Acute myocardial infarction following allogeneic hematopoietic stem cell transplantation: A national cohort study.

Perioperative visual loss (POVL) is a rare but catastrophic complication of non-ocular surgery, most commonly attributable to ischemic optic neuropathy (ION). Spine and cardiac surgeries account for the majority of cases, with posterior ION (PION) predominating after prone spine procedures and anterior ION (AION) more frequently observed following cardiac surgery. Despite its low incidence, the permanent nature of vision loss necessitates a clear understanding of underlying mechanisms and modifiable perioperative risk factors. This narrative review synthesizes evidence from epidemiologic studies, the American Society of Anesthesiologists (ASA) POVL Registry, large administrative databases, and physiologic investigations. Particular emphasis is placed on optic nerve anatomy and vascular supply, ocular perfusion pressure dynamics, intraocular pressure changes during prone positioning, and multivariate risk factors identified in registry-based analyses. The optic nerve's limited collateral circulation and confinement within rigid anatomic boundaries render it uniquely vulnerable to ischemia. Registry and physiologic data support a perfusion-failure model in which reductions in mean arterial pressure, anemia, and sustained elevations in intraocular and venous pressures converge to critically reduce ocular perfusion pressure. In spine surgery, PION is strongly associated with prolonged operative duration, prone positioning, venous congestion, obesity, blood loss, and fluid strategies that promote interstitial edema. In contrast, cardiac surgery-associated AION more often reflects preexisting vascular disease and perioperative hypotension. Embolic mechanisms account for a minority of cases. Perioperative ION most commonly results from global failure of optic nerve perfusion rather than focal vascular occlusion. Recognition of distinct pathophysiologic mechanisms across surgical contexts underscores the importance of prevention. Strategies that preserve ocular perfusion pressure, minimize venous congestion, limit interstitial edema, and avoid prolonged hypotension during high-risk procedures may reduce the incidence of this devastating complication.

Intracranial migration of cranial fixation hardware is a rare complication of neurosurgical procedures, and migration into the ventricular system is exceedingly uncommon. When such migration leads to obstruction of cerebrospinal fluid (CSF) pathways, it can result in acute hydrocephalus requiring urgent intervention. A 10-year-old girl with a history of left frontotemporal ganglioglioma underwent synthetic Medpor cranioplasty for radiation necrosis-associated calvarial erosion. Intraoperatively, a fixation screw inadvertently plunged through a bone defect into an area of encephalomalacia. Postoperative imaging revealed the screw within the antrum of the left lateral ventricle. The patient remained asymptomatic and was discharged with close monitoring. At 3-week follow-up, she developed progressive headaches and fatigue. Neuroimaging demonstrated migration of the screw into the cerebral aqueduct, with resulting obstructive hydrocephalus. She underwent endoscopic third ventriculostomy and successful endoscopic removal of the screw, with full clinical recovery. This case illustrates a rare but serious complication of cranioplasty: delayed migration of a cranial screw into the ventricular system causing aqueduct obstruction. Endoscopic management allowed for both CSF diversion and removal of the foreign body and was associated with an excellent clinical outcome.

Non-occlusive mesenteric ischemia (NOMI) is a rare but lethal complication after gastric cancer (GC) surgery, marked by intestinal hypoperfusion without arterial occlusion. Nonspecific symptoms and rapid deterioration hinder timely diagnosis. This study evaluated outcomes, diagnostic pathways, and management. We retrospectively reviewed eight GC patients who developed NOMI (February 2022-January 2024). Collected variables included demographics, surgical details, feeding practices, presentation, imaging, treatment, and outcomes. The primary endpoint was 30-day mortality. NOMI presented a median of 3 days postoperatively (range 2-5). Median age was 63.5 years; 75% were male; all had advanced GC and 62.5% had gastric outlet obstruction. Common signs were abdominal distension (75%), hypotension (50%), and peritonitis (25%). CT consistently showed small-bowel dilatation, pneumatosis intestinalis, and portal venous gas, mainly in distal jejunum/ileum. Seven patients underwent re-exploration: five required resection. After implementing a modified feeding protocol, cases reduced from seven to one. Thirty-day mortality was 50%, largely from sepsis and multiorgan dysfunction syndrome (MODS). In GC patients with feeding jejunostomy, NOMI remains a serious complication. A cautious feeding strategy-deferring feeds during vasopressor support, initiating low-strength kitchen feeds, slow escalation, and early oral intake-was associated with fewer cases. High clinical suspicion, rapid CT, and timely surgery are critical to improve outcomes.

Jejunal diverticulosis (JD) is an uncommon and often underdiagnosed condition, usually discovered incidentally and rarely associated with acute complications such as diverticulitis, obstruction, abscess, perforation, or fistula formation. However, when complications do occur, they can be severe and diagnostically challenging. We present the case of a 75-year-old Female who arrived with an acute-onset abdominal pain with progressive distension and persistent vomiting. Computed tomography (CT) revealed a small bowel obstruction due to an enterolith. Emergency laparotomy revealed a small bowel obstruction at mid ileum due to an enterolith as well as an omental band adhered to the inflamed jejunal diverticulum proximally resulting in a closed loop in the affected segment of small bowel. The omental band was divided and the enterolith was removed via an enterotomy without requiring a small bowel resection. The patient was managed with antibiotics postoperatively and she made an unremarkable recovery. Closed loop small bowel obstruction as a result of complicated jejunal diverticular disease is rare in the literature and it highlights the critical importance of maintaining a high index of suspicion, particularly in older patients presenting with acute abdomen.

Acute otomastoiditis is a common pediatric infection that may rarely lead to severe intracranial complications. The frequency of otomastoiditis, and even more so the frequency of intracranial complications, significantly increased after the end of the coronavirusdisease 19 pandemic. We report a 14-month-old boy with bilateral otomastoiditis complicated by extensive venous sinus thrombosis, petrous apicitis, and progressive infectious arteritis of the cavernous internal carotid artery. Serial magnetic resonance imaging and magnetic resonance angiography demonstrated interval internal carotid artery narrowing with vessel wall enhancement, subsequent arterial occlusion, and focal ischemic injury. Despite these findings, the patient remained neurologically intact and showed radiologic improvement at follow-up. This case highlights a rare arterial complication of pediatric otomastoiditis and underscores the importance of comprehensive and serial vascular imaging for early detection, differentiation from extrinsic compression, and guidance of multidisciplinary management.

BackgroundMumps is a highly neurotropic virus causing a wide variety of neurologic complications. Post-/para-infectious basal ganglia encephalitis is one of its rare complications, with higher morbidity compared with other complications.CasesWe present 5 cases with basal ganglia encephalitis secondary to mumps infection. A recent history of parotitis or febrile illness with serologic evidence of mumps, combined with acute onset of movement disorders, behavioral changes with or without seizures, and basal ganglia abnormalities on neuroimaging, suggests the diagnosis. The occurrence of extrapyramidal symptoms during recovery from a febrile illness, along with clinical improvement following immunomodulatory therapy, further supports the diagnosis.ConclusionPost-mumps basal ganglia encephalitis has higher morbidity than other mumps complications. Slower recovery and increased duration of hospitalization are noted. Including the mumps vaccine in routine immunization schedules is an effective way to prevent mumps and its associated basal ganglia encephalitis.

Ischaemic optic neuropathy (ION) is a rare but vision-threatening complication recently linked to GLP-1 receptor agonists, particularly semaglutide. Using over 30 million reports from the FDA Adverse Event Reporting System (2017-2024), we evaluated formulation- and sex-specific associations. Among 31 774 semaglutide cases, Wegovy demonstrated the strongest signal for ION (reporting odds ratio (ROR)=74.89) compared with Ozempic (ROR=18.81). Sex-stratified analyses showed higher odds in men (ROR=116.37), and multivariable regression confirmed greater risk with Wegovy versus Ozempic (adjusted OR (AOR)=4.74) and in men versus women (AOR=3.33). These findings highlight a potential dose-dependent safety concern that warrants urgent prospective evaluation to guide prescribing and regulatory policy.

Continuous lumbar drainage (LD) is often performed along with endoscopic cerebrospinal fluid (CSF) rhinorrhoea repair. They serve various functions, such as offsetting the pressure over the repair site, decreasing the CSF pressure gradient across the repair site, and facilitating graft adhesion. However, their insertion may cause neurological sequelae due to displacement, breakage, or dural trauma at the site. The authors present a case of a rare complication of LD insertion where the patient developed lumbar plexus neuropathy due to an epidural CSF collection. Imaging and neurological assessment helped with the diagnosis, while device removal with bed rest resolved the symptoms. There is a paucity of literature on this complication in adults, and this report describes the presentation, management, and treatment of this problem along with a suggested checklist.

BACKGROUND Upper-gastrointestinal (GI) bleeds refractory to endoscopic hemostasis can be treated with endovascular coil embolization. Transcatheter arterial embolization with endovascular coils is an effective and minimally invasive option with high success rates, and coil migration is a rare complication. This report describes the case of a 90-year-old woman with an upper-GI bleed managed with emergency transcatheter arterial embolization, presenting with an endovascular coil migration. CASE REPORT A 90-year-old woman presented to the emergency department (ED) with abdominal pain, dizziness, and diarrhea (day 0). Imaging revealed a duodenal bulb ulcer with a contained perforation, for which she underwent endovascular coil embolization on day 2. Thirteen days later, during an outpatient esophagogastroduodenoscopy (EGD), the endovascular coil was identified at the junction of the duodenal bulb and second portion of the duodenum. The endovascular coil was not removed due to risk of bleeding. At 6 weeks, she re-presented with mild symptoms and was managed conservatively. At 4 months, she remained asymptomatic and the endovascular coil had not passed. At 21-month follow-up, the endovascular coil remained unpassed, with intermittent symptoms, a finding that highlights the long-term management and challenges of this complication. CONCLUSIONS Due to the rarity of endovascular coil migration, there is no standard method for managing this complication. It is important to assess each patient individually, manage patient symptoms, and consult with interventional radiology and surgery as needed. This case shows that reporting such cases is essential to expand the limited literature, inform best practices, and guide clinicians faced with this rare complication.

ABSTRACTMitral valve papillary muscle rupture represents a rare yet critical complication of acute myocardial infarction, often leading to severe mitral regurgitation and subsequent pulmonary edema with high mortality. Despite optimal ventilatory support and pharmacological management, patients often exhibit refractory hypoxemia, rendering surgical intervention both technically demanding and high‐risk. A 40‐year‐old Asian male presented to the emergency department of Liaocheng People's Hospital following percutaneous coronary intervention (PCI) for acute myocardial infarction at an outside facility. Shortly post‐procedure, the patient developed dyspnea and oliguria. Despite endotracheal intubation, mechanical ventilation, and medical therapy, his condition deteriorated, necessitating transfer. Echocardiography and transesophageal echocardiography confirmed mitral valve papillary muscle rupture with severe regurgitation, complicated by profound pulmonary edema and refractory hypoxemia. Venovenous extracorporeal membrane oxygenation (VV‐ECMO) was promptly initiated, resulting in gradual improvement in oxygenation. Following a multidisciplinary evaluation, edge‐to‐edge mitral valve repair was successfully performed under VV‐ECMO support. ECMO was discontinued on postoperative day 4, and the patient was discharged after 14 days with marked clinical improvement. In cases of severe pulmonary edema secondary to mitral valve papillary muscle rupture post‐PCI for acute myocardial infarction, early VV‐ECMO implementation combined with edge‐to‐edge mitral valve repair under ECMO support may mitigate surgical risk and enhance outcomes. This integrated approach presents a viable therapeutic alternative for such high‐risk patients.

Is there any difference between surgical and endoscopic interventions related to the outcome of recurrent tracheoesophageal fistulas? A systematic review.

Bisphosphonates (BPs) are widely used for managing tumor metastasis and bone diseases, associated with a rare complication of medication-related osteonecrosis of the jaws (MRONJ). Though reasons are still debated, the MRONJ occurrence in paediatric population suffering osteogenesis imperfecta (OI) and treated with BPs is absent. Here, we reported a 33-year-old patient with OI (Type III) who developed MRONJ after receiving intravenous pamidronate from 16 years old. She complained of intermittent nasal bleeding for six years, and presented an exposed necrotic bone in the left maxilla. She underwent surgical debridement, and pathological examination confirmed MRONJ. To our knowledge, this was a very rare case of MRONJ in an adult with OI type III following pediatric BP exposure. This case underscored the need for long-term vigilance, as delayed onset into adulthood is possible. Clinicians should pay attention to sinonasal symptoms as potential manifestations of MRONJ, and strengthen dental preventive care to reduce local risk factors. Long-term follow-up longitudinal studies with a larger sample size in this population are needed.

Chronic total occlusions (CTOs) represent one of the most technically challenging subsets in coronary artery disease interventions, frequently complicated by severe calcification and difficult vessel anatomy. Microcatheters play a crucial role in CTO percutaneous coronary intervention (PCI), but their use can lead to rare complications such as tip entrapment and fracture, especially in calcified lesions. We present a case of microcatheter tip fracture during complex right coronary artery CTO PCI, managed successfully by employing a parallel-wire technique to bypass the fractured segment followed by stent deployment to crush and trap the fragment against the vessel wall. This approach resulted in complete revascularization without adverse events. The case highlights the importance of understanding device limitations, preparing for procedural complications, and utilizing alternative strategies such as the balloon-assisted sliding technique. As coronary calcification prevalence rises, awareness and effective management of such complications are increasingly critical for optimal patient outcomes.

Lateral Skull Base Pseudomeningoceles: Diagnosis, Prevention, and Treatment.

Post-sternotomy mediastinitis (PSM) is a rare but life-threatening complication of cardiac surgical procedures. This study evaluated the impact of a structured multi-disciplinary post-discharge care bundle on PSM incidence. A single-center, retrospective cohort study compared the incidence of PSM two years before and after implementation of a care bundle led by a multi-disciplinary team. The intervention included telephonic monitoring, a specialized wound-care clinic, and a standardized two-phase wound management protocol incorporating single-use negative pressure wound therapy. Outcomes were assessed using chi-square tests and logistic regression adjusted with propensity scores and inverse probability weighting. To rule out a temporal trend in newly identified wound infections, we performed a linear regression using bimonthly incident counts as the outcome. A total of 1,197 patients underwent median sternotomy between May 1, 2018, and April 30, 2022. The crude incidence of PSM was 3.32% in the pre-implementation group and 1.56% in the post-implementation group (p = 0.058). After adjustment with inverse probability of treatment weighting, the care bundle was associated with a significant reduction in PSM rate (absolute risk difference 1.96%, 95% confidence interval [CI]: 0.54-3.87; p = 0.044; relative reduction 59%, 95% CI: 16.3%-116%), despite a higher baseline surgical risk in the post-implementation cohort (higher EuroSCORE II, more urgent procedures, greater need for vasoactive support). The rate of newly identified wound infections did not exhibit a significant time trend (β = -0.43; p = 0.299). Implementation of a multi-disciplinary care bundle is significantly associated with a reduction in PSM incidence in cardiac sternotomy patients, underscoring the importance of structured outpatient wound surveillance.

Abstract Pyoderma gangrenosum (PG), as a complication of aesthetic surgery, is an unpleasant experience for both the surgeon and the patient. It can have serious health consequences and cause both mental and physical suffering. In some cases, it may be accompanied by the development of a systemic inflammatory response, which can be life-threatening, and may even represent the first manifestation of an autoimmune, systemic, or oncological disease. We present the case of a patient in her mid-40 s with autoimmune hypothyroidism on substitution therapy. Following bilateral periareolar mastopexy with augmentation, the patient developed fever and bilateral wound complications on postoperative day 5, including redness, swelling, wound exudate, ulceration, and dehiscence at the surgical incision sites, with subsequent progression to sepsis-like systemic inflammatory reaction/ severe systemic inflammatory response. Rapid consideration of pyoderma gangrenosum as a potential diagnosis led to implant removal and initiation of corticosteroid therapy on day 8. The patient reported subjective improvement within 24 h following corticosteroid administration, with an early reduction in body temperature and overall clinical improvement. Thanks to early recognition (from symptom onset to initiation of corticosteroid therapy and implant removal), we were able to prevent further deterioration of the local findings and avoid progression to severe sepsis within 10 days. Corticosteroid therapy was continued for nine months, together with supportive wound care, until full recovery. Subsequent evaluations did not reveal any new autoimmune or oncological diseases in this patient. We present new protocols and an algorithm at our department for managing similar situations, as well as for preoperative risk stratification and postoperative monitoring in aesthetic breast surgery, incorporating multidisciplinary consultations and tailored immunosuppressive strategies to reduce the incidence of PG and improve patient outcomes.

BACKGROUND Internal jugular vein catheterization is a primary vascular access method for hemodialysis; however, it carries a risk of complications. Common adverse events include arterial puncture, hematoma, and pneumothorax; rarer but more serious events involve catheter malposition into major arteries. Despite real-time ultrasound guidance, anatomic factors, technical considerations, and patient-specific characteristics may contribute to these adverse outcomes. CASE REPORT A 64-year-old man with end-stage renal disease and decompensated heart failure required urgent dialysis. During ultrasound-guided placement of a 12.5-Fr dual-lumen catheter, the sheath inadvertently traversed the jugular vein, entered the right subclavian artery, and advanced to the aortic arch. Computed tomography angiography confirmed the catheter course. In a hybrid operating room, the arterial injury was successfully managed using an endovascular suture device. This approach achieved hemostasis without additional venous injury and avoided the need for open surgical repair. No evidence of impaired intracranial blood flow was observed during follow-up. Dialysis was resumed via femoral access the following day; the patient was discharged without complications. This case highlights a rare but life-threatening complication of a routine procedure. CONCLUSIONS Real-time ultrasound guidance does not eliminate the risk of serious catheter misplacement during internal jugular vein cannulation. When inadvertent subclavian artery cannulation occurs, an endovascular suture device may provide a rapid and minimally invasive solution avoiding further venous compromise and posing no risk to cerebral perfusion. These findings support consideration of endovascular closure as an option for the management of iatrogenic arterial injuries, particularly in high-risk patients who are unsuitable for major surgery.

Background: Laparoscopic adjustable gastric banding (LAGB) has been widely used for the treatment of morbid obesity. Despite early success, long-term complications have become increasingly recognized. Among these, esophageal perforation is exceptionally rare. Case Presentation: We report the case of a 60-year-old male with LAGB placement ten years prior, who presented with acute respiratory distress, sepsis, and chest pain after vomiting. Imaging revealed a mid-to-distal esophageal perforation with an esophago-pulmonary fistula and right lower lobe abscess. Management and Outcome: The patient underwent direct full-thickness esophageal repair with an intercostal muscle flap. The gastric band was intentionally preserved due to the absence of stenosis or mucosal damage. Postoperative recovery was uneventful, and follow-up was favorable. Conclusion: To our knowledge, this is the first reported case of delayed esophageal perforation years after LAGB. It highlights the importance of long-term follow-up in bariatric patients and awareness of rare but serious complications. Multidisciplinary management is essential for optimal outcomes.

Fractured peripheral IV cannula: A rare complication of a routine practice