Foreign Body Imaging-Experience with 6 Cases of Retained Foreign Bodies in the Emergency
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Rectal Foreign Body: a Primer for Emergency Physicians Bobby Desai
Desai International Journal of Emergency Medicine 2011, 4:73 http://www.intjem.com/content/4/1/73 CASEREPORT Open Access Visual diagnosis: Rectal foreign body: A primer for emergency physicians Bobby Desai Abstract We present a case that is occasionally seen within emergency departments, namely a rectal foreign body. After presentation of the case, a discussion concerning this entity is given, with practical information on necessity of an accurate and thorough history and removal of the object for clinicians. Case anoscope inserted. The object could not be visualized, A 39-year-old male presented to the Emergency Depart- and therefore no attempt was made to remove it. Gen- ment with vague complaints of abdominal pain and con- eral surgery was consulted to see the patient and stipation. He stated that the abdominal pain was dull decided to take him to the operating room for removal. and crampy in nature and generalized in distribution. The patient agreed to this. Furthermore, he stated that he had not had a bowel The object was noted to be the extension arm of a movement in 2 days, though he felt as if he had to have vacuum cleaner. It was removed according to notes with one. He denied constitutional complaints of fevers, some difficulty and the patient was admitted to the hos- chills, nausea, and vomiting, and denied urinary com- pital for observation and intravenous antibiotics. The plaints as well. patient was subsequently discharged 2 days later in The patient’s vital signs were: temperature 37.2°C, excellent condition. Upon social work discharge, he was pulse 87 beats per minute, respiratory rate of 20 per again asked how that apparatus managed to be placed minute, and blood pressure 130/84 mmHg. -
Perforation Due to a Rectal Foreign Body and Radiological Findings
Case Report Ann Colorectal Res 2021;9(1):44-46. Perforation Due to a Rectal Foreign Body and Radiological Findings Saim Turkoglu1, MD; Adem Yokuş2, MD; Fırat Aslan3, MD 1Van Traınıng and Research Hospıtal, Van, Turkey 2Department of Radiology, Medical Faculty, Yuzuncu Yıl University, Van, Turkey 3Department of General Surgery, Medical Faculty, Yuzuncu Yıl University, Van, Turkey *Corresponding authors: Received: 01-03-2021 Saim Turkoglu, Van Traınıng and Research Hospıtal, Van,Turkey Revised: 03-04-2021 Tel: +90 5356452865; Fax: +90 432 2150471 Accepted: 05-04-2021 Email: [email protected] Abstract Introduction: Rectal foreign bodies have been increasingly seen and cause urgent surgical complications. Diagnosis and treatment of these cases in emergency departments may be difficult. The effective use of radiological imaging techniques can accelerate and facilitate this process. Case Presentation: A 65-year-old male patient, who underwent computed tomography (CT) with the suspicion of a foreign body in the rectum, was admitted to the emergency outpatient clinic. The patient was a male with a psychiatric illness who later underwent emergency surgery. Since the patient had impaired consciousness during the examination, anamnesis could not be obtained, so the initial impression upon surgical consultation was perforation due to rectal tumoral thickening. In almost all cases, plain radiography is sufficient and can eliminate diagnostic difficulties. However, this is not possible for non-opaque objects. Therefore, the CT scan played an important role in the diagnosis of this patient. A 30 cm foreign body, identified as salami, was removed from the abdomen of the patient, who was later taken for emergency surgery. -
THE ACUTE ABDOMEN Definition Abdominal Pain of Short Duration
THE ACUTE ABDOMEN Definition Abdominal pain of short duration that is usually associated with muscular rigidity, distension and vomiting, and which requires a decision whether an emergent operation is required. Problems and management options History and physical examination are central in the evaluation of the acute abdomen. However, in an ICU patient, these are often limited by sedation, paralysis and mechanical ventilation, and obscured by a protracted, complicated inhospital course. Often an acute abdomen is inferred from unexplained sepsis, hypovolaemia and abdominal distension. The need for prompt diagnosis and early treatment by no means equates with operative management. While it is a truism that correct diagnosis is the essential preliminary to correct treatment, this is probably more so in nonoperative management. On occasions, the need for operation is more obvious than the diagnosis and no delay should be incurred in an attempt to confirm the diagnosis before surgery. Frequently fluid resuscitation and antibiotics are required concurrently with the evaluation process. The approach is to evaluate the ICU patient in the context of the underlying disorder and decide on one of the following options: ∙ Immediate operation (surgery now)– the ‘bleeder’ e.g. ruptured ectopic pregnancy, ruptured abdominal aortic aneurysm (AAA) in the salvageable patient ∙ Emergent operation (surgery tonight)– the ‘septic’ e.g. generalized peritonitis from perforated viscus ∙ Early operation (surgery tomorrow)– the ‘obstructed’, e.g. obstructed colonic cancer ∙ Radiologically guided drainage – e.g. localized abscesses, acalculous cholecystitis, pyonephrosis ∙ Active observation and frequent reevaluation – e.g localized peritoneal signs other than in the RLQ, selected cases of endoscopic perforation . -
Head & Neck Surgery Course
Head & Neck Surgery Course Parapharyngeal space: surgical anatomy Dr Pierfrancesco PELLICCIA Pr Benjamin LALLEMANT Service ORL et CMF CHU de Nîmes CH de Arles Introduction • Potential deep neck space • Shaped as an inverted pyramid • Base of the pyramid: skull base • Apex of the pyramid: greater cornu of the hyoid bone Introduction • 2 compartments – Prestyloid – Poststyloid Anatomy: boundaries • Superior: small portion of temporal bone • Inferior: junction of the posterior belly of the digastric and the hyoid bone Anatomy: boundaries Anatomy: boundaries • Posterior: deep fascia and paravertebral muscle • Anterior: pterygomandibular raphe and medial pterygoid muscle fascia Anatomy: boundaries • Medial: pharynx (pharyngobasilar fascia, pharyngeal wall, buccopharyngeal fascia) • Lateral: superficial layer of deep fascia • Medial pterygoid muscle fascia • Mandibular ramus • Retromandibular portion of the deep lobe of the parotid gland • Posterior belly of digastric muscle • 2 ligaments – Sphenomandibular ligament – Stylomandibular ligament Aponeurosis and ligaments Aponeurosis and ligaments • Stylopharyngeal aponeurosis: separates parapharyngeal spaces to two compartments: – Prestyloid – Poststyloid • Cloison sagittale: separates parapharyngeal and retropharyngeal space Aponeurosis and ligaments Stylopharyngeal aponeurosis Muscles stylohyoidien Stylopharyngeal , And styloglossus muscles Prestyloid compartment Contents: – Retromandibular portion of the deep lobe of the parotid gland – Minor or ectopic salivary gland – CN V branch to tensor -
Managing Envenomations
ResidentOfficial Publication of the Emergency Medicine Residents’ Association June/July 2021 VOL 48 / ISSUE 3 Managing Envenomations How to Sustain a Career: Peer Support Guide to ABEM Certi ication We Help Healers SCP Reach New Heights Health Meet Your Medical Career Dream Team SCP Health Step Right Up, Residents! As you’re transitioning from residency to begin your career, our team is here to create a tailored environment for you that fosters growth and delivers rewarding daily work experiences. Explore clinical careers at scp-health.com/explore TOGETHER, WE HEAL Welcome to a New Academic Year! uly marks a turning point each year, as new interns arrive in programs throughout Jthe country, newly graduated residents launch the next phase of their careers, and medical students take the next steps in their journey to residency. DO YOU KNOW HOW EMRA CAN HELP? Resources for Interns Resources for PGY2+ Resources for Students All EM programs will receive EMRA residents members receive the EMRA shows up for medical students Intern Kits this summer with nearly 10-pound EMRA Resident Kit upon interested in this specialty. From resources that offer immediate first joining EMRA. It is packed with clinical new advising content every month to backup for those first nerve-wracking resources for every rotation — some you’ll opportunities for leadership and growth, shifts. The high-yield EMRA Intern need only rarely (but prove to be clutch), and EMRA student membership is high-yield. Kit is sent for free to all EM interns some you’ll use every single shift (EMRA Plus, our online resources are unparalleled: (membership not required) and Antibiotic Guide, anyone?). -
Chapter 32 FOREIGN BODIES of the HEAD, NECK, and SKULL BASE
Foreign Bodies of the Head, Neck, and Skull Base Chapter 32 FOREIGN BODIES OF THE HEAD, NECK, AND SKULL BASE RICHARD J. BARNETT, MD* INTRODUCTION PENETRATING NECK TRAUMA Anatomy Emergency Management Clinical Examination Investigations OPERATIVE VERSUS NONOPERATIVE MANAGEMENT Factors in the Deployed Setting Operative Management Postoperative Care PEDIATRIC INJURIES ORBITAL FOREIGN BODIES SUMMARY CASE PRESENTATIONS Case Study 32-1 Case Study 32-2 Case Study 32-3 Case Study 32-4 Case Study 32-5 Case Study 32-6 *Lieutenant Colonel, Medical Corps, US Air Force; Chief of Facial Plastic Surgery/Otolaryngology, Eglin Air Force Base Department of ENT, 307 Boatner Road, Suite 114, Eglin Air Force Base, Florida 32542-9998 423 Otolaryngology/Head and Neck Combat Casualty Care INTRODUCTION The mechanism and extent of war injuries are sig- other military conflicts. In a study done in Croatia with nificantly different from civilian trauma. Many of the 117 patients who sustained penetrating neck injuries, wounds encountered are unique and not experienced about a quarter of the wounds were from gunshots even at Role 1 trauma centers throughout the United while the rest were from shell or bomb shrapnel.1 The States. Deployed head and neck surgeons must be injury patterns resulting from these mechanisms can skilled at performing an array of evaluations and op- vary widely, and treating each injury requires thought- erations that in many cases they have not performed in ful planning to achieve a successful outcome. a prior setting. During a 6-month tour in Afghanistan, This chapter will address penetrating neck injuries all subspecialties of otolaryngology were encountered: in general, followed specifically by foreign body inju- head and neck (15%), facial plastic/reconstructive ries of the head, face, neck, and skull base. -
Deep Neck Infections 55
Deep Neck Infections 55 Behrad B. Aynehchi Gady Har-El Deep neck space infections (DNSIs) are a relatively penetrating trauma, surgical instrument trauma, spread infrequent entity in the postpenicillin era. Their occur- from superfi cial infections, necrotic malignant nodes, rence, however, poses considerable challenges in diagnosis mastoiditis with resultant Bezold abscess, and unknown and treatment and they may result in potentially serious causes (3–5). In inner cities, where intravenous drug or even fatal complications in the absence of timely rec- abuse (IVDA) is more common, there is a higher preva- ognition. The advent of antibiotics has led to a continu- lence of infections of the jugular vein and carotid sheath ing evolution in etiology, presentation, clinical course, and from contaminated needles (6–8). The emerging practice antimicrobial resistance patterns. These trends combined of “shotgunning” crack cocaine has been associated with with the complex anatomy of the head and neck under- retropharyngeal abscesses as well (9). These purulent col- score the importance of clinical suspicion and thorough lections from direct inoculation, however, seem to have a diagnostic evaluation. Proper management of a recog- more benign clinical course compared to those spreading nized DNSI begins with securing the airway. Despite recent from infl amed tissue (10). Congenital anomalies includ- advances in imaging and conservative medical manage- ing thyroglossal duct cysts and branchial cleft anomalies ment, surgical drainage remains a mainstay in the treat- must also be considered, particularly in cases where no ment in many cases. apparent source can be readily identifi ed. Regardless of the etiology, infection and infl ammation can spread through- Q1 ETIOLOGY out the various regions via arteries, veins, lymphatics, or direct extension along fascial planes. -
Surgical Management of Anorectal Foreign Bodies H Cinar, M Berkesoglu1, M Derebey2, E Karadeniz3, C Yildirim4, K Karabulut2, T Kesicioglu5, K Erzurumlu2
[Downloaded free from http://www.njcponline.com on Monday, June 11, 2018, IP: 102.251.47.77] Original Article Surgical Management of Anorectal Foreign Bodies H Cinar, M Berkesoglu1, M Derebey2, E Karadeniz3, C Yildirim4, K Karabulut2, T Kesicioglu5, K Erzurumlu2 Department of General Purpose: Anorectal foreign bodies (AFBs) inserted into anus constitute one of Surgery, Faculty of Medicine, the most important problems needing surgical emergency due to its complications. Ordu University, Ordu, 1Department of General We describe our experience in the diagnosis and treatment of AFBs retained Surgery, Mersin University, in the rectosigmoid colon. Materials and Methods: Between the years 2006 Abstract Mersin, 2Department of and 2015, a total of 11 patients diagnosed with AFBs were admitted to an General Surgery, Ondokuz emergency room and general surgery clinics. They were diagnosed and treated Mayıs University, Samsun, in four different hospitals in four different cities in Turkey. Information on the 3Department of General AFBs, clinical presentation, treatment strategies, and outcomes were documented. Surgery, Atatürk University, Erzurum, 4Department of We retrospectively reviewed the medical records of these unusual patients. General Surgery, Ordu Public Results: Eleven patients were involved in this study. All patients were male with Hospital, Ordu, 5Department their mean age was 49.81 (range, 23–71) years. The time of the presentation to of General Surgery, Faculty the removal of the foreign bodies ranged between 2 h and 96 h with a mean of of Medicine, Giresun 19.72 h. Ten patients inserted AFBs in the anus with the purpose of eroticism but University, Giresun, Turkey one patient’s reason to relieve constipation. -
Historical Note
East African Orthopaedic Journal HISTORICAL NOTE AMBROISE PARE 1510-1590 Pare was born in 1510 in Bourge-Hersent in North- were failing to emerge from the gums due to lack of West France. He initially worked with his brother who a pathway, and this failure was a cause of death. This was a surgeon cum barber. He practiced at Hotel Dieu, belief and practice persisted for centuries, with some Frances oldest Hospital. He was an anatomist and exceptions, until towards the end of the nineteenth invented several surgical instruments. He became a century lancing became increasingly controversial and war injury doctor at Piedmont where he used boiled oil was then abandoned (2). for treating gunshot wounds. One day he improvised In 1567, Ambroise Pare described an experiment using oil of roses, egg white and turpentine with very to test the properties of bezor stones. At the time, the good results. Henceforth he stopped the cauterization stones were commonly believed to be able to cure and hot oil method. the effects of any poison, but Pare believed this to be Pare was a keen observer and did not allow the impossible. It happened that a cook at Pare court was beliefs of the day to supersede the evidence at hand. In caught stealing fine silver cutlery, and was condemned his autobiographical book, Journeys in Diverse Places, to be hanged. The cook agreed to be poisoned, on the Pare inadvatienty practiced the scientific method when conditions that he would be given a bezoar straight he returned the following morning to a battlefield. -
Esophagopharyngeal Perforation and Prevertebral Abscess After Anterior Cervical Discectomy and Fusion: a Case Report
232 Case Report Esophagopharyngeal perforation and prevertebral abscess after anterior cervical discectomy and fusion: a case report Jay K. Shah1^, Filippo Romanelli1, Jason Yang2, Naina Rao3, Michael C. Gerling4 1Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center – Robertwood Johnson Barnabas Health, Jersey City, NJ, USA; 2Robert Wood Johnson University Hospital, RWJBarnabas Health, New Brunswick, NJ, USA; 3New York Grossman School of Medicine, NYU Langone Health, New York, NY, USA; 4Chief of Spine Surgery, Department of Orthopaedic Surgery, New York University Langone Hospital-Brooklyn, Tribeca, New York, NY, USA Correspondence to: Jay K. Shah, DO. Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center – Robertwood Johnson Barnabas Health, 355 Grand Street, Jersey City, NJ 07302, USA. Email: [email protected]. Abstract: Anterior cervical discectomy and fusion (ACDF) represents one of the most commonly performed spine surgeries. Dysphagia secondary to esophageal injury during retraction is one of the most common complications, and usually leads to self-limiting dysphagia. However, actual perforation and violation of the esophageal tissue is much rarer and can lead to delayed deep infections. Prevertebral abscess’ are one of the most feared complications after ACDF, as they can lead to severe tissue swelling, osteomyelitis, hardware failure, and even death. Due to their rarity, a gold standard of workup and treatment is still unknown. A healthy 47-year-old female presents 9 months after a C4–C7 ACDF done at an outside institution with a large prevertebral abscess, osteomyelitis, hardware failure, and pseudoarthrosis secondary to esophagopharyngeal defect and prominent hardware. Overall, the patient underwent eight surgeries, and required an extended course of intravenous (IV) antibiotics, multiple diagnostic procedures, and complex soft tissue coverage using an anterolateral thigh free flap. -
Bruises- Wounds
Henry Shih OD, MD Medical Director Austin Emergency Center- Anderson Mill 13435 US Highway 183 North Suite 311 Austin, TX 78750 512-614-1200 BRUISES- http://austiner.com/ What are bruises? — Bruises happen when blood vessels under the skin break, but the skin isn’t cut. Blood leaks into the tissues under the skin. Bruises start off red in color, and then turn blue or purple. As they heal, bruises can turn green and yellow. Most bruises heal in 1 to 2 weeks, but some take longer. How are bruises treated? — A bruise will get better on its own. But to feel better and help your bruise heal, you can: o Put a cold gel pack, bag of ice, or bag of frozen vegetables on the injured area every 1 to 2 hours, for 15 minutes each time. Put a thin towel between the ice (or other cold object) and your skin. Use the ice (or other cold object) for at least 6 hours after your injury. Some people find it helpful to ice longer, even up to 2 days after their injury. o Raise the area, if possible – Raising the area above the level of your heart helps to reduce swelling. o Take medicine to reduce the pain and swelling – To treat pain, you can take Tylenol. To treat pain and swelling, you can take ibuprofen (sample brand names: Advil, Motrin). But people who have certain conditions or take certain medicines should not take ibuprofen. If you are unsure, ask your doctor or nurse if you can take ibuprofen. -
Head and Neck Specimens
Head and Neck Specimens DEFINITIONS AND GENERAL COMMENTS: All specimens, even of the same type, are unique, and this is particularly true for Head and Neck specimens. Thus, while this outline is meant to provide a guide to grossing the common head and neck specimens at UAB, it is not all inclusive and will not capture every scenario. Thus, careful assessment of each specimen with some modifications of what follows below may be needed on a case by case basis. When in doubt always consult with a PA, Chief/Senior Resident and/or the Head and Neck Pathologist on service. Specimen-derived margin: A margin taken directly from the main specimen-either a shave or radial. Tumor bed margin: A piece of tissue taken from the operative bed after the main specimen has been resected. This entire piece of tissue may represent the margin, or it could also be specifically oriented-check specimen label/requisition for any further orientation. Margin status as determined from specimen-derived margins has been shown to better predict local recurrence as compared to tumor bed margins (Surgical Pathology Clinics. 2017; 10: 1-14). At UAB, both methods are employed. Note to grosser: However, even if a surgeon submits tumor bed margins separately, the grosser must still sample the specimen margins. Figure 1: Shave vs radial (perpendicular) margin: Figure adapted from Surgical Pathology Clinics. 2017; 10: 1-14): Red lines: radial section (perpendicular) of margin Blue line: Shave of margin Comparison of shave and radial margins (Table 1 from Chiosea SI. Intraoperative Margin Assessment in Early Oral Squamous Cell Carcinoma.