Covid no-related surgical emergencies during Covid-19 time. Case report: broad ligament internal hernia with associated small bowel necrosis.
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ABSTRACT:
SUBMITTER: Pascotto B
PROVIDER: S-EPMC7867399 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionGastric volvulus are rare. Complications can be life threatening, including necrosis and perforation. Assessment of mucosal viability is essential, and urgent surgical intervention is mandatory in case of vascular compromise.Presentation of caseAn 72-year-old female known for a paraesophageal hiatal hernia was admitted at our emergency department with acute abdominal pain. Blood count demonstrated leukocytosis and increased C-reactive protein. Abdominal computed tomography showed a mesenteroaxial gastric volvulus. Urgent upper endoscopy revealed mucosal ischemia, which prompted immediate laparotomy with partial gastrectomy, cruroplasty, and Dor fundoplication. Postoperative course was uneventful.DiscussionGastric volvulus is initially treated with nasogastric tube decompression, but definitive treatment is achieved surgically. When there is an associated hernia, closing the anatomical defect and fundoplication should be performed. Complication such as necrosis is associated with a high mortality, and requires urgent surgical repair.ConclusionGastric volvulus can be life-threatening. Urgent endoscopic or surgical assessment should be conducted to assess mucosal viability.
| S-EPMC7810906 | biostudies-literature
Project description:The COVID-19 pandemic has had a major impact on healthcare in many countries. This study assessed the effect of a nationwide lockdown in France on admissions for acute surgical conditions and the subsequent impact on postoperative mortality. This was an observational analytical study, evaluating data from a national discharge database that collected all discharge reports from any hospital in France. All adult patients admitted through the emergency department and requiring a surgical treatment between 17 March and 11 May 2020, and the equivalent period in 2019 were included. The primary outcome was the change in number of hospital admissions for acute surgical conditions. Mortality was assessed in the matched population, and stratified by region. During the lockdown period, 57 589 consecutive patients were admitted for acute surgical conditions, representing a decrease of 20.9 per cent compared with the 2019 cohort. Significant differences between regions were observed: the decrease was 15.6, 17.2, and 26.8 per cent for low-, intermediate- and high-prevalence regions respectively. The mortality rate was 1.92 per cent during the lockdown period and 1.81 per cent in 2019. In high-prevalence zones, mortality was significantly increased (odds ratio 1.22, 95 per cent c.i. 1.06 to 1.40). A marked decrease in hospital admissions for surgical emergencies was observed during the lockdown period, with increased mortality in regions with a higher prevalence of COVID-19 infection. Health authorities should use these findings to preserve quality of care and deliver appropriate messages to the population.
| S-EPMC8140197 | biostudies-literature
Project description:Ependymomas arise from ependymal cells lining the ventricles and central canal of the spinal cord and can occur throughout the whole neuraxis. The lesion rarely occurs in extracranial or extraspinal regions, particularly in the uterine broad ligament. Thus, for the pathogenesis of nonsacral extra-central nervous system (CNS) ependymomas remains elusive. Here, we describe a rare case of primary uterine broad ligament. ependymoma with cell-cycle-checkpoint kinase 2 (CHEK2) p.H371Y germline mutation. A 45-year-old woman presented with a uterine mass. The transvaginal sonographic examination confirmed a 4.4 cm × 3.7 cm, cystic and solid, mass located on the right side uterine wall near isthmus. First, laparoscopy with the neoplasm resection was carried out. Based on morphological and immunohistochemical characteristics of tumor cells that expressed glial fibrillary acidic protein (GFAP), S-100, and vimentin, the tumor was diagnosed as an ependymoma. After that, she underwent a laparotomic total hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Furthermore, we performed next-generation sequencing (NGS) of the patient's resected tumor tissue and peripheral blood and identified a novel CHEK2 p.H371Y germline mutation. Following surgery, the patient received oral tamoxifen (10 mg 2/day) and followed by letrozole (2.5 mg/day) for 6 months. The patient remained disease-free after 4 years of follow-up. Conceivably, CHEK2 p.H371Y is a driving gene for the development of extra-CNS ependymoma.
| S-EPMC9298396 | biostudies-literature
Project description:Internal hernias are a rare cause of acute intestinal obstruction. Supravesical hernia is an exceptional form of hernia that is often diagnosed intraoperatively. The abdominal CT scan performed in the emergency guides the preoperative diagnosis. Our work concerns a patient admitted to the visceral surgical department of the university hospital ibn Rochd of Casablanca for an occlusion dating back to 05 days, the abdmonial x-ray objectified hydro-aerial levels in the small intestine, and the CT scan found an invagination at the left fossa iliaca associated with a double hernia: internal supravesical and left inguinal. The patient was then operated after conditioning and the diagnosis of an internal supravesical hernia was retained per operatively. Internal supravesical hernia is a very rare cause of acute intestinal occlusion and is often diagnosed at the time of surgical exploration.
| S-EPMC8167154 | biostudies-literature
Project description:Internal hernia is a rare cause of small bowel obstruction. It may account for 0.2 to 0.9 % of cases of intestinal obstruction. Intestinal obstruction due to internal hernia is very dangerous and lethal because it may be silent or may present as severe acute abdominal pain. We describe a case of acute intestinal obstruction which presented in our emergency department.
| S-EPMC3444594 | biostudies-other
Project description:BACKGROUND:Leiomyosarcoma (LMS) is an uncommon mesenchymal neoplasm, which infrequently metastasizes to pancreas and thigh. Clinical presentation and imaging findings of metastatic broad ligament LMS are often nonspecific. Complete excision plays an important role in treatment of patients with localized LMS. CASE PRESENTATION:Here, we report a case of a 33-year-old woman with recurrent broad ligament LMS metastasizing to pancreas and thigh. Previously, she was diagnosed with broad ligament LMS and underwent hysterectomy, bilateral salpingo-oophorectomy. The disease-free interval was 2.5?years until metastases were found. Computerized tomography (CT) of abdomen and thighs, magnetic resonance imaging (MRI) of thighs and whole-body 18-fluorodeoxyglucose positron emission tomography - computed tomography (PET-CT) performed, revealed pancreatic and thigh metastasis. Ultrasonography-guided biopsy and histological examinations confirmed LMS at both the sites. Pancreatic metastasis was completely resected first. Then the patient underwent surgical resection of thigh metastasis when both chemotherapy and radiotherapy failed. She recovered well and remained free of disease recurrence in the 2 years follow-up. CONCLUSIONS:Though imaging lacks specificity, it is a valuable asset in assessing the burden of disease and characterizing lesions while histological examination with immunohistochemistry is helpful for the diagnosis of LMS. Complete surgical resection of all metastatic sites where-ever feasible should be strongly considered in a treated case of broad ligament LMS with a durable disease-free interval.
| S-EPMC7325277 | biostudies-literature
Project description:BackroundSecondary ventral hernias are incisional hernias developed in former postoperative scars. Up to 30% of all patients undergoing laparotomy develop an incisional hernia. Open ventral hernia repair is often performed under general anaesthesia but can also be performed under regional anaesthesia.Case reportWe report the case of an elderly man, who underwent open surgery of a large incisional hernia in spinal block. Regional anaesthesia was chosen due to the patient's additional diseases and disorders.ConclusionOpen surgery of large ventral hernia in spinal anaesthesia can be performed because the spinal anaesthesia provides adequate conditions for ventral hernia repair. The patient has to be in good physical condition in order for the surgery to be successful. During the surgery the patient has to be watched over vigilantly by the anaesthesiologist.
| S-EPMC6430731 | biostudies-literature
Project description:In the last few years, significant improvement in diagnosis and treatment of ferret emergencies has occurred. Scientific advances demonstrated the need of specific practices when dealing with emergencies in ferrets. The risk of overdiagnosis of hypoglycemia with human portable blood glucose meters is a clear example. The purpose of this article is to describe the current approach to common medical and surgical emergencies in ferrets.
| S-EPMC7110496 | biostudies-literature
Project description:Varicosities of the round ligament is a rare condition. Our gravid patient had left inguinal swelling noticeable for 2 weeks and pain on and off. Swelling was reducible and treating surgeon referred patient for ultrasound to rule out inguinal hernia. Round ligament varices present as a unilateral or bilateral inguinal mass with or without pain almost always in pregnant patient. Sonography and Doppler is the best modality to see tortuous venous channels of round ligament compared to bowel or omental contents suggesting of hernia. Differentiating round ligament varices from inguinal hernia is must before any unnecessary surgical intervention and should be kept as differential for unilateral or bilateral inguinal swelling during pregnancy.
| S-EPMC6581978 | biostudies-literature
Project description:Introduction and importance: Placenta percreta is an abnormal of placentation disorder that causes firm and deep attachment of placenta into myometrium due to absent decidua basalis and leads to significant morbidity and mortality due to severe hemorrhage. Presentation of case A 28-year, old women gravida 2 para 1 + 0 with previous one Lower segment caesarean section (LSCS), presented to emergency department of HFH with complaint of per vaginal bleeding. It was a twin pregnancy and was a rare case of complex placenta percreta with invasion into left broad ligament and urinary bladder in a woman having twin pregnancy. Placental invasion into bladder was diagnosed pre-operatively on USG scan, however; the broad ligament involvement was diagnosed intraoperatively. Patient underwent hysterectomy and internal iliac artery ligation to control hemorrhage soon after delivery of twins with T2 being IUD and patient shifted to ventilatory support but unfortunately due to massive hemorrhage and hemodynamic instability patient did not survive. Discussion Placenta percreta is a subtype of placenta accreta spectrum disorder that is associated with significant morbidity and mortality depending upon nature and extent of placental invasion. Preoperative diagnosis and management can be of significant value in preventing obstetrics related morbidity. A multidisciplinary approach is required in management of such cases and due to involvement of surrounding structures including urinary bladder. Conclusion Placenta percreta is a rare disorder of placentation that poses significant life-threatening risk of bleeding and maternal mortality and multidisciplinary approach can be of benefit in such cases. Highlights • Placenta percreta is a rare disorder that poses significant life-threatening risk to maternal as well as fetal wellbeing.• Early diagnosis can reduce mortality and morbidity.• A multidisciplinary approach is required in management of such cases of complex nature.
| S-EPMC9793151 | biostudies-literature