ABSTRACT
We report on a case of a healthy male patient who was referred to Urology for recurrent persistent urinary tract infections. Investigation revealed a large intraabdominal inflammatory collection abutting the cecum and bladder suspicious for ruptured appendicitis and colovesical fistula. He was taken to the operating room for exploratory laparotomy with General Surgery and Urology and found to have a ruptured appendix secondary to mucinous appendiceal neoplasm with invasion into the cecum and the bladder wall. He then underwent systemic chemotherapy followed by hyperthermic intraperitoneal chemotherapy. He is well with stable right lower quadrant inflammatory collection and without evidence of metastatic disease 22 months following initial surgery. This case presents a rare presentation of a rare disease process that is easy to misdiagnose or be delayed in diagnosis because of its vague and often varied presentation.
Subject(s)
Appendiceal Neoplasms , Appendix , Urinary Tract Infections , Appendiceal Neoplasms/complications , Appendiceal Neoplasms/diagnosis , Appendiceal Neoplasms/surgery , Appendicitis/diagnosis , Appendicitis/surgery , Appendix/surgery , Humans , Laparotomy , Male , Urinary Tract Infections/diagnosis , Urinary Tract Infections/etiologyABSTRACT
Maxillofacial and neck trauma from penetrating injuries present unique challenges for anesthesia providers and surgeons. In the austere conditions of a combat setting these challenges may be amplified due to limited resources and injury severity. Currently there is a lack of evidence and consensus on how to best manage a traumatized airway in this situation. The authors of this paper present the successful emergency management of a traumatized airway from a severe maxillofacial and neck-penetrating wound. A stepwise team approach using strong communication and a global mental model facilitated definitive airway management in this case allowing for safe transport to definitive care.