Intra-arterial injection of Diclofenac by informal health practitioner: A rare complication of a common drug.

Autor:	Chekuri R; Department of Surgical Disciplines, AIIMS, New Delhi, India., Pol MM; Department of Surgical Disciplines, AIIMS, New Delhi, India., Manohar M; Department of Surgical Disciplines, AIIMS, New Delhi, India., Yadav BP; Department of Surgical Disciplines, AIIMS, New Delhi, India., Garg R; Department of Surgical Disciplines, AIIMS, New Delhi, India.
Jazyk:	angličtina
Zdroj:	Annals of medicine and surgery (2012) [Ann Med Surg (Lond)] 2022 Sep 28; Vol. 83, pp. 104736. Date of Electronic Publication: 2022 Sep 28 (Print Publication: 2022).
DOI:	10.1016/j.amsu.2022.104736
Abstrakt:	Introduction and Importance: Intra-arterial injections (IA) though rare, cause acute limb ischaemia with often catastrophic outcomes. Symptoms could progress rapidly and early identification and intervention could help in preventing the limb gangrene. Methodology: The work has been reported in line with the SCARE 2020 criteria:Agha RA, Franchi T, Sohrabi C, Mathew G, for the SCARE Group. The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines, International Journal of Surgery 2020; 84:226-230. Operative procedure was performed by consultant of general surgery. Case Presentation: 38-year-old male presented to surgery casualty with history of sudden onset of pain and paraesthesia in the left forearm and palm followed by progressive weakness and discolouration, 15 hours following injection of Diclofenac in the mid cubital region. Clinical Discussion: On examination, limb temperature was lower, finger movements were minimal. However, distal pulses were palpable, and duplex ultrasound showed normal triphasic flow. In view of the equivocal clinico-radiological findings, the patient underwent CT-Angiography of upper limb, which showed non-opacification of radial and ulnar arteries. Fasciotomy of forearm, brachial artery exploration and removal of embolus was attempted in a doubtful viable left upper limb. No thrombus was noted. Subsequently, he was managed conservatively, and cervical sympathectomy was done. As there was progressive deterioration in the viability of the limb, the patient underwent an above elbow amputation. Conclusion: Intra-arterial injections can lead to limb threatening gangrene, the course of which can be rapid A multidisciplinary team approach was necessary to arrive at a diagnosis and provide optimum care. Competing Interests: None. (© 2022 The Authors.)
Databáze:	MEDLINE
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