scholarly journals Non‐operative management of bilateral contained thoracic esophageal perforation: a case report

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Armin Amirian ◽  
Reza Shahriarirad ◽  
Parviz Mardani ◽  
Maryam Salimi
Keyword(s):  
Conservative Management ◽  
Clinical Judgment ◽  
Esophageal Perforation ◽  
Operative Management ◽  
Contrast Imaging ◽  
Case Presentation ◽  
Esophageal Lumen ◽  
Barium Esophagogram ◽  
Esophageal Perforations ◽  
Non Operative Management

Abstract Background Despite profound advances in conservative management of esophageal perforation, patients’ selection for this type of treatment requires expert clinical judgment. Surgical intervention has been historically introduced as the optimal management in multifocal ruptures. Case presentation Here, we presented a 30-year-old man whose barium esophagogram confirmed bilateral perforations in the lower third of the esophagus contained in the mediastinum, and contrast drained back into the esophageal lumen. Concerning available contrast imaging studies and thoracic surgeons, conservative non-operative management was considered despite pneumomediastinum, a mild right-sided pleural effusion, and minimal leukocytosis. The patient was followed up for two months without any complications. Conclusions Bilateral and multifocal esophageal perforations can be managed conservatively provided that the leaks are confined to the mediastinum and drain back to the esophageal lumen, and other criteria for conservative management are met.

scholarly journals Omental Infarction: a Reappraisal of Conservative Management in Children

2014 ◽  
Vol 27 (4) ◽  
pp. 433 ◽  
Author(s):  
José Estevão-Costa ◽  
Ana Sofia Alvarenga ◽  
Ana Catarina Fragoso ◽  
Maria Garcia ◽  
Miguel Campos
Keyword(s):  
Conservative Management ◽  
Imaging Techniques ◽  
Operative Management ◽  
Single Institution ◽  
Laboratory Findings ◽  
Median Hospital Stay ◽  
Course Of Disease ◽  
Omental Infarction ◽  
Non Operative Management ◽  
Median Hospital

<p><strong>Introduction</strong>: Accurate recognition of omental infarction has resulted in increasing supporters of non-operative approach. In order to assess the efficacy and safety of conservative management, we surveyed the cases of omental infarction treated at a single institution.<br /><strong>Material and Methods:</strong> Primary omental infarction treated between 2004 and 2011 were reviewed. Cases recognized by imaging studies were submitted to conservative treatment that consisted of intravenous analgesics and antibiotics. Demographics, clinical presentation, laboratory findings, imaging diagnosis and outcome were analyzed.<br /><strong>Results:</strong> There were 9 cases of omental infarction. Eight patients (4 males; median age, 8.5 years) presented at initial course of disease; all had right-sided abdominal pain and a normal or lightly increased leukocyte count. Six cases, diagnosed by CT scan after US suspicion in four, were managed conservatively, recovered uneventfully, and were discharged after a median hospital stay of 3 days. Two patients were only recognized at surgery. An additional case presented with intestinal obstruction due to an internal hernia and was successfully resolved by laparoscopy.<br /><strong>Discussion:</strong> Imaging techniques were diagnostic of omental infarction in the majority of cases, enabling a conservative approach to be adopted. Non-operative management was successful with no complications in all patients presenting at the initial course of disease. One patient presented with a harmful complication that required operative treatment.<br /><strong>Conclusion:</strong> In the absence of a standard approach for omental infarction, conservative management is an effective noninvasive alternative but it claims for active surveillance.<br /><strong>Keywords:</strong> Infarction; Omentum.</p>

Open sternoclavicular osteophyte debridement in the surgical management of sternoclavicular osteoarthritis: clinical outcome of a new procedure

2020 ◽  
pp. 175857322097209
Author(s):  
Charles I Ayekoloye ◽  
Qi Yin ◽  
Amanda Wood ◽  
Simon Frostick
Keyword(s):  
Clinical Outcome ◽  
Conservative Management ◽  
Operative Management ◽  
Satisfaction Score ◽  
Dash Score ◽  
Patient Satisfaction Score ◽  
Subjective Satisfaction ◽  
Quick Dash ◽  
Non Operative Management

Introduction Symptomatic sternoclavicular osteoarthritis is uncommon but remains the most frequent non-traumatic condition affecting the sternoclavicular joint and tends to have a predilection for middle-aged women. It responds well to conservative management. Surgery is indicated when conservative management fails. We present the clinical outcome of open symptomatic sternoclavicular osteophyte debridement, a new operation for treating recalcitrant symptomatic sternoclavicular osteoarthritis. Methods Five patients (five symptomatic sternoclavicular joints) with symptomatic sternoclavicular osteoarthritis underwent open sternoclavicular debridement following failure of conservative treatment. There were three females and two males. Mean age was 46.6 years (range 37.17–66). Four cases were primary osteoarthritis and one case was secondary to trauma. They were reviewed at mean follow-up at 35.4 months with minimum follow-up of 29 months. Assessment included Quick Disabilities of Arm Shoulder and Hand (DASH) and subjective patient satisfaction score. Results There was no post-operative complication. Mean Quick DASH score 10.9 (range 0–29.5) at mean 35.4-month follow-up (range 29–43 months). Three patients reported excellent and two reported good outcome as per subjective satisfaction score. Conclusions Open sternoclavicular debridement has proved to be a simple, safe and highly effective new surgical treatment for patients with symptomatic sternoclavicular osteoarthritis unresponsive to non-operative management.

Conservative management of midcarpal instability

2015 ◽  
Vol 41 (1) ◽  
pp. 102-109 ◽  
Author(s):  
C. Harwood ◽  
L. Turner
Keyword(s):  
Ankle Joint ◽  
Conservative Management ◽  
Treatment Guidelines ◽  
Wrist Joint ◽  
Operative Management ◽  
Hand Therapy ◽  
Mild Pain ◽  
Complex Condition ◽  
High Level ◽  
Non Operative Management

Midcarpal instability is a complex condition that can present in various forms, from mild pain to debilitating subluxation. Once diagnosed, treatment guidelines for hand therapy are limited by the scarcity of high-level evidence. Evidence does exist for use of proprioceptive awareness and neuromuscular rehabilitation for instability of the knee, shoulder and ankle joint, but studies of similar programmes for the wrist joint have not been published. The purpose of this review is to examine the evidence supporting current concepts in the non-operative management of midcarpal instability, and to provide recommendations for the management of this condition with hand therapy.

scholarly journals A prospective and retrospective study on conservative management of hepatic and splenic injury following blunt abdominal trauma

2020 ◽  
Vol 7 (6) ◽  
pp. 1930
Author(s):  
Induchoodan Ponnamma Pillai Sukumaran Nair ◽  
Rajesh P. S.
Keyword(s):  
Abdominal Trauma ◽  
Conservative Management ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Road Traffic ◽  
Operative Management ◽  
Splenic Trauma ◽  
Solid Organ ◽  
Non Operative Management

Background: worldwide road traffic accidents accounts as the leading cause of death of young people. For a very long time most of the intra-abdominal injuries following blunt abdominal trauma were managed operatively. Conservative management is becoming more acceptable and effective management option for blunt abdominal trauma during the last few decades.Methods: This study was conducted in Government Medical College, Kottayam during September 2007 to December 2008. All conservatively managed blunt abdominal trauma patients during the study period were included in the study.Results: Out of 22 patients, 4 patients failed conservative management. Success rate was 81%. Most commonly injured solid organ in the study group was liver (77%). Maximum cases were of age group 10 to 20 (31.81%) years. 81% of patients were males. Motor vehicle accident was the most common cause of trauma (77%). Mean stay in intensive care unit was 4.2 days and mean hospital stay was 15.7 days. Mean systolic blood pressure was 110 mmHg ranging from 70 to 130 mmHg. 50% of patients had moderate hemoperitoneum and non-had massive hemoperitoneum.Conclusions: Non operative management is safe and effective approach in blunt spleen and liver injuries. Non operative management should be treatment of choice for all hemodynamically stable patients with blunt liver and splenic trauma.

scholarly journals Modalities in the management of splenic trauma

2020 ◽  
Vol 7 (9) ◽  
pp. 2940
Author(s):  
Swetha B. M. ◽  
Santosh Raja Erabati ◽  
V. V. Harika Majji
Keyword(s):  
Conservative Management ◽  
Road Traffic ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Splenic Trauma ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Hemodynamic Status ◽  
Fall From Height ◽  
Non Operative Management

Background: The aim of the study to study the modalities in the management of splenic trauma. Factors affecting non operative management in order to improve the outcome of conservative management, and the factors responsible for conversion to operative management.Methods: 30 patients were admitted in the Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, satisfying the inclusion criteria between 01 June 2016 to 31 August 2018.Results: A cross-sectional type of study was performed. Among the 30 patients, 21 were male and 9 were female. It was seen that in 80% of patients the mode of injury was road traffic accident. Human assault, animal attack and fall from height contributed to 6.66% each. The most common reason for conversion to operative management was fragile hemodynamic status of the patient. 20% of the cases were grade I, 40% grade II, 26.66% grade III, 6.66% each of grade IV and grade V, all cases of grade IV and grade V were managed operatively. In this study 60% of the cases could be managed conservatively, 1 case (3.33%) splenorraphy was done. 33.3% (1/3rd) patients required splenectomy, and 1 (3.33%) patient expired who presented late and with hemodynamic instability, belonged to grade V splenic injury.Conclusions: Conservative management has replaced splenectomy as the most common method of splenic trauma management in patients with stable hemodynamic status. Higher grades of splenic injuries have been managed conservatively. As a result, 60% of all blunt splenic injuries can be managed non-operatively with a success rate of 98%. Operative management associated with stringent intensive care unit (ICU), transfusions are restricted to higher grades of splenic injuries.

scholarly journals Recommencement of anticoagulation/antiplatelet therapy following non-operative management of a Chronic Subdural Hematoma – Is there an optimal time frame?

2021 ◽  
Vol 12 ◽  
pp. 456
Author(s):  
Savan Shah ◽  
K. Joshi George
Keyword(s):  
Conservative Management ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Operative Management ◽  
Time Frame ◽  
Primary Objective ◽  
Optimal Time ◽  
Male Predominance ◽  
Significant Difference ◽  
Non Operative Management

Background: There is no consensus among clinicians regarding recommencement of antithrombotic agents following conservative management of a Chronic Subdural Hematoma (cSDH). Thus, the primary objective of this study was to determine the most commonly recommended interval and whether the data reveal a general consensus that should be adopted. Methods: A retrospective analysis of Salford Royal Foundation Trust’s Neurosurgical referral database for patients referred with a cSDH between March 2017 and March 2020 was carried out. Patients were sorted by whether they were on blood-thinning medications. Results: Over the 3-year period, there were a total of 1220 referral and 1099 patients. 502 (41.14%) of these referrals and 479 (43.59%) patients were on one more blood thinning agent. Of these patients 221 (46.13%) conservative management, there was a clear male predominance (M: F ≈ 2.5:1) in this cohort. 2 weeks was the most commonly advised time-frame (n = 76, 36.36%) to withhold. Of the 234 referrals, there were 13 (5.88%) re-referrals in total. Crucially, there was no significant difference in reaccumulation rates between patients asked to withhold their blood thinners for 2 weeks versus those asked to stop for longer than 2 weeks (P = 0.57). Conclusion: For the majority of bleeds, there is no clear benefit from asking patients to withhold their anticoagulant/antiplatelet for longer than 2 weeks. In cases, where it is deemed appropriate to stop for longer than 2 weeks, clear instructions should be provided and documented along with reasons behind the decision.

scholarly journals Approach and management modalities in Esophageal Perforations

2018 ◽  
Vol 5 (2) ◽  
pp. 373
Author(s):  
Rajendra Desai ◽  
Srivastava R. ◽  
Chitrapu C. ◽  
Mohd Kaleemuddin ◽  
Chandramala Amenha
Keyword(s):  
Esophageal Perforation ◽  
Delayed Diagnosis ◽  
Operative Management ◽  
Treatment Method ◽  
Morbidity And Mortality ◽  
Proper Understanding ◽  
Delayed Treatment ◽  
Receive Treatment ◽  
Esophageal Perforations ◽  
High Degree

Esophageal perforation leads to increased morbidity and mortality. Treatment of choice is debatable. In adult cases of esophageal perforation, the important causes can be due to trauma, or due to foreign body or due to iatrogenic and sometimes it may be spontaneous. The rate of morbidity and mortality is increased among those who fall prey to delayed diagnosis and delayed treatment. Even after the proper treatment started within one day of diagnosis, the death rate can be 10-25%. And it increases to 40-60% among those who receive treatment after two days. In case the diagnosis of perforation is made within 24 hours, the treatment of choice is “primary closure of the perforation site and wide drainage of the mediastinum”. On the other hand, if the diagnosis is delayed for more than 24 hours, then the treatment of choice is questionable. Now a days conservative method of management is more or less adopted especially patients with small size perforation and minimum involvement of extra esophageal part. Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis. Hence multi-disciplinary approach is recommended for proper outcome. Timing of intervention is extremely critical in ensuring low mortality. Diagnosis is difficult, and a high degree of suspicion is required, especially in pediatric patients. As Endoscopic therapists play an increasingly “important role in the management of upper digestive disease”, a proper understanding of this complication of therapy is required by the therapist and the attending surgeons. Management of such perforations are both non-operative and operative. Nonoperative management used for limited perforations without sepsis, while operative management is reserved for more florid perforations and those in whom obstruction distal to the perforation exists. Endoscopic intervention may save some patients from being operated upon.

scholarly journals EP.WE.709A local experience of non-operative management for an appendicitis cohort during COVID-19

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Nainika Suresh Menon ◽  
Oliver Claydon ◽  
Billy Down ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Conservative Management ◽  
Primary Outcome ◽  
Day Treatment ◽  
District General Hospital ◽  
Operative Management ◽  
Complication Rates ◽  
Local Experience ◽  
Non Operative Management ◽  
Locally Conservative

Abstract Background During the first United Kingdom COVID-19 wave, the Royal Colleges of Surgeons initially recommended conservative management with antibiotics instead of surgery for appendicitis. This study compared local outcomes of appendicitis during this period with a pre-COVID-19 cohort. Methods An observational study was conducted in a district general hospital. All episodes of appendicitis were prospectively studied from 25th March 2020 until 26th May 2020 and compared with a retrospective pre-COVID cohort from 27th November 2019 until 29th January 2020. Primary outcome was 30-day treatment failure of simple appendicitis for conservatively managed cases during COVID-19 compared to surgically managed cases pre-pandemic. Treatment failure was defined as any unplanned radiological or surgical intervention. Results Over nine weeks, there were 39 cases of appendicitis during COVID-19 and 50 cases pre-COVID-19. Twenty-six and 50 cases underwent appendicectomy during and pre-COVID-19 respectively. There was no difference in 30-day postoperative complication rates and nor were there any peri-operative COVID-19 infections. Twelve cases of simple appendicitis underwent conservative management during COVID-19 and were compared with 23 operatively managed simple cases pre-pandemic. There was a higher failure rate in the conservative versus operative group (33.3 vs 0% OR = 24.88, 95% CI 1.21 to 512.9, p = 0.0095). Length of stay was similar (1.5 vs 2.0 p = 0.576). Discussion Locally, conservative management was more likely to fail than initial appendicectomy. We suggest that surgery should remain first line for appendicitis, with conservative management reserved for those with suspected or proven COVID-19 infection.

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