BackgroundBlunt cardiac trauma is diagnosed in less than 10% of trauma patients and covers the range of severity from clinically insignificant myocardial contusions to lethal multi-chamber cardiac rupture. The most common mechanisms of injury include: motor vehicle collisions (MVC), pedestrians struck by motor vehicles and falls from significant heights. A severe complication from blunt cardiac trauma is cardiac chamber rupture with pericardial tear. It is an exceedingly rare diagnosis. A retrospective review identified only 0.002% of all trauma patients presented with this condition. Most patients with atrial rupture do not survive transport to the hospital and upon arrival diagnosis remains difficult.Case presentationWe present two cases of atrial and pericardial rupture. The first case is a 33-year-old female involved in a MVC, who presented unresponsive, hypotensive and tachycardic. A left sided hemothorax was diagnosed and a chest tube placed with 1200 mL of bloody output. The patient was taken to the OR emergently. Intraoperatively, a laceration in the right pericardium and a 3 cm defect in the anterior, right atrium were identified. Despite measures to control hemorrhage and resuscitate the patient, the patient did not survive.The second case is a 58-year-old male involved in a high-speed MVC. Similar to the first case, the patient presented unresponsive, hypotensive and tachycardic with a left sided hemothorax. A chest tube was placed with 900 mL of bloody output. Based on the output and ongoing resuscitation requirements, the patient was taken to the OR. Intraoperatively, a 15 cm anterior pericardial laceration was identified. Through the defect, there was brisk bleeding from a 1 cm laceration on the left atrial appendage. The injury was debrided and repaired using a running 3–0 polypropylene suture over a Satinsky clamp. The patient eventually recovered and was discharged home.ConclusionsWe present two cases of uncontained atrial and pericardial rupture from blunt cardiac trauma. Contained ruptures with an intact pericardium present as a cardiac tamponade while uncontained ruptures present with hemomediastinum or hemothorax. A high degree of suspicion is required to rapidly diagnose and perform the cardiorrhaphy to offer the best chance at survival.
Background: Although numerous studies outside the United States (U.S.) have explored weight loss and comorbidity resolution among patients with class I obesity (body mass index [BMI] 30-34.9 kg/m 2 ) after metabolic surgery, few U.S.-based studies have been conducted. Objective: Our aim was to compare weight loss and comorbidity resolution among U.S. patients with class I obesity, who underwent laparoscopic sleeve gastrectomy (LSG) versus Roux-en-Y gastric bypass (RYGB). Methods: Weight loss and comorbidity data among only patients with class I obesity, who underwent LSG or RYGB, were examined. Between April 2009 and April 2017, 1215 metabolic surgeries were performed with 30 patients meeting the inclusion criteria (17 LSG and 13 RYGB). Results: Percent total weight loss (%TWL) for LSG peaked at 12 months (20.85%), while RYGB %TWL peaked at 18 months (21.65%). Percent excess weight loss (%EWL) peaked at 12 months after LSG (83.59%) and 18 months after RYGB (98.29%). Overall follow-up was 56.3%, 36.7%, and 43.3% at 12, 18, and 24 months. LSG and RYGB were both successful with regard to resolution of medical comorbidities at 12 months. Conclusion: RYGB and LSG appear to have similar, successful outcomes among U.S. patients with class I obesity for weight loss and comorbidity resolution.
Highlights Appendiceal torsion, a rare phenomenon, may be seen in Ehlers-Danlos syndrome. Appendiceal torsion is clinically indistinguishable from acute appendicitis. Ehlers-Danlos syndrome contributes to surgical problems due to fragility of tissue.
Introduction. Anastomotic pseudoaneurysms are a complication of vascular reconstructive surgery with the majority in the femoral region. Although rare, ruptured femoral anastomotic pseudoaneurysms have high mortality and require emergency surgery. Case Presentation. A 60-year-old male with a history of a left leg crush injury was treated with a superficial femoral artery interposition vein graft 30 years ago. He presented nowadays with a three-day history of severe pain in his left thigh. CT angiography demonstrated a ruptured anastomotic pseudoaneurysm with contrast extravasation into an intramuscular hematoma. He had significant scarring from his previous surgeries which made the leg hostile for an open repair. Therefore, percutaneous access selectively cannulated the left iliofemoral vasculature. An angiogram showed a distal superficial femoral artery pseudoaneurysm. Subsequently, two 10mmx15cm Viabahn covered stents (Gore & Associates, Flagstaff, AZ) were placed bridging healthy superficial femoral artery. A completion angiogram demonstrated no extravasation into the pseudoaneurysm. The patient recovered and was discharged home two days postoperatively. Conclusion. Ruptured femoral anastomotic pseudoaneurysms are traditionally repaired with open pseudoaneurysm excision and arterial reconstruction, although endovascular repair has been reported. Furthermore, most femoral anastomotic pseudoaneurysms form less than 10 years after initial operation. We present a unique case of ruptured superficial femoral artery pseudoaneurysm, 30 years after the initial operation. Endovascular stents offer effective treatment for ruptured anastomotic pseudoaneurysms.
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