Open Access Case Report

Conservative Management of a Hollow Viscus Perforation in a Covid-19 Positive Patient

S. S. Bhattacharjee, Greeshma Suresh, B. R. Arun

Asian Journal of Case Reports in Surgery, Page 1-5

Background: Spontaneous perforation of hollow viscous, following prolonged periods of fasting is usually seen in the first part of the duodenum. Surgical treatment is the gold standard therapeutic option. Mortality of around 8 to 25 % is seen and is usually associated with delayed diagnosis due to vague symptoms or due to delayed presentation. Several reports have been published on the conservative management of duodenal perforation.

Aim: Here, we present a case with suspected duodenal perforation with Covid19 positive status, at Silchar Medical College, Assam, India.

Case Presentation: Here, we present a 45 year old hypertensive male with acute onset of pain abdomen, nausea and abdominal distension for two days, in hemodynamic shock, diagnosed to be a case of hollow viscus perforation, suspected to be duodenal perforation with Covid19 positive status. He was resuscitated and managed conservatively with Ultrasonography guided insertion of a tube drain and symptomatic management of Covid19 was done.

Results: Full recovery of the patient after a period of 21 days hospital stay and uneventful discharge from the hospital followed.

Conclusion: Prompt drainage of secretions and prevention of accumulation of septic foci, under the cover of antibiotics, and acid suppressants is an alternative to surgical therapy in a case of duodenal perforation with Covid 19 positive status with inoperability due to hemodynamic unstability.

Open Access Case Report

Successful Post-surgical Wound Management with Hyperbaric Oxygen Therapy

Mohammed Alshamali, Mariam Kenawy, Latefa Almazroui, Majdah Al- Zoabi, Dhari Alzaid, Sanaa Sallam, Fatima Bulbul, Joud Abdulraheem, Khaleel Mohammad

Asian Journal of Case Reports in Surgery, Page 6-11

Hyperbaric oxygen therapy (HBOT) is a treatment in which 100% oxygen at a pressure greater than one atmosphere is administered to the patient. It can be used as an adjunctive therapy in many wound care settings.

We present a 41-year-old female, who had a prolonged hospital stay with an open abdominal wall dehiscence and scarring with multiple enterocutaneous fistulas. After her revisional surgery to resect the fistula, the patient developed ulceration and breakdown of her laparotomy wound. Hyperbaric oxygen therapy was initiated in addition to intensive wound care to stop the ulcer progression and promote the formation of granulation tissue.  Once therapy was completed, a split-thickness skin graft was performed on the granulation tissue to attain wound closure.

Hyperbaric oxygen therapy exerts its effect mainly by adequate tissue perfusion and oxygenation. It also has a crucial role in neovascularization as well as activating signaling pathways to stimulate wound growth factors. In this case report, a combination of HBOT, wound care, and adequate nutrition resulted in the formation of a healthy granulation tissue bed. Subsequently, this resulted in the successful adherence of the skin graft.

In addition to proper wound care and optimal nutritional support, HBOT can possibly play a role in enhancing wound healing in select cases.

Open Access Case Report

Missed Iatrogenic Cervical Esophageal Injury: A Favorable Result in a Late Case

Misauq Mazcuri, Ambreen Abid, Tanveer Ahmad, Nazish Sikander, Pratikshya Thapaliya

Asian Journal of Case Reports in Surgery, Page 12-16

Missed iatrogenic cervical esophageal injury after thyroidectomy is a rare complication. Post-operative painful deglutition, subcutaneous emphysema or local swelling should raise the alarm. Seven days after thyroidectomy, a patient was referred to us with copious purulent discharge and saliva draining from cervical wound. Cervical incision was taken down; wound irrigated and kept open for dressings. Focused wound management along with enteral feeding via feeding jejunostomy was initiated. Esophagoscopy was done in the second week and proximal edge of defect was identified. During the third week, when wound was clean and patient had gained her lost weight back, mucosal and muscular layers were repaired with interposition flap between esophagus and trachea. On seventh post-repair day esophagogram was normal. Patient was discharged on semisolids. Six weeks postoperatively, endoscopy and dilation was done for grade II dysphagia. Six months later, patient remains symptom free.

Open Access Case Report

Wound Bed Preparation in the Management of an Extensive and Infected Leg Ulcer, in a Patient with Multiple Co Morbidities

Andrei Zbuchea

Asian Journal of Case Reports in Surgery, Page 17-22

The case report presents the case of 45 years old female patient with multiple associated diseases sent for treatment to the Plastic Surgery Department, for multiple, extensive and infected left leg ulcer. In addition to systemic treatment, the patient has undergone multiple surgical procedures, debridement of the wound and then split skin grafting. The general treatment and the wound bed preparation prior to skin grafting have required a special attention, given the fragility of the patient condition and the obstacles to wound healing due to local and general deleterious factors. In order to ensure adequate local conditions for grafts integration, the proper wound bed preparation has consisted in serial debridement and application of topical agents with anti-infective, anti-inflammatory and nutritive activities, like medicinal honey dressings. The local and general evolution has been gradually favorable, with the remission of the leg phlegmon and stage integration of split skin grafts.

Open Access Case Study

Koebner’s Phenomenon in Psoriasis Post Nipple Sparing Mastectomy with Immediate Silicone Implant Breast Reconstruction

Y. L. Tan, R. A. Raflis, N. A. Hakim, E. N. Aina, A. Daphne

Asian Journal of Case Reports in Surgery, Page 23-26

The ‘Koebner’s phenomenon’ is a rare clinical response that occurs in patients with pre-existing cutaneous diseases like psoriasis. The phenomenon is triggered by skin incisions, causing an acute development of isomorphic pathological lesions along the lines of the skin trauma in an otherwise normal healthy area. Its occurrence following an immediate silicone implant breast reconstruction could result in severe morbidities. The awareness of this clinical entity and its complications is of paramount importance in preoperative decisions for breast reconstruction; given that they are rare but preventable.