Child abuse with multiple sharp foreign bodies penetrating the chest wall causing hemothorax and cardiac tamponade in two separate occasions: Case report.

We present a case of repeated child abuse causing left-sided hemothorax and cardiac tamponade on two separate occasions. A 14-year-old cerebral palsy male presented with left-sided hemothorax and multiple metallic foreign bodies in the chest wall managed by small limited incision, removal of the foreign bodies and chest tube. One week later, he came to our emergency department (ER) with multiple chest wall foreign bodies and tamponade managed by median sternotomy, removal of the foreign bodies, one of them was in the LAD. He had a smooth postoperative course and the case is under investigation.

Respiratory-digestive tract fistula: two-center retrospective observational study.

Background Aerodigestive fistulae can be defined as abnormal communications between the gastrointestinal tract and the respiratory tract. Choking after meals, coughing, feeding difficulties, tachycardia, and persistent pneumonia are the main presentations. The aim of our study was to review our experience in the management of 27 cases of acquired aerodigestive fistulae of different types, levels, and management. Methods We conducted a retrospective observational study on 27 cases of fistulae between the respiratory and digestive tracts, which were managed in 2 hospitals in Saudi Arabia in the last 5 years. The patients comprised 16 females and 11 males, with a mean age of 29 years (range 17-67 years). Results The most common aerodigestive tract fistula was tracheoesophageal in 8 patients, followed by esophagobronchial in 6, and esophagopleural in 5. Four postendoscopic fistulae were included. The least common were gastropleural and esophagopulmonary fistulae. The most common etiologies were iatrogenic and esophageal cancer, and the least common was blunt chest trauma. The main presentations were fever, chocking after or during meals, and tachycardia. We used various modalities of treatment: conservative, cervical repair, thoracoabdominal repair, hybrid insertion of a T-tube, endoscopic esophageal stenting, and endoscopic clipping of the fistulous tract. During follow-up, 6 patients died due to advanced esophageal cancer in 5 and upper airway obstruction after iatrogenic tracheobronchial fistula in one. Conclusion Acquired aerodigestive fistula is a devastating condition that should be managed early and aggressively by a multidisciplinary team.

Impacted thoracic foreign bodies after penetrating chest trauma.

BACKGROUND: Retained foreign bodies in the chest may include shell fragments, bullets, shrapnel, pieces of clothing, bones, and rib fragments. The risks of removal of foreign bodies must be weighed against the complications of leaving them inside the chest. METHODS: We treated 90 cases of retained intrathoracic foreign bodies in patients admitted to 3 tertiary centers in Saudi Arabia between March 2015 and March 2016. Sixty patients were injured by shrapnel, 26 had one or more bullets, 3 had broken rib fragments, and one had a metal screw. The chest wall was site of impaction in 48 cases, the lungs in 24, pleura in 14, and mediastinum in 4. RESULTS: Removal of the retained foreign body was carried out in 12 patients only: bullets in 9 cases, bone fragments in 2, and a metal screw in one. The predictors for removal were bullets, female sex, and mediastinal position with bilateral chest injury, especially with fracture ribs. CONCLUSION: Retained intrathoracic foreign bodies due to penetrating chest trauma are treated mainly conservatively unless there is another indication for chest exploration.

Post-traumatic ruptured gastrothorax mimicking chylothorax.

INTRODUCTION: The presence of the stomach in the chest is called gastrothorax. Few cases were reported. Most of them were related to congenital diaphragmatic hernia. OBJECTIVES: We are presenting a case of successful repair of ruptured traumatic gastrothorax which was masqueraded as chylothorax. METHODS: A male patient with rupture stomach in the left chest cavity. Results successful repair of ruptured traumatic gastrothorax. CONCLUSION: Traumatic ruptured gastrothorax can be mistaken for chylothorax.

Postsplenectomy left lower lobe bronchiectasis.

BACKGROUND: Bronchiectasis has decreased significantly. I describe a new underestimated clinicopathological entity of postsplenectomy left lower lobe bronchiectasis. METHODS: This is a retrospective study on 24 patients who had a left lower lobectomy for left lower lobe bronchiectasis after splenectomy. The mean age was 34.6 years (range 18 to 63 years); there were 19 men and 5 women. The available data included history, radiological investigations (ultrasonography and computed tomography of the chest and abdomen), operative data, postoperative complications, and follow-up data. RESULTS: All patients had a history of splenectomy and 10 had undergone subphrenic collection drainage either percutaneously or through open drainage a few years prior to the left lower lobectomy. Fourteen patients were lost to follow-up. The mean follow-up in 10 patients was 5.8 years (range 2 to 13 years). CONCLUSIONS: Postsplenectomy left lower lobe bronchiectasis is an underestimated clinicopathological entity of bronchiectasis. It can be managed by a left lower lobectomy, with acceptable results.

Left ventricular rupture post mitral valve replacement.

Prevention is better than cure best applies here. As per many authors, posterior leaflet chordae preservation prevent Left ventricular rupture (LVR) and preserve LV geometry. We are presenting here 5 types of left ventricular rupture (LVR) post Mitral valve replacement (MVR) with different methods to repair with the advantages and disadvantages of each. The mortality rate is still very high despite the advances in cardiac surgery. Many therapeutic approaches have been adopted. Yet, none is ideal.

Concealed neo-aortic incompetence and new right ventricular outflow tract obstruction after arterial switch operation in a late presenter.

We report a 9 year old boy who presented late with cyanosis as a case of dextro-transposition of great arteries, intact ventricular septum and left ventricular outflow tract obstruction (D-TGA/IVS/LVOTO). Arterial switch operation (ASO) with resection of sub-neo aortic membrane and repair of mitral valve were done for the naturally trained LV. On the second postoperative day, the newly discovered right ventricular outflow tract obstruction (RVOTO) was relieved and mitral valve replacement (MVR) was done for significant mixed stenotic/regurgitant mitral valve disease, and intraoperative extra-corporeal membrane oxygenation (ECMO) support was instituted for pulmonary dysfunction for 4 days. Failure of extubation warranted further assessment that revealed significant aortic incompetence (AI) during cardiac catheterisation study, which was underestimated by echocardiography. Aortic valve replacement (AVR) was done on the 11th postoperative day and he was then extubated and had uneventful hospital course in spite of two emergency procedures: drainage of sub-dural haematoma and appendectomy.