ABSTRACT
Abdominal compartment syndrome is a surgical emergency caused by a raised intra-abdominal pressure, which may lead to respiratory, cardiovascular and renal compromise. It is most commonly seen in post-operative and trauma patients and it has a variety of causes. Tension pneumoperitoneum (TP) is a rare cause of abdominal compartment syndrome most often seen after gastrointestinal endoscopy with perforation. We present the case of a fit 52-year-old experienced female diver who developed TP and shock following a routine training dive to 27m. Following accidental inhalation of water, she had an unstaged ascent and, on reaching the surface, developed severe acute abdominal pain and distension. She was brought to our emergency department by air ambulance for assessment. Clinical and radiological examination revealed a shocked patient with dramatic free intra-abdominal gas and signs of abdominal compartment syndrome, which was treated with needle decompression. Symptoms and signs resolved quickly with no need for further surgical intervention. TP is a surgical emergency where surgery can be avoided with prompt diagnosis and treatment.
Subject(s)
Barotrauma/etiology , Diving/adverse effects , Intra-Abdominal Hypertension/etiology , Pneumoperitoneum/etiology , Abdominal Pain/etiology , Barotrauma/surgery , Decompression Sickness/etiology , Decompression, Surgical/methods , Diagnosis, Differential , Female , Humans , Intra-Abdominal Hypertension/surgery , Middle Aged , Pneumoperitoneum/surgeryABSTRACT
From 2001 to 2005, 66 patients referred for perioperative hyperbaric oxygen therapy (HBO2) for debridement of necrotic tissue or prevention of radionecrosis were assessed with quality of life measures, before and after completion of HBO2 and surgery. The Medical Outcomes Short Form 36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) showed no significant changes. The European Organisation for Research and Treatment of Cancer Core (EORTC-C30) questionnaire showed significant improvement in pain, global health, and dyspnoea (p=0.011; p=0.027; p=0.008, respectively). The Head and Neck sub-module (H&N35) identified significant improvements in teeth, dry mouth and social contact (p=0.002; p=0.038; p=0.029, respectively). The University of Washington Scale (UW), showed significant changes in relation to chewing and shoulders (p=0.031; p=0.047). When sub-group analysis using 'osteoradionecrosis' and 'dental extraction or implants' was performed on the EORTC and UW data, variations in the patterns of significance were found. Adjunctive HBO2 should be considered for the treatment and prevention of some of the long-term complications of radiotherapy.
Subject(s)
Head and Neck Neoplasms/radiotherapy , Hyperbaric Oxygenation , Quality of Life , Radiation Injuries/therapy , Anxiety/psychology , Cohort Studies , Dental Implants , Depression/psychology , Female , Head and Neck Neoplasms/surgery , Health Status , Humans , Interpersonal Relations , Male , Mastication/physiology , Middle Aged , Mouth/radiation effects , Osteoradionecrosis/therapy , Pain Measurement , Perioperative Care , Radiation Injuries/prevention & control , Sexual Behavior , Tooth/radiation effects , Tooth Extraction , Treatment OutcomeABSTRACT
A facial nerve palsy, as a result of middle-ear high pressure, is a rare complication of sub-aqua diving. It may occur as a result of an acute pressure change in the middle ear during ascent in those patients who have experienced difficulty equalizing their middle-ear pressure during the prior descent. We present the case history of this occurring in a 21-year-old diver and discuss the pathophysiology, management and the previous literature. The correct diagnosis of this condition is important if unnecessary, and potentially hazardous, recompression treatment is to be avoided.
Subject(s)
Barotrauma/complications , Diving/adverse effects , Facial Paralysis/etiology , Adult , Barotrauma/diagnosis , Ear, Middle/physiopathology , Facial Paralysis/diagnosis , Female , HumansABSTRACT
Gastric rupture is an uncommon surgical problem which normally presents with an acute abdomen and peritonism. An unusual case following underwater ascent and its conservative management is presented.
Subject(s)
Diving/adverse effects , Stomach Rupture/etiology , Adult , Colic/etiology , Humans , Male , Radiography , Remission, Spontaneous , Stomach/diagnostic imaging , Stomach Rupture/diagnosis , Stomach Rupture/therapy , UltrasonographyABSTRACT
Two recent deaths from massive air embolism occurring while scuba diving off the South coast of Britain are reported. In each case the circumstances of death were uncertain. In both instances the cause of death, that is massive gas embolism, was determined by plain radiography and findings were confirmed at post-mortem. These cases illustrate that in unexplained deaths that occur after exposure to, or change in hyper- or hypobaric conditions, investigation should include pain radiographs of the chest, abdomen and skull.
