A Case Report of Percutaneous Right Ventricular Assist Device Utilization After Cesarean Delivery in a Patient With Severe Pulmonary Arterial Hypertension.

Physiologic changes of pregnancy are poorly tolerated in patients with pulmonary arterial hypertension (PAH), and peripartum maternal mortality is high. We present a case of a 31-year-old G3P0020 patient at 35 weeks' gestation with severe World Health Organization group I PAH who underwent cesarean delivery followed by percutaneous right ventricular assist device placement. Risks and benefits of the mode of delivery, neuraxial versus general anesthesia, and mechanical circulatory support are reviewed.

Internal hernia and small bowel obstruction caused by a linear cutter staple at appendiceal stump following laparoscopic appendectomy.

Commonly linear staplers are used to perform laparoscopic appendectomies. We report a case of a small bowel obstruction caused by a staple on the appendiceal stump creating an internal hernia <1 week after laparoscopic appendectomy. We discuss the available literature on bowel obstructions caused by staples. Most of the discussed complications were caused by staples free in the abdomen, which were remote from the staple line. Generally, loose staples do not cause problems, but if noted during the operation, we recommend removal to prevent future obstruction.

Bilateral luxatio erecta: a case report.

BACKGROUND: Luxatio erecta humeri or inferior dislocation of the glenohumeral joint is a rare presentation in the emergency department that is typically caused by a direct loading force on a fully abducted arm. This type of shoulder dislocation represents only 0.5% of all shoulder dislocations, making bilateral cases even more unique. OBJECTIVE: The authors report a case of bilateral luxatio erecta to highlight some of the key clinical signs and discuss proper methods of care. CASE REPORT: We report a case of bilateral luxatio erecta after a forward fall on a treadmill in a senior male patient. The patient grabbed onto the side rails of the treadmill such that his abducted arms received the entire force of the fall. These injuries were successfully reduced in the emergency department of our institution using a two-step approach for each: 1) conversion to anterior dislocation and 2) full reduction. CONCLUSIONS: Although shoulder dislocations remain a commonly seen injury in the emergency department, it is important to consider that not all dislocations are simply anterior. Signature signs of luxatio erecta are fixed abduction at the shoulder with elbow flexion and forearm pronation. The humeral head should be palpable inferior to the glenoid fossa. The most effective treatments for this injury involve sufficient muscle relaxation for reduction, a methodical approach to reduction, and appropriate immobilization.