Presentation
PRESENTATION OF CASE We present 3 cases with spontaneous ischemic gangrene of the rectum. [ncbi.nlm.nih.gov]
Sensory loss is present beyond the toes, and weakness is present. There is no audible Doppler arterial pulse present, but a venous pulse is heard. These patients generally have to be managed in the operating room. [reliasmedia.com]
AYURVEDIC MANAGEMENT OF ISCHEMIC GANGRENE- DUE TO DIABETES MELLITUS – A CASE REPORT Medical science says that ischemia is a common complication in Diabetes, especially in the lower limb but this is a case presenting ischemic changes in upper limb which [climic.com]
Key points Second edition presenting recent advances in general surgery Fully revised with addition of two new sections Includes more than 800 clinical photographs and diagrams Previous edition published in 2004 [books.google.com]
To the Editor: Warkentin (Aug. 13 issue) 1 highlights the misconception that all cases of ischemic limb gangrene are associated with the loss of an arterial pulse and presents the two syndromes associated with disseminated intravascular coagulation in [nejm.org]
Entire Body System
- Malnutrition
Risk factors include diabetes, smoking, atherosclerosis, renal disease, drug and alcohol abuse, malignancy, trauma or abdominal surgery, contaminated wounds, malnutrition, hypercoagulable states, and prolonged use of tourniquets. [us.bestpractice.bmj.com]
One study reported about one-third of those diagnosed with Fournier had alcoholism with resulting diabetes and malnutrition, while another 10% had been medical immunosuppressed via chemotherapy, steroids, or malignancy. [6] Since 2018, an increase in [en.wikipedia.org]
Investigations Laboratory tests such as FBC, LFTs and U&E may reflect malnutrition or dehydration. CXR should be carried out to exclude pneumonia, and cardiac scanning to exclude comorbidity. [patient.info]
After two failed attempts, worsening of dead tissue burden, and rest pain keeping her awake at night, this patient is probably suffering psychologically and likely has malnutrition. This should be addressed. [evtoday.com]
Weight loss with signs of malnutrition, abdominal tenderness without rebound tenderness during an episode of severe pain and indirect signs of atherosclerotic vascular disease raises the suspicion of CMI. [intechopen.com]
- Wound Infection
The clinical efficacy of two semi-quantitative wound-swabbing techniques in identifying the causative organism(s) in infected cutaneous wounds. Int Wound J. 2011;8(2):176–85. CrossRef PubMed Google Scholar 51. Cardinal M, et al. [link.springer.com]
Fournier gangrene See: Fournier gangrene gas gangrene Gangrene in a wound infected by a gas-forming microorganism, the most common causative agent being Clostridium perfringens. [medical-dictionary.thefreedictionary.com]
- Localized Edema
When a minor trauma occurs and local edema occludes a superficial branch of a small artery of the skin below it in the presence of neuropathy, a shallow neuro‐ischemic ulcer may form over the ischemic area. [onlinelibrary.wiley.com]
Musculoskeletal
- Foot Pain
Comprehensive Care Complete foot and ankle care from our dedicated professionals. Testimonials "I was a bit nervous to come in. I didn’t know what to expect as I had never been to a doctor for foot pain before. [mt-podiatry.com]
Case 3 Two days after undergoing percutaneous intervention for an ST-elevation myocardial infarction, a 74-year-old woman developed right foot pain, increasing numbness and sensory deficit, and minimal weakness. [evtoday.com]
Ischemic rest pain is classically described as a burning pain in the ball of the foot and toes that is worse at night when the patient is in bed. [aafp.org]
A diabetic patient complains of pain in the toes while lying down (rest pain) which is often relieved or diminished by hanging the foot over the side of the bed. [reversegangrene.com]
Skin
- Blister
Retiform purpura developed in hands (Figure 1B) blisters on dorsum and feet (Figure 1C) despite detectable pulses (cross marks). Thrombosed plantar cutaneous veins became apparent six days after admission. [ijcasereportsandimages.com]
Gangrene characterized by swelling and blistering of the tissues in the presence of bacterial infection following trauma or other injury to the affected area. wet gangrene A condition caused by relatively acute vascular occlusion–eg, burns, freezing, [medical-dictionary.thefreedictionary.com]
Distal peripheral vascular obstruction presents as blue, grey or purple patches, blisters or ulcers at the ends of the digits. See blue toe syndrome. Ischaemia in other sites may also result in localised necrosis of the skin and deeper tissues. [dermnetnz.org]
Small, dark blisters have developed over the entire foot and began to track up his leg during the ED evaluation. He feels somewhat “hot” and nauseated. [reliasmedia.com]
- Skin Ulcer
[…] lower limb NOS non-healing ulcer of skin non-infected sinus of skin trophic ulcer NOS tropical ulcer NOS ulcer of skin of lower limb NOS Type 2 Excludes pressure ulcer (pressure area) ( L89.- ) skin infections ( L00-L08 ) specific infections classified [icd10data.com]
[…] loss, skin ulceration, skin/soft tissue necrosis, atrophy of muscle, and decreased pulse strength compared to the other limb). [reliasmedia.com]
Workup
In most cases, patients undergo an extensive workup for obscure chronic abdominal pain before the patient is seen by a vascular surgeon. 3.2. [intechopen.com]
Serum
- Hyperglycemia
These include prematurity, polycythemia, hypernatremia, systemic infection, hypothermia, umbilical artery catheterization, hyperglycemia, congenital thrombophilia, maternal diabetes mellitus, congenital heart diseases, amniotic constriction bands, and [jpss.eu]
Diabetics are always at a high risk of compromised skin integrity and impaired wound healing due to peripheral neuropathy, vascular insufficiency, and hyperglycemia. [dovepress.com]
Multivariate analysis of our study echoes findings that basal A1C levels are a risk factor for amputation, and in similar studies hyperglycemia in perioperative patients has been identified as a separate risk factor for morbidity and mortality ( 23 ). [care.diabetesjournals.org]
Treatment
Such a rare and interesting case was taken at Sri Sri Ayurveda Hospital and handled by proper Ayurvedic line of treatment by which circulation is re-established which saved both limb and life of patient. Here is the case report. [climic.com]
Photographs showing the various stages of Treatment. [cureveda.com]
Diagnosis and treatment of gangrene. News-Medical. Retrieved on November 04, 2022 from https://www.news-medical.net/health/Diagnosis-and-treatment-of-gangrene.aspx. MLA Mandal, Ananya. "Diagnosis and treatment of gangrene". [news-medical.net]
The treatment for symmetrical peripheral gangrene has two parts: Treatment of the cause and prevention of complications. Also, the treatment depends on the stage of the gangrene. [angiologist.com]
The patient instead elected conservative treatment with analgesia, an antiplatelet agent, and management of his vascular risk factors. [nejm.org]
Prognosis
Symmetrical peripheral gangrene has a poor prognosis. Mortality is said to approach 40%. The reason for this prognosis is usually the underlying disease. Local outcomes are also horrific. [angiologist.com]
Prognosis is highly variable, but can involve significant morbidity and mortality. Gangrene is a complication of necrosis characterized by the decay of body tissues. [us.bestpractice.bmj.com]
What is the prognosis for gangrene ? Prognosis of ischaemic gangrene depends on the extent of disease, the underlying cause and the timing of appropriate treatment. [dermnetnz.org]
Prognosis For most patients the quality of life is poor. The constant fear of abdominal pain that may occur when eating food leads to significant weight loss. [patient.info]
Prognosis in chronic ischaemia: deterioration in 25% of cases, revascularisation in 5% of cases and amputation in 1–2% of cases. [ebm-guidelines.com]
Etiology
Its etiology is obscure and in many cases no etiological factor can be found but the presence of ischemic changes at birth suggests an intrauterine etiopathogenesis. [jpss.eu]
[…] produce similar changes as acute ischemia, may be segmental and patchy Epidemiology Usually age 50+ years but also infants with necrotizing enterocolitis Intestinal ischemia occurs in 3% of renal transplant patients ( Arch Pathol Lab Med 2002;126:1201 ) Etiology [pathologyoutlines.com]
[…] the diagnosis of acute mesenteric ischemia 10 ) arterial phase (e.g. triggered when abdominal aorta reaches >100 HU) portal venous phase, e.g. 30 seconds after arterial phase finishes Findings Imaging features can vary depending on the time course and etiology [radiopaedia.org]
Most important etiological agent of necrosis. Reduced oxygen supply most commonly due to vascular changes. However, also can be caused by chemical damage, CO poisoning. [quizlet.com]
Epidemiology
"Fournier's gangrene: Population based epidemiology and outcomes". The Journal of Urology. 181 (5): 2120–6. doi : 10.1016/j.juro.2009.01.034. PMC 3042351. PMID 19286224. [en.wikipedia.org]
Definition / general Ischemic changes may be mucosal, mural (due to hypoperfusion) or transmural (major vessels involved) Chronic ischemia may produce similar changes as acute ischemia, may be segmental and patchy Epidemiology Usually age 50+ years but [pathologyoutlines.com]
Epidemiology The incidence of ischaemic colitis has risen from 6.1 cases/100 000 person-years in 1976-80 to 22.9/100 000 in 2005-09 [ 5 ]. Many mild cases may go unreported. [patient.info]
Pathophysiology
[…] factors in dry gangrene There are different pathways involved in the pathophysiology of dry gangrene ( Figure 1 ). [dovepress.com]
Pathophysiology [ edit ] Gas gangrene is caused by exotoxin -producing Clostridium species (most often C. perfringens, and C. novyi, [5] but less commonly C. septicum [6] or C. ramnosum ), [7] which are mostly found in soil, but also found as normal gut [en.wikipedia.org]
Pathophysiology : Unlike ischemic colitis or proctitis, frank gangrene of the rectum is very rare. [ncbi.nlm.nih.gov]
With better understanding of the clinical syndromes and the pathophysiological basis of AMI a multidisciplinary approach in management has emerged for patients with suspected mesenteric vascular disease. [intechopen.com]
We found a strong association between PC activity levels and 1/INR, which supports a key pathophysiological role for severe depletion of PC activity levels in predisposing to microvascular thrombosis. [bloodjournal.org]
Prevention
HBO therapy prevents further damage by the bacteria and prevents production of toxins by the existing bacteria. Prevention of gangrene Prevention of gangrene involves keeping blood sugar and cholesterol under control. [news-medical.net]
Preventability of the adverse drug reaction (ADR) was assessed by Schumock and Thronton's scale. [16] Moreover, this ADR was found to be of definitely not preventable category. [jpharmacol.com]
The chief problem in managing patients with severe ischemia of the foot is the prevention of gangrene and amputation. [jamanetwork.com]
Clinicians must be vigilant for this complication and they should be reminded that it requires urgent management to prevent tissue loss. Figures and Topics from this paper. References Publications referenced by this paper. [semanticscholar.org]
Finally prevention of infection and progressive damage. This can be done with generic measures. [angiologist.com]