Wolford College

Migration is often a challenging process. Native Hawaiians migrate from Hawaii to Las Vegas at an impressive rate, but no research has explored how migration affects their health and well-being. The purpose was to describe how Native Hawaiians in Las Vegas perceive their health and well-being and any changes therein since migrating. Using a qualitative descriptive design, 27 participants took part in semistructured interviews. Most participants perceived no changes in health and minor changes in well-being. Many maintained their well-being by adapting valued activities to their new circumstances. However, 5 participants were deeply burdened by life in Las Vegas or longing for Hawaii, and their well-being suffered. They tended to identify barriers to well-being rather than ways to foster it. Health care providers can help Native Hawaiian migrants by encouraging early access to the health care system in their new location and facilitating participation in helpful, adaptive behaviors.

A 78-year-old man presented preoperatively with severe abdominal pain, dyspnea, and subcutaneous emphysema in his face, neck, and chest approximately 8 hours after colonoscopy with a sigmoid polypectomy. A pneumoperitoneum, free air in the mesentery, pneumoretroperitoneum, pneumomediastinum, and bilateral pneumothoraces were diagnosed using radiography and computed axial tomography. He emergently underwent an exploratory laparotomy with colostomy following bilateral chest tube placement. At laparotomy, a perforation of the posterior sigmoid colon was identified at the site of earlier polypectomy. The patient remained intubated and mechanically ventilated for 3 days postoperatively. Perforations of the colon during colonoscopies are the most serious complication of the procedure. Continued insufflation of air or carbon dioxide into a perforated colon can result in extraluminal gas that can result in life-threatening tension pneumothoraces. This case examines the consequences of colonic perforation and the anesthetic management for the definitive surgical treatment of a posterior sigmoid wall perforation. Anesthesia providers' awareness of the risk factors for colonic perforation due to colonoscopy, early signs and symptoms of perforation, and knowledge of the surgical and anesthetic management of perforation could lead to early recognition and intervention and likely to improved patient outcomes.