eFAST for the diagnosis of a perioperative complication during percutaneous nephrolithotomy

Abstract

A 29-year-old patient with normal preanesthetic evaluation was planned for percutaneous nephrolithotomy (PCNL) for right nephrolithiasis with right pyelolithiasis. Surgery was performed under general anesthesia with endotracheal intubation with muscle relaxation. At the conclusion of surgery, when the patient was turned over to supine position, tense abdomen was noted. Immediately extended focused assessment with sonography in trauma (eFAST) was done in which both right and left quadrants of abdomen including pericardial and suprapubic region, right and left thoracic, and both lung basis were examined. Fluid collection was seen in Morison’s pouch which was drained by the urologist under real-time ultrasonography guidance by anesthesiologist. Distension of abdomen subsequently subsided and patient had normal vitals. Trachea was extubated and patient shifted to post-operative ward. eFAST and FAST scans are routine procedures in the rapid assessment of trauma victims in emergency settings. The fluid extravasation during a routine PCNL procedure may lead to abdominal compartment syndrome. This case demonstrated that use of eFAST rapidly detected abdominal collection and ruled out life-threatening conditions such as hemothorax and pneumothorax and prevented abdominal compartment syndrome. Our case is only an example that potentially lethal conditions like these may be encountered in the perioperative setting and the knowledge of eFAST scan may be of great help.Electronic supplementary materialThe online version of this article (10.1186/s13089-018-0088-1) contains supplementary material, which is available to authorized users.

Abdominal compartment syndrome after endoscopic combined intrarenal surgery

“… 1 It is a rare complication as, to our knowledge, only nine cases have been previously reported (Table 1 ). 2 , 3 , 4 , 5 , 6 , 7 , 8 …”

“…According to previous reports, increased airway pressure, distended abdomen, or tachycardia, was an early sign of hydroperitoneum. 2 , 3 , 4 , 5 , 6 , 7 , 8 However, these signs may suggest a condition that led to ACS.…”

“…Percutaneous drainage was conducted for treatment in all previously reported cases. 2 , 3 , 4 , 5 , 6 , 7 , 8 It can be performed quickly, but its safety is questionable unless the fluid collection is visible on ultrasonography. Laparotomy is superior in terms of efficient drainage and surgical repair of abdominal organ injury.…”

“…1 It is a rare complication as, to our knowledge, only nine cases have been previously reported (Table 1). [2][3][4][5][6][7][8] Two mechanisms may result in hydroperitoneum. First, mucosal tearing may cause intravascular absorption of irrigation fluid.…”

Propagation of Tau via Extracellular Vesicles

“…Tau is a nucleic acid-binding protein (Villasante et al, 1981; Sultan et al, 2011) and, inside the exosome, it can be bound to a specific nucleic acid. This binding could result in conformational changes in the tau molecule, which would lead to diverse tau-prion strains (Holmes et al, 2013; Sharma et al, 2018). In summary, a better characterization of tau isoforms present in exosomes would help us to understand the mechanism of tau propagation.…”