Subject(s)
Arterial Occlusive Diseases/chemically induced , Arterial Occlusive Diseases/diagnostic imaging , Lower Extremity/blood supply , Methysergide/adverse effects , Migraine Disorders/prevention & control , Tomography, X-Ray Computed , Vasoconstrictor Agents/adverse effects , Arterial Occlusive Diseases/drug therapy , Clopidogrel , Drug Substitution , Female , Humans , Middle Aged , Oxazolidinones/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Predictive Value of Tests , Serotonin 5-HT1 Receptor Agonists/therapeutic use , Ticlopidine/analogs & derivatives , Ticlopidine/therapeutic use , Time Factors , Treatment Outcome , Tryptamines/therapeutic useABSTRACT
Proctologic emergency are very common and are a true challenge for a general practitioner (GP) in a sea-based environment. Performing simple surgical procedures could be essential for the management of these patients. Thrombosed external hemorrhoids are very painful and necessitate the extraction of the blood clot under local anesthesia. The perianal abscess and the pilonidal abscess are also painful entities and represent a significant septic risk. The surgical management of the latter two is simple but requires general anesthesia. Using ketamine and midazolam with these procedures offers a very high level of anesthetic safety. This short article describes the mentioned procedures that are richly illustrated.
Subject(s)
Anesthesia/methods , Anus Diseases/surgery , Colorectal Surgery/statistics & numerical data , Digestive System Surgical Procedures/methods , Emergencies , Military Personnel , Acute Disease , Anus Diseases/epidemiology , Digestive System Surgical Procedures/statistics & numerical data , France/epidemiology , Humans , IncidenceSubject(s)
Colon/surgery , Ileal Diseases/diagnostic imaging , Ileum/surgery , Intestinal Perforation/diagnostic imaging , Postoperative Complications/diagnostic imaging , Anastomosis, Surgical/methods , Colon/diagnostic imaging , Humans , Ileal Diseases/etiology , Ileum/diagnostic imaging , Intestinal Perforation/etiology , Male , Middle Aged , Postoperative Complications/etiology , Syndrome , Tomography, X-Ray ComputedABSTRACT
Jejunal diverticulosis is a rare malformation that is often asymptomatic. Complications might be similar to those occurring in large-bowel diverticula but also include a much more particular event: intestinal obstruction due to migration and impaction of enterolith formed inside diverticula. This is a very uncommon entity; diagnosis and management are thus often delayed. Mostly surgical exploration is necessary because obstruction symptoms are unresponsive to medical treatment. The authors report a new case of enterolith ileus in a 74-year-old man, due to jejunal diverticulosis, and its successful surgical management in emergency. Only 39 similar cases have ever been reported in the literature.
Subject(s)
Diverticulum/complications , Emergency Treatment/methods , Ileus/etiology , Ileus/surgery , Jejunal Diseases/complications , Lithiasis/etiology , Lithiasis/surgery , Aged , Contrast Media , Diagnosis, Differential , Diatrizoate Meglumine , Diverticulum/diagnosis , Diverticulum/surgery , Humans , Ileus/diagnosis , Jejunal Diseases/diagnosis , Jejunal Diseases/surgery , Lithiasis/diagnosis , Male , Tomography, X-Ray Computed/methodsABSTRACT
Appendicular abscess occurred in 14.2% of patients presenting acute appendicitis. Management of these patients remains controversial, ranging from an emergency appendectomy to a nonoperative treatment. On board French nuclear submarines, the usual treatment for all cases of appendiceal masses, including both appendicitis and appendiceal abscess, is an appendectomy. In the past 5 years, the introduction of ultrasonography (US) on board has enabled the diagnosis of appendiceal abscess with a high rate of accuracy, and the latest studies show that nonoperative treatment is an alternative approach. This nonsurgical treatment, based on intravenous administration of antibiotics, is successful in about 93% of the patients. Failure of nonsurgical treatment is a reliable indication of percutaneous drainage. The proportion of adult patients who need percutaneous drainage of abscesses is about 27%. A successful primary nonoperative treatment may or may not be followed by interval appendectomy at the conclusion of the patrol. Nonsurgical treatment is associated with a significantly lower morbidity than surgery. Considering that the on-board surgical facility is limited, nonsurgical treatment appears to be the best approach for treating a sailor with an appendiceal abscess during a submarine patrol mission.
