scholarly journals Cholecystobronchocolic Fistula: A Late Complication of Biliary Sepsis

HPB Surgery ◽  
1994 ◽  
Vol 7 (4) ◽  
pp. 319-326
Author(s):  
D. A. Collie ◽  
D. N. Redhead ◽  
O. J. Garden
Keyword(s):  
Respiratory Failure ◽  
High Mortality ◽  
Clinical Condition ◽  
Biliary Drainage ◽  
Rare Complication ◽  
Late Complication ◽  
Aggressive Management ◽  
Biliary Sepsis ◽  
Definitive Surgery

A case of a 48 year old woman presenting with bilioptysis due to a cholecystobronchocolic fistula is reported. Bilioptysis is a rare complication of biliary fistulae, with a high mortality due to chemical pneumonitis. Bronchospasm and rapid respiratory failure may ensue if aggressive management is not adopted. The site of fistulation is established by cholangiography, preferably by the percutaneous transhepatic route. Continued biliary drainage can lead to closure of these fistulae, or allow sufficient improvement in clinical condition to allow definitive surgery to be performed electively.

scholarly journals Bedside Percutaneous Approach in a Critically Ill ICU Patient with Complex Pancreatobiliary Disorder Followed by Endoscopic Approach: Lessons Learnt from a Tertiary Referral Center

2021 ◽  
pp. 210-217
Author(s):  
Cosmas Rinaldi Adithya Lesmana ◽  
Caecilia Herjuningtyas ◽  
Sri Inggriani ◽  
Yulia Estu Pratiwi ◽  
Laurentius A. Lesmana
Keyword(s):  
Critically Ill ◽  
Clinical Condition ◽  
Biliary Drainage ◽  
Pancreatic Pseudocyst ◽  
Endoscopic Approach ◽  
Team Approach ◽  
Training Experience ◽  
Percutaneous Approach ◽  
Tertiary Referral Center ◽  
Biliary Sepsis

Pancreatobiliary disorder is a challenging clinical condition, especially when this condition is causing severe infection or biliary sepsis, and sometimes it requires intensive care unit (ICU) treatment. Biliary drainage is the mainstay of therapy; however, the choice of the drainage method is dependent on the patient’s clinical condition and the disease itself. A 79-year-old female was transferred on a ventilator to our ICU from another hospital due to biliary sepsis, a large common bile duct stone, and an infected pancreatic pseudocyst. The patient also has other comorbidities such as heart problems, hypothyroidism, and diabetes mellitus. Bedside percutaneous transhepatic biliary drainage without fluoroscopy and percutaneous cyst aspiration was successfully performed, which improved the patient’s condition; this was followed by an endoscopic approach, i.e., endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided pancreatic pseudocyst drainage. The clinical improvement showed itself in the change of the patient’s respiratory status and ventilator mode. In conclusion, the percutaneous approach has a big role in managing critically ill patients in the ICU setting. However, expertise, training experience, and a multidisciplinary team approach are very important for successful management and patient outcome.

Enoxaparin-induced Wunderlich syndrome in a young patient with anti-GAD 65-associated opsoclonus and limbic encephalitis: a rare complication in a rare disease

2021 ◽  
Vol 14 (10) ◽  
pp. e244916
Author(s):  
Saranya B Gomathy ◽  
Animesh Das ◽  
Awadh Kishor Pandit ◽  
Achal Kumar Srivastava
Keyword(s):  
Rare Disease ◽  
Young Patient ◽  
Clinical Condition ◽  
Limbic Encephalitis ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Autoimmune Encephalitis ◽  
Rare Condition ◽  
Gad 65 ◽  
Good Improvement

Wunderlich syndrome is a rare condition characterised by acute spontaneous non-traumatic renal haemorrhage into the subcapsular and perirenal spaces. Our case of anti-GAD65-associated autoimmune encephalitis (AE), aged 30 years, developed this complication following use of enoxaparin and was managed by selective glue embolisation of subsegmental branches of right renal cortical arteries. Our case had opsoclonus as one of the clinical manifestations, which has till now been described in only two patients of this AE. This patient received all forms of induction therapies (steroids, plasmapheresis, intravenous immunoglobulin and rituximab) following which she had good improvement in her clinical condition. The good response to immunotherapy is also a point of discussion as this has been rarely associated with anti-GAD65 AE.

scholarly journals Percutaneous biliary drainage in the management of biliary sepsis

1982 ◽  
Vol 138 (1) ◽  
pp. 25-29 ◽  
Author(s):  
S Kadir ◽  
A Baassiri ◽  
KH Barth ◽  
SL Kaufman ◽  
JL Cameron ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Percutaneous Biliary Drainage ◽  
Biliary Sepsis

scholarly journals Master of the Masquerade: An Atypical Presentation of Acute Aortic Dissection

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ramy Mando ◽  
Daniel Tim ◽  
Anthony DeCicco ◽  
Justin Trivax ◽  
Ivan Hanson
Keyword(s):  
Mortality Rate ◽  
Early Diagnosis ◽  
Aortic Dissection ◽  
High Mortality ◽  
Acute Aortic Dissection ◽  
Atypical Presentation ◽  
Aggressive Management ◽  
Life Threatening

Acute aortic dissection (AAD) is associated with unacceptably high mortality rate. As such, early diagnosis and aggressive management are essential in order to avoid life-threatening complications. Herein, we report an atypical presentation of AAD and clinical sequelae.

scholarly journals Extra-thoracal migration of the Nuss Bar in corrective surgery for pectus excavatum: a very rare late complication

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Natalie Simon ◽  
Shyam Kolvekar ◽  
Amir Khosravi
Keyword(s):  
Pectus Excavatum ◽  
Surgical Intervention ◽  
Rare Complication ◽  
Late Complication ◽  
Nuss Procedure ◽  
Corrective Surgery ◽  
Chest Wall Deformity ◽  
X Ray ◽  
First Case

Abstract Pectus excavatum is a chest wall deformity with an incidence of around 1 in 400 live births. The Nuss procedure is a surgical intervention that aims to restore functional integrity in these patients. We report the first case of bar migration into the stomach necessitating further surgical intervention for removal. Our case presents a rare complication of pectus excavatum repair and highlights the importance of vigilant follow-up in these patients. If bar migration does occur, imaging in the form of X-ray and CT scans may be of use in early detection in order to expedite management.

scholarly journals Acute hypercapnic respiratory failure as a rare complication of meningoencephalitis: Two case reports

2017 ◽  
Vol 4 (2) ◽  
pp. 31
Author(s):  
Leonidas Grigorakos ◽  
Katerina Tzortzopoulou ◽  
Anastasia Alexopoulou ◽  
Eva Sotiriou ◽  
Dimitra Markopoulou ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Elderly Patients ◽  
Lumbar Puncture ◽  
Case Reports ◽  
Rare Complication ◽  
Antiviral Treatment ◽  
Proper Treatment ◽  
Hypercapnic Respiratory Failure ◽  
Arterial Blood ◽  
Acute Hypercapnic Respiratory Failure

Background: Differentiated diagnosis of meningoencephalitis in elderly patients, when an uncommon picture of respiratory infection leading to acute hypercapnic respiratory failure (AHRF) and without neurological signs is present, may raise serious difficulties.Case report: Two patients aged 72 (patient 1) and 75 (patient 2), without any medical history of respiratory problems, were hospitalized during spring with influenza symptoms. Within less than 24 hours from their admission, patients developed AHFR, which led to disturbances of arterial blood gases (ABGs). They were intubated and transferred, mechanically ventilated, to our intensive care unit (ICU). After normalization of ABGs, a weaning process followed. Weaning was unsuccessful, as unexpected neurological semiotics occurred. The imaging of neurological MRI revealed no special damage apart from microangiopathy. Further investigations through lumbar puncture with cerebrospinal fluid (CSF) testing revealed meningoencephalitis. Antiviral treatment was applied and the outcome was successful for both patients.Conclusion: Critical care medical personnel should be aware of the event of viral meningoencephalitis in elderly patients with AHRF. Especially in the middle of influenza endemic periods, the management of elderly patients may not be appropriate, thus resulting in serious delays for a proper treatment of disease. Laboratory screening of blood and urine, as well as other body fluids, can help detect and determine brain infection. Results from these tests can help exclude other diseases that mimic meningoencephalitis. In cases of patients who are hospitalized in the ICU due to AHRF and do not exhibit neurological abnormalities from the onset of illness, lumbar puncture and check of CSF should be a routine examination. Prophylactic vaccination of high-risk groups may be of crucial importance for preventing complications in patients who develop meningoencephalitis. However, once infected with this disease, the positive outcome is highly dependent on the immediate diagnosis and proper treatment of patients in the ICU.

scholarly journals Acute Febrile Encephalopathy in Children: A Prospective Study of Clinical Features, Etiology, Mortality, and Risk Factors from Western India

2018 ◽  
Vol 09 (01) ◽  
pp. 019-025 ◽  
Author(s):  
Kirti Gupta ◽  
Charul S. Purani ◽  
Anirban Mandal ◽  
Amitabh Singh
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Clinical Features ◽  
High Mortality ◽  
Tertiary Care ◽  
Primary Objective ◽  
Medical Emergency ◽  
Western India ◽  
Care Hospital ◽  
Factors Associated

ABSTRACT Introduction: Acute febrile encephalopathy (AFE) in children is a medical emergency and could be a manifestation of many systemic and central nervous system pathologies. The clinical features of AFE are nonspecific and etiological spectrum variable depending on the studied population. Materials and Methods: A prospective, observational study was carried out including children aged between 1 month and 12 years with AFE admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in Western India. The primary objective was to assess the clinical presentation and etiology of AFE while the secondary objectives were to correlate the clinical and etiological findings and to determine the risk factors associated with mortality. Results: Out of the ninety children with AFE included in this study, male:female ratio was 1.2:1; most of them were aged between 1 and 5 years and came with a history of <7 days (82.2%). All of them had altered sensorium, about 2/3rd had seizures and 47.8% having a Glasgow Coma Score (GCS) <8. Etiology remained elusive in about 40% of the cases, and viral infections were the most common among the ones with an identifiable cause. A variety of morbidity (shock, disseminated intravascular coagulopathy, respiratory failure, etc.) and high mortality (40%) was observed with risk factors associated with mortality being GCS <8, the presence of raised intracranial pressure, shock, and respiratory failure. Conclusion: AFE, though a rare diagnosis in children, is associated with significant morbidity and high mortality in a developing country like India.

Gallbladder carcinoma: A rare complication of percutaneous trans-hepatic biliary drainage (PTBD)

1991 ◽  
Vol 13 ◽  
pp. S140
Author(s):  
G. Lucani ◽  
C. Pozzi ◽  
A. Pallino ◽  
R. Lauro ◽  
U. Fox
Keyword(s):  
Gallbladder Carcinoma ◽  
Biliary Drainage ◽  
Rare Complication

Thoracic duct injury during anterior cervical discectomy: a rare complication

1998 ◽  
Vol 88 (1) ◽  
pp. 151-154 ◽  
Author(s):  
Anna Kristina E. Hart ◽  
John H. Greinwald ◽  
Christopher I. Shaffrey ◽  
Gregory N. Postma
Keyword(s):  
Thoracic Duct ◽  
Early Recognition ◽  
Rare Complication ◽  
Content Type ◽  
Cervical Discectomy ◽  
Aggressive Management ◽  
Thoracic Duct Injury ◽  
First Case ◽  
Chyle Leakage ◽  
Chylous Fistula

✓ Chylous fistula resulting from intraoperative injury to the cervical thoracic duct is well described as a complication of neck dissection. However, injury to the thoracic duct during spinal surgery is rarely reported. The authors present the first case of thoracic duct injury occurring during cervical discectomy and fusion via an anterior approach. The anomalous location of the terminal arch of the thoracic duct in this patient contributed to the complication. The morbidity of chyle leakage is minimized by its early recognition, a thorough understanding of lymphatic system anatomy, and aggressive management of the thoracic duct injury.

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