Guide wire fracture during percutaneous coronary intervention (PCI) is rare. It can cause fatal complications such as thrombus formation, embolization, and perforation. Guide wire fracture could occur during intervention for severely calcified stenotic lesions, and rarely from distal small branches of stenotic lesions. There are several methods for its management depending on the material character, position, length of the remnant, and the patient's condition. If percutaneous retrieval was not achieved, the surgical procedure should be considered for prevention of potential risks, although the remnant guide wire does not usually cause complications. We experienced a patient with a guide wire fracture during PCI, and managed to prevent its complications through surgical removal of the remnant wire. We report this case here.
Spontaneous bladder rupture is rare. Such an occurrence may appear similar to renal failure because the resulting urine leakage into the peritoneal cavity and absorption across the peritoneum increases serum creatinine although glomerular filtration rate is normal. A 46-year-old man presented with abdominal distension for 7 days after consuming a large volume of alcohol. Initial laboratory tests showed a blood urea nitrogen level of 174.3 mg/dL, serum creatinine of 11.49 mg/dL, and serum sodium of 105 mmol/L. Abdominal distension resolved after draining 5,200 mL of urine through a bladder catheter. Computed tomography cystography revealed intraperitoneal leakage of contrast dye from the left dome of the bladder, suggesting an intraperitoneal bladder rupture. Azotemia was completely normalized on the third day of hospitalization. This case shows that pseudo-renal failure should be considered when caring for a patient with unexplained azotemia and ascites.
Simultaneous thrombosis of multiple coronary arteries in acute myocardial infarction is very rare in clinical settings. Its mechanism is not yet clear, but patients displaying multivessel simultaneous thrombosis tend to have poor clinical outcomes. Hence, it is important to recognize this condition and provide timely and proper management. We report a case of simultaneous thrombosis involving multiple coronary arteries in a patient with ST-segment elevation myocardial infarction.
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