A 27-year-old female heroin addict presented with a peritonitic and distended abdomen. Her medical history included depression and a 3-year history of heroin abuse with attendant constipation. CT scan showed free intraperitoneal gas, massive faecal distension of the rectum and sigmoid colon and likely bowel necrosis. She underwent an emergency Hartmann's procedure for perforation of the sigmoid colon. Pathology identified two areas of stercoral ulceration, one of them being the area of perforation. Postoperatively, the patient developed a deep vein thrombosis and is now on anticoagulant therapy. She was discharged 4 weeks after admission. The patient has been reviewed at follow-up clinic by the surgical team and specialist stoma nurses. She is coping well with good stoma function. We will perform a colonoscopy to identify any further areas of stercoral ulceration but there are no plans for further surgery at present.
A two-stage revision total hip replacement (THR) remains the gold standard for treating chronic periprosthetic joint infection. The goals for the first stage are twofold: (1) remove infected tissue/implants, obtaining tissue samples for culture; (2) deliver local antibiotics and maintain hip function with a prosthesis with antibiotic-loaded acrylic cement. With extensive bone loss prefabricated spacers are not sufficient, therefore customised spacers are required. The current technique, coating cephalomedually femoral nail in cement, is complex, time consuming, functions poorly and causes wear debris from excessive friction at the femoral/acetabular articulation. We report a technique to create a custom made composite spacer using a short femoral nail, standard Exeter femoral stem (Stryker), Trident acetabular cup (Stryker) and polymethyl methacrylate (PMMA) bone cement with antibiotics. This technique restores hip biomechanics and gives a stable articulation, even in the presence of abductor deficiency, due to dual mobility bearings.
Rapid deployment valves significantly facilitated the performance of AVR surgery, which can be objectively confirmed by the observed reductions in ischemic and operative times. Operative and early follow up results are very favorable, but further data and follow up is required. On the basis of the Edward Perimount family of valves, long term durability and hemodynamic performance should be comparable.
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