ABSTRACT
Pneumorrhachis is a rare entity, where air pockets are found in the spinal canal and the etiology can be categorized into traumatic and non-traumatic, the latter further categorized into spontaneous, iatrogenic, and associated with infections. Infective causes are often associated with gas-forming organisms and are associated with significant morbidity and mortality. Often the diagnosis is not suspected until imaging is done. We report the case of a 57-year-old man who presented with fever, backache, lower leg weakness, and dysuria. A computed tomography scan for evaluation of intra-abdominal sepsis incidentally showed pneumorrhachis affecting the thoracic and lumbar levels, gas-forming paraspinal abscess, prostate abscess, liver cirrhosis, and sigmoid colon carcinoma. Blood culture isolated Klebsiella pneumoniae. The patient recovered after six weeks of intravenous antibiotics followed later by sigmoid colectomy and chemotherapy. A literature review identified 63 cases of pneumorrhachis associated with infections and can be categorized into infections with spontaneous pneumorrhachis (predominantly respiratory tract infections), infections with pneumorrhachis (predominantly with emphysematous infections), and iatrogenic with infections and pneumorrhachis (predominantly postspinal interventions). Infections with pneumorrhachis occurred in older age groups and were associated with higher mortality compared to the other two categories.
ABSTRACT
Percutaneous endoscopic gastrostomy tube is the modality of choice for long-term enteral nutrition. In the event that replacement tubes are not available, urinary catheters can be used to maintain patency of the gastrostomy tract. This study reports our experience in a nurse-led service using Foley catheters as temporary gastrostomy tubes and the associated complications. Patients who had used Foley catheter as gastrostomy tube over a 2-year period (Jan 2011 to December 2012) were studied. Twenty-one patients had used Foley catheters as a temporary gastrostomy tube, and 12 (57.4%) did not experience any complications, including three patients who were still using Foley catheters at a median of 15 months (range 3-18). Two patients preferred the Foley catheter as feeding tubes. Six patients had replacements with formal balloon replacement tubes, and two patients did not require replacement. Complications occurred in nine (42.6%) patients: repeated burst Foley catheter balloon with peristomal leakage (n = 4), lumen blockage (n = 1), and catheter migration resulting in small bowel obstruction (n = 4). All complications were successfully managed with tube replacements. We showed that in a nurse-led service, using a Foley catheter as a temporary feeding gastrostomy tube is safe, but requires monitoring for complications.
Subject(s)
Catheters, Indwelling/statistics & numerical data , Enteral Nutrition/nursing , Gastrostomy/instrumentation , Nurse Clinicians/organization & administration , Adult , Aged , Catheters, Indwelling/adverse effects , Cohort Studies , Employee Performance Appraisal , Enteral Nutrition/instrumentation , Enteral Nutrition/methods , Female , Humans , Leadership , Male , Middle Aged , Monitoring, Physiologic/methods , Nurse's Role , Nurses , Retrospective Studies , Risk Assessment , Time FactorsABSTRACT
Biliary cystadenoma is a rare tumor of the biliary tree and a rare cause of obstructive jaundice. Most are intrahepatic, and pure extrahepatic biliary cystadenoma is less common. Cases are more common in women. Unless suspected, diagnosis of extrahepatic biliary cystadenoma is often delayed. Here, we report the case of a young woman with extrahepatic biliary cystadenoma who presented at Raja Isteri Pengiran Anak Saleha Hospital with obstructive jaundice initially thought to be due to a large biliary stone based on the endoscopic cholangiogram image. She was successfully managed with resection of the cystadenoma.
