Unusual localization of bleeding under acenocoumarol: Spinal subdural hematoma.

BACKGROUND: The spinal subdural hematoma (SSH) is an extremely rare entity which represents only 4.1% of all spinal hematomas. It needs accurate diagnosis and rapid intervention because of the major neurological risk induced by spinal compression. Several etiologies have been reported: anticoagulant treatments, haematological disorders, arterio-venous malformation, repeated attempts at lumbar punctures and tumors. We report the case of an 82-year-old patient under acenocoumarol for atrial fibrillation who presented with paraplegia secondary to SSH. CASE REPORT: An 82-year-old patient with a history of ischemic heart disease and atrial fibrillation under acenocoumarol was admitted to emergency department with sudden onset of paraplegia and intense back pain associated with urinary incontinence and anal sphincter disorder. On examination his lower limb power was MRC grade 0 out of 5 in all ranges of movement bilaterally and a complete bilateral anesthesia reaching the T12 dermatome was noted. Biological test results showed an International Normalized Ratio at 10. Magnetic resonance imaging revealed a posteriorly located spinal hematoma at T12 level, measuring 36 mm with spinal cord compression. After correction of hemostasis disorders the patient was admitted to the operating room for a T11-L1 laminectomy with evacuation of the subdural hematoma. Muscle power showed a gradual improvement in the lower limbs estimated at 3/5 with regression of sphincter disorders but unfortunately a sequellar sensory impairment persisted. CONCLUSION: SSH is a rare situation of acenocoumarol bleeding incident, it should be evoked in any patient treated by this molecule with signs of spinal cord compression.

[Asystole during surgery to manage small intestine cancer: are we dealing with anaphylaxis or carcinoid crisis]. / Asystolie au cours d'une chirurgie pour tumeur de l'intestin grêle: anaphylaxie ou crise carcinoïde.

Cardiac arrest in the operating room is a life-threatening event with multiple causes. We report the case of a 53-year old female patient with no particular past medical history scheduled for surgery to manage small intestine cancer. Twenty minutes after anesthetic induction the patient had asystole rapidly reversible after resuscitation measures. The association of face rash with chest rash gave rise to suspicion of late anaphylactic reaction. Rapid patient recovery allowed to resume surgical procedure. Tumor manipulation immediately caused a second severe bradycardia rapidly reversible after the administration of 0.5 mg atropine. Skin rush at the level of the face and the chest occurred again. This second complication immediately gave rise to suspicion of carcinoid crisis. Sandostatine was then administered. No other complication occurred, the patient spent 24 hours in the Intensive Care Unit receiving sandostatine infusion. Urinary 5-HIAA values were very high and histological examination of the surgical specimen confirmed carcinoid tumor. This study aims to highlight the rarity of this entity and the importance of suspecting carcinoid crisis in patients with intraoperative complications during anesthesia for small intestine tumor surgery.

Gitelman syndrome: a rare life-threatening case of hypokalemic paralysis mimicking Guillain-Barré syndrome during pregnancy and review of the literature.

In rare cases, patients with Gitelman syndrome may present with hypokalemic paralysis mimicking Guillain-Barré syndrome. The severity of resultant symptoms may be life-threatening. Controversial drugs such as aldactone, amiloride, and eplerenone should be used in this situation despite the lack of safety data.

Double aortic arch presenting with respiratory distress: A case report and review of the literature.

Tracheal compression by vascular structures in infants is uncommon and may be masked by nonspecific respiratory symptoms. Double aortic arch (DAA) is the most common vascular ring. We describe a case of a 9-month-old male infant presented with respiratory distress and found to have a DAA. In this report, the authors emphasize the consideration of this pathology-induced respiratory distress and discuss its anesthetic management.

[Rare etiology of subocclusive syndrome: inflammatory fibroid polyp of the ileum, about a clinical case]. / Etiologie rare d'un syndrome subocclusif: polype fibrinoïde inflammatoire de l'iléon, à propos d'un cas clinique.

Inflammatory fibroid polyp (IFP) is a rare benign lesion, originating from the submucosa in the gastrointestinal tract. It generally appears as an isolated benign lesion, rarely located at the level of the ileum. Its origin is controversial. Clinical presentation varies depending on its location; invagination and obstruction are the most common indicative symptoms when the polyp is located at the level of the small intestine. We report the case of a 22-year old patient with abdominal pain, nausea and vomiting and a personal history of intermittent constipation and a weight loss during the previous year. Radiological imaging objectified ileo-ileal invagination completely obstructing the ileum light. Segmental resection of the obstructed ileal segment and termino-terminal anastomosis were performed. The final diagnosis of IFP was established using histological examination and immunohistochemical investigation.

Management of undiagnosed pheochromocytoma with acute appendicitis.

The authors reported and discussed management a case of undiagnosed pheochromocytoma suspected because the catastrophic hemodynamic changes in a patient with an acute appendicitis.