Mucormycosis is a rare and life-threatening fungal infection that is associated with high mortality in immunocompromised individuals. Although it most commonly affects lungs and paranasal sinuses, cases of invasive mucormycosis of the gastrointestinal tract have also been reported. Gastrointestinal mucormycosis (GIM) is most commonly found in the stomach, colon, and ileum. Etiologies of GIM include ingestion of spores and penetrating abdominal trauma, causing mucocutaneous disruption. We present a case of an immunocompetent man who presented to our hospital after a gunshot wound to the abdomen. His hospital course was complicated with the development of invasive GIM in the form of a large gastric ulcer, which caused gastrointestinal bleeding and eventually perforation.
ABSTRACT:The anesthetic management of a patient with Dilated Cardiomyopathy (DCM) undergoing non-cardiac surgery is always a challenge to the anesthesiologist as DCM is most commonly complicated by progressive congestive heart failure and malignant arrhythmias. Idiopathic dilated cardiomyopathy is a primary myocardial disease of unknown etiology characterized by left ventricular or biventricular dilation and impaired contractility. Depending upon diagnostic criteria used, the reported annual incidence varies between 5 and 8 cases per 100,000 population. It is more common in men. Dilated cardiomyopathy is defined by the presence of: a) fractional myocardial shortening less than 25%(>2SD) and/or ejection fraction less than 45%(>2SD), and b) Left ventricular end diastolic diameter (LVEDD) greater than 117% excluding any known cause of myocardial disease. Such cases always prove a challenge to the anesthetist because of the complications associated with the condition. Here we report the successful perioperative management of a patient with severe dilated cardiomyopathy undergoing surgery for carcinoma colon. KEYWORDS: Dilated cardiomyopathy, Congestion, Arrhythmia, Perioperative, Colon.CASE REPORT: 60 years old, historically normotensive, non-diabetic, euthyroid female presented with chief complaints of severe abdominal pain and vomiting for 2 days. Patient was managed conservatively and subjected to further evaluation. Colonoscopy revealed polyps in anorectum, descending colon and transverse colon. Histopathological examination of polyp revealed villous adenoma with high grade dysplasia. CECT abdomen showed a descending colon growth with bilateral pleural effusion. While hospitalized, patient developed hepatomegaly, pedal oedema with CXR showing features of LVF and bilateral pleural effusion, more on right side. USG revealed congested hepatic veins with minimal (R) sided pleural effusion. ECG showed LBBB pattern. Patient was subjected to cardio logical evaluation and diagnosed as a case of severe dilated cardiomyopathy. ECHO revealed a dilated LV, severe global hypokinesia with ejection fraction of 15%, Grade iii diastolic dysfunction with moderate MR with severe PAH (Gradient 65mm Hg) with dilated LA. Patient was put on medical therapy (Tab. losartan, lasilactone and carvedilol) for 2 weeks by cardiologists.Patient was reviewed by the cardiologist after 2 weeks of medical treatment and cleared for the surgery as a very high risk case. A detailed counselling of the patient and the attendants was done, explaining the risks involved, nature of the surgical procedure and outcome. After taking a high risk written and informed consent, patient was planned for elective (L) hemicolectomy. Pre op investigations were normal with KFT (57/1.1) Tablet losartan was stopped by the cardiologist 1 day prior to surgery while tablets lasilactone and carvedilol were continued on the morning of surgery. In OR, multichannel monitoring was attached.
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