Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gas gangrene is a life-threatening, necrotising soft tissue infection. Colorectal malignancy-associated Clostridiumsepticum is a rare cause of gas gangrene. This case outlines an initial presentation of colonic malignancy as gas gangrene from C.septicum infection.A 69-year-old man presented with abdominal pain, vomiting and constipation. Abdominal X-ray revealed dilated small bowel loops. Lactate was elevated. A diagnosis of small bowel obstruction was made. Subsequent CT revealed caecal thickening and subcutaneous emphysema overlying the left flank. Clinically, he became haemodynamically unstable. Examination revealed crepitus overlying the left flank in keeping with gas gangrene. The patient required immediate surgical debridement. Tissue specimens cultured C.septicum Following a complicated postoperative period, he was transferred to the plastic surgery team for further tissue debridement and reconstruction. A colonoscopy was later performed which was suspicious for malignancy. Colorectal multidisciplinary team discussion is awaited.
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PMID:Deadly combination: Clostridium septicum and colorectal malignancy. 2919 51

Small bowel obstruction is the most common surgical emergency after a patient has had abdominal surgery. However, Boerhaave syndrome secondary to an ileostomy obstruction has not been reported in current literature. We present a rare case of two concurrent surgical emergencies in a patient with Boerhaave syndrome and small bowel obstruction. A 38-year-old woman presented with sudden onset severe central chest pain associated with breathlessness. She had a history of Crohn's disease, which had been treated with pancolectomy and ileostomy. Clinical examination showed an extensive palpable surgical emphysema extending from the neck to the pelvis with a distended abdomen. Computed tomography contrast of the chest and abdomen reported bilateral pneumothoraces, ruptured oesophagus and distended small bowel secondary to obstruction at the ileostomy. She was referred to the nearest cardiothoracic centre for an urgent assessment. Unfortunately she passed away shortly after the scan. Ruptured oesophagus is associated with a high mobidity and mortality if it is not recognised, so early diagnosis and prompt treatment is crucial in reducing the mortality rate. There is a strong association between stoma formation and incidence of small bowel obstruction but no difference between an ileostomy and colostomy. This case helps to illustrate the challenging management of chronic recurring abdominal obstruction and the delicate balance of risk of complication versus benefit of various management being surgical or conservative. All general surgeons should be wary of the potential complication of oesophageal perforation secondary to intestinal obstruction.
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PMID:A rare complication of ileostomy obstruction: Boerhaave syndrome. 3011 37

An 83-year-old man with metastatic esophageal and colon cancer underwent a therapeutic colonoscopy in an attempt to place a colonic stent to alleviate symptoms of severe bowel obstruction. Moderate sedation with intravenous propofol was provided during the case. During the procedure, the patient experienced bilateral tension pneumothoraces and subcutaneous emphysema of the neck and face. A needle decompression of the tension pneumothorax was performed emergently, and chest tubes were subsequently inserted bilaterally in the intensive care unit. Colonic perforation was highly suspected based on the clinical manifestations and procedural difficulties, although a diagnostic abdominal computed tomography scan was never completed because of the family's desire to provide only comfort care. The patient died 24 hours after the event. A literature search revealed that 10 cases of pneumothorax occurred following a colonoscopy. The purpose of this case report and review of the literature is to increase awareness of pneumothorax as an extremely rare but severe and often life-threatening complication of colonoscopy among anesthesia care providers. The mechanisms of pneumothorax development are also discussed.
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PMID:Bilateral Tension Pneumothoraces During Colonoscopy: A Case Report and Review of Literature. 3156 52


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