Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 379
Filtrar
1.
Int J Surg Case Rep ; 119: 109685, 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38701615

RESUMO

INTRODUCTION AND IMPORTANCE: Drainage tubes are commonly used to remove unwanted fluid after surgery. However, they are not indicated in all situations, and there is no evidence to support their common utilization. CASE PRESENTATION: A 31-year-old woman at 38 weeks of gestation with a history of five cesarean sections presented with lower abdominal pain following a tonic-clonic epileptic seizure. Emergency surgery was performed due to fetal distress, and the uterus was found to be ruptured. After delivering the baby and closing the uterus, a drainage tube was inserted into the pouch of Douglas. Two days after surgery, the right ampulla and infundibulum were eviscerated from the drain site during the drainage tube removal. A second surgery was performed to reduce the herniated uterine tube. CLINICAL DISCUSSION: Drainage tubes are typically easily removed without complications. Some reported complications related to drainage tube removal include herniation, anchoring and suctioning of the uterine tube to the drainage tube, knotting with the colonic epiploica, and fracturing and retraction of the drainage tube due to adhesions. To the best of our knowledge, this is the first reported case of uterine tube evisceration during drainage tube removal. CONCLUSION: Evisceration after drainage tube removal is very rare. We believe that this is the first report of immediate evisceration after the removal process. Such complications can be avoided with more restricted instructions for the use of drainage tubes and more researches on the reasons for these complications.

2.
J Surg Case Rep ; 2024(4): rjae191, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38572288

RESUMO

Vaginal vault dehiscence with evisceration is a rare but a potentially life-threatening complication of total hysterectomy that requires prompt recognition, diagnosis, and management. The overall incidence of vaginal vault dehiscence is 0.53%. The mortality rate increases to 5.6% when bowel evisceration is present. We report a case of vaginal vault dehiscence with small bowel evisceration complicated by bowel necrosis and intra-abdominal haemorrhage in a 48-year-old woman following her first sexual intercourse 4 months after her total abdominal hysterectomy.

3.
Int J Clin Pediatr Dent ; 17(1): 89-91, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38559861

RESUMO

Background: On account of loss of eye following Rubella infection, a 13-month-old baby girl patient required a maxillofacial prosthesis to restore her facial esthetics and social health as she grows. Case presentation: The process of prosthesis fabrication began at the time of enucleation where a conformer was given. Post healing the procedure was completed in a span of 2 days taking adequate trials and cross references for the like-like appearance of the prosthesis. Conclusion: A heat-cure acrylic resin based prosthetic eye was delivered with adequate instructions on the insertion and removal and hygiene maintenance given to the care providers. How to cite this article: Shetty NHG, Shetty MS, Saha S, et al. Prosthetic Management of an Eviscerated Eye of a 13-month-old Patient: A Case Report. Int J Clin Pediatr Dent 2024;17(1):89-91.

4.
Cureus ; 16(3): e56564, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38646353

RESUMO

Abdominal pain ranks as the predominant cause for emergency department consultations. Although rare, transvaginal evisceration of the small intestine necessitates immediate surgical intervention due to its potential to induce intestinal ischemia and peritonitis. Key risk factors include postmenopausal status, a history of gynecologic surgery, and heightened abdominal pressure. Clinical presentation typically involves pain and protrusion of intestinal contents or even abdominal viscera. Diagnosis relies on thorough clinical assessment, and treatment strategies should be tailored to each patient. Here, we describe the case of a 65-year-old female patient with a non-traumatic evisceration of the ileum, who had undergone total abdominal hysterectomy following anterior colpocele a year ago, subsequently necessitating exploratory laparotomy and repair of the vaginal ampulla.

5.
Cureus ; 16(3): e56009, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38618341

RESUMO

Spontaneous bowel evisceration from a ruptured, long-standing abdominal wall hernia is a very rare complication with significant morbidity and mortality, usually occurring in incisional or recurrent groin hernias. In this case report, we elucidate an unexpected scenario of spontaneous incisional hernia rupture leading to bowel evisceration, detailing the clinical presentation, diagnostic workup, and surgical management. By highlighting this rare complication, we emphasise the significance of vigilance in monitoring hernia patients and the necessity of expedited surgical intervention to prevent complications, optimise outcomes, and minimise morbidity.

6.
Cont Lens Anterior Eye ; 47(3): 102149, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38521700

RESUMO

PURPOSE: To assess which signs and eye prosthesis care habits are related to subjective discomfort in patients with dry anophthalmic socket syndrome (DASS), using standardized tools from daily practice. METHODS: 62 anophthalmic sockets were compared with their healthy fellow eye using the Standard Patient Evaluation of Eye Dryness (SPEED) score. The correlations between SPEED questionnaire and the prosthesis care, discharge characteristics score, conjunctival inflammation score, meibomian gland dysfunction (MGD) scores and Schirmer I test were studied. RESULT: The anophthalmic sockets group achieved a higher SPEED test score (p < 0.01), discharge score (p < 0.01), conjunctival inflammation score (p < 0.01), MGD scores (p < 0.01) and lower Schirmer I test (p < 0.01) compared with their fellow, healthy eye. Patients with a prosthesis replacement of one year or less, those with a current fit time of one year or less and those with a cleaning frequency above one month reported better SPEED, (p < 0.01), conjunctiva inflammation (p < 0.01) and MGD scores (p < 0.01). CONCLUSION: Most anophthalmic patients suffer mild to severe DASS, which seems related to discharge, conjunctival inflammation and MGD. Moreover, certain practices related to the care of the prosthesis such as replacing with a frequency lower than yearly, current fitting time inferior to one year and a removing and cleaning regime above one month, were related to a lower discomfort sensation, conjunctival inflammation and MGD. Clinicians should consider the DASS when facing patients with anophthalmic socket and discomfort symptoms.


Assuntos
Anoftalmia , Síndromes do Olho Seco , Olho Artificial , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/fisiopatologia , Adulto , Idoso , Inquéritos e Questionários , Implantes Orbitários , Idoso de 80 Anos ou mais , Adulto Jovem
7.
Injury ; 55(5): 111504, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38508982

RESUMO

OBJECTIVES: To describe the mechanisms and visual outcomes of recreational and sports-related open globe injuries (OGIs). METHODS: A retrospective case series of eyes experiencing OGI secondary to recreational and sports-related activities at Memorial Hermann Hospital - Texas Medical Center (MHH-TMC) from January 1st, 2010 through March 31st, 2015 was conducted. Exclusionary criteria included no documented ophthalmologic examination upon presentation and repairs performed by services other than ophthalmology. A two-tailed t-test and Fisher's exact test were utilized to assess for statistical significance (p < 0.05). RESULTS: A total of 20 eyes from 20 patients experiencing OGIs secondary to recreational and sports-related activities were included. Thirteen eyes (65 %) presented with OGIs from penetrating objects while seven eyes (35 %) had injuries from blunt injuries. Males comprised most of the total study group (17 of 20 patients), and zone 3 injuries were the most common location of OGI. While eyes with OGIs from blunt trauma underwent evisceration/enucleation procedures more frequently than OGIs from penetrating mechanisms (71% vs 23 %) (p = 0.10), the final visual outcomes were similarly poor between groups. Only three eyes in this series experienced an improvement from baseline VA; all three eyes had lacked initial findings consistent with severe injury. CONCLUSIONS: Recreational and sports related OGIs most commonly occur in zone 3 and in young males, regardless of injury type. OGIs due to both penetrating and blunt trauma mechanisms implicate poor functional outcomes, but the absence of certain presenting injury features may indicate possibility of eventual visual recovery.


Assuntos
Ferimentos Oculares Penetrantes , Traumatismos Oculares , Esportes , Ferimentos não Penetrantes , Masculino , Humanos , Feminino , Estudos Retrospectivos , Acuidade Visual , Traumatismos Oculares/complicações , Ferimentos não Penetrantes/complicações , Prognóstico
8.
Cureus ; 16(2): e53715, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38455783

RESUMO

Intussusception in adults is less frequent than in children, and it is less commonly seen in the colon than in the intestines. This may be explained by the fixation of the colon to the retroperitoneum. We herein describe a case of sigmoid colon intussusception caused by a sigmoid colon adenocarcinoma. An 81-year-old man presented with abdominal pain and signs and symptoms of gastrointestinal obstruction. CT revealed a "target sign" with a mass in the sigmoid colon. We diagnosed the patient with colonic obstruction secondary to intussusception of the sigmoid colon and performed an emergency transverse colostomy. On the first postoperative day, the patient had a parastomal evisceration. Oncologic resection of the sigmoid colon without reduction of the intussusception was performed. The tumor was pathologically diagnosed as well-differentiated adenocarcinoma and classified as pT3N0. The patient was discharged on the ninth postoperative day with an uneventful postoperative course. The surveillance was validated for this patient.

9.
J Surg Case Rep ; 2024(3): rjae127, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38463734

RESUMO

Vaginal evisceration is a rare surgical emergency in which intra-abdominal contents protrude through a dehisced vaginal cuff, which can lead to bowel ischemia and abdominal sepsis. This condition occurs due to vaginal cuff weakness secondary to prior surgeries or trauma. Recurrence after repair is rare and few cases have been documented. Here we present a young woman with multiple prior gynecologic surgeries who presented with eviscerated small bowel and omentum from her vagina five months following surgical treatment of a previous vaginal evisceration. Via a transabdominal surgical approach, general surgery and gynecology teams reduced the intra-abdominal contents, resected a pedicle of necrotic omentum, suture repaired the vaginal cuff, and placed a dehydrated placental allograft. This extremely rare case of recurrent vaginal evisceration demonstrates the importance of taking appropriate preventative surgical measures, maintaining a healthy level of suspicion for recurrence, knowing potential complications, and educating patients to prevent recurrent vaginal evisceration.

10.
Proc (Bayl Univ Med Cent) ; 37(2): 348-354, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38343486

RESUMO

Mucormycosis is an invasive fungal infection that can cause acute clinical decompensation and death. The literature demonstrates case fatality rates around 50% with differential clinical courses contingent upon anatomical incursion. Rhino-orbital cerebral mucormycosis represents a rapidly hostile variant with poorer outcomes, warranting prompt recognition, workup, and intervention. It is seldom included in differential diagnoses in those with head and neck pathology within the inpatient setting as diagnostic parsimony and low prevalence lead this entity to be often overlooked. Given the acuity and risk factors involved, considering mucormycosis may be prudent during the assessment of hyperglycemic or immunodeficient patients exhibiting maxillofacial disease. When acquiring histories of presenting illness and performing physical examinations, assessment includes mindfulness of diabetes mellitus, craniofacial lesions, and alertness to clinical deterioration. Given the rising incidence of complicated diabetes mellitus in conjunction with a paucity of mucormycosis reports noting the orbit as the diagnostic harbinger, we report the case of a 59-year-old woman admitted to the critical care setting for diabetic ketoacidosis and altered mental status. Physical examination revealed a swollen orbit, later diagnosed as mucormycosis with associated sino-orbit involvement and cranial nerve deficits warranting urgent and extensive facial debridement.

11.
Int J Surg Case Rep ; 115: 109198, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38181656

RESUMO

INTRODUCTION: Transanal small bowel evisceration remains a rarely recorded emergent situation in the scientific literature. This article describes the rather seldom complication of a non-treated long standing rectal prolapse presenting in the form of transanal prolapse of the small bowel due to rectal perforation. PRESENTATION OF CASE: We present the case of an 84 year old female, who presented to our emergency department with transanal evisceration of the small bowel. DISCUSSION: This rare case presentation led us to perform an accompanying review of the literature, using Pubmed® searching for the words "transanal evisceration", "rectal prolapse", and "rectal perforation". We discuss the outcomes of our literature review, possible pathogenesis and the available treatment options. CONCLUSION: Although transanal evisceration of small bowel presents a rare emergency, having the knowledge of this condition would help early recognition of this incidence and hopefully lead to early treatment, which would avoid drastic consequences as a result of small bowel strangulation.

12.
Ophthalmologie ; 121(1): 27-35, 2024 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-37815541

RESUMO

BACKGROUND: The handling of fireworks regularly leads to a variety of injuries affecting the periocular region. Due to the COVID-19 lockdown and a sales ban on consumer fireworks for the private sector the number of injuries massively decreased; however, a considerable increase was registered again at the last New Year festivities. The aim of this work was to present the extent and spectrum of such injuries in a maximum care center. METHODS: As part of the nationwide survey of firework-associated eye injuries in emergency care eye clinics and hospitals, data from the MHH Eye Hospital in Hannover were compiled over the period of 3 days (30.12.2022-01.01.2023) and evaluated with respect to gender, age, severity, injury pattern, type of fireworks and treatment. RESULTS: Of a total of n = 25 injured patients, n = 19 (76%) were male. Most patients presented on New Year's Day (n = 14, New Year's Eve: n = 9; 30.12.2022: n = 2), with the majority of cases presenting with mild injuries with irritation and erosion of the ocular surface (n = 15; 60%). Of the patients four sustained moderate to severe injuries with bulbar contusion, hyphema, and sometimes iris base tears (16%). Of the patients six suffered severe, mainly open, eye injuries (24%), two of which required primary evisceration. Ignition of fireworks batteries revealed the highest risk of serious injury, affecting mainly males 31-40 years of age. Children up to 12 years of age generally sustained only minor injuries, although there were exceptions as there were among adolescents. The person who caused the fireworks injury was affected in about 52% of the cases; in 48% the victim of the accident was a bystander. In cases of complex injuries, under certain conditions only surgical exploratory diagnostics could lead to the correct diagnosis and best possible care. CONCLUSION: The extent of firework injuries is manifold and the consequences including blindness are considerable. The burden on physicians on duty on New Year's Eve and New Year's Day was enormous, as with the permission of private fireworks a large number of patients had to be cared for via the emergency room, some of whom required complex surgical care. To prevent serious eye injuries, targeted education about the risks of private fireworks and possibilities to increase safety should be intensified.


Assuntos
Traumatismos por Explosões , COVID-19 , Traumatismos Oculares , Criança , Adolescente , Humanos , Masculino , Feminino , Traumatismos por Explosões/epidemiologia , Universidades , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Traumatismos Oculares/epidemiologia
13.
Updates Surg ; 76(1): 309-313, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37898965

RESUMO

Anal squamous cell carcinoma (ASCC) is the most common histological subtype of malignant tumor affecting the anal canal. Chemoradiotherapy (CRT) is the first-line treatment in nearly all cases, ensuring complete clinical response in up to 80% of patients. Abdominoperineal resection (APR) is typically reserved as salvage therapy in those patients with persistent or recurrent tumor after CRT. In locally advanced tumors, an extralevator abdominoperineal excision (ELAPE), which entails excision of the anal canal and levator muscles, might be indicated to obtain negative resection margins. In this setting, the combination of highly irradiated tissue and large surgical defect increases the risk of developing postoperative perineal wound complications. One of the most dreadful complications is perineal evisceration (PE), which requires immediate surgical treatment to avoid irreversibile organ damage. Different techniques have been described to prevent perineal complications after ELAPE, although none of them have reached consensus. In this technical note, we present a case of PE after ELAPE performed for a recurrent ASCC. Perineal evisceration was approached by combining a uterine retroversion with a gluteal transposition flap to obtain wound healing and reinforcement of the pelvic floor at once, when a mesh placement is not recommended.


Assuntos
Neoplasias do Ânus , Procedimentos de Cirurgia Plástica , Protectomia , Neoplasias Retais , Retroversão Uterina , Feminino , Humanos , Retroversão Uterina/complicações , Retroversão Uterina/cirurgia , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Recidiva Local de Neoplasia/cirurgia , Recidiva Local de Neoplasia/etiologia , Protectomia/efeitos adversos , Neoplasias do Ânus/cirurgia , Neoplasias do Ânus/etiologia , Complicações Pós-Operatórias/etiologia
14.
Urol Case Rep ; 52: 102629, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38146484

RESUMO

We herein report a case of successful laparoscopically assisted transperineal repair of anterior enterocele dehiscence with small bowel evisceration after robot-assisted radical cystectomy. A 75-year-old woman underwent robot-assisted radical cystectomy with anterior vaginectomy and urethrectomy for bladder cancer (pTisN0M0). Vaginal reconstruction was performed using the posterior vaginal wall. Four months after surgery, she presented with small bowel evisceration due to anterior enterocele dehiscence. She underwent laparoscopically assisted transperineal repair. The anterior enterocele dehiscence did not occur at the vaginal closure site but instead between the vaginal wall and posterior pubic bone. No recurrence had developed at 2 months postoperatively.

15.
Meat Sci ; 208: 109365, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37939509

RESUMO

The aim of the study is to provide an up-to date overall evaluation of visual contamination occurring on the slaughter line in order to provide a basis for implementing contamination control measures and to the hygienic quality of the processes. For this purpose, 627 contaminated pig carcasses in an industrial slaughterhouse in north western Germany were examined in 2021 for its distribution of type, areal extent and localization of slaughter contamination. Prior to official meat inspection, two persons visually scanned dorsal and ventral surfaces of the eviscerated but not yet split pig carcasses from cranial to caudal and recorded types, areal extent and localization of the contamination. The main contamination type were intestinal contents, bile, stomach contents, tubular rail fat and "others", which mostly consisted of a reddish foam from the respiratory tract. 103 out of 627 contaminated animals showed more than one contamination, which leads to a total number of 754 contaminations detected. Intestinal contents accounted for almost half of all contaminations and "others" for 30%. Forelimb, back and ham together counted for 70% of the contaminated regions. The affected area was smaller than that of a one euro coin (diameter about 23 mm) in 86% of the cases.


Assuntos
Matadouros , Carne , Suínos , Animais , Higiene , Alemanha , Microbiologia de Alimentos , Contaminação de Alimentos/análise
16.
Ocul Oncol Pathol ; 9(5-6): 138-151, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38089175

RESUMO

Introduction: Sympathetic ophthalmia (SO) is a rare bilateral granulomatous panuveitis that can follow surgical or nonsurgical ocular trauma in one eye. Because its diagnosis requires clinical-pathologic correlation, the true incidence of SO is unknown, and there is a need to understand the recent trends in risk factors and frequency of this condition. Methods: Pathology records of all enucleated or eviscerated (ENEV) eyes at three pathology laboratories were reviewed. Data collected included patient demographics, procedure indication, pathology diagnosis, and clinical history of trauma and uveitis. IRIS® Registry (Intelligent Research in Sight) was searched for all patients with SO, acquired absence of eye (AAE), and/or ENEV. Data obtained included patient demographics, ocular procedures, and preoperative diagnoses within 30 days of AAE/ENEV. Results: In the pathology laboratory setting, the incidence of SO over a 36-year period in patients who underwent ENEV was 0.2% (20/9,092); the 5-year incidence ranged from 0.0 to 0.3%. Among the 20 eyes with SO, the inciting event was surgical trauma in 50% (10/20), nonsurgical trauma in 45% (9/20), and missing/undetermined in 5% (1/20). SO was suspected preoperatively in 7/20 (35%) patients. Clinical concern for SO and ruptured globe were indications for ENEV in 50/9,092 (0.5%) and 872/9,092 (10%) patients, respectively. In the IRIS Registry, 0.7% (199/27,830) of patients with AAE/ENEV had diagnosis of SO. The frequency of SO between 2015 and 2020 was 0.01% (7,371/62,318,249); of these 7,371 cases, 199 (3%) had AAE/ENEV. In 25,975 patients with available data, injury and SO were listed as diagnoses less than 30 days prior to AAE/ENEV in 909 (4%) and 63 (0.2%) cases, respectively. Conclusion: The frequency of SO in recent decades has been low. Most cases of SO are not managed with eye removal. In histopathology-confirmed SO, surgical trauma is as frequent as nonsurgical trauma as an inciting etiology of disease.

17.
Arch. Soc. Esp. Oftalmol ; 98(12): 703-712, dic. 2023. tab
Artigo em Espanhol | IBECS | ID: ibc-228145

RESUMO

El tratamiento de la asimetría facial en pacientes con microftalmos o cavidades anoftálmicas adquiridas suele requerir cirugías reconstructivas agresivas. En los últimos años se han publicado trabajos sobre el uso de rellenos para optimizar la simetría del tejido orbitario, como técnicas mínimamente invasivas.Por este motivo, hemos realizado una revisión sistemática de la literatura publicada hasta el momento sobre la administración orbitaria de rellenos para el tratamiento de la pérdida de volumen. Se identificaron 14 artículos que cumplían con los criterios de selección; en los que se analizó el material utilizado, la técnica de inyección, el estudio anatómico de los pacientes antes del procedimiento y la presencia de complicaciones asociadas. Los materiales utilizados como relleno son: la grasa autóloga, la hidroxiapatita cálcica, el colágeno, el ácido hialurónico o el gel de poliacrilamida. Se aplicaron técnicas estándar de inyección peribulbar y retrobulbar, con escasas complicaciones asociadas, siendo la má grave el desarrollo de cuadros vaso-vagales. El seguimiento de los pacientes suele limitarse en la mayoría de los estudios a 12 meses, con variaciones significativas en la exoftalmometría posprocedimiento. En conclusión, la utilización de rellenos parece una práctica segura y con buenos resultados, aunque se precisan estudios con tiempo de seguimiento más prolongado que los publicados hasta el momento. (AU)


The treatment of facial asymmetry in patients with microphthalmos or acquired anophthalmic cavities usually requires aggressive reconstructive surgeries. In recent years, studies have been published on the use of fillers to optimize orbital tissue symmetry, as minimally invasive techniques.For this reason, we performed a systematic review of the literature published to date on the use of fillers for the treatment of volume loss in acquired anophthalmic or microphthalmic cavities. Fourteen articles were reviewed in which the material used, the injection technique, the anatomical study of the patients before the procedure and the presence of associated complications were analyzed.Various materials have been used as fillers, including autologous fat, calcium hydroxyapatite, collagen, hyaluronic acid, or polyacrylamide gel. Standard peribulbar and retrobulbar injection techniques were applied, with few associated complications, the most serious being the development of vasovagal symptoms. Patient follow-up is usually limited in most studies to 12 months.In Conclusion, the use of fillers seems to be a safe practice, with good results and few complications, although studies with longer follow-up times than those published to date would be required. (AU)


Assuntos
Humanos , Microftalmia/tratamento farmacológico , Injeções Intravítreas , Enucleação Ocular , Evisceração do Olho , Ácido Hialurônico/administração & dosagem
18.
J Surg Case Rep ; 2023(11): rjad609, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38026736

RESUMO

Abdominal wound dehiscense, or burst abdomen, is a critical postoperative complication necessitating immediate intervention. We present an extremely rare case of left hepatic lobe evisceration through wound dehiscense in a 65-year-old female receiving palliative care for hypopharyngeal squamous cell carcinoma. The patient's midline incision that was performed for feeding jejunostomy tube displayed liver protrusion on Day 14 postoperatively. Surgical exploration revealed a healthy liver, prompting reduction and secondary sutures to prevent complications. Abdominal wound dehiscense risk factors, including advanced age, poor nutrition, and medical illness, contribute to its occurrence. Although guidelines for liver evisceration management are lacking, our case emphasizes proper technique, wound care, and nutritional support to aid the healing process and to ensure a better outcome for the patients.

19.
Patient Saf Surg ; 17(1): 26, 2023 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-37872589

RESUMO

BACKGROUND: Parastomal evisceration represents a preventable surgical complication that should not occur with appropriate technical diligence and surgical skills. While late parastomal hernias are well described in the literature, there is a paucity of reports on the early postoperative occurrence of parastomal intestinal evisceration. CASE PRESENTATION: An urgent laparotomy was performed on a 58-year-old female patient for an acute cecal perforation with generalized peritonitis related to underlying colon cancer. Intraoperative revelations necessitated a carcinologic right colectomy and the creation of an end-loop ileocolostomy. Following six sessions of adjuvant chemotherapy, Computed tomography scans raised uncertainties about the presence of peritoneal carcinomatosis. Consequently, a collaborative decision was reached in a multidisciplinary discussion to conduct a surgical biopsy of these deposits before reinstating digestive continuity. The surgical procedure started with stoma mobilization. However, adhesions and a relatively confined aperture curtailed a comprehensive peritoneal cavity exploration. Thus, a midline incision was executed. The verdict from the frozen section examination affirmed metastatic presence, prompting the retention of the stoma. Within 48 h post-surgery, an early-stage parastomal evisceration occurred, stemming from an inadequately sealed aponeurotic sheath. The exposed bowel surface was encased in fibrin, necessitating meticulous irrigation with a warm saline solution before repositioning it within the peritoneal cavity. Accurate adjustment of the aponeurosis closure ensued, coupled with a meticulous reconstitution of the stoma. The postoperative course was uneventful. The patient was subsequently referred for hyperthermic intraperitoneal chemotherapy. CONCLUSIONS: Preventing parastomal evisceration requires adherence to established stoma-creation protocols, including creating a properly sized fascial opening and secure fixation. In instances of excessive fascial opening, ensuring a tension-free and meticulous closure is imperative.

20.
Cureus ; 15(9): e44831, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37809215

RESUMO

Medicinal leech therapy (MLT) is used in various medical disciplines, among which are reconstructive surgery and microsurgery. Medicinal leech therapy is also often adopted by alternative and traditional medicine, aiming to treat various common medical symptoms, such as fever and arthritis. Congenital umbilical hernia is a rather common physical finding in the pediatric population, where every third Caucasian newborn, roughly, is being diagnosed with the condition, and even more so among the African population. Fortunately, most cases resolve spontaneously in the first years of life. Toddlers whose hernia does not close typically require umbilical hernia repair. This article describes the case of a five-year-old girl with an asymptomatic congenital umbilical hernia who was admitted to the ER due to an omental eventration that occurred following the placement of a leech on her umbilicus in her parents' attempt to treat a febrile episode. She subsequently underwent an urgent umbilical exploration and a repair of her umbilical hernia. The main known risks of leeching are bacterial infection, anemia, prolonged bleeding, and, less frequently, pruritus, allergies, marked edema, and cellulitis. This article presents yet another possible complication that, to the best of our knowledge, has not been documented before in the literature. Several old-school therapies transcended over time into medical disciplines. Given that "traditional" practices often take place within households and communities, it is of crucial importance to point out potential complications, both rare and common, that can be caused by those practices in order to reduce the risk of severe, undesired outcomes. Indeed, the growing interface between traditional, alternative therapies and modern, conventional medicine urges better parental guidance and improved education regarding potentially harmful and unauthorized interventions.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...