Intrapleural placement of a nasogastric tube

We report nine cases of Achromobacter xylosoxidans bacteremia diagnosed in patients with hematologic malignancies. There was not an obvious epidemiologic link between cases and the organism was not isolated from any source. Outcome was cure in all nine cases. In our experience, catheter removal is generally required for eradication of A. xylosoxidans.     

Unilateral nasal obstruction: an unusual presentation of a complication of nasotracheal intubation

Partial avulsion of the middle turbinate is an unusual complication of nasotracheal intubation while minor nasal mucosal trauma is not uncommon. Nasal turbinate avulsion often presents with persistent epistaxis but in the case reported, unilateral nasal obstruction with minimal epistaxis was the presenting feature. Unilateral nasal obstruction following nasotracheal intubation should raise suspicion of significant disruption of the intranasal architecture.     

A rare complication of the use of a finger cot to protect the cuff of a tracheal tube during nasotracheal intubation

Some anesthetists in Switzerland and elsewhere use a finger cot to protect the cuff of the endotracheal tube during nasotracheal intubation. In the presented report the finger cut was lost during the procedure and the patient presented 3 months later with a lateral neck mass. The finger cot was found within that mass at exploration. Apart from the other potential risks of this manoeuvre, this severe complication should incite caution against the practice described above.     

Examining the safety of nasogastric tube placement after endoscopic sinus surgery

Several cases of intracranial injury during the placement of nasogastric tubes have been reported, usually in the setting of anterior skull base fractures. The fovea ethmoidalis and sphenoid sinus are often exposed after endoscopic sinus surgery, so that these structures are potentially placed in the line of contact during nasogastric tube placement. In order to evaluate the ability of the fovea ethmoidalis and roof of the sphenoid sinus to withstand penetration from possible contact during nasogastric tube placement, 12 fresh cadaver heads were studied. After complete endoscopic ethmoidectomy and wide sphenoidotomy, standard 18F and 16F nasogastric tubes were inserted to produce deliberate direct contact with both the fovea ethmoidalis and the sphenoid sinus roof. No penetrations of the fovea occurred in 20 specimen sides with the 18F tube; penetration did occur with the 16F tube in 1 of 13 sides (7.7%). With respect to the sphenoid sinus, no intracranial penetrations occurred in 16 and 11 sides for the 18F and 16F tubes, respectively. The sphenoid sinus was easily entered even in the presence of an intact middle turbinate. These data suggest that although intracranial penetration during nasogastric intubation after endoscopic sinus surgery is an unlikely event, there is a non-negligible risk of such injury. Nasogastric intubation should be performed with caution in patients with a history of sinus surgery.     

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.     

Salmonellosis: an unusual complication of hepatocellular carcinoma

Salmonella abscess of a tumor is extremely rare, only three occurrences having been described to date. An unusual case is presented in which Salmonella infantis septicemia was the presenting symptom of multicentric hepatocellular carcinoma in a previously healthy 67-year-old man.     

Pneumomediastinum: an unusual complication of bronchial asthma in a young man

We report a patient with bronchial asthma who presented with pneumomediastinum, pneumopericardium, pneumoretroperitoneum, pneumorrhachis and extensive subcutaneous emphysema, after a period of coughing. Pathogenesis, diagnostic procedures and treatment of pneumomediastinum and its complications are discussed.     

Perforation of the right ventricle: a complication of blind placement of a chest tube into the postpneumonectomy space

Coinfection of the nervous system by two distinct nonviral organisms is uncommon and often undiagnosed. Medical teaching emphasizes that a single pathologic process should be sought; however, in the presence of severe immunocompromise this approach may not hold true. We describe seven HIV-1 seropositive patients with cryptococcal meningitis, three of whom had a proven nervous system infection with a second organism: concurrent tuberculous meningitis, a tuberculoma, and the first documented case of cryptococcal meningitis and neurosyphilis.     

Neonatal bladder rupture: an unusual complication of umbilical catheterization

Bladder injury in the neonatal period is an exceedingly rare phenomenon that is usually iatrogenic. Bladder rupture as a complication of umbilical catheterization in a newborn with urinary ascites, respiratory distress and hematuria is presented and discussed.     

Colorectal intussusception: an unusual gastrointestinal complication of hereditary angioedema

One case of prenatally diagnosed congenital diaphragmatic hernia was reviewed in terms of the anesthetic managements. Concentrations of diazepam, pancuronium and fentanyl were measured in maternal, fetal and umbilical serum. As expectedly, the transition of diazepam through the placenta was large and the concentration of diazepam in the fetal serum was equal to that of maternal serum, but only a small amount of pancuronium was transferred.     

Spinal subdural haematoma: an unusual complication of lumbar puncture

A case in which a spinal subdural haematoma obscured the diagnosis of spinal stenosis is described. The haematoma resulted as a complication of the lumbar puncture necessary for the myelogram. No other aetiological factors were found, but it is suggested that this condition may become more frequent as the result of iatrogenic haemostatic defects.     

Laryngeal foreign body: an unusual complication of percutaneous tracheostomy

Impaction of a foreign body in the larynx is a serious event. While inhaled foreign bodies may occasionally impact in the larynx especially in children, a laryngeal foreign body as a complication of percutaneous tracheostomy has not been reported in the literature. We describe the case of a fragment of a Seldinger wire retained in the larynx for two years following a percutaneous tracheostomy and review the literature on the complications of this procedure.     

Spontaneous gas gangrene: an unusual complication of colonic carcinoma

About two cases of Buschke-Loewenstein tumor--one of the penis in man infected with HIV and another of perianal area-, the authors insist on the relative frequency of Buschke-Loewenstein tumor in non-circumcised and homosexual groups. They emphasize the continuous precancerous spectrum of Buschke-Loewenstein tumor.