Evidence Of Strangulation Research Articles

MiniMizer Gastric Ring displacement at 31weeks of gestation as a life-threatening complication.

This case report describes a pregnant woman who underwent a laparoscopic MiniMizer Gastric Ring procedure for clinically severe obesity only one month before conception. At 31 weeks of gestation, the patient as admitted to the hospital with postprandial vomiting and persistent left-sided colicky abdominal pain. Maternal abdominal MRI revealed an intestinal obstruction and elective surgery was recommended. Due to the considerable risk to the fetus, antenatal corticosteroids were immediately administered to promote lung maturation and magnesium sulfate was started for fetal neuroprotection. During an exploratory laparoscopy, significantly enlarged and ischemic intestinal loops were found, leading to the decision to perform an atraumatic "en caul" cesarean delivery. After a successful "en caul" delivery, the MiniMizer ring, which had dislodged downwards and led to mesenteric ischemia, was visualized. Intraoperative esophagogastroduodenoscopy revealed a 1cm defect in the stomach wall related to gastric ring, covered with purulent exudate. Further exploration, showed a herniation of the distal alimentary loop through the Petersen foramen. Successful management included ring removal and intestinal loop reduction from the Petersen's space, without evidence of strangulation, as confirmed with indocyanine green (ICG) angiography. The postoperative course was uneventful. Women with obesity who have undergone bariatric surgery should to be informed of the increased likelihood of becoming pregnant after treatment. It is advised to notify the patient of the importance of maintaining a sufficient interval between bariatric surgery and conception. Additionally reports from the literature on various complications during pregnancy after bariatric surgery are presented.

Laparoscopic Mesh Repair Of Diaphragmatic Morgagni Hernia

Diaphragmatic hernias of Morgagni were first described in 1769 as anatomical defects in the anterior diaphragm that allow herniation of abdominal viscera into the thorax by Giovanni Battista Morgagni, an Italian anatomist and pathologist. Patients reported to have previous normal radiographs suggest that these hernias may be acquired through a congenital defect in the diaphragm 4. Most hernias of Morgagni are diagnosed late because patients can be asymptomatic or present with vague gastrointestinal and respiratory symptoms and signs. USG has been shown to be useful in assessing diaphragmatic hernias but CT is the most sensitive as it gives excellent anatomical detail on the contents of the hernia and its complications such as strangulation Once diagnosed, the requirement for surgery is largely dependent upon the presentation Repair avoids further complications but it is the timing which is important. Emergency intervention is not always necessary unless there is evidence of strangulation. Laparoscopy is an excellent way to confirm diagnosis and to repair non-complicated hernia of Morgagni. The hernia sac can be easily viewed through the laparoscope. The hernia contents can then be easily reduced once the peritoneum at the perimeter of the defect is incised. The sac is usually not removed; as this may result in massive pneumomediastinum with potential respiratory and circulatory complications.

Ring removal: an illustrated summary of the literature.

The inability to remove a ring from a finger is a common presentation to Emergency Departments in addition to Orthopaedic and Plastic Surgery Units. This is often complicated by factors including trauma and infection, leading to a superimposed tourniquet effect by the ring, strangulating the subcutaneous tissues. The threat of neurovascular compromise favours early removal of the ring to limit associated morbidity. This article illustrates the common methods within the literature. We offer assessing clinicians an illustrated summary of techniques for removing an incarcerated ring from an extremity and summarise notable considerations to be acknowledged at time of assessment and ring removal. A literature search using PubMed and Medline was performed to identify all articles written in English on ring removal. The 12 publications included in this illustrated review describing techniques for removal of an incarcerated ring were published between 1991 and 2018 and include modifications to overcome difficulties due to the composition of the ring or severity of the ring incarceration and penile/scrotal ring removal. The ring removal techniques are ring preserving or destructive. The technique used depends on factors including the extent of associated trauma to the digit, evidence of strangulation, ring composition, patient preference and equipment availability. Before an attempt at ring removal, high arm elevation, indirect ice compression of the digit and adequate analgesia maximise chances of success. In cases of strangulation, emergent referral to a specialist is indicated for removal and further management.

Using micro-computed tomography to examine the larynx in cases of suspected strangulation\u2014a comparison of case findings and control images

The examination of strangulation is one of the most challenging causes of death diagnoses encountered in forensic pathology. The injuries are often subtle and difficult to detect, especially in cases that lack superficial marks. Fractures of the laryngeal skeleton are commonly regarded as evidence of strangulation but these can be too subtle to be detected during autopsy. Micro-CT is a novel imaging technique that achieves a spatial resolution 1 μm or less which lends itself to the examination of small and delicate structures such as the larynx. However, there is little information to date regarding the appearance of the larynx at this scale, thus complicating the interpretation of the micro-CT images. This study therefore uses micro-CT to examine ten larynges from strangulation deaths and to compare them to nineteen samples from donor individuals in order to distinguish between naturally occurring features and actual trauma. It was found that there are several features which mimic damage in the donor group. Using associated case information, initial trends and patterns of different strangulation methods were established.

Living Victims of Strangulation

The prevalence of reported domestic violence or intimate partner violence has greatly increased, with approximately 1.5 million women violently assaulted annually in the United States by an intimate partner. Strangulation is often seen in violence against women, including domestic violence cases. Strangulation is defined as "a form of asphyxia characterized by closure of the blood vessels or air passages of the neck as a result of external pressure on the neck." This is a 10-year case review of 102 living victims of strangulation who underwent medicolegal evaluation at the Clinical Forensic Medicine Program at a State Medical Examiner's Office serving Southern Indiana and all of Kentucky. The majority of victims (79%) were strangled by an intimate partner, and manual strangulation was the most common method (83%). A total of 38 victims (38%) described a history of domestic violence, and the same number lost consciousness while being strangled. Nine (9%) women were pregnant at the time of the attack, while 13 (13%) had a history of being sexually abused in addition to being strangled. A paucity of cases involved only strangulation, as most of the victims were subjected to myriad forms of blunt force trauma which included not only the head and neck but also other bodily regions. This is a unique presentation of strangulation of living persons as most evidence of strangulation in the forensic literature has been derived from postmortem examinations of the victims. This comprehensive study discussing the examination of a living strangulation victim offers valuable insight into the mechanism and the physical findings involved in the strangulation process.

The Choking Game

A 12-year-old girl was brought to the pediatric emergency department by ambulance after her mother found her hanging from her bunk bed. The patient was resuscitated initially but died 5 days later after support was withdrawn. A sexual assault examination was performed, and the finding was negative. The case was investigated as a possible homicide or suicide. Upon questioning relatives, it was disclosed that the deceased had played the choking game. No one knew she had been playing the game alone. The choking game is popular with adolescents and is particularly dangerous when played alone. Emergency physicians should be aware of the characteristic warning signs that include frequent severe headaches, altered mental status after spending time alone, neck markings, and bloodshot eyes and counsel adolescents about the real risks associated with the activity. Accident, suicide, homicide, autoerotic behavior, and the "choking game" should be considered in the differential when an adolescent presents with evidence of strangulation.

Reoperation for Small Bowel Obstruction-How Critical Is the Timing?

The timing of reoperation for small bowel obstruction is a topic of significant debate. Any patient with evidence of strangulation should undergo urgent surgical intervention. However, predicting strangulation can be difficult. Because of this, previous authors have recommended everything from emergency operation for all patients presenting with small bowel obstruction to periods of observation that extend up to 14 days. Over the past century, the primary etiology of small bowel obstruction has shifted from hernias to postoperative adhesive disease, leading to a shift in the management paradigm. To manage small bowel obstruction successfully today, the clinician must distinguish the patient requiring urgent operation from those who benefit from nonoperative management. Furthermore, the clinician must be able to determine the appropriate length of time for conservative management. In this article we review the significant body of literature on this topic including the diagnostic workup and timing of potential operative intervention in the patient with small bowel obstruction.

Síndrome da alça aferente com necrose simulando pseudocisto de pâncreas

Afferent loop obstruction after gastrectomy and Billroth II reconstruction is an uncommon problem. Complete acute obstruction requires emergent laparotomy. We describe a patient who developed acute abdominal pain, hyperamylasemia, and palpable abdominal mass, five years after Billroth II gastrectomy. At laparotomy the patient was found to have a complete stricture of the afferent limb with evidence of strangulation and necrosis. There was no evidence of pancreatitis or pancreatic pseudocyst. The patient underwent pancreaticoduodenectomy plus degastrectomy and died 18 hours after the procedure in the ICU. The mass was initially inte1preted as pancreatic pseudocyst. Ultrasonography may provide enough evidence to differentiate a pancreatic pseudocyst. from an obstructed afferent loop, by the presence of a peripancreatic cystic mass or debris within the mass or the absence of the keyboard sign, suggesting effacement of the valvulae conniventes of the small bowel. Howewer, CT scan of the abdomen has been suggested to be highly characteristic, if not pathognomonic, for an obstructed afferent loop and should be considered first in patients with pancreatitis after Billroth II gastrectomy. A history of previous gastrectomy, recurrent or severe abdominal pain, hyperamylasemia with characteristic tomography, and endoscopic findings will establish the diagnosis and necessitate surgical evaluation and intervention.