Despite the growing numbers of laparoscopic operations, ION has rarely been described. The cases that were published involved laparoscopic prostatectomy and a prolonged steep Trendelenburg position. We postulate that the patient presented here had suffered both from a relative hypotension and from an acute rise in the intraorbital pressure due to patient position, both factors combining to cause a disruption to ocular perfusion resulting in ION with severe permanent visual damage.
A patient with end-stage congestive cardiac failure and acute renal failure was admitted to the intensive care unit for inotropic support. Following no improvement with treatment, the focus of care shifted to the patient's comfort, palliative care and family support. She wished to die at home and therefore all efforts were made to fulfil her desire. This was achieved and she was discharged from the intensive care unit on inotropes and allowed to die in the comfort of her own home, with the withdrawal of treatment occurring only when the patient was ready.
Postoperative loss of vision is a serious but under-appreciated complication after surgery. Although more commonly seen with cardiac and spinal surgery, we report a rare case where ischemic optic neuropathy is associated with laparoscopic surgery. An ASA-2 middle-aged man with hypertension and obesity underwent a laparoscopic resection of rectosigmoidal adenocarcinoma. Intraoperatively, no surgical complications were noted with minimal blood loss encountered. He was positioned in a steep Trendelenberg position for 5 continuous hours, and had a mean blood pressure of at least 75 mm Hg throughout. Postoperatively, he had obvious facial and periorbital swelling. Initial decreased visual acuity was noted immediately and this only partially improved over several days and weeks. Magnetic resonance imaging and angiography revealed no structural abnormality and after ophthalmology review, a diagnosis of ischemic optic neuropathy was made. We describe a case showing the association of postoperative loss of vision with laparoscopic surgery and prolonged Trendelenberg positioning.
A 17-year-old man was admitted to Accident & Emergency out of hours with unilateral tonsillar enlargement covering more than 75% of his oropharyngeal inlet. He appeared calm and stable on initial presentation, but in a short span of time rapidly deteriorated, leading to near complete airway obstruction necessitating an emergency awake cricothyroidotomy. Tracheostomy and tonsillectomy were done after this, he was ventilated postoperatively in intensive therapy unit and discharged home in a week. This is a rare clinical scenario in a patient presenting with palatine tonsillitis. A few subtle points in the history and examination alerted the team and prevented a risky inter hospital transfer for ear, nose and throat review. This is the first reported case in UK of palatine tonsillitis not due to infectious mononucleosis presenting with acute upper airway obstruction in a patient with no airway anomalies. It may also have been a varied presentation of COVID-19.
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