International Journal of Case Reports


Emergency surgery for a Morgagni hernia causing respiratory failure

Case Report of International Journal of Case Reports Emergency surgery for a Morgagni hernia causing respiratory failure Yoshitsugu Tsukamoto, Takeharu Enomoto, Takehito Otsubo, Kenta Katsumata, Natsuko Kamei, Jin Shimada, Shinya Mikami Division of Gastrointestinal and General Surgery, Department of Surgery, St. Marianna University School of Medicine Reports of emergency surgical repair of a retrosternal hernia causing respiratory failure in an adult are rare. We treated an 82-year-old man who had been suffering breathlessness upon exertion, some speech difficulty, and, most recently, visual hallucinations. He had consulted a physician who ordered an arterial blood gas test, which revealed hypoxemia, and thoracoabdominal computed tomography (CT), which revealed a hernia that was compressing the pulmonary parenchyma. Over the next 30 days, the hernia worsened, acute respiratory failure developed, and the patient was transferred to our hospital by ambulance. The patient presented to us not only with respiratory failure but also a decreased level of consciousness. CT performed upon admission revealed prolapse of the transverse colon from the posterior surface of the sternum to the right thoracic cavity, left deviation of the mediastinum, and compression of the pulmonary parenchyma, which we believed to be the cause of the hypoxemia. With the hernial orifice appearing to be on the right, a Morgagni hernia was diagnosed. Emergency surgery was deemed necessary. An epigastric midline laparotomy incision was placed, and we observed a retrosternal hernia, with an enlarged foramen of Morgagni measuring 70mm × 50 mm as the hernial orifice. The hernia contained portions of the greater omentum and transverse colon. We returned the contents to the peritoneal cavity manually closed the hernia orifice by simple suturing and reinforced the repair with a mesh patch. With signs of cardiac failure developing, temporary noninvasive positive-pressure ventilation was instituted from postoperative day 5 to postoperative day 11, but the patient’s ...

Serious Staphylococcus Aureus Infection in a Patient with Diabetes Mellitus

Case Report of International Journal of Case Reports Serious Staphylococcus Aureus Infection in a Patient with Diabetes Mellitus Cátia Pereira, Joana Cascais Costa, Joana Coelho Internal Medicine Departement - Centro Hospitalar Universitário de Coimbra The immune system and metabolism are closely related and it is recognized that diabetes mellitus (DM) and its complications have a compromising impact on the degree of immunosuppression. The authors present the case of a 65-year-old man with a history of type 2 DM and ulcers of the lower limbs who went to the emergency departament with odynophagia, dysphagia, fever and cervicalgia. He had a painful cervical and supraclavicular region and highly infectious parameters in blood samples. The cervical radiography suggested vertebral fusion and cervical computed tomography with soft tissue thickening, hypopharyngeal deviation and gaseous foci suggestive of abscess. He started empiric antibiotic therapy and was performed an abscess drainage where Staphylococcus aureus oxacillin susceptible was isolated. S. aureus bacteremias have a higher prevalence in diabetics, being essential the rapid orientation in situations of bacteremia to clarify the infectious focus and immediate onset of antibiotic therapy which decreases mortality. Keywords: Type 2 Diabetes Mellitus, Imunosupression,Staphylococcus aureus ...

Oral pyridostigmine for treatment of postoperative ileus associated with elevated catecholamine levels: A case report

Case Report of International Journal of Case Reports Oral pyridostigmine for treatment of postoperative ileus associated with elevated catecholamine levels: A case report Sherif Aly, MD 1,2; Gentian Kristo, MD, MPH, FACS1,3. 1Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA; 2Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; 3Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA. The etiology of post-operative ileus is usually multifactorial, but increased catecholamines have been implicated as an important cause. We present a case of catecholamine-induced prolonged post-operative ileus treated successfully with Pyridostigmine. A 70-year-old male underwent a low-anterior resection and diverting loop ileostomy for rectal cancer. Immediately post-operatively he developed refractory hypertensive urgency and a small bowel ileus. Biochemical testing revealed markedly elevated 24-hour urinary metanephrines and normetanephrines. However, radiologic studies failed to identify a pheochromocytoma. The ileus persisted despite employing a multimodal regimen consisting of avoidance of narcotic pain medications, gastric decompression via a nasogastric tube, maintenance of normal levels of electrolytes, parenteral nutritional support, and early mobilization. Two weeks after the surgery the patient was treated with oral Pyridostigmine with appropriate return of bowel function. Excessive circulating catecholamines play an important role in the etiology of refractory post-operative ileus, and cholinesterase inhibitors such as Pyridostigmine could be used as an effective treatment in such cases. Disclosure Statement: The authors have no conflicts of interest or financial disclosures to declare. Keywords: post-operative ileus; catecholamines; pheochromocytoma; cholinesterase inhibitor ...

Pulmonary metastasis of a Dermatofibrosarcoma of Darier and Ferrand treated by IMATINIB: a case report

Case Report of International Journal of Case Reports Pulmonary metastasis of a Dermatofibrosarcoma of Darier and Ferrand treated by IMATINIB: a case report Kamal EL BAKRAOUI 1, Mohamed TARCHOULI2, Ibrahim ELGHISSASSI 1, Rhizlane BELBARAKA3, Hassan ERRIHANI1. 1Department of Medical Oncology, National Institute of Oncology, CHU Rabat, Morocco. 2Departement of Surgery, First Medical and Surgical Center, Agadir, Morocco. 3Department of Medical Oncology, FMPM, CHU Marrakech, Morocco. Dermatofibrosarcoma (DFS) described by Darier and Ferrand represents less than 5% of soft tissue sarcomas and metastases only very rarely. We report the case of a 51-year-old patient followed for six years for a DFS of the right thigh root recurrent several times after non-optimal surgical resections. The occurrence of thoracic pain associated with a cough with dyspnea, motivated the realization of a thoracic computed tomography (CT) showing a right basal pulmonary mass with pulmonary nodules. CT biopsy of one of the pulmonary nodules confirmed the metastatic nature of these lesions. The search for translocation t (17,22) could not be performed. A treatment based on imatinib has been started. The evolution was marked by the disappearance of the respiratory symptomatology and a good radiological response. The advent of targeted therapy with imatinib transformed the prognosis for this disease, which was considered incurable at the metastatic stage. Conflict of interest: The author declares that he has no conflict of interest Keywords: Darierand Ferrand Dermatofibrosarcoma, Imatinib, Pulmonary Metastasis, Recurrence, Translocation ...

Inadvertent epidural administration of remifentanil (Ultiva®) during labour analgesia

Case Report of International Journal of Case Reports Inadvertent epidural administration of remifentanil (Ultiva®) during labour analgesia Dany Khodra aReplacement Anesthesiologist in Belgium The use of remifentanil patient-controlled analgesia for labour analgesia remains controversial. The high potency of the drug, the fear of serious adverse drug reactions and drug administration errors are all legitimate concerns. We report the case of a woman in labour who inadvertently received a remifentanil solution via epidural route. In addition to the risk of respiratory depression, the epidural administration of remifentanil contains glycine in its solution and is therefore contraindicated due to potential neurological injury. The patient received a total of 2 mg of remifentanil and 15 mg of glycine in her epidural over a long period before the error was identified. Interestingly the patient was mostly comfortable during labour and fortunately no maternal or neonatal adverse events occurred. Keywords: remifentanil; glycine; epidural; obstetrical analgesia; medical errors; human factor ...

Dr. Xiaoning Luo
Professor, Department of Otorhinolarygology-Head and Neck Surgery, Guangdong General Hospital, Guangzhou, China

Dr. N.S. NEKI
Professor & Head, Dept.of Medicine, Govt. Medical College, Amritsar, India

Dr. Jitesh K. Kar
Clinical assistant professor, Department of Internal Medicine – Neurology, University of Alabama at Birmingham, Huntsville Regional Campus

Dr. Nisar Haider Zaidi
MBBS, MS, MRCS (Glasgow), FICS, FACS. Department of surgery, King Abdulaziz University Hospital , POBox-80215 Jeddah 21589 , Saudi Arabia

Dr. Giuseppe Lanza
Consultant Neurologist and Clinical Researcher, Department of Neurology IC of the “Oasi” Institute for Research on Mental Retardation and Brain Aging

Dr. Yousif Mohamed Y. Abdallah
Professor (Assistant), Radiological Science and Medical Imaging Department, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia

Dr. Karol Szyluk
District Hospital of Orthopedics and Trauma Surgery

Dr. Mohd Normani Zakaria
Chairman / Head of Hospital Unit / Assistant Professor / Consultant Audiologist, Audiology and Speech Pathology Programme, School of Health Sciences,, Universiti Sains Malaysia 

Dr. Dennis J. Mazur
Senior Scholar, Center for Ethics in Health Care, and Professor of Medicine, Oregon Health and Science University, Portland, Oregon USA

Dr. Marcos Roberto Tovani Palone
Department of Pathology and Legal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.

Dr. Begum Sertyesilisik
Assoc. Prof. at the Istanbul Technical University

Dr. Jamunarani Veeraraghavan
Baylor College of Medicine, One Baylor Plaza, Houston, Texas 

Dr. Rajinder Pal Singh Bajwa
Niagara Falls Mem Med Center, Division of Infectious Diseases, 621 Tenth Street, Niagara Falls, NY

Dr. Can SARICA
Adiyaman University School Of Medicine, Department Of Neurosurgery, Adiyaman

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