Thyroidectomy is a routinely common practiced surgery. Morbidity and mortality from thyroid surgery are disregarded nowadays and undervalued in the literature. Perioperative risks and complications still exist for large goiters and can be life-threatening. These complications may occur during the anesthesia and intubation, intra-, or postoperatively. We set out through a case of a large cervical multinodular goiter (MNG) and a review of literature the perioperative complications and how to avoid them. During the total thyroidectomy operation, an accidental devascularisation of a parathyroid gland, a cervical hematoma which was evacuated by surgical reoperation, hemodynamic disorder and a transitory hypoparathyroidism were the postoperative complications that occurred. Surgery for large goiters remains difficult; so adequate preoperative assessment, particular attention and careful operative procedure should be followed to obtain better surgical outcomes.
Echinococcus granulosus, the pathogen responsible for hydatid disease, mostly settles in the liver and lungs but affects the peritoneum less frequently. Rupture of a cyst into the peritoneal cavity is a potentially life-threatening incident. Although numerous studies on ruptured hepatic hydatid cysts have been published, few cases of peritoneal cyst rupture have been reported. We describe the case of a 19-year-old woman who presented with an acute abdomen and allergic reactions after a fall. Ultrasonography and computed tomography revealed a hydatid cyst of the liver and ruptured pelvic hydatid cyst. First, the patient received appropriate measures to prevent anaphylactic shock and later underwent emergency surgery. Partial cystectomy of the ruptured pelvic hydatid cyst, peritoneal washing, and unroofing of the large unruptured hepatic hydatid cyst were conducted. Albendazole was administered postoperatively for 3 months. No recurrence was noticed during 3 years of follow-up. Although rarely documented, acute rupture of a peritoneal hydatid cyst is the most severe complication of peritoneal echinococcosis. Typically after trauma, it must be considered in the presence of an acute abdomen with allergic reactions. Ultrasonography and computed tomography have high sensitivity in demonstrating rupture of a hydatid cyst. Emergency surgery is the only effective treatment and should aim at the complete removal of a cyst, if possible, and peritoneal washing with scolicidal agents. Additional studies should be conducted to evaluate the feasibility of laparoscopy. Albendazole should be prescribed postoperatively to prevent recurrence. Mortality is closely related to anaphylaxis; hence, early and accurate diagnosis and appropriate preventive measures are crucial.
Gastric duplication cyst is uncommon congenital malformation rarely seen in the adult population. Although complications related to duplication such as infection, haemorrhage, obstruction, and fistula formation with neighbouring structures had been previously reported, fistulization into the colon in adult has been previously never described to our knowledge. In this study, we present the case of a 36‐year‐old male patient with moderate mental retardation who presented with 10 months history of progressive abdominal pain, nausea, vomiting, and important weight loss. Clinical assessment and radiological investigations demonstrated the presence of non‐communicating gastric duplication cyst inserted on the greater curvature of the antrum and fistulized into the transverse colon. At laparotomy, the cyst was completely excised and the colon containing the fistula was resected with colo‐colonic anastomosis. Pathology confirmed gastric duplication and demonstrated that the inner surface of the cyst was lined by gastric type mucosa. The patient had an uneventful recovery and after 3 months of follow‐up, all symptoms disappeared. Also, he gained 11 kg in weight. This case highlights, therefore, the fact that all gastric duplication cysts should be removed in order to avoid the risk of serious complications.
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