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We present a rare case of prolonged ileus caused by underlying Shigella infection after surgical hernia repair. Infectious disease is an uncommon cause of postoperative prolonged ileus in adults. Our 48-year-old male patient underwent bilateral open inguinal hernia repair and open umbilical hernia repair without complication at an academic institution, with same-day discharge. Eight days later, he presented to the emergency department with complaints of severe cramping abdominal pain, nausea, emesis, and watery diarrhea. Physical examination, computed tomography scan of the abdomen and pelvis, and abdominal X-ray were initially concerning for bowel obstruction. The patient was admitted to the general surgery service. Concern for ileus with underlying gastritis arose after a small bowel follow-through showed contrast eventually reaching the rectum. A subsequent gastrointestinal pathogens panel was positive for Shigella. The patient's symptoms resolved after appropriate antibiotic treatment. Shigellosis and other infectious diseases should be considered in the differential diagnosis of postoperative prolonged ileus.
RESUMEN
BACKGROUND: The use of cervical drains to prevent cervical hematoma or seroma after thyroidectomy remains a controversial issue. OBJECTIVE: Identify clinical and surgical risk factors for hematoma or seroma and evaluate the usefulness of routine use of drains following thyroid surgery. MATERIAL AND METHODS: The authors conducted a retrospective multicentric study related to consecutive patients submitted to thyroid surgery in seven Portuguese hospitals between January 2018 and December 2020 (n=945). The data collected included the following parameters: age and gender of the patients, anticoagulation or anti-aggregating therapy, histological diagnoses, type of surgery, the presence or absence of postoperative drains, thyroid weight, length of hospital stay, postoperative complications, and reinterventions. In this study, surgical complications evaluated were limited to the presence of hematoma or seroma. A total of 945 patients who underwent thyroid surgery were included in the study. Twenty-seven patients (2.9%, n=27) experienced complications classified as hematomas or seromas. In the series, significant differences were observed between the two groups according to hypocoagulation or anti-aggregation status (OR=3.62; 95% CI 1.14-11.4) (p=0.001) and the nature of histological diagnosis (toxic vs. non-toxic benign disease) (OR=6.59; 95% CI 1.83-23.7). Hypocoagulation or anti-aggregation status were independently associated with a higher risk of complications. The presence of drains was associated with longer hospitalization periods (p<0.001) and not a decreased need for reintervention. CONCLUSION: Cervical hematoma or seroma are rare complications associated with both hypocoagulation and anti-aggregation therapy and with the presence of benign toxic pathology. The use of drains does not decrease the need for reintervention and is even associated with a longer length of hospital stay; therefore, their routine use should not be advised.
RESUMEN
Laparoscopic adjustable gastric banding (LAGB) is a popular bariatric surgical procedure used to aid in weight loss. Although significant complications may occur after LAGB, they are rare. LAGB causing discitis and osteomyelitis are incredibly rare, with only one other reported case. In this case report, we describe the case of a middle-aged woman who experienced discitis and osteomyelitis due to a disengaged LAGB catheter, which had eroded through her stomach and a part of her cecum. Overall, this case highlights the rare but potential complication of LAGB causing discitis and osteomyelitis. Patients with a history of LAGB placement should be monitored for this possibility and further investigation is needed to identify and mitigate risk factors.
RESUMEN
Percutaneous endoscopic gastrostomy (PEG) tube placement is a widespread method of delivering sustained nutrition to individuals requiring long-term support. Multiple techniques exist to achieve this, and adverse events can arise if not done properly including but not limited to pneumoperitoneum and bowel perforation. Safeguard tactics exist to prevent these complications but they are not always successful. Herein, we explore a case of PEG tube misplacement through the transverse colon. A 69-year-old male with a history of advanced dementia, cerebrovascular accident (CVA), and seizure disorder presented for a replacement of his malfunctioning PEG tube at a different site. On postoperative day one, the patient developed abdominal pain and shortness of breath. His subsequent imaging workup revealed pneumoperitoneum, and the patient ultimately underwent an exploratory laparotomy to repair the damage, washout his abdomen, and reinsert the PEG tube. Postoperatively, the patient had a lengthy hospital stay, which was complicated and prolonged by sepsis and mechanical ventilation. The PEG tube placement procedure is not without its difficulties in all stages, pre- intra- and post-operatively, especially in patients with neurocognitive compromise, therefore, it is important to continue exploring methods to optimize the operation.
RESUMEN
Acute myeloid leukemia (AML) is a rare and aggressive malignancy that can present with a broad range of clinical manifestations. Central nervous system (CNS) involvement is rarely documented and may alter the treatment course and overall prognosis. Although several etiologies have been suggested, the exact mechanism of CNS involvement remains unclear. Furthermore, little is known about the impact of surgical stress on the development of AML. Surgeons should be aware of this potential outcome following surgery, particularly if a leukemoid reaction develops post-operatively, as early detection can prevent delays in appropriate treatment. Further data are needed to better understand the pathogenesis and underlying inflammatory cascades following surgical trauma that possibly contribute to the development of AML.