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International Journal of Surgery... Aug 2018Aim of this study is to report and to analyze the incidence, clinical impact and treatment options of ectopic air localizations after transanal procedures. (Review)
Review
BACKGROUND
Aim of this study is to report and to analyze the incidence, clinical impact and treatment options of ectopic air localizations after transanal procedures.
METHODS
A systematic literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research was carried out using the PubMed database, identifying 40 articles with the following keywords: "transanal" AND "emphysema"; "transanal" AND "subcutaneous emphysema"; "transanal" AND "pneumomediastinum"; "transanal" AND "pneumothoraces"; "transanal" AND "pneumopericardium"; "transanal" AND "retropneumoperitoneum".
RESULTS
Nineteen articles, published between 1993 and 2017, were included in the study for a total of 29 patients. The most frequent air localization was in the retroperitoneum, followed by subcutaneous tissues, mediastinum and neck. This condition was treated conservatively in 20 patients, with colostomy in 4 patients, with bowel resection and negative diagnostic laparoscopy in one patient each. In three cases the treatment was not specified. Ectopic air location resolved in all cases.
CONCLUSIONS
Pneumo-mediastinum and pneumo-retroperitoneum after transanal procedures are unusual complications with a dramatic radiological appearance but can be managed successfully with a completely benign course in most cases. Initially, a conservative approach is recommended. Surgical treatment should be reserved only in case of fluid collection or suture dehiscence.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Mediastinal Emphysema; Middle Aged; Postoperative Complications; Radiography; Retropneumoperitoneum; Subcutaneous Emphysema; Transanal Endoscopic Surgery
PubMed: 29936199
DOI: 10.1016/j.ijsu.2018.05.743 -
JAAPA : Official Journal of the... Nov 2021Since its discovery, COVID-19 has infected nearly 112 million people and caused about 2.5 millions deaths worldwide. Our understanding of the clinical presentation and...
Since its discovery, COVID-19 has infected nearly 112 million people and caused about 2.5 millions deaths worldwide. Our understanding of the clinical presentation and complications of COVID-19 is still evolving. Bilateral pulmonary ground-glass opacities on imaging have become characteristic in the diagnosis of COVID-19, but pneumomediastinum has now also been reported in some patients with COVID-19. Reports on the overall prognosis for these patients are conflicting and little information exists regarding long-term complications. This article describes the clinical course of a patient who did not need mechanical ventilation but developed spontaneous pneumomediastinum.
Topics: COVID-19; Humans; Mediastinal Emphysema; Prognosis; Respiration, Artificial; SARS-CoV-2
PubMed: 34593717
DOI: 10.1097/01.JAA.0000794992.99292.48 -
Chirurgia (Bucharest, Romania : 1990) Jun 2022Abstract COVID-19 (Coronavirus-19 disease), a new clinical entity caused by SARS-COV-2 infection, could explain the physiopathology of cervicothoracic air collections... (Review)
Review
Abstract COVID-19 (Coronavirus-19 disease), a new clinical entity caused by SARS-COV-2 infection, could explain the physiopathology of cervicothoracic air collections (pneumothorax, pneumomediastinum, and subcutaneous emphysema). We conducted an 8-months retrospective analysis of a single-center SARS-CoV-2 cases associating pneumothorax, pneumomediastinum, and subcutaneous emphysema, either alone or combined. All non-intubated patients with the complications cited above had a favorable outcome after pleural drainage, percutaneous drainage, and/or conservative treatment, while the intubated patients, with multiple comorbidities, have had an unfavorable outcome, regardless the chosen treatment. Pleural drainage was used for pneumothorax cases; pneumomediastinum with subcutaneous emphysema required insertion of subcutaneous needles or angio-catheters with manual decompressive massage. Conservative methods of treatment were used for patients with pneumomediastinum and medium or severe respiratory disfunction. Etiopathogenic classification of pneumothorax should include SARS-CoV-2 infection as a possible cause of secondary spontaneous pneumothorax due to COVID-19 pneumonia. Survival rate after the occurrence of these complications was small (18,75%), 4 of the patients were cured, 2 had a favorable outcome and 26 have died. Pleural drainage which is mandatory to do for patients with pneumothorax complication in COVID -19 pneumonia, doesn't change the prognosis for those with severe affecting lungs, because the prolonged ventilation and the other comorbidities have led to death in most of these cases.
Topics: COVID-19; Humans; Mediastinal Emphysema; Pneumothorax; Retrospective Studies; SARS-CoV-2; Subcutaneous Emphysema; Treatment Outcome
PubMed: 36049090
DOI: 10.21614/chirurgia.2719 -
American Journal of Respiratory and... Jul 2021
Topics: Embolism, Air; Fatal Outcome; Humans; Male; Mediastinal Emphysema; Pneumonia
PubMed: 33971112
DOI: 10.1164/rccm.202002-0266IM -
Monaldi Archives For Chest Disease =... Sep 2020Spontaneous pneumomediastinum is a benign entity but can worsen the underlying condition with which it is associated. We evaluated the incidence and the clinical...
Spontaneous pneumomediastinum is a benign entity but can worsen the underlying condition with which it is associated. We evaluated the incidence and the clinical relevance of spontaneous pneumomediastinum in a consecutive series of 102 patients with COVID-19 pneumonia. Six cases of pneumomediastinum were identified by high-resolution chest CT-scan. Three patients required early intubation, and one of them died, while in in the remaining subjects the clinical course was benign. The presence of pneumomediastinum required some changes in the management of mechanical ventilation. In conclusion, spontaneous pneumomediastinum is a possible complication of severe COVID-19 pneumonia that can affect patient management and clinical outcomes.
Topics: Aged; Aged, 80 and over; Betacoronavirus; COVID-19; Coronavirus Infections; Female; Humans; Incidence; Italy; Male; Mediastinal Emphysema; Middle Aged; Pandemics; Pneumonia, Viral; Retrospective Studies; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 32990690
DOI: 10.4081/monaldi.2020.1399 -
The National Medical Journal of India 2022Spontaneous pneumothorax leading to pneumomediastinum, pneumopericardium and surgical emphysema is a benign condition. Progression to the development of epidural...
Spontaneous pneumothorax leading to pneumomediastinum, pneumopericardium and surgical emphysema is a benign condition. Progression to the development of epidural pneumatosis is rare. We report a 19-year-old man who presented with dyspnoea and swelling of the chest wall following a bout of cough. Bilateral subcutaneous emphysema was palpated on the anterior chest wall from the sternum to the midaxillary regions. His chest X-ray revealed subcutaneous emphysema and pneumopericardium. His computed tomography of the thorax to rule out life-threatening conditions revealed bilateral subcutaneous emphysema, pneumomediastinum, pneumo-pericardium and pneumothorax. He was transferred to the intensive care unit. An intercostal drainage tube was inserted in the left pleural cavity. The patient was followed up with repeat chest X-rays. The patient's symptom got relieved and was discharged after day 9. Diagnosis of pneumomedia-stinum may not be as lamentable as it is seen. Close cardio-pulmonary monitoring is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management. In this case, the patient's symptoms and severe tachypnoea prompted the insertion of an intercostal drainage tube.
Topics: Adult; Humans; Male; Mediastinal Emphysema; Pneumopericardium; Pneumothorax; Postoperative Complications; Radiography; Subcutaneous Emphysema; Young Adult
PubMed: 36039622
DOI: 10.25259/NMJI_363_19 -
The Israel Medical Association Journal... May 2022
Topics: COVID-19; Humans; Mediastinal Emphysema; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 35598061
DOI: No ID Found -
Clinical Imaging Oct 2022To investigate the incidence, risk factors, and outcomes of barotrauma (pneumomediastinum and subcutaneous emphysema) in mechanically ventilated COVID-19 patients. To...
OBJECTIVES
To investigate the incidence, risk factors, and outcomes of barotrauma (pneumomediastinum and subcutaneous emphysema) in mechanically ventilated COVID-19 patients. To describe the chest radiography patterns of barotrauma and understand the development in relation to mechanical ventilation and patient mortality.
METHODS
We performed a retrospective study of 363 patients with COVID-19 from March 1 to April 8, 2020. Primary outcomes were pneumomediastinum or subcutaneous emphysema with or without pneumothorax, pneumoperitoneum, or pneumoretroperitoneum. The secondary outcomes were length of intubation and death. In patients with pneumomediastinum and/or subcutaneous emphysema, we conducted an imaging review to determine the timeline of barotrauma development.
RESULTS
Forty three out of 363 (12%) patients developed barotrauma radiographically. The median time to development of either pneumomediastinum or subcutaneous emphysema was 2 days (IQR 1.0-4.5) after intubation and the median time to pneumothorax was 7 days (IQR 2.0-10.0). The overall incidence of pneumothorax was 28/363 (8%) with an incidence of 17/43 (40%) in the barotrauma cohort and 11/320 (3%) in those without barotrauma (p ≤ 0.001). In total, 257/363 (71%) patients died with an increase in mortality in those with barotrauma 33/43 (77%) vs. 224/320 (70%). When adjusting for covariates, barotrauma was associated with increased odds of death (OR 2.99, 95% CI 1.25-7.17).
CONCLUSION
Barotrauma is a frequent complication of mechanically ventilated COVID-19 patients. In comparison to intubated COVID-19 patients without barotrauma, there is a higher rate of pneumothorax and an increased risk of death.
Topics: Barotrauma; COVID-19; Humans; Incidence; Mediastinal Emphysema; Pneumothorax; Prognosis; Retrospective Studies; Subcutaneous Emphysema
PubMed: 35926316
DOI: 10.1016/j.clinimag.2022.06.014 -
Journal of Medical Case Reports Mar 2021Spontaneous Pneumomediastinum is a rare disease. It could be a simple and self-limited condition or be a life-threatening complication of underlying diseases. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Spontaneous Pneumomediastinum is a rare disease. It could be a simple and self-limited condition or be a life-threatening complication of underlying diseases. The therapeutic options also differ by the cause. This systematic review was done to provide, as far as we know, the first attempt to broadly assess the clinical feature, predisposing factors, possible management, and outcome of spontaneous primary pneumomediastinum.
METHODS
In addition to the two patients treated at our hospital, a Pub Med Search for literature on case reports of spontaneous pneumomediastinum published in English up to November 2018 was done. We extracted data on patients' demographic characteristics, symptoms, timing, diagnosis, management, and outcome of the treatment were analyzed based on the preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) RESULT: A total of 339 cases were reviewed. 71.7% of them were male. The Mean age affected was 22.4 ± 11.3 years. Chest pain, 196 (57.8%), is the most common presenting symptom, followed by dyspnea, 156 (46%), cough 95 (28%), neck swelling 92 (27.13%), cervical pain 88 (25.9%), dysphagia 39 (11.5%), odynophagia 37 (10.9%), and Dysphonia 14 (4.1%). Fifty-seven patients (16.8%) had a prior history of Asthma, 19 (5.6%) had Connective Tissue Disorders, and 12 (3.5%) had associated malignancy as an identified risk factor. In 35 (10.3%) patients, spontaneous pneumomediastinum was found incidentally. The mean number of days before the clinical resolution of spontaneous pneumomediastinum was 6.65 ± 11.8 days and the average hospital stay was 4.15 ± 1.93 days. Nineteen (5.6%) patients have died as a result of the underlying disease not related to SPM.
CONCLUSION
Spontaneous pneumomediastinum is uncommon, usually benign, a self-limited disorder that commonly occurs in a young adult without any apparent precipitating factor or disease. Spontaneous pneumomediastinum usually responds very well to conservative treatment without recurrence. However, secondary causes should be ruled out to minimize the unfavorable outcome.
Topics: Adolescent; Adult; Chest Pain; Child; Cough; Dyspnea; Female; Humans; Male; Mediastinal Emphysema; Neoplasm Recurrence, Local; Young Adult
PubMed: 33761988
DOI: 10.1186/s13256-021-02701-z -
Journal of Pediatric Surgery Jun 2015We characterize the outcomes of pediatric spontaneous pneumomediastinum in the largest series to date and propose a management pathway.
PURPOSE
We characterize the outcomes of pediatric spontaneous pneumomediastinum in the largest series to date and propose a management pathway.
METHODS
All patients at our institution with ICD-9 code 518.1 confirmed to have isolated radiographic findings of spontaneous pneumomediastinum between January 2003 and February 2014 were retrospectively reviewed for admission, intensive care unit (ICU) stay, complications, and outcome.
RESULTS
We identified 96 children with 99 episodes, median age 14.1 years (IQR: 8.7-16.4). Primary symptoms were chest pain, cough, and dyspnea. Most were hospitalized (n=91, 91.9%), with 20 (20.2%) admitted to ICU. Median lengths of stay (LOS) were 1 day (IQR: 1-2) for non-ICU admissions and 3 days (IQR: 2-3) for ICU admissions. The surgical service discharged non-ICU patients 0.94 days earlier than medical services (95% CI 0.38-1.50, p=0.0014). Asthma affected neither LOS nor ICU admission rates. Follow-up imaging, when obtained (n=81, 81.8%), did not alter management. Recurrences occurred in three asthmatics, all after one year. Each was rehospitalized and discharged uneventfully. No patient developed pneumomediastinum-related complications (e.g., pneumothorax, pneumopericardium, or mediastinitis).
CONCLUSION
Spontaneous pneumomediastinum without associated comorbidities can be managed with expectant outpatient observation without further imaging. Children with asthma should be treated independent of spontaneous pneumomediastinum.
Topics: Adolescent; Asthma; Chest Pain; Child; Cough; Dyspnea; Female; Humans; Intensive Care Units; Length of Stay; Male; Mediastinal Emphysema; Radiography; Recurrence; Retrospective Studies; Watchful Waiting
PubMed: 25840604
DOI: 10.1016/j.jpedsurg.2015.03.024