Rare Postoperative Complication Research Articles

A clinical study regarding the outcomes of symptomatic spinal epidural haematoma after adult spinal deformity surgery.

Symptomatic spinal epidural haematoma (SSEH) is a rare but serious postoperative complication. This study aimed to assess the prevalence, causes and treatment of SSEH after adult spinal deformity (ASD) surgery. The patients admitted from August 2012 till August 2016 were retrospectively reviewed using case notes. During these four years, 102 patients were admitted with adult spinal deformity, out of which 3 (2.9%) developed post-operative SSEH. The duration between surgery to onset of SSEH was 10-13 hours (average 11.7 hours) post-operatively. Three patients were treated by haematoma evacuation at 8.5-14 hour (average 11.4 hours) after the symptoms appeared. One patient had improved by 2 Frankel grades, and two patients had improved by1 Frankel grade at the last followup. The results concluded that post-operative SSEH occurred in 2.9% of ASD patients who underwent corrective spinal procedures. Improvement in neurological deficits can be achieved by early haematoma evacuation.

A New Type of Chronic Wound Infection after Wisdom Tooth Extraction: A Diagnostic Approach with 16S-rRNA Gene Analysis, Next-Generation Sequencing, and Bioinformatics.

Delayed-onset infections are rare postoperative complications of lower third molar extractions. This article presents a case of a chronic combined hard and soft tissue infection after the extraction of a third molar, where the causative organisms could only be elucidated by molecular methods. Experimental 16S-rRNA gene analysis with next-generation sequencing and bioinformatics was used to identify the bacterial spectrum of the infection. 16S-rRNA gene analysis delivered the microbiome of the abscessing inflammation while standard culture and laboratory examinations were all sterile. The microbiome showed a mixed bacterial infection with a dominance of Delftia and Alcanivorax (spp.) besides other bacteria of the normal oral flora. Using 16S-rRNA-gene analysis, next-generation sequencing, and bioinformatics, a new type of chronic wound infection after wisdom tooth extraction was found. The property of Delftia and Alcanivorax (spp.) as water-affine environmental bacteria raises suspicion of infection from contaminated water from a dental unit. Thus, osteotomies of teeth should only be done with sterile cooling water. The 16S-rRNA gene analysis should become a part of the routine diagnostics in medical microbiology.

Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

BackgroundPouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later.Case presentationA 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged.ConclusionProper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

Microbiological analysis of infectious lymphocele: Case series and literature review

BackgroundInfectious lymphocele is a rare post-operative complication of abdominal surgery, and few studies have focused on its causative organisms. The aim in this research is to clarify microbiology and appropriate empiric treatment of infective lymphocele. MethodsWe performed a single center, retrospective observational study between April 2000 and March 2018 with a case review and literature search. Data were collected in a chart review. ResultsTwenty-four cases were founded in our institution. 153 cases, including 16 cases from our institution, that detected causative organisms was also analyzed. Infectious lymphocele was found to occur post gynecological/urological surgery in cancer patients. We also reported that bacteremia incidence and the mortality rate of infectious lymphocele cases were very low. The major sites of infectious lymphocele were pelvis or inguinal area.Our case series and literature review showed Gram positive cocci were the major causative organisms, with Staphylococcus aureus constituting one third of them (53/153 cases). Streptococcus species (26/153cases) and coagulase negative Staphylococci (17/153 cases) were the second and third most detected organisms. ConclusionIn gynecologic and urologic cancer patients, Gram positive cocci were the most common organisms causing lymphocele infection. Gram-positive coverage might be reasonable for empiric therapy in infectious lymphocele.

VASCULAR COMPLICATION ASSOCIATED WITH TEMPOROMANDIBULAR JOINT SURGERY

There are several treatments for patients with temporomandibular disorders. Open temporomandibular joint (TMJ) surgery is indicated for cases in which conservative or minimally invasive treatment did not achieve satisfactory results. Discopexy by open surgery of the TMJ is 1 of the modalities of treatment for patients with displacement of articular disk in which they are viable to be repositioned and fixed with the aid of bone anchorage. There are several reports in the literature regarding postoperative complications involving open surgeries of TMJ that may be potentially associated with anatomy, infections, autoimmune diseases, stomatognathic biomechanics, and the neurovascular system. The objective of the present study is to report a rare postoperative complication in a female patient, 34 years of age, who underwent an open surgical procedure of TMJ discus in which she developed a pseudoarterial aneurysm of the superficial temporal artery surgically treated in the second operative time.

Rare Intraoperative and Postoperative Complications After Transabdominal Laparoscopic Hernia Repair: Results from the Multicenter Wall Hernia Group Registry.

Background: Inguinal hernioplasty is the most frequently performed operation in the Western world today. Although the laparoscopic approach for inguinal hernia repair has shown excellent results in terms of complications and recurrences, the anterior approach is still the most used. Postoperative pain and recurrences are the most widely studied complications in both approaches, but there is little information about the often more troublesome rare complications of laparoscopic surgery and their treatment. Methods: In the period from January 1, 2014 to December 31, 2019, 1874 hernioplasty operations were performed with the transabdominal approach and recorded prospectively in the Wall Hernia Group database. The mean follow-up was 47 months (range 3-64 months). All less frequent complications were analyzed and a literature review was carried out to assess the presence of similar cases and their treatment in other series. Results: Eight cases of rare complications were identified and subdivided according to the Clavien-Dindo classification. They included a bowel perforation, 4 cases of bleeding, 2 bowel obstructions, and an injury to the motor branch of the obturator nerve. The postoperative course in these patients was significantly longer than in patients with a regular postoperative course. In 2 cases the complication occurred during the first admission, while the remaining 6 patients had to be readmitted within 30 days after discharge. Conclusions: Although serious postoperative complications in laparoscopic inguinal hernioplasty are rare, all surgeons, also those who have completed the learning curve, should be aware of their possible occurrence.

Arteriocaliceal Fistula: A Life-Threatening Condition After Retrograde Intrarenal Surgery.

Background: Retrograde intrarenal surgery (RIRS) has emerged as a viable and safe option for renal stones <2 cm. Because of its high efficiency and relative safety, experienced endourologists have applied it to even larger stones. We present a case of arteriocaliceal fistula, which is a rare postoperative complication of RIRS. Case Presentation: A 52-year-old man with a rich history of endourologic procedures and extracorporeal shockwave lithotripsy caused by inferior caliceal calculi was subjected to RIRS. This was complicated by transient intraoperative hemorrhage, followed by recurrent hematuria and clot retention several days postoperatively. Renal arteriography revealed the presence of an arteriocaliceal fistula. This was completely resolved with selective arterial embolization. Conclusion: This case highlights that early detection and timely intervention are crucial to avoid serious consequences of post-RIRS hemorrhage resulting from arteriocaliceal fistula.

Scleral Dellen: Early Complication Of Pterygium Surgery And Literature Review

Introduction :&#x0D; Severe Scleral Dellen is a rare and early postoperative complication of pterygium surgery.&#x0D; The various cases reported in the literature are mostly related to this surgical technique; simple excision of the conjunctiva, notably either without adjuvant treatment or using mitomycyine C in preoperative or otherwise beta radiation.&#x0D; The particularity of our case is that the scleral Dellen is associated with excision and simple suture of the conjunctiva without adjuvant treatment or cauterization of the vessels. The other particularity of this case is that it is to our knowledge the first case of scleral dellen reported in Morocco, and even at the African level.&#x0D; Case report&#x0D; This case is a 38-year-old military patient with no medical history&#x0D; The patient was scheduled for pterygium surgery.&#x0D; 16 days later, the patient came back after noticing the appearance of a blackish brown spot at the nasal side of the right eye associated with mild eye pain.&#x0D; The slit lamp examination of the involved eye revealed a severe scleral thining, surrounded by an oedematous conjunctiva and the visualization of the ciliary body through the fine sclera. The conjunctival sutures were no longer in place.&#x0D; After three days and with treatement, we observed a scleral cicatrization, followed by a gradual covering of the sclera by conjunctiva.&#x0D; Discussion :&#x0D; In our case as in that described by Garcia-Medina and collaborators, we performed a conjunctival suture with two stitches to cover the sclera. Otherwise, both of the stitches were not found later, which suggests that, like in the Garcia-Medina report; a bad handling by the patient (eye rubbing), loose stitches or even both.&#x0D; Thus, the sclera would have been exposed in the two cases.&#x0D; Regarding the treatment of this complication, the graft of a conjunctival flap was performed in two cases with favorable evolution.&#x0D; In all other cases, only medical treatment has been successfully initiated.&#x0D; In our case we opted for medical treatment only, including local antibiotic therapy, intensive lubrication with artificial tears (hourly drop) and the occlusion of the eye. The evolution was also favorable under this treatment.&#x0D; Hence, our case is similar to the Garcias-Medina and collaborators one, concerning the surgical technique, and also the scleral Dellen treatment. Although the difference and the particularity of our case was the absence of cauterization use during the surgical act.&#x0D; Conclusion:&#x0D; Scleral Dellen is rare complication of pterygium surgery, which occurs early after the surgical act.&#x0D; Its exact physiopathology remains unknown, but some factors may be incriminated; first of them is the surgical technique as a simple excision with exposed sclera.&#x0D; This complication can occur in patients, without any particular medical or ophthalmological history or any underlying pathology. It could also occur for primary pterygium. Medical treatment alone may be appropriate to manage this complication.

Implant Material As A Modifiable Risk Factor For Infection In THA: A Literature And Registry Review

Aim:Periprosthetic Joint Infection (PJI) is a rare but serious post-operative complication of hip replacement that often ends in complex implant revision and dramatically impacts the quality of life of the patient. Finally, costs associated with PJI significantly impact healthcare systems. Current research focuses on understanding the mechanisms of infection and identifying the risk factors related thereto. The objective of this study was to examine the potential impact of bearing materials on the incidence of infection in THA.Methods:Registries are a valuable tool to analyze large cohorts of THA patients and the influence of selected parameters on the clinical outcome of the surgeries. Data from THA patients recorded in the NJR, AOA and NZ registries were analyzed with respect to the incidence of infection. Material data and scientific publications were also reviewed to investigate if the incidence of PJI might be correlated with the specific bearing material used.Results:The use of metal bearings was consensually identified in all large patient cohorts as an independent risk factor for PJI. In contrast, using ceramic bearings was associated with a lower risk of revision for PJI.1 In vitro and ex vivo studies comparing the biological response to ceramic, metal and polyethylene materials are helpful to explain these findings. Metal exposure might activate the immune system and the released metal particles and ions might trigger adverse reactions with high inflammatory potential In contrast, extreme low wear ceramic bearings are well tolerated, show an excellent biological behavior 2,3,4,5,6 and might even support the wound healing process by initiating a healthy fibrotic pseudo-capsulation4. Furthermore, low wear is less likely to serve as a nidus for infection.Discussion and conclusion:Considering modifiable risk factors prior to THA is a key aspect for surgery success, implant longevity and patient satisfaction. Selecting a bearing material with enhanced biocompatibility like ceramics seems to have a measureable impact on the clinical outcomes. Favourable host-implant interactions might explain this observation.Literature: 1) Lenguerrand et al. Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study The Lancet, 2018DOI:https://doi.org/10.1016/S1473-3099(18)30345-12) Faye PA et al. Biomed Mater. 2017;12(1):0150233) Cunningham BW et al. Journal of Neurosurgery: Spine. 2013;19(3):336-3504) Savarino L et al. Acta Orthopaedica. 2009;80(2):162-1675) Asif IM et al. Front. Bioeng. Biotechnol. Conference : 10th World Biomaterials Congress. doi: 10.3389/conf. FBIOE.2016.01.007936) Asif I M et al. Characterisation and Biological Impact of Wear Particles from Composite Ceramic Hip Replacements. PhD thesis, University of Leeds (2018). http://etheses.whiterose.ac.uk/20563/7) Pitto et al Are ceramic-on-ceramic bearings in total hip arthroplasty associated with reduced revision risk for late dislocation? Clin Orthop Relat Res. 2015;473(12):3790–3795. doi:10.1007/s11999-015-4395-6

Liver clot- A rare post-operative complication following tooth extraction

Post-operative bleeding is a common post extraction complication usually associated with both intra-alveolar and trans-alveolar extractions. The bleeding is mostly due to venous bleed are usually managed by pressure pack or sutures. Occasionally the clot will increase in size and may extend upto the size of few centimetres which are known as “Liver-clot” due to its similarity with liver tissues in appearance. This event may occur peri-operatively or post-operatively or may occur as delayed response upto 72 hours post-operatively. The dimensions of the clots are dictated by the amount of exposure of blood stream to tissue factors that are present perivascularly. We are reporting a series of cases that developed liver-clot post operatively and have discussed the possible mechanism of clot growth and its spatiotemporal dynamics of the clot in response to tissue factors Keywords: Liver clot, Tissue factors, Venous haemorrhage, Spatiotemporal dynamics.

Laparoscopic assessment and transvaginal reparation of post-coital vaginal cuff dehiscence with bowel evisceration: a case report

Vaginal cuff dehiscence (VCD) is a rare postoperative complication of total hysterectomy. Presenting symptom is acute pelvic or abdominal pain accompanied by nausea and vomiting. Immediate recognition and surgical repair are crucial for successful management. A 40-year-old para 1+0 presented with complaints of pelvic pain associated with sexual activity, three months after a total laparoscopic hysterectomy. Speculum examination revealed the presence of bowel into the vagina. Diagnostic laparoscopic assessment combined with VCD repair through the transvaginal route. The occurrence of VCD after laparoscopic hysterectomy has been linked to overuse of electrocautery, prolonged inflammatory response and suturing methods. Laparoscopic, abdominal and vaginal approaches are the routes for repairing VCD. However, it depends on the clinical presentation and surgeon expertise. Careful history, and physical examination are vital factors in guiding clinicians to diagnose and treat VCD. Nevertheless, an ideal modality remains variable to each case.

Epiphrenic diverticulum of the lower third of the esophagus after previous antireflux surgery

In this article is described a rare postoperative complication: epiphrenal diverticulum of the esophagus of the lower third of the esophagus in patient after antireflux surgery. Brief description of the main stages of surgical treatment. 96 patients with cardiofundal, subtotal or total hiatal hernias underwent operation. There were complications of I-II degree according to Clavien-Dindo in the early postoperative period in 11 patients (11.4%). Complications of IIIb degree were revealed in 2 patients (2.1%) in the early postoperative period and in 1 patient (1.0%) in the late postoperative period (2 months after hospitalization) - epiphrenal diverticulum of the esophagus. Laparotomy, the sagittal diafragmalnaya, diverticulectomy, valisesta pyloroplasty were performed. Postoperative period without complications. The patient's nutrition through the mouth is restored on the 5-th day. No dysphagia and reflux esophagitis were detected radiologically and endoscopically.

Treatment experience of delayed massive gastrointestinal bleeding caused by intra-abdominal arteriointestinal fistula in gastric cancer patients after radical gastrectomy

BackgroundGastric cancer (GC) remains one of the leading causes of cancer-related death. Arteriointestinal fistula is a very rare but lethal postoperative complication in GC patients after gastrectomy. However, very few reports associated with arteriointestinal fistula have been published, and there is no matured diagnosis and treatment consensus for arteriointestinal fistula. Herein, we will investigate the etiology, clinical feature, diagnostic method, treatment, and prognosis by summarizing two patients we treated and consulting related cases reported in recent years.Case presentationA 61-year-old male and 75-year-old female with advanced gastric cancer of gastric antrum underwent radical distal gastrectomy and D2 regional lymphadenectomy. Residual gastrojejunostomies by the Roux-en-Y method were performed. The two patients recovered well after gastrectomy, and they received postoperative adjuvant chemotherapy. However, both of them suffered sudden hematemesis and melena about 2 months after surgery, resulting in unstable vital signs. Emergency exploratory laparotomy and interventional embolotherapy by digital subtraction angiography were immediately respectively performed. During this process, arteriointestinal fistulas were found in both of them. Pseudoaneurysms of gastroduodenal artery and common hepatic artery were respectively ruptured and bleeding into the duodenum. Finally, the male patient recovered, while the female patient died because of rebleeding and hemorrhagic shock.ConclusionsArteriointestinal fistula, with low morbidity but high mortality, is an acute and fatal postoperative complication for GC patients after radical gastrectomy. DSA is the preferred method to diagnose arteriointestinal fistula. Embolotherapy by DSA should be performed immediately once arteriointestinal fistula is confirmed. Emergency laparotomy is another selection if the embolotherapy failed. We should pay more attention to perioperative preventive measures for formation of pseudoaneurysm, which is the leading cause of arteriointestinal fistula.

NCMP-18. POST-OPERATIVE NEUROLOGICAL DEFICIT /VASOSPASM AFTER CRANIOPHARYNGIOMA SURGERY: EVALUATION OF CAUSATIVE FACTORS AND PREVENTION

Abstract INTRODUCTION Referring to a rare post-operative complication associated with craniopharyngioma surgery, Vasospasm. A number of possible causative factors have been postulated, like tumour encasing vessel, handling of vessels during surgery, but none have been able to explain delayed complication. Thus, we have evaluated series of patients operated in a single centre, to look for the possible aetiology METHODS Patient’s data have been collected retrospectively in the past 4 year, from a single centre, and cases that developed post-operative neurological deficit/vasospasm, proven clinically and/or radiology were included. Of 116 patients operated 6 were found to have clinical deterioration, and were confirmed using transcranial Doppler and/or radiologically demonstrable vasospasm. Each case was analysed retrospectively, and relevant variables were studied. RESULTS Patients developed neurological deficit/vasospasm ranging from Post-operative day 2 to second week after surgery. 1 expired, 2 improved over time, and 3 had persisting deficits. On evaluation, fluid balance showed changes, with serum Sodium levels. However, change of status from high volume status to low volume status was seen in almost all. CONCLUSIONS Development of post-operative neurological deficit/vasospasm is usually a cumulative result of some intraoperative insult like vessel handling, which could be a predisposing factor, and various post-operative factors like change In volume status, serum electrolytes levels, hormone status levels. Most important of all is to have an early and low threshold level to diagnose it, as early detection and action may a significant and possibly preventable morbidity or mortality

2512 A Rare Late Complication After Roux-en-Y Gastric Bypass: Recurrent Hepatic Abscesses

INTRODUCTION: There are many rare late post-operative complications for Roux-en-Y gastric bypass (RYGB), but hepatic abscesses from enteric fistula formation is a rare complication. Herein we describe a case of recurrent hepatic abscess formation after a revision of a RYGB procedure CASE DESCRIPTION/METHODS: A 66 year-old female with a history of obesity status-post a RYGB in 2003 requiring revision with partial gastrectomy with GJ creation in 2017 presented to her PCP with abdominal pain, reduced appetite, fevers, and chills. She had several admissions for recurrent polymicrobial hepatic abscesses requiring prolonged courses of IV antibiotics after her revision. She had a temperature of 101.1 F, blood pressure of 101/55, heart rate 69. Labs revealed ALP of 280, ALT of 83, AST of 208, and WBC of 11.5. CT revealed an 11 cm abscess between the liver and diaphragm (Figure 1). She was started on antibiotics and interventional radiology did CT-guided abscess drain placement revealing green pus. An upper endoscopy revealed Roux-en-Y gastrojejunostomy anatomy with gastrojejunal anastomosis with healthy mucosa. Given her recurrent abscesses, there was concern that this was a biliary or intestinal fistulous tract causing the abscesses. Imaging with CT fistulogram demonstrated a fistulous tract in the bilio-pancreatic limb of the RYGB. She underwent exploratory laparotomy with findings of the gastric remnant which was adherent to the left lobe of the liver (Figure 2). The staple line of gastric remnant along with the fistula were resected and underwent successful repair. She has had no further recurrence of hepatic abscesses. DISCUSSION: Late post-operative of RYGB include enteric fistulas, cholelithiasis, marginal ulcers, small bowel obstruction, and nutritional deficiencies. However, hepatic abscesses from enteric fistula formation is a rare complication. Liver abscesses can seed from the biliary tree and liver parenchyma through the hepatic artery or portal venous system. Only 5-15% of infections are accounted from surgical trauma. The etiology of recurrent hepatic abscesses in our patient resulted from fistula formation at the gastric staple line leading to an exposure to enteric secretions. Given RYGB anatomy, accessing the gastric remnant is often difficult and at times never done. This case highlights the need for providers to continue to have a high index of suspicion of pathology occurring in the gastric remnant and to consider fistula formation.

Post-surgical hydropneumopericardium: a case report of dramatic increase in the apparent size of pericardial effusion with positional changes

BackgroundPneumopericardium is an uncommon clinical finding. It most commonly occurs after chest trauma but can also emerge as a complication following interventional or surgical procedures and can result in life-threatening complications. A high index of clinical suspicion should be present and once the condition is recognized, it should be managed promptly. Paucity of literature on pneumopericardium makes outlining any new case of paramount importance to emphasize the aspects of diagnosis and management of this rare condition.Case summaryA 59-year-old woman with severe mitral valve and moderate tricuspid valve regurgitation underwent mitral and tricuspid valve repair with uneventful post-operative in-hospital stay. She presented 10 days after discharge with progressive shortness of breath. Chest X-ray revealed right hydropneumothorax. Transthoracic echocardiography (TTE) performed in the emergency department showed an apparently small pericardial effusion with patient in supine position; the effusion size increased substantially when imaging in left lateral decubitus, with presence of intrapericardial air bubbles. Computed tomography scan of the chest confirmed the presence of right hydropneumothorax and hydropneumopericardium, with a communicating pleuro-pericardial tract. The patient underwent chest tube placement which successfully decompressed both pleural and pericardial space.DiscussionHydropneumopericardium is a rare post-operative complication. Comprehensive TTE with imaging from multiple acoustic windows is mandatory when evaluating the extent of pericardial effusion. Presence of cardiac tamponade is crucial in determining the management plan.

Negative Pressure Pulmonary Edema: A Case Report

Aim: Negative pressure pulmonary edema (NPPE) is a rare postoperative complication that arises due to upper airway obstruction and appears within an hour of extubation. Case: The patient was a 19 years-old male with no chronic diseases or complaints in his preoperative assessment. Forty-five minutes after extubation, the patient reported dyspnea, hemoptysis, chest pain and oxygen saturation was 60%. Computer Tomography (CT) scans revealed bilateral infiltration and consolidation, more prominent in the central and apical regions. His bedside echocardiogram was normal. NPPE was considered in the diagnosis; oxygen support, intravenous furosemide, nebulized salbutamol and budosenide were administered in addition to non-invasive mechanical ventilation. Two hours later, the symptoms abated. His repeat X-ray taken after 12 hours showed reduction in lung infiltrates and patient was discharged after five days. Conclusion: Abrupt decrease in oxygen saturation after extubation, dyspnea, chest pain and hemoptysis point to negative pressure pulmonary edema; the patient must immediately be moved to the intensive care unit and promptly treated.

Renal replacement therapy after elective surgical procedures

Acute kidney injury (AKI) is not a rare postoperative complication in surgical patients. AKI dramatically affects patient's condition, increases hospital-stay and risk of lethal outcome. Moreover, AKI may be followed by deterioration of basic renal function in short- and long-term period. It seemed interesting to us to generalize the clinical data of general surgical patients treatment, which were need to use renal replacement therapy for acute renal failure in postoperative period. The analysis made us possible to draw conclusions that can broaden our understanding of the causes, course and outcomes of acute renal failure in such a patients.

A Rare and Late Postoperative Complication of Nissen Fundoplication: Mixed Hiatus Hernia.

How to cite this article: Kekilli M, Dogan Z, Karaahmet F. A Rare and Late Postoperative Complication of Nissen Fundoplication: Mixed Hiatus Hernia. Euroasian J Hepatogastroenterol, 2018;8(2):172.

Cervical spine surgery complicated by postoperative Guillain-Barré syndrome

Abstract Guillain-Barre syndrome (GBS) is an idiopathic, immune-mediated attack of the peripheral nervous system, with patients most commonly presenting with bilateral, ascending weakness, and loss of deep tendon reflexes. Considered an extremely rare post-operative complication, particularly in cervical spine patients, we report a unique case of GBS following anterior cervical spine surgery. The patient is a 65-year-old male with no relevant prior medical or surgical history who presented with right arm weakness and stiffness. After decompression and fusion via an anterior approach, the patient was discharged two days later without incident. On post-operative day 8, the patient returned to the hospital with profound weakness in the bilateral lower extremities. Subsequent cerebrospinal fluid analysis and nerve conduction studies revealed albuminocytologic dissociation and axonal polyneuropathy, respectively. The patient was diagnosed with GBS and was promptly treated with intravenous immunoglobulin (IVIG). At 5-month follow-up, the patient returned to his pre-operative baseline and exhibited full strength in the lower extremities. GBS is an extremely rare post-operative complication of cervical spine surgery and needs to be identified quickly in patients presenting with post-operative sensorimotor changes to improve the natural history of the disease.