Non-operative management of traumatic pancreatic pseudocysts associated with pancreatic duct laceration in children

1998 ◽  
Vol 28 (1) ◽  
pp. 5-8 ◽  
Author(s):  
J. Lucaya ◽  
Elida Vázquez ◽  
Ferran Caballero ◽  
Peter G. Chait ◽  
Alan Daneman ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Operative Management ◽  
Pancreatic Pseudocysts ◽  
Non Operative Management

Non-operative Management of Necrotic Pancreatic Collection and Bleeding Pseudoaneurysm Communicating with Bowel Lumen at Multiple Sites: a Case Report and Review of the Literature

2016 ◽  
Vol 25 (1) ◽  
pp. 109-114 ◽  
Author(s):  
Roshan Razik ◽  
Gary R. May ◽  
Fred Saibil
Keyword(s):  
Operative Management ◽  
Gastroduodenal Artery ◽  
Pancreatic Pseudocysts ◽  
Gallstone Pancreatitis ◽  
Endoscopic Retrograde ◽  
Pancreaticoduodenal Artery ◽  
Edematous Pancreatitis ◽  
Walled Off Necrosis ◽  
Non Operative Management ◽  
Guided Therapy

Pancreatic pseudocysts and foci of walled-off necrosis (WON) are well-known complications of acute pancreatitis. We present a case of severe gallstone pancreatitis complicated by WON, fistulization to the bowel and gastrointestinal bleeding. Bleeding was localized to a pseudoaneurysm of the gastroduodenal artery within the WON using imaging and endoscopy. Angiography and image-guided therapy were then used to control bleeding with coil-embolization. To our knowledge, this is the first report of non-operative management of a patient with severe pancreatitis complicated by WON and a bleeding pseudoaneurysm with multiple communications to the hollow viscera. Therapeutic options are discussed and a thorough literature review is included. Abbreviations: EGD: esophagogastroduodenoscopy; ERCP: endoscopic retrograde cholangiopancreatography; GDA: gastroduodenal artery; GI: gastrointestinal; IEP: interstitial edematous pancreatitis; IPDA: inferior pancreaticoduodenal artery; WON: walled-off necrosis.

Non-operative management of extralobar pulmonary sequestration: a safe alternative to resection?

2019 ◽  
Vol 36 (3) ◽  
pp. 325-331
Author(s):  
Victoria K. Robson ◽  
Hester F. Shieh ◽  
Jay M. Wilson ◽  
Terry L. Buchmiller
Keyword(s):  
Pulmonary Sequestration ◽  
Operative Management ◽  
Safe Alternative ◽  
Extralobar Pulmonary Sequestration ◽  
Non Operative Management

scholarly journals The management and outcome of paediatric splenic injuries in the Netherlands

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maike Grootenhaar ◽  
Dominique Lamers ◽  
Karin Kamphuis-van Ulzen ◽  
Ivo de Blaauw ◽  
Edward C. Tan
Keyword(s):  
The Netherlands ◽  
Hospital Stay ◽  
Operative Management ◽  
Trauma Centre ◽  
Management Approach ◽  
Haemodynamic Instability ◽  
Low Grade ◽  
High Grade ◽  
Level 1 ◽  
Non Operative Management

Abstract Background Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature. Results There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493. Conclusion Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management. Level of evidence Therapeutic study, level III

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