Summary:A 56-year-old woman underwent abdominoplasty with no immediate complications. She had no known bleeding history nor any relevant past surgical history. Adequate preventive measures for venous thromboembolism were performed, including sequential compression devices, good hydration, and early ambulation. At 17 days post operation, the patient presented to the emergency room complaining of left leg swelling and sharp, shooting pain radiating down her left leg. Workup in the Emergency Room revealed significant venous thrombosis involving complete occlusion of the major veins of the left leg. There were no indications of cardiopulmonary compromise. Angiography revealed an anatomical variant consistent with May-Thurner Syndrome (MTS). This variant first described in 1957 may present in up to one-quarter of patients, more commonly in young women. This case appears to the first reported of MTS occurring in association with a postoperative complication of abdominoplasty. Diagnosis and management considerations are discussed.
Hepatotoxicity associated with inhalation anesthetics is a known rare occurrence. Sevoflurane, one of the newest generation agents, has a more ideal safety profile due to its lack of airway irritation, rapid onset of action, and quick elimination. However, based on several case reports, sevoflurane has been associated with acute liver toxicity following surgery. Literature review reveals other reports demonstrating an association between inhaled anesthetics and acute liver damage.A 90-year-old Caucasian man with chronic renal insufficiency, but otherwise relatively healthy and active, suffered a displaced nasal fracture from a fall. There was no syncope or loss of consciousness. After primary care in the emergency room, he was referred to plastic surgery for treatment of his nasal fracture. Visible deformity and airway compromise was noted for which early closed reduction was recommended. Following medical clearance through his internist, he underwent a 30 minute procedure under general anesthesia in an outpatient surgery center.Sevoflurane was used along with propofol and nitrous oxide. Surgery and recovery were uneventful. Follow-up on post-operative days 1 and 5 did not reveal any problems. On post-operative day 10, he presented to the emergency room with constipation and jaundice. Work-up for painless jaundice ensued; no biliary obstruction was found, though he was noted to have a bilirubin of 12 mg/dL and markedly elevated transaminases. He rapidly developed respiratory failure and worsening of his chronic renal failure. Unfortunately, the patient continued to deteriorate and passed away 26 days after surgery.Although a rare event, acute liver failure from exposure to inhalation anesthetics has been reported. With our patient, his advanced age including chronic renal failure likely contributed to the development of liver failure that then precipitated multiple system failure and a rapid demise. This case report reminds us that even the most minor of procedures can have major consequences.A 90-year-old Caucasian male with a history of chronic renal insufficiency sustained a nasal fracture after a fall. He denied any loss of consciousness and noted bleeding from his nose. He was treated at a local emergency room, where a
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