Colopleural fistula, a rare pathological connection between the colon and the pleural cavity, is associated with high mortality and typically requires surgical management. We report the case of a 63-year-old man with colopleural fistula secondary to diverticulitis that progressed to a lung abscess. He was transferred with sepsis and metabolic acidosis in the setting of pneumonia and a left lower lobe (LLL) abscess. During intravenous antibiotic therapy at the referring hospital, he developed uncontrolled epistaxis requiring additional management. His medical history included diabetes mellitus, atrial fibrillation, and prior repair of a perforated gastric ulcer. Despite 5 days of antibiotic therapy, the infection persisted. On hospital day 6, contrast-enhanced computed tomography revealed a fistulous tract between the LLL and the splenic flexure; colonoscopy confirmed diverticulosis with a fistulous communication. Surgical management included left hemicolectomy, adhesiolysis, video-assisted thoracoscopic LLL resection, and diaphragmatic repair. Postoperatively, an intra-abdominal abscess required reoperation, and gastric ulcer bleeding was treated endoscopically. The patient was discharged without further complications. Colopleural fistula should be suspected in cases of lung abscess that are unresponsive to antibiotics; early contrast-enhanced imaging and timely surgical intervention are essential to optimize outcomes.
Purpose Post–intensive care syndrome (PICS) has traditionally been conceptualized as comprising physical, cognitive, and psychological impairments. However, emerging evidence highlights additional domains, including fatigue, sleep disturbance, pain, social participation, and self-management. This COSMIN-based scoping review aimed to map available PICS assessment instruments, evaluate their psychometric and methodological quality, and propose future directions for the development of comprehensive multidomain tools. Methods Following the COSMIN guideline, JBI methodology, and the PRISMA-ScR framework, we systematically searched PubMed, Embase, the Cochrane Library, CINAHL, and RISS for studies published between January 2012 and June 2024. Two reviewers independently screened studies and extracted data. Psychometric properties, including content validity, structural validity, internal consistency, reliability, measurement error, and responsiveness, were evaluated according to COSMIN criteria. Results Twenty-eight studies describing 20 PICS-related instruments were identified. Single-domain measures were used more frequently than multidomain instruments. Multidomain tools demonstrated acceptable internal consistency; however, evidence for confirmatory factor analysis, measurement invariance, test-retest reliability, and measurement error was limited. Several patient-experienced domains, including fatigue, sleep disturbance, pain, and social participation, were only partially represented across instruments, thereby limiting the comprehensive assessment of recovery trajectories. Conclusion Despite growing recognition of PICS, the use of validated assessment tools in clinical practice remains inconsistent, and existing instruments do not adequately capture the full spectrum of physical, cognitive, psychological, and social outcomes. Evidence supporting their psychometric robustness is also limited. A patient-centered, multidomain instrument with strong methodological foundations is urgently needed to enable accurate monitoring, guide timely interventions, and improve long-term outcomes among intensive care unit survivors.
Acute corrosive injury most commonly affects the upper aerodigestive tract and may necessitate emergency surgery in a minority of cases when transmural necrosis develops. The present case manifested with multiorgan dysfunction and subsequently deteriorated, developing acute peritoneal signs that required emergency surgical intervention. Intraoperatively, the distal thoracic esophagus and proximal stomach appeared unexpectedly viable; however, there was extensive transmural circumferential gangrene involving the distal stomach, duodenal C-loop, and proximal jejunum. A surgical decision between pancreatoduodenectomy and pancreas-sparing duodenectomy was required. Given the patient’s poor general condition and hemodynamic instability, pancreas-sparing duodenectomy with ampullo-jejunal anastomosis was performed. Although the postoperative course was complicated, the patient gradually recovered and was discharged on an oral liquid diet. This report outlines the complexities associated with such atypical presentations and emphasizes the importance of individualized surgical decision-making and multidisciplinary postoperative care in the comprehensive management of acute corrosive injuries.
Fournier gangrene (FG) is an uncommon but life-threatening condition characterized by rapidly spreading necrotizing fasciitis of the perianal, genital, or perineal regions and accounts for less than 0.02% of hospital admissions, with a reported fatality rate of 20% to 30%. Early diagnosis and prompt multidisciplinary management are essential for achieving optimal outcomes. A 63-year-old man presented with swelling in the right scrotal region. He underwent surgical incision and drainage followed by negative pressure wound therapy. Despite the severity of the presentation, the patient’s prognosis was favorable. This case highlights the risk of misdiagnosing FG in the outpatient setting when initial symptoms resemble benign scrotal conditions and underscores the importance of rapid intervention. The involvement of a clinical pharmacist may enhance patient care by supporting the implementation of an optimized treatment strategy for FG.
Sigmoid volvulus involves the axial rotation of a distended sigmoid colon around its mesenteric axis, obstructing venous and arterial blood flow. This obstruction leads to progressive bowel ischemia, tissue necrosis, and, if not promptly addressed, an increased risk of perforation. In this case series, involving six patients with sigmoid volvulus, all were managed by exploratory laparotomy, consisting of detorsion, resection of the affected colon segment, and anastomosis. Postoperative recovery was generally uneventful, with normal bowel function restored by day 3 in all cases. Patients were discharged on day 10, and no significant complications occurred. Sigmoid volvulus is a common surgical emergency in older patients and is effectively managed by resection and primary anastomosis using GIA staplers. This surgical approach ensures excellent outcomes, minimal complications, and a low mortality rate.
