Barotrauma is pressure-induced injury. The application of direct pressure to the body may cause trauma, including positive pressure from artificial ventilation. Trauma may also be caused by the effects of pressure changes on gas-containing body spaces, not in communication with the environment. This can include the external ear, the middle ear (and, indirectly, the inner ear), the para-nasal sinuses, the lungs, the gut, and abscess cavities (for example, in the teeth). Gas may penetrate tissues adjoining the affected space (such as the anterior cranial fossa, via the ethmoid sinus), or may embolise via the blood stream. The most severe expression of this is cerebral arterial gas embolism, which may present as a stroke. The management of these problems includes prevention, the use of pressure-equalizing techniques, vasoconstrictor drugs, surgery, and hyperbaric oxygen therapy.
Radiation enteritis can be challenging to diagnose and treat. We report the case of a 44-year-old woman who was diagnosed with a squamous cell carcinoma of the cervix in 1978 and treated with hysterectomy and post-operative radiotherapy. Over the next 20 years she required multiple intestinal operations resulting in short bowel syndrome. She became symptomatic of severe hypomagnesaemia which could not be corrected with oral supplementation and which required intravenous magnesium sulfate every 5-7 days for an 11-month period. However, following 25 sessions of hyperbaric oxygen therapy, she was able to discontinue intravenous magnesium and maintain her serum magnesium level with oral treatment. Her weight and stoma output improved. For over 4 years subsequent to this therapy she has not required further intravenous magnesium although has needed temporary nutritional support. Her case is complicated by vitamin A, B and D deficiencies.
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