Incarcerated small bowel associated with elective abortion uterine perforation.

BACKGROUND: Uterine perforation is a rare but recognized complication of abortion. Perforations may not be recognized at the time of the procedure, and patients may present days or weeks later with sequelae of the complication. OBJECTIVES: To raise awareness of this rare complication that can present days to weeks after the precipitating event. CASE REPORT: A 21-year-old woman presented 3 weeks after an elective abortion with symptoms of bowel obstruction. Exploratory laparotomy revealed small bowel herniation into a perforated uterus, causing the obstruction. In retrospect, a pre-operative ultrasound and computed tomography (CT) scan suggested this finding, but it went unrecognized at that time. A small bowel resection was performed and the patient made an uneventful recovery. CONCLUSION: Intrauterine bowel after abortion has been described only a handful of times in the literature. Uterine perforation during abortion is usually asymptomatic and generally can be managed conservatively, but herniation of bowel through the uterine defect can result in obstruction and strangulation. Intrauterine bowel requires prompt laparotomy and possible resection of non-viable bowel. Although ultrasound and CT scans may aid in diagnosis of this rare complication, a clinical suspicion for uterine perforation should be maintained by health care providers when treating patients who have had an abortion.

Did too much Wii cause your patient's injury?

Motion-controlled game consoles like Wii may be used to play virtual sports, but the injuries associated with them are real. Here's what to watch for--and a handy table linking specific games to particular injuries.

Pulmonary complications of 9931 narrow-bore nasoenteric tubes during blind placement: a critical review.

INTRODUCTION: A critical review of the pulmonary complications associated with blind placement of narrow-bore nasoenteric tubes (NETs) is discussed. Preventive measures and placement techniques are addressed to decrease patient morbidity and mortality. METHODS: A thorough database review was conducted to identify all randomized controlled and retrospective trials specifically addressing pulmonary complications from narrow-bore NET placement. Five unique studies, comprising more than 9900 NET placements, were identified. On the basis of the literature reviewed, the authors identified 3 major complications associated with blind NET placement: patient mortality directly resulting from NET misplacement, incidence of tracheopulmonary malpositioning, and correlation between NET misplacement and mechanical ventilation. RESULTS: Of the 9931 NET placements reviewed, there were 187 total improper tube placements in the tracheobronchial tree, which translates to a 1.9% mean overall malposition rate. Of these 187 misplacements, there were 35 (18.7%) reported pneumothoraces, at least 5 of which resulted in patient death. NET malpositioning was reported in 13%-32% of subsequent repositioning attempts. This increased risk exposes the patient population to a cumulative mortality from tracheobronchial malpositioning approaching >20%. Unexpectedly, of the 187 total misplacements, 113 (60.4%) of the patients were mechanically ventilated. CONCLUSIONS: Practitioners need to be aware of the potential for pulmonary complications associated with blind NET placement. Changes in institutional protocol should be considered to minimize unnecessary risks. As with any procedure, experienced personnel should be primarily used for tube placement and responsible for assisting others with less familiarity to learn the proper methods.

Late presentation of a mucinous ovarian adenocarcinoma which was initially diagnosed as a primary pancreatic carcinoma: a case report and review of the literature.

INTRODUCTION: Adenocarcinoma of the ovary is an aggressive neoplasm which often metastasizes to the lung or liver. Metastases rarely occur to the pancreas, but a tissue diagnosis is required to confirm this event. Although most tumors of the pancreas are primary pancreatic neoplasms, metastatic lesions have been reported most commonly as arising from renal cell carcinoma. CASE PRESENTATION: We report the case of a 51-year-old Caucasian woman with ovarian mucinous adenocarcinoma with metastasis to the head of the pancreas that was originally misdiagnosed as a pancreatic primary tumor. CONCLUSION: Mucinous ovarian adenocarcinomas rarely metastasize to the pancreas. New pancreatic lesions should be investigated through tissue biopsy and tumor markers, while keeping an open-minded differential diagnosis to avoid a misdiagnosis or a delay in treatment.

Cecal volvulus in a multiple-gestation pregnancy.

BACKGROUND: Intestinal obstruction during pregnancy is rare, with volvulus being responsible for about 25% of cases. CASE: We present a case in which a woman in the 12th week of a twin gestation presented with abdominal pain and distension. She was initially diagnosed with an ileus, and radiological studies at the time were deferred. The patient's symptoms worsened, and eventually she was taken to surgery for a diagnostic laparoscopy, which revealed a cecal volvulus with ischemic changes. A right hemicolectomy with primary anastomosis was performed. CONCLUSION: Volvulus in pregnancy carries a high mortality rate, often because diagnosis is delayed due to avoidance of radiography and because of similarity of symptoms to other clinical entities. A high index of suspicion for volvulus must be maintained when a pregnant patient presents with obstructive symptoms. Abdominal radiographs may be justified in aiding the diagnosis, and diagnostic laparoscopy is a viable alternative when the patient has an acute abdomen.

A unique case of ovarian psammocarcinoma with mediastinal, pulmonary, subcutaneous, and omental metastases.

Psammocarcinoma is a rare form of serous ovarian and peritoneal carcinoma, characterized by abundant psammoma bodies, invasiveness, and low-grade cytological features. Many of the cases which have been reported had extraovarian spread and peritoneal seeding at the time of presentation. We present a case of 45-year-old woman with ovarian psammocarcinoma who initially presented with a metastatic subcutaneous nodule, and was found to have pulmonary and mediastinal metastases. We believe this to be the first report of a psammocarcinoma with these metastases. Ovarian and peritoneal psammocarcinomas are quite rare, and because of this, knowledge of their behavior is limited. Although most seem to follow an indolent course similar to that of borderline lesions of the ovary, this case demonstrates that some of these tumors may be clinically aggressive with distant metastases.

Ischemic volvulus of the transverse colon: A case report and review of literature.

A 75-year old male presented to the emergency room with worsening abdominal pain and distension. Plain radiographs were suggestive of a large bowel obstruction due to volvulus. An attempt to detorse the volvulus and decompress the colon endoscopically failed, after which the patient was taken for an exploratory laparotomy. A transverse colon volvulus was found, and an extended right hemicolectomy and ileostomy was performed. We discuss the diagnosis and management of transverse colon volvulus and review the pertinent literature.