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Kumar N, Das A, Dhamala I, Basu S. The Use of CECT in the Diagnosis of Intestinal Obstruction: A Case of Difficult Diagnosis in a Strangulated Left Femoral Hernia. Niger J Clin Pract 2024; 27:534-536. [PMID: 38679778 DOI: 10.4103/njcp.njcp_590_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 03/04/2024] [Indexed: 05/01/2024]
Abstract
ABSTRACT A femoral hernia is an uncommon and acquired hernia in the groin. Its incidence in adults is 2%-8% of all abdominal wall hernias, and it has a female-to-male ratio of 1.8:1. It is usually found in elderly patients and is associated with increased morbidity due to delays in diagnosis leading to a high incidence of incarceration and strangulation. Accurate preoperative diagnosis of femoral hernia is challenging, especially in obese patients in whom a small femoral hernia can be hidden under the groin fat. Unlike an inguinal hernia, it rarely reduces on its own and if asymptomatic and small, is often unnoticed by the elderly obese patient. Femoral hernia is often unsuspected and overlooked in males as it is predominant among females. Delay in diagnosis can lead to intestinal gangrene and high morbidity. We present a case of an incarcerated left femoral hernia in an elderly obese male who presented with acute intestinal obstruction. He was managed with resection of the gangrenous segment and double barrel ileostomy. Although uncommon in males, a femoral hernia has a high incidence of strangulation, and therefore should always be ruled out as a cause of acute intestinal obstruction in elderly patients. Therefore, never forget to examine the groin in case of intestinal obstruction.
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Affiliation(s)
- N Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Koshida Y, Yamane T. Polyarteritis Nodosa: Gangrene in a Rheumatoid Arthritis Patient. J Clin Rheumatol 2023; 29:e137-e138. [PMID: 37337335 PMCID: PMC10662570 DOI: 10.1097/rhu.0000000000001998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
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Hart O, Hong Q, Lee KT, Gormley S, Tehan P, Sommerset J, Khashram M. A substantial number of patients with rest pain, ulceration or gangrene are unable to undergo current non-invasive perfusion testing-Could another modality be utilised? Wound Repair Regen 2023; 31:779-782. [PMID: 38058241 DOI: 10.1111/wrr.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 12/08/2023]
Abstract
Rest pain, ulceration and gangrene are hallmark features of chronic limb-threatening ischaemia (CLTI). Wound healing can be challenging, and this is compounded by an inability to measure lower limb perfusion via non-invasive tools such as toe pressure (TP). Novel perfusion tests, such as pedal acceleration time (PAT), may overcome some limitations. This study aimed to quantify the proportion of patients with CLTI that were unable to undergo TP measurement. Over a three-year duration, 344 consecutive patients with CLTI underwent PAT assessment (403 limbs). Overall, 32% of limbs were unable to undergo first toe TP, and 12.9% were unable to undergo first and second toe TP due to forefoot/digit amputation or tissue loss. Inability to measure first toe TP disproportionately impacted CLTI patients with diabetes compared to patients without diabetes (39.6% limbs (106/268); vs. 17% limbs (23/135); p < 0.001). Novel modalities may provide a useful tool for assessing perfusion in CLTI.
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Affiliation(s)
- Odette Hart
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Vascular and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Qiantai Hong
- Department of Vascular and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Khai Tuck Lee
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Sinead Gormley
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Vascular and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Peta Tehan
- Department of Surgery, School of Clinical Sciences, Clayton, Monash University, Australia
| | - Jill Sommerset
- HOPE Vascular and Podiatry, Houston, Texas, USA
- Elson S. Floyd College of Medicine, Washington State University, Pullman, Washington, USA
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Vascular and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
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Elgendy A, Khirallah MG, Elsawaf M, Hassan HS, Ghazaly M. Acute appendicitis in children: is preoperative hyponatremia a predictive factor of perforation/gangrene? A prospective study. Pediatr Surg Int 2023; 39:281. [PMID: 37817011 PMCID: PMC10564656 DOI: 10.1007/s00383-023-05561-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Distinguishing between perforated/gangrenous from uncomplicated appendicitis in children helps management. We evaluated hyponatremia as a new diagnostic marker for perforated/gangrenous appendicitis in children. METHODS A prospective study including all children with acute appendicitis who underwent appendectomy at our institution from May 2021 to May 2023. Medical history and clinical criteria were analyzed. All blood samples were taken upon admission including serum inflammatory markers and electrolytes. Patients were divided into two groups (Group I: uncomplicated and Group II: perforated/gangrenous), and data between both groups were compared. RESULTS The study included 153 patients [Group I: 111 (73%), Group II: 42 (27%)]. Mean serum sodium concentration in children with perforated/gangrenous appendicitis was significantly lower compared to children with uncomplicated appendicitis (131.8 mmol/L vs. 138.7 mmol/L; p < 0.001). The ROC curve of preoperative sodium level to differentiate between perforated/gangrenous and uncomplicated appendicitis revealed an AUC of 0.981. The cut-off-value of sodium level < 135 mmol/L identified perforated/gangrenous appendicitis with a sensitivity of 94% and a specificity of 91% (p < 0.001). Predictive factors of perforated/gangrenous appendicitis were: age less than 5 years (12% vs. 3%; p = 0.02), experiencing symptoms for more than 24 h (100% vs. 58%; p < 0.001), body temperature more than 38.5 °C (52% vs. 13%; p < 0.001), a serum sodium level less than 135 mmol/L (90% vs. 6%; p < 0.001), and a CRP serum level more than 50 mg/L (71% vs. 17%; p < 0.001). CONCLUSIONS Hyponatremia, upon admission, is a novel, objective biochemical marker that can identify perforated/gangrenous appendicitis in children. We advocate that the assessment of serum sodium level should be added to the diagnostic algorithm in children with suspected acute appendicitis. Surgical intervention in patients with hyponatremia should not be delayed, and non-operative management should be avoided.
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Affiliation(s)
- Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Tanta University, 35 Ali Beek Elkbeer Street, Tanta, 31515, Egypt.
| | | | - Mohamed Elsawaf
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hussam S Hassan
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
- Department of Surgery, Faculty of Medicine, Jouf University, Aljouf, Saudi Arabia
| | - Mohamed Ghazaly
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Tanta University, 35 Ali Beek Elkbeer Street, Tanta, 31515, Egypt
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Ly PN. Polycythemia as an Underlying Cause of Digital Gangrene: A Rare and Unusual Case Presentation. J Am Podiatr Med Assoc 2023; 113:22-240. [PMID: 37938912 DOI: 10.7547/22-240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Digital gangrene is frequently encountered in patients who have diabetes with peripheral vascular compromise, with or without superimposed infection. Preoperative laboratory values and radiographic images are important to determine a proper course of action. Equally important is a thorough history taking to confirm or rule out systemic entities and preexisting conditions that can aggravate or predispose one to the development of digital gangrene. A patient with diabetes presented with a rare and unusual case of digital gangrene, as he clinically had strong pedal pulses. Preoperative workup revealed a suspicion of polycythemia, which was subsequently confirmed. The patient underwent several days of phlebotomy until his hemoglobin and hematocrit levels were brought down to optimized levels before a digital amputation was performed. He went on to heal uneventfully, and he is currently being closely followed by oncology/hematology colleagues with periodic phlebotomy.
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Affiliation(s)
- Peter N Ly
- *VA Central California Health Care System, Surgical Service 112, Fresno, CA
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6
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Luo S, Feng Y, Zhou Y. Calciphylaxis causing skin gangrene in an old woman with end-stage renal disease. Indian J Dermatol Venereol Leprol 2023; 89:792. [PMID: 37436012 DOI: 10.25259/ijdvl_525_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 05/02/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Shuaihantian Luo
- Department of Dermatology, The second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yu Feng
- Department of Dermatology, The second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying Zhou
- Department of Dermatology, The second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Mikhaylichenko MI, Kuznetsov MS, Krasilnikov AA. [Venous gangrene of small intestine following coronavirus infection (SARS-COVID-19)]. Khirurgiia (Mosk) 2023:118-122. [PMID: 38010026 DOI: 10.17116/hirurgia2023111118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
The pandemic of a new coronavirus infection has made certain adjustments to modern emergency medicine. Systemic endothelial dysfunction following COVID-19 largely determines hemostatic disorders. Numerous studies revealed that intense platelet adhesion followed by platelet aggregates in COVID-19 patients and functional disorders of fibrinolysis system are combined with activation and severe endothelial dysfunction. The last one inevitably leads to thrombosis and adverse vascular events. There are a lot of studies devoted to deep vein thrombosis and fatal massive pulmonary embolism under COVID-19 infection. However, there are no descriptions of mesenteric thrombosis followed by intestinal wall necrosis. Our experience is based on the treatment and follow-up of 14 patients with venous gangrene of small intestine under COVID-19-induced severe endothelial dysfunction. We present a 40-year-old man with coronavirus infection complicated by ileum gangrene and subsequent favorable outcome.
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Bhatt K, Jindal P, Gupta S, Suri S. Digital gangrene and pulmonary consolidation in a young girl with Takayasu arteritis. Mod Rheumatol Case Rep 2022; 6:230-233. [PMID: 34904154 DOI: 10.1093/mrcr/rxab038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/06/2021] [Accepted: 10/01/2021] [Indexed: 06/14/2023]
Abstract
Takayasu arteritis (TA) is a large-vessel vasculitis most commonly affecting women of childbearing age. The disease process is usually slow and smoldering, presenting over months to years. Digital gangrene is an uncommon manifestation of TA because of the formation of good collateral circulation. Similarly, although pulmonary artery involvement is well described, pulmonary parenchymal involvement is very rare. We are reporting a case of a young girl with TA presenting with digital gangrene and pulmonary consolidation, which was treated successfully with a combination of aggressive systemic immunosuppression and anti-coagulants. The possible mechanism for gangrene along with the confounding diagnostic possibility of co-existing tuberculosis have been discussed.
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Affiliation(s)
| | | | - Sudesh Gupta
- Satyam Medical Center, Dehradun, Uttarakhand, India
| | - Shalini Suri
- Suri Diagnostic Center, Dehradun, Uttarakhand, India
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Abstract
Gangrenous cholecystitis is a kind of acute cholecystitis, whose course of disease progresses rapidly, early diagnosis is difficult and mortality is high, and clinicians are prone to misdiagnosis and missed diagnosis in clinical work.However, gangrenous cholecystitis has been ignored in various guidelines.This paper systematically summarized the pathogenesis, pathological manifestations, epidemiology, clinical diagnosis and treatment of gangrenous cholecystitis, hoping to provide a complete and clear diagnosis and treatment process for clinicians.
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Affiliation(s)
- Z Li
- Department of General Surgery,Beijing Fengtai Hospital of Integrated Traditional and Western Medicine, Beijing 100072, China
| | - S Y Jia
- Department of General Surgery,Beijing Fengtai Hospital of Integrated Traditional and Western Medicine, Beijing 100072, China
| | - F Z Liu
- Department of General Surgery,Beijing Fengtai Hospital of Integrated Traditional and Western Medicine, Beijing 100072, China
| | - L J Ya
- Department of General Surgery,Beijing Fengtai Hospital of Integrated Traditional and Western Medicine, Beijing 100072, China
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Sil A, Chakraborty U, Chandra A, Biswas SK. COVID-19 associated symmetrical peripheral gangrene: A case series. Diabetes Metab Syndr 2022; 16:102356. [PMID: 34920197 PMCID: PMC8626894 DOI: 10.1016/j.dsx.2021.102356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS The novel coronavirus disease (COVID-19) caused by SARS-CoV-2 has turned the world topsy-turvy since its onset in 2019. The thromboinflammatory complications of this disease are common in critically ill patients and associated with poor prognosis. Symmetrical peripheral gangrene (SPG) is characterized by symmetrical distal gangrene in absence of any large vessel occlusion or vasculitis and it is usually associated with critical illness. Our aim was to report the clinical profile and outcome of patients diagnosed with SPG associated with COVID-19. To the best of our knowledge, no such similar cases have been reported till date. METHODS In this case series, we have discussed the clinical presentation, laboratory parameters and outcome in a series of two patients of SPG associated with COVID-19 and also compared those findings. Due to paucity of data, we also reviewed the literature on this under-diagnosed and rarely reported condition and association. RESULTS Two consecutive patients (both males, age range: 37-42 years, mean: 39.5 years) were admitted with the diagnosis of COVID-19 associated SPG. Both patients had clinical and laboratory evidence of disseminated intravascular coagulation (DIC). Leucopenia was noted in both patients. Despite vigorous therapy, both patients succumbed to their illness within a fortnight of admission. CONCLUSION SPG in the background of COVID-19 portends a fatal outcome. Physicians should be aware of its grim prognosis.
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Affiliation(s)
- Abheek Sil
- Department of Dermatology, Venereology, and Leprosy, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata, 700004, India
| | - Uddalak Chakraborty
- Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Annex 1, 52/1 Shambhunath Pandit Street, Kolkata, 700020, India
| | - Atanu Chandra
- Department of Internal Medicine, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata, 700004, India.
| | - Surajit Kumar Biswas
- Department of Dermatology, Venereology, and Leprosy, RG Kar Medical College and Hospital, 1, Khudiram Bose Sarani, Kolkata, 700004, India
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Rastogi A, Dogra H, Jude EB. COVID-19 and peripheral arterial complications in people with diabetes and hypertension: A systematic review. Diabetes Metab Syndr 2021; 15:102204. [PMID: 34303918 PMCID: PMC8266514 DOI: 10.1016/j.dsx.2021.102204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023]
Abstract
AIMS Identify the prevalence, risk factors and outcomes of lower extremity ischemic complications. METHODS A systematic review was conducted by searching PubMed and SCOPUS databases for SARS-CoV-2, COVID-19 and peripheral arterial complications. RESULTS Overall 476 articles were retrieved and 31 articles describing 133 patients were included. The mean age was 65.4 years. Pain and gangrene were the most common presentation. Hypertension (51.3%), diabetes (31.9%) and hypercholesterolemia (17.6%) were associated co-morbidities. Overall, 30.1% of patients died and amputation was required in 11.8% patients. CONCLUSIONS COVID-19 patients with diabetes or hypertension are susceptible for lower limb complications and require therapeutic anti-coagulation.
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Affiliation(s)
- Ashu Rastogi
- Deptt of Endocrinology, PGIMER, Chandigarh, 160012, India.
| | - Himika Dogra
- Deptt of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Tameside on Lyne, UK
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12
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Ozasa M, Fujikawa K, Ozasa S, Sakaguchi R, Furukawa K, Ueki N, Uchida T, Nakashima M, Mizokami A. Limited cutaneous systemic sclerosis with gangrene: an autopsy case. Mod Rheumatol Case Rep 2020; 4:243-247. [PMID: 33087012 DOI: 10.1080/24725625.2019.1702495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/13/2019] [Indexed: 06/11/2023]
Abstract
We describe an autopsy case of a 75-year-old female with limited cutaneous systemic sclerosis (lcSSc) and gangrene due to macrovascular involvement. She was diagnosed with lcSSc complicated with pulmonary arterial hypertension and digital ulcers 9 years before admission. She had recurrent and refractory lower limb ulcers (LLUs), and died because of sepsis caused by gangrene infection. Autopsy findings revealed severely thickened arterial walls of the visceral organs, consistent with vascular involvement of SSc. Systemic vascular involvement in lcSSc may progress in patients with LLUs who harbour several risk factors for vascular involvement.
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Affiliation(s)
- Mutsumi Ozasa
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Soichiro Ozasa
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Ryuki Sakaguchi
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Kentaro Furukawa
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Nozomi Ueki
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Tomohisa Uchida
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Masahiro Nakashima
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
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13
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Mbanje C, Mungazi SG, Muchuweti D, Mazingi D, Mlotshwa M, Maunganidze AJV. Ileo-sigmoid knotting: the Parirenyatwa hospital experience. S AFR J SURG 2020; 58:70-73. [PMID: 32644309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ileo-sigmoid knotting is a rare cause of intestinal obstruction with a rapidly progressive course, for which expedient surgical intervention is required to prevent mortality. The aim of this study was to determine the characteristics, presentation, morbidity and mortality associated with ileo-sigmoid knotting at Parirenyatwa Group of Hospitals (PGH). To determine the preoperative diagnostic precision and management patterns of ileo-sigmoid knotting cases at PGH. METHODS A retrospective analysis was performed on patients operated on at Parirenyatwa Hospital with a diagnosis of ileo-sigmoid knotting between April 2011 and April 2018. Data inclusive of demographics, time to presentation and surgery, preoperative diagnosis, complications and in-hospital mortality was collected. The relationship between the duration of symptoms prior to surgery and incidence of both septic shock and transfusion were analysed. RESULTS Twenty-one cases of ileo-sigmoid knotting were identified for analysis. The median age was 37 years (range 18-65 years) with a 6:1 male to female ratio. Two of the three females included were pregnant. Twenty patients (95.2%) described an acute onset abdominal pain, with 83.3% experiencing the pain nocturnally, while asleep. The median duration of symptoms at presentation was 12.5 hours (range 2-39 hours). At admission, leucocytosis (WCC > 11x10³/dl) was noted in eleven patients (52.4%). Seventy-three per cent of patients were noted to have electrolyte derangements at presentation. Seven patients (33.3%) had recorded episodes of severe hypotension (SBP < 90) prior to surgery. The most common preoperative diagnosis, based on both clinical assessment and plain x-ray evaluation, was sigmoid volvulus (52.4%), with no preoperative diagnosis of ileo-sigmoid knotting being made. All patients had gangrenous small bowel, with 81% having a gangrenous sigmoid colon. All cases underwent small bowel resection and primary anastomosis plus Hartmann's procedure. Postoperatively, eleven patients (52.4%) developed septic shock, while 62% required blood transfusion. There was one (4.8%) early postoperative mortality. CONCLUSION To avoid mortality, the diagnosis of ileo-sigmoid knotting should be entertained and the imperative of emergency surgery recognised in the young male or pregnant female patient with acute nocturnal onset abdominal pain, a rapidly deteriorating small bowel obstruction clinical picture and with radiological features suggestive of both small and large bowel obstruction.
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Affiliation(s)
- C Mbanje
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe
| | - S G Mungazi
- Department of Surgery and Anaesthetics, Faculty of Medicine, National University of Science and Technology, Zimbabwe
| | - D Muchuweti
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe
| | - D Mazingi
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe
| | - M Mlotshwa
- Colorectal Surgery, Western Sussex Hospitals, National Health Services Trust, United Kingdom
| | - A J V Maunganidze
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Zimbabwe
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Mahajan SS, Tandon VR, Sarin R, Roshi, Gupta AK, Kohli A. Digital gangrene induced by inadvertent intra-arterial cocktail injection of anesthetic agents such as pentazocine, promethazine, and atropine: A serious adverse drug experience. Indian J Pharmacol 2018; 50:354-357. [PMID: 30783330 PMCID: PMC6364335 DOI: 10.4103/ijp.ijp_131_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 12/04/2018] [Indexed: 11/22/2022] Open
Abstract
Gangrenous changes in skin due to accidental intra-arterial injection of promethazine and pentazocine have been reported. Accidental intra-arterial injection is most commonly encountered in the antecubital fossa. However, recent reports in the radial and ulnar arteries have also been encountered. We hereby report a serious, preventable adverse drug experience in the form of digital gangrene induced by inadvertent intra-arterial cocktail injection of anesthetic agents such as pentazocine, promethazine, and atropine, which seems to be in the radial artery as the lateral three digits and dorsum of the hand are affected.
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Affiliation(s)
- Sonia Shinde Mahajan
- Department of Pharmacology and Therapeutics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Vishal R. Tandon
- Department of Pharmacology and Therapeutics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Rajat Sarin
- Department of Pharmacology and Therapeutics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Roshi
- Department of Pharmacology and Therapeutics, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Akhil Kumar Gupta
- Department of CTVS, Superspecialty Hospital, GMC, Jammu, Jammu and Kashmir, India
| | - Arvind Kohli
- Department of CTVS, Superspecialty Hospital, GMC, Jammu, Jammu and Kashmir, India
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15
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Warkentin TE. Heparin-induced thrombocytopenia-associated thrombosis: from arterial to venous to venous limb gangrene. J Thromb Haemost 2018; 16:2128-2132. [PMID: 30099843 DOI: 10.1111/jth.14264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Indexed: 12/17/2022]
Abstract
Heparin-induced thrombocytopenia (HIT) is an acquired immune-mediated hypercoagulability state that is strongly associated with thrombosis. During the 1970s and 1980s, the prevailing concept was that HIT was associated only with arterial thrombosis, through its unique pathogenesis via heparin-dependent, platelet-activating IgG antibodies. However, in 1990, when I began to encounter HIT in my clinical practice, I found that most such patients developed symptomatic venous thrombosis. This historical sketch summarizes some of the research that challenged the dogma of HIT being a mainly arterial prothrombotic disorder. Two studies - one a substudy of a randomized trial of post-orthopedic surgery thromboprophylaxis, and the second a retrospective five-hospital analysis of consecutive patients with positive test results for HIT antibodies - showed a marked predominance of venous over arterial thrombosis complicating HIT (~ 4 : 1). By the end of the 1990s, an even more dramatic manifestation of HIT-associated venous thrombosis was recognized: venous limb gangrene. Here, ischemic limb necrosis occurs despite palpable arterial pulses, as a result of both macrovascular and microvascular venous thrombosis. The surprising explanation was natural anticoagulant impairment (severe depletion of protein C, a vitamin K-dependent anticoagulant) resulting from treatment of HIT-associated deep vein thrombosis with warfarin (vitamin K antagonist). These insights from HIT research helped to elucidate the pathogenesis of ischemic limb losses in other intense non-HIT hypercoagulability states, including warfarin-associated venous limb gangrene complicating cancer-associated hypercoagulability, and symmetrical peripheral gangrene complicating disseminated intravascular coagulation of critical illness, in which proximate 'shock liver' helps to explain the profound failure of natural anticoagulant systems (protein C; antithrombin) in predisposing to peripheral limb microthrombosis in circulatory shock.
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Affiliation(s)
- T E Warkentin
- Department of Pathology and Molecular Medicine, and Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Andersen CA, Daab LJ, Le TD, Green DM, Tyminski RL, Ponticello M, Marmolejo V. Treatment of Nonreconstructable Critical Limb Ischemia With Ischemic Wounds Utilizing a Noninvasive Intermittent Pneumatic Compression Device Monitored With Fluorescence Angiography. Wounds 2018; 30:191-196. [PMID: 30059338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Critical limb ischemia (CLI) is a leading cause of lower extremity amputation. When CLI is identified, revascularization should be performed if possible. When options for revascularization do not exist, use of a noninvasive intermittent pneumatic compression device (NPCD) can be considered. OBJECTIVE Presented here are 2 cases of patients with nonreconstructable CLI at risk for limb loss who were serially assessed with indocyanine green fluorescence angiography (ICGFA) to determine the effects of NPCD use on local tissue perfusion. MATERIALS AND METHODS Both patients were treated with the NPCD for 1 hour, 3 times per day, for 4 weeks. Serial ICGFA utilizing a ICGFA device was performed at various time points to monitor the effects of NPCD use on tissue perfusion. RESULTS The treatment of both patients with serial ICGFA provided limited objective evidence of increased local tissue perfusion which expedited wound resolution. CONCLUSIONS Larger randomized control trials of this modality of perfusion assessment and NPCD use are recommended.
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Affiliation(s)
- Charles A Andersen
- Madigan Army Medical Center, Tacoma, WA; Midwest Podiatry Services, Wichita, KS; BSN Medical, Tacoma, WA; and Scriptum Medica, University Place, WA
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17
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Affiliation(s)
- M G Berry
- St Andrew's Centre for Plastic and Burn Surgery, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK.
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18
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Brennan MB, Hess TM, Bartle B, Cooper JM, Kang J, Huang ES, Smith M, Sohn MW, Crnich C. Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes. J Diabetes Complications 2017; 31:556-561. [PMID: 27993523 PMCID: PMC5328848 DOI: 10.1016/j.jdiacomp.2016.11.020] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/07/2016] [Accepted: 11/28/2016] [Indexed: 12/18/2022]
Abstract
AIM Diabetic foot ulcers are associated with an increased risk of death. We evaluated whether ulcer severity at presentation predicts mortality. METHODS Patients from a national, retrospective, cohort of veterans with type 2 diabetes who developed incident diabetic foot ulcers between January 1, 2006 and September 1, 2010, were followed until death or the end of the study period, January 1, 2012. Ulcers were characterized as early stage, osteomyelitis, or gangrene at presentation. Cox proportional hazard regression identified independent predictors of death, controlling for comorbidities, laboratory parameters, and healthcare utilization. RESULTS 66,323 veterans were included in the cohort and followed for a mean of 27.7months: 1-, 2-, and 5-year survival rates were 80.80%, 69.01% and 28.64%, respectively. Compared to early stage ulcers, gangrene was associated with an increased risk of mortality (HR 1.70, 95% CI 1.57-1.83, p<0.001). The magnitude of this effect was greater than diagnosed vascular disease, i.e., coronary artery disease, peripheral arterial disease, or stroke. CONCLUSION Initial diabetic foot ulcer severity is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke. Unrecognized or under-estimated vascular disease and/or sepsis secondary to gangrene should be explored as possible causal explanations.
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Affiliation(s)
- Meghan B Brennan
- University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705; Edward Hines Jr. Veterans Hospital, 5000 S 5(th) Ave, Hines, IL 60141.
| | - Timothy M Hess
- University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Brian Bartle
- Edward Hines Jr. Veterans Hospital, 5000 S 5(th) Ave, Hines, IL 60141
| | - Jennifer M Cooper
- University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL 60637
| | - Jonathan Kang
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Elbert S Huang
- Edward Hines Jr. Veterans Hospital, 5000 S 5(th) Ave, Hines, IL 60141; University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL 60637
| | - Maureen Smith
- University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705
| | - Min-Woong Sohn
- Edward Hines Jr. Veterans Hospital, 5000 S 5(th) Ave, Hines, IL 60141; University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22908
| | - Christopher Crnich
- University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
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Chiar CI, Elango T, Sivaneswaran L, Umasangar R, Mohan N. An unexpected gangrenous duplication of ileum. Med J Malaysia 2017; 72:83-84. [PMID: 28255153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Alimentary tract duplication is a rare congenital anomaly which may involve any part of the alimentary tract extending from stomach to rectum. Clinical presentation may mimic an inflamed appendix as described in this case. A 9-year-old boy with a clinical diagnosis of perforated appendix was noted to have a normal appendix intra-operatively. On further search for an underlying pathology, a gangrenous ileal duplication was discovered. En-bloc resection with primary bowel anastomosis was done. Histopathology report revealed a gangrenous small bowel duplication. We discuss the preoperative diagnostic dilemma and management options in approaching this rare entity.
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Affiliation(s)
- C I Chiar
- Hospital Taiping, Department of Surgery, Perak, Malaysia.
| | - T Elango
- Hospital Taiping, Department of Surgery, Perak, Malaysia
| | - L Sivaneswaran
- Hospital Taiping, Department of Surgery, Perak, Malaysia
| | - R Umasangar
- Hospital Taiping, Department of Surgery, Perak, Malaysia
| | - N Mohan
- Hospital Taiping, Department of Surgery, Perak, Malaysia
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20
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Daldoul S, Massoudi I, Mabrouk A, Ksontini I, Abid W, Ben Moussa M. An unexpected cause of retroperitoneal gangrene. Tunis Med 2017; 95:152-155. [PMID: 29424879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Retroperitoneal Gangrene is a serious condition whose causes are many. We report three originally cases of anorectal suppuration complicated by retroperitoneal gangrene without Fournier's gangrene until there ever described in the literature. The diagnosis was made in all cases on CT because of atypical clinical presentation. The surgical approach was carried out in different ways to treat perineal and retroperitoneal lesions.
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21
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Aounallah A, Ghariani Fetoui N, Ghariani N, Korbi M, Mokni S, Boussofara L, Saidi W, Ksiaa M, Ben Jazia I, Guerfala M, Sriha B, Belajouza C, Denguezli M, Nouira R. [Thrombotic skin gangrene: A rare extra-intestinal manifestation of ulcerative colitis]. Ann Dermatol Venereol 2016; 144:109-112. [PMID: 27769565 DOI: 10.1016/j.annder.2016.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/23/2016] [Accepted: 09/14/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thrombotic cutaneous gangrene is a rare extra-intestinal manifestation of ulcerative colitis with a severe prognosis. CASE REPORT A 35-year-old woman with a 7-year history of ulcerative colitis presented with extensive ecchymotic lesions that began a few hours earlier. On examination, she was febrile with multiple necrotic lesions. Skin biopsy showed multiple microthrombi in the dermal vessels. A diagnosis of thrombotic cutaneous gangrene was established. The patient was treated with heparin and systemic corticosteroids. The majority of cutaneous lesions showed improvement after 1 month. Thrombophlebitis of the left lower limb occurred subsequently. CONCLUSION Thrombotic cutaneous gangrene is attributed to microvascular thrombosis, which arises from the hypercoagulability observed in ulcerative colitis. Complete blood and coagulation tests must be performed and early anticoagulation with heparin must be considered in order to prevent the progression of cutaneous infarction.
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Affiliation(s)
- A Aounallah
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie.
| | - N Ghariani Fetoui
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - N Ghariani
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - M Korbi
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - S Mokni
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - L Boussofara
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - W Saidi
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - M Ksiaa
- Service de gastro-entérologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - I Ben Jazia
- Service de médecine interne et gastroentérologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - M Guerfala
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - B Sriha
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - C Belajouza
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - M Denguezli
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
| | - R Nouira
- Service de dermatologie, CHU Farhat Hached, avenue Ibn El Jazzar, 4000 Sousse, Tunisie
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22
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Huang Q, Liu YL. [Systemic necrotizing vasculitis presenting as gangrene combined with diabetes insipidus: a case report]. Beijing Da Xue Xue Bao Yi Xue Ban 2015; 47:1028-1030. [PMID: 26679670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The male patient reported here presented as gangrene and central diabetes insipidus (CDI), who had characteristics of vasculitis. The patient complained about polydipsia and polyuria half a year ago, and then developed tingling, pain and blackish discoloration of some fingers and toes 3 month ago. He also had Raynaud's phenomenon. After admission, his laboratory examination showed the rise of erythrocyte sedimentation rate, C-reactive protein, immunoglobulin, β2-glycoprotein I and the activity of rheumatoid factors, lupus anticoagulant test. his pituitary gland showed loss of posterior signal on magnetic resonance imaging. In addition, his vasopressin test was active. However, there was no sufficient evidence to diagnose any specific disease; as a consequence the patient was diagnosed as idiopathic systemic necrotizing vasculitis (SNV). For SNV, the patient was treated with glucocorticoid 40 mg/d and impact therapy of cyclophosphamide 0.4 g every 2 weeks. He also received symptomatic treatment for gangrene and CDI. Cutaneous involvement leading to gangrene was widely reported in SNV, however pituitary involvement in SNV leading to CDI was rare. The prognosis of this patient was poor.
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Affiliation(s)
- Qing Huang
- Department of Gastroenterology, Peking University People's Hospital, Beijing 100044, China
| | - Yu-lan Liu
- Department of Gastroenterology, Peking University People's Hospital, Beijing 100044, China
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23
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Dolák S, Prochotský A, Mifkovič A, Škultéty J, Ježovít M, Koudelka P, Bluska P. [A rare case of an acute abdomen patient with gangrene of the colon as a complication of systemic lupus erythematosus]. Rozhl Chir 2015; 94:74-77. [PMID: 25659257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The authors present a case report of a 39-year-old woman with acute abdomen - a comorbid patient with systemic lupus erythematosus, chronic renal insufficiency as a complication of lupus nephritis, included in a haemodialysis programme. The patient had also undergone transplantation of the left kidney in the past. She was initially admitted to the Department of Traumatology for a total endoprosthesis procedure due to bionecrosis of the head of the thigh bone. Postoperatively, the patients condition was complicated by gangrene of the colon confirmed by CT scan and during the operation. The patient was operated on - subtotal colectomy, terminal ileostomy and left-sided ovariectomy was performed. The postoperative course was complicated by perforation of the jejunum which was sutured. The patient was admitted to ICU and, after recovery, to our surgical department. Because of the metabolic disturbance she was treated in the internal medicine department. After 60 days she was discharged in a good condition, walking and with full per os realimentation.Key words: lupus erythematosus gangrene of the colon acute abdomen.
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24
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Aukema A, van Soest EJ. [A man with haematochezia and abdominal pain]. Ned Tijdschr Geneeskd 2015; 159:A8634. [PMID: 25761296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 83-year-old male was admitted to the Emergency Department with acute haematochezia and abdominal pain. At digital rectal examination multiple soft distensions were palpable. Sigmoidoscopy revealed ischaemia of the rectum with severe gangrene. The patient was discharged after fluid resuscitation. Follow-up sigmoidoscopy 4 weeks later showed a fully recovered rectum.
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Affiliation(s)
- Allard Aukema
- Kennemer Gasthuis, afd. Maag-, Darm- en Leverziekten, Haarlem
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25
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Al Zubidi N, Ling JD, Lee AG. Atonic pupils secondary to presumed systemic vasopressor-related ischemia. Can J Ophthalmol 2014; 48:e123-4. [PMID: 24093203 DOI: 10.1016/j.jcjo.2013.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/03/2013] [Accepted: 03/12/2013] [Indexed: 11/19/2022]
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26
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Khan MLUZ, Abbassi MR, Jawed M, Shaikh U. Male gender and sonographic gall bladder wall thickness: important predictable factors for empyema and gangrene in acute cholecystitis. J PAK MED ASSOC 2014; 64:159-162. [PMID: 24640804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To underline the status of male gender and gall bladder wall thickness as significant risk factors for acute cholecystitis complications. METHODS The retrospective study, with purposive sampling of the patients of acute cholecystits in age above 18 years, who were operated within 10 days of onset of symptoms, was conducted at the Department of Surgery, Dow University Hospital, Karachi, by reviewing the patients' medical record from March 2010 to August 2012. Correlation of incidence of acute cholecystitis complications (empyema and gangrene) to male gender and to the sonographic gall bladder wall thickness more than 4.5 mm was analysed using SPSS 16. RESULT Out of 62 patients, 8 (13%) patients had gangrene while 10 (16.12%) had empyema. Overall, there were 21 (33.87%) males in the study. Ten (47.6%) of the male patients developed empyema or gangrene of the gall bladder as a complication of acute cholecystitis. Of the 41 (66.12%) female patients, only 8 (19.5%) developed these complications. There were 22 (35.48%) cases of gall bladders with sonographic wall thickness more than 4.5 mm who were operated for acute cholecystitis. Of them, 16 (72.7%) had empyema or gangrene. CONCLUSION Male gender and sonographic gall bladder wall thickness more than 4.5 mm were statistically significant risk factors for suspicion of complicated acute cholecystitis (empyema/gangrene) and by using these risk factors, we can prioritise patients for surgery in the emergency room.
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27
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Khrupkin VI, Gostishchev VK, Zolotarev DV, Degtiareva EV. [The thoracoscopy in complex treatment of non-specific pleural empyema and purulent-destructive diseases of lungs]. Khirurgiia (Mosk) 2014:15-20. [PMID: 25484146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The results of treatment of 697 patients with different kinds of non-specific pleural empyema and gangrenous lesions of lungs are presented in the article. Need for complex and differentiated treatment of pleural empyema with obligatory use of thoracoscopy is revealed. High efficiency of early thoracoscopic sanitation improving outcomes and length of hospital stay is proved. Thoracoscopic necrosectomy is alternative and effective surgery in treatment of gangrenous lesions of lungs.
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28
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Gali BM, Bakari AA, Wadinga DW, Nganjiwa US. Missed diagnosis of a delayed diaphragmatic hernia as intestinal obstruction: a case report. Niger J Med 2014; 23:83-85. [PMID: 24946460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Penetrating diaphragmatic injury rarely occurs in isolation. Diagnosis of traumatic diaphragmatic hernia resulting from penetrating diaphragmatic injury may be delayed or missed with attendant high morbidity and mortality. We reported a 28-year-old man who presented with features of subacute intestinal obstruction which became severe over the last four days. He had a stab injury to his left lower chest wall that was sutured 31/2 years prior to the development of symptoms. Emergency laparotomy with incidental findings of missed diaphragmatic hernia with gangrenous jejunal segment was found. The hernia was reduced, gangrenous segment resected with end to end anastomosis, and repair of diaphragmatic rent done. He had an uneventful recovery and follow up. There is the need to maintain high index of suspicion of Traumatic Diaphragmatic Hernia (TDH) in a patient with recent or previous thoraco-abdominal injury that will reduce the rate of missed or delayed diagnosis.
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29
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Sataa S, Mizouni H, Mnif E. Urinary peritonitis caused by gangrenous cystitis. Tunis Med 2013; 91:736-737. [PMID: 24458679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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30
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Nomura S, Watanabe M, Komine O, Shioya T, Toyoda T, Bou H, Shibuya T, Suzuki H, Uchida E. Serum total bilirubin elevation is a predictor of the clinicopathological severity of acute appendicitis. Surg Today 2013; 44:1104-8. [PMID: 23880964 DOI: 10.1007/s00595-013-0659-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/03/2013] [Indexed: 01/26/2023]
Abstract
PURPOSE Elevation of the serum total bilirubin (STB) level not stemming from hepatic dysfunction or biliary obstruction may be seen in cases of acute appendicitis. This paper deals with the clinical significance of such elevations. METHODS Data from 410 appendectomized patients classified into two groups (a high preoperative STB group and a normal preoperative STB group) were analyzed to reveal the significance of preoperative hyperbilirubinemia. We also examined whether the preoperative STB level might serve as a risk factor for gangrenous appendicitis by a multivariate analysis. RESULTS Gangrenous appendicitis was more common in the high preoperative STB group (p < 0.001). The multivariate analysis revealed that an elevated preoperative STB level (odds ratio 1.7919) was a risk factor for gangrenous appendicitis. CONCLUSION In patients with an elevated preoperative STB level, it is very likely that the inflammation is severe and that the disease has progressed to a severe condition histopathologically; therefore, meticulous attention should be paid to the selection of the surgical procedure, as well as to the postoperative clinical course.
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Affiliation(s)
- Satoshi Nomura
- Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital, 1-396, Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
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31
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Affiliation(s)
- Hiroaki Iwasaki
- Department of Internal Medicine, Chiba Rosai Hospital, Japan.
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32
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Gostishchev VK, Lipatov KV, Asatrian AG, Vvedenskaia OV. [Predicting the risk of septic and necrotic complications in femoral amputation stump]. Khirurgiia (Mosk) 2013:4-8. [PMID: 24300602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Treatment results of 430 patients with ischemic gangrene of lower limbs were analyzed and major risk factors of postoperative complications considering the femoral amputation stump were outlighted. These are: the high level of artery occlusion, ligature muscle compression in the stump, absence of active drainage and elderly age (more than 80 years), anemia. The intraoperative use of laser Doppler flowmetry gives the possibility to assess the potential viability of muscles at the amputation level. Predicting the risk of local postoperative complications allowed the differential approach to the stump formation and improved the treatment results.
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33
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Leung L. Painful black toe - a case study. Aust Fam Physician 2012; 41:704-706. [PMID: 22962648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Critical limb ischaemia refers to an advanced form of peripheral vascular disease where severe arterial occlusion manifests as chronic ischaemic rest pain, nonhealing ulcers and gangrene. Depending on the severity of disease and level of occlusion, endovascular revascularisation and vascular surgical bypass are indicated to salvage the limb before the inevitable lifesaving choice limb amputation. OBJECTIVE This article illustrates a clinical scenario in which, without any intervention, the ischaemic anatomy may dry up and mummify. It is a remarkable reminder of the natural history of such events. DISCUSSION Medical management including analgesia, wound care, infection control and aggressive modification of atherosclerotic risks factors may contribute to a better prognosis. For inoperable cases, pneumatic compression and spinal cord stimulation can be considered to relieve symptoms and improve wound healing.
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Affiliation(s)
- Lawrence Leung
- Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada.
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34
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Hai A, Aslam M, Ashraf TH. Symmetrical peripheral gangrene: a rare presentation of antiphospholipid syndrome. Intern Emerg Med 2012; 7 Suppl 1:S71-3. [PMID: 22042628 DOI: 10.1007/s11739-011-0714-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 10/13/2011] [Indexed: 10/16/2022]
Affiliation(s)
- Abdul Hai
- Department of Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard University, New Delhi, India.
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35
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Fink M, Conrad D, Matthews M, Browning JC. Primary ecthyma gangrenosum as a presenting sign of leukemia in a child. Dermatol Online J 2012; 18:3. [PMID: 22483514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Ecthyma gangrenosum is a type of skin infection characterized by black eschars on an erythematous base. It most commonly occurs with pseudomonas infection in an immunocompromised setting. We present a case of primary ecthyma gangrenosum as the presenting sign of pre-B acute lymphoblastic leukemia (ALL) in a child.
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Affiliation(s)
- Matthew Fink
- Division of Dermatology and Cutaneous Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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36
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Bébarová L, Rezác T, Stasek M, Skopal F, Klos D, Neoral C. [The importance of early surgical intervention in the treatment of necrotizing vasculitis]. Rozhl Chir 2012; 91:87-89. [PMID: 22746087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Vasculitides are an etiologically heterogeneous group of vascular affections leading to vascular wall damage followed by ischaemia of the tissues supplied by the affected vessels. Damage to the vessels of lower extremities is frequent; in serious cases a complete destruction of soft tissue as well as skeletal lesions may occur. This then results in a situation which, without a well-timed surgical intervention, often requires an amputation of the limb. We are presenting a case of a 61-year-old female patient with a large plantar defect of the right foot and gangrene of three toes of the same limb which developed as a result of necrotizing vasculitis.
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Affiliation(s)
- L Bébarová
- I. chirurgická klinika LF UP a FN Olomouc.
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37
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Paajanen H. [Peculiar "appendicitis" turning out to be an internal hernia]. Duodecim 2012; 128:2365-2367. [PMID: 23342483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
After abdominal muscle exercises a young man suffered from upper abdominal pains and vomiting. The pain moved to the lower abdomen and the abdominal wall hardened. Clinical picture and laboratory findings were in agreement with acute appendicitis, and the patient was operated. Unexpectedly the small intestine and the ascending colon appeared almost entirely gangrenous upon gridiron incision, and the surgical incision was widened. An extensive internal herniation was revealed, with the small intestine having protruded through the sigmoid mesentery, causing a disturbance of the blood circulation and necrosis of the bowel. Swift and sufficient resection of the bowel saved the patient's life.
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38
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Shatobalov VK, Ramazanov RR. [The acute appendicitis' diagnostic Alvorado's system]. Khirurgiia (Mosk) 2012:36-42. [PMID: 22810343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The recent studies prove that the treatment of the acute appendicitis should aim the preservation of the organ, considering the important functions of the least. The combined antimicrobial therapy allows the successful conservative treatment of all cases of the acute appendicitis but the gangrenous, which should be treated operatively. The use of glucocorticosteroids together with antibiotics is pathogenetically substantiated. To improve the diagnostics of the acute appendicitis, the modernized Alvorado's system was suggested by the authors. The least is adopted for the diagnostics of intraabdominal abscesses and gangrenous appendicitis.
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Kotokey RK, Kaushik BPN. Symmetrical peripheral gangrene and neurological manifestations in Plasmodium falciparum malaria. J Assoc Physicians India 2011; 59:449-451. [PMID: 22315752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A case of Falciparum malaria complicated with symmetrical peripheral gangrene has been discussed. This association is not very common as reported in the literature. The special feature of this case is that the patient had bilateral hypoglossal nerve palsy and the signs of pyramidal tract involvement which improved after conservative management.
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Affiliation(s)
- Ratan K Kotokey
- Department of Medicine, Assam Medical College and Hospital, Dibrugarh 786 002, Assam, India
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Prasad D, Mohanty D, Garg PK, Agarwal V, Jain BK. Adult intussusception: is associated bowel gangrene common? Trop Gastroenterol 2011; 32:45-49. [PMID: 21922856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Adult intussusception is a rare clinical entity in contrast to pediatric intussusception. Varied and non-specific clinical features, delayed presentation, and lack of awareness among attending surgeons to consider it as differential diagnosis complicates the clinical course of the disease. METHODS A retrospective study was conducted in a tertiary care teaching hospital in north India. Nine adult patients who presented with intussusception over a period of six years were analyzed. Their clinical profile, management and underlying pathology were studied. RESULTS Five out of nine patients had acute presentation while remaining four presented with subacute/chronic symptoms. Median duration of presentation was 8 days (range 2-180 days). Clinical diagnosis of intussusception was considered in only one patient. Ultrasonography clinched the diagnosis in all four patients who presented with subacute/chronic symptoms. Ileo-ileal intussusception was present in five patients, with one having associated jejuno-jejunal intussusception. Other four patients had ileo-colic intussusception. Seven of the 9 patients (77%) were found to have associated bowel gangrene. Resection of the bowel segment having intussusception was done in all patients. Five patients had associated benign intestinal pathology while idiopathic intussusception was present in four patients. CONCLUSION The patients presented in the series are distinct from cases reported earlier in literature in term of late presentation, manifesting as acute intestinal obstruction, high frequency of associated intestinal gangrene, and absence of associated intestinal malignancy. Patients presenting with features of intestinal obstruction and abdominal lump should be subjected to urgent imaging studies to examine the possibility of intussusception. The high frequency of bowel gangrene encountered in patients of adult intussusception mandates prompt surgical intervention soon after diagnosis.
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Affiliation(s)
- Dharmendra Prasad
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India-110095
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Tiwari N, Sharma AK, Galagali A, Kumar M, Chand K. Acute idiopathic gastric gangrene with perforation. Trop Gastroenterol 2010; 31:339-341. [PMID: 21568159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- N Tiwari
- Military Hospital, CTC, Pune, India
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Galsgaard K, Hilberg O, Hjorthaug K. [Pheochromocytoma presenting as ischaemic gangrene of lower limbs]. Ugeskr Laeger 2010; 172:2124-2125. [PMID: 20654282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We describe a 71-year-old woman who was admitted with pneumonia. She quickly developed severe pain and gangrene in all four extremities and had several fingers and crurae amputated. Pheochromocytoma was diagnosed by a 2 x 2 24-hour urine collection, computerized axial tomography and MIBG scintigraphy. The patient was suppressed with phenoxybenzamine hydrochloride and propanolol for three weeks and was subsequently laparoscopically adrenalectomized on her left side.
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Ahmed ME, Mahmoud SM, Mahadi SI, Widatalla AH, Shawir MA, Ahmed ME. Hand sepsis in patients with diabetes mellitus. Saudi Med J 2009; 30:1454-1458. [PMID: 19882060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To report on the clinical presentation and possible risk factors leading to hand sepsis, amputation, management, and outcome in diabetic patients presenting to a multidisciplinary diabetic center in Khartoum, Sudan. METHODS This is a retrospective descriptive study of all diabetic patients presenting with hand sepsis between September 2002 and March 2008 to Jabir Abueliz Diabetic Centre (JADC) in Khartoum, Sudan. RESULTS A hundred and nineteen diabetic patients with hand sepsis were managed in JADC. The causative agent was unknown in 48.7%, and due to trauma in 42.9%. The most common presentation was cellulitis in 36.1% of patients and deep seated abscess in 29.5%. In 22.7% there was significant sensory neuropathy with loss of perception to 10 gm monofilament nylon. An associated foot ulcer was present in 13.4% of patients. One or more digits amputation was carried out in 17 (14.3%) of patients and hand amputation was unavoidable in 2 (1.7%). Complete healing with good function was achieved in 79%. There was no mortality in this series. CONCLUSION Hand sepsis in diabetics is a serious complication, but with early presentation to a specialized diabetic care facility, satisfactory outcome could be achieved.
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Affiliation(s)
- Mohamed E Ahmed
- Jabir Abueliz Diabetic Centre, University of Khartoum, Khartoum, Sudan.
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Yesil S, Akinci B, Yener S, Bayraktar F, Karabay O, Havitcioglu H, Yapar N, Atabey A, Kucukyavas Y, Comlekci A, Eraslan S. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Hormones (Athens) 2009; 8:286-95. [PMID: 20045802 DOI: 10.14310/horm.2002.1245] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline. DESIGN In this observational study, data were collected prospectively in 670 consecutive diabetic foot ulcer episodes in 510 patients examined between January 1999 and June 2008 and were used to evaluate potential predictors of amputation retrospectively. After exclusion of patients who did not come to the hospital for follow-up for a minimum of six months, data of 574 foot ulcer episodes were evaluated. RESULTS Limb ischemia, osteomyelitis and presence of gangrene and ulcer depth, determined by the Wagner classification system, were the major independent predictors of overall and major amputations. Older age, presence of coronary artery disease, smoking and ulcer size were found to be associated with either overall or major amputations. Baseline levels of acute phase reactants (white blood cell count, polymorphonuclear leukocyte count, platelet count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and albumin) and decreased hemoglobin levels were associated with amputation risk. Multivariate analysis showed that one standard deviation increase in baseline CRP and ESR levels were independent predictors of overall and major amputations, respectively. CONCLUSIONS The presence of limb ischemia, osteomyelitis, local and diffuse gangrene and ulcer depth were independent predictors of amputation. Baseline levels of ESR and CRP appeared to be helpful for clinicians in predicting amputation.
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Affiliation(s)
- Sena Yesil
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School, Inciralti, Izmir, Turkey
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Bugaje MA, Umar LW, Ogirima MO, Hassan L. Gangrene of the limb complicating Salmonella typhi septicaemia in a Nigerian child. Niger J Clin Pract 2009; 12:335-337. [PMID: 19803040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report an unusual case of lower limb gangrene in a pubertal boy following a typical clinical presentation of septicaemia due to Salmonella typhi. After an initial response to presumed appropriate antibiotic and supportive therapy, the patient developed tissue ischaemia in both feet. There were no clinical or laboratory evidence suggestive of DIC or coagulopathy. Following conservative management which included oral administration of vitamin C, there was gradual regression of ischaemic changes, progressive healing and recovery of function of the left foot while the condition of the right foot deteriorated with extensive tissue necrosis and dry gangrene that extended to the distal one third of the foot. This necessitated surgical disarticulation of the metatarsophalangeal joints two months after admission. This report is to alert clinicians about this rare complication of a common curable disease with a view to anticipating the possibility of it occurring as well as considering appropriate preventive measures.
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Affiliation(s)
- M A Bugaje
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital Zaria, Nigeria.
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Serban D, Brănescu CM, Savlovschi C, Dascălu AM, Borcan R, Tiucă F, Oprescu S. [A rare cause of pneumoperitoneum]. Chirurgia (Bucur) 2009; 104:223-226. [PMID: 19499668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We provide the description of a 77 year old patient, admitted into the IC unit, with whom the surgical intervention was required by the presence of a massive pneumoperitoneum observed during abdominal CT. Anamnestic and clinical information was scarce; the patient had been admitted into the gastroenterology unit with the following diagnosis: acute pancreatitis, renal failure, atrioventricular block, while the hemodynamic instability made hospitalisation into the IC unit mandatory. Anatomopathological lesions secondary to a major vascular damage at the level of the celiac trunk and at the superior mesenteric level were noticed intraoperatively: total gastric necrosis with perforation, splenic infarction, entero-mesenteric infarction, abdominal wall necrosis. The patient did not allow for a surgical solution. The anatomopathological examination of the gastric tissue fragment enabled the diagnosis of extensive gangrene of the gastric wall. The relevance of the case consists in the presence of an abdominal vascular damage detected in full development, where the pneumoperitoneum required surgical exploration. The intricacy of the anatomopathological lesions accounts for the acute painful abdominal onset, accompanied by quick hemodynamic, clinical, and biochemical deterioration. Thus, gastric perforation through rupture secondary to total gastric gangrene of vascular origin joins the many causes of pneumoperitoneum.
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Affiliation(s)
- D Serban
- Universitatea de Medicină si Farmacie "C. Davila" Bucureşti.
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Caillouët IS, Jaffe BM. Torsion and gangrene of a Meckel's diverticulum. J La State Med Soc 2009; 161:19-54. [PMID: 19278165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A 19-year-old woman presented to the emergency department with intermittent and progressively worsening abdominal pain, nausea, and vomiting. A computed tomographic scan revealed findings consistent with distal small bowel obstruction of unknown etiology. In the operating room, a torsed and gangrenous Meckel's diverticulum with extension of ischemia to adjacent small bowel was discovered and immediately resected. Pathology confirmed the diagnosis of gangrenous Meckel's diverticulum. Torsion and gangrene of a Meckel's diverticulum is a rare complication and often presents with vague and poorly localized signs and symptoms. The preoperative diagnosis is often difficult and presumed to be appendicitis or small bowel obstruction of unclear etiology. Complications of Meckel's diverticulum should be considered in patients with lower abdominal pain and acute abdomen.
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Affiliation(s)
- Irene S Caillouët
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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