Esophageal perforation caused by a blister-wrapped tablet

An 84-year-old man was diagnosed with esophageal perforation following ingestion of a blister-wrapped tablet. His condition improved after 2 weeks of conservative treatment using antibiotics and high-protein enteral nutrition.     

Pelvic inflammatory disease and tubo-ovarian abscess

Pelvic inflammatory disease (PID) is common infection among reproductive-aged women. The presentation ranges from acute severe illness to a more indolent and mild clinical picture. Attention has turned to subclinical PID as an important entity. The majority of the public health impact from PID comes from its attributable long-term sequelae, including tubal-factor infertility, ectopic pregnancy, and chronic pelvic pain. Tubo-ovarian abscess (TOA) represents a severe form of PID. Vigilance is required when caring for women who have PID to detect the presence of a TOA given the serious nature of the infection and the potential need for procedural intervention.     

Pelvic aspergillosis with tubo-ovarian abscess in a renal transplant recipient.

Common clinical manifestations of aspergillosis in renal transplant recipients are fever and pulmonary infiltrates, but involvement of the reproductive system is rare. We report a case of pelvic aspergillosis with tubo-ovarian abscess in a renal transplant patient. The patient received a cadaveric renal transplantation, and two episodes of acute rejection were treated with methylprednisolone pulse therapy. Surgical biopsy specimens of pelvic abscess detected by ultrasonogram and CT revealed Aspergillus. With amphotericin B treatment, the patient is well with normalization of erythrocyte sedimentation rate and C-reactive protein.     

Clinitest tablet ingestion: an in vitro investigation concerned with initial emergency management

To help establish a rational approach to the initial management of Clinitest tablet ingestion, we investigated the effect of number of tablets, volume of diluent, and type of diluent on dissolution time (TD), temperature generation (delta T), and pH. Dissolution time was independent of the number of tablets and the volume of fluid; however, it was dependent on the type of fluid used. The thermal generation (delta T) was dependent on the number of tablets and volume of fluid, but was independent of the type of fluid used. The pH changes were independent of the number of tablets and volume of fluid; however, they were greatly dependent on the type of fluid. These data suggest that dissolution is rapid (in seconds) and, therefore, the most effective intervention may occur shortly after ingestion of the tablets; the larger the volume of diluting fluid, the smaller the risk of thermal damage from these ingestions; and orange juice should be considered as a possible diluent because it is capable of reducing the pH of the Clinitest tablet without increasing thermal generation.     

Liver abscess after hemorrhoidectomy

PURPOSE: Pyogenic liver abscess after hemorrhoidectomy is extremely rare. Only two such cases have been previously reported; the diagnosis in each was made intraoperatively. We report two additional cases of hepatic abscess after hemorrhoidectomy, both treated nonoperatively with a successful outcome. METHODS: The two cases were analyzed for history, presentation, laboratory data, radiologic studies, and bacteriology. RESULTS: In both cases, the patients presented within one week of the hemorrhoidectomy. Treatment with broadspectrum intravenous antibiotics was successful in achieving significant clinical improvement. The liver function test values reverted back to normal and followup computed tomography (CT) scans of the liver revealed marked improvement of the abscesses. Laparotomy was avoided in both of the patients. CONCLUSIONS: Increased awareness of this serious complication will afford earlier diagnosis. In addition, proper aerobic and anaerobic bacterial isolation techniques will allow appropriate nonoperative therapy, decreasing the high morbidity and mortality rates associated with this complication.     

Pelvic sepsis after stapled hemorrhoidopexy

Stapled hemorrhoidopexy is a surgical procedure used worldwide for the treatment of grade Ⅲ and N hemorrhoids in all age groups. However, lifethreatening complications occur occasionally. The following case report describes the development of pelvic sepsis after stapled hemorrhoidopexy. A literature review of techniques used to manage major septic complications after stapled hemorrhoidopexy was performed. There is no standardized treatment currently available. Stapled hemorrhoidopexy is a safe, effective and time-efficient procedure in the hands of experienced colorectal surgeons.     

Ursodeoxycholic acid ingestion after ileal resection

The effect of ursodeoxycholic acid ingestion on biliary bile acids and biliary lipids was studied in six patients after ileal resection. All patients had bile acid malabsorption, as documented by increased breath and fecal excretion of¹⁴C after oral administration of [1-¹⁴C] cholylglycine. Fasting duodenal bile was collected by intubation before and seven days after ursodeoxycholic acid administration (4 g/day), and biliary bile acid and lipid composition were determined. Ursodeoxycholic acid ingestion increased the percentage of ursodeoxycholic acid in bile tenfold (3.6±2.6% vs 38.6±12.0%) and decreased chenodeoxycholic acid in bile by approximately 40%. Before ursodeoxycholic acid ingestion, bile was supersaturated in all patients. After ursodeoxycholic acid ingestion, cholesterol saturation decreased in all six patients by an average of 43%, and bile became unsaturated in five. Ursodeoxycholic acid ingestion had no effect on stool frequency. We conclude that, as in subjects with an intact enterohepatic circulation, ursodeoxycholic acid therapy has litholytic potential in patients after ileal resection.This work was supported by NIH Grants AM 15887 and RR 585 and by the Mayo Foundation. Part of this work was reported at the 1979 meeting of the American Gastroenterological Association and published in abstract form.At the time this work was done, Dr. LaRusso was a Teaching and Research Scholar of the American College of Physicians.     

Myocardial injury after phenylpropanolamine ingestion.

Three patients developed clinical evidence of myocardial injury after acute ingestion of phenylpropanolamine, a sympathomimetic amine found in a large number of decongestant and appetite suppressant formulations. Increases in the serum creatine kinase and MB isoenzyme levels, ventricular arrhythmias, and electrocardiographic repolarisation abnormalities were seen. Excessive catecholamine stimulation has been shown to produce acute myocardial necrosis experimentally, and a similar mechanism may be present in these patients.