Cases reported "Embolism, Air"

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11/66. Portomesenteric gas due to intestinal obstruction: a case report.

    A case of mesenteric vein gas as a nonfatal complication of intestinal obstruction is reported. A 48-year-old woman presented postoperatively signs and symptoms of acute abdomen on the eighth day following a gastric pull-up surgery due to an oesophageal carcinoma. The abdominal tomography findings revealed dilated jejunal segments and free gas in the superior mesenteric vein and end branches of the portal vein in the left hepatic lobe. The patient underwent a second laparotomy with a provisional diagnosis of intestinal ischaemia. Intraoperative gross appearance of the intestines revealed no ischaemic finding, the pathology was the dense adhesions between the jejunal segments and previous incision site. On the basis of these findings, the operation was ended with adhesiolysis. One month after the operation, the patient was well, there were no complications. As the authors, we think that the main reason for portomesenteric gas is mucosal destruction and that these case may be followed conservatively as long as intestinal ischaemia is excluded.
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ranking = 1
keywords = operative
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12/66. Severe intraoperative air embolism during convexity meningioma surgery in the supine position. Case report.

    BACKGROUND: Acute venous air embolism (AE) is a well-known intraoperative complication of neurosurgical procedures, especially during surgical procedures performed in the sitting position, but it is a rare complication in the supine position. A case of a patient who developed an AE during a supratentorial craniotomy in the supine position is presented and the literature is reviewed. CASE DESCRIPTION: A 45-year-old man had a large left frontal convexity meningioma. He was operated upon and, during craniotomy in the supine position, suffered a massive episode of air embolism with severe respiratory and hemodynamic changes. The AE episode occurred while we were cutting the bone for the craniotomy before turning the bone flap. Because the patient was bleeding profusely, the bone flap was quickly removed to achieve hemostasis. Aspiration of irrigant into the cut bone surfaces through several venous diploic channels in the bone edges was observed. The procedure was terminated when hemostasis was achieved. The meningioma was successfully removed in a second operation. CONCLUSION: We think that our case should serve to warn the neurosurgical community about the risk of AE in supratentorial procedures in the supine or semisitting positions when preoperative radiological imaging studies show the presence of important venous channels in relation to the site of the tumor.
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ranking = 3
keywords = operative
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13/66. Probable gas embolism during operative hysteroscopy caused by products of combustion.

    PURPOSE: Gas embolism is a rare but well documented entity during operative hysteroscopy, with an incidence of 10-50%. Catastrophic outcomes occur at a rate of three in 17,000 procedures. The purpose of this report is to present a non-fatal case of gas embolism probably caused by the gaseous products of combustion. CLINICAL FEATURES: A 50-yr-old woman with a history of menorrhagia was scheduled for hysteroscopy and endometrial ablation and polypectomy. Fifteen minutes into the procedure, with the patient in lithotomy position, 20 degree head down tilt, and breathing spontaneously, a sudden oxygen desaturation occurred from 97% to 87%. The patient's end-tidal carbon dioxide dropped from 46 mmHg to 27 mmHg. The patient's breathing pattern remained normal, respiratory rate remained 11-12 breaths x min(-1) but amplitude of the reservoir bag movement was increased. Cardiovascular variables remained stable. She responded rapidly to 100% oxygen and made an uneventful recovery. Having ruled out other possible causes, we concluded gas embolism was responsible for the fall in oxygen saturation and end-tidal CO(2). CONCLUSION: With all the precautions in place to minimize the likelihood of fluid overload and ambient air embolism occurring, we surmised that products of combustion were the cause of the gas embolism. During endometrial ablation, gaseous products of combustion, mainly carbon dioxide, accumulate. The gases may then contribute to the rise in uterine pressure that occurs as irrigation fluid enters the uterus and this rise in pressure in turn encourages passage of gas into the open venous sinuses.
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ranking = 2.5
keywords = operative
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14/66. carbon dioxide embolism diagnosed by transesophageal echocardiography during endoscopic vein harvesting for coronary artery bypass grafting.

    IMPLICATIONS: We describe a case of massive carbon dioxide embolism with an abrupt decrease in arterial blood pressure and continuous mixed venous oxygen saturation during endoscopic vein harvesting that was immediately diagnosed by intraoperative transesophageal echocardiography.
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ranking = 0.5
keywords = operative
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15/66. Prevention of air embolism with intravascular carbon dioxide washout.

    air embolism remains a constant hazard from all operative procedures which involve opening the central cardiovascular system. Standard surgical maneuvers have been developed to prevent embolization by evacuating the air before restoring the circulation. Under certain circumstances these maneuvers may not be effective in removing air from the aortic arch. Introduction of carbon dioxide directly into the aorta to displace blood for adequate visualization has proved to be a simple, safe adjunct to the prevention of air embolization in operations involving the aortic arch.
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ranking = 0.5
keywords = operative
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16/66. Incidental detection of paradoxical air embolism with a transoesophageal Doppler probe inserted for measuring descending aortic blood flow.

    We present a case of paradoxical air embolism in a patient undergoing neurosurgery of the posterior fossa in the sitting position. Paradoxical air embolism was detected in the descending aorta by a transoesophageal Doppler probe, which was inserted primarily for non-invasive haemodynamic monitoring. The patient suffered no serious complications of paradoxical air embolism and recovered well. We suggest that paradoxical air embolism can be detected intraoperatively not only by transoesophageal echocardiography, but also with a transoesophageal Doppler probe.
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ranking = 0.5
keywords = operative
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17/66. Cerebral and coronary air embolism: an intradepartmental suicide attempt.

    Uncooperative but alert on arrival, a 21-year-old suicidal man was found suddenly unconscious with agonal respirations 2 h into his Emergency Department evaluation. Initially admitted for ingesting multiple pills and self-inflicting a deep wrist laceration, the patient now had a glasgow coma scale score of 3, a dense left-sided hemiplegia, and an electrocardiogram suggestive of acute myocardial infarction. This constellation of physical findings, together with an echocardiogram revealing bi-ventricular gas artifact, led to a diagnosis of coronary and cerebral air emboli. The patient was urgently resuscitated and then underwent hyperbaric oxygen therapy. Subsequent examination confirmed a full recovery. This article details this unprecedented case, as well as clinically relevant aspects of air embolism.
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ranking = 0.5
keywords = operative
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18/66. Massive air embolism--a possible cause of death after operative hysteroscopy using a 32% dextran-70 pump.

    Although considered a safe procedure, operative hysteroscopy has been reported to result in serious and even fatal complications. A fatal outcome is described after operative hysteroscopy. The attending team made a diagnosis of massive air embolism. However, HBO therapy, which is the specific treatment for air embolism, yielded only transient improvement. The pathologist's diagnosis on autopsy was anaphylaxis. These two complications must be borne in mind during the procedure, and a contingency plan developed for dealing with them should they arise.
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ranking = 3
keywords = operative
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19/66. Postoperative aneurysms of the heart. Case report and review of the literature.

    A postoperative left ventricular pseudoaneurysm is reported in a seven-year-old after closure of an atrial septal defect and repair of partial anomalous venous drainage. A discussion of the etiology and clinical presentation of post operative aneurysms are presented. Cardiac aneurysms of both the true and false variety have been commonly reported following myocardial infarction, blunt and penetrating trauma and infectious processes such as tuberculosis and syphilis. As the frequency of open heart correction of congenital and acquired lesions increases, the incidence of post-operative pseudoaneurysm of heart can also be expected to increase. The diagnosis of this entity in the postoperative period is often difficult and may lead to delay in detection and correction. The clinical presentation and subsequent course of false anurysm differs from the more common true aneurysm to an extent which should be recognized by both cardiologists and cardiac surgeons. A case of left ventricular pseudoaneurysm after open heart repair of an atrial septal defect is reported and a clinical profile which may be helpful in the earlier recognition of this entity is presented.
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ranking = 4
keywords = operative
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20/66. Loss of SSEP during sitting craniotomy.

    A 54-year-old woman with a past medical history of asthma and depression presented with right side hearing loss and ataxia. She was scheduled for a sitting craniotomy for cerebellopontine angle tumor resection. Somatosensory evoked potential, brainstem auditory evoked response, and facial nerve EMG were monitored intraoperatively. Approximately 30 minutes into the case, there was an episode of air embolism, which resolved after the source was identified and treated. Near the conclusion of the case, there was an abrupt loss of the right cortical somatosensory evoked potential signal, which never returned to baseline. A postoperative CT scan showed a substantial amount of subarachnoid air and intraventricular air in the frontal and temporal regions. The patient awakened in the ICU with no new neurologic deficit besides preoperative hearing loss on the right side. Despite the high specificity of somatosensory evoked potential change associated with postoperative neurodeficit when the change never returns to the baseline, there was no postoperative neurologic deficit in this patient. This case indicates the false-positive somatosensory evoked potentials caused by pneumocephalus in the sitting position.
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ranking = 2.5
keywords = operative
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