ABSTRACT
Small bowel obstruction (SBO) is a major cause of morbidity and financial burden in hospitals around the world. Foreign body (FB) ingestion as a cause is rare. While most cases are straight forward, some can be extremely subtle. We present a case of SBO caused by an undigested piece of pineapple core.
Subject(s)
Breast Neoplasms/pathology , Nipples/pathology , Phyllodes Tumor/pathology , Adult , Female , HumansABSTRACT
A 53-year-old mentally retarded male was brought to our emergency room after vomiting a plastic glove. Computed tomography revealed marked gastric distention containing large amount of residual food debris. Endoscopic retrieval was unsuccessful. Surgical removal of the foreign bodies was done. The patient did well and was discharged from the hospital.
ABSTRACT
Intrathoracic esophageal anastomotic leaks after cancer resection are very morbid and challenging problems. Esophageal stents play an integral role in the management of these patients. Herein, we present a case of lower esophageal cancer who developed a leak at his gastroesophageal anastomosis after resection and was successfully managed with a fully covered metal stent. Our objective was to remind our colleagues regarding a safe alternative treatment for this complication.
ABSTRACT
Our patient is a 58-year-old female who presented to our emergency room with left upper quadrant abdominal pain the day after outpatient screening colonoscopy. A computed tomography (CT) scan of the abdomen and pelvis revealed a grade III spleen injury. She was admitted to our intensive care unit, and a gradual decline in her hematocrit was noticed. The patient did well and was discharged from hospital the day after splenic artery embolization.
ABSTRACT
Deep venous thrombosis (DVT) prophylaxis is the current standard of care in trauma patients. While most of the anticoagulation complications are obvious and can be promptly identified, heparin-induced thrombocytopenia (HIT) requires a high index of suspicion for early diagnosis to prevent a potentially fatal outcome. A 39-year-old female presented to our emergency room after sustaining a gunshot wound to her left flank and pelvis requiring a sigmoid colon and left fallopian tube and ovary resection with colostomy diversion. The patient did well in her early postoperative period; however, her condition rapidly deteriorated after that as a result of mesenteric ischemia caused by heparin-induced thrombocytopenia. After multiple visits to the operating room, the patient ended up with short bowel syndrome, necessitating a referral to a bowel transplant center. Our aim is to increase awareness of this potentially lethal complication with a mortality rate up to 30% of patients.
ABSTRACT
Purpura fulminans (PF) is a dermatologic manifestation of an underlying life-threatening condition associated with disseminated intravascular coagulation and skin necrosis. The known categories include protein C deficiency or abnormalities of other coagulation systems (inherited or acquired), acute infectious PF and idiopathic. We describe a case of PF induced by Escherichia coli-associated bacteremia.
ABSTRACT
Distributive (vasodilatory) shock is common in patients admitted to the intensive care unit (ICU). Treating distributive shock presents a challenge, especially if a patient is tachyphylactic to commonly used vasopressors. This case report illustrates the use of a newly approved vasopressor in a patient with vasodilatory shock resulting from a motor vehicle injury. A 56-year-old man was brought to our emergency department (ED) hemodynamically unstable requiring aggressive resuscitation. The results of his evaluation were consistent with multisystem trauma for which he required intubation on arrival, and he received multiple units of blood and blood product via transfusion. The patient's condition declined despite receiving multiple vasopressors in the ICU. A few days after admission, the patient developed ischemic bowel requiring surgical resection. While his chance of survival was believed to be dismal, the use of angiotensin II (ATII) as a last resort proved to be helpful.
ABSTRACT
Intussusception is a rare cause of bowel obstruction caused by both benign and malignant pathology. We are presenting the case of an elderly patient who had been diagnosed with irritable bowel syndrome for many years prior to presenting to us with ileocecal intussusception causing a small bowel obstruction. Laparoscopic resection of the terminal ileum and cecum was performed. Pathology revealed multiple submucosal lipomas as the underlying cause.
ABSTRACT
STUDY OBJECTIVES: To compare the incidence of hypoglycemic events in patients exposed to gatifloxacin or levofloxacin, and to measure the odds of experiencing a hypoglycemic event after receiving gatifloxacin versus levofloxacin while adjusting for confounders. DESIGN: Nested case-control study within a historical cohort. SETTING: A tertiary care, 730-bed, teaching hospital in central Illinois. PATIENTS: Seven thousand two hundred eighty-seven hospitalized patients who received gatifloxacin or levofloxacin therapy. MEASUREMENTS AND MAIN RESULTS: A total of 113 patients (case patients) had blood glucose levels below 51 mg/dl; 113 control patients, matched for age and sex, had no hypoglycemia. Matched conditional logistic regression models adjusted the odds of having hypoglycemia for significant covariates. The 12-month incidence of hypoglycemia was 11/1000 patients after levofloxacin administration and 21/1000 patients after gatifloxacin (absolute risk increase 10/1000 patients, 95% confidence interval [CI] 4-16/1000). Renal failure, sepsis syndrome, and concomitant hypoglycemic drug therapy significantly predicted hypoglycemia. After adjustment for significant predictors, the odds of having hypoglycemia were 2.81 (95% CI 1.02-7.70) times higher after gatifloxacin than levofloxacin therapy. CONCLUSION: Among inpatients, the incidence of hypoglycemic events is greater after treatment with gatifloxacin than levofloxacin. The odds of experiencing hypoglycemic events are greater with gatifloxacin even after adjusting for other hypoglycemia risk factors, such as concomitant hypoglycemic drugs, renal failure, and sepsis syndrome.
