M&M - Dr. Allen
CASE ONE: Epigastric pain after colonscopy
-Perforation - instrument vs air pressure
-Visceral injury (spleen, diaphragm, volvulus)
-Infection (bacteremia, retroperitoneal abscess, appendicitis)
-Pneumatic injuries (Distention, pneumoperitoneum, pneumothorax)
-Rate of perforation 1/1500... increases with biopsy/polypectomy
Splenic laceration/rupture from colonscopy
-Incidence 0.00005-0.017%. Likely under-reported. 14 Million colonscopies per yr in US
-Mortality 5%. Danger lies in delayed diagnosis. Symptoms often attributed to air insufflation or serositis.
-Female predominance, increased risk prev abdominal surgeries
-Mechanism? Traction on splenocolic ligament, adhesions, direct trauma
-Presentation: Abdominal pain, dizziness, Kehr's sign, worsening anemia
(Kehr sign referred pain from diaphragm to shoulder)
-Dx; Ultrasound, DPL, CT
-Management: Symptomatic, serial Hb and abd exam, possible surgery
CASE TWO: Sore throat
Uvular Edema: Rarely reported in isolation
Etiologies: Allergy/anaphylaxis, infection, angioedema, trauma
Quincke's Disease: Inhalation injury, hereditary angioedema, cocaine/marijuana abuse, idiopathic/snoring in obesity.
Presentation: Dysphagia, odynophagia, sore throat, foreign body sensation. Uncommonly resp distress, dyspnea, fever.
-Some association with epiglottis
-If infection suspect, cover strep species and consider lateral neck xray
-If not infectious, steroids +/- H2 blockers
-75% recurrence rate - either first 48 hours or remote
CASE THREE: Groin pain
Avascular necrosis of femur
-Risk factors. Trauma, steroid use, hemoglobinopathy, dysbaric phenomena, autoimmune disease, storage disease, smoking, HLD, excess alcohol consumption
-Often present with groin pain, throbbing, deep. Bilateral disease 50-80%
-Can by identified by painful forced internal rotation at hip
-Radiographic findings: Crescent sign (intact bone with deeper area of necrosis). On MRI "single density line" early, "double line sign" found in 80% cases, high intensity line surrounded by low intensity
-Treatment: 85% collapse rate, surgical intervention is mainstay. Of those treated with conservative therapy, 76% proceeded to arthroplasty
Your comment will be posted after it is approved.
Leave a Reply.