ABSTRACT
A 77-year-old man with Alzheimer's disease was admitted to a rural hospital in June 2012 and an acute cholecistytis was first diagnosed. Surgery was not considered as a possible option due to the critical condition of the patient and his severe comorbidities. After 2â days of broad-spectrum antibiotics, the patient worsened and developed severe sepsis. A gallbladder perforation with intrahepatic abscess formation was diagnosed on ultrasonography (US) and abdominal CT scan. The patient underwent percutaneous US-guided gallbladder drainage with resolution of the sepsis and rapid clinical improvement. After 1â month, the drainage was removed and the patient was discharged. He survived in good condition for 18â months and he passed away from pneumonitis in December 2013. This case shows that in a case of acute cholecystitis with gallbladder perforation, percutaneous gallbladder drainage can be a lifesaving procedure in elderly patients with severe comorbidities (including Alzheimer's disease) who are not candidates for elective surgery.
Subject(s)
Cholecystitis, Acute/therapy , Drainage/methods , Gallbladder/diagnostic imaging , Liver Abscess/therapy , Ultrasonography, Interventional/methods , Aged , Alzheimer Disease/complications , Cholecystectomy , Cholecystitis, Acute/complications , Cholecystitis, Acute/diagnostic imaging , Contraindications , Gallbladder Diseases/diagnostic imaging , Gallbladder Diseases/therapy , Humans , Liver Abscess/diagnostic imaging , Liver Abscess/etiology , Male , Tomography, X-Ray ComputedABSTRACT
Background. The aim of this study is to investigate the evidence of hypokalemia as a suitable parameter for therapeutic decision making after severe blunt liver trauma. Methods. We reviewed the medical records of 11 patients (9 M, 2 F, mean age 32 years) admitted to San Matteo Hospital of Pavia between 2007-2009. All of them were victims of road accidents hospitalized for blunt liver injury and submitted to surgery. Results. Hypokalemia was observed in 7/11 (63.6%) patients during the preoperative period (mean value 2.91 mEq/L). Serum potassium concentration normalized in all patients at the 7th postoperative day only (P < 0.01). Conclusions. According to literature results, our study confirms that after blunt hepatic injury serum potassium levels may decrease significantly. Therefore, kalemia must be carefully monitored in order to establish appropriate treatment and avoid any complications.
ABSTRACT
PURPOSE: In the case of an acute aortic dissection, a surgical aortic procedure is usually the priority in order to restore the perfusion of vital organs. Afterwards, associated ischemic abdominal visceral lesions can be resected. For particular patients, it could be highly beneficial to perform the abdominal surgery before surgically addressing the aorta. The aim of this paper is to contribute to the therapeutic choice in cases of acute aortic dissection with acute abdomen. CASE REPORT: The case is reported of a 38-year-old patient, affected by an acute aortic dissection (Stanford type A) and peritonitis.Suspecting the necessity for a complex combined surgical procedure, the patient underwent emergency diagnostic laparoscopy, which showed an infarctual necrosis of the distal ileum and right colon. Therefore, he immediately underwent a wide right hemicolectomy. Afterwards, an ascending aortic substitution was performed.The patient was discharged on the 15th post-operative day, and he is doing well, 1 year and 3 months after the operation. CONCLUSION: In the case of an acute aortic dissection with acute abdomen, emergency laparoscopy is a precious surgical technique to identify criteria that can lead to therapeutic decisions, including timing.
