Postpartum endometritis leading to decidual abscess

Postpartum Endometritis [PPE] is one of the common causes of postpartum fever. PPE leading to decidual abscess has not been reported previously in the literature. Risk factors for PPE range from invasive fetal monitoring to maternal diabetes mellitus and anemia. Our patient had several risk factors for the development of PPE. Commonly PPE is a polymicrobial infection but in our case it was monobacterial. Ultrasonography, tissue histopathology and culture sensitivity are helpful in diagnosing PPE, as well as tailoring the antimicrobial therapy. PPE is a common etiology for postpartum fever and acute infection of decidua which may progress and lead to decidual abscess formation. Endometritis can be monobacterial from the genital tract organisms. Uterine curettage and endometrial tissue culture and sensitivity will guide in tailoring the antimicrobial therapy

Blind nasogastric lube insertion: be careful

Nasogastric tubes are used in all specialties of medical practice. In critically ill patients, these feeding tubes provide enteral nutrition, which maintains enteric mucosal integrity as well as the immune system of the body, less risk of sepsis and decrease in length of intensive care stay. The insertion of nasogastric tube [NGT] is being considered as a simple blind bedside procedure but this procedure is not free of complications and can be fatal as these tubes can be malpositioned into the respiratory tract or central nervous system. Critically ill patients with endotracheal and tracheostomy tube are at particular risk for malpositioning of the nasogastric tubes due to loss of protective reflexes. Here we report three cases, two intubated and one patient with tracheostomy, in whom the enteral feeding tube was malpositioned into the respiratory system, detected early and a new one inserted in correct position, confirmed by x-ray. The aim of this report is to increase awareness about malpositioning of gastric feeding tubes, proper confirmation of their positioning, risk factors for malpositioning and its prevention

Post-operative fat embolism syndrome: a case report and review of literature

Fat embolism occurs in all patients with long bone fractures and intramedullary reaming of long bone but is usually asymptomatic. A few patients will have pulmonary, cerebral and dermal dysfunction; this triad is called fat embolism syndrome [FES]. We report a case of FES developed after intramedullary nailing of both femurs that was successfully managed in our surgical intensive care unit [SICU]