ABSTRACT
Accidental ingestion of fish bones can potentially lead to serious complications like perforation of the alimentary tract and the formation of abscesses in adjacent organs. Prompt and accurate diagnosis of the etiology of hepatic abscesses is critical to prevent clinical deterioration and poor outcomes. Notably, fish bones can be subtle in imaging studies and erroneously interpreted as calcifications, vessels, or artifacts potentially delaying diagnosis and management. Further complicating medical management, fish bones can be seeded with oral microflora which may not be effectively targeted by empiric antibiotics. Patients presenting with an occult hepatic abscess often have repeated visits to the emergency department with vague symptomology and abdominal pain without recollection of any precipitating events. In this case report, a multidisciplinary approach, including a high index of suspicion applied to CT imaging, was vital in identifying a foreign body within an abscess localized between the greater curvature of the stomach and left liver lobe. The foreign body, mimicking an intraperitoneal calcification, was a fish bone that had transmigrated through the stomach wall into the liver lobe. Once identified, definitive treatment included laparoscopic drainage of the abscess, extraction of the foreign body, and coverage with broad-spectrum antibiotics.
ABSTRACT
the prevalence of ventricular assist devices (VADs) is increasing as advanced cardiac therapies progress. These patients commonly require non-cardiac surgical procedures (NCS), although data are scant regarding the safety, timing, and operations that may safely be performed. We aim to describe our experience with VAD patients undergoing NCS. We retrospectively reviewed records on patients who underwent NCS after VAD implantation between 2013 and 2015 at a single Joint Commission-accredited VAD institution. Data collection included demographics, ischemic cardiomyopathy or nonischemic cardiomyopathy, operative details, and perioperative anticoagulation management and outcomes. Seventy-two NCS were performed by general surgeons, thoracic surgeons, plastic surgeons, urologists, vascular surgeons, ENTs, and other services. Procedures were similarly varied, including video-assisted thoracoscopy with decortications or lung biopsy, tracheostomies, percutaneous endoscopic gastrostomies , exploratory laparotomies, and wound debridements and/or closures. The ten deaths in the study group were judged not to be directly related to NCS. Eleven cases had postoperative bleeding and two cases had postoperative thrombosis, including one pump thrombosis. Based on our results, VAD is not an absolute contraindication to NCS, and a variety of NCS procedures can safely be performed. Further study should focus on quantifying and mitigating the risk that VADs bring to NCS.
