scholarly journals Management of esophageal perforation with fistula formation in an 80 year old woman with multiple co-morbidities

2021 ◽  
Vol 7 (5) ◽  
pp. 882
Author(s):  
Jalal Almarzooq ◽  
Ayman Alkhabbaz ◽  
Nabeel Abdulla
Keyword(s):  
Foreign Body ◽  
Conservative Management ◽  
Esophageal Perforation ◽  
Open Surgery ◽  
Surgical Intervention ◽  
Fish Bone ◽  
Foreign Body Ingestion ◽  
Fistula Formation

<p class="abstract">Esophageal perforation due to foreign body ingestion may lead to serious complications. Here we present a case of an 80 year old lady with multiple co-morbidities who presented with a proximal esophageal perforation with fistula formation following ingestion of a fish bone. Due to her age and co-morbidities the decision was made to manage her conservatively by IV antibiotics, NG tube feeds and observation. Follow up after 2 months showed resolution of the perforation and fistula, without the patient needing any surgical intervention. This case highlights conservative management of esophageal perforation with complications in patients with co-morbidities where open surgery is not favoured.</p>

scholarly journals Relative Efficacy of Three of Nonsurgical Treatments for Calcific Tendinitis: Physical Therapy vs Steroid Injection vs Ultrasound-Guided Aspiration

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0021
Author(s):  
Mauricio Drummond ◽  
Caroline Ayinon ◽  
Albert Lin ◽  
Robin Dunn
Keyword(s):  
Physical Therapy ◽  
Rotator Cuff ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Corticosteroid Injection ◽  
Calcific Tendinitis ◽  
Ultrasound Guided ◽  
Calcium Deposits

Objectives: Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC) that accounts for up to 7% of cases of shoulder pain1. The most common conservative treatments typically include physical therapy (PT), corticosteroid injection (CSI), or ultrasound-guided aspiration (USA). When conservative management fails, the patient may require arthroscopic surgery to remove the calcium with concomitant rotator cuff repair. The purpose of this study was to characterize the failure rates, defined as the need for surgery, of each of these three methods of conservative treatment, as well as to compare post-operative improvement in patient-reported outcomes (PROs) – including subjective shoulder values (SSV) and visual analog scale (VAS) pain scores – based on the type of pre-operative conservative intervention provided. A secondary aim was to compare post-operative range of motion (ROM) outcomes between groups that failed conservative management. We hypothesized that all preoperative conservative treatments would have equivalent success rates, PROs, and ROM. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12122 shoulders. JAMA. 1941;116(22):2477-2489. Methods: A retrospective review of all patients who were diagnosed with calcific tendinitis at our institution treated among 3 fellowship trained orthopedic surgeons between 2009 and 2019 was performed. VAS, SSV, and ROM in forward flexion (FF) and external rotation (ER) was abstracted from the medical records. Scores were recorded at the initial presentation as well as final post-operative follow-up visit for those who underwent surgery. The conservative treatment method utilized by each patient was recorded and included PT, CSI, or USA. Failure of conservative management was defined as eventual progression to surgical intervention. Statistical analysis included chi-square, independent t test and ANOVA. Descriptive statistics were used to report data. A p<0.05 was considered to be statistically significant. Results: 239 patients diagnosed with calcific tendinitis were identified in the study period with mean age of 54 years and follow up of at least 6 months. In all, 206 (86.2%) patients underwent a method of conservative treatment. Of these patients, 71/239 (29.7%) underwent PT, 67/239 (28%) attempted CSI, and 68/239 (28.5%) underwent USA. The overall failure rate across all treatment groups was 29.1%, with injections yielding the highest success rate of 54/67 (80.6%). Physical therapy saw the highest failure rate, with 26/71 (36.7%) proceeding to surgical intervention. Patients undergoing physical therapy were statistically more likely to require surgery compared to those undergoing corticosteroid injection (RR 1.88, p= 0.024). Of all 93 patients who underwent surgery, VAS, SSV, ROM improved significantly in all groups. On average, VAS decreased by 4.02 points (6.3 to 2.3), SSV increased by 33 points (51 to 84), FF improved by 13.8º, and ER improved 8.4º between the pre- and post-operative visits (p<0.05). The 33 patients who did not attempt a conservative pre-operative treatment demonstrated the largest post-operative improvement in VAS (-6.00), which was significantly greater than those who previously attempted PT (-3.33, p<0.05). There was a trend towards greater improvement in SSV in the pre-operative PT group (45 to 81) compared to others, but this did not reach statistical significance (p=0.47). Range of motion was not significantly affected by the method of pre-operative conservative intervention. Conclusions: Conservative treatment in the form of physical therapy, corticosteroid injection, and ultrasound-guided aspiration is largely successful in managing calcific tendinitis of the shoulder. Of these, PT demonstrated the highest rate of failure in terms of requiring surgical management. PRO improvement varied among the conservative modalities used, however patients who did not attempt conservative management experienced the greatest improvements following surgery. If surgery is necessary following failed conservative treatment, excellent outcomes can be expected with significant improvements in ROM and PROs. This information should be considered by the surgeon when deciding whether to recommend conservative treatment for the management of calcific tendinitis, as well as which specific method to employ.

Conservative Management in Two Penetrating Fishbone Injuries: A Case Series and Literature Review

2021 ◽  
Keyword(s):  
Foreign Body ◽  
Literature Review ◽  
Conservative Management ◽  
Case Reports ◽  
Case Series ◽  
Foreign Body Ingestion ◽  
Medical Referral

Foreign body ingestion is a regular medical referral. Patients present with different objects such as chicken bones, nails, coins, and fishbones. It is usually managed in causality and passes without any intervention. However, occasionally, we come across fishbone complications requiring intervention. We discuss the course and management of two case reports of fishbone injuries in different abdominal regions.

scholarly journals Enterohepatic Migration of Fish Bone Resulting in Liver Abscess

2015 ◽  
Vol 2015 ◽  
pp. 1-2 ◽  
Author(s):  
Chikwendu Ede ◽  
Sanju Sobnach ◽  
Delawir Kahn ◽  
Ahmed Bhyat
Keyword(s):  
Foreign Body ◽  
Liver Abscess ◽  
Preoperative Diagnosis ◽  
Hepatic Abscess ◽  
Fish Bone ◽  
Abscess Formation ◽  
Secondary Peritonitis ◽  
Foreign Body Ingestion

Liver abscess formation due to enterohepatic migration of a foreign body is extremely rare. Foreign body ingestion is generally an unconscious and painless event, thus complicating preoperative diagnosis in most patients. We report the case of a 61-year-old man who presented with secondary peritonitis from a ruptured hepatic abscess after an ingested fish bone migrated into the liver.

A propensity-adjusted comparison of middle meningeal artery embolization versus conventional therapy for chronic subdural hematomas

2021 ◽  
pp. 1-6
Author(s):  
Joshua S. Catapano ◽  
Andrew F. Ducruet ◽  
Candice L. Nguyen ◽  
Tyler S. Cole ◽  
Jacob F. Baranoski ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Conservative Management ◽  
Conventional Therapy ◽  
Surgical Intervention ◽  
Middle Meningeal Artery ◽  
Adjusted Analysis ◽  
Subdural Hematomas ◽  
Tertiary Center ◽  
Meningeal Artery

OBJECTIVEMiddle meningeal artery (MMA) embolization is a promising treatment strategy for chronic subdural hematomas (cSDHs). However, studies comparing MMA embolization and conventional therapy (surgical intervention and conservative management) are limited. The authors aimed to compare MMA embolization versus conventional therapy for cSDHs using a propensity-adjusted analysis.METHODSA retrospective study of all patients with cSDH who presented to a large tertiary center over a 2-year period was performed. MMA embolization was compared with surgical intervention and conservative management. Neurological outcome was assessed using the modified Rankin Scale (mRS). A propensity-adjusted analysis compared MMA embolization versus surgery and conservative management for all individual cSDHs. Primary outcomes included change in hematoma diameter, treatment failure, and complete resolution at last follow-up.RESULTSA total of 231 patients with cSDH met the inclusion criteria. Of these, 35 (15%) were treated using MMA embolization, and 196 (85%) were treated with conventional treatment. On the latest follow-up, there were no statistically significant differences between groups in the percentage of patients with worsening mRS scores. Of the 323 total cSDHs found in 231 patients, 41 (13%) were treated with MMA embolization, 159 (49%) were treated conservatively, and 123 (38%) were treated with surgical evacuation. After propensity adjustment, both surgery (OR 12, 95% CI 1.5–90; p = 0.02) and conservative therapy (OR 13, 95% CI 1.7–99; p = 0.01) were predictors of treatment failure and incomplete resolution on follow-up imaging (OR 6.1, 95% CI 2.8–13; p < 0.001 and OR 5.4, 95% CI 2.5–12; p < 0.001, respectively) when compared with MMA embolization. Additionally, MMA embolization was associated with a significant decrease in cSDH diameter on follow-up relative to conservative management (mean −8.3 mm, 95% CI −10.4 to −6.3 mm, p < 0.001).CONCLUSIONSThis propensity-adjusted analysis suggests that MMA embolization for cSDH is associated with a greater extent of hematoma volume reduction with fewer treatment failures than conventional therapy.

scholarly journals Esophageal Perforation Caused by a Fish Bone Treated with Surgically Indwelling Drainage and Fibrin Glue Injection for Fistula Formation

2013 ◽  
Vol 19 (4) ◽  
pp. 289-292 ◽  
Author(s):  
Toru Kimura ◽  
Toshiki Takemoto ◽  
Yoshinori Fujiwara ◽  
Katsunari Yane ◽  
Hiroyuki Shiono
Keyword(s):  
Fibrin Glue ◽  
Esophageal Perforation ◽  
Fish Bone ◽  
Fistula Formation ◽  
Glue Injection

scholarly journals Aortic penetration due to a fish bone: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Daming Jiang ◽  
Yi Lu ◽  
Yigong Zhang ◽  
Zhanglong Hu ◽  
Haifeng Cheng
Keyword(s):  
Foreign Body ◽  
Fish Bone ◽  
Term Treatment ◽  
Aortoesophageal Fistula ◽  
First Case ◽  
Long Term Treatment ◽  
Swallowing Pain ◽  
Life Threatening ◽  
Sharp Foreign Body

Abstract Background Aortoesophageal fistula (AEF) caused by an esophageal foreign body is a life-threatening crisis, with rapid progress and high mortality. The first case of AEF was reported in 1818, but the first successfully managed case was not until 1980. Although there have been some reports on this condition, in most cases, the aorta was invaded and corroded due to its adjacent relationship with the esophagus and subsequent mediastinitis. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body, likely because this type of injury is extremely rare and most patients cannot receive timely treatment. Here, we present a rare case of a fish bone that directly pierced the aorta via the esophagus. Case presentation A 31-year-old female experienced poststernum swallowing pain after eating a meal of fish. Gastroscope showed a fishbone-like foreign body had penetrated the esophagus wall. Computed tomography revealed that the foreign body had directly pierced the aorta to form an AEF. Surgery was successfully performed to repair the aorta and esophagus. The postoperation and follow-up was uneventful. Conclusions For the treatment of foreign bodies in the esophagus, we should be alert of the possibility of AEFs. The effective management of AEFs requires early diagnosis and intervention, as well as long-term treatment and follow-up, which still has a long way to go.

scholarly journals Accidental multiple magnet ingestion by an adult: a case report

2020 ◽  
Vol 7 (6) ◽  
pp. 2050
Author(s):  
Suraj Gopal ◽  
Dubey Indu Bhushan ◽  
Junaid Ahmad Sofi
Keyword(s):  
Foreign Body ◽  
Surgical Intervention ◽  
The Other ◽  
Foreign Body Ingestion ◽  
Pressure Necrosis ◽  
History Of ◽  
Magnet Ingestion ◽  
Magnetic Foreign Body ◽  
Asymptomatic Individuals ◽  
Early Surgical Intervention

Accidental multiple magnetic foreign body ingestion although common in children is rare in adults. Multiple magnetic foreign body ingestion possess a definitive risk of causing intestinal perforation, volvulus or fistulas and requires early surgical intervention even in apparently asymptomatic individuals to prevent catastrophic complications. We report a case of an 18 year old male with a history of accidental simultaneous ingestion of two semi-circular shaped magnets along with a nail. The peculiarity of the case being that despite the magnets being simultaneously ingested, one was in the stomach and the other in the jejunum adhered to each other through the transverse colon mesentery causing pressure necrosis of the adjoining wall with the patient being asymptomatic.

scholarly journals Risk Factors for Failure of Nonoperative Treatment for Unilateral Cervical Facet Fractures

2017 ◽  
Vol 11 (3) ◽  
pp. 356-364 ◽  
Author(s):  
Carola Francisca van Eck ◽  
Mitchell Stephen Fourman ◽  
Amir Mohamad Abtahi ◽  
Louis Alarcon ◽  
William Fielding Donaldson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conservative Management ◽  
Radiographic Progression ◽  
Surgical Intervention ◽  
Nonoperative Management ◽  
Classification Systems ◽  
Retrospective Clinical Study ◽  
Radicular Symptoms ◽  
Time Of Presentation

<sec><title>Study Design</title><p>Retrospective clinical study.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to determine what percentage of patients who underwent nonoperative management of unilateral non-displaced or minimally displaced facet fractures progressed radiographically and to determine what percentage of patients required surgical intervention and to identify risk factors for failure of conservative management.</p></sec><sec><title>Overview of Literature</title><p>According to most commonly used classification systems, unilateral, non-and minimally displaced facet fractures are be amendable to nonoperative management.</p></sec><sec><title>Methods</title><p>A retrospective review of the Trauma Registry of a Level I trauma center was performed to identify all patients diagnosed with a non- or minimally displaced unilateral facet fracture which was managed nonoperatively. Several demographic variables and clinical outcomes were recorded. Using computed tomography scanning and plain radiographs, fracture pattern, listhesis, displacement, angle and percentage of the facet that included the fracture were determined. Radiographic progression was defined as the occurrence of listhesis of more than 10% of the anterior-posterior dimensions of the inferior vertebral body during radiographic follow-up. Failure of conservative management was defined as a patient requiring surgical intervention after initially being managed nonoperatively.</p></sec><sec><title>Results</title><p>Seventy-four patients were included. Fifteen patients (20%) progressed radiographically. However, only 2 developed radicular symptoms and none developed myelopathy or other catastrophic cord related symptoms. Seven patients (9%) underwent surgery. Indications for surgery included significant radiographic progression and/or radicular symptoms. Risk factors for failure of conservative management included presence of radiculopathy at the time of presentation, a higher body mass index, increased Injury Severity Score, greater initial fracture displacement and more than 2 mm of listhesis.</p></sec><sec><title>Conclusions</title><p>Patients with non-displaced or minimally displaced facet fractures who do not have neurological symptoms at the time of presentation can safely be managed conservatively with careful observation and follow-up.</p></sec>

scholarly journals Conservative management of early uncomplicated appendicitis in children

2017 ◽  
Vol 4 (3) ◽  
pp. 1024 ◽  
Author(s):  
Sunil Kumar Maini ◽  
Neeraj Kumar Jain ◽  
Manjari Goel Jain ◽  
Vicky Khobragade
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Conservative Management ◽  
Medical Management ◽  
Surgical Intervention ◽  
Lower Abdominal Pain ◽  
Primary Treatment ◽  
Research Centre ◽  
Uncomplicated Appendicitis

Background: Right lower abdominal pain management in children is a challenging task for the surgeon. Most of the time right lower abdominal pain ends up in acute appendicitis. For long time appendicetomy was the treatment of choice. However surgical intervention has its own disadvantages such as pain, scarring, adhesions, hernia development and venous thrombosis disease. Anxiety and fear of surgery were also two difficulties in obtaining consent for surgery. Parents often request and insist for medical management. Their unwillingness for surgical intervention was the most important reason for medical management of uncomplicated acute appendicitis.Methods: Our prospective observational study was conducted in the Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of January 2014 to January 2016 and follow up was done till December 2016. Our target group was children under 16 years. A total of 92 children with complaint of right lower abdominal pain attended the hospital for treatment. Routine investigations including ultrasonography of abdomen were performed for all the patients. Out of 92 patients diagnosis of acute appendicitis was made in 74 patients, Surgery was performed in 32 patients, while remaining 42 patients were treated conservatively and the results were analyzed.Results: In this study of 92 patients of pain in right iliac fossa below 16 years, 74 (80.43%) were diagnosed as acute appendicitis. 32 (43.24%) Patients were operated earlier. 42 (56.75%) Patient were treated conservatively. Out of 42 patients, 12 (16.21%) patients were operated within 1 year, 30 (40.54%) Patients didn’t require any surgical intervention during 1 year follow up. In present study, significant role of antibiotic was found in conservative management of acute appendicitis in children. So it can be concluded that conservative management of acute appendicitis in children can be attempted under observation.Conclusions: Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. Appendicectomy should be done but conservative management of acute appendicitis in children can be attempted under observation.

scholarly journals A case of esophageal perforation: Clinical and diagnostic management in emergency medicine

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Marco Di Serafino ◽  
Maurizio Martorano ◽  
Pamela Delmonaco ◽  
Chiara Gullotto ◽  
Andrea Baglioni ◽  
...  
Keyword(s):  
Foreign Body ◽  
Esophageal Perforation ◽  
Delayed Diagnosis ◽  
Penetrating Trauma ◽  
Foreign Body Ingestion ◽  
Delay In Diagnosis ◽  
Diagnostic Management ◽  
Esophagus Perforation ◽  
Boerhaave Syndrome ◽  
Diagnostic Work

Esophageal perforation is a welldefined and severe clinical condition. The associated mortality rates range between 5% and 40% and are worsened by delayed diagnosis. Rapid diagnosis and therapy provide the best chance for survival; however, a delay in diagnosis is common, resulting in substantial morbidity and mortality. There are several aetiologies of esophagus perforation. Most esophageal ruptures are secondary to medical instrumentation. Other causes are Boerhaave syndrome, toxic ingestions and radiation, foreign body ingestion, penetrating trauma, and, rarely, blunt chest trauma. We reported the clinical management and the diagnostic work-up case of esophagus perforation due to the foreign body ingestion.

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