ABSTRACT
The authors report a case of a 75-year-old male with pulmonary embolism (PE) successfully treated using the INARI FlowTriever System, a mechanical thrombectomy device. Imaging confirmed deep vein thrombosis and PE presented after two days of left lower extremity (LLE) pain and dyspnea on exertion with history of peripheral vascular disease, coronary artery disease, insulin dependent diabetes mellitus, hyperlipidemia and LLE percutaneous coronary intervention with coronary stent placement. PE treatment with single session clot burden reduction resulted in immediate improvement in oxygenation and echocardiogram confirmed relief of right heart strain. The patient's immediate hemodynamic improvement without thrombolytic therapy, which can take hours for morbidity reduction, supports the expansion of the use of thrombectomy devices for the treatment of submassive symptomatic PE in clinical practice, with further research indicated.
ABSTRACT
INTRODUCTION: One of the most common surgical procedures performed annually is inguinal hernia repair. Inguinal hernias are traditionally known to be caused by a weakening in the abdominal wall and precipitated by increased intraabdominal pressure. Recently, intra-abdominal cancer producing the increased intraabdominal pressure, along with metastasis directly into the inguinal canal, have been identified in more studies as causes of inguinal hernias. PRESENTATION OF CASE: This case focuses on a unique presentation of small-cell neuroendocrine carcinoma presenting as an inguinal hernia. DISCUSSION: This patient's rapid demise and advanced metastatic disease upon presentation is alarming, but his advanced disease process presenting as a routine inguinal hernia is noteworthy. Upon literature analysis, the number of advanced disease processes - most notably cancer - presenting as hernias is significant. CONCLUSION: This case emphasis the importance of perioperative screening, and presents the question, should hernias indicate further workup in the appropriate, at-risk patient populations.
ABSTRACT
Pulmonary embolism is most feared sequela of a proximal deep vein thrombosis (DVT). Currently, first-line DVT treatment is anticoagulation to prevent post-thrombotic sequelae like pedal edema as well as a life threatening pulmonary embolism . Advanced therapy considerations for limb- or life-threatening DVT include catheter-directed thrombolysis and thrombectomy. Thrombectomy is necessary when thrombolytics are contraindicated secondary to increased bleeding risk. The authors present a DVT case treated with the mechanical thrombectomy device, ClotTriever (Inari Medical, Irvine, CA), resulting in the efficient and effective removal of thrombus with near-complete resolution of venous symptoms and prompt hospital discharge.
ABSTRACT
INTRODUCTION: Retained gallstones post-cholecystectomy act as a nidus for abscess formation. It is unusual for intraabdominal abscesses to remain asymptomatic due to its propensity to cause inflammation and irritation to the peritoneum. PRESENTATION OF CASE: A 73-year-old female presented with acute onset of right-sided abdominal pain and fever. Her past surgical history was significant for a cholecystectomy in 2010, hysterectomy, and partial nephrectomy. She was diagnosed with an intraabdominal abscess secondary to a retained gallstone post-cholecystectomy. She underwent laparoscopic surgery to drain and remove the abscess. The patient's abdominal pain improved, remains afebrile, and is passing stool regularly. DISCUSSION: Gallbladder perforation is common and is dependent on the integrity of the gallbladder and surrounding structures. It is unusual for an intra-abdominal abscess to develop so late following gallstone spillage. This example brings to light the potential long-term sequelae of gallbladder perforation and future complications. CONCLUSION: This case highlights the importance of irrigation of the peritoneal cavity and retrieval any spilled gallstones during surgery in the event of gallbladder perforation.
