Acute obstructive hydrocephalus: an unusual complication after cardiopulmonary bypass

A case of acute obstructive hydrocephalus in a patient undergoing an aortic valve replacement is presented. This condition came about as a result of massive left cerebellar hemisphere infarction, probably due to a calcific embolism from the aortic valve. The cerebrospinal fluid circulation was blocked by compression of the fourth ventricle and the Sylvius aqueduct secondary to ischemic edema. Following external ventricular drainage, the hydrocephalus resolved but a neurological deficit secondary to the cerebellar and brain stem infarction became evident. The diagnostic, prognostic and therapeutic implications of this unusual complication following cardiac surgery are discussed.     

Acute appendicitis as a rare complication after colonoscopy

Complications due to colonoscopy are uncommon, and acute appendicitis is a very rare complication of colonoscopy. We present the case of an 83-year-old man who underwent colonoscopy and subsequently developed acute appendicitis. In patients with abdominal pain who have had a recent colonoscopy, a high index of suspicion is necessary for the accurate diagnosis of appendicitis. Colonoscopists should be aware of this rare complication and consider it when making a differential diagnosis of post-colonoscopy abdominal pain.     

Acute urinary retention in the elderly: an unusual presentation of appendicitis with a high perforation risk

BACKGROUND: Urological manifestations are rare in acute appendicitis. Although acute urinary retention (AUR) is more commonly found in elderly patients, any previous cases reported have been under the age of 30. OBJECTIVE: The aim of this study was to investigate the incidence, clinical presentation, and results of adult appendicitis patients presenting with AUR. AUR is defined as the sudden inability to urinate with obstructive symptoms. METHODS: A retrospective case note review of 480 adult patients (>/=18 years) with appendicitis, diagnosed at the Veterans General Hospital-Taipei over a 3-year period, was carried out. RESULTS: Six patients (1.3% of the adults or 3.9% of the elderly patients), 5 men and 1 woman averaging 71.5 years of age, presented with AUR. Associated existing diseases were benign prostatic hyperplasia in 2 of the males and surgical repair for uterine prolapse in the only female. The mean duration from initial gastrointestinal symptoms to AUR was 1.7 days. The quantity of residual urine ranged from 180 to 450 ml. All patients had persistent right lower quadrant tenderness and hematuria. Five (83.3%) were found to have a perforated appendix at operation, and their average hospital stay was 14.7 (8-29) days. CONCLUSIONS: AUR may occur as an initial presentation in acute complicated appendicitis in the elderly. It has been reported that the prolonged hospital stay might be related to the delayed diagnosis and resulting complications arising in these patients. Primary care physicians need to be reminded that this common genitourinary complaint may arise in patients with acute appendicitis. When confronted with a geriatric patient presenting with AUR, one should entertain an alternative diagnosis and a reexamination of the patient is mandatory.     

Splenic trauma: an unusual complication of colonoscopy with polypectomy

Nowadays, colonoscopy has become an invaluable tool in the diagnosis and treatment of diseases of the colon and rectum. Colonoscopy is still an invasive exam with several complications. The most common complications are perforation and bleeding, which occur in up to 1% after diagnostic colonoscopy and 3% of patients undergoing therapeutic colonoscopy. Less common complications include pneumothorax, pneumomediastinum, colonic volvulus, hernia incarceration, retroperitoneal abscess and mesenteric tear. Splenic rupture is a rare and potentially lethal colonoscopic complication with less than 45 cases reported in the world. The overall incidence is 0.004%. Mechanisms of injury and available treatment options remain discussed. We present a case of splenic rupture after colonoscopy with polypectomy in a 73-year-old woman managed first with nonoperative treatment and nine days later with surgical treatment. As the indications for colonoscopy expand, including the introduction of mass screening for colorectal cancer, endoscopists should be increasingly aware of that life-threatening complication after colonoscopy and know the emergency treatment.     

Ruptured spleen: an unusual complication of laparoscopy

Introduction

Splenic rupture is a well-known complication of open surgery but is much less common at laparoscopic surgery.

Case outline

A 45-year-old man underwent laparoscopy for perforated duodenal ulcer. The abdominal cavity was washed out and the ulcer was sutured. He was discharged on the fifth postoperative day but was readmitted because of a sharp pain in the left upper quadrant radiating to the left shoulder. He then developed haemorrhagic shock. Urgent laparotomy revealed a diffuse haemoperitoneum consequent upon a posterior subcapsular haematoma of the spleen.

Discussion

There are four previous case reports of splenic rupture at laparoscopy. In the present case, a posterior subcapsular haematoma arose during lavage of the left subdiaphragmatic area. Such a haematoma is undetectable during laparoscopy.     

Unilateral sacroiliitis as an unusual complication of acupuncture

Septic sacroiliitis in an uncommon disease and is rarely reported as a complication of acupuncture. We present a case of unilateral septic sarcoiliitis, which developed as a complication of acupuncture because of failure to sterilise the skin properly before treatment. Bone scan and computed tomography were positive for sacroiliitis. After a course of antibiotics with oxacillin for 6 weeks, the condition was completely improved. This case report stresses the importance of sterilisation procedures before acupuncture therapy.     

A case of transient left ventricular apical ballooning with an unusual complication

A retrospective study of patients with acute myocardial ischemia syndrome, mainly middle-aged and elderly women, was published in july 2001. The main features of acute myocardial ischemia were typical triggering circumstances, initial ECG mimicking acute myocardial infarction (AMI with transient appearance of Q waves and large negative T waves), mild or no enzymatic changes, and a combination of a normal coronary angiogram and transient left ventricular apical dyskinesia that normalized within days. The clinical course and prognosis were completely different from those of conventional AMI, with an increased number of acute-phase complications such as acute pulmonary edema, cardiogenic shock, and ventricular tachycardia. Despite this, the long-term outcome was better than that of AMI. We report a typical case diagnosed in a Spanish woman who developed embolic stroke, a complication not previously described, most likely related with her apical dyskinesia.