Hepatic infarction is a rare and fatal complication associated with hemolysis, elevated liver enzymes and low platelets syndrome. It can develop into fulminant liver failure and lead to death in 16% of cases. A 25-year-old woman, with unremarkable prenatal history, was sent to gynecological emergency unit for management of severe preeclampsia at 30 weeks and 4 days of pregnancy. Initial laboratory studies revealed aspartate aminotransferase at 290 U/L, alanine aminotransferase at 193 U/L and a normal value of hemoglobin, platelets and the prothrombin time. Behind the persistence of high blood pressure despite dual therapy, an emergent cesarean section was performed. However, two days after surgery, the patient accused an epigastric pain and was subsequently noted to have developed HELLP syndrome: thrombocytopenia (77000 /ul), anemia (hemoglobin 9.1 g/dL) and worsened liver injury (aspartate aminotransferase 2809 U/L; alanine aminotransferase 2502 U/L). A thoraco-abdominopelvic computed tomography (CT) was performed, which revealed massive hepatic infarction more marked on the right lobe, by showing the existence of diffuse hypodense plaques, poorly limited, not enhanced after injection, interesting all hepatic segments. The vascular permeability of the portal and subhepatic was preserved. During the surveillance, the laboratory tests worsened (hemoglobin = 4,6 g/dl; platelets count = 20000 /ul; WBC = 26000 /ul; CRP = 340 mg/l; albumin = 16 g/l, prothrombin time (PT) = 50%). The patient received antibiotics, she was transfused by red blood cells and platelets concentrates, she also received albumin with the pleural effusion drainage. The damaged hepatic areas stayed stable in control CT and the patient gradually improved here biological test, to become normal at 11 days after delivery. Hepatic infarction is an extraordinarily rare complication of preeclampsia. The diagnosis should be suspected by noting elevated liver enzymes, thrombocytopenia and typical images of hepatic infarction on abdominal CT. Early recognition and multidisciplinary management is necessary to prevent hepatic failure and death.
Subcutaneous emphysema (SE) refers to trapped air beneath the dermis. It can affect any body site and may spread from one area to another by travelling along fascial planes under the effect of pressure gradient. In some cases, air effusion in different body cavities can secondary occur leading to pneumomediastinum or pneumothorax. SE is not dangerous in it and may regress spontaneously. However, extensive SE complications such as respiratory failure and cardiovascular collapse may engage the vital prognosis requiring urgent care. In this article, we present a case of a 30-year-old male with extensive subcutaneous emphysema associated to a pneumomediastinum, secondary to a deep perianal wound. We report this case for its rarity.
Bilateral vocal cords paralysis is a serious condition that can be due to pathology of the vocal fold itself, damage to the cranial nerves ensuring their mobility, or central neurological disorders. In this article, we present a case of a 13-year-old girl who was admitted to the intensive care unit postoperatively for posterior cerebral fossa tumor surgery. She was reintubated after an extubation failure as a result of laryngeal dyspnea with stridor and chest in-drawing. The examination revealed damage to III, VI, and IX nerves with the immobility of vocal cords that were abducted towards the midline. A weaning tracheotomy was performed with a good clinical evolution and the patient was discharged 13 days after the surgery with maintained follow-ups. We report this case for its rarity.
Patients with nonsurgical malignant pheochromocytoma are at risk for major hemodynamic instability during periods of stress, including the perioperative period. Unpredictable changes in catecholamine levels are observed in these patients who are candidates for surgery other than adrenal tumor resection, which may lead to hemodynamic instability. For this reason, adequate preoperative preparation of patients with pheochromocytoma is considered as the mainstay of anesthetic management. This case report describes the perioperative management of a patient with a malignant pheochromocytoma who was to undergo a hemiarthroplasty following a left femoral neck fracture.
Shoulder dislocation reflects a complete loss of contact between the humeral head and the glenoid cavity. It is a frequent pathology and is the most common dislocation in the body. More frequent in young adults with a clear male predominance, which can lead to a socio-professional and sporting handicap. The diagnosis of glenohumeral instability is most often clinical. Standard radiography is sufficient for bone assessment. Arthroscanner and arthro-irm are currently the most effective techniques for confirming the diagnosis, assessing the extent and severity of the lesions, and searching for associated lesions. The treatment is surgical, the LATARJET operation remains the gold standard of treatment of instability of the shoulder. It allows the recovery of joint mobility as well as satisfactory joint stability.
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