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1.
David H. Ballard Nadine M. Kaskas Alireza Hamidian Jahromi Justin Skweres Asser M. Youssef 《International journal of surgery case reports》2014,5(12):1238-1241
INTRODUCTION
Traumatic abdominal wall hernia (TAWH) and traumatic abdominal aortic injury (TAAI) are two uncommon complications secondary to blunt trauma. In both TAWH and TAAI, reported cases are often associated with poly-trauma. TAWH may be initially missed if more pressing issues are identified during the patient''s primary survey. TAAI may be an incidental finding on imaging or, if severe, a cause of an acute abdomen and hemodynamic abnormality.PRESENTATION OF CASE
A 54-year-old white male suffered a TAWH and TAAI (pseudoaneurysm) due to severe blunt trauma. TAWH was apparent on physical exam and the TAAI was suspected on computed tomography (CT). The patient''s TAWH was managed with a series of abdominal explorations and the TAAI was repaired with endovascular stenting.DISCUSSION
TAWH and TAAI are commonly due to severe blunt trauma from motor vehicle collisions. Diagnosis is made through physical exam, imaging studies, or surgical exploration. A variety of surgical techniques achieve technical success.CONCLUSION
The patient with blunt trauma to the abdomen is at risk for TAWH and TAAI, which are often associated with other injuries. Investigations should include thorough clinical exam through secondary survey and radiologic imaging in the hemodynamically normal patient. 相似文献2.
Vamsi R. Velchuru Marek Zawadzki Amy L. Levin Christine M. Bouchard Slawomir Marecik Leela M. Prasad John J. Park 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2013,17(1):152-155
Background and Objective:
Endoscopic removal of large colonic submucosal lesions can lead to a higher risk of perforation. Although not as common following diagnostic and therapeutic colonoscopy, it does occur more often following therapeutic colonoscopy. We present a case of a large submucosal mass excised endoscopically, resulting in a large perforation that was closed using endoclips. While endoclips are typically used for smaller perforations, we have found that they can be used safely on a larger defect.Methods:
A 68-y-old woman presented with a 2.9-cm benign submucosal mass found in the hepatic flexure. It was removed via endoscopic polypectomy, leaving a perforation of 3cm x 3cm. The perforation was closed with endoscopic clips.Results:
Histology of the specimen showed clear margins. At 4-wk follow-up, the patient had no complications. A colonoscopy at 6-mo follow-up showed only a scar at the procedure site with no complaints.Conclusions:
Large iatrogenic colonic perforations can be managed successfully using endoclips, particularly in a prepped colon. 相似文献3.
4.
Claudio Sandoval Gustavo Stringel 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》1997,1(2):131-133
Background and Objectives:
Video-assisted thoracoscopy has been successfully used for several different thoracic procedures in adults. However, its use in children has been limited. The present study evaluated our experience with video-assisted thoracoscopy in the diagnosis of mediastinal masses in children.Methods:
Nine children (age range, 3 to 18 years) with undiagnosed mediastinal masses underwent video-assisted thoracoscopy. The operation was performed using general anesthesia, with the patient intubated with a single lumen endotracheal tube.Results:
In all cases adequate tissue for diagnosis was obtained. Three patients had tuberculosis, two had Hodgkin''s disease, two had granuloma, one had metastatic Wilms1 tumor, and one had thymic hyperplasia. There were no complications related to the operative procedure.Conclusions:
Video-assisted thoracoscopy for the diagnosis of mediastinal masses in children is a safe procedure. It provides good visualization, access to the mediastinum and adequate tissue for diagnosis. Further, postoperative discomfort is tolerable and cosmetic results are excellent. 相似文献5.
INTRODUCTION
Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires.METHODS
The NRLS database was interrogated for all incidents of surgical fires reported between 1 March 2004 and 1 March 2011. Each report was scrutinised manually to discover the cause of the fire.RESULTS
Thirteen surgical fires were reported during the study period. Of these, 11 were found to be directly related to spirit-based surgical skin preparation or preparation soaked swabs and drapes.CONCLUSIONS
Despite manufacturer''s instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring. 相似文献6.
Soo Jeong Han Chung Mi Kim Jeong Eun Lee Tae Hoon Lee 《The journal of spinal cord medicine》2009,32(4):404-407
Background/Objective:
In spinal cord injury (SCI), loss of central or peripheral neural control causes neurogenic bowel. Patients may not exhibit the typical signs and symptoms of gastrointestinal disease. Few studies have looked at the risk of gastrointestinal disease in this group and the indications for preventive screening. The objective of this study was to study colonoscopic lesions in patients with SCI and determine whether there are any differences in the prevalence of lesions between SCI and control patients.Design:
Case control study.Methods:
Twenty-five patients with SCI were compared with 41 control patients who received colonoscopy at the same time. Mann-Whitney test for continuous variable, and Fisher exact test for frequency variables were used.Outcome Measures:
Demographic information, duration of SCI, and colonoscopy findings were gathered.Results:
Colonic lesions were observed in 52% of patients with SCI and in 41.5% of control patients. Most frequent lesions in SCI group were inflammatory bowel disease (16%) and polyp (16%), followed by proctitis (12%) and hemorrhoid (12%). In the control group, hemorrhoid (17.1%) was most common, followed by polyp (12.2%) and melanosis coli (9.8%). No significant differences were found between the 2 groups. In the SCI group, no significant differences in lesions were found among the patients with cervical, thoracic, and lumbar SCI in the SCI group. Duration of SCI did not affect the pattern of colonoscopic lesions.Conclusion:
Patients with SCI had the same incidence of colonoscopic lesions as control patients. Inflammatory bowel disease, which is a risk factor for cancer, was the most common findings in the SCI group, although there was no significant difference from the control group. In patients with SCI, colonoscopy screening is warranted at the same frequency as for the general population. 相似文献7.
JRA Skipworth DA Raptis JS Rawal S Olde Damink A Shankar M Malago C Imber 《Annals of the Royal College of Surgeons of England》2009,91(4):W6-W11
INTRODUCTION
We present a case of splenic rupture in a 71-year-old woman admitted 6 days following a diagnostic colonoscopy. She underwent an open splenectomy and made a delayed, but complete, recovery.We proceeded to perform a retrospective review of all relevant literature to assess the frequency of similar post-colonoscopy complications.MATERIALS AND METHODS
Using relevant keywords, we identified 63 further PubMed reports of splenic injury associated with colonoscopy that were reported in English.FINDINGS
We have described only the fourth report of splenic injury secondary to colonoscopy from a UK centre. Literature review reveals a mean age of 63 years and a female preponderance for this complication.Most patients present on the day of their colonoscopy with abdominal pain, anaemia, elevated white cell count and Kehr''s sign. CT is the investigation of choice and splenectomy the definitive management of choice. Most patients make a routine recovery, with mortality rates of approximately 8%.There is likely to be an under-reporting of this complication from UK-based centres,with the majority of reports originating from Europe and US.This points to a possible under-diagnosis or under-recognition of this potentially fatal complication. The incidence of such post-colonoscopic complications may increase with the forthcoming introduction of the National Bowel Cancer Screening Programme. 相似文献8.
JK Randall CS Good JM Gilbert 《Annals of the Royal College of Surgeons of England》2013,95(8):586-590
Introduction
We report the outcomes of a long-term surveillance programme for individuals with a family history of colorectal cancer.Methods
The details of patients undergoing a colonoscopy having been referred on the basis of family history of colorectal cancer were entered prospectively into a database. Further colonoscopy was arranged on the basis of the findings. The outcomes assessed included incidence of cancer and adenoma identification at initial and subsequent colonoscopy.Results
The records of 2,293 patients (917 men; median patient age: 51 years) were entered over 22 years, giving data on 3,982 colonoscopies. Eight adverse events (0.2%) were recorded. Twenty-seven cancers were found at first colonoscopy and thirteen developed during the follow-up period. There were significantly more cancers identified in those with more than one first-degree relative with cancer than in other groups (p=0.01). The number of adenomas identified at subsequent surveillance colonoscopies remained constant with between 9.3% and 12.0% of patients having adenomas that were removed. Two-thirds (68%) of patients with cancer and three-quarters (77%) with adenomas fell outside the British Society of Gastroenterology (BSG) 2006 guidelines.Conclusions
Repeated colonoscopy continues to yield significant pathology including new cancers. These continue to occur despite removal of adenomas at prior colonoscopies. The majority of patients with cancers and adenomas fell outside the BSG 2006 guidelines; more would have fallen outside the 2010 guidelines. 相似文献9.
Linda A. Dultz Brant W. Ullery Huan Huan Sun Tara L. Huston Soumitra R. Eachempati Philip S. Barie Jian Shou 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(1):80-83
Background:
Lipomas are the most common benign mesenchymal tumors of the gastrointestinal tract, with the colon being the most prevalent site. Intestinal lipomas are usually asymptomatic. Tumors >2 cm in diameter may occasionally cause nonspecific symptoms, including change in bowel habits, abdominal pain, or rectal bleeding, but with resection the prognosis is excellent. Herein, we describe the case of an elderly male who presented with painless hematochezia.Methods:
Both colonoscopy and computed tomography of the abdomen and pelvis confirmed the presence of a mass near the ileocecal valve. Because of continuing bleeding, the patient required laparoscopic-assisted right hemicolectomy to resect the mass.Results:
Both gross and microscopic pathology were consistent with lipoma at the ileocecal valve.Conclusion:
Previous cases of ileocecal valve lipomas have been reported in the English literature, with the majority presenting as intussusception or volvulus. We present a rare case of an ulcerated ileocecal valve lipoma presenting as lower gastrointestinal bleeding that was treated successfully with laparoscopic resection. 相似文献10.
Background and Objectives:
Recently there has been a renewed interest in office based laparoscopy sterilization utilizing local anesthesia with conscious intravenous sedation. The safety of performing the procedure outside of a hospital environment has been questioned. The author attempts to determine the incidence of major complications with a review of the literature and a retrospective chart review of his personal cases.Methods:
During the period from 1971 to 1995, the author performed 1,753 laparoscopic procedures, utilizing local anesthesia in 1,562 cases and general anesthesia in the remainder. The focus of this chart study is the 1,190 laparoscopy sterilization cases performed in an office exam room setting, utilizing local anesthesia and conscious intravenous analgesia. Conventional 10 mm single puncture laparoscopy equipment was used. Major complications were defined as requiring laparotomy, blood transfusion, cardiopulmonary resuscitation, or emergency transfer to the hospital.Results:
The author''s series contained one major complication, which was easily handled in the office environment. A review of the literature, including the author''s series, revealed a major complication incidence of 5 out of 20,568 cases reviewed. None of these five complications would have required immediate laparotomy or blood transfusion to prevent a fatality.Conclusion:
The author proposes that there is no documented evidence that office laparoscopy places the patient at increased risk for a life-threatening complication and should be considered by experienced gynecologic laparoscopists who are interested in cost containment. 相似文献11.
Benjamin F. Ricciardi MD Mathias P. Bostrom MD Lars Lidgren MD Jonas Ranstam MD Katharina M. D. Merollini PhD Annette W-Dahl PhD 《HSS journal》2014,10(1):45-51
Background
Prevention strategies are critical to reduce infection rates in total joint arthroplasty (TJA), but evidence-based consensus guidelines on prevention of surgical site infection (SSI) remain heterogeneous and do not necessarily represent this particular patient population.Questions/Purposes
What infection prevention measures are recommended by consensus evidence-based guidelines for prevention of periprosthetic joint infection? How do these recommendations compare to expert consensus on infection prevention strategies from orthopedic surgeons from the largest international tertiary referral centers for TJA?Patients and Methods
A review of consensus guidelines was undertaken as described by Merollini et al. Four clinical guidelines met inclusion criteria: Centers for Disease Control and Prevention''s, British Orthopedic Association, National Institute of Clinical Excellence''s, and National Health and Medical Research Council''s (NHMRC). Twenty-eight recommendations from these guidelines were used to create an evidence-based survey of infection prevention strategies that was administered to 28 orthopedic surgeons from members of the International Society of Orthopedic Centers. The results between existing consensus guidelines and expert opinion were then compared.Results
Recommended strategies in the guidelines such as prophylactic antibiotics, preoperative skin preparation of patients and staff, and sterile surgical attire were considered critically or significantly important by the surveyed surgeons. Additional strategies such as ultraclean air/laminar flow, antibiotic cement, wound irrigation, and preoperative blood glucose control were also considered highly important by surveyed surgeons, but were not recommended or not uniformly addressed in existing guidelines on SSI prevention.Conclusion
Current evidence-based guidelines are incomplete and evidence should be updated specifically to address patient needs undergoing TJA.Electronic supplementary material
The online version of this article (doi:10.1007/s11420-013-9369-1) contains supplementary material, which is available to authorized users. 相似文献12.
I.M. Shapey K. Mahmood M.H. Solkar 《International journal of surgery case reports》2014,5(12):995-997
INTRODUCTION
Duodenocolic fistula is a rare complication of malignant colonic disease especially when involving and originating from the sigmoid colon. We aim to discuss the unusual clinical presentation of this case as well as the investigation and management of duodenocolic fistulas.PRESENTATION OF CASE
A 91 year old lady presented as an emergency to a general surgical service at a District General Hospital with diarrhoea, vomiting and weight loss. Computed Tomography (CT) reported a large ovarian cyst elevating the sigmoid colon into immediate proximity of the duodenum. Adenocarcinoma was confirmed on histology obtained by colonoscopy. A classic apple core lesion with fistulating tract from the sigmoid colon to the duodenum was synchronously demonstrated on barium enema.DISCUSSION
Sigmoido-duodenal fistulae represent a complex manifestation of gastrointestinal pathologies.CONCLUSION
Management options must be considered in the context of patient wishes, their co-morbidities, and predicted post-operative outcome. In most cases this is likely to represent a non-operative approach, however surgical resection may benefit selected cases on occasion. 相似文献13.
Devin R. Halleran David R. Halleran 《International journal of surgery case reports》2014,5(12):1295-1298
INTRODUCTION
Herein we present the case of an 86-year-old woman with gallstone perforation of the sigmoid colon.PRESENTATION OF CASE
An 86-year-old woman with known cholelithiasis presented to our office with one week of abdominal pain and nausea. X-rays taken at presentation demonstrated pneumobilia, and CT scan showed a 3.5 cm gallstone in the sigmoid colon. Medical management was unsuccessful in passing the stone, and a colonoscopy on day 4 was unsuccessful in incorporating the stone. Subsequent clinical deterioration prompted a laparotomy, where a perforation was discovered. A Hartmann''s procedure was performed and the patient recovered after a complicated post-operative course.DISCUSSION
Gallstone ileus is an uncommon, but medically important, cause of bowel obstruction. This presentation is considered a surgical emergency and thus prompt identification and removal is essential. Obstructions tend to occur in either the stomach or along the various segments of the small intestine but have been reported in the colon as well.CONCLUSION
In cases of gallstones that manage to pass into the large intestine, it is prudent to attempt conservative measures for passage. Failure to do so should raise suspicion of a possible stricture, either benign or malignant, preventing its evacuation. Earlier surgical intervention should be considered in these cases. 相似文献14.
Surgical rates in subprovincial areas across Canada: rankings of 39 procedures in order of variation
Jane F. Gentleman Eugene Vayda Greg F. Parsons Michael N. Walsh 《Canadian journal of surgery》1996,39(5):361-367
Objective
To rank 39 surgical procedures in order of variation of inpatient surgical rates, according to a new index of variation and to test the hypothesis that there is greater variation for primarily discretionary operations than for primarily non-discretionary operations.Design
A population-based retrospective cohort study.Setting
Nine provinces (99.19% of Canada’s population).Participants
All hospital inpatients who underwent any of 39 types of surgery and were separated from hospital between Apr. 1, 1988 and Mar. 31, 1990 (the most recent time period for which Canada-wide data were available at the subprovincial level analysed).Main Outcome Measure
Rankings of the 39 procedures according to the index of variation, calculated from inpatient surgery rates in 255 census divisions across Canada.Results
The 13 procedures with the greatest variation were all primarily discretionary. Thirteen of the 14 procedures with the lowest variation were primarily non-discretionary. All but one of the procedures whose degree of discretion was deemed intermediate were in the middle third of the rankings.Conclusions
The greatest variation is found in primarily discretionary operations. Further investigation should be focused on identified geographical locations where rates for operations that are primarily discretionary are unusually high or low, and particularly on those operations for which there is disagreement regarding the indications for surgery. 相似文献15.
Marko Kraljevi? Henry Hoffmann Alexandra Knipprath Urs von Holzen 《International journal of surgery case reports》2014,5(12):958-960
INTRODUCTION
Colon cancer in pregnant women is rare and tends to produce unspecific symptoms until advanced stage. Therefore common manifestations during pregnancy must be properly evaluated to avoid delayed diagnosis.PRESENTATION OF CASE
A 31-year-old pregnant woman presented with nausea, vomiting and obstipation. An obtained magnetic resonance imaging (MRI) showed distended colon and the consecutive colonoscopy with biopsies confirmed the diagnosis of stenosing carcinoma of the descending colon. Left sided hemicolectomy was performed 10 days after initial presentation. Tumor histology confirmed the diagnosis of adenocarcinoma of the descendo-sigmoidal junction. Adjuvant chemotherapy with 5-fluorouracil was started in the 29th gestational week. The patient had an uneventful delivery of a healthy baby in her 39th gestational week.DISCUSSION
Colorectal carcinoma during pregnancy is a rare event and its diagnosis is often delayed because symptoms are unspecific until the disease is advanced. Although constipation in pregnancy is a common symptom differential diagnosis of a mechanical stenosis should always be contemplated, especially when conservative treatment of constipation fails. MRI is the imaging tool of choice as abdominal computed tomography (CT) is contraindicated in pregnancy. Endoscopic confirmation should be obtained to gain pathological diagnosis of colorectal carcinoma. Surgery is the gold standard of treatment. In relation to the stage of the disease chemotherapy is of great importance.CONCLUSION
Obstructing colorectal cancer can be a rare reason for the common problem of constipation in pregnancy. Beside clinical examination, MRI scan and colonoscopy will reveal the tumor in most cases and should be followed by surgical treatment and chemotherapy according to the stage of disease. 相似文献16.
Sriniwasan B. Mani Eric W. Lloyd Aoife MacMahon Matthew M. Roberts David S. Levine Scott J. Ellis 《HSS journal》2015,11(3):243-248
Background
The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous joint preparation, and shear-strain-relieved calcaneal bone graft.Questions/Purposes
Does the performance of the Lapidus procedure with rigid cross screw fixation, complete joint preparation, and shear-strain-relieved calcaneal bone graft achieve higher union rates than currently reported? If nonunion does occur, what is the clinical course?Methods
We reviewed both radiographic and clinical results of the modified Lapidus procedure with the above technique in 171 patients (182 feet). Evaluation included age, gender, tobacco use, diabetic status, and radiographic analysis at least 3 months postoperatively.Results
The modified Lapidus procedure described above resulted in a union rate of 97.3% (177 of 182 feet). Three of the five feet with radiographic nonunions were clinically symptomatic.Conclusions
The union rate of the modified Lapidus procedure is higher than previously reported when performed with rigid cross screw fixation, meticulous joint preparation, and shear-strain-relieved bone graft. Nonunion of the first tarsometatarsal joint should be considered an infrequent occurrence.Electronic supplementary material
The online version of this article (doi:10.1007/s11420-015-9462-8) contains supplementary material, which is available to authorized users. 相似文献17.
Fotios Mitropoulos George Giannakoulas Alexandros Kallifatidis Meletios Kanakis Maria Kiaffas Andrew C. Chatzis 《International journal of surgery case reports》2014,5(12):1058-1060
INTRODUCTION
Cardiac myxoma is the most common primary cardiac tumour in adulthood and may present in the context of Carney''s complex.PRESENTATION OF CASE
A 32-year-old male with a history of repaired tetralogy of Fallot in childhood was admitted with severe pulmonary valve regurgitation and a mobile mass in the right ventricle. The patient underwent pulmonary valve replacement and mass excision. Pathology examination showed myxoma.DISCUSSION
In the majority of cases myxomas originate in the atria, nevertheless they can also be found in a ventricular cavity. Myxoma is a prevalent feature of Carney''s complex, an inherited, autosomal disease, characterised by multiple tumours in several organs. Tetralogy of Fallot has also been described in association with Carney''s complex.CONCLUSION
Coexistence of tetralogy of Fallot with a cardiac ventricular myxoma in a patient not affected from Carney''s complex or other familial syndrome. 相似文献18.
Adilia Maria Pires Sciarra Ulisses Alexandre Croti Fernando Batigalia 《Brazilian Journal Of Cardiovascular Surgery》2014,29(1):89-92
Introduction
Congenital heart diseases are the world''s most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable.Objective
To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil.Methods
The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence.Results
Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed.Conclusion
It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases. 相似文献19.
Study design
Case report.Objective
To report a case of cervical instability from an os odontoideum that presented as posterior thoracic pain and to present a review of the literature.Background
Thoracic posterior paraspinal spasms and pain are common chief complaints in individuals with spinal abnormalities.Methods
A 19-year-old man presented with posterior thoracic pain for nearly 1 year following a college sports-related injury (lacrosse). Computed tomography and magnetic resonance imaging did not reveal any significant thoracic or lumbar spinal cord or nerve root pathology, but did reveal an incidental finding of an os odontoideum.Results
Surgical stabilization of the atlantoaxial instability resulting from the os odontoideum resulted in complete resolution of the patient''s thoracic pain.Conclusions
Thoracic back pain without a clear thoracic spine etiology warrants further workup to rule out the possibility of spinal instability. 相似文献20.
Nicholas A. Ryan Vicki Sue-Mei Ng Haleh Sangi-Haghpeykar Xiaoming Guan 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2015,19(3)