Case Study: A 5-Year-Old Male with Right Lower Quadrant Abdominal Pain

Carrie A. Laituri MD ∙ Carissa L. Garey MD ∙ Daniel J. Ostlie MD
 

Download PDF

Case Study: A 5-Year-Old Male with Right Lower Quadrant Abdominal Pain

1098 Kb

Case Study: A 36-Year-Old Male with Fevers and Malaise

Preetha Umamaheswaran MD¹ ∙ Jaclyn Snikeris¹ ∙ Augusto Podesta MD² ∙ Timothy S. Hall MD¹
 

Download PDF

Case Study: A 36-Year-Old Male with Fevers and Malaise

6216 Kb

Introduction This study investigates if body fat parameters, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), total adipose tissue (TAT) and body mass index (BMI), are correlated with increased risk of complications following surgery for colorectal cancer.
Methods Retrospective study of 54 consecutive patients undergoing elective resectional surgery for colorectal cancer with curative intent. A consultant radiologist reviewed all pre-operative CT scans and calculated body fat parameters using GE software. Primary outcomes were anastomotic leakage and 30 day mortality. Secondary outcomes included length of operation, number of lymph nodes retrieved, medical complications and duration of hospital stay.
Results There were 5 leaks (9.3%) and 3 deaths (5.6%). Out of the four fat parameters, only VAT was significantly associated with an increased risk of developing anastomotic leakage (P=0.0341). The fat parameters were not significantly associated with any other outcome. Although male sex was associated with higher VAT (p=0.001), it was not an independent risk factor for leakage (p=0.380).
Conclusion Increased VAT is associated with a greater risk of anastomotic leakage following resection surgery for colorectal cancer. Further studies are warranted to investigate if pre-operative radiology may be used to stratify high-risk patients who may benefit from a temporary diverting stoma.

Download PDF

Visceral Adiposity is Associated with Increased Risk of Anastomotic Leakage Foll

450 Kb

Overview High-impact flexion-distraction injuries to the thoracolumbar spine, often seen in lap-belted passengers, can be associated with abdominal visceral injuries as well as bony spine injuries, such as Chance fractures. However, more rostral injuries may remain undetected, with potentially significant clinical implications. In the case presented, a 7 year-old boy was a lap-belted passenger in a high-speed motor vehicle accident.  He was hemodynamically unstable on arrival to the hospital with complaints of headache, bilateral sixth nerve palsies, neck pain, paraplegia and a T4 sensory level.  Further evaluation disclosed an intracranial subdural hematoma, diffuse axonal injury, a partial atlanto-occipital dislocation (AOD), multiple spinal cord contusions, and an L2 Chance fracture. His neurologic status remained unchanged, and he underwent L1-3 posterior spinal fusion with instrumentation. His cervical ligamentous injury was treated with halo fixation. This child illustrates numerous potential injuries associated with hyperflexion-distraction injuries, as seen in lap-belted patients. Maintaining a high index of suspicion for occult rostral CNS injuries such as atlanto-occipital dislocation and diffuse axonal injury is vital. In addition, the need for vigorous fluid resuscitation and normotension are important to maintain perfusion of the potentially compromised spinal cord, especially in the immediate period after injury.

Download PDF

Redefining the Seat Belt Syndrome

1074 Kb