Gallstone ileus results in a mechanical small bowel obstruction when an itinerant gallstone tumbles downstream and obstructs the bowel lumen. Associated proximal intestinal injury with perforation is rare, and concomitant perforation of multiple segments of bowel in the setting of gallstone ileus has never been reported in the literature. We are reporting the case of a 67-year-old female patient who had gallstone ileus causing perforation of multiple segments of small bowel. At operation, she was found to have a 3.2-cm gallstone lodged at the terminal ileum, perforation of both the mid ileum and mid jejunum, and gross enteric spillage. She underwent removal of the gallstone and small bowel resection x 2. She was initially left in discontinuity with an open abdomen. She returned to the operating room 2 days later for bowel anastomosis and abdominal closure. She recovered well after surgery and was discharged home.

Inguinal hernias containing the stomach are extremely rare, and have never been described in females. We are reporting the case of a 79 year old female who presented in septic shock with a left inguinal hernia containing the stomach, resulting in gastric perforation and loss of abdominal domain. She underwent emergency exploratory laparotomy with manual reduction of the hernia, wedge resection of the perforated gastric segment, abdominal washout, and closure of the abdominal fascia using biological mesh. She had a complicated but successful postoperative course, and was discharged to a rehabilitation center three weeks after hospital admission.

This study investigated the accuracy and utility of capillary lactic acid measurements during periods of tissue ischemia and after revascularization using the StatStrip lactic acid analyzer (Nova Biomedical, Waltham, Mass). The primary objective of this study was to examine whether local capillary lactate levels are elevated in patients with critical limb ischemia. The secondary objective was to examine whether these capillary lactic acid levels decrease after surgical revascularization. Patients scheduled for elective or emergent surgery for the treatment of critical limb ischemia at Mount Sinai Beth Israel and who were willing and able to consent were included in this pilot study. The pilot study included 14 patients who received the following interventions: one emergent open embolectomy, two endovascular revascularizations for acute limb ischemia, four endovascular revascularizations for chronic limb ischemia, and one lower extremity bypass for chronic limb ischemia. Six patients were not successfully revascularized. The average preoperative capillary lactic acid level in the affected lower extremity for all patients was 5.1 mmol/L. In cases of acute limb ischemia, the average preoperative lactic acid level in the affected lower extremity was 10.5 mmol/L; in cases of chronic limb ischemia, the average preoperative lactic acid level was 2.3 mmol/L. For patients with acute limb ischemia undergoing embolectomy or endovascular revascularization, lactic acid levels in the affected lower extremity normalized within 30 minutes. All patients undergoing revascularization for chronic limb ischemia displayed a spike in capillary lactate concentration after revascularization. The average increase was 105% (range, 50%-236%) 30 minutes after revascularization, with a return to baseline observed within 3 hours. This pilot study suggests that capillary lactic acid level monitoring may offer an objective measure of tissue ischemia and revascularization. This may be especially valuable in the evaluation and management of acute limb ischemia, when rapid diagnosis and management are critical to limb salvage. We will continue this study at our institution to include 100 patients undergoing successful revascularization for acute or chronic limb ischemia.

Background: Using finger-stick capillary blood to assess lactate from the microcirculation may have utility in treating critically ill patients. Our goals were to determine how finger-stick capillary lactate correlates with arterial lactate levels in patients from the surgical intensive care unit, and to compare how capillary and arterial lactate trend over time in patients undergoing resuscitation for shock.Methods: Capillary whole blood specimens were obtained from finger-sticks using a lancet, and assessed for lactate via a handheld point-of-care device as part of an "investigational use only" study. Comparison was made to arterial blood specimens that were assessed for lactate by standard laboratory reference methods.Results: 40 patients (mean age 68, mean APACHEII 18, vasopressor use 62%) were included. The correlation between capillary and arterial lactate levels was 0.94 (p < 0.001). Capillary lactate measured slightly higher on average than paired arterial values, with a mean difference 0.99 mmol/L. In patients being resuscitated for septic and hemorrhagic shock, capillary and arterial lactate trended closely over time: rising, peaking, and falling in tandem. Clearance of capillary and arterial lactate mirrored clinical improvement, normalizing in all patients except two that expired.Conclusion: Finger-stick capillary lactate both correlates and trends closely with arterial lactate in critically ill surgical patients, undergoing resuscitation for shock. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

Surgeons have been extracting metallic foreign bodies (MFB) for centuries. Perhaps the earliest literary account comes from Homer's epic poem The Iliad (ca BC 800), based on events of the Trojan War from Greek mythology. Makaon operated on an arrow wound to the abdomen of King Menelaus by extracting the arrow, sucking blood from the wound to remove poison, and applying a salve [ [1] Manring M.M. Hawk A. Calhoun J.H. Andersen R.C. Treatment of war wounds: a historical review. Clin Orthop Relat Res. 2009; 467: 2168 Crossref PubMed Scopus (104) Google Scholar ]:The shaft he drew, but left the head behind.Straight the broad belt with gay embroidery graced,He loosed; the corslet from his breast unbraced;Then suck'd the blood, and sovereign balm infused,Which Chron gave, and Aesculapius used [ [2] The Iliad of Homer, translated by Alexander Pope, 1899. The Project Gutenberg EBook, 2006. Available from: http://www.gutenberg.org/files/6130/6130-h/6130-h.html/. [accessed 16.12.12]. Google Scholar ]. Novel methods of removing metallic foreign body from human soft tissue: a report of 7390 casesJournal of Surgical ResearchVol. 183Issue 1PreviewWe studied methods of locating metallic foreign bodies in soft tissue of the human body. Full-Text PDF

BACKGROUND:Waterless alcohol-based hand sanitizers are an increasingly popular method of hand hygiene and help prevent hospital-acquired infection (HAI). Whether hand sanitizer dispensers (HSDs) may themselves harbor pathogens or act as fomites has not been reported.METHODS:All HSDs in the surgical intensive care unit of an urban teaching hospital were cultured at three sites: The dispenser lever, the rear underside, and the area surrounding the dispensing nozzle.RESULTS:All HSDs yielded one or more bacterial species, including commensal skin flora and enteric gram-negative bacilli. Colonization was greatest on the lever, where there is direct hand contact.CONCLUSION:Hand sanitizer dispensers can become contaminated with pathogens that cause HAI and thus are potential fomites.

Interposition of the descending colon between the kidney and the psoas major muscle is a rare hindgut anatomic