1/46. Extrauterine abdominal pregnancy: report of a case.A healthy, 34-year-old, gravida 3, para 1,011, patient presented for cesarean delivery in her 35th week of gestation with a diagnosis of complete placenta previa. During her 26th week of gestation, the patient was admitted to a high-risk obstetric unit with the diagnosis of premature rupture of membranes. Numerous ultrasonographic studies were conducted throughout her 10-week hospital stay, confirming the admitting diagnosis. A routine cesarean section was planned, and preparations were made for a potential increase in blood loss related to the placenta previa. The procedure began under spinal anesthesia and, upon incision of the abdomen, an extrauterine pregnancy was identified. The patient was immediately anesthetized and intubated at the request of the surgeon. During the 3-hour surgical procedure, the patient sustained massive blood loss, transfusions, central line placement, and aggressive pharmacological therapy. The patient was extubated the day after surgery, and was discharged approximately 1 week later. The only major complication was compartment syndrome of the left upper extremity related to the infiltration of vasopressors requiring fasciotomy and closure 2 days later. The incidence, morbidity/mortality, and anesthetic implications of abdominal pregnancy are reviewed.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/46. Compartment syndrome in a patient with X-linked agammaglobulinaemia and ecthyma gangrenosum. Case report.Compartment syndrome is a surgical emergency that requires immediate decompression. We know of no documented cases that describe ecthyma gangrenosum as a primary cause of compartment syndrome. We present a case of a baby with x-linked agammaglobulinaemia who developed compartment syndrome associated with systemic pseudomonas aeruginosa infection and ecthyma gangrenosum of the leg. He was treated by debridement and fasciotomies followed by primary closure and skin grafting and made an uneventful recovery.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
3/46. poisoning-induced acute atraumatic compartment syndrome.Acute Atraumatic Compartment Syndrome (AACS) can be a potentially life and limb threatening complication of either drug abuse or medication injection. Prompt recognition followed by emergency fasciotomy is required to avoid permanent disability. A better understanding of the different clinical presentations may lead to improved outcomes through more expedient diagnosis and treatment. We describe five new cases of AACS caused by illicit drug abuse within the McGill University hospitals, with a review of all 102 similar patients previously documented in the literature between January 1970 and May 1997. The average age for all cases was 29 years, with 74% being male. The presence of edema, pain, tension, and skin changes were the most frequent symptoms and signs reported. There appear to be two distinct mechanisms of poisoning-induced AACS: (1) direct vasotoxicity and (2) limb compression caused by prolonged comatose state. Direct vasotoxicity is more likely to lead to eventual amputation, whereas prolonged limb compression is more likely to progress to systemic complications such as azotemia, hypotension, cardiac arrhythmia, and renal failure (crush syndrome). Long-term sequelae of motor loss, sensory disruption, and development of contracture were common in AACS of both causes. Because Compartment Syndrome is a surgical emergency, primary care and emergency physicians must have a high index of suspicion to promptly recognize and treat this problem.- - - - - - - - - - ranking = 0.12463811840456keywords = drug (Clic here for more details about this article) |
4/46. Acquired anti-FVIII inhibitors in children.Acquired inhibitors to FVIII (anti-FVIII) are uncommon in children. An acquired anti-FVIII developed in a previously healthy 4-year-old boy treated with penicillin for streptococcal pharyngitis. aspirin prophylaxis begun for suspected rheumatic fever led to compartment syndromes of all four extremities, which resolved with high-dose FVIII and surgical decompression. Anti-FVIII in this patient, and the five additional cases identified in a survey of 160 haemophilia treatment centres, occurred at a median age of 8 years, with median initial and peak titres of 4.6 and 6.9 Bethesda Units (BU), respectively. All six presented with bleeding, including haematomas (three intramuscular, one intracranial), and ecchymoses in three. The median baseline FVIII was 0.05 U mL(-1), and the median baseline activated partial thromboplastin time (APTT) was 79.8 s. The inhibitor resolved completely in five patients (83%) within a median 5 months, after treatment with FVIII concentrate, steroids, cytoxan, methotrexate, and no treatment. The inhibitor persisted in the patient with Goodpasture's disease, despite steroids, cytoxan, cyclosporin, and intravenous gamma globulin. aspirin therapy, in two, worsened ongoing bleeding. The association of penicillin-like drugs in this and three other cases in the literature suggest that to avoid potential catastrophic bleeding, it is prudent to obtain an APTT prior to initiating aspirin for suspected rheumatic fever. In conclusion, acquired anti-FVIII inhibitors in children may cause severe bleeding, and remit in the majority after FVIII and/or immunosuppressive therapy.- - - - - - - - - - ranking = 0.062319059202279keywords = drug (Clic here for more details about this article) |
5/46. Modified shoelace technique for delayed primary closure of the thigh after acute compartment syndrome.The authors report a case of acute compartment syndrome in the thigh in a 19-year-old man with multiple injuries including fracture of the femoral diaphysis. Decompressive fasciotomy was performed emergently. Complete progressive closure of the wound without split-thickness skin grafting was achieved using a modified shoelace technique: sutures were run inside wide drains placed in contact with the muscles and were then tightened over the skin. These drains enlarged the contact area between sutures and muscles, preventing damage to muscles.- - - - - - - - - - ranking = 5keywords = closure (Clic here for more details about this article) |
6/46. lower extremity compartment syndrome following a laparoscopic Roux-en-Y gastric bypass.BACKGROUND: bariatric surgery has the potential for serious complications. A case is presented of unilateral lower extremity compartment syndrome after a laparoscopic Roux-en-Y gastric bypass performed in the modified lithotomy position. CASE REPORT: A 38-year-old female (weight 134.5 kg, BMI 49.6) underwent a laparoscopic Roux-en-Y gastric bypass (operating time 375 min). Postoperatively, she complained of bilateral lower extremity pain that gradually subsided over the course of the day. However, on the 1st postoperative day she developed numbness on the dorsum of the foot and compartment syndrome was diagnosed (anterior compartment pressure 71 mmHg). She underwent emergency fasciotomy, which resulted in a reduction of the pain and numbness on the dorsum of the foot. The next day she ambulated without difficulty and was discharged home on the 5th postoperative day. 12 days after her operation, delayed primary closure of the fasciotomy wound was done with the assistance of a novel device (Proxiderm) that applies constant tension to the wound edges. Subsequent recovery was uneventful, and at 4-month follow-up the patient had a weight loss of 28 kg without any right leg motor or sensory deficits. CONCLUSION: Bariatric surgeons should be aware of compartment syndrome as a rare but serious complication. Prevention, early recognition, and prompt fasciotomy are crucial for a favorable outcome.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
7/46. Massive ventral hernias: role of tissue expansion in abdominal wall restoration following abdominal compartment syndrome.Massive ventral hernias may result from a variety of clinical situations. One such clinical situation, a common problem in trauma patients, is abdominal compartment syndrome. Abdominal compartment syndrome frequently results in a massive abdominal defect when primary closure after surgical decompression is not possible. We offer a technique for repairing these massive ventral hernias by first expanding the lateral abdominal wall muscles, fasciae, and skin with tissue expanders and then closing the defect with elements of the "components separation" method. Additionally we present other clinical situations resulting in a massive ventral hernia that were repaired using this technique.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
8/46. A case of severe hyperkalaemia and compartment syndrome due to rhabdomyolysis after drugs abuse.Severe hyperkalaemia is one of the complications of the non-traumatic rhabdomyolysis, which have been related to drug abuse, alcohol, etc. We report on a case of bilateral tibial compartment syndrome, severe hyperkalaemia and rhabdomyolysis after drug abuse. A 35-year-old male intravenous drug user was admitted to the emergency department after being found unconscious in his cell of the prison. physical examination at emergency department revealed no abnormalities except constricted pupils. Two hours after admission a wide QRS was observed in the electrocardiography and he developed asystole. cardiopulmonary resuscitation was performed and transcutaneous pacing was applied at the beginning of cardiac arrest (150 mAmp and stimulation frequency 80 beats/min). At the moment of cardiac arrest, laboratory test showed potassium 9.2 mmol/l. Return of spontaneous circulation occurred in 21 min, and he was admitted to the intensive care Unit. Thirty-six hours after admission a compartment syndrome of both lower legs was suspected because of oedema with peripheral pulses. rhabdomyolysis has been reported after drug abuse. There is severe hyperkalaemia which should be identified and treated. A more rare complication of rhabdomyolysis is the compartment syndrome, a surgical emergency, which requires immediate fasciotomy to prevent serious complications.- - - - - - - - - - ranking = 0.49855247361823keywords = drug (Clic here for more details about this article) |
9/46. thigh compartment syndrome after acute ischemia.thigh compartment syndrome (TCS) is a poorly recognized clinical condition that may follow reperfusion of acutely ischemic thigh muscles. The anterior muscle group appears to be at greatest risk because of its layered arrangement. Intense pain, swelling, and elevated compartment pressures characterize the early presentation in the affected muscle group. If untreated myonecrosis, myoglobinuria, and renal failure may result. TCS was observed in a patient who was treated for a gunshot wound to the left thigh. The superficial femoral and profunda femoris veins as well as the profunda femoris artery were disrupted. The superficial femoral vein and profunda femoris artery injuries were repaired but the mangled branches of the profunda femoris vein were ligated. Postoperatively he developed intense thigh pain, swelling, and elevated compartment pressures. Lateral thigh fasciotomy, extensive debridement of necrotic muscle, and delayed wound closure resulted in a full recovery. physicians should recognize the numerous clinical circumstances that could lead to TCS--particularly those associated with trauma or physical activity. Timely recognition and intervention may be both limb and life saving. Associated irreparable injury to the profunda femoris vein may aggravate this condition.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
10/46. Serial abdominal closure technique (the "SAC" procedure): a novel method for delayed closure of the abdominal wall.Abdominal compartment syndrome may occur after any elective or emergent abdominal operations that are complicated by postoperative hemorrhage or in the trauma patient who has massive fluid replacement for intra-abdominal bleeding. Once the abdomen is decompressed the type of closure varies as much as the surgeon performing the procedure. We have devised a simple, reproducible, inexpensive, and safe method to close the abdomen at the bedside. Serial abdominal closure (SAC) was performed on three patients 45, 54, and 14 years of age who had developed abdominal compartment syndrome secondary to an upper gastrointestinal bleed requiring massive transfusion, a tear of the superior mesenteric vein, and a grade 4 liver laceration respectively, all necessitating abdominal decompression. All three patients had their abdominal wounds closed at the bedside over the course of several days with our SAC technique. Subsequent postoperative course was uneventful and the abdominal wall was free of defects at one-year follow-up. SAC is an efficient, inexpensive, and easily reproducible method of managing the open abdomen. The use of SAC prevented abdominal closure-related complications such as enteric fistula and hernia formation in our three patients.- - - - - - - - - - ranking = 11keywords = closure (Clic here for more details about this article) |
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