Síndrome de Hamman (neumomediastino) posparto. Síntesis de la bibliografía y reporte de caso / Postpartum Hamman (pneumomediastinal) syndrome. Synthesis of the literature and case report

Resumen ANTECEDENTES: El síndrome de Hamman se caracteriza por la coexistencia de aire libre en el mediastino sin una causa identificable; también puede ser secundario a traumatismos, infecciones intratorácicas, procedimientos médicos como la esofagoscopia y broncoscopia. Su incidencia se estima entre 1 en 2000 y 1 en 100,000 embarazos. CASO CLÍNICO: Paciente de 18 años, con 65 kg de peso, 1.56 m de talla e IMC 26.74, correspondiente a sobrepeso, primigesta, sin antecedentes patológicos ni heredofamiliares relevantes, con evolución normal del embarazo. A las 39 semanas acudió a urgencias ginecológicas debido a contractilidad uterina y salida de líquido por la vagina. La finalización del embarazo fue por parto, con recién nacido vivo. En el puerperio mediato (30 horas después del parto) súbitamente tuvo disnea, ortopnea y dolor en la región infraclavicular, sensación de "burbujeo" en la parte anterior del tórax. La radiografía simple de tórax mostró aire libre en el mediastino y enfisema subcutáneo. La TAC de tórax evidenció múltiples burbujas de aire, con extensión del espacio perivertebral de predominio derecho. La conclusión diagnóstica fue: enfisema extenso subcutáneo en los espacios del cuello, con alcance al mediastino anterior, con extenso neumomediastino y cardiomegalia global. CONCLUSIONES: El síndrome de Hamman prevalece en primigestas jóvenes y tiene un curso benigno. El tratamiento debe ser conservador, con oxígeno y analgésicos.

Abstract BACKGROUND: Hamman's syndrome is characterized by the coexistence of free air in the mediastinum without an identifiable cause; it may also be secondary to trauma, intrathoracic infections, medical procedures such as oesophagoscopy and bronchoscopy. Its incidence is estimated to be between 1 in 2000 and 1 in 100,000 pregnancies. CLINICAL CASE: 18-year-old female patient, weight 65 kg, height 1.56 m and BMI 26.74, corresponding to overweight, primigravida, with no relevant pathological or heredofamilial history, with normal evolution of pregnancy. At 39 weeks, she attended the gynaecological emergency department due to uterine contractility and leakage of fluid from the vagina. The pregnancy was terminated by delivery, with a live newborn. In the immediate postpartum period (30 hours after delivery) she suddenly experienced dyspnoea, orthopnoea and pain in the infraclavicular region, with a sensation of "bubbling" in the anterior chest. Plain chest X-ray showed free air in the mediastinum and subcutaneous emphysema. Chest CT showed multiple air bubbles, with extension of the perivertebral space predominantly on the right. The diagnostic conclusion was: extensive subcutaneous emphysema in the neck spaces extending into the anterior mediastinum, with extensive pneumomediastinum and global cardiomegaly. CONCLUSIONS: Hamman syndrome is prevalent in young primigravidae and has a benign course. Treatment should be conservative, with oxygen and analgesics.

Disc battery in the pediatric oesophagus

The wide usage of disc batteries in toys, in the late seventies presented a new problem. In the form of accidental lodgements in the pediatric aerodigestive tract. The physico-chemical nature of the disc battery necessitates an early removal, so as to avoid a fatal outcome if missed and retained for a long duration. Management of one such case is reported with radiographic documentation.

Incidence and management of foreign bodies in aerodigestive tract in a tertiary level

Introduction: Foreign body (FB) ingestion and aspiration is a life-threatening condition which is quite common in children. It is important to diagnose foreign body aspiration early as delay in its recognition and treatment results in high morbidity and mortality. The objective of the present prospective study was to study foreign bodies in aerodigestive tract on the basis of history, examination, and investigation, their incidence, type of foreign body, site of lodgment, common symptoms with which presented, and the nature of the problem in dealing with these patients during the management. Materials and Methods: A total of 86 cases of FB in aerodigestive tract admitted in ENT ward of Bundelkhand Medical and Hospital were included in the study. The symptoms, site and radiographic findings were recorded for each patient. Various procedures were used for removal of various FB at different locations. Majority of these procedures were performed under anesthesia. Results: Of all admitted foreign body cases (86 cases), incidence was more for males (63 cases) than for females (23 cases). Likewise, it was encountered more commonly in the age group of 1-10 years. FB were removed smoothly and successfully in all cases. Overall outcome was excellentwith minimum morbidity and no mortality. According to the site of involvement, hospital stay was varied. Conclusion: In this study, it is evident that FB in aerodigestive tract is a common clinical problem in otorhinolaryngological practice. Although, some presents with serious and life-threatening emergencieswhilemany does not have an immediate problem of airway. Higher incidence of foreign body in children can be prevented by educating the parents about keeping the articleaway from reach of children and observing the activity of the child.

A food bolus obstructing the oesophagus in a patient with infantile cerebral palsy

Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter.Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia.Usually, the patient will point at the level of FB on the neck to indicate the location.Methods: Clinical report.Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy.Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It maycause total dysphagia as the passage of food is completely blocked.

Foreign bodies in upper aero-digestive tract: a clinical study.

Background: Foreign-body ingestion and aspiration are common childhood adverse events, hence are commonest causes of morbidity and mortality in infants and children worldwide. Aim of current study was to identify the patients with foreign-body ingestion and aspiration, develop a suitable algorithm for their management and study various complications following their removal. Methods: The present study was carried out in G.R. medical college, Gwalior, M. P. during last one year on hundred patients diagnosed as case of foreign-body in upper aero-digestive tract on the basis of history, examination and investigations. Results: Foreign-bodies in upper aero-digestive tract were seen mostly in children less than 10 years of age (91%). The youngest was 8 months old and the oldest 48 years. Coins were the most common foreign-bodies in oesophagus (90%) while whistle in the upper airway (40%). Right bronchus is the commonest site of impaction in the airway (50%), while cricopharynx is most common in the oesophagus (95.55%). Patients with oesophageal foreign bodies presented mostly with the chief complaint of foreign body sensation (63.4%) in the throat whereas those with airway foreign body presented mostly with dyspnoea and choking sensation (60%). Pooling of saliva was most commonly seen in patients with oesophageal foreign bodies (43.3%). Tachypnoea was the most common sign in cases of tracheabronchial foreign bodies (80%). Positive radiological evidence was present in 88% of upper aero-digestive foreignbodies. Only 2.2% cases showed complications following oesophagoscopy. Tracheo-bronchial foreign-bodies were removed by emergency bronchoscopy. 20% cases had complications post-operatively. Conclusion: Early detection by meticulous history, imaging modality & prompt management remains basis for favourable outcome and prevents fatal complications.

Clinico-pathological Profile of Oesophageal Dysphagia.

Introduction: Dysphagia can cause significant morbidity and mortality, especially in the elderly and the paediatric population. The study was undertaken to determine the clinico-pathological profile of the patients diagnosed with oesophageal dysphagia in a rural tertiary care hospital of India. Methods: This cross sectional, descriptive study was carried out in the ENT Department of Rural Medical College and Pravara Rural Hospital, Loni, Maharashtra. Patients attending the ENT Out Patient Department during 2009 and later diagnosed as cases of oesophageal dysphagia formed the statistical sample. Results: Out of 61 patients, 37 were male and 24 female. Majority of the patients belonged to age group 41-50 years (24.6%), were farmer by occupation (31.1%) and belonged to middle socioeconomic status (34.4%). Pain (throat, retrosternal or epigastric) was the most common (70.5%) presenting complaint. For 39.3% study subjects, the presenting complaint was 3 to 6 months old. Barium swallow study revealed a positive finding in 74.1% (n=40/54) patients, with carcinoma of oesophagus (27.8%) as the most common aetiology, followed by motility disorders and benign strictures. Oesophagoscopy detected lesions in 49 (90.74%) cases and like barium swallow, it also detected carcinoma oesophagus as the most common cause of oesophageal dysphagia. Reflux oesophagitis was the most common form of the oesophagitis and the microbiological examination and culture of samples of 14 patients diagnosed with any form of oesophagitis showed Candida albicans in 21.4%. Conclusion: Dysphagia is a common presenting complaint in the ENT clinic. There is a male preponderance with incidence of malignancy rising with age. Barium swallow may be used as the first line of investigation; however, oesophagoscopy gives a better diagnosis.