Subject(s)
Aorta, Abdominal , Aortic Diseases/diagnostic imaging , Duodenal Diseases/diagnostic imaging , Endosonography , Fistula/diagnostic imaging , Intestinal Fistula/diagnostic imaging , Aged , Aortic Diseases/surgery , Diagnosis, Differential , Duodenal Diseases/surgery , Fistula/surgery , Humans , Intestinal Fistula/surgery , MaleABSTRACT
Severe ethylene glycol toxicity can cause profound morbidity and is almost universally fatal if untreated. Central nervous system depression with intoxication, pulmonary edema, and acute oliguric renal failure with crystalluria are among the most commonly encountered complications of ingestion. The previously reported gastrointestinal side effects of ethylene glycol toxicity are mostly nonspecific, including nausea, abdominal pain, and cramping. In addition, hepatic damage due to calcium oxalate deposition has been reported. We describe a patient who developed acute colonic ischemia following ethylene glycol intoxication. Three months after the ingestion, the patient presented with severe abdominal pain secondary to a colonic stricture and perforation, necessitating emergent colectomy. Histology of the resected colon revealed polarizable polyhedral crystals suggestive of oxalate deposition. The pathophysiology underlying ethylene glycol intoxication, treatment strategies, and gastrointestinal toxicity are discussed.
Subject(s)
Colon/pathology , Ethylene Glycol/poisoning , Intestinal Perforation/etiology , Ischemia/etiology , Oxalates/chemistry , Colectomy , Colon/blood supply , Colon/chemistry , Crystallization , Humans , Male , Middle Aged , Poisoning/complications , Poisoning/diagnosis , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Needle-knife papillotomy is often used when selective biliary access cannot be achieved. It is difficult to perform and is associated with an increased risk of complications. Initial experience with a new device for pre-cut access is presented. This device may be easier to use and its use may be associated with a lesser risk for complications compared with other methods. METHODS: The device is a miniature scissor mounted on a flexible shaft. It is used to cut the common channel and a short segment of the intrasphincteric common bile duct. The device was used if at least 4 attempts to cannulate the common duct with standard methods were unsuccessful in patients requiring biliary decompression. Data on outcomes and complications were collected. RESULTS: In 8 of 12 patients, scissor pre-cut clearly facilitated common bile duct cannulation. No complications were encountered. CONCLUSIONS: In this small case series, scissor pre-cut papillotomy was safe and effective. Common bile duct access was facilitated in the majority of patients studied.
