Successful Surgical Outcome after Traumatic Diaphragmatic Intra-Pericardial Herniation from Blunt Abdominal Injury

Intrapericardial diaphragmatic hernia (IPDH) is a rare manifestation of non-hiatal diaphragmatic hernias (NHDH). Intrapericardial diaphragmatic hernia is defined as the prolapse of the abdominal viscera into the pericardium through the diaphragm. Their incidence has increased over the last 50-60 years, secondary to high-speed transport, and constitutes 5% of major thoracic and abdominal trauma today. These injuries can present during the initial workup or months after the initiating injury. These hernias can be caused by both blunt and penetrating trauma with concomitant central tendon rupture and pericardial laceration. We report an interesting case of intrapericardial diaphragmatic hernia with delayed presentation that was successfully reduced via open surgical repair after a laparoscopic repair attempt failed. We present a 77-year-old female admitted to the hospital after a motor vehicle crash. On hospital day 9, the patient developed shortness of breath, which prompted a chest x-ray. The chest x-ray revealed bowel in the patient’s chest. The patient was taken to the operating room, where they underwent an attempted laparoscopic diaphragmatic hernia repair and, ultimately, open repair of the diaphragmatic hernia. The patient did well after surgery and was discharged on post-injury day 22

KELT-17B: A HOT-JUPITER TRANSITING AN A-STAR IN A MISALIGNED ORBIT DETECTED WITH DOPPLER TOMOGRAPHY

We present the discovery of a hot-Jupiter transiting the V=9.23 mag main-sequence A-star KELT-17 (BD+14 1881). KELT-17b is a 1.31 -0.29/+0.28 Mj, 1.525 -0.060/+0.065 Rj hot-Jupiter in a 3.08 day period orbit misaligned at -115.9 +/- 4.1 deg to the rotation axis of the star. The planet is confirmed via both the detection of the radial velocity orbit, and the Doppler tomographic detection of the shadow of the planet over two transits. The nature of the spin-orbit misaligned transit geometry allows us to place a constraint on the level of differential rotation in the host star; we find that KELT-17 is consistent with both rigid-body rotation and solar differential rotation rates (alpha < 0.30 at 2 sigma significance). KELT-17 is only the fourth A-star with a confirmed transiting planet, and with a mass of 1.635 -0.061/+0.066 Msun, effective temperature of 7454 +/- 49 K, and projected rotational velocity v sin I_* = 44.2 -1.3/+1.5 km/s; it is amongst the most massive, hottest, and most rapidly rotating of known planet hosts.Comment: 15 pages, 9 figures, accepted for publication in A

The Case for Using Composition Tomography to evaluate Perirectal Necrotizing Fasciitis: Is It Really Necessary?

Clinical reviews of Fournier’s Gangrene state that diagnostic protocol includes interpreting CT, MRI, or Ultrasound imaging along with clinical symptoms and lab findings. We think that the use of imaging techniques as a diagnostic tool is no longer needed as Fournier’s Gangrene is specific enough of a disease that clinicians can diagnose using labs and physical examination alone. Cases of perirectal necrotizing soft tissue infection recorded at St. Marys Medical Center were reviewed. Results of physical exams and imaging were compared along with measurements of severity upon admittance and length of stay. Due to the COVID-19 pandemic, we investigated if patients were delaying seeking treatment for their condition that those presenting pre-pandemic. It was found that no additional, clinically significant, information was gained using imaging techniques, particularly CT scans, that wasn’t gathered using a physical exam. The only instances where imaging provided useful were when the patient presented to the clinical setting very early in the disease process. It was also found that a higher number of patients delayed seeking treatment due to the Sars-CoV-2 pandemic. Our sample size was too small to determine whether the number of delayed patients was statistically significant. We conclude that CT scans are not needed in diagnosing Fournier’s Gangrene unless the disease is in its early stages. This should result in more rapid diagnosis and treatment in the operating room. This is especially important when hospital resources are short and the patient presents in an advanced disease state; relevant to the ongoing Sars-CoV-2 pandemic

Ogilvie\u27s Syndrome: Acute Colonic Pseudoobstruction. A Review for Residents.

Ogilvie\u27s syndrome (acute colonic pseudoobstruction) was first described in 1948. Acute colonic pseudoobstruction can occur in a variety of clinical settings, including postsurgical, obstetrics, pelvic surgery, critical care and sepsis. Clinicians need to recognize the syndrome early. Colonic distention without evidence of obstruction can be seen on plain films of the abdomen or CT scan. Successful therapies, including bowel rest, neostigmine and colonoscopic decompression, have been used. Avoiding respiratory compromise from abdominal distention and colonic perforation of the primary goals of treatment. Surgical intervention should be reserved for patients who are refractory to medical treatment or develops signs and symptoms of colonic ischemia or perforation