Potential Life-threatening Complications Research Articles

Successful treatment of type III atresia ani and rectovaginal fistula in a kitten

A six-weeks-old, female kitten presented with dehydration, depression, atresia ani and a discharge of watery feces from the vulvar opening. On radiographic examination, the blind-end of the rectum was determined to be >1 cm cranial from the anal dimple, classifying it as type III atresia ani. Atresia ani combined with a rectovaginal fistula is an uncommon congenital defect of the terminal rectum and anus that can occur in kittens. After supportive medical treatment for three days, the patient was strong enough for surgical correction. The distal rectal pouch was connected to the unperforated anus and the rectovaginal fistula was closed. The kitten recovered uneventfully and was able to defecate normally at 38 weeks follow-up. In this case report, the importance of early surgical correction to avoid potential life-threatening complications from this congenital abnormality is demonstrated.

May-Thurner Syndrome: An Anatomic Predisposition to Deep Vein Thrombosis

May-Thurner syndrome (MTS) is a rare clinical condition caused by extrinsic compression of the left common iliac vein by the right common iliac artery, leading to venous stasis and predisposing to thrombus formation. Here, we present the case of a 39-year-old female with no obviously known other risk factors predisposing to thrombosis who presented with severe left leg pain and swelling for a week. The international normalized ratio was elevated and the venous Doppler study showed extensive thrombosis extending from the left common iliac vein to the common femoral vein and the popliteal vein. She was diagnosed with MTS and treated with catheter-directed mechanical thrombolysis and thrombectomy, along with angioplasty of the left common iliac vein and external iliac vein, with near-complete resolution post-treatment.MTS should be suspected in patients who present with unilateral limb thrombosis regardless of the presence of predisposing factors. Timely management with endovascular procedures is necessary to help prevent other potential life-threatening complications.

Evaluation of serum and ascitic monocyte chemotactic protein-1 level in patients with and without spontaneous bacterial peritonitis

Objectives To evaluate the diagnostic value of serum and ascitic fluid monocyte chemotactic protein-1 (MCP-1) level in cirrhotic patients with and without spontaneous bacterial peritonitis (SBP). Background SBP is one of the potential life-threatening complications in ascitic cirrhotic patients, with a mortality rate ranging between 30 and 50%. Patients and methods This study was conducted on 40 patients with cirrhotic ascites with and without SBP admitted to Internal Medicine Department, Menoufia University Hospital, and El Sahel Teaching Hospital from October 2017 to October 2018. All patients included in this study were divided into two groups as follows: group I included 10 ascitic patients without SBP, and group II included 30 ascitic patients with SBP. Results Mean level of MCP-1 was significantly higher in SBP group than non-SBP group. For MCP-1, the cutoff point that gives an area of 91% was 122.5 ng/ml, with sensitivity of 86% and of specificity 95%. For serum MCP-1, the cutoff point that gives an area of 91% was 100.5 ng/ml, with of sensitivity 85% and specificity of 94%. For polymorphonuclear cell count, the cutoff point that gives an area of 78% was 62.5 cell/cm3, with a sensitivity of 100% and specificity of 41%. Conclusion MCP-1 is a good diagnostic marker for SBP with its high sensitivity (86.7%) and specificity (95.4%) with high reliability (91%) in patients with SBP. Moreover, MCP-1 is a good prognostic marker owing to its positive relation with the severity of liver disease, which is indicated by high model for end-stage liver disease scores.

Post-Transfusion Overall Survival for HLA- Alloimmunized Platelet Refractorythrombocytopenic Leukemia Patients

BACKGROUND: Platelet alloimmunization and refractoriness is an established complication of platelet (PLT) transfusion, known to be treatment-limiting with potential life-threatening complications for hemato-oncologic patients undergoing chemotherapy (Hess et al.). Previous studies have explored the association of PLT refractoriness with lymphocytotoxic antibody positivity, more frequent platelet transfusion and platelet age (Slichter et al, Blood, 2005). They have also developed cross matching or HLA matching for donor selection as the basis of managing refractory patients. However, the impact of patient characteristics on the clinical outcomes of refractoriness is not fully understood.Objective: To analyze overall survival (OS) of PLT refractory leukemia patients transfused with HLA-matched platelets in association with the demographic and clinical characteristics of these patients.METHODS: We analyzed the demographics, clinical characteristics and platelet refractoriness (defined as two consecutive <24 hr post-transfusion corrected platelet count increments (CCI) of < 5 K/uL), ABO matching (fully compatible, minor mismatch or major mismatch), and HLA match grade (A, B, C). The threshold for transfusion was <7 K/uL and only patients with recorded platelet counts pre- and post-transfusion were included. The majority of post-transfusion counts were performed < 24 hrs. Transfusion efficacy was defined as having: i) difference in platelet counts > 5 pre- and post-transfusion; ii) ABO match or compatible; iii) HLA match grade A or B1.We included two measurements for overall survival (OS): from the date of the first transfusion and also from the last transfusion to the date of last follow-up or date of death. A PLT transfusion record for each measure was obtained using a majority rules algorithm. Group differences in OS were assessed using the log-rank test. For differences in PLT counts, the median value for each patient was used. The association between mean PLT count difference, age, and weight with OS was evaluated using univariate Cox proportional regression models.RESULTS: We identified 33 leukemia patients who received a total of 145 HLA-matched platelet transfusions from 2010-2017. A majority [60%] of the patients had a diagnosis of acute myeloid leukemia or myelodysplastic syndrome and received ≤2 HLA-matched platelet transfusions. Complex cytogenetics was identified in 7 of 23 (30%) patients, while the majority (97%) showed broad reactivity against HLA Class I and Class II antigens. Less than half (45%) of the platelets transfused were HLA match grade B and a third of the platelets (35%) were ABO compatible.The median OS was 16.7 months and the 1-year OS rate was 64%. A significant association between post-transfusion OS with age [p=0.016] and complex cytogenetics [p=0.013] was observed. However, no significant association between OS and gender, weight, ethnicity, and the number of pregnancies was noted. Although the median OS was longer for patients with ABO match/compatible transfusions (vs. incompatible), HLA match grades B2/B3/C platelets (vs. A/B1), and >2 platelets transfusions (vs. ≤ 2), none of these differences were statistically significant (Table 1).CONCLUSIONS: In summary, our findings reveal a significant association of OS was noted with age and complex cytogenetics in platelet refractory hemato-oncologic patients who received HLA-matched platelet transfusions. This association prompts further investigation into how patient profiles may be used in HLA-alloimmunized patients with platelet refractoriness. However, this may need to be studied in a larger cohort of patients in the future. [Display omitted] DisclosuresDiNardo:Celgene: Honoraria, Research Funding; Agios: Honoraria, Research Funding; AbbVie: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Daiichi-Sankyo: Honoraria, Research Funding. Cortes:ImmunoGen: Consultancy, Research Funding; ARIAD: Consultancy, Research Funding; Novartis Pharmaceuticals Corporation: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Teva: Research Funding; Sun Pharma: Research Funding; Pfizer: Consultancy, Research Funding. Kantarjian:Delta-Fly Pharma: Research Funding; Amgen: Research Funding; Novartis: Research Funding; Bristol-Meyers Squibb: Research Funding; Pfizer: Research Funding; ARIAD: Research Funding.

Near miss: determinants of maternal near miss and perinatal outcomes: a prospective case control study from a tertiary care center of India

Background/Purpose To study the causes of maternal near miss and compared maternal and perinatal outcome of maternal near miss cases with controls (women with potential life-threatening complication [PLTC]) and maternal death. Methods Mothers (n = 100) who fulfilled the WHO criteria for maternal near miss (MNM) were identified and enrolled in the study. Two controls for each near miss case were taken. This included the women who had same PLTC but did not reach near miss within one week of enrollment. The comparison of maternal and fetal outcome was done between the two groups and with the maternal death (MD) group, who presented initially as near miss. Results Obstetric hemorrhage was the most common potential life-threatening complication in MNM and MD group. On multiple logistic regression analysis, we found that the presence of organ dysfunction was the independent predictor of near miss and need of mechanical ventilation and coagulation dysfunction as an independent predictor of maternal death. A mother in the near miss group or death group had a higher chance of giving birth to a still-born child (p = < 0.001). Risk of neonatal death after NICU admission was numerically more among near miss and death group than controls, although statistically insignificant (p > .05) Conclusion Despite making tremendous progress in obstetric care facilities at a tertiary level, developing countries need to strengthen primary care infrastructure and referral system. To improve maternal care, there should be the provision of health education for all pregnant women and antenatal services should be improved.

The Role of Computer-Aided Design Implant Insertion in Revision Pectus Surgery

Pectus excavatum affects about 1 in 500 people. Several surgical procedures have been proposed, including correction of the chest wall through a Nuss or modified Ravitch procedure. Further corrective revision operations remain challenging, and certainly potential life-threatening complications are described with less predictable outcomes. Secondary surgical procedures with a deep customized 3-dimensional elastomer implant are an elegant, effective, and safe solution compared with further corrective revision surgery.

Predictive Factors for Severe Maternal Morbidity in Brazil: A Case-Control Study.

The maternal mortality or "maternal near miss" ratio in Brazil reflects the socioeconomic indicators as well as the healthcare quality in some areas of this country, pointing out fragile points in the health services. The aim of this study was to estimate the association of diverse variables related to pregnancy and the occurrence of Near Miss in a population of women who were cared in public maternity wards in Brazil. A case-control study was performed. The association between variables and outcomes was verified through a chi-square test. A multiple analysis was carried out, producing odds ratio (OR) estimates with values of p≤0.25 in the univariate model. The results point to the following risk factors for Severe Maternal Morbidity: non-white (<0.001, OR 2.973), family income of up to two minimum wage salaries (<0.001; OR 2.159), not having a partner (<0.001, OR 2.694), obesity (<0.001, OR 20.852), not having received pre-natal care (<0.001, OR 2.843), going to less than six prenatal appointments (<0.001, OR 3.498), undergoing an inter-hospital transfer (<0.001, OR 24.655), and the absence of labor during admission (<0.001, OR 25.205). Although the results vary, the incidence of women with potential life-threatening complications is high in Brazil, which reinforces the need to universalize more complex interventions as well as coverage of primary care. The presence of precarious socio-economic indicators and unqualified obstetric care were risk factors for Severe Maternal Morbidity.

Multiple organ dysfunction syndrome: an extended patient care report

This report describes and reflects on the intensive nursing care provided to a patient with multiple organ dysfunction syndrome (MODS) and systemic inflammatory response syndrome (SIRS). Veterinary nurses are at the forefront of supportive care for these critical patients and nursing interventions should focus on close and frequent monitoring for early detection of sepsis. An understanding of the physiological processes that occur with these diseases can increase awareness of the potential life-threatening complications associated with MODS, thus, allowing early recognition and intervention to maximise successful patient outcomes.

Effectiveness and safety of infliximab in cardiac Sarcoidosis

BackgroundImmunosuppressive therapy in active cardiac sarcoidosis (CS) might prevent potential life-threatening complications. Infliximab (IFX) is a tumor necrosis factor alpha monoclonal antibody proven to be effective in refractory extracardiac sarcoidosis. It is sparsely used in CS, because of its association with worsening heart failure in prior studies. The goal of this study is to assess the effectiveness and safety of IFX in CS. Methods and resultsA retrospective, single center cohort study was performed in sarcoidosis patients treated with IFX based on a cardiac indication between January 2016 and March 2019. Patients received IFX intravenously at a dose of 5 mg/kg at week 0, 2, and subsequently every 4 weeks. After every six months, treatment response was evaluated within the multidisciplinary team using FDG-PET/CT, transthoracic echocardiography, biomarkers and device interrogation reports. Responder analysis definitions were based on; dosage of immunosuppressive drugs, improvement in functional class, left ventricular ejection fraction (LVEF) and SUVmax. Twenty-two patients were included (mean age 51.0 SD10.0 years, male 68.2%) with a mean follow-up of 18.9 months (6 to 44 months) of whom 18 (82%) were classified as responders. Median SUVmax on FDG-PET/CT decreased from SUVmax 5.2 [3.7–8.4] to 2.3 [1.4–2.3], p = 0.015. The target-to-background ratio decreased from 3.2 [2.1–5.1] to 1.0 [0.7–2.4], p = 0.002. The median left ventricular (LV) ejection fraction increased from 45.0% [34.0–60.0] to 55.0% [41.0–60.0], p = 0.02. The majority of patients (73%) experienced no side effects and no patients had worsening of heart failure. ConclusionIn this pilot study, patients with refractory CS treated with infliximab, on top of standard of care, had a reduction in inflammation on FDG-PET/CT and an improvement in LV function, without serious adverse events.

Acute compartment syndrome (ACS) - a case of delayed diagnosis

Acute Compartment Syndrome (ACS) is a potential limb and life-threatening complication following trauma. ACS is characterised by increased pressure within a defined fascial compartment which diminishes perfusion pressure, leading to local tissue ischaemia. Timely diagnosis of ACS is crucial to prevent serious complications or irreversible damage which may lead to amputation or death. Even though the most common aetiology for ACS is major trauma, routine examination for ACS is rarely ennforced in patients with minor trauma or soft-tissue injuries which puts patients at risk of a detrimental delay in treatment. Trauma nurses and other clinicians should therefore avoid relying solely on specific clinical presentations to detect or suspect the development of ACS. This paper will present a case of ACS with an unusual presentation, and critically evaluate the diagnostic challenges of ACS in atypical presentations.

Consensus evidence-based recommendations for treat-to-target management of immunoglobulin A vasculitis

IgA vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is the most common cause of systemic vasculitis in childhood. Given its potential life-threatening systemic complications, early and accurate diagnosis as well as management of IgAV represent a major challenge for health care professionals. This study was carried out to attain an evidence-based expert consensus on a treat-to-target management approach for IgAV using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the patient, intervention, comparison, and outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the IgAV management. The core leadership team identified researchers and clinicians with expertise in IgAV management in Egypt upon which experts were gathered from different governorates and health centers across Egypt. Delphi process was implemented (two rounds) to reach a consensus. An online questionnaire was sent to expert panel (n = 26) who participated in the two rounds. After completing round 2, a total of 20 recommendation items, categorized into two sections were obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%. Consensus was reached (i.e. ⩾75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the diagnosis and management have been suggested. This was an expert, consensus recommendations for the diagnosis and treatment of IgAV and IgA vasculitic nephritis, based on best available evidence and expert opinion. The guideline presented a strategy of care with a pathway to achieve a state of remission as early as possible.Plain Language SummaryGiven its potential life-threatening systemic complications, early and accurate diagnosis of immunoglobulin A vasculitis represents a major challenge for health care professionals. This work provided cornerstone principles for the management of the condition. Adopting PICO approach and implementing Delphi process a consensus was reached on evidence-based treat-to-target treatment recommendations. This will endorse enhancement and consistency of care of this cohort of patients in standard practice.

Delirium in critically ill patients with COVID-19 pneumonia

The ICU delirium is a predictor of mortality, length of stay in hospital, time on ventilation, and long-term cognitive impairment. There is a well-established association between acute respiratory distress syndrome (ARDS) and ICU delirium. However, the profile and disease progression trajectory of COVID-19 patients with ICU delirium has not been studied. This case series reviews our institution’s experience in COVID-19 patients with ICU delirium. Of all four patients, two of them died in hospital, and the other two survived to the hospital discharge. The disease progressions were tracked, as well as the ICU delirium. Potential life-threatening complications and organ failure symptoms were also presented. To improve the patients’ overall health outcome, Haloperidol was prescribed with careful consideration.

TREATMENT AND RESOLVING SEVERE, POTENTIAL LIFE-THREATENING COMPLICATIONS (PNEUMOMEDIASTNUM, PNEUAMTOCELES, PULMONARY FIBROSIS ) IN COVID-19 PATIENT-CASE REPORT

SARS-CoV-2 sometime is associated with potential life-threatening rare complication, more specifically, pneumomediastinum, pneumatocelеs, cyst formations, and very often pulmonary fibrosis.&nbsp; Our patient was 35 years old with main complaints: dry cough. chest pain, fatigue. She experienced a severe form of COVID 19, which resulted in complications of pneumomediastinum, pneumatocell, and pulmonary fibrosis. During the treatment of six months there is an almost complete withdrawal of the complications. She now feels well, able to work, and is still under our control. Physicians should be aware and careful in COVID 19 patients with severe clinical form given ventilator support, that such complications are possible and before a discharge from the hospital to do an X-ray or CT scan of the lungs. Especially when advising procedures such as postural drainage. Key words: COVID19, pneumomediastinum, pneumatocella, pulmonary fibrosis https://doi.org/10.55302/JMS2143138s

Pituitary apoplexy: An emergent and potential life-threatening complication of pituitary adenomas.

Pituitary apoplexy is an emergent and potential life-threatening complication of pituitary adenomas if not managed properly. The aim of our study is to present our series of pituitary adenomas and to focus on the clinical, radiological, and surgical characteristics of this rare complication. In this study, a total of 143 patients with pituitary adenoma underwent surgical treatment between 2016 and 2018. All patients were operated using endoscopic endonasal transsphenoidal (EET) technique. The data of pituitary apoplexy cases were recorded. Resection rates, hormonal results, and visual outcomes of patients with pituitary apoplexy were evaluated. Of the 143 patients, 8 (5.59%) were presented with the symptoms and radiological findings of pituitary apoplexy. The mean age was 26.75 years, and 4 (50%) of them were male and 4 were female. Pre-operative mean Knosp grading score was 2.1 All of eight patients underwent emergent surgical intervention and total resection was achieved in 75% of patients with apoplexy. Hormone levels were significantly decreased after surgery (p<0.05), except prolactin (p>0.05). Cerebrospinal fluid leakage occurred in one pa-tient. None of the patient with pituitary apoplexy died in our series. Pituitary apoplexy is an important complication of pituitary adenomas. Early diagnosis and surgical intervention provide excellent ophthalmological and hormonal outcomes. Emergent EET approach is crucial for patients with ophthalmological findings and macroadenomas.

Impact of the Coronavirus Pandemic on Emergency Department (ED) Visits for Ob/Gyn Care

The COVID-19 pandemic has disrupted currently held norms and best practices for women who require evaluations and interventions for Obstetrics and gynecology (Ob/Gyn) emergency care. The resulting paradigm shifts have demonstrated a reassessment of how Ob/Gyn emergency care is provided in an acute setting while avoiding potential short and long-term harm. The objective of this study is to retrospectively evaluate if patients self-selected to avoid Emergency Department (ED) visits for perceived minor complaints and if postponing such care increased morbidity. Patients accessing Ob/Gyn ED care during the Covid-19 "lockdown period" (group A) in New York State were compared with those during a similar time frame in 2019 (group B). Primary outcomes were the number of ED visits and admission diagnoses. Secondary outcomes were the number of surgeries and clinical acuity on presentation. There was a 72% reduction in the total number of ED visits in group A compared to group B. Although the majority of the visits were for abdominal pain and vaginal bleeding in both groups, among patients who presented with vaginal bleeding in group A, a significantly higher number was due to early pregnancy loss rather than non-pregnancy-related uterine bleeding. The number of visits for non-emergency visits such as vulvovaginitis and contraceptive management was significantly lower and absent respectively. There were 61.5% fewer cases requiring emergency surgery in group A, however, the case acuity remained high with many patients being clinically unstable at presentation. There was a nonsignificant trend of an increased number of surgeries for ectopic pregnancy and pregnancy loss in group A compared to group B. Non-emergency surgeries, and visits for pain control, wound infections or ileus were absent in group A. We conclude that the decline in the ED visits and total number of emergency surgeries during the “lockdown period “were secondary to patients’ choices. This decrease was more pronounced for minor indications; however, many patients with serious conditions had delayed ED visits until they were clinically unstable. Therefore a reassessment of how patients access Ob/Gyn care via ED is indicated, with the goal being to avoid visits for minor indications while preventing potential life-threatening complications.

Subcapsular Hepatic Hematoma after Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is an important life-saving procedure in emergency care. However, CPR is associated with various complications. A 41-year-old man was admitted to the intensive care unit after CPR. A sudden decrease in the blood pressure and hematocrit level was recorded. An abdominal computed tomography (CT) showed a large subcapsular hematoma in the left lobe of the liver. With conservative treatment, the hematoma reduced in size, but it was later managed with percutaneous drainage. The patient recovered and was discharged. We obtained a favorable outcome with conservative, nonsurgical treatment. Subcapsular hepatic hematoma is a potential life-threatening complication that should be considered in CPR survivors.

Maternal and Perinatal outcome in eclampsia at a teaching hospital of Eastern Nepal

Introduction: Eclampsia is a multisystem disorder with potential life-threatening complications that can result in significant maternal and fetal morbidity and mortality. The case fatality rate of eclampsia is 1.8% in developed countries, 17.7% in India and 13% in Nepal. The incidence of pre-eclampsia and eclampsia is high in developing countries due to hypoproteinemia, malnutrition and poor obstetric facilities.&#x0D; Objective: To assess the maternal and perinatal outcome in patients of eclampsia&#x0D; Methodology: This was a hospital based cross-sectional study where all the patients presenting with eclampsia from June 2019 to November 2020 in the department of Obstetrics &amp; Gynecology, Birat Medical College and Teaching Hospital were enrolled for the study. Data analyzed included various maternal parameters and fetal parameters along with the mode of delivery, outcome of baby, postpartum maternal condition and maternal mortality were noted.&#x0D; Results: Among 6631 deliveries, 50 patients had eclampsia with the incidence of 7.54/1000 deliveries. Thirty four (68%) patients were of 20-30 years of age, 37 (74%) were primigravidas, 36 (72%) from rural areas, 34 (68%) were illiterate, 49 (98%) were low to middle socioeconomic status, 41 (82%) were unbooked and 33 (66%) patients had antepartum eclampsia. Eleven (22%) women developed eclampsia related complications. There were 02 (4%) maternal deaths and the common causes were HELLP Syndrome and pulmonary oedema. Neonatal outcome consisted of live births in 39 (78%) newborns, 03 (6%) were still births, 08 (16%) were birth asphyxia and 15 (30%) were low birth weight.&#x0D; Conclusion: Majority of the patients were young, illiterate, unbooked primi gravidas with poor to average socioeconomic status from rural areas. Majority of the eclamptic women nearly 39 (78%) cases delivered via caesarean section for better neonatal outcome. Two (4%) eclamptic women died as a result of eclamptic complications and three (6%) newborns had neonatal deaths because of low birth weight and prematurity. Adequate antenatal screening, early detection of hypertension, timely referral, and early initiation of treatment and termination of eclamptic patients can help to improve the maternal and perinatal outcomes.

S2058 The Angry Gut: Immune-Mediated Widespread Gastrointestinal Inflammation Secondary to Pembrolizumab

INTRODUCTION: Pembrolizumab is an inhibitor of programmed death 1 (PD-1) receptor which has gained popularity in the treatment of squamous cell carcinoma of the head and neck, non-small cell lung carcinoma, and renal cell carcinoma and melanoma. Immune-mediated gastrointestinal symptoms after initiation of Pembrolizumab have been reported, however, remain uncommon. The current literature points to sporadic cases of isolated esophagitis, gastritis, and colitis however, we present a case of pembrolizumab induced Grade III mucositis with esophagitis, gastritis, and colitis in the same patient. To our knowledge, this is one of the first cases of widespread immune-mediated gastrointestinal inflammation from Pembrolizumab treatment. CASE DESCRIPTION/METHODS: A 65-year-old female with a medical history of Stage IV lung cancer with femur metastasis presented to the hospital with oral cavity ulcerations and bloody diarrhea that started one week after initiation of Pembrolizumab. She also had crampy lower abdominal pain with each bowel movement. She had difficulty tolerating solid food due to severe pain during swallowing, however, she was able to tolerate liquids. Physical examination showed pallor, lower abdominal tenderness, and hyperactive bowel sounds. Significant labs included hemoglobin 6.2 gm/dl, leukocyte count 1.0 × 103/uL, neutrophils 7300/uL, platelet count 8 × 103/uL, creatinine 3.36mg/dL and lactic acid 2.8 mmol/L. Infectious causes of diarrhea were ruled out with stool studies and blood cultures. In the hospital, her stool output was 3L per day. CT abdomen pelvis revealed wall thickening of left and sigmoid colon with increased air-fluid levels indicative of colitis and hyper-secretory state. EGD and colonoscopy revealed ulcerations of the oropharynx, severe esophagitis, non-bleeding gastric erosions, and inflamed recto-sigmoid and sigmoid colon mucosa. Biopsies revealed inflammatory changes. She was treated with diphenoxylate-atropine, octreotide, solumedrol, prednisone, and infliximab which partially controlled her symptoms. She opted for comfort measures and was discharged home on hospice care. DISCUSSION: With the growing utilization of immunotherapies in malignancies, it is imperative to report potential life-threatening complications such as widespread gastrointestinal inflammation mediated by pembrolizumab in our case. Physicians should be trained to promptly recognize and treat based on the severity of the gastrointestinal side effects.Figure 1.: CT Abdomen and Pelvis without contrast revealing left colon and sigmoid thickening with increased air-fluid levels.Figure 2.: EGD and Colonoscopy revealing severe esophagitis and sigmoid colon inflammation.Figure 3.: Biopsy revealing prominent crypt epithelial apoptosis and lymphocytic infiltration.

O05 Active Bechet's with life threatening arterial disease, complicated by concurrent COVID-19 infection at the peak of the COVID-19 pandemic: did immunosuppression help or hinder?

O05 Active Bechet's with life threatening arterial disease, complicated by concurrent COVID-19 infection at the peak of the COVID-19 pandemic: did immunosuppression help or hinder?

Bridging Stent Placement in Vena Cava Syndrome With Tumor Thrombotic Extension in the Right Atrium.

Venous stent placement of symptomatic occlusion of the superior and inferior vena cava is considered the treatment of choice in malignant disease because this technique can restore patency and achieve a relief of symptoms. However, tumor thrombus extension into the right atrium harbors the potential risk of stent migration and perforation. One strategy to avoid this potential life-threatening complication could be the placement of a bridging stent from the superior vena cava-to-inferior vena cava. This case reports describes the superior vena cava-to-inferior vena cava bridging stent technique in 2 patients with malignant occlusion of the superior and inferior vena cava. Special considerations such as technical details of the devices and potential complications are discussed.