A 17-year-old man presented to the emergency department 10 days postlaparoscopic appendicectomy with ongoing lower abdominal pain. The pain was associated with fevers, chills, sweating and ...constipation. There were no other associated symptoms. On examination, there was suprapubic and right lower quadrant tenderness and an elevated blood pressure (140/90 mm Hg). The patient later developed severe bilateral flank pain. Investigations revealed elevated C reactive protein, leukocyturia and microscopic haematuria. Blood and urine cultures were negative. CT angiogram demonstrated bilateral wedge-shaped peripheral renal hypodensities suggestive of several peripheral infarcts with intrarenal microaneurysms. Treatment with steroids and cyclophosphamide was initiated, leading to significant clinical improvement. Review of the histological appendix specimen revealed features consistent with small-medium vessel vasculitis.
Osteochondromas are bone exostoses, with the vast majority extending from the metaphyseal region of long bones and are capped by cartilage. A review of the current literature reveals spontaneous ...regression of osteochondromas is a rarely documented event, with all but two of these recorded events resolving before skeletal maturity and within 6 years of identification. We present a case of trauma-induced resolution of a solitary osteochondroma after less than 3 months in a 15-month-old male, with a review of current literature.
Tracheal and bronchial varices are rarely found in children. However, they have been described in adults with failing Fontan circuits or secondary to vascular pathology, such as portal and pulmonary ...hypertension. We report the presentation of haemoptysis and bronchial varices in a child, six years after a Fontan procedure for tricuspid atresia. She had tortuous mediastinal and transpleural arterial collaterals on computed tomography (CT) angiography and cardiac catheterization and subsequently underwent embolization of these collaterals. While the haemoptysis settled post embolization, the bronchial varices persisted on repeat bronchoscopy. She has since been clinically well with no further haemoptysis.
Tracheal and bronchial varices are rare, especially in children. We report the first presentation of bronchial varices and haemoptysis in a child, six years after a Fontan procedure for tricuspid atresia. She had tortuous mediastinal and transpleural arterial collaterals on imaging and subsequently underwent embolization of these collaterals with haemoptysis settling after this.
Para-infections aneurysms are a very rare complication but bear the risk of significant morbidity and mortality in case of rupture and hemorrhage. We present the youngest published case of a ...right-sided pulmonary artery pseudoaneurysm due to nonmultiresistant
pneumonia in a 7-month old boy, complicated by 2 episodes of significant hemorrhage. Selective microvascular plug embolization of the feeding segmental pulmonary artery by interventional radiology and cardiology was successfully undertaken while having a cardiothoracic surgical team on stand-by. Follow-up ultrasounds showed no residual flow distal to the microvascular plug. The patient had complete clinical recovery 10 months after the initial presentation. Interventional radiology procedures are challenging in children due to limited availability of appropriately-sized equipment, low case numbers, and a limited body of literature.
Journey of a stone-thirty years on Nan, Xinyi; Prabha, Ramesh Damodaran; Rashid, Muddassir ...
Journal of surgical case reports,
02/2023, Letnik:
2023, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Laparoscopic cholecystectomy is the gold standard surgical treatment of gallstone disease and a commonly performed procedure in general surgery. Retained gallstones from intraoperative spillage ...remain largely asymptomatic and complications are rare. Peak incidence of presentation occurs within a year; however, it is important to recognize retained gallstones as a differential for acute presentations even many years postoperatively. We present the case of a 74-year-old female who presented with a retained-gallstone-associated abdominal wall abscess 30 years after spillage during the original surgery, which was successfully treated with a stepwise extraperitoneal approach with local drainage.
Background: There is ambiguity regarding anatomical site of embolization, frequency of follow-up scans and splenic function following angioembolisation in the management of high grade blunt splenic ...injury. A splenic salvage pathway in patients who are hemodynamically stable or resuscitated to stability was introduced across two trauma centres. The aims of this project were: to develop a clinical pathway to manage hemodynamically stable blunt splenic injury patients and to determine rates of splenic salvage for patients with high grade splenic injury, assess complications and splenic function following completion of the pathway.Methods: Prospective study over a period of 24 months. Data was collected to evaluate rates of splenic salvage, complications and function of the spleen following angioembolisation.Results: Thirty-three patients, predominantly males (n=29) between the ages of 14-85 years, were included in the study. Three (9%) with grade V injury, underwent angioembolization on admission but required splenectomy as an inpatient. On day 14, all patients (n=30) with splenic salvage underwent blood tests, with 3 patients (9%) receiving vaccination for altered red cell morphology. The introduction of clinical pathway led to an increase in our splenic salvage rate to 91%.Conclusions: We believe that introduction of proposed clinical pathway may result in increased rates of splenic salvage with preservation of function following angioembolisation.
Laparoscopic cholecystectomy has become the preferred method of treatment of cholelithiasis since its inception in 1987. Although overall complication rate is less than that of traditional approach, ...two operative complications of laparoscopic cholecystectomy have been frequently described in the literature. One is the bile duct injury or leak and the other one spillage of stones resulting in delayed abscess formation (Horton and Florence, Am J Surg 175:375–379, 1998; Frola et al., BJR 72:201–203, 1999). The incidence of abscess is very rare (approximately 0.3%). The location of the subsequent abscess and the inflammatory masses containing stones or stone fragments is generally in the abdominal wall, subhepatic space, or the retroperitoneum below the subhepatic space but can occur anywhere in the abdomen, right thorax, at trocar site, and at incisional hernia (Zehetner et al., Am J Surg 193:73–78, 2007; Offiah et al., BJR 75:393–394, 2002; Morrin et al., AJR 174:1441–1445, 2000). We report here a case of abscess formation due to spilled stone occurring 6 months post-laparoscopic-cholecystectomy. The diagnosis was suggested by ultrasound examination and was further confirmed by computed tomography scan of the abdomen.
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