Surgery Journal最新文献

{"title":"An Unusual Combination of Three Rare Complications: Pleuro-Pancreatic Fistula, Chylous Ascites, and Renal Vein Thrombosis, in a Case of Acute Severe Pancreatitis","authors":"Tanweerul Huda, A. Mohan, Mohammad Masoom Parwez, B. Pandya","doi":"10.1055/s-0039-1700807","DOIUrl":"https://doi.org/10.1055/s-0039-1700807","url":null,"abstract":"Abstract Background Acute pancreatitis is fraught with a variety of complications, which account for the mortality associated. Our case had a fulminant course, with three rare, near-fatal complications and was successfully managed conservatively. Pleural effusion due to pleuro-pancreatic fistula is uncommon, seen in only 1% cases, of which right-sided effusions are rarer still. Management modalities include conservative, endoscopic, and surgical options. Chylous ascites is an extremely rare complication of pancreatitis and is managed with high protein, low lipid diet, restricted to medium-chain triglycerides (MCTs). Extra-splanchnic venous thrombosis is uncommon in pancreatitis, and isolated renal vein thrombosis is very rare. Case Presentation A 34-year-old, chronic alcoholic male, presented to the outpatient department (OPD) in a state of shock and respiratory distress. Chest radiograph showed massive right-sided pleural effusion. The pleural fluid was hemorrhagic with markedly elevated amylase levels, and contrast-enhanced computed tomography (CECT) confirmed the presence of a right-sided pleuro-pancreatic fistula. Left renal vein thrombosis was also noted. The patient improved with chest drain, intravenous (IV) octreotide, and anticoagulants. Subsequently, he developed hemorrhagic pancreatic ascites, which later turned chylous. This was managed with dietary modifications. The patient had a prolonged recovery but was finally discharged after 45 days. Conclusion It is a challenge managing the various complications of acute severe pancreatitis. We describe this case to emphasize maintaining a high sensitivity for timely diagnosis and appropriate addressal of all the complications for better patient outcomes.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":"5 1","pages":"e188 - e191"},"PeriodicalIF":0.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1700807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48397887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Acquired Transthoracic Littre's Hernia","authors":"Arthur Curmi, A. Dimech, R. Dalli, A. Mostafa, J. Debono","doi":"10.1055/s-0039-1696727","DOIUrl":"https://doi.org/10.1055/s-0039-1696727","url":null,"abstract":"Abstract Introduction The Littre hernia is a rare complication of Meckel's diverticulum. Meckel's diverticulum is vestigial remnant of the omphalomesenteric duct occurring in approximately 2% of the general population with an estimated 4 to 16% risk of complications. Usual sites of the Littre hernia include inguinal (50%), umbilical (20%), and femoral (20%). We report a case of an acquired transthoracic Littre's hernia occurring through the left part of the diaphragm triggered by a history of traumatic rib fractures associated with alcohol abuse. Case Report A 71-year-old man presented with 4-day history of worsening shortness of breath, colicky lower abdominal pain, and inability to open bowels despite passing flatus, without nausea or vomiting. His past medical history was remarkable for multiple traumatic rib fractures caused by falls which were associated with excessive alcohol consumption. A noncontrast computed tomography (CT) scan of the abdomen and pelvis showed distended jejunal loops containing air/fluid levels likely resulting from herniated jejunum between the left chest wall and left diaphragm. An urgent laparotomy was performed which revealed small bowel and omentum herniating through a small defect in the left posterior hemidiaphragm. The contents of the sac were reduced and a Meckel's diverticulum was found inside the sac, characteristic of Littre's hernia. The diaphragmatic defect was closed and the Meckel diverticulum stapled and excised. Discussion Herniation of Meckel's diverticulum through the diaphragm most commonly occurs in the pediatric population. Acquired transthoracic Littre's hernia is rare and may arise following thoracobdominal trauma caused by surgery, motor vehicle accidents, and falls from height. Left-diaphragmatic tears are characteristically more clinically apparent and symptomatic than the right since the liver often has a protective effect on the right part of the diaphragm. Herniation of abdominal contents in the chest cavity causes respiratory distress and requires urgent surgical correction. Diagnosis is often delayed since diaphragmatic hernia tends to present very late after the initial trauma, subjecting the patient to possible life-threatening complications. While it is easier to reduce the herniated contents and repair the diaphragm via a thoracic approach, laparotomy is often preferred in cases of acute trauma associated with intra-abdominal injuries. Repair of Littre's hernia then consists of resection of the diverticulum and herniorraphy. Conclusion Internal Littre's hernia is usually of congenital origin. This is the first case of a transthoracic Littre's hernia caused by traumatic rib fractures. Hence, it is of utter importance that a clinician is aware of such uncommon pathology.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":"5 1","pages":"e150 - e153"},"PeriodicalIF":0.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1696727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48492974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Hemorrhoid Vascular Injuries with Cigarette Smoking—An Evaluation with Interesting Prospects","authors":"S. Nagaraj, Amit Mori, M. Reddy","doi":"10.1055/s-0039-1700497","DOIUrl":"https://doi.org/10.1055/s-0039-1700497","url":null,"abstract":"Abstract Background Hemorrhoids are vascular structures in the anal canal which are seldom used to evaluate vascular diseases. Cigarette smoking is well-known to cause both arterial and venous vascular injuries. However, the impact of smoking on hemorrhoid vasculature is unknown. Objective Considering that vasculature in the hemorrhoids has the same anatomy and pathophysiology of vascular damage as other systemic vasculatures, we conducted this study to evaluate the relation between smoking and incidence of hemorrhoidal vascular injury. Design and Data Analysis Retrospective review of all the screening colonoscopies performed at our Department of Gastroenterology (predominantly serving urban minority population) over 3 years was conducted and patients with recorded smoking history were included in the study (n = 242). Fisher's exact test with two-tailed p-value and odds ratio were used to evaluate for the association between smoking and incidence of hemorrhoids. Results We studied 242 subjects and found statistically significant association between smoking and hemorrhoids (p < 0.05) with the risk of developing hemorrhoids among smokers being 2.4 times that of a nonsmoker. We further noted no significant difference in the incidence of hemorrhoidal vascular injuries between the past versus current smokers and male versus female smokers. Conclusion This is one of the first studies to establish an association between smoking and hemorrhoids. Our study shows that the hemorrhoidal vasculature is impacted by smoking similar to other vascular systems. This study sheds light on the possibility of evaluating hemorrhoids for clues of other systemic and gastrointestinal vascular damage. This correlation can add clinical value especially given the flexibility of assessing hemorrhoids as an outpatient in a cost effective and comfortable manner.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":"5 1","pages":"e172 - e176"},"PeriodicalIF":0.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1700497","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48967742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracoscopic Esophagectomy for a Huge Leiomyosarcoma","authors":"J. Manipadam, S. Bains, S. Mahesh, Ami Emmanuel, H. Ramesh","doi":"10.1055/s-0039-1696729","DOIUrl":"https://doi.org/10.1055/s-0039-1696729","url":null,"abstract":"Abstract Esophageal leiomyosarcoma is the commonest of all esophageal sarcomas but yet has a very low incidence. These tumors have been resected by the open approach so far. We describe the steps and challenges involved in the thoracoscopic excision of a huge leiomyosarcoma of the esophagus.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":"5 1","pages":"e163 - e169"},"PeriodicalIF":0.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1696729","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45143777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report Describing Three Cases of Challenging or Failed Intubation after Cervical Spine Surgery: A Peril of Early Extubation","authors":"P. Mishra, K. Mishra, C. Palmer, A. Robertson","doi":"10.1055/s-0039-1700806","DOIUrl":"https://doi.org/10.1055/s-0039-1700806","url":null,"abstract":"Abstract Postoperative airway complications can be a common, yet perhaps underappreciated, complication in patients undergoing cervical spine surgery. Presented here are three cases in which patients experienced postoperative airway compromise, resulting in difficulty establishing a secure airway following cervical spine operations. Establishing factors that contribute to airway complications after cervical spine surgery can aid in early identification of high-risk patients to create an appropriate airway management strategy. Ultimately, the frequency of airway difficulty after removal of the endotracheal tube in patients undergoing cervical spine surgery should not be taken lightly.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":"5 1","pages":"e181 - e183"},"PeriodicalIF":0.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1700806","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49433335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foreign Body Inside the Tunnel: A Rare Cause of Acute Cubital Tunnel Syndrome","authors":"G. Yildiran, M. Sutcu, O. Akdağ, Z. Tosun","doi":"10.1055/s-0039-1696951","DOIUrl":"https://doi.org/10.1055/s-0039-1696951","url":null,"abstract":"Abstract Foreign bodies are common entities found in hand surgery practice. However, they are a very rare cause of the acute cubital tunnel syndrome. A 48-year-old male patient was consulted for cubital tunnel symptoms after 2-day unconscious state in the intensive care unit. The ulnar nerve was explored, a piece of glass was removed inside the cubital tunnel, and the nerve was repaired. However, compression neuropathy symptoms due to the acute trauma are interesting. Nerve laceration with a foreign body should be considered in acute-onset cubital tunnel syndrome, in which the foreign body history of a trauma patient cannot be determined explicitly.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":"5 1","pages":"e170 - e171"},"PeriodicalIF":0.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1696951","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43767024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ossified Spinal Meningioma: A Case Report and a Review of the Literature","authors":"M. Taha, A. Alawamry, H. Abdel-aziz","doi":"10.1055/s-0039-1697634","DOIUrl":"https://doi.org/10.1055/s-0039-1697634","url":null,"abstract":"Abstract Ossified spinal meningiomas are a rare form of spinal tumors. These tumors increase surgical morbidities due to their hard consistency and strong adhesion to the neural tissue and relatively narrow surgical space. Here, the authors describe the clinical findings, surgical strategies, and histological findings of a patient with an ossified meningioma. Preoperative diagnosis of these tumors can prevent surgical morbidities. Total resection can be curative with the application of meticulous microsurgical techniques.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":"5 1","pages":"e137 - e141"},"PeriodicalIF":0.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1697634","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43432185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sports-Related Pediatric Facial Trauma: Analysis of Facial Fracture Pattern and Concomitant Injuries","authors":"Andrew A. Dobitsch, N. Oleck, Farrah C. Liu, Jordan N. Halsey, Ian C Hoppe, Edward S. Lee, M. Granick","doi":"10.1055/s-0039-1697627","DOIUrl":"https://doi.org/10.1055/s-0039-1697627","url":null,"abstract":"Abstract Objective Sports-related injuries, such as facial fractures, are potentially debilitating and may lead to long-term functional and aesthetic deficits in a pediatric patient. In this study, we analyze sports-related facial fractures in the urban pediatric population in an effort to characterize patterns of injury and improve management strategies and outcomes. Methods Retrospective chart review was performed for all facial fractures resulting from sports injuries in the pediatric population at a level-1 trauma center (University Hospital, Newark, NJ). Results Seventeen pediatric patients were identified as having sustained a fracture of the facial skeleton due to sports injury. Mean age was 13.9 years old. A total of 29 fractures were identified. Most common fracture sites included the orbit (n = 12), mandible (n = 5), nasal bone (n = 5), and zygomaticomaxillary complex (n = 3). The most common concomitant injuries included skull fracture (n = 3), intracranial hemorrhage (n = 4), and traumatic brain injury (n = 4). One patient was intubated upon arrival to the emergency department. Hospital admission was required in 13 patients, 4 of which were admitted to an intensive care setting. Nine patients required operative intervention. Mean length of hospital stay was 2.4 days. No patients were expired. Conclusions Sports-related facial fractures are potentially debilitating injuries in the pediatric population. Analysis of fracture pattern and concomitant injuries is imperative to develop effective management strategies and prevention techniques.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":"5 1","pages":"e146 - e149"},"PeriodicalIF":0.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1697627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45577379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Huge Retroperitoneal Dermoid: A Presentation","authors":"Tanweerul Huda, M. Singh","doi":"10.1055/s-0039-1697630","DOIUrl":"https://doi.org/10.1055/s-0039-1697630","url":null,"abstract":"Abstract Teratoma can be defined as a true neoplasm that contains tissues that either are foreign to the primary site of origin or are histologically diverse and represent more than one of the embryonic germ layers. A 20-year-old female patient presented with chief complaints of swelling in the right upper abdomen since childhood and back pain for the past 4 years. Per abdomen, examination revealed a lump of around 15 cm in size in the right hypochondrial region extending to the epigastric region. Contrast-enhanced computed tomography abdomen revealed a 14.3 × 14.1 × 17.4 cm well-defined heterogeneously hypoattenuating nonenhancing complex cystic mass with focal areas of calcifications and fat attenuation in retroperitoneum. The patient was taken up for exploratory laparotomy and a tumor was found in the retroperitoneum, retrocavally and was excised with due care. Histopathological examination features were suggestive of mature cystic teratoma. The postoperative stay was uneventful.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":"5 1","pages":"e142 - e145"},"PeriodicalIF":0.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1697630","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41468699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Factors for Postoperative Outcome in Children with Jejunoileal Atresia","authors":"Charlotta Jarkman, M. Salö","doi":"10.1055/s-0039-1697628","DOIUrl":"https://doi.org/10.1055/s-0039-1697628","url":null,"abstract":"Abstract Background Jejunoileal atresia is a relatively rare congenital gastrointestinal requiring surgery and long postoperative care. The postoperative outcome is affected by many factors and this study focuses on finding predictors for time to full enteral feeding, length of hospital stay (LOH), and postoperative complications. Methods This was a retrospective study of all children operated for isolated jejunoileal atresia between 2001 and 2017 at a tertiary center of pediatric surgery. Independent variables regarding demographical-, operative-, and postoperative data were abstracted. Primary outcome was time to full enteral feeding, LOH, and postoperative complications in terms of reoperation or central line complication. Any significant variables from the univariate analysis were further analyzed with logistic regression and presented as odds ratio with 95% confidence interval. Results After exclusion because of concomitant gastroschisis (n = 1), and death before discharge (n = 2), 47 patients were further analyzed (49% boys, 53% premature). No significant differences could be seen in the univariate analysis between children with short and long time (median > 17 days) to full enteral nutrition. Patients with longer LOH (median >32 days) had significantly lower birth weight compared with those with shorter LOH; median 2,550 g versus 2,980 g (p = 0.04). Patients with a central line complication had significantly longer median time to full enteral feeding (median 27 vs. 12 days, p = 0.03), and significantly longer median LOH (median 43 vs. 21 days, p = 0.03), but these parameters were not significant in a multivariate analysis. No significant results were found regarding reoperation. Conclusion Low birth weight seems associated with an increased LOH in children operated on for jejunoileal atresia, and central line complications seem related to the duration with central line in this group. The small cohort may constitute a power problem in this study and further research regarding the included variables may reveal more potential predictors for the postoperative outcome.","PeriodicalId":44614,"journal":{"name":"Surgery Journal","volume":"5 1","pages":"e131 - e136"},"PeriodicalIF":0.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1697628","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48631311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}