Is surgical exploration mandatory in pneumatosis intestinalis with portomesenteric gas? Lesson learned in a neutropenic patient under chemotherapy

2021 ◽  
Author(s):  
Pasi Pengermä ◽  
Jevgeni Katunin ◽  
Arto Turunen ◽  
Ioannis Rouvelas ◽  
Ari Palomäki ◽  
...  
Keyword(s):  
Neutropenic Patient ◽  
Pneumatosis Intestinalis ◽  
Surgical Exploration

Is surgical exploration necessary in asymptomatic intestinal pneumatosis after lung transplantation?

2021 ◽  
Vol 14 (11) ◽  
pp. e243955
Author(s):  
Julie Van Den Bosch ◽  
Pieter Broos ◽  
Guy Vijgen
Keyword(s):  
Decision Making ◽  
Lung Transplantation ◽  
Clinical Decision Making ◽  
Bowel Wall ◽  
Pneumatosis Intestinalis ◽  
Clinical Decision ◽  
Bowel Ischaemia ◽  
Incidental Diagnosis ◽  
Surgical Exploration ◽  
Intestinal Pneumatosis

Pneumatosis intestinalis is described as gas within the bowel wall and can be a sign of bowel ischaemia with a pending perforation. The described patient presented with the incidental diagnosis of pneumatosis intestinalis with free intraperitoneal gas on CT scan. His medical history included a successful lung transplantation. We here describe the clinical decision-making and evaluate our case with previous cases in the literature.

scholarly journals How to Avoid Nontherapeutic Laparotomy in Patients With Multiple Organ Failure of Unknown Origin. The Role of CT Scan Revisited

2015 ◽  
Vol 100 (3) ◽  
pp. 466-472 ◽  
Author(s):  
Stephanie Li Sun Fui ◽  
Renato Micelli Lupinacci ◽  
Christophe Trésallet ◽  
Matthieu Faron ◽  
Gaelle Godiris-Petit ◽  
...  
Keyword(s):  
Ct Scan ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Univariate Analysis ◽  
Unknown Origin ◽  
Pneumatosis Intestinalis ◽  
Ct Scans ◽  
Preoperative Imaging ◽  
Surgical Exploration ◽  
Nontherapeutic Laparotomy

Diagnosis of intra-abdominal diseases in critically ill patients remains a clinical challenge. Physical examination is unreliable whereas exploratory laparotomy may aggravate patient's condition and delay further evaluation. Only a few studies have investigated the place of computed tomography (CT) on this hazardous situation. We aimed to evaluate the ability of CT to prevent unnecessary laparotomy during the management of critically ill patients. Charts of all consecutive patients who had undergone an emergency nontherapeutic laparotomy from 1996 to 2013 were retrospectively studied and patient's demographic, clinical characteristics, and surgical findings were collected. During this period 59 patients had an unnecessary laparotomy. Fifty-one patients had at least one preoperative imaging and 36 had a CT scan. CT scans were interpreted to be normal (n = 12), with minor anomalies (n = 10), or major anomalies (pneumoperitoneum, portal venous gas/pneumatosis intestinalis, thickened gallbladder wall, and small bowel obstruction signs). Surgical exploration was performed through laparotomy (n = 55) or laparoscopy. Overall mortality was 37% with a median survival after surgery of 7 days. In univariate analysis, hospitalization in ICU before surgical exploration was the only factor related to death. In our series CT scans, objectively interpreted, helped avoid unnecessary surgical exploration in 61% of our patients.

scholarly journals Extensive pneumatosis intestinalis: a benign bystander

2018 ◽  
Vol 5 (3) ◽  
pp. 1114
Author(s):  
Yazmin Johari ◽  
Geraldine Ooi ◽  
Vignesh Narasimhan
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Surgical Management ◽  
Clinical Finding ◽  
Radiological Finding ◽  
Pneumatosis Intestinalis ◽  
Clinical Findings ◽  
Surgical Exploration ◽  
Clinically Significant ◽  
Ct Finding

Pneumatosis intestinalis is a rare clinical finding detected radiologically and intraoperatively that points to an underlying benign or worrisome cause. Management of pneumatosis intestinalis poses an interesting dilemma for surgeons given the heterogeneity of its potential causes. In clinically significant pneumatosis, urgent surgical management is paramount. However, in benign causes of pneumatosis, surgical exploration is not necessary and maybe harmful. Clinical findings of peritonism, increased lactate and radiological finding porto-mesenteric venous gas are suggestive of clinically significant pneumatosis that warrants surgical management. In this case report, we described an incidental computed tomography (CT) finding of extensive pneumatosis in an elderly man with appendicitis.

Indications for Surgical Exploration in the Diagnosis of Intrahepatic Obstructive Jaundice

1952 ◽  
Vol 22 (2) ◽  
pp. 232-243
Author(s):  
Leonard A. Stine ◽  
Richard M. Bendix ◽  
Jerome M. Swarts
Keyword(s):  
Obstructive Jaundice ◽  
Surgical Exploration

Simple bone cyst: Uncommon cyst of jaw

2020 ◽  
Vol 5 (3) ◽  
pp. 1252-1254
Author(s):  
Gopal Gurung ◽  
Laxmi Prasad Chapagain ◽  
Yagya Bahadur Rokaya
Keyword(s):  
Orthodontic Treatment ◽  
Bone Cyst ◽  
Definitive Treatment ◽  
Simple Bone Cyst ◽  
Jaw Cysts ◽  
Surgical Exploration ◽  
X Ray ◽  
Dental Examination ◽  
Distal Surface ◽  
Hollow Cavity

Simple bone cyst (SBC) of the jaws is uncommon, representing approximately 1% of all jaw cysts. It is often accidentally discovered on routine dental examination as it is asymptomatic in most of cases. In this report, we discuss a case of SBC in a 16 years old female who presented in our department for correction of her mal-aligned teeth. On routine x-ray for orthodontic treatment, a well defined, unilocular radiolucent area approximately 3x1cm in size with scalloped borders on the left body of mandible expanding from distal surface of 34 to distal surface of 37 was discovered. Surgical exploration was required for both diagnostic and definitive treatment. The operative finding was hollow cavity without any epithelial lining.

An Attempted Homicidal Cut Throat Injury: A Case Study

2020 ◽  
Vol 3 (2) ◽  
pp. 147-151
Author(s):  
Mukesh Kumar Sah ◽  
Madhu Thakur
Keyword(s):  
Physical Examination ◽  
Blood Vessels ◽  
Management Practice ◽  
Limited Time ◽  
Optimal Management ◽  
Surgical Exploration

Homicidal cut throat is an injury over the front of neck by sharp instruments with an intent of murder. The neck contains vital structures (nerves, blood vessels, airway and pharyngeal conduit) in a compact fashion that may be difficult to access for physical examination or surgical exploration in a limited time. That is why these cases create panic and pose great challenges in the management. Here is a case of an attempted homicidal cut throat injury that highlights some of the challenges encountered in the management along with discussion on the evolving knowledge of the optimal management practice.

Fascicular torsions of the anterior and posterior interosseous nerve in 4 cases: neuroimaging methods to improve diagnosis

2020 ◽  
Vol 132 (6) ◽  
pp. 1925-1929 ◽  
Author(s):  
Jennifer Kollmer ◽  
Paul Preisser ◽  
Martin Bendszus ◽  
Henrich Kele
Keyword(s):  
Magnetic Resonance ◽  
Surgical Intervention ◽  
Case Series ◽  
Diagnostic Methods ◽  
Posterior Interosseous Nerve ◽  
Nerve Ultrasound ◽  
Magnetic Resonance Neurography ◽  
Surgical Exploration ◽  
Hyperintense Signal ◽  
Emergency Surgical Intervention

Diagnosis of spontaneous fascicular nerve torsions is difficult and often delayed until surgical exploration is performed. This case series raises awareness of peripheral nerve torsions and will facilitate an earlier diagnosis by using nerve ultrasound (NUS) and magnetic resonance neurography (MRN). Four patients with previously ambiguous upper-extremity mononeuropathies underwent NUS and 3T MRN. Neuroimaging detected proximal torsions of the anterior and posterior interosseous nerve fascicles within median or radial nerve trunks in all patients. In NUS, most cases presented with a thickening of affected nerve fascicles, followed by an abrupt caliber decrease, leading to the pathognomonic sausage-like configuration. MRN showed T2-weighted hyperintense signal alterations of fascicles at and distal to the torsion site, and directly visualized the distorted nerves. Three patients had favorable outcomes after being transferred to emergency surgical intervention, while 1 patient with existing chronic muscle atrophy was no longer eligible for surgery. NUS and MRN are complementary diagnostic methods, and both can detect nerve torsions on a fascicular level. Neuroimaging is indispensable for diagnosing fascicular nerve torsions, and should be applied in all unclear cases of mononeuropathy to determine the diagnosis and if necessary, to guide surgical therapies, as only timely interventions enable favorable outcomes.

Surgical exploration of the head, neck and chest

2010 ◽  
Vol 2010 (7) ◽  
pp. 24-24
Author(s):  
Daniel Brockman
Keyword(s):  
Surgical Exploration ◽  
Head Neck
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