentation is diverse, patients typically have a history of "B" symptoms and lymphadenopathy in areas such as the neck, mediastinum, or abdomen. However, a growing body of evidence suggests DLBCL can present as a cystic mass in diverse tissues. We present the case of a large cystic left retroperitoneal mass of unknown origin in a patient subsequently diagnosed with DLBCL. The diagnosis was obtained via percutaneous biopsy of the cystic mass in preparation for surgical excision. Upon diagnosis, surgical intervention was aborted, and the patient was started on chemotherapy treatment. However, four weeks into her treatment, she slipped and fell while in the bathroom and presented to the emergency department in shock with a computed tomography (CT) scan suggestive of splenic rupture. She underwent emergent splenectomy and resection of the cystic mass. She was discharged on postoperative day 7 and is currently continuing with outpatient chemotherapy. The presentation of DLBCL is notoriously diverse, however, this patient represents a unique presentation that adds to a growing body of literature suggesting DLBCL can present as a cystic mass. Pathological diagnosis should be obtained in all patients with cystic lesions of unknown origin before any surgical intervention to avoid unnecessary surgery and provide an optimal management plan.

E-scooter and E-bike injury pattern profile in an inner-city trauma center in upper Manhattan.

BACKGROUND: Electric bikes and scooters are becoming popular means of short-distance transportation in major cities. Regulations for safe riding established by ride-sharing companies and local governments have not been effectively implemented. Inner-city hospitals are at the frontline of receiving traumas related to e-bikes and e-scooters and are receiving an increasing number of injuries. The works of literature reporting these injuries are limited. METHOD: This study reviewed all the trauma activations at a major trauma center in NYC from 04/2019 to 08/2021. Patients with e-bike and e-scooter injuries were included in the study. Socio-demographics of riders, passengers, injury patterns, and outcomes were reviewed. Logistics regression was used to analyze the factors associated with Injury Severity Scale. RESULTS: We reviewed 1979 patient charts of trauma activation in the Emergency Department. We included 88 scooters, 24 E-bike, and 5 nonrider scooter injuries. 91% were male and 9% were Female victims. The majority were African American patients (34%) and Hispanic patients (46%). 87% belonged to the 18-50 years age group, and 13% were above 50 years and below 18 years were excluded from the study. 36% of victims were under the influence of drugs or alcohol and only 25% of riders wore helmets. 58% of patients were discharged from the ED, 42% required hospital admission, and 14% required ICU care. Odds of non-mild injury (moderate to critical injury) in comparison to mild injury were significantly greater with increasing age. CONCLUSIONS: The use of e-bikes and e-scooters is increasing as a means of affordable short-distance transportation but with evidence of significant injuries with varying severity. These findings suggest a need to review public policy regarding e-bike and electric scooter use regulations for the safety of riders and pedestrians; Driving While Intoxicated (DWI) law enforcement, mandatory helmet, education, speed control, creation of special lanes, and no car zones.

Right Hepatic Artery Pseudoaneurysm Presenting As Upper Gastrointestinal Bleed: A Deadly Hit and Run Following Blunt Trauma.

Hepatic artery pseudoaneurysm (HAA) is a rare complication of blunt trauma, occurring in only 1% of patients. It is life-threatening with abysmal and atrocious outcomes if not recognized early and managed promptly. Other etiologies include transjugular-intrahepatic portosystemic shunt (TIPS), pancreatitis, cholecystectomy, and liver transplantation. We report a near-miss case in a 38-year-old woman following a motor vehicle accident. She sustained Grade III/IV liver laceration (>50% subcapsular hematoma), presenting with upper gastrointestinal bleeding (UGIB). Our patient was managed emergently intra-operatively, with hemostasis promptly achieved; however, she continued to bleed postoperatively, becoming hemodynamically unstable and unresponsive to both massive blood transfusions and high-dose proton pump inhibitors. Further imaging demonstrated HAA for which coil embolization was carried out by interventional radiology (IR).

Prevotella bivia: A Rare Cause of Zuska's Breast Disease.

Zuska's breast disease is a rare disorder leading to recurring subareolar abscess typically in obese patients with a history of smoking. The pathophysiology is a combination of ductal obstruction from squamous metaplasia and infection usually by anaerobic and gram-positive bacteria. Zuska's breast disease does not have a single standardized treatment partly attributed to the lack of physician awareness of the disorder. The initial management should include smoking cessation, anaerobic and gram-positive antibiotic coverage, and drainage of abscesses if present.