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Annals of Medicine and Surgery (2012) Feb 2023Injuries from animal attack are one of the major public health problems at present scenario globally. Proper documentation is required for the study of different types...
UNLABELLED
Injuries from animal attack are one of the major public health problems at present scenario globally. Proper documentation is required for the study of different types of injuries caused by animal attacks so that early intervention can be done during life-threatening conditions.
CASE PRESENTATION
A 36-year-old male presented with an alleged history of attack by two rhinoceros sustaining injuries over the abdomen, chest, shoulder and thigh.
CLINICAL FINDINGS AND INVESTIGATIONS
There was a lacerated abdomen with evisceration of the stomach, small intestine, transverse colon and omentum and a lacerated wound over the left lateral thigh and left buttock along with the right shoulder. Extended Focused Assessment with Sonography in Trauma ultrasound showed minimal free fluid in the pelvis. Blood profile revealed reduced haemoglobin and deranged prothrombin time/international normalized ratio.
INTERVENTIONS AND OUTCOME
Patient underwent exploratory laparotomy twice with repair of diaphragmatic injury, excision of avulsed greater omentum in the first setting and repair of gastric perforation in the second setting with stable haemodynamic status.
CONCLUSION
Abdominal evisceration injury by rhinoceros attack is life threatening though rare. Its management should consist of assessing for and controlling associated haemorrhage, assessing for bowel content leakage, covering the eviscerated abdominal contents and early reduction of viscera if there is no active bleeding.
PubMed: 36845804
DOI: 10.1097/MS9.0000000000000214 -
Journal of Neurochemistry Feb 2023Chronic pelvic pain (CPP) is the primary symptom of endometriosis patients, but adequate treatments are lacking. Modulation of ion channels expressed by sensory nerves...
Chronic pelvic pain (CPP) is the primary symptom of endometriosis patients, but adequate treatments are lacking. Modulation of ion channels expressed by sensory nerves innervating the viscera has shown promise for the treatment of irritable bowel syndrome and overactive bladder. However, similar approaches for endometriosis-associated CPP remain underdeveloped. Here, we examined the role of the voltage-gated sodium (Na ) channel Na 1.7 in (i) the sensitivity of vagina-innervating sensory afferents and investigated whether (ii) Na 1.7 inhibition reduces nociceptive signals from the vagina and (iii) ameliorates endometriosis-associated CPP. The mechanical responsiveness of vagina-innervating sensory afferents was assessed with ex vivo single-unit recording preparations. Pain evoked by vaginal distension (VD) was quantified by the visceromotor response (VMR) in vivo. In control mice, pharmacological activation of Na 1.7 with OD1 sensitised vagina-innervating pelvic afferents to mechanical stimuli. Using a syngeneic mouse model of endometriosis, we established that endometriosis sensitised vagina-innervating pelvic afferents to mechanical stimuli. The highly selective Na 1.7 inhibitor Tsp1a revealed that this afferent hypersensitivity occurred in a Na 1.7-dependent manner. Moreover, in vivo intra-vaginal treatment with Tsp1a reduced the exaggerated VMRs to VD which is characteristic of mice with endometriosis. Conversely, Tsp1a did not alter ex vivo afferent mechanosensitivity nor in vivo VMRs to VD in Sham control mice. Collectively, these findings suggest that Na 1.7 plays a crucial role in endometriosis-induced vaginal hyperalgesia. Importantly, Na 1.7 inhibition selectively alleviated endometriosis-associated CPP without the loss of normal sensation, suggesting that selective targeting of Na 1.7 could improve the quality of life of women with endometriosis.
PubMed: 36840383
DOI: 10.1111/jnc.15795 -
The Archives of Bone and Joint Surgery 2023Revision of an intrapelvic migration of the acetabular component of a total hip is a challenging surgery due to the risk of injury to the pelvic viscera. The primary...
Acetabular Screw in Close Proximity to the Posterior Branch of the Internal Iliac Artery in Revision Hip Surgery with Intrapelvic Migration of Acetabular Component: Preoperative Placement of a Fogarty Catheter in the Internal Iliac Artery (Case Report).
Revision of an intrapelvic migration of the acetabular component of a total hip is a challenging surgery due to the risk of injury to the pelvic viscera. The primary concern is vascular injury due to the risk of mortality and limb loss. The researchers present one case where the acetabular screw was near the posterior branch of the internal iliac artery. A Fogarty catheter was placed in the internal iliac artery preoperatively, and the amount of fluid to inflate the catheter and completely block the artery was determined. The catheter was kept in a deflated condition. The hip reconstruction was performed, and there was no incidence of vascular injury during the procedure; hence, the Fogarty catheter was removed postsurgery. The placement of a Fogarty catheter in the at-risk vessel provides the freedom to proceed with the hip reconstruction through the standard approach. In case of an inadvertent event of a vascular injury, it can be inflated with the predetermined amount of saline to check the bleeding until the vascular surgeons take over the case.
PubMed: 36793662
DOI: 10.22038/ABJS.2022.62952.3051 -
Cureus Jan 2023An isolated perforation of the duodenum is rare in cases of blunt abdominal trauma, and diagnosis is often delayed due to subtle clinical signs. We present the case of a...
An isolated perforation of the duodenum is rare in cases of blunt abdominal trauma, and diagnosis is often delayed due to subtle clinical signs. We present the case of a 13-year-old male patient who presented to the hospital with an alleged history of being run over in the abdomen by a vehicle and a complaint of severe abdominal pain. Radiography of the abdomen in the standing position showed air under the diaphragm, and ultrasonography revealed free fluid in the pelvic and peritoneal cavities, clinching the diagnosis of hollow viscus perforation. The patient was resuscitated and underwent an exploratory laparotomy under general anesthesia. On exploration, no perforation was found in the intraperitoneal organs. The retroperitoneum was opened, and the Cattell-Braasch maneuver was used to approach the duodenum. A single perforation was discovered in the fourth part, and a modified graham patch repair was done. As soon as the patient's bowel sounds returned, a low-fat diet was started through a nasojejunal tube placed distal to the perforation site. The patient was discharged in good condition and is doing well with regular follow-ups. This case emphasizes the need for a high index of suspicion for gut perforation of both intra- and retroperitoneal organs after blunt trauma. This will help in early diagnosis and timely management to reduce perforation-associated mortality. Damage control surgery, with primary closure of the perforation, is well-suited and preferred in an emergency and resource-limited setting.
PubMed: 36788890
DOI: 10.7759/cureus.33571 -
Cureus Jan 2023The spleen is typically located in the left upper quadrant and is held in position by the suspensory ligaments, which include the gastrosplenic ligament, the splenorenal...
The spleen is typically located in the left upper quadrant and is held in position by the suspensory ligaments, which include the gastrosplenic ligament, the splenorenal ligament, and the phrenicocolic ligament. Abnormalities within these ligaments result in the mobility of the spleen, so it may be located in the pelvis or iliac region, which is termed a wandering spleen. We present a case of a middle-aged man who presented to the emergency department with generalized abdominal pain and diffuse guarding and tenderness. The patient had a previous history of peptic ulcer disease and multiple emergency department visits for gastritis. Given the assumed diagnosis of perforated viscus, the patient underwent a computed tomography scan that demonstrated the absence of the spleen in its usual location and showed an ectopic pelvic spleen. The patient underwent successful surgical treatment with splenopexy. The wandering spleen is a rare medical condition that presents a clinical diagnostic challenge and requires a high index of suspicion. Despite its rarity, the wandering spleen should be considered in patients with recurrent abdominal pain.
PubMed: 36741617
DOI: 10.7759/cureus.33246 -
Journal of Surgical Case Reports Dec 2022Ventriculoperitoneal (VP) shunts are the main treatment modality for patients with hydrocephalus. The complications arising in patients with VP shunts are well...
Ventriculoperitoneal (VP) shunts are the main treatment modality for patients with hydrocephalus. The complications arising in patients with VP shunts are well documented. We present a case of infertility in a patient with a long-standing VP shunt. Her infertility is thought to be the result of pelvic adhesions due to factors related to the distal end of her VP shunt. A 22-year-old female with a 1-year history of infertility was referred due to bilateral hydrosalpinges. Diagnostic laparoscopy revealed multiple adhesions surrounding the distal end of the fallopian tubes. The distal portion of a VP shunt, which was placed over the course of her childhood, was found to be grossly inflamed and densely adherent to the pelvic viscera. VP shunts may produce abdominal adhesions and can cause mechanical infertility.
PubMed: 36540299
DOI: 10.1093/jscr/rjac590 -
Polski Przeglad Chirurgiczny Apr 2022<b>Introduction:</b> Perineal hernia (PH), also termed pelvic floor hernia, is a protrusion of intraabdominal viscera into the perineum through a defect in...
<b>Introduction:</b> Perineal hernia (PH), also termed pelvic floor hernia, is a protrusion of intraabdominal viscera into the perineum through a defect in the pelvic floor. </br></br> <b>Aim:</b> The study was conducted to evaluate the cases of perineal hernia resulting as a complication of abdominoperineal resection (APR) of rectal cancer. </br></br> <b> Material and methods:</b> 30 cases from 24 articles published in reputable peer reviewed journals were evaluated for eight variables including [I] patient age, [II] gender, [III] time since APR, [IV] clinical presentation, [V] approach to repair, [VI] type of repair, [VII] presence/absence of pelvic adhesions [VIII] complications. </br></br> <b>Results:</b> There was a total of 30 cases (18 males and 12 females) with a mean age of 71.5 years. The time of onset of symptoms ranged from 6 days to 12 years. Perineal lump with pain was the chief presenting feature followed by intestinal obstruction. Different approaches were adopted to repair by various methods. </br></br> <b>Conclusions:</b> Perineal hernia as a complication of abdominoperineal resection is reported increasingly nowadays, as the approach to management of rectal cancer has gradually got shifted from open to minimally invasive in recent years. There is a need to spread awareness about this condition, so that it is actively looked for, during the postoperative follow-up. Management is surgical repair; the approach and type of repair should be individualized.
Topics: Female; Male; Humans; Aged; Proctectomy; Rectal Neoplasms; Intestinal Obstruction; Abdominal Cavity; Hernia
PubMed: 36468514
DOI: 10.5604/01.3001.0015.7677 -
Ethiopian Journal of Health Sciences Oct 2022Abdominopelvic vascular structures are exposed to be compressed by adjacent organs or might cause compression of the adjacent hollow viscera. Most of these conditions...
BACKGROUND
Abdominopelvic vascular structures are exposed to be compressed by adjacent organs or might cause compression of the adjacent hollow viscera. Most of these conditions are asymptomatic and they are detected on imaging incidentally. However, when they are symptomatic, they can lead to a variety of uncommon syndromes in the abdomen and pelvis. Aim of the study was to assess the prevalence of incidental abdominopelvic vascular compressions on computed tomography.
METHOD
A retrospective cross-sectional study was conducted. All the CT was performed using 64 slice machine. All computed tomography scan of the abdomen between January and April 2019 were evaluated. Data were collected by evaluating abdominal Computed Tomographic scans from Picture archiving and communication system (PACS). Statistical analysis was performed by using SPSS version 25.0 software.
RESULTS
Out of 623 multi detector abdominopelvic computed tomography (MDCT) performed between January 2019 and April 2019; a total of 513 (N = 513) patients were included in the study. This study group comprised of 277 (54 %) females and 236 male (46%) patients. Mean age was 38 ± 20 (mean ± SD). We identified 35(6.8%) participants with imaging features of Superior mesenteric artery (SMA) compressions and a 34(6.6%) with imaging features of nutcracker phenomenon. The celiac artery was compressed by median arcuate ligament (MAL) in 22(4.3%) of them.
CONCLUSION
Incidentally detected intraabdominal vascular compressions are common to asymptomatic patients. This result emphasizes that, vascular compression syndromes diagnosis should not be made on imaging alone.
Topics: Female; Humans; Male; Adolescent; Young Adult; Adult; Middle Aged; Retrospective Studies; Prevalence; Cross-Sectional Studies; Tomography, X-Ray Computed; Vascular Diseases; Abdomen
PubMed: 36339956
DOI: 10.4314/ejhs.v32i1.8S