Correction: The Tumbling Bullet: Subacute Intestinal Obstruction due to a Retained Bullet.

[This corrects the article DOI: 10.7759/cureus.9844.].

Cardiac Adverse Events With Remdesivir in COVID-19 Infection.

Since December 2019, coronavirus has gradually progressed to a pandemic with no efficacious treatment. Remdesivir is an antiviral medication and inhibitor of viral RNA dependent RNA polymerase with inhibitory action against SARS-CoV virus. Two patients diagnosed with coronavirus infection with worsening respiratory status were initiated with multimodality therapy with antibiotics, steroids and remdesivir. After initiation of remdesivir, the patients' developed bradycardia, with one of the two also showing signs of worsening QT interval. This reverted upon stopping remdesvir therapy. The prevalence of bradycardia with prolonged QT interval is not well-known yet with this medication.

A Retrospective Study Comparing Radiological to Histopathological Diagnosis After Laparoscopic Cholecystectomy for Suspected Cholecystitis.

Introduction Acute calculus cholecystitis is one of the most common causes of acute abdominal pain in patients presenting to the emergency department, representing a third of all surgical emergency hospital admissions. Laparoscopic surgery is typically performed within 24 to 48 hours of hospital admission. Due to similarities in presentation, it is often difficult to differentiate between biliary colic and acute cholecystitis. Currently, it is not clear how the clinical and radiological diagnosis of acute calculus cholecystitis correlates with the histopathological diagnosis.  Methods We performed a retrospective analysis of 350 patients who underwent laparoscopic cholecystectomy in our community hospital for acute calculus cholecystitis. The aim was to compare pre-operative radiological diagnoses of acute calculous cholecystitis to post-operative histopathological diagnosis. Four radiographic modalities were used for diagnosis of acute calculous cholecystitis: ultrasound, computerized tomography, MRI, and hepatobiliary scintigraphy (HIDA scan). A correlation was found between both the clinical pain of biliary origin and radiological diagnosis with subsequent histopathological diagnosis after laparoscopic surgery. Results When the four commonly used imaging modalities were compared, HIDA scan had the highest sensitivity and ultrasound had the highest specificity in successfully diagnosing acute calculus cholecystitis that had been confirmed with histopathological analysis. Conclusion No absolute correlation was found between any of the imaging modalities when compared to the pathological diagnosis. The ultrasound had maximum specificity, while the HIDA scan had maximum sensitivity when radiological imaging was compared to histopathology.

The Role of Minimally Invasive Surgery in Appendectomy Within a Hernia.

We present three cases where an inflamed incarcerated appendix was in a femoral, inguinal, and an umbilical hernia. All three patients underwent an appendectomy laparoscopically. The hernias in two of the patients (femoral and inguinal) were left unrepaired as the primary goal was to relieve the patients' symptoms and achieve source control. The hernia was repaired primarily in the patient with an umbilical hernia intraoperatively. At three months follow-up, none of the patients had a clinically visible hernia.

Unusual Delayed Complication of Pacemaker Leads.

We present three patients who complained of chest pain secondary to displaced pacemaker leads. They underwent evaluation in the emergency room multiple times for chest pain. Imaging was useful to diagnose misplaced ventricular leads of the pacemaker. The patients needed a pericardial window for the extraction of leads and repair of the heart defect. The perioperative course was managed with a multidisciplinary team of cardiologists and electrophysiologists.

Is It Safe to Perform Lung Surgery During the Coronavirus Pandemic?

BACKGROUND:  Coronavirus disease (COVID-19) patients are rapidly growing in our community. Patients with compromised lungs and older age are supposedly at high risk of poor outcomes with COVID-19. We aimed to evaluate the COVID-19 impact on lung surgery during this pandemic at our hospital. METHODOLOGY: This is a retrospective study of all lung surgery patients at our hospital in Boca Raton over three months (February to April 2020). All patients who remained for at least one-day inpatient post-lung surgery were assessed to see if they had an increased incidence of coronavirus infection during the hospital stay or at the follow-up office visit. RESULTS: A total of 44 patients underwent thoracic surgery. It was found that there was no incidence of coronavirus infection in these patients. CONCLUSION: With adequate precautions, older patients can undergo lung surgery during this pandemic. There was no incidence of COVID-19 found among the patients during the hospital stay or at the first follow-up in the office. Also, the postoperative course was not adversely affected.

Fallopian Tube Tumor Mimicking Primary Gastrointestinal Malignancy.

A 67-year-old female patient positive for a mismatch repair gene mutation and history of serous carcinoma of the fallopian tube presented with a lower gastrointestinal bleed. Clinical workup was suggestive of a primary gastrointestinal malignancy. Pathological review after right hemicolectomy revealed the primary tumor was a fallopian tube carcinoma. Over the next few years, she presented with upper and lower gastrointestinal bleeds from a recurrent metastatic disease, which was from the primary fallopian tube cancer. Although serous carcinoma of the fallopian tube is not an uncommon diagnosis, it is unusual for it to present with symptoms of recurrent gastrointestinal bleed mimicking a primary gastrointestinal malignancy.

The Tumbling Bullet: Subacute Intestinal Obstruction due to a Retained Bullet.

A 29-year-old female presented with multiple gunshot wounds to the back and bilateral lower extremities. The patient underwent an exploratory laparotomy with small-bowel resection of two segments with primary stapled anastomosis and partial nephrectomy. The postoperative course showed prolonged intermittent bowel obstruction secondary to the bullet, which lodged in the distal ileum. The patient eventually passed the bullet; it, however, led to a delay in recovery.

Gluteal Compartment Syndrome After Prolonged Immobilization in Drug Abusers.

Background There has been an increasing incidence of drug abuse patients presenting with rhabdomyolysis after prolonged immobilization. Our study was to assess etiology and management challenges with patients presenting with gluteal compartment syndrome after drug abuse. Methodology We did a retrospective analysis of five patients who presented with gluteal compartment syndrome secondary to drug abuse over one year. Results We had a 100% association with rhabdomyolysis and acute renal injury necessitating hemodialysis. There was a frequent association with the involvement of additional compartments like thigh and leg. Conclusion Patients with drug overdose can present with unusual compartment syndrome involvement like the gluteal compartment. Compartment syndrome is a surgical emergency and needs multidisciplinary involvement.

Overwhelming Post-Splenectomy Infection Syndrome: Variability in Timing With Similar Presentation.

Overwhelming post-splenectomy infection (OPSI) syndrome is a rare and well-known entity that rapidly progresses with poor outcomes. Two patients underwent splenectomy after trauma and later presented with flu-like symptoms and thrombocytopenia, which then progressed to fulminant sepsis and death. The first patient had sepsis 20 days post-splenectomy, and the second patient underwent splenectomy 15 years before presentation. Both patients expired within 24 hours of the onset of symptoms. Even with no specific criteria for diagnosis, prompt identification of the overwhelming post-splenectomy infection is necessary; however, the prognosis is usually poor, even with aggressive treatment.

Major Bleed Post Minimally Invasive Surgical Repair of Inguinal Hernia.

At our center, over 200 patients undergo minimally invasive repairs of inguinal hernias every year using a laparoscope and a robotic-assisted technique. In three patients who underwent a minimally invasive procedure for uncomplicated indirect inguinal hernia, the postoperative course was complicated with bleeding and required an exploratory laparotomy. Post-procedure, the patients developed tachycardia and hypotension with a drop in hemoglobin, for which the patients required surgical re-exploration in an emergent fashion. The factors leading to bleeding were analyzed and are reported herein to increase awareness and prevent the occurrence of these complications during inguinal hernia surgery.

Appendicitis Caused by Endometriosis Within the Bowel Wall.

Acute appendicitis is one of the most common causes of acute abdominal pain seen in the emergency room. Common etiologies include obstructing appendicolith and lymphoid adenopathy. Appendiceal endometriosis is rare and typically involves the serosal layer. This case report describes an unusual case of appendicitis secondary to endometriosis in the musclularis mucosa of the appendix in the 36-year-old lady with no prior history of endometriosis.

Methotrexate for Cornual Ectopic Pregnancy.

A 27-year-old pregnant female presented to the emergency department with pelvic pain and vaginal bleeding. At the time of diagnosis, she had an ectopic pregnancy in the right cornua 4 cm in size with a human chorionic gonadotropin (hCG) value of 14,438 international units per mL. The ectopic pregnancy was initially managed by intramuscular methotrexate. However, after 10 days, despite an hCG value drop to 409 international units per mL, an indication that methotrexate was working, the patient had a subsequent rupture with hemoperitoneum necessitating exploratory laparotomy and abdominal hysterectomy.

Ogilvie Syndrome Following an Inflatable Penile Implant.

A 59-year-old male patient presented with Ogilvie syndrome which developed after inflatable penile prosthesis placement. The patient presented to the emergency room three days after having an inflatable penile prosthesis with complaints of obstipation. A trial of conservative measures failed, and because of the development of peritonitis, the patient underwent a right hemicolectomy with a loop ileostomy.

Pelvic Rectal Stercoral Perforation Resulting in Diffuse Pneumatosis.

An 83-year-old woman with oral corticosteroid use for chronic autoimmune conditions presented with abdominal pain and constipation for the previous seven days. CT of the abdomen and pelvis revealed a large fecaloma with diffuse pneumatosis involving the retroperitoneum, subcutaneous tissue, and mediastinum. An emergent exploratory laparotomy revealed perforation of the rectum below the peritoneal reflection into the retroperitoneum. An end-colostomy with Hartmann's operation was then performed intra-operatively. Despite operative treatment complicated by prolonged intubation, the patient succumbed to multiorgan failure and expired.

Vascular Shunt for Small Vessel Trauma in a Polytrauma Patient.

A 15-year-old male patient presented with multiple gunshot injuries. The patient underwent emergency lifesaving exploratory laparotomy and subsequently needed repair of his left upper limb ulnar artery injury. A shunt helped restore blood flow to the hand in a setting of damage control surgery in an exsanguinating patient with an ulnar artery injury having a massive disruption. After resuscitation, the patient underwent definitive repair of the artery using a vein interposition graft.

Bleeding After a Single Dose of Ketorolac in a Postoperative Patient.

A 74-year-old male patient with extensive cardiac history and hepatitis on apixaban and clopidogrel presented with adhesive small bowel obstruction. The patient underwent an exploratory laparotomy and adhesiolysis for small bowel obstruction. On postoperative day 6, after a single dose of ketorolac, the patient had an intra-abdominal bleed requiring exploratory laparotomy and washout.

Delayed Presentation of Foot Compartment Syndrome.

A 30-year-old male after consuming alcohol and drugs lost consciousness and passed out in his bathroom. After 10 hours, he was found immobilized stuporous on his bathroom floor and brought by emergency service to the emergency room. He was found to have compartment syndrome of the right lower limb and underwent emergency fasciotomy of three compartments of the thigh and four compartments of the leg. The postoperative course was complicated by acute kidney injury necessitating hemodialysis. On postoperative day three from the index fasciotomy patient was found to develop foot compartment syndrome despite not having foot compartment involved in the initial presentation. In opioid abuse, patients' additional compartments can get involved during the disease process, and it is essential to identify them with regular physical examination and use of biomarkers.

Laparoscopic Approach for Gallstone Ileus in Geriatric Patients.

We report two patients who presented with small bowel obstruction secondary to gallstones in the ileum. Both patients were geriatric women with multiple comorbidities. The first patient was a 73-year-old woman who presented with a gallstone eroding and obstructing the duodenum (Bouveret's syndrome) secondary to gallbladder cancer with diffuse metastatic spread to the liver. The stone was disimpacted endoscopically using lithotripsy. The patient presented two days later after the stone had migrated downstream into the small bowel causing obstruction requiring surgical intervention. Second patient was an 81-year-old woman who presented with small bowel obstruction caused by a gallbladder stone impacted in the distal ileum. Both patients were managed laparoscopically with a mini laparotomy to extract the affected segment of bowel loop via small incision on the anterior abdominal wall at the port site with enterolithotomy. Both patients were discharged by postoperative day four with no complications. We conclude that, in elderly patients with multiple comorbidities presenting with gallstone ileus, laparoscopic approach provides early recovery with minimal pain.

Isolated Injury to Prepuce After Motor Vehicle Collision.

A four-year-old male restrained passenger in the rear seat was in a motor vehicle collision. He had pain and swelling in the tip of the penis with the inability to micturate. The patient on evaluation had an isolated injury of the prepuce. The patient underwent an evaluation to rule out underlying penile/urethra and associated injury of kidney and bladder. The patient had an isolated injury to prepuce, causing urinary retention for which he underwent circumcision.