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1.
Pan Afr Med J ; 38: 8, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33520077

RESUMO

The ileosigmoid knot (ISK) or double ileosigmoid volvulus is a wrapping of the small intestine around the base of the sigmoid colon. We report an unusual case in the digestive surgery department of the Ibn Tofail Hospital of CHU Mohammed VI Marrakech of a 28-year-old man with Down's syndrome who presented with symptoms and signs of intestinal obstruction. Abdominal CT scan revealed a whirl sing and significant distension of the sigmoid loop. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. The surgical procedure was a necrotic digestive segments resection, with a double-barrelled ileostomy and a Hartmann procedure. One month afterwards, the patient was operated on to reestablish of the continuity. Through this observation and a review of the literature we define the diagnostic, therapeutic and prognosis aspects of this rare clinical entity.


Assuntos
Síndrome de Down , Obstrução Intestinal/cirurgia , Volvo Intestinal/cirurgia , Adulto , Gangrena/diagnóstico , Gangrena/cirurgia , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Ileostomia , Obstrução Intestinal/diagnóstico por imagem , Volvo Intestinal/diagnóstico por imagem , Laparotomia , Masculino , Doenças do Colo Sigmoide/diagnóstico por imagem , Doenças do Colo Sigmoide/cirurgia , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 14(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419746

RESUMO

A 24+5-week preterm neonate with a severe scalp lesion was admitted to the neonatal intensive care unit (NICU) after caesarean section due to maternal chorioamnionitis (MC). An Arabin pessary had been inserted in addition to a previous cervical cerclage due to cervix insufficiency at 21+5 weeks of pregnancy (wp). At 23+5 wp, preterm rupture of membranes was evidenced. Both devices were kept to provide fetal viability. On 24+4 wp, she developed MC. Urgent caesarean section was performed. Transvaginal manual manipulation was required during the procedure. On NICU, she presented severe shock which required high-dose vasopressors and blood products. Following surgical repair, a bilateral grade IV intracranial haemorrhage was evidenced. Subsequently, it was agreed to withdraw life support. We hypothesise that MC and local infection could have acted as predisposing factors, with the presence of a pessary in the setting causing uterine contractions and its manipulation acting as a precipitating factor.


Assuntos
Gangrena/etiologia , Doenças do Prematuro/etiologia , Isquemia/etiologia , Couro Cabeludo/irrigação sanguínea , Evolução Fatal , Feminino , Gangrena/patologia , Gangrena/cirurgia , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/patologia , Doenças do Prematuro/cirurgia , Isquemia/patologia , Isquemia/cirurgia
3.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500313

RESUMO

Novel COVID-19 continues to intrigue medical professionals with its varied presentations. Though it affects the respiratory tract primarily, thrombogenesis has been the Achilles' heel. A 44-year-old man diagnosed with COVID-19 presented with upper limb pain at a local hospital and was found to have thrombosis of the right axillary artery. Despite a successful embolectomy at the local hospital, there was re-occlusion of the axillary artery and the limb became ischaemic. He was referred to our institution by which time the limb became gangrenous above the elbow and had to be amputated. Extensive sloughing of the nerves was also seen in the local area. Hypercoagulability presenting with various manifestations is common in COVID-19 and needs early anticoagulation. We present this asymptomatic patient who lost a limb to this COVID-19 sequelae.


Assuntos
Amputação , Braço/cirurgia , Artéria Axilar , Gangrena/cirurgia , Isquemia/cirurgia , Trombose/complicações , Adulto , Braço/irrigação sanguínea , Braço/patologia , Artéria Axilar/cirurgia , Embolectomia , Gangrena/etiologia , Gangrena/patologia , Humanos , Isquemia/etiologia , Isquemia/patologia , Masculino , Recidiva , Trombose/cirurgia
4.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372017

RESUMO

Perineal hernia with bowel gangrene is uncommon but known complication of laparoscopic extralevator abdominoperineal excision (ELAPE). We present a rare case of closed loop small bowel obstruction with bowel gangrene secondary to an incarcerated perineal hernia that developed 7 years after an ELAPE. Intraoperatively, we found a definitive transition point due to adhesions in pelvis and a closed loop obstruction of the distal small bowel at different site with gangrenous intestine. She was managed successfully surgically with adhesiolysis and fixation of defect with biological mesh. Prevalence of perineal hernias will rise in future because of the increasing cases of ELAPE, in which no repair of pelvic floor is performed. The need of follow-up of these operations and more reporting of such cases are important in increasing awareness of these complications. Patients should be made aware of such complications and should seek urgent medical care.


Assuntos
Hérnia/complicações , Obstrução Intestinal/etiologia , Laparoscopia/efeitos adversos , Períneo , Protectomia/efeitos adversos , Aderências Teciduais/etiologia , Idoso de 80 Anos ou mais , Colostomia , Feminino , Gangrena/complicações , Gangrena/cirurgia , Humanos , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Complicações Pós-Operatórias , Neoplasias Retais/cirurgia , Telas Cirúrgicas , Fatores de Tempo , Aderências Teciduais/patologia , Aderências Teciduais/cirurgia
5.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370941

RESUMO

A 9-year-old girl was admitted to the paediatric intensive care unit with acute respiratory failure due to influenza. Nine months earlier, she presented with unexplained lymphoedema of the lower extremities and monocytopenia. She had a history of occasional finger warts and onychomycoses. During hospitalisation, the patient was diagnosed with Emberger syndrome caused by GATA2 deficiency. The admission was complicated by thromboses in the right hand, leading to amputation of multiple fingers. From then on, the patient has been in good recovery, the function of her right hand was improving and an allogeneic haematopoietic cell transplantation has now been successfully performed.


Assuntos
Dedos/patologia , Deficiência de GATA2/complicações , Fator de Transcrição GATA2/deficiência , Vírus da Influenza A/imunologia , /imunologia , Amputação , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Criança , Códon sem Sentido , Análise Mutacional de DNA , Quimioterapia Combinada , Feminino , Dedos/cirurgia , Deficiência de GATA2/diagnóstico , Deficiência de GATA2/genética , Deficiência de GATA2/imunologia , Fator de Transcrição GATA2/genética , Gangrena/imunologia , Gangrena/cirurgia , Glucocorticoides/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Humanos , Vírus da Influenza A/isolamento & purificação , Influenza Humana/complicações , Influenza Humana/imunologia , Influenza Humana/terapia , Influenza Humana/virologia , Pulmão/diagnóstico por imagem , Pulmão/imunologia , Respiração Artificial , /terapia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
6.
Am J Case Rep ; 21: e926886, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32999267

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in Wuhan, China, in late 2019 and has led to an ongoing pandemic. COVID-19 typically affects the respiratory tract and mucous membranes, leading to pathological involvement of various organ systems. Although patients usually present with fever, cough, and fatigue, less common manifestations have been reported including symptoms arising from thrombosis and thromboembolism. A spectrum of dermatologic changes is becoming recognized in patients with COVID-19 who initially present with respiratory symptoms. The mechanism behind these manifestations remains unclear. This report presents the case of a 47-year-old Hispanic man who developed cutaneous vasculitic lesions and gangrene of the toes following admission to hospital with COVID-19 pneumonia. CASE REPORT COVID-19 has been associated with cardiovascular disease entities including stroke, acute coronary syndrome, venous thromboembolism, and peripheral vascular disease. We present a case in which a 47-year-old Hispanic man arrived at the Emergency Department with COVID-19 and was admitted for respiratory failure. Despite anticoagulation initiated on admission in the presence of an elevated D-dimer, the patient developed gangrene of all his toes, which required bilateral transmetatarsal amputation. CONCLUSIONS This case shows that dermatologic manifestations may develop in patients who initially present with COVID-19 pneumonia. These symptoms may be due to venous thrombosis following SARS-CoV-2 vasculitis, leading to challenging decisions regarding anticoagulation therapy. Randomized controlled trials are needed to evaluate the efficacy of anticoagulation, to choose appropriate anticoagulants and dosing, and to assess bleeding risk.


Assuntos
Infecções por Coronavirus/complicações , Gangrena/etiologia , Gangrena/cirurgia , Pneumonia Viral/complicações , Síndrome Respiratória Aguda Grave/complicações , Dedos do Pé/cirurgia , Vasculite/etiologia , Amputação/métodos , Infecções por Coronavirus/diagnóstico , Serviço Hospitalar de Emergência , Seguimentos , Gangrena/fisiopatologia , Hispano-Americanos , Humanos , Masculino , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Multimorbidade , Pandemias , Admissão do Paciente , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etnologia , Insuficiência Respiratória/etiologia , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Dedos do Pé/irrigação sanguínea , Dedos do Pé/fisiopatologia , Resultado do Tratamento , Vasculite/fisiopatologia
11.
West Afr J Med ; 37(2): 189-196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150639

RESUMO

Extremity gangrene is a fairly common pathology, which complicates systemic vascular and endocrine diseases. Most often, it is encountered in diseases like uncontrolled Diabetes Mellitus, presenting as diabetic foot gangrene, severe peripheral arteriosclerosis with gangrene of the extremity complicating severe uncontrolled systemic hypertension and meningococcal septicaemia with peripheral gangrene. It also occurs in some cases of snake bite as well as frost bite (in regions with extreme cold weather conditions). Some of them present as monolateral extremity gangrene. However, others present as bilateral symmetrical peripheral gangrene (SPG) characterized by bilateral extremity ischaemia resulting in gangrene in which there is no major vascular occlusive disease. There is disseminated intravascular coagulation with the gangrene being considered as a cutaneous marker and some of the patients that survive ultimately require amputation of the affected limb(s) in the severe cases. The mild cases end up losing some of the digits or just exfoliation of the dead cutaneous layer. The effects are generally more severe in the lower limbs than in upper limbs. Notable among these are some of those complicating meningococcal sepsis resulting from peripheral intravascular coagulation. We present here, five patients who presented with varying degrees of peripheral gangrene during an epidemic of meningitis and the treatments that were carried out depending on the severity of their cases.


Assuntos
Amputação , Coagulação Intravascular Disseminada/cirurgia , Gangrena/etiologia , Meningite Meningocócica/complicações , Infecções Meningocócicas/cirurgia , Sepse/microbiologia , Coagulação Intravascular Disseminada/complicações , Coagulação Intravascular Disseminada/diagnóstico , , Gangrena/cirurgia , Humanos , Perna (Membro) , Infecções Meningocócicas/complicações , Sepse/complicações
14.
J Surg Res ; 250: 232-238, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31870563

RESUMO

BACKGROUND: Surgical outcomes may differ between low-volume and experienced hospitals. We sought to identify characteristics of remote patients-those living more than 50 miles from an experienced center-who underwent leg amputations for peripheral artery disease (PAD) and foot complications at low-volume and experienced hospitals and identify regions of Texas where such patients live. MATERIALS AND METHODS: Publicly available Texas hospitalization data from 2004 through 2009 were used to identify patients with PAD who underwent leg amputation for foot complications, including foot ulcers, foot infections, and gangrene. Geocoding was used to further identify a subset of remote patients and to estimate distances from zip code of residence to hospital in which care was received. RESULTS: Among all leg amputations, 850 (18.6%) were performed on patients classified as remote, and 3723 (81.4%) were performed on patients classified as nonremote. Compared with nonremote patients, remote patients were more often categorized as white and more frequently received Medicare and/or Medicaid. Of the subset of remote patients, those at low-volume hospitals were older, were less often categorized as Hispanic, more often had Medicaid coverage, were also more frequently admitted through the emergency department, and often had a foot infection compared with those at experienced centers. Geospatial analysis identified five concentrated geographic areas of remote patients who live more than 50 miles from an experienced center. CONCLUSIONS: These findings suggest travel distance may at least influence, if not constrain, the choice of hospital for patients with PAD and foot complications. Efforts to decrease leg amputations among remote patients should be focused on five specific geographic areas of Texas.


Assuntos
Amputação/estatística & dados numéricos , Úlcera do Pé/cirurgia , Gangrena/cirurgia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Doença Arterial Periférica/cirurgia , Adolescente , Adulto , Idoso , Feminino , Úlcera do Pé/complicações , Geografia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/estatística & dados numéricos , Análise Espacial , Texas , Transportes/estatística & dados numéricos , Enxerto Vascular/estatística & dados numéricos , Adulto Jovem
15.
J Foot Ankle Surg ; 59(1): 27-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882144

RESUMO

Ray resection is frequently performed in cases of infection or ischemia, but the literature is scarce concerning its outcome as a definitive treatment. In this retrospective cohort study, we reviewed our cohort with transmetatarsal ray resection with a mean follow-up of 36.3 months. Reulcerations, transfer ulcers, and reamputations were determined. Risk factor analysis for revision surgery was conducted. Among 185 patients, 71 (38.4%) had revision surgery within a mean of 1.4 ± 2.6 years (range 2 days to 12.9 years), 22 (11.9%) had major amputations, 49 (26.5%) had minor amputations, 11 (5.9%) had same-ray reulceration, 40 (21.6%) had transfer ulceration, and 2 (1.1%) had both reulceration and transfer ulceration. Occurrence of a postoperative ulcer was statistically significantly associated with revision surgery (p < .01). In conclusion, metatarsal ray resection is a reasonable treatment option in cases of forefoot ischemia or infection to prevent major amputation but fails in 11.9%, and reulceration is associated with further revisions, making ulcer prevention paramount.


Assuntos
Amputação , Úlcera do Pé/cirurgia , Ossos do Metatarso/cirurgia , Osteomielite/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Úlcera do Pé/etiologia , Úlcera do Pé/patologia , Gangrena/etiologia , Gangrena/cirurgia , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Osteomielite/patologia , Reoperação , Resultado do Tratamento
17.
Foot (Edinb) ; 40: 109-115, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31675679

RESUMO

The use of single photon emission computer tomography (SPECT/CT) in acute vascular injury is not well documented. SPECT/CT combines the anatomic detail of computer tomography with the functional vascular perfusion of photon emission to determine the viability of osseous structures and surrounding soft tissue. The superimposed imaging provides the practitioner with a reliable anatomic image of viability of a specific anatomic area following insult or injury. We present two cases, bilateral lower extremity frostbite, and symmetric peripheral gangrene in which this imaging modality provided guidance for surgical intervention with adequate predictability and results.


Assuntos
Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/cirurgia , Congelamento das Extremidades/diagnóstico por imagem , Congelamento das Extremidades/cirurgia , Gangrena/diagnóstico por imagem , Gangrena/cirurgia , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Adulto , Idoso , Amputação , Humanos , Masculino , Imagem Multimodal
18.
J Foot Ankle Surg ; 58(6): 1171-1176, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31679669

RESUMO

Total transmetatarsal amputation (TMA) can be an option for foot salvage in gangrene, sepsis, or infected necrosis. However, the literature concerning predictive outcome factors and bacterial sampling is scarce. To identify potential associations between revision surgery and underlying bacteria or other preoperative selection criteria, we reviewed all patients with TMA who were treated at our institution. We compared the patients with remissions with surgical revisions. Among 96 adult patients with TMA (105 amputations), 42 required a revision surgery (40%), 18 had a further minor proximal surgical reamputation (17%) and 18 had a major proximal surgical reamputation (14%). In group comparisons, a previous infection with Staphylococcus aureus was protective with a lower revision risk (4/26 with revision surgery vs 22/26 without revisions; p = .03). This was the opposite for postoperative persistent soft tissue or bone infections (p < .01) and delayed wound healing (p < .01), which were positively associated with a revision risk. The American Society of Anesthesiologists Score, sex, age, body mass index, diabetes, polyneuropathy, chronic renal failure, dialysis, peripheral arterial disease, smoking status, and antibiotic regimen did not influence this revision risk. These results must be interpreted cautiously because no multiple variable calculations could be conducted as a result of the paucity of cases and confounding could not be evaluated sufficiently. TMA is an option to prevent major amputations, but it may be associated with a subsequent revision risk of 40% in adult patients. In our cohort study, persistent postamputation infection and delayed wound healing were associated with revision. However, no preoperative selection criteria were found that lead to revision surgery except for an infection with Staphylococcus aureus, which protected against revision surgery.


Assuntos
Amputação , Pé/cirurgia , Ossos do Metatarso/cirurgia , Reoperação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Pé Diabético/cirurgia , Feminino , Úlcera do Pé/cirurgia , Gangrena/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/cirurgia , Infecções dos Tecidos Moles/cirurgia , Cicatrização
19.
J Pak Med Assoc ; 69(8): 1216-1218, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431784

RESUMO

Peripartum cardiomyopathy (PPCM) is a condition of unknown etiology that presents as heart failure due to left ventricular systolic dysfunction in the last of month of pregnancy and up to six months after giving birth. PPCM predisposes towards thrombo-embolism and an acute limb ischaemia can be a manifestation of this disease. We present a case of a 23-year-old lady presenting an acute lower limb ischaemia four months post-partum. Doppler ultrasound showed bilateral femoral emboli and cardiac ECHO showed a 24% ejection fraction. Amputation was performed on both limbs, below her right knee and above her left knee. The patient was started on heart failure medication and her symptoms improved with diuretic therapy, confirming the diagnoses of PPCM. It is important to recognise acute limb ischaemia as a rare manifestation of PPCM, as a timely diagnosis and effective treatment of the disease can improve the prognosis. We believe this is the first case to be reported in medical literature from Pakistan of a patient presenting PPCM with bilateral acute limb ischaemia and gangrene.


Assuntos
Cardiomiopatias/complicações , Embolia/etiologia , Artéria Femoral/diagnóstico por imagem , Gangrena/etiologia , Isquemia/etiologia , Transtornos Puerperais/diagnóstico por imagem , Amputação , Cardiomiopatias/diagnóstico por imagem , Ecocardiografia , Embolectomia , Embolia/diagnóstico por imagem , Embolia/cirurgia , Feminino , Gangrena/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Extremidade Inferior , Volume Sistólico , Falha de Tratamento , Ultrassonografia Doppler , Adulto Jovem
20.
Cir Cir ; 87(4): 443-449, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264982

RESUMO

Background: Gangrenous cholecystitis (GC) must be promptly treated for its high morbimortality. The object of our study is to identify clinical, laboratory or ultrasound factors that might us diagnose GC. Method: A Retrospective cohort study is devised including all patients admitted to Hospital de Laredo (Cantabria, Spain) between 2015 and 2017 with the diagnose of acute cholecystitis and having been operated. Patients were classified in two groups according to pathology: GC and non-GC. We compared their demographics characteristics, comorbidities, laboratory parameters and ultrasound findings. Results: A total of 115 patients were operated, of whom 32 had CG and 83 CNG. Neutrophil-to-lymphocyte ratio and C-reactive protein (CRP) showed significantly increased levels in GC group (p = 0.042) and CRP (p < 0.0001). To CRP showed an area under the ROC curve of 0.872 (95% confidence interval: 0.797-0.946). Acalculous cholecystitis was significantly associated to GC (24.1 vs. 7%; p < 0.005). In the multivariate analysis only the CPR showed as a predictive factor. A cutting point of CRP at 15.25 mg/dl, that had high sensibility (90.6%) and high negative predictive value (95%). Conclusion: CRP helped identify patients with CG to indicate early surgical intervention.


Assuntos
Proteína C-Reativa/análise , Colecistite Aguda/diagnóstico , Vesícula Biliar/patologia , Colecistite Acalculosa/complicações , Idoso , Área Sob a Curva , Biomarcadores/análise , Colecistite Aguda/sangue , Colecistite Aguda/patologia , Colecistite Aguda/cirurgia , Intervalos de Confiança , Feminino , Gangrena/sangue , Gangrena/diagnóstico , Gangrena/cirurgia , Humanos , Contagem de Leucócitos , Masculino , Análise Multivariada , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia
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