Open AccessMyasthenia Revealed Following Laparotomy - A Case Report
Author(s) -
Abdelilah Ghannan,
Abdellah Tazi,
J. Tadili,
M. Faroudy,
Ali Kettani
Publication year - 2015
Publication title -
international journal of medicine and surgery/international journal of medicine and surgery
Language(s) - English
Resource type - Journals
eISSN - 2550-4983
pISSN - 2336-0313
DOI - 10.15342/ijms.v2i1.16
Subject(s) - medicine , mechanical ventilation , respiratory failure , myasthenia gravis , respiratory distress , septic shock , laparotomy , surgery , fulminant , weaning , pneumonia , perioperative , anesthesia , neostigmine , etiology , sepsis
Myasthenia (muscle weakness) is a rare neuromuscular disease of which respiratory failure is the main complication. The accidental discovery of such disease in the perioperative period is rare and potentially serious.We report a case of a woman who underwent emergency operation for appendiceal peritonitis, and failed repeatedly at weaning from postoperative mechanical ventilation. The usual etiologies such as postoperative respiratory complications, ventilator-associated pneumonia, acute respiratory distress syndrome complicating the septic shock or having no impact on it, and neuromyopathy’s resuscitation were considered, researched, examined or eliminated.Faced with the diagnostic impasse and the obvious weaning failure, another interview revealed signs of muscle fatigue which led to the diagnosis of myasthenia gravis decompensated perioperatively. Once the diagnosis was confirmed by means of a neostigmine test, the specific treatment began, particularly through plasma exchange sessions, and the process of weaning resumed. The result was complete weaning. A three-month follow-up showed a stable patient with no significant muscular disability.