scholarly journals Clostridium difficileEnteritis after Total Abdominal Colectomy for Ulcerative Colitis

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Hassan Nasser ◽  
Semeret Munie ◽  
Dania Shakaroun ◽  
Tommy Ivanics ◽  
Surya Nalamati ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Small Bowel ◽  
Case Reports ◽  
Multiorgan Failure ◽  
Rare Condition ◽  
Nucleic Acid Amplification ◽  
Wall Thickening ◽  
Total Proctocolectomy ◽  
High Dose ◽  
Port Site Hernia

Introduction.IsolatedClostridium difficilesmall bowel enteritis is a rare condition with significant morbidity and mortality.Presentation of Case.An 83-year-old female with refractory ulcerative colitis underwent a total proctocolectomy and end ileostomy. Her postoperative course was complicated with return to the operating room for repair of an incarcerated port site hernia. Subsequently, she developed septic shock and multiorgan failure requiring intubation and mechanical ventilation, renal replacement therapy, and high dose vasopressors. Diagnostic workup revealed diffuse small bowel wall thickening on computed tomography scan as well as positive nucleic acid amplification test forC. difficiletoxin B gene. Despite treatment with antibiotics and maximum attempts at resuscitation, the patient expired.Discussion. C. difficileinfection most commonly affects the colon but rarely can involve the small bowel. The pathogenesis ofC. difficileenteritis is unclear but is believed to mirror that of colitis. Surgical patients are susceptible forC. difficileinfection, as they tend to be relatively immunosuppressed in the postoperative period. Radiologic findings of enteritis may mimic those of colitis and this includes small bowel dilation and thickening. Treatment for this condition has not been well established but it is approached similar to colitis.Conclusion.Despite an increase in the number of case reports ofC. difficileenteritis, it continues to be a rare but potentially fatal infection. Clinicians should maintain a high index of suspicion especially in patients with inflammatory bowel disease who undergo colon resections.

scholarly journals An intraoperative diagnosis of sclerosing encapsulating peritonitis: a case report

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Jonathan Sivakumar ◽  
Gregor Brown ◽  
Laurence Galea ◽  
Julian Choi
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Case Reports ◽  
Fibrous Tissue ◽  
Rare Condition ◽  
Exploratory Laparotomy ◽  
Intraoperative Diagnosis ◽  
Sclerosing Encapsulating Peritonitis ◽  
Encapsulating Peritonitis

Abstract Primary sclerosing encapsulating peritonitis (SEP) is an idiopathic and rare condition characterized by chronic peritoneal inflammation. We describe the case of an intraoperative diagnosis of SEP, presenting as a mimicker of small bowel obstruction. The patient was a 59-year-old male with suspected small bowel obstruction. On exploratory laparotomy, it was noted that there was thick fibrous tissue involving the visceral and parietal peritoneum enveloping grossly dilated loops of small bowel. This case reports on the histopathological features of peritoneal biopsies as well as radiological findings. There is no consensus regarding the standard management for idiopathic SEP. The present case demonstrates a significant improvement in the patient’s condition with conservative management alone. A critical teaching point is that in the absence of an obvious cause, SEP is a rare but important differential diagnosis for surgeons to consider in the context of recurrent bowel obstruction.

Fournier's gangrene as Amyand's hernia complication

2019 ◽  
Vol 98 (7) ◽  
pp. 291-296
Keyword(s):  
Case Report ◽  
Case Reports ◽  
Rare Condition ◽  
Sporadic Case ◽  
Fournier’S Gangrene ◽  
Amyand’S Hernia ◽  
Fournier's Gangrene ◽  
Randomized Controlled Studies ◽  
Based Medicine ◽  
Hernia Complication

Introduction: Fournier’s gangrene is a rare but fast deteriorating and serious condition with high mortality. In most cases, it is characterized as necrotizing fasciitis of the perineum and external genitals. Amyand’s hernia is a rare condition where the appendix is contained in the sac of an inguinal hernia. Inflammatory alterations in the appendix account only for 0.1 % of the cases when Amyand’s hernia is verified. Fournier’s gangrene as a complication of a late diagnosis of appendicitis located in the inguinal canal is described in the literature as rare case reports. Case report: The case report of a 70-year-old patient with Fournier’s gangrene resulting from gangrenous appendicitis of Amyand’s hernia. Conclusion: Fournier’s gangrene as a complication of Amyand’s hernia is a rare condition. Only sporadic case reports thereof can be found in the literature. Because of the rarity of this pathology and the lack of randomized controlled studies, it is difficult to determine the optimal treatment according to the principles of evidence-based medicine. An appropriate approach for this condition appears to be the combination of guidelines developed in Amyand’s therapy according to Losanoff and Basson, along with the recommended “gold standard” therapy for Fournier’s gangrene. This means early and highly radical surgical debridement, adequate antibiotic therapy and intensive care.

Bone marrow necrosis and fat embolism syndrome: a near fatal complication in previously undiagnosed sickle beta + thalassaemia

2021 ◽  
Vol 14 (1) ◽  
pp. e238317
Author(s):  
Nibash Budhathoki ◽  
Sunita Timilsina ◽  
Bebu Ram ◽  
Douglas Marks
Keyword(s):  
Bone Marrow ◽  
Multiorgan Failure ◽  
Rare Condition ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Bone Marrow Necrosis ◽  
Embolism Syndrome ◽  
Hb S ◽  
High Index Of Suspicion ◽  
Specific Symptoms

Prevalence of haemoglobin sickle-β+ thalassaemia (Hb S/β+thal) is variable with geography ranging from 0.2% to 10% among sickle cell patients. Clinical presentation of Hb S/β+thal patients depends on HbA level, with milder disease often going undiagnosed. However, rarely these patients can present with a fulminant vaso-occlusive crisis (VOC). Given VOC can present with non-specific symptoms, the diagnosis and treatment is often delayed. Here, we present a patient who initially developed altered mental status, pancytopenia and multiorgan failure due a critical VOC resulting in bone marrow necrosis and fat embolism. Subsequent workup confirmed that our patient had Sickle-β+ thalassaemia, which had gone undiagnosed, despite subclinical evidence of haemolysis on routine lab work for years. Following diagnosis and initiation of RBC exchange, he improved significantly and was discharged home. High index of suspicion and bone marrow biopsy is vital for early diagnosis and management of this rare condition.

scholarly journals High incidence of postoperative silent venous thromboembolism in ulcerative colitis: a retrospective observational study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Norimitsu Shimada ◽  
Hiroki Ohge ◽  
Hiroki Kitagawa ◽  
Kosuke Yoshimura ◽  
Norifumi Shigemoto ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Venous Thromboembolism ◽  
Total Colectomy ◽  
Univariate Analysis ◽  
Operation Time ◽  
High Serum ◽  
Total Proctocolectomy ◽  
Colon And Rectum ◽  
Predictive Risk ◽  
D Dimer

Abstract Background The incidence of postoperative venous thromboembolism (VTE) is high in patients with inflammatory bowel disease. We aimed to analyze the incidence and predictive factors of postoperative VTE in patients with ulcerative colitis. Methods Patients with ulcerative colitis who underwent colon and rectum surgery during 2010–2018 were included. We retrospectively investigated the incidence of postoperative VTE. Results A total of 140 colorectal surgery cases were included. Postoperative VTE was detected in 24 (17.1 %). Portal–mesenteric venous thrombosis was the most frequent VTE (18 cases; 75 %); of these, 15 patients underwent total proctocolectomy (TPC) with ileal pouch–anal anastomosis (IPAA). In univariate analysis, VTE occurred more frequently in patients with neoplasia than in those refractory to medications (27.2 % vs. 12.5 %; p < 0.031). TPC with IPAA was more often associated with VTE development (28 %) than total colectomy (10.5 %) or proctectomy (5.9 %). On logistic regression analysis, TPC with IPAA, total colectomy, long operation time (> 4 h), and high serum D-dimer level (> 5.3 µg/mL) on the day following surgery were identified as predictive risk factors. Conclusions Postoperative VTE occurred frequently and asymptomatically, especially after TPC with IPAA. Serum D-dimer level on the day after surgery may be a useful predictor of VTE.

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