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Christian Mcmahon posted an update 6 months, 1 week ago
h 10% topical Lignocaine is an alternative for the insertion of LMA to Propofol, with better hemodynamic stability and cost-effectiveness.
Biloma forms due to common bile duct (CBD) injury as a laparoscopic cholecystectomy complication. Foscenvivint Spontaneous localized biloma forming cysts in the biliary duct is rare.
We report a 47-year-old male with complaint of a painful lump in the upper abdomen two months after laparoscopic cholecystectomy. Magnetic resonance cholangiopancreatography (MRCP) found a large epigastric cyst mass, without any signs of CBD injury. Patient was managed with percutaneous drainage in the outpatient clinic and kept the contents of the drainage bag for evaluation. After two months follow-up the outcome was favorable.
Biloma forming cysts is a very rare complication post laparoscopic cholecystectomy. Biloma most common occurs as free fluid in the abdominal cavity. Clinical diagnostics, intraoperative historical evaluation and support with MRCP may determine the treatment options. Decision to manage with non-operative procedures by percutaneous drainage and evaluations of the patient in the outpatient clinic had a favorable outcome.
Post laparoscopic biloma cysts are a very rare case. Management with percutaneous drainage in an outpatient clinic and ambulatory drainage is an effective and safe procedure.
Post laparoscopic biloma cysts are a very rare case. Management with percutaneous drainage in an outpatient clinic and ambulatory drainage is an effective and safe procedure.
and importance Mucoceles are expansive pseudocystic formations, developed from the sinuses of the face, affecting mainly adults. Evolving at low noise, they are most often revealed by neurological or ophthalmological complications. We report a rare case of a bilateral frontal mucocele with orbito-cerebral extension following nasal sinus polyposis.
This was a 35-year-old patient with a history of Widal syndrome, who presented frontal headaches and left proptosis evolving for 4 months, in whom clinical examination revealed a left superomedial eyelid swelling, left proptosis and stage 2 nasosinus polyposis. Computed tomography and craniofacial magnetic resonance imaging were in favor of a bilateral frontal mucocele with left orbital and bilateral cerebral extensions. The patient was bilaterally operated by a combined approach including external Jacques eyebrow and endonasal Draf IIa procedure in addition to a radical total ethmoidectomy. The outcomes were favorable with regression of headaches and resolution of exophthalmos.
The frontal mucocele, although benign, has an aggressive potential in the absence of treatment either towards the endocranium or the orbit behind the orbital septum causing intra-orbital extension, or in front of it; causing the dominant upper palpebral form as in the case of our patient. The treatment is still based on surgical excision of the cyst with drainage of the causal sinus, which was carried out for our patient.
Despite its benign behavior, frontal mucocele may become serious by compression of neighboring organs which require an early and appropriate surgical management.
Despite its benign behavior, frontal mucocele may become serious by compression of neighboring organs which require an early and appropriate surgical management.
Acute blunt traumatic diaphragmatic rupture (BTDR) caused by falling from a height is rare. Transabdominal diaphragmatic repair in an acute setting following BTDR requires good clinical decision-making and diagnostic tests.
A 36-year-old male was involved in a work accident. He fell from a 30-m radio transmitter tower while wearing an attached safety body harness. He arrived in the emergency room with complaints of breathing difficulty, abdominal and pelvic pain. We discovered a diaphragmatic rupture with abdominal organ herniation based on the imaging. We decided to perform an emergency laparotomy. We discovered a 12cm diaphragmatic defect on the anteromedial side of the left during surgery. We carried out the evacuation by suction and controlled the bleeding in the wound at the edge of the diaphragm. On postoperative day 4 (POD), the patient complained of dyspnea, and chest radiology revealed a hemothorax in the left lung. We then installed a water-sealed drainage (WSD) until POD 6. On the following day, his complaint was resolved, the WSD was removed and the patient was discharged uneventfully.
Abdominal CT scan can be helpful in determining early diagnosis of traumatic diaphragm rupture with abdominal organ herniation, allowing for prompt surgical intervention to minimize morbidity and mortality. Furthermore, reinforced sutures might be useful to prevent recurrence of the symptoms.
In conclusion, injury due to wearing a safety body harness when falling can be a potential cause of BTDR. Management of BTDR transabdominally is a safe and effective procedure.
In conclusion, injury due to wearing a safety body harness when falling can be a potential cause of BTDR. Management of BTDR transabdominally is a safe and effective procedure.
Paradoxical embolism is a rare medical phenomenon. Depending on the site of embolisation, it can cause different symptoms. Although rare, mesenteric ischemia can reveal paradoxical embolism, and the embolisation of two different sites is rarely described in the literature.
We report the observation of a patient with a table associating an acute mesenteric ischemia and an acute ischemia of the upper limb; whose the etiological assessment revealed a deep venous thrombosis of the lower limbs complicated by pulmonary embolism.
These paradoxical embolisms occurred through a patent foramen ovale. The diagnosis of the patent foramen ovale in this patient was revealed by transthoracic echocardiography, with bubble test. The patient benefited from an embolectomy of the superior mesenteric artery and an embolectomy using fogarty catheter by approching humeral artery at the elbow crease with good postoperative evolution. The patient was put on long-term anticoagulation with Acenocoumarol (because of low socio-economic level of our patient). We didn’t recommended the closure of the PFO because of the small size of the shunt and especially because the patient refuses that procedure.
Paradoxical embolism remains a pathology rarely mentioned by clinicians, although it can engage the functional and vital prognosis of the patient, hence the interest of a good cardiac evaluation in any patient with embolic ischemia.
Paradoxical embolism remains a pathology rarely mentioned by clinicians, although it can engage the functional and vital prognosis of the patient, hence the interest of a good cardiac evaluation in any patient with embolic ischemia.
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