11/30. Fecopneumothorax and colopleural fistula - uncommon complications of Crohn's disease. BACKGROUND: Colopleural fistula and fecopneumothorax are very rare complications of Crohn's disease. fistula formation is frequent in Crohn's disease and occurs in approximately 33% of patients. On the other hand, fistulous communication between the pleural cavity and adjacent organs below the diaphragm is extremely rare. CASE PRESENTATION: We describe the case of 27 year-old female with colopleural fistula as a complication of Crohn's disease. The diagnosis was established with clinical exam, barium enema, chest X-ray, abdominal and chest CT exam. The treatment was surgical. CONCLUSION: Colopleural fistula and fecopneumothorax are rare but life treating complications of Crohn's disease. Surgical treatment is mandatory as soon as the diagnosis is established. ( info) |
12/30. 'Nutrothorax' due to misplacement of a nasogastric feeding tube. we report a serious complication of blind nasogastric feeding tube insertion in a 65-year-old female patient, which was overlooked and caused severe respiratory failure. ( info) |
13/30. Disseminated nocardiosis. A middle aged female suffering from idiopathic thrombocytopenic purpura (ITP), on treatment with steroids, developed bronchopneumonia and pyopneumothorax due to opportunistic infection by nocardia asteroides. Aspirates obtained from the lungs, liver, spleen, kidneys and bone marrow were positive for nocardia asteroides, confirming disseminated infection in an immunocompromised host. The patient succumbed to the infection. ( info) |
14/30. Pneumothorax complicating small-bore feeding tube placement. Small-bore Silastic feeding tubes are being used with increasing frequency for short- and long-term enteral hyperalimentation. We present three cases where these flexible tubes were passed into the tracheobronchial tree and then out into the pleural space. The result in each case was a pneumothorax or hydropneumothorax. These cases were collected at one community hospital over a 6-month period. A review of the current literature reveals reports of 10 similar cases. We conclude that, although the exact incidence of pleural complications of small-bore feeding tubes is unknown, it is not insignificant. The traditional methods of assessing proper nasogastric tube placement are inadequate when applied to these small tubes. Only a chest roentgenogram can assure placement in the stomach. education of hospital staff on methods to avoid malposition of feeding tubes has resulted in an absence of pulmonary complications over a subsequent 1-year period. ( info) |
15/30. Atraumatic perforation of the esophagus: current concepts and report of an additional case. Truly atraumatic perforation of the esophagus is extremely rare. One such case with clinical features classic of this entity is reported. Characteristic findings of hydropneumothorax and pneumomediastinum on plain chest film, and the contrast esophagogram confirmed the diagnosis quickly. However, since the patient sought medical help late, with established septicemic shock, only closed chest drainage could be offered which proved grossly inadequate, and the patient died within 24 hours of presentation. As in the literature, this case report suggests that a case of esophageal perforation can easily and quickly be recognized on plain chest film, and that early aggressive surgical intervention in the form of open and wide mediastinal and chest drainage, with or without esophageal repair, resection or exclusion, offers the patients the best chances of survival against this otherwise invariably fatal event. ( info) |
| Peritoneoscopy is recognized as a safe and effective procedure, even though numerous complications have been reported. We have seen a patient in whom left hydropneumothorax developed after laparoscopy, a complication not previously reported. ( info) |
17/30. Delayed recognition of vascular complications caused by central venous catheters. Three patients are described in whom vascular complications occurred after placement of central venous catheters. Inappropriate catheter length and site of cannulation, catheter movement, and unsuitable catheter material can lead to complications. Guidelines for cannulation of central veins are defined, and recommendations for chest roentgenography, which could result in early recognition of catheter misplacement, are provided. ( info) |
18/30. hydropneumothorax--an unusual complication of lung lavage. hydropneumothorax is an uncommon but potentially fatal complication for a patient undergoing positive pressure ventilation. The case of a 23-year-old woman with severe asthma requiring lung lavage is described. Twenty minutes after an uneventful left lung lavage, the patient experienced increased peak airway pressure, decreased oxygen saturation and hypercarbia, despite ventilation with 90 per cent oxygen. A chest x-ray revealed mediastinal shift and a left sided pneumothorax. drainage was carried out, revealing air and clear fluid in the pleural space. The importance of technical problems such as patient and endotracheal tube positioning, elimination of cross-spilling and cardiopulmonary effects of lavage are discussed. ( info) |
19/30. Intrapleural perforation of peptic ulcer in association with diaphragmatic hernia. Two patients with perforation of intrathoracic peptic ulcer in association with paraoesophageal hiatus hernia are described. This unusual complication of hiatus hernia should be considered in the differential diagnosis of patients presenting with spontaneous hydropneumothorax. ( info) |
| A case of pulmonary sarcoidosis involving the pleura and complicated by spontaneous hydropneumothorax is reported. diagnosis is made by cytological features of pleural effusion and confirmed by mediastinal biopsy. The rare occurrence of this clinical situation must be diagnosed because of the important therapeutic implications, but in any event it indicates the severity of granulomatous disease. ( info) |