The American surgeon
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The American surgeon · Mar 2007
Case ReportsA surprising twist to an old problem: sigmoid volvulus in a 19-year-old man.
Sigmoid volvulus classically presents in the seventh or eighth decade, therefore, diagnosis of sigmoid volvulus in an adolescent may be delayed or missed. This life-threatening diagnosis should be considered in young patients presenting with abdominal pain, nausea, vomiting, and constipation. Intraoperative findings in a 19-year-old man with a sigmoid volvulus highlight the importance of considering further studies, such as an abdominal CT scan, which goes beyond the typical obstruction evaluation in the adolescent patient. When nonoperative management fails to decompress the volvulus, complicating factors should be considered, and laparotomy is indicated to provide definitive treatment for this condition.
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Cases of burns from child abuse are low because of under-reporting, low index of suspicion, or lack of verity proof. Although the reported incidence of child abuse by burns is 4 to 39 per cent, less than one-half are substantiated. We retrospectively reviewed all burns in children less than 6 years old admitted to our burn center within an 8-year period (1997-2003). ⋯ In extreme cases, however, multiple areas of the body were involved with intervening spared sites. The perpetrator was the mother's boyfriend in all cases. Burns in children less than 2 years old left in the care of the mother's boyfriend, involving the left extremity (or extremities), and caused by tap water should prompt the clinician to more actively confirm or exclude abuse.
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The American surgeon · Mar 2007
Case ReportsFasciotomy closure using simultaneous vacuum-assisted closure and hyperbaric oxygen.
Fasciotomies performed for compartment syndrome and ischemic vascular disease often requires closure in 2 to 4 weeks by skin graft. This leaves the patient with an unsightly scar and a limb with reduced strength. The use of vacuum-assisted closure (VAC) and hyperbaric oxygen therapy (HBOT) quickly reduce the edema and permit earlier closure with adjacent skin. ⋯ The pathophysiology of compartment syndrome and ischemia-reperfusion syndrome is discussed. These patients had closure of the fasciotomy wounds in 3 to 18 days. The simultaneous use of HBOT and VAC accelerates the reduction of edema in a synergistic fashion, permitting early closure of fasciotomy wounds.
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The American surgeon · Mar 2007
Case ReportsRemoval of a large spherical foreign object from the rectum using an obstetric vacuum device: a case report.
Reports of retained rectal foreign bodies are increasingly common worldwide. It is likely that any surgeon practicing at a major medical center will encounter this type of case, and thus, should be familiar with both surgical and nonsurgical management options. ⋯ Low-lying objects can usually be extracted in the emergency room transanally, whereas high-lying foreign bodies may require anesthesia and laparotomy. We report an experience using an obstetric vacuum device to extract a high-lying foreign body from the rectum.
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The American surgeon · Mar 2007
Case ReportsAsymptomatic intussusception of the appendix secondary to endometriosis.
This is a report of a 47-year-old woman with an asymptomatic clinical presentation of appendiceal intussusception secondary to endometriosis. Initially discovered during routine colonoscopy as a submucosal mass, it was ultimately diagnosed after surgical resection by pathology findings. The theories regarding the pathogenesis of appendiceal intussusception are reviewed and discussed here.