scholarly journals A rare presentation of aorto-bronchial fistula and the relevance of open repair in endovascular era

2020 ◽  
Vol 7 (7) ◽  
pp. 2393
Author(s):  
M. Faizal Effendi Zulkifli ◽  
M. Azri Marican ◽  
Abdul Rashid M. Radzif ◽  
Muhammad Ibrahim Azmi ◽  
Mohamad Arif Muhammad ◽  
...  
Keyword(s):  
Lower Lobe ◽  
Lung Parenchyma ◽  
Operative Management ◽  
Massive Bleeding ◽  
Definitive Treatment ◽  
Rare Presentation ◽  
Bronchial Fistula ◽  
Aorta Aneurysm ◽  
Non Operative Management ◽  
Thoracic Aorta Aneurysm

Aorto-bronchial fistula is a rare but potentially fatal condition due to torrential bleeding from erosion of aneurysmal wall into bronchial wall or lung parenchyma. It is usually associated with infection, lung transplantation, pulmonary malignancies, atherosclerotic and mycotic aneurysms, and anastomotic pseudoaneurysms after open or endovascular surgery. The typical presentation usually manifested by haemoptysis, but rarely the patient also can be presented with hematemesis and this will delay the definitive treatment. Surgical or endovascular repair is mandatory because non-operative management will lead to a poor prognosis due to massive bleeding from the fistula.  We would like to present a unique case of an elderly man presented with intermittent haematemesis, in which he later developed profound haemoptysis and diagnosed with ABF. Although in the era of endovascular, the ABF was successfully treated via open thoracotomy, resection of thoracic aorta aneurysm, left lower lobe lobectomy, and completed with aortic repair using Gelweave aortic graft.

scholarly journals Interventional radiology versus operative management for splenic injuries: a study protocol for a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028172
Author(s):  
Masahiro Kashiura ◽  
Noritaka Yada ◽  
Kazuma Yamakawa
Keyword(s):  
Systematic Review ◽  
Interventional Radiology ◽  
Meta Analysis ◽  
Operative Management ◽  
Sensitivity Analyses ◽  
Definitive Treatment ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Statistical Heterogeneity ◽  
Non Operative Management

IntroductionOver the past decades, the treatment for blunt splenic injuries has shifted from operative to non-operative management. Interventional radiology such as splenic arterial embolisation generally increases the success rate of non-operative management. However, the type of intervention, such as the first definitive treatment for haemostasis (interventional radiology or surgery) in blunt splenic injuries is unclear. Therefore, we aim to clarify whether interventional radiology improves mortality in patients with blunt splenic trauma compared with operative management by conducting a systematic review and meta-analysis.Methods and analysisWe will search the following electronic bibliographic databases to retrieve relevant articles for the literature review: Medline, Embase and the Cochrane Central Register of Controlled Trials. We will include controlled trials and observational studies published until September 2018. We will screen search results, assess the study population, extract data and assess the risk of bias. Two review authors will extract data independently, and discrepancies will be identified and resolved through a discussion with a third author where necessary. Data from eligible studies will be pooled using a random-effects meta-analysis. Statistical heterogeneity will be assessed by using the Mantel-Haenszel χ² test and the I² statistic, and any observed heterogeneity will be quantified using the I² statistic. We will conduct sensitivity analyses according to several factors relevant for the heterogeneity.Ethics and disseminationOur study does not require ethical approval as it is based on the findings of previously published articles. This systematic review will provide guidance on selecting a method for haemostasis of splenic injuries and may also identify knowledge gaps that could direct further research in the field. Results will be disseminated through publication in a peer-reviewed journal and presentations at relevant conferences.PROSPERO registration numberCRD42018108304.

scholarly journals 594 Optimising Hand Trauma Care at a Major Trauma Centre (MTC) During the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Khajuria
Keyword(s):  
Operative Management ◽  
Trauma Centre ◽  
Definitive Treatment ◽  
Face To Face ◽  
Major Trauma Centre ◽  
Treatment Centre ◽  
One Stop ◽  
The One ◽  
Non Operative Management

Abstract Introduction This study evaluates the management of hand injuries during COVID-19 following the prompt implementation of the BOA guidelines; reconfiguration of hand services and implementation of the ‘one-stop’ model. Method 285 cases OVER A 1-MONTH PERIOD were RETROSPECTIVELY reviewed to evaluate the effectiveness of managing patients using the ‘one-stop’ model and the new Urgent Treatment Centre (UTC). Results 277 patients were included in the study. During Covid-19, operative cases fell by 62%. 86.3% (239/277) of cases were managed in the UTC; 54.4% (130/239) required conservative management and 45.6% (109/239) required minor procedures (in UTC). REMOVABLE SPLINT USE was optimized through design of ‘softcasts’ for non-operative management of distal radius fractures. A patient education video: ‘softcast removal at home’ was created and in cases requiring sutures, 95.1% (39/41) were absorbable, thereby avoiding COVID-19 exposure for follow-up. Only 50.5% (140/277) of patients had formal follow-up arranged and patient information follow-up cards were developed. Conclusions The one-stop model prevents delay in definitive treatment, allows effective initial treatment, and minimizes the need for face-to-face follow up. In light of a possible second wave of COVID-19 cases, this new model should be considered for implementation by all hand’s units for the foreseeable future.

scholarly journals Prognostic Factors in the Decision-Making Process for Sigmoid Volvulus. Results of a Single-Centre Retrospective Cohort Study.

2021 ◽  
Author(s):  
Zoe Slack ◽  
Mohamed Shams ◽  
Raheel Ahmad ◽  
Roshneen Ali ◽  
Diandra Antunes ◽  
...  
Keyword(s):  
Operative Management ◽  
Functional Condition ◽  
Sigmoid Volvulus ◽  
Definitive Treatment ◽  
Rectal Tube ◽  
Term Survival ◽  
Average Survival ◽  
Younger Age ◽  
Non Operative Management

Abstract BACKGROUND: Sigmoid volvulus is a common cause of emergency surgical admission. It often affects older males who are institutionalized and are less suitable surgical candidates. Definitive treatment is surgical, but first line treatment is via endoscopic devolution with or without placement of a rectal tube. After non-operative management recurrence is likely and carries a high mortality, therefore an early surgical approach may be considered in patients who are fit for surgery. We have retrospectively analyzed a cohort of patients with sigmoid volvulus in order to clarify if and when a more aggressive management is indicated.METHODS: We have reviewed data on admitted patients diagnosed with sigmoid volvulus over a 2-year period. Demographic, clinical data, morbidity and mortality were recorded in a database. The primary endpoint was patient survival. Secondary endpoint was the estimation of the factors that condition surgical choice.RESULTS: We analysed 332 admission of 78 patients. 39.7% of patients underwent surgical resection. The average survival was 54.9±8.8 months from the first hospitalization, irrespective of the treatment. Long-term survival was positively influenced by being female, having a low "social score", a younger age and surgery. Multivariate analysis showed that only being female and surgery were independently associated with better survival.CONCLUSION: Early surgery may be the best approach in patients with recurrent sigmoid volvulus, as it ensures longer survival with a better quality of life, regardless of the patient's social and functional condition.

scholarly journals Thoracic aorta aneurysm- a rare cause of chronic backache with mediastinal shadow: case report

2018 ◽  
Vol 4 (12) ◽  
pp. 296
Author(s):  
Akash Mathur ◽  
Devleena Gangopadhyay ◽  
Ashutosh Daga ◽  
Puneet Saxena ◽  
Hemant Malhotra
Keyword(s):  
Case Report ◽  
Thoracic Aorta ◽  
Beta Blockers ◽  
Left Lung ◽  
Lower Lobe ◽  
Symptomatic Treatment ◽  
Aortic Aneurysms ◽  
Aorta Aneurysm ◽  
Thoracic Aortic Aneurysms ◽  
Thoracic Aorta Aneurysm

<p class="abstract">Thoracic aortic aneurysms (TAA) are rarely symptomatic. A 55 year old male presents with longstanding chronic backache. CXR showed left hilar shadow with collapse of left lung. Considering the CXR findings and with the patient being chronic smoker a strong possibility of carcinoma lung with bony metastasis was kept and further CECT chest was done. The CECT chest was suggestive of a thoracic aorta aneurysm with thrombosis compressing left principal bronchus and its lower lobar branch resulting in distal area of collapse and consolidation of left lower lobe. These findings were further confirmed on CT angiography. The patient was thus diagnosed as a case of descending thoracic aorta aneurysm probably of atherosclerotic etiology with thrombosis. Patient was started on beta blockers and ACE inhibitors along with supportive and symptomatic treatment and was further transferred to the department of CTVS for surgical intervention. Thus, this case report here signifies that possibility of thoracic aorta aneurysm should always be considered in a patient with chronic backache specially in presence of mediastinal shadow on CXR.</p>

scholarly journals Damage control in penetrating carotid artery trauma: changing a 100-year paradigm

2021 ◽  
Vol 52 (2) ◽  
pp. e4054807
Author(s):  
José Julian Serna ◽  
Carlos Alberto Ordoñez ◽  
Michael W Parra ◽  
Yaset Caicedo ◽  
Alberto Rosero ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Damage Control ◽  
Hypovolemic Shock ◽  
Damage Control Surgery ◽  
Operative Management ◽  
Altered Mental Status ◽  
Massive Bleeding ◽  
Carotid Artery Injuries ◽  
Therapeutic Decision Making ◽  
Non Operative Management

Carotid artery trauma carries a high risk of neurological sequelae and death. Surgical management of these injuries has been controversial because it entails deciding between repair or ligation of the vessel, for which there is still no true consensus either way. This article proposes a new management strategy for carotid artery injuries based on the principles of damage control surgery which include endovascular and/or traditional open repair techniques. The decision to operate immediately or to perform further imaging studies will depend on the patient's hemodynamic status. An urgent surgical intervention is indicated if the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock. An altered mental status upon arrival is a potentially poor prognosis marker and should be taken into account in the therapeutic decision-making. We describe a step-by-step algorithmic approach to these injuries, including open and endovascular techniques. In addition, conservative non-operative management has also been included as a potentially viable strategy in selected patients, which avoids unnecessary surgery in many cases.

scholarly journals TP9.2.30Sigmoid Volvulus: Is a More Aggressive Approach Justified? Results of a Retrospective Cohort Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Zoe Slack ◽  
Mohamed Shams ◽  
Mahmoud Sallam ◽  
Giles Bond-Smith ◽  
Giovanni Tebala
Keyword(s):  
Operative Management ◽  
Functional Condition ◽  
Sigmoid Volvulus ◽  
Definitive Treatment ◽  
Rectal Tube ◽  
Term Survival ◽  
Aggressive Approach ◽  
Average Survival ◽  
Younger Age ◽  
Non Operative Management

Abstract Aims Sigmoid volvulus is a common cause of emergency surgical admission. It often affects older males who are institutionalised and are less suitable surgical candidates. Definitive treatment is surgical but first line treatment is via endoscopic devolution with or without placement of a rectal tube. After non-operative management recurrence is likely and carries a high mortality, therefore an early surgical approach may be considered in patients who are fit for surgery. We have retrospectively analysed a cohort of patients with sigmoid volvulus in order to clarify if and when a more aggressive management is indicated. Methods We have reviewed data on admitted patients diagnosed with sigmoid volvulus over a 2-year period. Demographic, clinical data, morbidity and mortality were recorded in a database. Analysis was carried out with statistical programs. The primary endpoint was patient survival. Secondary endpoint was the estimation of the factors that condition surgical choice. Results We analysed 78 cases. 74.4% had multiple admissions and recurrences. 39.7% of patients underwent surgical resection. The average survival was 54.9±8.8 months from the first hospitalisation, irrespective of the treatment. Long-term survival was positively influenced by being female, having a low “social score”, a younger age and surgery. Multivariate analysis showed that only being female and surgery were independently associated with better survival. Conclusions In conclusion, we believe that early surgery may be the best approach in patients with recurrent sigmoid volvulus, as it ensures longer survival with a better quality of life, regardless of the patient's social and functional condition.

scholarly journals P84 Optimising hand trauma care at a Major Trauma Centre (MTC) during the COVID-19 pandemic

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Apoorva Khajuria ◽  
Matthew Jones ◽  
Apoorva Khajuria
Keyword(s):  
Operative Management ◽  
Trauma Centre ◽  
Definitive Treatment ◽  
Face To Face ◽  
Major Trauma Centre ◽  
Treatment Centre ◽  
One Stop ◽  
The One ◽  
Non Operative Management

Abstract Introduction This study evaluates the management of hand injuries during COVID-19 following the prompt implementation of the BOA guidelines; reconfiguration of hand services and implementation of the ‘one-stop’ model. Methods 285 cases OVER A 1-MONTH PERIOD were RETROSPECTIVELY reviewed to evaluate the effectiveness of managing patients using the ‘one-stop’ model and the new Urgent Treatment Centre (UTC). Results 277 patients were included in the study. During Covid-19, operative cases fell by 62%. 86.3% (239/277) of cases were managed in the UTC; 54.4% (130/239) required conservative management and 45.6% (109/239) required minor procedures (in UTC). REMOVABLE SPLINT USE was optimized through design of ‘softcasts’ for non-operative management of distal radius fractures. A patient education video: ‘softcast removal at home’ was created and in cases requiring sutures, 95.1% (39/41) were absorbable, thereby avoiding COVID-19 exposure for follow-up. Only 50.5% (140/277) of patients had formal follow-up arranged and patient information follow-up cards were developed. Conclusion The one-stop model prevents delay in definitive treatment, allows effective initial treatment, and minimizes the need for face-to-face follow up. In light of a possible second wave of COVID-19 cases, this new model should be considered for implementation by all hand’s units for the foreseeable future.

scholarly journals FOREIGN BODY BRONCHUS PRESENTING WITH PLEURAL EFFUSION –A RARE PRESENTATION

2017 ◽  
Vol VOLUME 5 (VOLUME 5 NUMBER 2 JULY 2017) ◽  
pp. 18-20
Author(s):  
Sanjay Kumar
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Lower Lobe ◽  
Intrathoracic Pressure ◽  
The Elderly ◽  
Lung Parenchyma ◽  
Rigid Bronchoscopy ◽  
Flexible Bronchoscopy ◽  
Rare Presentation ◽  
Flexible Bronchoscope

INTRODUCTION: Aspirated foreign bodies most commonly are lodged in the right main stem and lower lobe. Aspiration has been documented in all lobes, including the upper lobes, though with less frequency.1-4 CASE REPORT: A 28 year old female presented with the chief complaints of shortness of breath since 15 days, cough with expectoration since 15 days, chest pain since 15 days. On examination the trachea was shifted to left side, bilateral chest movements were unequal with reduced chest movement on right side, tenderness was present on right side of chest. Chest X-Ray showed right sided hydropneumothorax. On flexible bronchoscopy Right bronchus intermedius showed foreign material. Foreign body removal under general anesthesia was done by rigid bronchoscopy. DISCUSSION: Unlike foreign-body aspiration in young children and in the elderly, this occurence is uncommon in adults. The availability of both rigid and flexible bronchoscopy should be emphasized since larger aspirates may not be retrievable with a flexible bronchoscope. Surgery constitutes the final, definitive option and is generally well tolerated, particularly when the lung parenchyma is spared.5-7 This case emphasizes the fact that healthy adults may tolerate aspiration of foreign bodies for a long time without acute life-threatening consequences.5-8 The exact mechanism is not known. The possible mechanisms are either it may be a result of an inflammatory response to a foreign body in the bronchus or it is secondary to the atelectasis and the sudden morenegative intrathoracic pressure.9-11

scholarly journals 883 Modified Framework for The Management of Acute Gallstone Disease During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A White ◽  
J Brewer ◽  
E Efthimiou ◽  
H Khwaja ◽  
G Bonanomi
Keyword(s):  
Gallstone Disease ◽  
Operative Management ◽  
Definitive Treatment ◽  
Biliary Colic ◽  
Gallstone Pancreatitis ◽  
Early Laparoscopic Cholecystectomy ◽  
Global Pandemic ◽  
Early Adoption ◽  
Efficient Resource ◽  
Non Operative Management

Abstract Introduction On 12/03/2020 WHO declared SARS-CoV-2 a global pandemic. PHE and RCS advised non-operative management wherever possible, changing management of acute gallstone disease from early laparoscopic cholecystectomy to conservative treatment and frequent percutaneous drainage. Planning, prioritisation, and implementation of “COVID-Safe” pathways presented multi-factorial challenges throughout the NHS. Method Prospective data of patients admitted with acute gallstone pathology was collected at Chelsea & Westminster Hospital (23/03/2020-16/08/2020), and prioritised using Tokyo, FSSA and RCS Guidance. A restructured “Gallbladder-pathway” was implemented comprising trust-wide referral proforma, weekly clinical planning MDT meetings and dedicated theatre lists. Results Sixty-eight patients were prioritized as either “Urgent” (25), “Expedited” (12) or “Elective” (31); comprising gallstone pancreatitis (11), acute cholecystitis (53), obstructive jaundice (12) and biliary colic (8). 12 patients required cholecystostomies. During the “Peak” (23/3/20-02/06/2020) no cholecystectomies were performed, 10 in “Recovery” (02/06/20-06/07/20) in NCEPOD theatre, 21 in “Resolution” (06/07/20-18/08/20) since implementation of the “Gallbladder-Pathway”. Eleven patients (16%) re-presented while awaiting definitive treatment, none critically ill. The highest number of re-presentations was in “Urgent” patients (36%) and those with cholecystostomy (45%). Conclusions Early adoption of a modified “Gallbladder-pathway” during the pandemic allowed accurate case stratification, efficient resource allocation and safe care. Our model enabled prompt service recovery and a framework to navigate future disruption.

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