Pub Date : 2024-03-16DOI: 10.18203/2349-2902.isj20240684
M. Murshid, Abdulellah Talal Al-Alhazmi, Farrukh Alim Ansari
Background: Obstructive jaundice is a condition caused by bile flow blockage and has various benign and malignant etiologies. Accurate and timely diagnosis is essential for effective treatment, particularly in cases of possible malignancy. Advances in diagnostic methods have improved our understanding and management of diseases. This study aimed to investigate the causes and clinical presentation of obstructive jaundice in Saudi Arabian population. Methods: This study included 193 patients diagnosed with obstructive jaundice admitted to the surgical wards from January 2019 to December 2022. Methods involved comprehensive clinical evaluations, medical history reviews, physical examinations, laboratory tests, and diagnostic imaging to identify the underlying disease. Data were collected systematically and statistically analyzed. Results: The study included 193 patients with a male-to-female ratio of 1:1.4, and an average age of 54.10 years. Malignant causes, primarily carcinoma of the pancreatic head, accounted for 59.4% of cases, while benign causes, notably choledocholithiasis, accounted for 41.6%. Symptoms included jaundice, abdominal pain, and loss of appetite, with treatment varying according to the identified cause. Conclusions: The study highlights that obstructive jaundice is more commonly found in females and tends to be caused by benign conditions in younger people, while malignant causes are more prevalent in older individuals. The most common malignant cause is carcinoma of the pancreatic head, and leading benign cause is choledocholithiasis. For diagnosing obstructive jaundice, key imaging techniques include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and computed tomography (CT).
{"title":"Exploring the causes of obstructive jaundice: a single-centre retrospective analysis","authors":"M. Murshid, Abdulellah Talal Al-Alhazmi, Farrukh Alim Ansari","doi":"10.18203/2349-2902.isj20240684","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240684","url":null,"abstract":"Background: Obstructive jaundice is a condition caused by bile flow blockage and has various benign and malignant etiologies. Accurate and timely diagnosis is essential for effective treatment, particularly in cases of possible malignancy. Advances in diagnostic methods have improved our understanding and management of diseases. This study aimed to investigate the causes and clinical presentation of obstructive jaundice in Saudi Arabian population.\u0000Methods: This study included 193 patients diagnosed with obstructive jaundice admitted to the surgical wards from January 2019 to December 2022. Methods involved comprehensive clinical evaluations, medical history reviews, physical examinations, laboratory tests, and diagnostic imaging to identify the underlying disease. Data were collected systematically and statistically analyzed.\u0000Results: The study included 193 patients with a male-to-female ratio of 1:1.4, and an average age of 54.10 years. Malignant causes, primarily carcinoma of the pancreatic head, accounted for 59.4% of cases, while benign causes, notably choledocholithiasis, accounted for 41.6%. Symptoms included jaundice, abdominal pain, and loss of appetite, with treatment varying according to the identified cause.\u0000Conclusions: The study highlights that obstructive jaundice is more commonly found in females and tends to be caused by benign conditions in younger people, while malignant causes are more prevalent in older individuals. The most common malignant cause is carcinoma of the pancreatic head, and leading benign cause is choledocholithiasis. For diagnosing obstructive jaundice, key imaging techniques include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and computed tomography (CT).","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"72 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140237129","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}
Pub Date : 2024-03-11DOI: 10.18203/2349-2902.isj20240675
Aleksandra Polikarpova, Ngee-Soon Lau, David J. Coker
Spontaneous pneumomediastinum (SPM) is a condition characterised by presence of air in the mediastinum that is not iatrogenic or secondary to trauma. We conducted a retrospective review of 4 cases, treated at our hospital for SPM in 2023. The mean age of the patients was 35 years (range, 28-58 years), with 3 male (75%). Only one of the patients (25%) had precipitating projectile vomiting followed by hematemesis. Chest pain was by far the most common symptom (75%). One patient presented with haematemesis, raised inflammatory markers and fever. Pneumomediastinum was diagnosed by plain chest radiography in all cases. In all cases a computed tomography (CT) scan of the chest with on table contrast was performed with half of the patients needing fluoroscopy swallow later in the admission. Half of the patients were treated for suspected oesophageal perforation and received antibiotics and kept nil by mouth, the other two patients only required supportive care. The mean length of hospital stay was 3.4 days (range, 1.2-4.7 days). SPM is a benign process primarily affecting young otherwise healthy males. There is a growing body of evidence to suggest that CT of the chest with on table contrast should be reserved for patients presenting with red flags such as abdominal pain, hematemesis, fever and raised inflammatory markers.
{"title":"Spontaneous pneumomediastinum: case series and literature review","authors":"Aleksandra Polikarpova, Ngee-Soon Lau, David J. Coker","doi":"10.18203/2349-2902.isj20240675","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240675","url":null,"abstract":"Spontaneous pneumomediastinum (SPM) is a condition characterised by presence of air in the mediastinum that is not iatrogenic or secondary to trauma. We conducted a retrospective review of 4 cases, treated at our hospital for SPM in 2023. The mean age of the patients was 35 years (range, 28-58 years), with 3 male (75%). Only one of the patients (25%) had precipitating projectile vomiting followed by hematemesis. Chest pain was by far the most common symptom (75%). One patient presented with haematemesis, raised inflammatory markers and fever. Pneumomediastinum was diagnosed by plain chest radiography in all cases. In all cases a computed tomography (CT) scan of the chest with on table contrast was performed with half of the patients needing fluoroscopy swallow later in the admission. Half of the patients were treated for suspected oesophageal perforation and received antibiotics and kept nil by mouth, the other two patients only required supportive care. The mean length of hospital stay was 3.4 days (range, 1.2-4.7 days). SPM is a benign process primarily affecting young otherwise healthy males. There is a growing body of evidence to suggest that CT of the chest with on table contrast should be reserved for patients presenting with red flags such as abdominal pain, hematemesis, fever and raised inflammatory markers.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140252864","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}
Pub Date : 2024-03-11DOI: 10.18203/2349-2902.isj20240674
Sarah Mahmood, A. Brodaric, Rajkumar Srinivasan, Ruben Cohen-Hallaleh
Background: Seroma formation is a known complication following mastectomy and axillary lymph node dissection (ALND) leading to morbidity and financial implications for patients. ARISTATM AH has been designed to prevent postoperative seromas formation in vitro. Methods: We performed a single institution, single surgeon retrospective study from January 2017 to December 2022 in patients undergoing mastectomy/axillary dissection to evaluate seroma formation rates and timing of drain removal. Results: A total of 72 cases were included in our retrospective review of electronic medical records. Of these, 40 patients underwent ipsilateral mastectomies with sentinel node biopsies, 8 patients underwent bilateral mastectomies, and 18 patients underwent axillary dissections without concurrent mastectomy. Our analysis showed a non-significant decrease in seroma formation when ARISTATM AH was used intra-operatively (10%) compared to standard care (24%), (p=0.14). The ARISTATM AH group had a statistically significantly longer mean drain removal time than the standard care group (12.9 vs 7.6 days, p=0.002). Conclusions: There was a trend towards lower seroma formation and a significantly longer requirement for drain placement after mastectomy in ARISTATM AH group. Further research including randomised controlled multi-centre study evaluating the benefit of topical haemostatic agents in reducing seroma formation in breast surgery is warranted.
{"title":"Impact of microporous polysaccharide haemostatic agent on patients undergoing mastectomy or axillary dissection on seroma formation and timing of drain removal","authors":"Sarah Mahmood, A. Brodaric, Rajkumar Srinivasan, Ruben Cohen-Hallaleh","doi":"10.18203/2349-2902.isj20240674","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240674","url":null,"abstract":"Background: Seroma formation is a known complication following mastectomy and axillary lymph node dissection (ALND) leading to morbidity and financial implications for patients. ARISTATM AH has been designed to prevent postoperative seromas formation in vitro.\u0000Methods: We performed a single institution, single surgeon retrospective study from January 2017 to December 2022 in patients undergoing mastectomy/axillary dissection to evaluate seroma formation rates and timing of drain removal.\u0000Results: A total of 72 cases were included in our retrospective review of electronic medical records. Of these, 40 patients underwent ipsilateral mastectomies with sentinel node biopsies, 8 patients underwent bilateral mastectomies, and 18 patients underwent axillary dissections without concurrent mastectomy. Our analysis showed a non-significant decrease in seroma formation when ARISTATM AH was used intra-operatively (10%) compared to standard care (24%), (p=0.14). The ARISTATM AH group had a statistically significantly longer mean drain removal time than the standard care group (12.9 vs 7.6 days, p=0.002).\u0000Conclusions: There was a trend towards lower seroma formation and a significantly longer requirement for drain placement after mastectomy in ARISTATM AH group. Further research including randomised controlled multi-centre study evaluating the benefit of topical haemostatic agents in reducing seroma formation in breast surgery is warranted.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"62 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140252023","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}
Pub Date : 2024-03-08DOI: 10.18203/2349-2902.isj20240670
Arief Fadli Putra, F. A. Yulianto
Urethral calculus is rare in pediatrics, especially with acute urinary retention. The diagnosis of urethral calculus is made by proper history taking, physical examination, and imaging studies. In this case, the diagnosis was made mainly by anamnesis, inspection, and palpation of the calculus in the external urethral meatus. Invasive and less invasive procedures such as open surgery, meatotomy, or laser lithotripsy procedure, can be a management of urethral calculus. In this case, simple extraction was performed without meatotomy or other invasive procedures. A 5-year-old, boy was reported to come to the emergency department because of severe pain in his penis and acute urinary retention. The patient had a history of dysuria, a habit of delaying urination, and low fluid intake. On physical examination, it was found a distention in the suprapubic area and a green-white solid mass at the external urethral meatus. A 10-millimeter calculus was successfully extracted from the external urethral meatus with simple extraction procedures under local anesthesia. This case report demonstrated a rare case of pediatric acute urinary retention secondary to impacted urethral meatal calculus in an emergency setting of a low-level hospital. Immediate and proper management was required due to the patient's condition and considering the lack of facilities. The extraction of calculus with minimal urethral damage was the recommendation.
{"title":"Pediatric acute urinary retention due to impacted urethral meatal calculus: a rare case report","authors":"Arief Fadli Putra, F. A. Yulianto","doi":"10.18203/2349-2902.isj20240670","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240670","url":null,"abstract":"Urethral calculus is rare in pediatrics, especially with acute urinary retention. The diagnosis of urethral calculus is made by proper history taking, physical examination, and imaging studies. In this case, the diagnosis was made mainly by anamnesis, inspection, and palpation of the calculus in the external urethral meatus. Invasive and less invasive procedures such as open surgery, meatotomy, or laser lithotripsy procedure, can be a management of urethral calculus. In this case, simple extraction was performed without meatotomy or other invasive procedures. A 5-year-old, boy was reported to come to the emergency department because of severe pain in his penis and acute urinary retention. The patient had a history of dysuria, a habit of delaying urination, and low fluid intake. On physical examination, it was found a distention in the suprapubic area and a green-white solid mass at the external urethral meatus. A 10-millimeter calculus was successfully extracted from the external urethral meatus with simple extraction procedures under local anesthesia. This case report demonstrated a rare case of pediatric acute urinary retention secondary to impacted urethral meatal calculus in an emergency setting of a low-level hospital. Immediate and proper management was required due to the patient's condition and considering the lack of facilities. The extraction of calculus with minimal urethral damage was the recommendation.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"23 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140258136","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}
Pub Date : 2024-03-08DOI: 10.18203/2349-2902.isj20240668
Ryan J. Green, Sarath Vennam, Max Ireland, Grant Withey, Amelia Melloy
A patient in her 60 years presented for routine mammographic screening. A lesion was identified, which on biopsy was proven to be marginal zone lymphoma (MZL). MZL is a group of indolent non-Hodgkin’s B-Cell lymphomas. Involvement of breast tissue is rare and can mimic more common breast pathology. In addition, the patient had widespread subcutaneous lesions which is also atypical of the cutaneous form of MZL lymphoma. This case describes the multi-modality radiological findings of this uncommon presentation of diffuse cutaneous MZL.
一位 60 多岁的患者前来接受常规乳腺 X 线照相检查。检查发现了一个病灶，活检证实为边缘区淋巴瘤（MZL）。边缘区淋巴瘤是一类不活跃的非霍奇金B细胞淋巴瘤。淋巴瘤累及乳腺组织的情况非常罕见，可能会模仿更常见的乳腺病理。此外，患者还伴有广泛的皮下病变，这也是皮肤型MZL淋巴瘤的非典型表现。本病例描述了这种不常见的弥漫性皮肤型MZL的多模态放射学结果。
{"title":"Asymptomatic marginal zone lymphoma detected on routine mammogram, an unusual presentation","authors":"Ryan J. Green, Sarath Vennam, Max Ireland, Grant Withey, Amelia Melloy","doi":"10.18203/2349-2902.isj20240668","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240668","url":null,"abstract":"A patient in her 60 years presented for routine mammographic screening. A lesion was identified, which on biopsy was proven to be marginal zone lymphoma (MZL). MZL is a group of indolent non-Hodgkin’s B-Cell lymphomas. Involvement of breast tissue is rare and can mimic more common breast pathology. In addition, the patient had widespread subcutaneous lesions which is also atypical of the cutaneous form of MZL lymphoma. This case describes the multi-modality radiological findings of this uncommon presentation of diffuse cutaneous MZL.\u0000 ","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"36 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140257376","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}
Pub Date : 2024-03-08DOI: 10.18203/2349-2902.isj20240669
Ricardo-Raziel Peña-González, Ricardo-Paul Arellano-López, Erick-F. Hernández, Brandon-Rafael Contreras-Díaz, Williams O. Ramírez-Miguel, Eduardo Aguilera-Callejas, Jonathan Quiroz-Alvarez, Gabriela E. Gutiérrez-Uvalle
The pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by presence of gaseous cysts containing nitrogen, hydrogen and carbon dioxide in the intestinal wall that can be idiopathic or associated with other diseases. There are 5 theories about the pathophysiology: mechanic (obstruction), immunosuppression (atrophy of Peyer's patches), bacterial (Clostridium spp.), pulmonary (chronic pulmonary disease) and chemical (exposure to trichloroethylene). The aim of this paper is to present a clinical case of a patient with rheumatic comorbidity admitted to the emergency service and diagnosed with acute abdomen secondary to intestinal volvulus associated with pneumatosis intestinalis.
{"title":"Pneumatosis intestinalis as a manifestation of chronic intestinal volvulus: case report","authors":"Ricardo-Raziel Peña-González, Ricardo-Paul Arellano-López, Erick-F. Hernández, Brandon-Rafael Contreras-Díaz, Williams O. Ramírez-Miguel, Eduardo Aguilera-Callejas, Jonathan Quiroz-Alvarez, Gabriela E. Gutiérrez-Uvalle","doi":"10.18203/2349-2902.isj20240669","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240669","url":null,"abstract":"The pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by presence of gaseous cysts containing nitrogen, hydrogen and carbon dioxide in the intestinal wall that can be idiopathic or associated with other diseases. There are 5 theories about the pathophysiology: mechanic (obstruction), immunosuppression (atrophy of Peyer's patches), bacterial (Clostridium spp.), pulmonary (chronic pulmonary disease) and chemical (exposure to trichloroethylene). The aim of this paper is to present a clinical case of a patient with rheumatic comorbidity admitted to the emergency service and diagnosed with acute abdomen secondary to intestinal volvulus associated with pneumatosis intestinalis.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"14 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140258072","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}
Pub Date : 2024-03-05DOI: 10.18203/2349-2902.isj20240660
Simone H. Mangan, Justin Ng, Jessica Y Ng
Flexible endoscopy is a gold standard diagnostic test for the evaluation of the gastrointestinal tract and an accessible intervention in clinical practice. Completion rates are generally high while perforation rates are low in experienced hands. Situs inversus totalis (SIT) is a rare congenital abnormality that involves the complete transposition of all the viscera. In less-experienced hands, incompletion and perforation rates may increase in patients with SIT due to unfamiliarity with anatomy. The purpose of this case report is to present methods such as reverse manoeuvres to assist in the safe completion of an endoscopy in SIT when technical difficulties arise. Using a case of a patient in a rural hospital who presented for a colonoscopy who had SIT, we discuss the use of adjuncts, variations in segment specific manoeuvres, traditional positioning and abdominal pressure points in-order to perform a safe and successful endoscopy in a patient with SIT.
柔性内窥镜检查是评估胃肠道的金标准诊断检测，也是临床实践中可采用的干预措施。在经验丰富的医生手中，检查的完成率通常很高，而穿孔率则很低。全胃窦不全（Situs inversus totalis，SIT）是一种罕见的先天性畸形，涉及所有内脏的完全移位。在经验不足的医生手中，由于不熟悉解剖结构，SIT 患者的手术不完全率和穿孔率可能会增加。本病例报告的目的是介绍一些方法，如反向操作，以帮助 SIT 患者在出现技术困难时安全地完成内窥镜检查。 通过一个在乡镇医院接受结肠镜检查的 SIT 患者的病例，我们讨论了辅助工具的使用、特定节段操作的变化、传统定位和腹部压力点，以便为 SIT 患者安全、成功地进行内镜检查。
{"title":"Navigating endoscopic challenges in situs inversus totalis: strategies for optimal procedure completion and patient safety","authors":"Simone H. Mangan, Justin Ng, Jessica Y Ng","doi":"10.18203/2349-2902.isj20240660","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240660","url":null,"abstract":"Flexible endoscopy is a gold standard diagnostic test for the evaluation of the gastrointestinal tract and an accessible intervention in clinical practice. Completion rates are generally high while perforation rates are low in experienced hands. Situs inversus totalis (SIT) is a rare congenital abnormality that involves the complete transposition of all the viscera. In less-experienced hands, incompletion and perforation rates may increase in patients with SIT due to unfamiliarity with anatomy. The purpose of this case report is to present methods such as reverse manoeuvres to assist in the safe completion of an endoscopy in SIT when technical difficulties arise. Using a case of a patient in a rural hospital who presented for a colonoscopy who had SIT, we discuss the use of adjuncts, variations in segment specific manoeuvres, traditional positioning and abdominal pressure points in-order to perform a safe and successful endoscopy in a patient with SIT.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"3 5‐6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140265037","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}
Pub Date : 2024-03-05DOI: 10.18203/2349-2902.isj20240661
Alexander Yuen
Neutropaenic enterocolitis (NE) is a life-threatening complication of neutropenia rarely seen in adults. Cases of NE arising outside the context of haematological malignancies or oncological treatments remain extremely infrequent. We present a case of bowel perforation secondary to NE in a female adult patient who developed agranulocytosis after commencement of thionamide antithyroid medications for hyperthyroidism. Patients recently commenced on thionamides should be educated on the symptoms of agranulocytosis and present to the hospital. Emergency physicians and surgeons alike should have a high index of suspicion for NE in this group of patients and prompt surgical intervention may be required to reduce the significant mortality rate.
中性粒细胞减少性小肠结肠炎（NE）是一种危及生命的中性粒细胞减少并发症，在成人中很少见。在血液恶性肿瘤或肿瘤治疗之外出现的中性粒细胞减少性肠炎病例仍极为罕见。我们在此介绍一例继发于 NE 的肠穿孔病例，患者为一名成年女性，因甲状腺功能亢进开始使用硫代酰胺类抗甲状腺药物治疗后出现粒细胞减少。近期开始服用硫胺类药物的患者应了解粒细胞减少的症状并前往医院就诊。急诊内科医生和外科医生都应高度怀疑这类患者患有NE，可能需要及时进行手术干预，以降低可观的死亡率。
{"title":"A rare case of bowel perforation in an adult with antithyroid medication induced neutropaenic enterocolitis","authors":"Alexander Yuen","doi":"10.18203/2349-2902.isj20240661","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240661","url":null,"abstract":"Neutropaenic enterocolitis (NE) is a life-threatening complication of neutropenia rarely seen in adults. Cases of NE arising outside the context of haematological malignancies or oncological treatments remain extremely infrequent. We present a case of bowel perforation secondary to NE in a female adult patient who developed agranulocytosis after commencement of thionamide antithyroid medications for hyperthyroidism. Patients recently commenced on thionamides should be educated on the symptoms of agranulocytosis and present to the hospital. Emergency physicians and surgeons alike should have a high index of suspicion for NE in this group of patients and prompt surgical intervention may be required to reduce the significant mortality rate.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"120 27","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140079105","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}
Pub Date : 2024-02-29DOI: 10.18203/2349-2902.isj20240589
Shashank Jain, Shraddha Dama, Nikhil L. Beldar, Abhishek G. Mahadik, Abhijeet Budhkar
Rhabdomyosarcoma (RMS) is known to be common childhood soft tissue sarcoma (STS). RMS is infrequent in adults. STS constitute <1% of all adult solid malignant sarcomas and RMS accounts for 3% of all STS. The tumor is divided into three main subtypes-embryonal, alveolar, and pleomorphic (most common in adults). The most common primary sites are extremities. It’s an aggressive lesion with a high rate of metastasis. The patient presented with a non-healing wound over a posterior-medial aspect of the right leg with features suggestive of cellulitis. The patient gave a history of fall 5 months ago for which he took treatment at a local doctor, he continued to have severe pain for which an orthopedic opinion was taken and advised conservative management for an un-displaced fracture of the fibula. He later developed swelling over the lower-middle part of his right leg 3 months ago for which an ultrasound was done suggestive of a large amount of fluid suspicious of hematoma secondary to A-V malformation, an attempt for drainage of fluid was made leading to an evacuation of blood clots further procedure was abandoned and the patient transferred to our center. CT-angio demonstrated it as a heterogeneously attenuating solid cystic lesion. After appropriate consents-wound exploration was done with the evacuation of soft gelatinous material with pus discharge and blood clots. HPE-suggestive of high-grade pleomorphic rhabdomyosarcoma. The patient was advised amputation but denied any further treatment. Post-operative recovery was uneventful with no recurrence for the first 6 months after which the patient did not follow up. Post-traumatic mass at extremities should be evaluated with a high index of suspicion of STS. In case of doubt, either a preoperative biopsy or an intraoperative frozen section is a safe practice.
{"title":"Case report of high-grade pleomorphic sarcoma (rhabdomyosarcoma): a missed diagnosis in the non-healing post-traumatic wound of the elderly","authors":"Shashank Jain, Shraddha Dama, Nikhil L. Beldar, Abhishek G. Mahadik, Abhijeet Budhkar","doi":"10.18203/2349-2902.isj20240589","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240589","url":null,"abstract":"Rhabdomyosarcoma (RMS) is known to be common childhood soft tissue sarcoma (STS). RMS is infrequent in adults. STS constitute <1% of all adult solid malignant sarcomas and RMS accounts for 3% of all STS. The tumor is divided into three main subtypes-embryonal, alveolar, and pleomorphic (most common in adults). The most common primary sites are extremities. It’s an aggressive lesion with a high rate of metastasis. The patient presented with a non-healing wound over a posterior-medial aspect of the right leg with features suggestive of cellulitis. The patient gave a history of fall 5 months ago for which he took treatment at a local doctor, he continued to have severe pain for which an orthopedic opinion was taken and advised conservative management for an un-displaced fracture of the fibula. He later developed swelling over the lower-middle part of his right leg 3 months ago for which an ultrasound was done suggestive of a large amount of fluid suspicious of hematoma secondary to A-V malformation, an attempt for drainage of fluid was made leading to an evacuation of blood clots further procedure was abandoned and the patient transferred to our center. CT-angio demonstrated it as a heterogeneously attenuating solid cystic lesion. After appropriate consents-wound exploration was done with the evacuation of soft gelatinous material with pus discharge and blood clots. HPE-suggestive of high-grade pleomorphic rhabdomyosarcoma. The patient was advised amputation but denied any further treatment. Post-operative recovery was uneventful with no recurrence for the first 6 months after which the patient did not follow up. Post-traumatic mass at extremities should be evaluated with a high index of suspicion of STS. In case of doubt, either a preoperative biopsy or an intraoperative frozen section is a safe practice.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"29 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140414059","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}
Pub Date : 2024-02-29DOI: 10.18203/2349-2902.isj20240566
Kevin Kah Wai Yoong, M. Chen, A. Liew, Senali Weeratunga, Y. Tay
Background: Formation of loop ileostomy is common after anterior resection to reduce the sequalae of an anastomosis leak. Delays to reversal of ileostomy is associated with complications. Methods: Retrospective study between 1 July 2017 to 30 June 2023. Patients were included: >18 years old, loop ileostomy formed as part of anterior resection surgery (benign and malignant). Exclusion criteria: loop ileostomy performed during other colonic resections, patients with inflammatory bowel disease, de-functioning ileostomy for obstructions. Primary outcome measures included complications associated with delayed closure of loop ileostomy and readmissions after reversal surgery. Secondary measures included reasons for delay to surgery, complications prior to reversal surgery, and morbidity and mortality associated with it. Results: 135 patients were included. 85.9% of patients experienced delays in reversal surgery. Those without delays in surgery had higher rate of stoma-related complications (p=0.002). Delays were due to a long waitlist (p<0.01) and adjuvant chemotherapy (p=0.598). There were no significant differences in the delays to surgery during COVID pandemic. Delays were associated with higher rate of wound infection (6.04%), post-operative ileus (12.07%), anastomotic leak (1.72%), and Clostridium difficile (C. diff) infection (3.45%). Handsewn end to end anastomosis was associated with higher proportion of post-operative ileus compared to the stapled side to side anastomosis group. Conclusions: Reversal of ileostomy within 6 months of index surgery after adjuvant therapy could potentially reduce post-operative complications, and alleviate the burden on our healthcare system in the long run. A stapled side to side anastomosis should also be considered.
{"title":"Retrospective study in a single unit: outcomes of delays in reversal of loop ileostomy","authors":"Kevin Kah Wai Yoong, M. Chen, A. Liew, Senali Weeratunga, Y. Tay","doi":"10.18203/2349-2902.isj20240566","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240566","url":null,"abstract":"Background: Formation of loop ileostomy is common after anterior resection to reduce the sequalae of an anastomosis leak. Delays to reversal of ileostomy is associated with complications.\u0000Methods: Retrospective study between 1 July 2017 to 30 June 2023. Patients were included: >18 years old, loop ileostomy formed as part of anterior resection surgery (benign and malignant). Exclusion criteria: loop ileostomy performed during other colonic resections, patients with inflammatory bowel disease, de-functioning ileostomy for obstructions. Primary outcome measures included complications associated with delayed closure of loop ileostomy and readmissions after reversal surgery. Secondary measures included reasons for delay to surgery, complications prior to reversal surgery, and morbidity and mortality associated with it.\u0000Results: 135 patients were included. 85.9% of patients experienced delays in reversal surgery. Those without delays in surgery had higher rate of stoma-related complications (p=0.002). Delays were due to a long waitlist (p<0.01) and adjuvant chemotherapy (p=0.598). There were no significant differences in the delays to surgery during COVID pandemic. Delays were associated with higher rate of wound infection (6.04%), post-operative ileus (12.07%), anastomotic leak (1.72%), and Clostridium difficile (C. diff) infection (3.45%). Handsewn end to end anastomosis was associated with higher proportion of post-operative ileus compared to the stapled side to side anastomosis group.\u0000Conclusions: Reversal of ileostomy within 6 months of index surgery after adjuvant therapy could potentially reduce post-operative complications, and alleviate the burden on our healthcare system in the long run. A stapled side to side anastomosis should also be considered.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"43 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140414214","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：