ABSTRACT
Porous diaphragm syndromes are characterized by the passages of substances such as fluids, blood and gases through diaphragmatic defect from the peritoneal cavity into the pleural space. Clinically, they usually present with pleural effusions, hemothorax, pneumothorax and even empyema, secondary to the abdominal pathology. This condition may give rise to respiratory and cardiovascular problems in peri-anesthetic period. We report a case of progressive hemothorax induced by postoperative abdominal bleeding leading to cardiac arrest in gynecologic patient with undiagnosed porous diaphragmatic syndrome.
Subject(s)
Humans , Diaphragm , Empyema , Gases , Heart Arrest , Hemorrhage , Hemothorax , Peritoneal Cavity , Pleural Effusion , PneumothoraxABSTRACT
We present two cases of dynamic left ventricular outflow tract obstruction in 2 patients who were undergoing living donor liver transplantation. On the preoperative transthoracic echocardiography, the first patient showed normal ventricular function and a normal wall thickness, but severe hemodynamic deterioration developed during the anhepatic period and this was further aggravated after reperfusion in spite of volume resuscitation and catecholamine therapy. Intraoperative transesophageal echocardiography revealed the systolic anterior motion of the mitral valve leaflet together with left ventricular outflow tract obstruction. The second patient showed left ventricular hypertrophy with left ventricular outflow tract obstruction on the preoperative echocardiography. Intraoperative transesophageal echocardiography was used to guide fluid administration and the hemodynamic management throughout the procedure and a temporary portocaval shunt was established to mitigate the venous pooling during the anhepatic period. The purpose of this report is to emphasize the clinical significance of dynamic left ventricular outflow tract obstruction in patients who are undergoing living donor liver transplantation and the role of intraoperative echocardiography to detect and manage it.
Subject(s)
Humans , Echocardiography , Echocardiography, Transesophageal , Hemodynamics , Hypertrophy, Left Ventricular , Liver , Liver Transplantation , Living Donors , Mitral Valve , Reperfusion , Resuscitation , Ventricular FunctionABSTRACT
Pseudo-Meigs' syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. The major problem associated with pseudo-Meigs' syndrome is the respiratory distress caused by a giant mass in the peritoneal space, massive ascites and pleural effusion. Even if there are no respiratory problems prior to surgery, potential respiratory dysfunction can occur during the peri-anesthetic period, leading to hypoxia, hypercapnea and respiratory acidosis. We report a case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs' syndrome.
Subject(s)
Humans , Acidosis, Respiratory , Anesthesia , Hypoxia , Ascites , Hydrothorax , Pleural EffusionABSTRACT
Pseudo-Meigs' syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. The major problem associated with pseudo-Meigs' syndrome is the respiratory distress caused by a giant mass in the peritoneal space, massive ascites and pleural effusion. Even if there are no respiratory problems prior to surgery, potential respiratory dysfunction can occur during the peri-anesthetic period, leading to hypoxia, hypercapnea and respiratory acidosis. We report a case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs' syndrome.