Point of care ultrasound needle guidance to assist diagnosis of acute gluteal compartment syndrome.

Gluteal compartments can be difficult to assess for acute compartment syndrome (ACS) compared to other fascial compartments due to their anatomy and rarity of presentation. Point-of-care ultrasound (POCUS) needle guidance may assist in obtaining accurate compartment pressure measurements within the gluteal compartments. We present a case in which a 69-year-old woman presented following a fall resulting in a superior prosthetic hip dislocation. One-hour post hip-reduction, the patient began to experience severe pain of the right leg, swelling to the gluteal region, and numbness to her foot. With consideration of a developing gluteal compartment syndrome in mind, POCUS was used to guide the needle of a compartmental pressure monitor system into the gluteal maximus and medius-minimus compartments which demonstrated elevated compartment pressures consistent with ACS. The patient was subsequently taken for emergent fasciotomy and hematoma evacuation. There has been limited investigation into compartment pressure measurement under US guidance versus a palpation/landmark-guided technique. This case shows the feasibility of US needle guidance when assessing compartment pressures for this uncommon diagnosis.

A Case of Transvaginal Small Bowel Evisceration following Hysterectomy with Discussion of Emergency Department Diagnosis and Management.

Transvaginal small bowel evisceration is a rare surgical emergency that requires urgent surgery to prevent bowel necrosis, sepsis, and death. It was first reported in 1864 by Hyernaux with less than 100 cases reported since the original publication. The overall mortality rate is reported as 5.6 percent. We present the case of a 49-year-old woman who presented to the emergency department with a chief complaint of moderate abdominal pain and vaginal bleeding for 1 hour. The patient reported that she underwent a robotic-assisted laparoscopic hysterectomy 11 weeks prior for uterine fibroids. Visual examination revealed a loop of the small bowel coming from the superior aspect of her vagina. Literature reviews have noted a higher incidence of dehiscence following robotic-assisted total laparoscopic hysterectomy. It is important for the emergency physician to make the diagnosis, initiate prompt consultation with departments of obstetrics and gynecology and general surgery, and treat for potential infection.

Cutaneous Manifestation as Initial Presentation of Metastatic Breast Cancer: A Systematic Review.

Metastatic breast cancer initially may present with cutaneous lesions. The goal of this systematic review was to evaluate available reports where the initial discovery of primary breast cancer occurred through the diagnosis of metastatic cutaneous lesions. We aimed to better understand these cases and the role of dermatologists in their diagnosis. A review of the literature for case reports and retrospective studies was conducted using the following databases: MEDLINE/PubMed, EMBASE, Cochrane library, CINAHL, and EBSCO. The PRISMA guidelines were utilized. Studies were included if they reported a cutaneous metastasis of a primary breast cancer in females. Studies were excluded if skin metastasis occurred in a patient with a history of breast cancer. Thirty-six publications were identified. Among these, 27 were case reports, and 9 were retrospective reviews. An enhanced understanding of how these cutaneous metastases present may be of clinical benefit to physicians, particularly dermatologists.