Frederick Tiesenga's research while affiliated with West Suburban Medical Center and other places

This case report describes the clinical course of a 51-year-old Caucasian woman with a history of anemia who presented to the emergency department with worsening diffuse abdominal pain and weakness two days after dental surgery. The patient's condition rapidly deteriorated, manifesting as tachycardia, diaphoresis, and a peritonitic abdomen. A CT scan revealed a perforated gastric ulcer, prompting emergent laparoscopy, Graham patch repair, and abdominal washout. Postoperatively, the patient developed leukocytosis, and imaging indicated the formation of an abscess. Despite initial attempts at percutaneous drainage, a subsequent exploratory laparotomy was performed. The patient's leukocytosis eventually resolved, and she was discharged after 21 days with outpatient follow-up. The discussion delves into the declining incidence of peptic ulcer disease but a constant rate of complications, emphasizing the role of factors such as nonsteroidal anti-inflammatory drug use. The diagnostic approach using CT scans in suspected perforated peptic ulcers is highlighted. The study also explores risk stratification scoring systems, with a preference for operative management. The laparoscopic omental patch repair (Graham patch) is discussed, citing its safety and efficacy. The case presented an uncommon occurrence of failed primary percutaneous abscess drainage, leading to subsequent surgical drainage. The discussion concludes by noting variables that may contribute to drainage failure and emphasizes the need for further research to understand such complications.

A hematoma is a collection of pooled blood that can be confined to a space under the skin, tissue, or organ. It occurs due to injury to the vasculature arising from trauma, previous surgeries, or vascular defects. Anticoagulants can remarkably increase a patient’s risk for hematoma formation. Most hematomas will resolve spontaneously over time, but there are certain instances where surgical intervention becomes necessary. We present a case of a 71-year-old female on anticoagulants who presented to the emergency department (ED) with an expanding hematoma on her right leg after a fall and had to undergo an emergency surgical evacuation. The etiology, appropriate management, and complications of hematomas will also be covered in this paper.

Prostate cancer has an indolent progression course and commonly metastasizes to the vertebrae bone and regional lymph nodes. We report a patient with prostate cancer who has developed cutaneous metastases in multiple regions, including the right infraclavicular and abdominal area, as well as the left supraclavicular region. It presented as isolated, prominent nodules that were microscopically proven to be of prostate adenocarcinoma when biopsied. This rare presentation is a marker of an advanced disease course with a poor prognosis in castrate-resistant prostate cancer. Thorough clinical examination to rule out metastasis from the prostate and other dermatological conditions is paramount as well as ensuring early detection and optimizing patient outcomes.

Hidradenitis suppurativa (HS), more commonly known as acne inversa, occurs due to chronic inflammation of the body’s apocrine glands, most commonly affecting areas of the body where there is prolonged skin-on-skin friction. HS affects approximately 4% of the United States population, most commonly women in their second or third decade of life, especially those of African American ethnicity. HS presents as tender subcutaneous nodules which often rupture, leading to the formation of painful dermal abscesses which undergo fibrosis and lead to the formation of extensive sinus tracts, a phenomenon known as “tunneling”. HS is staged clinically using the Hurley staging system, where the stage determines what treatment modalities are used. These modalities can include medical management such as antibiotics, or biologics such as tumor necrosis factor (TNF)-alpha inhibitors like adalimumab, as well as surgical options including incision with or without drainage. Due to the similar presentation of HS with other conditions, this disease is commonly misdiagnosed, often leading to delayed treatment initiation and worse outcomes for patients. Presented is a case report of a 30-year-old African American male with perianal HS and the potential long-term complications and challenges of management of this disease.

Small bowel obstruction (SBO) refers to the inability of contents to pass through the lumen of the small intestine. This is a common surgical emergency in the United States. Although intra-abdominal adhesions are the predominant cause, SBO can occur secondarily to various etiologies, be it one cause or several. Management of SBO secondary to adhesions and metastasized rectal adenocarcinoma, complicated by pulmonary, hepatic, and ureteral disease, highlights the criticality of a multidisciplinary approach. We present a case of a 59-year-old male with SBO secondary to rectal adenocarcinoma. Treatment included surgical resection, acute stabilization, referral for outpatient surgical follow-up, and oncologic management.

Keloids are pathological scars characterized by abnormal proliferation of tissue as a result of cutaneous injury. There is a high prevalence of keloid development in certain ethnicities. Individuals from African, Hispanic, and Asian backgrounds have a higher likelihood of developing keloids when compared to Caucasians. Keloids are known to lack spontaneous regression and have a high rate of recurrence after removal, thereby causing a cosmetic problem that affects people physically and emotionally. Keloids commonly occur after burns, tattoos, piercings, and deep wounds; however, in rare cases, they may develop after minimally invasive procedures. This case describes the experience of a 48-year-old African American male who underwent a thyroid fine needle aspiration biopsy and subsequently developed a keloid in the neck region. This report aims to explore this unique occurrence, highlight the interplay between epidemiology, race, and genetics in influencing the development of keloids, and review the management strategies for neck keloids.

Marginal ulcers can be a rare but fatal post-surgical complication of Roux-en-Y gastric bypass (RYGB). In this report, we will describe the case of a 70-year-old female, with a seven-year status post-gastrojejunostomy who presented with a perforated marginal ulcer and showed significant improvement in her symptoms after a revisional operation for the marginal ulcer. The goal of this case report is to make clinicians aware of the unique complications of RYGB and outline the appropriate workup for patients presenting with post-bariatric abdominal pain.