Impalement injuries are rare and among the most spectacular and dramatic traumatic injuries especially of the chest. The survival of a patient with a thoracic impalement injury can be extremely rare. Herein we present...Impalement injuries are rare and among the most spectacular and dramatic traumatic injuries especially of the chest. The survival of a patient with a thoracic impalement injury can be extremely rare. Herein we present and discuss our successes of the management of 7 rare cases of thoracic impalement injuries over a 5-year period from January 2014 to June 2019 at the Komfo Anokye Teaching Hospital, Kumasi in Ghana. We discuss the presentation, diagnosis, treatment and outcomes of the seven cases encountered.展开更多
We present the case of a 46-year old man with a two-year history of losing his denture presenting with cachexia and a two-month history of dysphagia to both liquids and solids associated with odynophagia. Review at th...We present the case of a 46-year old man with a two-year history of losing his denture presenting with cachexia and a two-month history of dysphagia to both liquids and solids associated with odynophagia. Review at the ENT department where a diagnostic rigid oesophagoscopy was done under general anaesthesia showed a denture impacted to the wall of the oesophagus at 17 cm from the incisor. Attempts at retrieval were unsuccessful as the denture was deeply embedded in the oesophageal wall <em>and bled easily on attempted removal</em>. He subsequently underwent a 2-stage surgical management approach by the cardiothoracic surgical team. Patient first underwent nutritional rehabilitation for a month through a created feeding gastrostomy tube via a limited midline laparotomy. He then had a open cervical oesophagotomy and removal of the denture. Currently doing well six months after surgery and tolerating normal oral diet.展开更多
Achalasia cardia is a primary oesophageal motility disorder of unknown aetiology characterized manometrically by insufficient relaxation of the lower oesophageal sphincter (LES) and loss of oesophageal peristalsis;rad...Achalasia cardia is a primary oesophageal motility disorder of unknown aetiology characterized manometrically by insufficient relaxation of the lower oesophageal sphincter (LES) and loss of oesophageal peristalsis;radiographically by aperistalsis, oesophageal dilation with minimal LES opening, bird-beak appearance, poor emptying of barium;and endoscopically by dilated oesophagus with retained saliva, liquid and undigested food particles in the absence of mucosal stricturing or tumour. Achalasia cardia patients usually present with difficulty in swallowing both solids and liquids and this may be associated with regurgitation, heartburn and chest pains. Treatment options include medical or pharmacologic therapy, botulinum toxin injection, pneumatic dilation and oesophagocardiomyotomy or the Heller myotomy with or without antireflux procedure and recently the POEM (Perioral oesophageal myotomy). Herein, we present our experience with four cases managed surgically via thoracotomy without antireflux surgery over a 5-year period, from January 2015 to June 2019 at the Komfo Anokye Teaching Hospital, the second largest teaching hospital in Ghana.展开更多
Introduction: Blunt traumatic pericardial rupture (BTPR) or traumatic pericardiotomy is a rare typical trauma. It is usually discovered at autopsy. Surgical repair is mandatory especially if prompt diagnosis is made b...Introduction: Blunt traumatic pericardial rupture (BTPR) or traumatic pericardiotomy is a rare typical trauma. It is usually discovered at autopsy. Surgical repair is mandatory especially if prompt diagnosis is made because of the associated high mortality. Clinical Case: We report the successful management and survival of BTPR patient after chest trauma presenting with massive haemothorax and transient loss of vision, necessitating urgent surgical treatment. The patient was involved in a road traffic accident having a head-on collision with the rear of the vehicle ahead whiles trying to overtake it. Discussion: It is usually discovered at autopsy or during emergent surgical exploration through either sternotomy or thoracotomy [1] due to its delayed diagnosis, unusual presentation, association with other major cardiopulmonary injuries and complications such as cardiac herniation, fatal arrhythmias, cardiogenic shock and cardiac arrest. Conclusion: Blunt traumatic pericardial rupture should be suspected in any patient in whom hemodynamic instability occurs rapidly after trauma without evidence of major bleeding. Prompt surgical exploration may yield excellent results.展开更多
文摘Impalement injuries are rare and among the most spectacular and dramatic traumatic injuries especially of the chest. The survival of a patient with a thoracic impalement injury can be extremely rare. Herein we present and discuss our successes of the management of 7 rare cases of thoracic impalement injuries over a 5-year period from January 2014 to June 2019 at the Komfo Anokye Teaching Hospital, Kumasi in Ghana. We discuss the presentation, diagnosis, treatment and outcomes of the seven cases encountered.
文摘We present the case of a 46-year old man with a two-year history of losing his denture presenting with cachexia and a two-month history of dysphagia to both liquids and solids associated with odynophagia. Review at the ENT department where a diagnostic rigid oesophagoscopy was done under general anaesthesia showed a denture impacted to the wall of the oesophagus at 17 cm from the incisor. Attempts at retrieval were unsuccessful as the denture was deeply embedded in the oesophageal wall <em>and bled easily on attempted removal</em>. He subsequently underwent a 2-stage surgical management approach by the cardiothoracic surgical team. Patient first underwent nutritional rehabilitation for a month through a created feeding gastrostomy tube via a limited midline laparotomy. He then had a open cervical oesophagotomy and removal of the denture. Currently doing well six months after surgery and tolerating normal oral diet.
文摘Achalasia cardia is a primary oesophageal motility disorder of unknown aetiology characterized manometrically by insufficient relaxation of the lower oesophageal sphincter (LES) and loss of oesophageal peristalsis;radiographically by aperistalsis, oesophageal dilation with minimal LES opening, bird-beak appearance, poor emptying of barium;and endoscopically by dilated oesophagus with retained saliva, liquid and undigested food particles in the absence of mucosal stricturing or tumour. Achalasia cardia patients usually present with difficulty in swallowing both solids and liquids and this may be associated with regurgitation, heartburn and chest pains. Treatment options include medical or pharmacologic therapy, botulinum toxin injection, pneumatic dilation and oesophagocardiomyotomy or the Heller myotomy with or without antireflux procedure and recently the POEM (Perioral oesophageal myotomy). Herein, we present our experience with four cases managed surgically via thoracotomy without antireflux surgery over a 5-year period, from January 2015 to June 2019 at the Komfo Anokye Teaching Hospital, the second largest teaching hospital in Ghana.
文摘Introduction: Blunt traumatic pericardial rupture (BTPR) or traumatic pericardiotomy is a rare typical trauma. It is usually discovered at autopsy. Surgical repair is mandatory especially if prompt diagnosis is made because of the associated high mortality. Clinical Case: We report the successful management and survival of BTPR patient after chest trauma presenting with massive haemothorax and transient loss of vision, necessitating urgent surgical treatment. The patient was involved in a road traffic accident having a head-on collision with the rear of the vehicle ahead whiles trying to overtake it. Discussion: It is usually discovered at autopsy or during emergent surgical exploration through either sternotomy or thoracotomy [1] due to its delayed diagnosis, unusual presentation, association with other major cardiopulmonary injuries and complications such as cardiac herniation, fatal arrhythmias, cardiogenic shock and cardiac arrest. Conclusion: Blunt traumatic pericardial rupture should be suspected in any patient in whom hemodynamic instability occurs rapidly after trauma without evidence of major bleeding. Prompt surgical exploration may yield excellent results.
