Berrettini Anastomosis Iatrogenic Injury Relating to Carpel Tunnel Syndrome Case Study

Some diseases require medical mitigation following the diagnosis, and sometimes the situation means that the patient has to undertake strong medication. However, this medicine is designed pharmacodynamically to interact with other organs before they reach the intended organ. Some mitigation imposes challenges on the involved organ. While the main organ will be healed, some drugs’ footprints will be left out to other organs. These are called iatrogenic injuries. In the case of anastomosis, it requires the alteration of surgical methods or the origin of iatrogenic injury in the arm;thus, the knowledge of anastomosis is very important to the field of medical practice. In addition, carpal tunnel release becomes vital in curing carpal tunnel syndrome. The paper focuses on a case of a 42-year-old woman found to have a complication to her middle finger. This case becomes important for studying Berrettini anastomosis iatrogenic injury, which relates to carpal tunnel syndrome. The Berrettini branch is a complication that facilitates communication between the superficial ulnar and median nerve. The analysis also provides the electro-diagnostic evidence of Berrettini anastomosis on how it can give a position three-finger and thus contribute to a force explanation of the median neuropraxia. Lastly, the paper provides information on the implication of the Berrettini branch for surgical use. The implication of pictures in the digital era can be used to analyze the varied connection and length between the median nerve and ulnar section. It’s easy to locate the position of high risk of iatrogenic injury in the palm due to the consistent location of Berrettini communication branches. The precaution is that operations have to be conducted moderately for a clear vision as the carefully mitigated practice ensures protection from the destruction and injury of the surrounding structures.

Post-cholecystectomy iatrogenic bile duct injuries:Emerging role for endoscopic management

Post-cholecystectomy iatrogenic bile duct injuries(IBDIs),are not uncommon and although the frequency of IBDIs vary across the literature,the rates following the procedure of laparoscopic cholecystectomy are much higher than open cholecystectomy.These injuries caries a great burden on the patients,physicians and the health care systems and sometime are life-threatening.IBDIs are associated with different manifestations that are not limited to abdominal pain,bile leaks from the surgical drains,peritonitis with fever and sometimes jaundice.Such injuries if not witnessed during the surgery,can be diagnosed by combining clinical manifestations,biochemical tests and imaging techniques.Among such techniques abdominal US is usually the first choice while Magnetic Resonance Cholangio-Pancreatography seems the most appropriate.Surgical approach was the ideal approach for such cases,however the introduction of Endoscopic Retrograde Cholangio-Pancreatography(ERCP)was a paradigm shift in the management of such injuries due to accepted success rates,lower cost and lower rates of associated morbidity and mortality.However,the literature lacks consensus for the optimal timing of ERCP intervention in the management of IBDIs.ERCP management of IBDIs can be tailored according to the nature of the underlying injury.For the subgroup of patients with complete bile duct ligation and lost ductal continuity,transfer to surgery is indicated without delay.Those patients will not benefit from endoscopy and hence should not do unnecessary ERCP.For low–flow leaks e.g.gallbladder bed leaks,conservative management for 1-2 wk prior to ERCP is advised,in contrary to high-flow leaks e.g.cystic duct leaks and stricture lesions in whom early ERCP is encouraged.Sphincterotomy plus stenting is the ideal management line for cases of IBDIs.Interventional radiologic techniques are promising options especially for cases of failed endoscopic repair and also for cases with altered anatomy.Future studies will solve many unsolved issues in the management of IBDIs.

Migration of varicocele coil leading to ureteral obstruction and hydronephrosis:A case report

BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization.Imaging confirmed left ureteral obstruction and hydronephrosis.Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's symptoms.Follow-up at six months and two years showed sustained improvement.CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.

Iatrogenic bile duct injuries from biliary tract surgery

BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery.However,bile duct injury is a rare but still one of the most common complications.These injuries sometimes present variably after primary surgery.Timely detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury(IBDI) were managed at the Department of Surgery,First Affiliated Hospital,Xi’an Jiaotong University.All the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS:Recovery of the patients was uneventful.All patients were followed-up at the surgical outpatient department for six months to three years.So far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries,and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.

Liver transplantation in the treatment of severe iatrogenic liver injuries

The place of liver transplantation in the treatment of severe iatrogenic liver injuries has not yet been widely discussed in the literature. Bile duct injuries during cholecystectomy represent the leading cause of liver transplantation in this setting, while other indications after abdominal surgery are less common. Urgent liver transplantation for the treatment of severe iatrogenic liver injury may-represent a surgical challenge requiring technically difficult and time consuming procedures. A debate is ongoing on the need for centralization of complex surgery in tertiary referral centers. The early referral of patients with severe iatrogenic liver injuries to a tertiary center with experienced hepato-pancreatobiliary and transplant surgery has emerged as the best treatment of care. Despite widespread interest in the use of liver transplantation as a treatment option for severe iatrogenic injuries, reported experiences indicate few liver transplants are performed. This review analyzes the literature on liver transplantation after hepatic injury and discusses our own experience along with surgical advances and future prospects in this uncommon transplant setting.

Monitoring somatosensory evoked potentials in spinal cord ischemia-reperfusion injury

It remains unclear whether spinal cord ischemia-reperfusion injury caused by ischemia and other non-mechanical factors can be monitored by somatosensory evoked potentials. Therefore, we monitored spinal cord ischemia-reperfusion injury in rabbits using somatosensory evoked potential detection technology. The results showed that the somatosensory evoked potential latency was significantly prolonged and the amplitude significantly reduced until it disappeared during the period of spinal cord ischemia. After reperfusion for 30-180 minutes, the amplitude and latency began to gradually recover; at 360 minutes of reperfusion, the latency showed no significant difference compared with the pre-ischemic value, while the somatosensory evoked potential amplitude in- creased, and severe hindlimb motor dysfunctions were detected. Experimental findings suggest that changes in somatosensory evoked potentia~ ~atency can reflect the degree of spinat cord ischemic injury, while the amplitude variations are indicators of the late spinal cord reperfusion injury, which provide evidence for the assessment of limb motor function and avoid iatrogenic spinal cord injury.

Iatrogenic Bile Duct Injuries after Cholecystectomy, Is the Laparoscopic Approach a Good Idea?

Objective: The treatment of iatrogenic bile duct injuries is still a challenge for hepatobiliary and general surgeons. Roux-en-Y hepaticojejunostomy, one of the most appropriate techniques for the treatment of circumferential lesions, either occurring less than 2 cm from the bifurcation or in the bifurcation of the common hepatic duct, requires experience in advanced laparoscopy and hepatobiliary surgery. This study aims to present the results of laparoscopic hepaticojejunostomy (LHJ) for the treatment of iatrogenic bile duct injuries (IBDI). Methods: A retrospective study analyzing the medical records of patients diagnosed with IBDI and treated using LHJ of patients at the Hospital S?o José do Avaí (HSJA). Sex, age, previous cholecystectomy technique, signs and symptoms, postoperative complications, length of stay, injury classification, and time elapsed from injury to diagnosis were analyzed. Magnetic resonance cholangiography (MRC), endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography. Results: From March 2006 to December 2018, six patients underwent LHJ. In five cases (83.33%), the primary operation was a laparoscopic cholecystectomy (LC) and in one patient (13.66%) open cholecystectomy. The most frequent clinical sign was jaundice. The mean surgical time was 153.2 minutes (range: 115 to 206 minutes), and the hospital stay was 3 to 7 days (mean: 4.16 days). One patient had infection of the umbilical trocar incision and one patient presented with stenosis of the hepaticojejunal anastomosis and was treated with radioscopic pneumatic dilatation. Conclusion: LHJ for circumferential and total IBDI either diagnosed early (during surgery) or late, may be a safe and effective option, with similar results to the conventional technique, a low complication rate and all the known advantages of minimally invasive surgery.

High ligation of the hernia sac in open nonmesh inguinal herniorrhaphy is an important cause of iatrogenic vas deferens injury

Vasectomy damage is a common complication of open nonmesh hernia repair.This study was a retrospective analysis of the characteristics and possible causes of vas deferens injuries in patients exhibiting unilateral or bilateral vasal obstruction caused by open nonmesh inguinal herniorrhaphy.The site of the obstructed vas deferens was intraoperatively confirmed.Data,surgical methods,and patient outcomes were examined.The Anderson–Darling test was applied to test for Gaussian distribution of data.Fisher’s exact test or Mann–Whitney U test and unpaired t-test were used for statistical analyses.The mean age at operation was 7.23(standard deviation[s.d.]:2.09)years and the mean obstructive interval was 17.72(s.d.:2.73)years.Crossed(n=1)and inguinal(n=42)vasovasostomies were performed.The overall patency rate was 85.3%(29/34).Among the 43 enrolled patients(mean age:24.95[s.d.:2.20]years),73 sides of their inguinal regions were explored.The disconnected end of the vas deferens was found in the internal ring on 54 sides(74.0%),was found in the inguinal canal on 16 sides(21.9%),and was found in the pelvic cavity on 3 sides(4.1%).Location of the vas deferens injury did not significantly differ according to age at the time of hernia surgery(≥12 years or<12 years)or obstructive interval(≥15 years or<15 years).These results underscore that high ligation of the hernial sac warrants extra caution by surgeons during open nonmesh inguinal herniorrhaphy.

Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm!

BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy.Yet gastroenterologists,like any individual,can rarely suffer acute-changes-inmental-status from medical disorders,and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday.CASE SUMMARIES Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak,two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy.Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps,and absurdly“pressed”endoscopic steering dials to“take”endoscopic photographs;Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum,and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall.Endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager.She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies(fulfilling ethical imperative of“physician,firstdo-no-harm”),and go to emergency room for medical evaluation.Both endoscopists complied.In-hospital-work-up revealed toxic encephalopathy in both from:case-1-urosepsis and left-ureteral-impacted-nephrolithiasis;and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger.Endoscopists rapidly recovered with medical therapy.CONCLUSION This rare syndrome(0.0011%of endoscopies)may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy.Recommended management(followed in both cases):1-recognize incident as medical emergency demanding immediate action to prevent iatrogenic patient injury;2-inform Chief-of-Gastroenterology;and 3-immediately intervene to abort endoscopy to protect patient.Syndromic features require further study.

Internal biliary fistula due to cholelithiasis:A single-centre experience

AIM： To discuss about the perioperative problems encountered in patients with internal biliary fistula （IBF） caused by cholelithiasis.METHODS： In our hospital, 4 130 cholecystectomies were carried out for symptomatic cholelithiasis from January 2000 to March 2004 and only 12 patients were diagnosed with IBF. The perioperative data of these 12 IBF patients were analyzed retrospectively.RESULTS： The incidence of IBF due to cholelithiasis was nearly 0.3%. The mean age was 57 years. Most of the patients presented with non-specific complaints. Only two patients were considered to have IBF when gallstone ileus was observed during the investigations. Nine patients underwent emergency laparotomy with a pre-operative diagnosis of acute abdomen. In the remaining three patients, elective laparoscopic cholecystectomy was converted to open surgery after identification of IBF. Ten patients had cholecystoduodenal fistula and two patients had cholecystocholedochal fistula. The mean hospital stay was 23 d. Two wound infections, three bile leakages and three mortalities were observed.CONCLUSION： Cholecystectomy has to be performed in early stage in the patients who were diagnosed as cholelithiasis to prevent the complications like IBF which is seen rarely. Suspicion of IBF should be kept in mind, especially in the case of difficult dissection during cholecystectomy and attention should be paid in order to prevent iatrogenic injuries.

Surgical Management of Traumatic Facial Paralysis:A Case Review Study

Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the patients were treated with various surgical methods according to their pathogeny.Results The mean percentage facial function improvement (House-Brackmann GradeⅠ-Ⅱ) was 86% in temporal bone fracture and function was improved after proper operation to iatrogenic facial nerve injury.Conclusions Patients with traumatic facial paralysis receive proved outcomes itreaed with proper surgical methods according to their particular condition of nerve injury.

Viabahn Stent Graft for Inadvertent Insertion of a Central Venous Catheter in the Subclavian Artery

Subclavian artery (SCA) injuries associated with central venous catheter (CVC) insertion are uncommon yet lethal complications that typically require surgical treatment. This case report presents the case of a 94-year-old man with an iatrogenic right SCA injury resulting from a misplaced CVC. Computed tomography revealed the catheter piercing the right internal jugular vein to enter the right SCA and then reaching the aortic arch. Emergent endovascular treatment was performed, and a 13-mm × 50-mm self-expanding Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA) was placed via the right brachial artery. The misplaced catheter was successfully removed under simultaneous postdeployment balloon dilatation. This case highlights the utility of the Viabahn stent graft for iatrogenic right SCA injury caused by a misplaced CVC and presents some insights and tips for a safer procedure.