ABSTRACT
Portal vein thrombosis (PVT) following laparoscopic surgery including Roux-en-Y bypass, sleeve gastrectomy and Nissen's fundoplication is a rare but recognised complication. Laparoscopic gastric plication in a new procedure that is popular in some parts of the world. We report a case of a patient suffering PVT as a complication of this surgery.
Subject(s)
Bariatric Surgery/adverse effects , Laparoscopy/adverse effects , Portal Vein/diagnostic imaging , Venous Thrombosis/etiology , Adult , Computed Tomography Angiography , Female , Humans , Obesity, Morbid/surgery , Postoperative Complications/diagnostic imaging , Postoperative Complications/etiology , Splenic Infarction/diagnostic imaging , Splenic Infarction/etiology , Venous Thrombosis/diagnostic imagingABSTRACT
AIM: Enterocutaneous fistula (ECF) is considered to be one of the most challenging complications a general surgeon can encounter. The current mainstay of treatment is surgical closure, associated with significant morbidity and mortality. Vacuum assisted closure (VAC) has been successfully used for closure of persistent abdominal wounds for a number of years. This study aims to investigate whether current literature supports the use of VAC for ECF. METHOD: A PubMed search of the search terms 'enterocutaneous fistula' and 'vacuum assisted closure/therapy' was performed in December 2014. Results were restricted to articles involving human subjects with an available abstract and full text written between 1950 and 2014. The end-points analysed included rate of fistula closure, duration of follow-up, and morbidity and mortality where available. RESULTS: Ten studies (all level IV) including 151 patients were examined. In all except one, surgery was the underlying aetiology with median number of fistulae per patient of one. The median rate of closure with VAC was 64.6% (7.7-100%) with healing occurring within 58 (12-90) days. Follow-up was only mentioned in three of the 10 studies, in which the patients were followed for 3, 20 and 28.5 months. No complications were reported in all but one of the studies, in which abdominal wall disruption and intestinal obstruction were identified in a minority of patients. CONCLUSION: The included studies suggest that VAC therapy may be considered a safe treatment for ECF. The current evidence is generally of low level and characterized by heterogeneity. Definitive recommendations based on this information cannot therefore be made. Further studies are necessary to establish any proven benefit over standard surgical or conservative therapy.
Subject(s)
Digestive System Surgical Procedures , Intestinal Fistula/therapy , Negative-Pressure Wound Therapy/methods , Postoperative Complications/therapy , Humans , Time Factors , Wound HealingABSTRACT
A four-year-old male child was reported with sudden inability to stand walk of 10 days duration. Acute paralytic poliomyelitis was diagnosed in the presence of fever, respiratory infection, muscle tenderness, and weakness in lower extremity in an unimmunized child. Reevaluation after a week showed swelling, thickening, and tenderness of left femur. Plain x-ray of the left thigh was advised to exclude underlying osteomyelitis of the femur. X-ray showed features of scurvy. The child responded well to parenteral vitamin C therapy and resumed normal walking with in two weeks. Scurvy can present as pseudoparalysis of acute onset without any other signs even in older children. It emphasized the need for an index of suspicion of scurvy in a case of suspected paralysis. Dramatic response to vitamin C therapy can be used to confirm the diagnosis in the absence of laboratory support. Health education can be accelerated to prevent a disease like scurvy.
