Retroperitoneal and mediastinal emphysema as a complication of colonoscopy

Retroperitoneal and mediastinal emphysema as a complication of colonoscopy, though infrequent, may occur. It is important to realize that this can be a benign clinical condition that will resolve with conservative management. A case of retroperitoneal emphysema after routine colonoscopy is reported with a review of literature and a brief discussion.     

Case report: pneumomediastinum and pneumothorax complicating colonoscopy

Colonic perforation is potentially the most serious complication of colonoscopy. Both the clinical manifestation and rapidity of onset of symptoms can vary depending on whether the perforation occurs directly into the peritoneal cavity or into the retroperitoneal space. Colonic perforation is often associated with abdominal pain, although more uncommon presentations have been documented. A case report of a unilateral pneumothorax and pneumomediastinum complicating colonoscopy is described, which responded well to conservative measures without recourse to surgical intervention, antibiotic therapy or parenteral alimentation.     

Tension pneumothorax precluding laparoscopic repair of diaphragmatic hernia

BACKGROUND: Central Europe and the Czech Republic are specific in the prevalence of obesity which has increased by 10-40% during the last 10 years. METHODS: In the Czech republic there is 30 years of experience of a comprehensive approach to obesity treatment which includes: dietary treatment; exercise; behavioral modification; drug treatment; and bariatric surgery. Each of these approaches has its place in complex obesity management. Since 1983 bariatric surgery has been established in the Czech Republic for the treatment of morbid obesity. Vertical banded gastroplasty (VBG), gastric banding, laparoscopic nonadjustable and adjustable gastric bandings have been used over the years. Since 1993 laparoscopic gastric banding has been the only method used in our department. RESULTS: The comprehensive approach for obesity treatment in the Czech Republic has resulted in the development of obesity management and research centers, regional obesity units, obesity out-patients clinics and weight reduction clubs. The surgical treatment is a well-established part of this system and the long-term results of surgical treatment are acceptable both in terms of weight loss and complication rate. There has been no statistical difference in weight loss results following VBG and laparoscopic gastric banding, but there is a significant decrease in morbidity, and shorter hospital stay associated with laparoscopic gastric banding. CONCLUSIONS: The surgical approach in obesity treatment has an important place in the comprehensive care of obese patients. Laparoscopic gastric banding in the hands of an experienced surgeon is a method with low morbidity, short hospital stay and long-term weight loss results which are fully comparable with the results of other surgical approaches.     

Splenic rupture: an unusual complication of colonoscopy

Splenic rupture is an uncommon complication of colonoscopy. A high index of suspicion is a crucial factor in the prompt diagnosis of this rare but potentially fatal complication. We report a case of splenic rupture diagnosed 3 days after a colonoscopy and requiring splenectomy. We also reviewed 17 reported cases of splenic rupture after colonoscopy, including our case. The presumed mechanisms of splenic rupture during colonoscopy are direct trauma to the spleen, excessive splenocolic ligament traction, and decrease in the relative mobility between the spleen and the colon. Of the 17 cases reviewed, 10 had polypectomy and/or biopsy performed during colonoscopy. Other probable risk factors are identified and tabulated. The hemodynamic status of the patient is the primary factor used to determine the therapeutic option. Computed tomographic (CT) scan of the abdomen reliably demonstrates well-contained splenic laceration and subcapsular hematoma, and differentiates these splenic complications from perisplenic clot and hemoperitoneum. Thus, CT scan may help decide which patients may be managed operatively or nonoperatively. Splenectomy is the operative procedure of choice for splenic rupture after colonoscopy. Conservative management includes broad spectrum antibiotics, intravenous fluids, blood transfusion, and close hemodynamic monitoring. The factors mandating further evaluation of persistent abdominal pain after colonoscopy are hemodynamic instability, clinical features of acute abdomen, leukocytosis, and/or acute anemia. The onset of abdominal pain associated with one or more of these critical factors is usually within 24 h after colonoscopy. An emergent CT scan of the abdomen is the modality of choice to further evaluate these clinical features, but intestinal perforation and external bleeding must first be excluded.     

Chylothorax as a complication of sarcoidosis

This case report features a male patient of 45 years of age presenting with a right sided moderately compressive pleural effusion, that was clearly identified as chylothorax on thoracocentesis. Sarcoidosis with systemic involvement had already been diagnosed in 1995 by a parotid gland biopsy. Thoracoscopy revealed multiple discrete nodules parietally besides a number of more extensive yellowish lesions resembling malignant lymphoma. However visualization of a thoracic duct leakage was not possible. Histologically the biopsies taken represented exclusively non-caseating sarcoidosistype granulomas. Complete and permanent remission of the chylothorax was achieved within only ten days following talcum pleurodesis, alimentary measures and induction of systemic steroid therapy. The etiological classification of this extremely rare complication appears very clear. Pathogenetic and differential therapeutic aspects are discussed against the background of a review of the literature.     

Epididymo-orchitis as a complication of brucellosis

A study of 84 patients who were diagnosed with epididymo-orchitis between July 1987 and September 1993 is presented. Brucellosis was a complication in 14 cases (17%). All 14 cases had elevated agglutination titers. Brucella blood culture was found to be positive in 4 of 14 cases (28.5%). Standard therapy regime (streptomycin plus tetracycline) was effective in 13 of 14 (93%) cases.     

Right-sided pneumothorax as a result of a left-sided chest tube

Chest tubes are inserted for a variety of reasons, and a number of complications have been associated with their use. We report a case of traumatic hemopneumothorax in which the chest tube crossed the mediastinum into the contralateral lung causing a pneumothorax. Its position was not apparent on portable chest radiographs.     

Syringohydromyelia as a complication of Goldenhar syndrome

Goldenhar syndrome is a multifocal developmental disorder consisting of ocular, auricular and vertebral anomalies. A case of Goldenhar syndrome is presented with a previously undescribed association with syringohydromelia. The pertinent literature is reviewed and possible mechanisms of the pathogenesis of syringohydromyelia in this syndrome are discussed.     

Pseudoaneurysm as a complication of knee arthroscopy

This is a report of a pseudoaneurysm of the inferior medial geniculate artery following knee arthroscopy. This case was treated successfully with embolization.     

Subcutaneous emphysema as a complication of tonsillectomy

Subcutaneous emphysema occurs when air is introduced into the tissues. This can happen as a complication during, or immediately after surgery. It has rarely been described after tonsillectomy. Definitive treatment will depend on the cause. We report two cases of subcutaneous emphysema following tonsillectomy.     

Cavitary aspergillosis as a complication of AIDS

The authors report a case of type 2 dissection, strictly confined to the terminal portion of the ascending aorta, not seen by transesophageal echocardiography because of the existence of a blind spot and responsible for a false negative. The role of TEE in the diagnostic approach to dissections is reviewed, as are its limitations, of which it is important to be aware because of the poor prognosis of pathology of this type.     

Aneurysmal hemorrhage as a complication of paracentesis

Aneurysms of the temporal part of the carotid artery are unusually rare. The literature contains only a few previous reports dealing with hemorrhage from such malformations. In the present case massive bleeding occurred from a right-sided intrapetrous aneurym after myringotomy, which was performed as treatment for bilateral secretory otitis media. Due to the absence of any specific symptoms and the masking effect of middle ear glue preoperative identification of the aneurysm was not possible. Subsequent angiography showed the large fusiform extension of the intrapetrous aneurysm as well as multiple intracranial aneurysms. Leakage from the aneurism was closed definitively with muscle, fascia lata and a gelatin-resorcin-formalin-glue (Cardial). In order to apply the tissue patch the hypotympanic site of the aneurism was exposed using a posterior otosurgical approach. Due to extensive intracranial collateralization to the vertebral arteries bleeding persisted even after ligation of both carotid arteries. Temporary cardiac asystole was then induced to allow safe closure of the aneurysm. Following surgery the patient sustained loss of hearing in her ear and a partial peripheral facial palsy.     

Melanoptysis as a complication of fibreoptic bronchoscopy

The case is presented of a coal miner with bilateral masses of progressive massive fibrosis, who developed acute cavitation following fibreoptic bronchoscopy and biopsies. Indeed, immediately upon bronchoscopy with transbronchial biopsy, there was expectoration of abundant melanoptysis. Three days later, the chest radiograph showed a cavity and the patient again coughed up black material, in the context of pulmonary infection. One week later, there was complete emptying of the conglomerate mass. To the authors' knowledge, this is the first reported case of a conglomerate mass of progressive massive fibrosis which cavitated as a result of bronchoscopy.