PMID- 36389186
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221119
IS  - 2049-0801 (Print)
IS  - 2049-0801 (Electronic)
IS  - 2049-0801 (Linking)
VI  - 83
DP  - 2022 Nov
TI  - Intra-arterial injection of Diclofenac by informal health practitioner: A rare 
      complication of a common drug.
PG  - 104736
LID - 10.1016/j.amsu.2022.104736 [doi]
LID - 104736
AB  - 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.
CI  - (c) 2022 The Authors.
FAU - Chekuri, Ritvik
AU  - Chekuri R
AD  - Department of Surgical Disciplines, AIIMS, New Delhi, India.
FAU - Pol, Manjunath Maruti
AU  - Pol MM
AD  - Department of Surgical Disciplines, AIIMS, New Delhi, India.
FAU - Manohar, Manav
AU  - Manohar M
AD  - Department of Surgical Disciplines, AIIMS, New Delhi, India.
FAU - Yadav, Bhanu Pradeep
AU  - Yadav BP
AD  - Department of Surgical Disciplines, AIIMS, New Delhi, India.
FAU - Garg, Raghav
AU  - Garg R
AD  - Department of Surgical Disciplines, AIIMS, New Delhi, India.
LA  - eng
PT  - Case Reports
DEP - 20220928
PL  - England
TA  - Ann Med Surg (Lond)
JT  - Annals of medicine and surgery (2012)
JID - 101616869
PMC - PMC9661636
OTO - NOTNLM
OT  - Acute limb isch
OT  - Amputation
OT  - Intra arterial injection
OT  - Limb salvage
OT  - a
OT  - emia
COIS- None.
EDAT- 2022/11/18 06:00
MHDA- 2022/11/18 06:01
PMCR- 2022/09/28
CRDT- 2022/11/17 12:22
PHST- 2022/08/05 00:00 [received]
PHST- 2022/09/18 00:00 [revised]
PHST- 2022/09/18 00:00 [accepted]
PHST- 2022/11/17 12:22 [entrez]
PHST- 2022/11/18 06:00 [pubmed]
PHST- 2022/11/18 06:01 [medline]
PHST- 2022/09/28 00:00 [pmc-release]
AID - S2049-0801(22)01496-0 [pii]
AID - 104736 [pii]
AID - 10.1016/j.amsu.2022.104736 [doi]
PST - epublish
SO  - Ann Med Surg (Lond). 2022 Sep 28;83:104736. doi: 10.1016/j.amsu.2022.104736. 
      eCollection 2022 Nov.