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Neglected, Traumatic Duodenal Rupture - Case Report

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Żyluk A., Jagielski W., Puchalski P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 12
672-676
EN
A case of neglected, double-site, post-traumatic duodenal rupture, which was overlooked at the emergency laparotomy due to intra-abdominal bleeding is presented. For nine days the excessive laceration remained asymptomatic, probably because of visceral adhesions. Both tears of the duodenum were eventually repaired, but symptoms and signs of high mechanical obstruction had developed afterwards, requiring repeated surgery (gastric decompression). Endoscopy performed 2 weeks after duodenal repair showed both, repair site and gastro-jejunal anastomosis permeable. All symptoms quickly with-drawn and the patient recovered. Possible causes of the atypical clinical course in this case were discussed.
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A Comparison of the Efficacy of a Local Vs Brachial Plexus Block Anaesthesia in the Carpal Tunnel Release: The Results of a Prospective and Randomised Trial

100%
Żyluk A., Puchalski P., Walaszek I., Janowski P.
Polish Journal of Surgery
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2008
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vol. 80
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issue 11
615-620
EN
Carpal tunnel release can be performed in local anaesthesia, peripheral nerves blocks (either proximally or distally), intravenous regional (Bier block) and general anaesthesia. To our knowledge, in Poland operations of carpal tunnel syndrome are routinely performed under brachial plexus block anaesthesia.The aim of the study was to compare the effectiveness of local versus brachial plexus block anaesthesia for carpal tunnel decompression.Material and methods. One hundred and fifty-five patients diagnosed with carpal tunnel syndrome were randomly allocated to the local anaesthesia or brachial plexus block. Operations were done with two minimally invasive techniques: one and two small incisions. Questionnaires received from 135 patients, 115 women (85%) and 20 men (15%) in a mean age of 57 years (range 31-87) were analyzed. Sixty-six patients (49%) received local infiltration with 2% Lignocaine, and 69 (51%) received brachial plexus block with a mixture of 2% Lignocaine and 0.5% Bupivacaine. Pre- intra- and post-operative patients' complaints were assessed in visual analogue scale, as well as duration of anaesthesia, operation and surgeon subjective satisfaction were noted.Results. Except tourniquet pain, there were no significant differences between the groups in the pain scores associated with disease or operation. Although tourniquet pain was significantly lower favoring brachial plexus block, but the difference was slight (VAS 1.9) and most the patients well tolerated short-time inflation of the tourniquet. No significant difference was observed in duration of the operation, whereas duration of performing anaesthesia was significantly longer in brachial plexus blocks, but the difference of the mean values was as low as 1 minute. Operation under brachial plexus block provided greater surgeon's comfort.Conclusions. The results of this study show similar effectiveness of local and brachial plexus block anaesthesiae for carpal tunnel release, and confirm advantages of the former technique as simpler, cheaper and easier available. It seems that, according to European trends, local anaesthesia should be considered a method of choice in this operation and that fear associated with its use are not justified.
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