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1.
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
2.
Cir Cir ; 87(S1): 58-61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501630

RESUMO

Introduction: Gallbladder volvulus is a rare and difficult to diagnose pediatric entity, its delayed treatment leads to complications. A 9 months old male case solved by laparoscopy is reported. Case report: Twelve hours of development with irritability, vomiting and fever. Painful abdomen, leukocytosis and ultrasound with perivesicular fluid. Computed tomography revealed cystic bending, increased density and reinforcement of contrast medium. Gallbladder was found volvulated and necrotized by laparoscopy. Discussion: It is a very rare disease. A 9 months old baby was reported in whom a minimally invasive approach allowed diagnosis and safe treatment.


Assuntos
Doenças da Vesícula Biliar/cirurgia , Volvo Intestinal/cirurgia , Laparoscopia/métodos , Abdome Agudo/etiologia , Doença Aguda , Colecistite/etiologia , Emergências , Vesícula Biliar/patologia , Gangrena/etiologia , Humanos , Lactente , Masculino
3.
Am J Case Rep ; 20: 1170-1174, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31395848

RESUMO

BACKGROUND Calciphylaxis is a rare and fatal systemic disease which most commonly occurs in patients with end-stage renal disease. It is a poorly understood vascular calcification with unclear pathology that leads to vascular compromise due to vascular occlusion with endoluminal calcification. CASE REPORT We report a case of a 61-year-old male with chronic kidney disease stage 5 who developed calciphylaxis. The patient was diagnosed with dry gangrene of the second and third digits of the right hand and second, third, and fourth phalanges of the left hand. Despite medical therapy and local wound care, the lesions progressively worsened with time. The patient was found to have secondary hyperparathyroidism (parathyroid hormone was 1028 pg/mL) and underwent subtotal parathyroidectomy. In our patient, the skin lesions due to calciphylaxis completely resolved over the course of 12 months. CONCLUSIONS Parathyroidectomy has been associated with clinical benefit in patients with calciphylaxis. Clinicians should consider parathyroidectomy in the setting of high parathyroid hormone and calciphylaxis. Although parathyroidectomy is an effective treatment option for calciphylaxis it is not a definitive treatment and calciphylaxis can occur, though rarely, even after parathyroidectomy. There is a need to do further studies in order to confirm the efficacy of parathyroidectomy.


Assuntos
Calciofilaxia/etiologia , Dedos/patologia , Gangrena/etiologia , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia , Insuficiência Renal Crônica/complicações , Calciofilaxia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
4.
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
5.
J Med Case Rep ; 13(1): 212, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31296267

RESUMO

INTRODUCTION: Plasmodium vivax was traditionally thought to be benign; however, nowadays it presents with a myriad of systemic complications like cerebral malaria, acute respiratory distress syndrome, acute kidney injury, acute pancreatitis, hepatic dysfunction, and disseminated intravascular coagulation, which were earlier attributed only to Plasmodium falciparum malaria. Here we report a case of a middle-aged man who presented with disseminated intravascular coagulation manifesting as symmetrical peripheral gangrene. What makes this case more interesting is that the malaria isolated was Plasmodium vivax instead of Plasmodium falciparum. Such findings were previously reported, but this is the first case where the patient was managed conservatively with antimalarial drugs without the need for amputation, which focuses on the very important role of early diagnosis and timely management. CASE PRESENTATION: A 44-year-old Indian man from north India presented with history of fever of 2 days' duration with severely painful cold extremities. No pulse could be recorded on examination. A diagnosis of symmetrical peripheral gangrene was made. During the etiological evaluation, Plasmodium vivax malaria was found leading to disseminated intravascular coagulation causing this complication. He was started on artesunate and lumefantrine combination therapy and he recovered completely without the requirement of amputation. CONCLUSION: This case highlights the non-benign nature of Plasmodium vivax and its emerging complications. Also it correlates symmetrical peripheral gangrene with Plasmodium vivax malaria. It also emphasizes the importance of timely diagnosis and intervention to reduce mortality and morbidity.


Assuntos
Coagulação Intravascular Disseminada/etiologia , Gangrena/etiologia , Malária Vivax/complicações , Adulto , Antimaláricos/administração & dosagem , , Mãos , Humanos , Malária Vivax/diagnóstico , Malária Vivax/tratamento farmacológico , Masculino , Plasmodium vivax/isolamento & purificação
6.
Indian Heart J ; 71(2): 166-169, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31280831

RESUMO

The primary aortic thrombosis (PAT) is an uncommon noncardiac cause of distal peripheral embolization to lower extremities. Also, this condition develops in the absence of extensive atherosclerosis of aorta or abnormal dilatation like aneurysm of the aorta. In most of the cases, there was either no or minimal atherosclerosis of the aorta. The disease can involve any part of the aorta, but in most of the cases, the thoracic aorta below the origin of the left subclavian artery followed by the infrarenal portion of the abdominal aorta was the most common site of involvement. In our case, there was extensive thrombosis starting from the lower part of the thoracic aorta extending across both the renal arteries up to the aortic bifurcation without any underlying aortic pathology or hypercoagulable disease. There are no guidelines for the management of the PAT, but our experience is based on few case series, case reports, and meta-analysis where there are variable success rate using conservative medical management, endovascular procedure, or surgical thrombectomy. Vitamin K antagonist was the drug of choice in all the cases as a part of conservative medical management or used to prevent recurrence after the endovascular or surgical procedure. We present a case of PAT where the use of dabigatran leads to complete resolution and prevented the recurrence of the disease during two-year follow-up, which is the first and unique case report of the literature.


Assuntos
Antitrombinas/uso terapêutico , Doenças da Aorta/tratamento farmacológico , Dabigatrana/uso terapêutico , Trombose/tratamento farmacológico , Amputação , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/cirurgia , Feminino , Pé/irrigação sanguínea , Pé/cirurgia , Gangrena/etiologia , Gangrena/cirurgia , Humanos , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/etiologia , Doenças Vasculares Periféricas/cirurgia , Trombose/complicações , Trombose/diagnóstico por imagem
7.
Medicina (Kaunas) ; 55(7)2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31319486

RESUMO

Symmetrical peripheral gangrene (SPG) is a rare entity characterized by ischemic changes of the distal extremities with maintained vascular integrity. We present the case of a 64-year-old man with bilateral necrotic toes and deranged liver function tests. This was thought to be related to severely depressed ejection fraction from non-ischemic etiology, presumably chronic alcohol ingestion. We hope that awareness of SPG and association with a low output state will aid in early detection and prevention.


Assuntos
Baixo Débito Cardíaco/complicações , Gangrena/etiologia , Insuficiência Cardíaca/complicações , Baixo Débito Cardíaco/etiologia , Ecocardiografia/métodos , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência/organização & administração , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade
8.
BMJ Case Rep ; 12(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302625

RESUMO

Toe necrosis has many aetiologies. The most common one is ischaemia. In fact, both direct and indirect toe necrosis, as well as related lower limb gangrene, could be secondary to mechanical trauma, infections, pharmacological sensitivity, cancer, blue toe syndrome and other granulomatous diseases. We report a case of toes necrosis caused by an uncommon aetiology.


Assuntos
Angiopatias Diabéticas/complicações , Doenças do Pé/etiologia , Gangrena/etiologia , Fumar Maconha/efeitos adversos , Amputação , Humanos , Masculino , Dedos do Pé/cirurgia , Adulto Jovem
9.
Diabetes Metab Syndr ; 13(2): 959-963, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336551

RESUMO

BACKGROUND AND AIM: Diabetic foot is a major comorbidity of diabetes, with 15-25% of diabetic patients developing diabetic foot ulcer during their lifetime. Other major diabetic foot complications include cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis. Dry gangrene involves tissue necrosis due to chronic ischemia whereby the tissue becomes numb, dry, wrinkled, and dead. Although diabetic foot complications have been extensively studied in literature, there is limited data on the management of dry gangrene. METHODS: We report a case series of 12 patients with diabetes-related dry gangrene in the toes, initially planned to be managed conservatively with autoamputation. RESULTS: One patient had an autoamputation, while eight patients underwent surgical amputations (six major amputations, two minor amputations) for better clinical outcomes. Two patients died, while no change was observed in one patient even after 12 months of follow-up. CONCLUSION: Managing diabetic dry toe gangrene by waiting for autoamputation may lead to worse clinical outcomes and should be practiced cautiously on a case-by-case basis. Early surgical intervention should be opted to improve patients' quality of life.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/complicações , Gangrena/cirurgia , Osteomielite/fisiopatologia , Qualidade de Vida , Dedos do Pé/cirurgia , Idoso , Feminino , Seguimentos , Gangrena/epidemiologia , Gangrena/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Cicatrização
11.
J Med Case Rep ; 13(1): 181, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31196215

RESUMO

INTRODUCTION: Giant ovarian cysts are rarely described in the literature, owing to the availability of advanced imaging technologies in developed countries leading to early treatment. In resource-limited settings, various factors lead to late presentation. CASE PRESENTATION: We present a case of a 48-year-old black African woman with a giant mucinous cystadenoma who presented to a tertiary hospital with massive abdominal distention 5 years after being referred from a district hospital for the same problem. Surgical management resulted in fatal complications. CONCLUSIONS: The surgical management of these huge tumors is associated with many life-threatening complications. Transvaginal ultrasound should be used in resource-limited settings to delineate ovarian masses. Community health workers must be involved in scouting and follow up of community members with unusual abdominal swellings in developing countries to avoid delays in care.


Assuntos
Parede Abdominal/patologia , Cistadenoma Mucinoso , Gangrena , Neoplasias Ovarianas , Ovariectomia , Complicações Pós-Operatórias , Cistadenoma Mucinoso/patologia , Cistadenoma Mucinoso/fisiopatologia , Cistadenoma Mucinoso/cirurgia , Diagnóstico Tardio , Países em Desenvolvimento , Evolução Fatal , Feminino , Gangrena/etiologia , Gangrena/terapia , Humanos , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/fisiopatologia , Neoplasias Ovarianas/cirurgia , Ovariectomia/efeitos adversos , Ovariectomia/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Carga Tumoral , Zimbábue
12.
BMJ Case Rep ; 12(5)2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31151967

RESUMO

Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction rapidly progressing to bowel gangrene. It is characterised by the wrapping of loops of ileum and sigmoid colon around each other. The condition often remains undiagnosed preoperatively; however, it can be suspected by the triad of small bowel obstruction, radiographic features suggestive of predominately large bowel obstruction and inability to deflate the intestine by a sigmoidoscope. We are reporting a case of 56-year-old man who presented with features of acute intestinal obstruction and compensated shock within 24 hours of onset of symptoms. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. In view of haemodynamic instability, end ileostomy was done after excising gangrenous segments. The patient improved and stoma closure and ileocolic anastomosis were done after 3 months in follow-up.


Assuntos
Gangrena/etiologia , Doenças do Íleo/complicações , Obstrução Intestinal/etiologia , Volvo Intestinal/complicações , Doenças do Colo Sigmoide/complicações , Doença Aguda , Gangrena/cirurgia , Humanos , Doenças do Íleo/cirurgia , Obstrução Intestinal/cirurgia , Volvo Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Raras , Choque/etiologia , Doenças do Colo Sigmoide/cirurgia , Resultado do Tratamento
13.
BMJ Case Rep ; 12(5)2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31088812

RESUMO

A 77-year-old man, who was taking prednisolone 7.5 mg, underwent wedge resection for nodules in the right lower lobe of the lung. The nodules were diagnosed as amyloid tumour. On the sixth postoperative day, sudden tachycardia, fever, creatine phosphokinase increase, renal dysfunction and metabolic acidosis were observed. CT showed no signs of infection, exacerbation of interstitial pneumonia, pulmonary embolism or occlusion in the major vessels of the mesentery. Exploratory laparotomy revealed intestinal necrosis in the inferior mesenteric artery area, and left hemicolectomy was performed. Postoperative pathological examination revealed gangrenous ischaemic colitis. Although gangrenous ischaemic colitis is not a complication specific to general thoracic surgery, it can be fatal. Because of the high risk of developing gangrenous ischaemic colitis in elderly patients and the increase in concomitant diseases, thoracic surgeons should always be mindful of the condition.


Assuntos
Colite Isquêmica/cirurgia , Gangrena/patologia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Prednisolona/administração & dosagem , Idoso , Colite Isquêmica/diagnóstico por imagem , Colite Isquêmica/etiologia , Colite Isquêmica/patologia , Gangrena/etiologia , Gangrena/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Prednisolona/efeitos adversos , Tomografia Computadorizada por Raios X
14.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31138600

RESUMO

Cryofibrinogenaemia is a rare haematological disorder characterised by cold temperature-induced precipitation of plasma proteins causing small-vessel occlusive vascular disorder with a hallmark of skin ulceration. It remains an underdiagnosed entity because of a lack of diagnostic criteria. Cryoglobulinaemia vasculitis is a small-vessel vasculitis involving the skin, the joints, the peripheral nerve system and the kidneys. Its association with cryofibrinogenaemia causes more severe phenotype with poor prognosis. We describe the case of a 59-year-old woman presenting with cold-induced extensive bilateral foot gangrene due to coexisting cryofibrinogenaemia and cryoglobulinaemic vasculitis that required bilateral amputation and rituximab perfusions as maintenance therapy.


Assuntos
Crioglobulinemia/diagnóstico , Pé/irrigação sanguínea , Gangrena/etiologia , Amputação/métodos , Antirreumáticos/uso terapêutico , Crioglobulinemia/complicações , Crioglobulinemia/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Pé/patologia , Gangrena/patologia , Gangrena/cirurgia , Humanos , Pessoa de Meia-Idade , Doenças Raras , Rituximab/administração & dosagem , Rituximab/uso terapêutico , Resultado do Tratamento , Vasculite/complicações
16.
BMJ Case Rep ; 12(4)2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30948409

RESUMO

Varicella gangrenosum is a gangrenous ulceration of varicella lesions involving the skin and soft tissues of the body. The term was coined more than 100 years ago. This occurs due to superimposed bacterial infection. The presentation of primary varicella in adults is more severe with catastrophic systemic complications as compared with children. These complications include necrotising fasciitis, disseminated intravascular coagulation, wet/dry gangrene and death, as was seen in our case. Survival is dependent on early diagnosis and treatment. Adequate antibiotic treatment and particularly early radical surgical debridement should be the cornerstone of management. Less than 10 such cases are reported in the literature.


Assuntos
Varicela/complicações , Fasciite Necrosante/etiologia , Gangrena/etiologia , Infecções Estafilocócicas/complicações , Fasciite Necrosante/diagnóstico , Evolução Fatal , Gangrena/diagnóstico , Doenças dos Genitais Masculinos/etiologia , Herpesvirus Humano 3/isolamento & purificação , Humanos , Extremidade Inferior/patologia , Masculino , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Adulto Jovem
18.
BMJ Case Rep ; 12(2)2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30796076

RESUMO

Juvenile gangrenous vasculitis of the scrotum is a rare entity, of which to our knowledge we describe the first documented case in the UK. It follows a typical disease course, demonstrated by an 18-year-old male who presented with three necrotic scrotal lesions; proceeded by 3 days of fever, pharyngitis and lethargy. Previous cases have been managed successfully with systemic steroids. On this occasion, surgical debridement was made of the necrotic areas under antibiotic cover and complete resolution was achieved with excellent wound healing and no evidence of recurrence. This case report discusses the importance of disease recognition and the merits of surgical management. We also add to the debate as to whether this disease is a variation of pyoderma gangrenosum or a distinct entity itself within the pantheon of scrotal gangrene.


Assuntos
Antibacterianos/uso terapêutico , Gangrena/etiologia , Doenças dos Genitais Masculinos/patologia , Necrose/etiologia , Escroto/irrigação sanguínea , Vasculite/complicações , Adolescente , Desbridamento/métodos , Gangrena/patologia , Gangrena/terapia , Doenças dos Genitais Masculinos/terapia , Humanos , Masculino , Necrose/patologia , Necrose/terapia , Escroto/patologia , Resultado do Tratamento , Vasculite/tratamento farmacológico , Vasculite/patologia
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