A Rare Case of Large Bowel Obstruction Secondary to Bone Grafting
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Minimally Invasive Surgical Treatment Using 'Iliac Pillar' Screw for Isolated
European Journal of Trauma and Emergency Surgery (2019) 45:213–219 https://doi.org/10.1007/s00068-018-1046-0 ORIGINAL ARTICLE Minimally invasive surgical treatment using ‘iliac pillar’ screw for isolated iliac wing fractures in geriatric patients: a new challenge Weon‑Yoo Kim1,2 · Se‑Won Lee1,3 · Ki‑Won Kim1,3 · Soon‑Yong Kwon1,4 · Yeon‑Ho Choi5 Received: 1 May 2018 / Accepted: 29 October 2018 / Published online: 1 November 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Purpose There have been no prior case series of isolated iliac wing fracture (IIWF) due to low-energy trauma in geriatric patients in the literature. The aim of this study was to describe the characteristics of IIWF in geriatric patients, and to pre- sent a case series of IIWF in geriatric patients who underwent our minimally invasive screw fixation technique named ‘iliac pillar screw fixation’. Materials and methods We retrospectively reviewed six geriatric patients over 65 years old who had isolated iliac wing fracture treated with minimally invasive screw fixation technique between January 2006 and April 2016. Results Six geriatric patients received iliac pillar screw fixation for acute IIWFs. The incidence of IIWFs was approximately 3.5% of geriatric patients with any pelvic bone fractures. The main fracture line exists in common; it extends from a point between the anterosuperior iliac spine and the anteroinferior iliac spine to a point located at the dorsal 1/3 of the iliac crest whether fracture was comminuted or not. Regarding the Koval walking ability, patients who underwent iliac pillar screw fixation technique tended to regain their pre-injury walking including one patient in a previously bedridden state. -
Retained Fecaliths After Laparoscopic Appendectomy Disappearing Spontaneously with Non-Operative Management
IJCRI 2013;4(11):650–653. Katagiri et al. 650 www.ijcasereportsandimages.com CASE REPORT OPEN ACCESS Retained fecaliths after laparoscopic appendectomy disappearing spontaneously with non-operative management Hideki Katagiri, Mai Ishitani, Takashi Sakamoto, Yasuo Yoshinaga, Tadao Kubota, Akira Miyabe ABSTRACT ********* Introduction: Intra-abdominal abscess after doi:10.5348/ijcri-2013-11-402-CR-16 laparoscopic appendectomy is a well-known complication. In cases of perforated appendicitis, the frequency of postoperative intra-abdominal abscess formation can be up to 20%. However, intra-abdominal abscess due to retained fecaliths INTRODUCTION has rarely been reported. A retained fecalith following appendectomy is a rare complication A fecalith is often detected in cases of acute and it has been reported that retained fecaliths appendicitis. It can drop pre- or intraoperatively into the should be removed immediately after their peritoneal cavity [1]. The frequency of retained fecaliths diagnosis because of its potential to cause after appendectomy is unknown and only a few case abscess. We present a rare case of retained reports have been published [2]. Postoperative abscess fecaliths after laparoscopic appendectomy which after appendectomy is a well-known complication and, in disappeared spontaneously with non-operative cases of perforated appendicitis, the frequency can be up management. to 20% [3]. A retained fecalith can cause intra-abdominal abscess and the abscess often relapses despite adequate Keywords: Retained fecaliths, Laparoscopic drainage [4]. Previous reports recommended the removal appendectomy, Intra-abdominal abscess of complicated fecaliths after diagnosis. We present a very rare case of retained fecaliths after laparoscopic ********* appendectomy which disappeared spontaneously with non-operative management. Katagiri H, Ishitani M, Sakamoto T, Yoshinaga Y, Kubota T, Miyabe A. -
Intussusception of the Appendix: New Trends and Comprehensive Analysis of 140 Case Reports Barbara Wexelman
Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 7-9-2009 Intussusception of the Appendix: New trends and comprehensive analysis of 140 case reports Barbara Wexelman Follow this and additional works at: http://elischolar.library.yale.edu/ymtdl Recommended Citation Wexelman, Barbara, "Intussusception of the Appendix: New trends and comprehensive analysis of 140 case reports" (2009). Yale Medicine Thesis Digital Library. 469. http://elischolar.library.yale.edu/ymtdl/469 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale Medicine Thesis Digital Library by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale. For more information, please contact [email protected]. Intussusception of the Appendix: New trends and comprehensive analysis of 140 case reports A THESIS SUBMITTED TO THE YALE UNIVERSITY SCHOOL OF MEDICINE IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF MEDICINE BY BARBARA A. WEXELMAN 2008 Barbara Wexelman 1 ABSTRACT Title: INTUSSUSCEPTION OF THE APPENDIX: NEW TRENDS AND COMPREHENSIVE ANALYSIS OF 140 PUBLISHED CASE REPORTS. Barbara A. Wexelman, Cassius Ochoa Chaar, and Walter Longo. Section of Colorectal Surgery, Department of Surgery, Yale University, School of Medicine, New Haven, CT. Statement of Purpose: This paper uses 139 published case reports to understand the demographic, diagnostic, and treatment trends of intussusception of the appendix. Methods: Using the PubMed literature search engine to find all English references of “intussusception” and “appendix”, and reviewing those that contained actual case reports of intussusception of the appendix, we analyzed the demographics, presentation, diagnostic methods, surgical treatment, and histology from 140 articles representing data from 181 patients. -
Twisted Bowels: Intestinal Obstruction Blake Briggs, MD Mechanical
Twisted Bowels: Intestinal obstruction Blake Briggs, MD Objectives: define bowel obstructions and their types, pathophysiology, causes, presenting signs/symptoms, diagnosis, and treatment options, as well as the complications associated with them. Bowel Obstruction: the prevention of the normal digestive process as well as intestinal motility. 2 overarching categories: Mechanical obstruction: More common. physical blockage of the GI tract. Can be complete or incomplete. Complete obstruction typically is more severe and more likely requires surgical intervention. Functional obstruction: diffuse loss of intestinal motility and digestion throughout the intestine (e.g. failure of peristalsis). 2 possible locations: Small bowel: more common Large bowel All bowel obstructions have the potential risk of progressing to complete obstruction Mechanical obstruction Pathophysiology Mechanical blockage of flow à dilation of bowel proximal to obstruction à distal bowel is flattened/compressed à Bacteria and swallowed air add to the proximal dilation à loss of intestinal absorptive capacity and progressive loss of fluid across intestinal wall à dehydration and increasing electrolyte abnormalities à emesis with excessive loss of Na, K, H, and Cl à further dilation leads to compression of blood supply à intestinal segment ischemia and resultant necrosis. Signs/Symptoms: The goal of the physical exam in this case is to rule out signs of peritonitis (e.g. ruptured bowel). Colicky abdominal pain Bloating and distention: distention is worse in distal bowel obstruction. Hyperresonance on percussion. Nausea and vomiting: N/V is worse in proximal obstruction. Excessive emesis leads to hyponatremic, hypochloremic metabolic alkalosis with hypokalemia. Dehydration from emesis and fluid shifts results in dry mucus membranes and oliguria Obstipation: severe constipation or complete lack of bowel movements. -
Delayed Presentation of a Retained Fecalith
Open Access Case Report DOI: 10.7759/cureus.15919 Delayed Presentation of a Retained Fecalith Fawwad A. Ansari 1 , Muhammad Ibraiz Bilal 1 , Muhammad Umer Riaz Gondal 1 , Mehwish Latif 2 , Nadeem Iqbal 2 1. Medicine, Shifa International Hospital, Islamabad, PAK 2. Gastroenterology, Shifa International Hospital, Islamabad, PAK Corresponding author: Fawwad A. Ansari, [email protected] Abstract A fecalith is a common cause of acute appendicitis, and laparoscopic surgery is the mainstay of its management. Literature review shows that a fecalith may be retained in the gut following a laparoscopic appendectomy in some rare cases. In most cases, the fecalith becomes symptomatic with time due to the formation of an abscess, fistulous tract, or inflammation of the appendicular stump (stump appendicitis). We report a case of retained appendicular fecalith presenting with symptoms similar to acute appendicitis, 15 years after laparoscopic appendectomy. Categories: Gastroenterology, General Surgery Keywords: colonoscopy, acute appendicitis, appendectomy, fecalith, right iliac fossa pain, complications Introduction A fecalith is a hard stony mass of feces in the intestinal tract. Fecal impaction occurs when a large amount of fecal matter gets compacted and cannot get evacuated spontaneously [1]. In its extreme form, fecal impaction can lead to the formation of a fecalith due to the hardening of fecal material that forms a mass separate from other bowel contents [2]. It can occur in any part of the intestine [1]. Most often, a fecalith arises in the colon (mostly sigmoid) or rectum and very rarely in the small intestine [2]. Here we present a case of a retained appendicular fecalith in a patient who presented with an acute abdomen. -
Clinical Acute Abdominal Pain in Children
Clinical Acute Abdominal Pain in Children Urgent message: This article will guide you through the differential diagnosis, management and disposition of pediatric patients present- ing with acute abdominal pain. KAYLEENE E. PAGÁN CORREA, MD, FAAP Introduction y tummy hurts.” That is a simple statement that shows a common complaint from children who seek “M 1 care in an urgent care or emergency department. But the diagnosis in such patients can be challenging for a clinician because of the diverse etiologies. Acute abdominal pain is commonly caused by self-limiting con- ditions but also may herald serious medical or surgical emergencies, such as appendicitis. Making a timely diag- nosis is important to reduce the rate of complications but it can be challenging, particularly in infants and young children. Excellent history-taking skills accompanied by a careful, thorough physical exam are key to making the diagnosis or at least making a reasonable conclusion about a patient’s care.2 This article discusses the differential diagnosis for acute abdominal pain in children and offers guidance for initial evaluation and management of pediatric patients presenting with this complaint. © Getty Images Contrary to visceral pain, somatoparietal pain is well Pathophysiology localized, intense (sharp), and associated with one side Abdominal pain localization is confounded by the or the other because the nerves associated are numerous, nature of the pain receptors involved and may be clas- myelinated and transmit to a specific dorsal root ganglia. sified as visceral, somatoparietal, or referred pain. Vis- Somatoparietal pain receptors are principally located in ceral pain is not well localized because the afferent the parietal peritoneum, muscle and skin and usually nerves have fewer endings in the gut, are not myeli- respond to stretching, tearing or inflammation. -
Lab #23 Anal Triangle
THE BONY PELVIS AND ANAL TRIANGLE (Grant's Dissector [16th Ed.] pp. 141-145) TODAY’S GOALS: 1. Identify relevant bony features/landmarks on skeletal materials or pelvic models. 2. Identify the sacrotuberous and sacrospinous ligaments. 3. Describe the organization and divisions of the perineum into two triangles: anal triangle and urogenital triangle 4. Dissect the ischiorectal (ischioanal) fossa and define its boundaries. 5. Identify the inferior rectal nerve and artery, the pudendal (Alcock’s) canal and the external anal sphincter. DISSECTION NOTES: The perineum is the diamond-shaped area between the upper thighs and below the inferior pelvic aperture and pelvic diaphragm. It is divided anatomically into 2 triangles: the anal triangle and the urogenital (UG) triangle (Dissector p. 142, Fig. 5.2). The anal triangle is bounded by the tip of the coccyx, sacrotuberous ligaments, and a line connecting the right and left ischial tuberosities. It contains the anal canal, which pierced the levator ani muscle portion of the pelvic diaphragm. The urogenital triangle is bounded by the ischiopubic rami to the inferior surface of the pubic symphysis and a line connecting the right and left ischial tuberosities. This triangular space contains the urogenital (UG) diaphragm that transmits the urethra (in male) and urethra and vagina (in female). A. Anal Triangle Turn the cadaver into the prone position. Make skin incisions as on page 144, Fig. 5.4 of the Dissector. Reflect skin and superficial fascia of the gluteal region in one flap to expose the large gluteus maximus muscle. This muscle has proximal attachments to the posteromedial surface of the ilium, posterior surfaces of the sacrum and coccyx, and the sacrotuberous ligament. -
Surgical Approaches to Fractures of the Acetabulum and Pelvis Joel M
Surgical Approaches to Fractures of the Acetabulum and Pelvis Joel M. Matta, M.D. Sponsored by Mizuho OSI APPROACHES TO THE The table will also stably position the ACETABULUM limb in a number of different positions. No one surgical approach is applicable for all acetabulum fractures. KOCHER-LANGENBECK After examination of the plain films as well as the CT scan the surgeon should APPROACH be knowledgeable of the precise anatomy of the fracture he or she is The Kocher-Langenbeck approach is dealing with. A surgical approach will primarily an approach to the posterior be selected with the expectation that column of the Acetabulum. There is the entire reduction and fixation can excellent exposure of the be performed through the surgical retroacetabular surface from the approach. A precise knowledge of the ischial tuberosity to the inferior portion capabilities of each surgical approach of the iliac wing. The quadrilateral is also necessary. In order to maximize surface is accessible by palpation the capabilities of each surgical through the greater or lesser sciatic approach it is advantageous to operate notch. A less effective though often the patient on the PROfx® Pelvic very useful approach to the anterior Reconstruction Orthopedic Fracture column is available by manipulation Table which can apply traction in a through the greater sciatic notch or by distal and/or lateral direction during intra-articular manipulation through the operation. the Acetabulum (Figure 1). Figure 2. Fractures operated through the Kocher-Langenbeck approach. Figure 3. Positioning of the patient on the PROfx® surgical table for operations through the Kocher-Lagenbeck approach. -
Iliac Crest Herniation Secondary to Autogenous Bone Grafting Found on Osteopathic Examination Christine J
CASE REPORT Iliac Crest Herniation Secondary to Autogenous Bone Grafting Found on Osteopathic Examination Christine J. Ou, DO William C. Sternfeld, MD Julie M. Stausmire, MSN, ACNS-BC From Mercy St. Vincent Surgical repair of difficult or nonunion fractures is frequently performed with Medical Center in autogenous bone grafts, most commonly from the iliac crest. Complications Toledo, Ohio. Dr Ou is a fifth-year resident from this procedure may include vessel injury, nerve injury, pelvic instability, in the Osteopathic bowel herniation, and ileus. The authors report a case of iliac crest herniation General Surgery in a patient presenting with a small-bowel obstruction 2 years after anterior iliac Residency Program crest graft harvest for an open reduction and internal fixation repair of a right Financial Disclosures: None reported. humeral shaft fracture. An emergency operation revealed that the right colon had herniated through an opening in the right iliac crest. The appendix had Support: None reported. adhered to new osseous bone formed postoperatively, requiring an appendec- Address correspondence to Julie M. Stausmire MSN, tomy. The hernia defect was successfully repaired with polypropylene mesh. ACNS-BC, A high index of suspicion for graft site herniation is needed for patients with a Mercy St. Vincent history of iliac crest bone grafting who present with symptoms of abdominal Medical Center, 2213 Cherry St, pain, flank or hip pain, ileus, or small-bowel obstruction. Toledo, OH 43608-2801. J Am Osteopath Assoc. 2015;115(8):518-521 doi:10.7556/jaoa.2015.107 E-mail: [email protected] Submitted October 29, 2014; final revision utogenous bone grafting is a common procedure for orthopedic surgeons. -
Abdominal Pain
10 Abdominal Pain Adrian Miranda Acute abdominal pain is usually a self-limiting, benign condition that irritation, and lateralizes to one of four quadrants. Because of the is commonly caused by gastroenteritis, constipation, or a viral illness. relative localization of the noxious stimulation to the underlying The challenge is to identify children who require immediate evaluation peritoneum and the more anatomically specific and unilateral inner- for potentially life-threatening conditions. Chronic abdominal pain is vation (peripheral-nonautonomic nerves) of the peritoneum, it is also a common complaint in pediatric practices, as it comprises 2-4% usually easier to identify the precise anatomic location that is produc- of pediatric visits. At least 20% of children seek attention for chronic ing parietal pain (Fig. 10.2). abdominal pain by the age of 15 years. Up to 28% of children complain of abdominal pain at least once per week and only 2% seek medical ACUTE ABDOMINAL PAIN attention. The primary care physician, pediatrician, emergency physi- cian, and surgeon must be able to distinguish serious and potentially The clinician evaluating the child with abdominal pain of acute onset life-threatening diseases from more benign problems (Table 10.1). must decide quickly whether the child has a “surgical abdomen” (a Abdominal pain may be a single acute event (Tables 10.2 and 10.3), a serious medical problem necessitating treatment and admission to the recurring acute problem (as in abdominal migraine), or a chronic hospital) or a process that can be managed on an outpatient basis. problem (Table 10.4). The differential diagnosis is lengthy, differs from Even though surgical diagnoses are fewer than 10% of all causes of that in adults, and varies by age group. -
Amyand's Hernia: Report of Two Cases and a Review
CASE REPORT Hastal›klar› Dergisi &Journal of Diseases of the Colon and Rectum Amyand’s Hernia: Report of Two Cases and a Review of the Literature Amyand F›t›¤›nda ‹ki Olgu ve Literatürün Gözden Geçirilmesi ÜMRAN MUSLU, ÖMER ARDA ÇET‹NKAYA T.C. Sa¤l›k Bakanl›¤› Alaca Devlet Hastanesi, Genel Cerrahi Bölümü, Alaca, Çorum-Türkiye ÖZET ABSTRACT Amyand f›t›¤› adland›rmas› inguinal f›t›k kesesi içerisinde The designation “Amyand’s” in association with a hernia rüptüre appendiks vermiformisi tan›mlamak için Claudius is used for Amyand's name to any hernia was used for Amyand ilk kez appendektomiyi uygulad›¤›nda a ruptured appendix found in an inguinal hernia sac kullan›lmaktayd›. Daha sonralar›, inguinal f›t›k keseleri based on the recognition that Claudius Amyand was the içerisinde inflame olsun ya da olmas›n appendiks first to perform an appendectomy. Recently, inguinal vermiformis bulunmas› durumuna Amyand f›t›¤› hernias containing the appendix,both inflamed and not, denilmeye bafllanm›flt›r. F›t›k defektinin kontamine have been called Amyand hernia. Roughly only 0.1% alanlarda sentetik veya biyosentetik yamalar ile onar›m› of inguinal hernias contain an inflamed appendix. The halen tart›flmal›d›r. Sa¤laml›k, esneklik, konuk doku repair of such defects with mesh grafts is still debatable kompatibilitesi ve enfeksiyonlardan korunma yetene¤i due to unresolved suspicion of contamination. Strength, ideal bir yaman›n tan›m› olmal›d›r. Pek çok sentetik ve flexibility, host tissue compatibility and ability to avoid biyolojik yama dokusu tüm dünyada kullan›lmas›na infections should characterize an ideal mesh. -
Problems in Family Practice Acute Abdominal Pain in Children
dysuria. The older child may start bed wetting with or without dysuria. A problems in Family Practice drop of fresh, clean unspun urine will usually reveal pyuria, but in the early case relatively few white blood cells may be seen compared to gross bacillu- Acute Abdominal Pain ria. The infection may have underlying urinary tract abnormality, stone, in Children hydronephrosis, polycystic kidney or renal neoplasms. The IVP is important Hyman Shrand, M D in detecting these underlying prob lems. Cambridge, M assachusetts 4. Viral Hepatitis. Malaise, anorexia, abdominal pain, and tenderness over Acute abdominal pain in children is a common and challenging prob the liver occur with hepatitis A or B. lem for the family physician. The many causes of this problem require Later, patients who become jaundiced a systematic approach to making the diagnosis and planning specific have dark urine and pale stools. In therapy. A careful history and physical examination, together with a teenagers, “needle tracks” suggest sy ringe transmitted Type B (H.A.A.) small number of selected laboratory studies, provide a rational basis hepatitis. Youngsters with infectious for effective management in most cases. This paper reviews the more mononucleosis may present as hepati common causes of acute abdominal pain in children with special em tis. phasis on their clinical differentiation. 5. Upper Respiratory Tract. Strepto coccal pharyngitis, a common cause of Abdominal pain in a child is always followed by vomiting is more likely an vomiting and abdominal pain, can be an emergency. The primary physician intra-abdominal disorder. recognized by looking at the throat must identify a “medical” cause in or with confirmatory throat culture.