scholarly journals The Technique and Advantages of Contrast-Enhanced Ultrasound in the Diagnosis and Follow-up of Traumatic Abdomen Solid Organ Injuries

2021 ◽  
Author(s):  
Marco Di Serafino ◽  
Francesca Iacobellis ◽  
Maria Laura Schillirò ◽  
Roberto Ronza ◽  
Francesco Verde ◽  
...  
Keyword(s):  
Operative Management ◽  
Solid Organ ◽  
Permanent Disability ◽  
Advantages And Disadvantages ◽  
Pictorial Review ◽  
Common Causes ◽  
Moderate Energy ◽  
Abdominal Lesions ◽  
Non Operative Management

Trauma is one of the most common causes of death or permanent disability in young people, so a timely diagnostic approach is crucial. In polytrauma patients, CEUS has been shown to be more sensitive than US for the detection of solid organ injuries, improving the identification and grading of traumatic abdominal lesions with levels of sensitivity and specificity similar to those seen with MDCT. CEUS is recommended for the diagnostic evaluation of hemodynamically stable patients with isolated blunt moderate-energy abdominal traumas and for the diagnostic follow-up of conservatively managed abdominal traumas. In this pictorial review we illustrate the advantages and disadvantages of CEUS and the procedure details with tips and tricks during investigation of blunt moderate-energy abdominal trauma as well as during follow-up in non-operative management.

scholarly journals Non operative management of a patient with splenic trauma with angioembolisation after delayed presentation

2019 ◽  
Vol 6 (9) ◽  
pp. 3412
Author(s):  
Deepak Paul ◽  
Thomas K. Thomas ◽  
Dayananda Babu ◽  
Rajan Janardhanan ◽  
Ribin Christhudas
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Operative Management ◽  
Organ Injury ◽  
Splenic Trauma ◽  
Solid Organ ◽  
Delayed Presentation ◽  
Mortality And Morbidity ◽  
Common Causes ◽  
Non Operative Management

Road traffic accidents are one of the most common causes of death in India. Those involved in RTA’s frequently suffer from solid organ injury, spleen being the second most common organ involved. Splenic injuries are associated with great deal of mortality and morbidity. Splenic injuries were classically treated with splenectomy but there has been a paradigm shift to non-operative management in recent times leading to splenic salvage and preservation of function of the spleen. This report is about a lady who was managed successfully with angioembolization in spite of the fact that the patient presented late after RTA. 

scholarly journals Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 734
Author(s):  
Ivona Djordjevic ◽  
Dragoljub Zivanovic ◽  
Ivana Budic ◽  
Ana Kostic ◽  
Danijela Djeric
Keyword(s):  
Splenic Abscess ◽  
Operative Management ◽  
High Energy ◽  
Significant Difference ◽  
Injury Grade ◽  
Grade Ii ◽  
The Mean ◽  
Non Operative Management ◽  
Grade Iii

Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.

Selective non-operative management of anterior abdominal stab wounds with emphasis on the value of follow-up abdominal CT scanning

Trauma ◽  
2017 ◽  
Vol 20 (3) ◽  
pp. 194-202
Author(s):  
El Yamani Fouda ◽  
Alaa Magdy ◽  
Sameh Hany Emile
Keyword(s):  
Ct Scan ◽  
Ct Scanning ◽  
Operative Management ◽  
Abdominal Ct ◽  
Management Group ◽  
Abdominal Ct Scan ◽  
Laparotomy Group ◽  
Abdominal Stab Wounds ◽  
Non Operative Management

Background and aim Selective non-operative management of patients with penetrating abdominal stabs is the preferred treatment strategy. The present study aimed to assess the efficacy and safety of non-operative management with emphasis on the value of follow-up abdominal CT scanning in management of patients with penetrating anterior abdominal stab. Patients and methods This is a retrospective chart review of stable patients with anterior abdominal stab wounds. Patients were divided in terms of initial decisions into two groups: laparotomy group and non-operative management group. Abdominal CT scan was performed for patients in the non-operative management group on admission and follow-up CT scanning was performed in cases of clinical and/or biochemical deterioration. Results The laparotomy group included 82 patients and 68.2% of them had unnecessary laparotomies. The non-operative management group comprised 97 patients and 90.7% of them did not require subsequent laparotomy. Abdominal CT scan had a sensitivity of 88.9% and specificity of 100% in detection of intra-abdominal injuries. Follow-up CT scanning detected bowel injuries missed by initial CT scan in three patients. The non-operative management group had significantly lower post-operative complication rate than the laparotomy group (4.1% vs. 18.3%), with a significantly shorter length of stay. Conclusions Non-operative management is the optimal management strategy for stable patients with penetrating anterior abdominal stab to decrease unnecessary laparotomy rates, hospital stay and costs. Follow-up abdominal CT scanning facilitated the decision making for patients selected for non-operative management and is highly sensitive in the diagnosis of patients who require subsequent exploration.

scholarly journals Conservative Management of Gallstone Disease in the Elderly Population: Outcomes and Recurrence

2019 ◽  
Vol 109 (3) ◽  
pp. 205-210
Author(s):  
I Mora-Guzmán ◽  
M Di Martino ◽  
AC Bonito ◽  
VV Jodra ◽  
SG Hernández ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Survival Curve ◽  
Gallbladder Disease ◽  
Gallstone Disease ◽  
Operative Management ◽  
Index Admission ◽  
Consecutive Series ◽  
Early Cholecystectomy ◽  
Non Operative Management

Background & Aims: The prevalence of gallstone disease increases with age, being early cholecystectomy the most accepted treatment in the vast majority of patients in order to prevent complications and recurrence. The aim of this study is to determine the recurrence rate and its possible predictors after initial non-operative management. Materials and Methods: We reviewed a consecutive series of patients, older than 65 years, admitted for a gallstone-related disease and treated with a non-operative management between January 2010 and December 2013. We analyzed comorbidities, clinical data, diagnosis, management, recurrence, and its treatment. Median follow-up after the discharge was 2 years. Recurrence was analyzed by a Kaplan–Meier survival curve. Possible recurrence’s predictors were analyzed. Results: The study included 226 patients. Mean age was 80.4 ± 7.2 years, 127 (56%) were female. The main causes of index hospitalization were acute cholecystitis (58%) and biliary pancreatitis (18.1%). After 2 years of follow-up, the recurrence rate was 39.8%; mean time to recurrence was 255.2 ± 42.1 days, 81% of patients recurred within 1 year. Bile duct disease implied a higher recurrence rate than the gallbladder disease group (52% vs 33%, p < 0.001). Subjects with two or more diagnoses during index admission presented higher recurrence rate (32% vs 49%, p < 0.001). Conclusion: More than a third of elderly patients could present a recurrence within 2 years after initial non-operative management. Early cholecystectomy should be considered at index admission in order to prevent recurrence.

scholarly journals Predictors of the failure of conservative treatment in patients with a thoracolumbar burst fracture

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Ehsan Alimohammadi ◽  
Seyed Reza Bagheri ◽  
Paniz Ahadi ◽  
Sahar Cheshmehkaboodi ◽  
Homa Hadidi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conservative Treatment ◽  
Burst Fracture ◽  
Binary Logistic Regression ◽  
Operative Management ◽  
Binary Logistic Regression Analysis ◽  
Thoracolumbar Burst Fracture ◽  
Potential Risk Factors ◽  
Non Operative Management

Abstract Background There is a controversy about the management of patients with a thoracolumbar burst fracture. Despite the success of the conservative treatment in most of the cases, some patients failed the conservative treatment. The present study aimed to evaluate risk factors for the need for surgery during the follow-up period in these patients. Methods We retrospectively evaluated 67 patients with a traumatic thoracolumbar burst fracture who managed conservatively at our center between May 2014 and May 2019. Suggested variables as potential risk factors for the failure of conservative treatment including age, gender, body mass index (BMI), smoking, diabetes, vertebral body compression rate (VBCR), percentage of anterior height compression (PAHC), Cobb angle, interpedicular distance (IPD), canal compromise, and pain intensity as visual analog scale (VAS) were compared between patients with successful conservative treatment and those with failure of non-operative management. Results There were 41 males (61.2%) and 26 females (38.8%) with the mean follow-up time of 15.52 ± 5.30 months. Overall, 51 patients (76.1%) successfully completed conservative treatment. However, 16 cases (23.9%) failed the non-operative management. According to the binary logistic regression analysis, only age (risk ratio [RR], 2.21; 95% confidence interval [95%], 1.78–2.64; P = 0.019) and IPD (RR 1.97; 95% CI 1.61–2.33; P = 0.005) were the independent risk factors for the failure of the non-operative management. Conclusions Our results showed that older patients and those with greater interpedicular distance are at a higher risk for failure of the conservative treatment. As a result, a closer follow-up should be considered for them.

Long-Term Follow-Up After Non-operative Management of Blunt Splenic and Liver Injuries: A Questionnaire-Based Survey

2017 ◽  
Vol 42 (5) ◽  
pp. 1358-1363 ◽  
Author(s):  
Peter Moreno ◽  
Matthias Von Allmen ◽  
Tobias Haltmeier ◽  
Daniel Candinas ◽  
Beat Schnüriger
Keyword(s):  
Operative Management ◽  
Liver Injuries ◽  
Long Term Follow Up ◽  
Non Operative Management

scholarly journals Safety of vacuum-assisted biopsy/mammatome guided, non-operative management of B3 lesions with atypia: a 7-year follow-up study

2015 ◽  
Vol 17 (S1) ◽  
Author(s):  
Alex Wilkins ◽  
Peter Kneeshaw ◽  
Penelope McManus ◽  
Kartikae Grover ◽  
Caroline Bradley ◽  
...  
Keyword(s):  
Operative Management ◽  
Follow Up Study ◽  
B3 Lesions ◽  
Non Operative Management

scholarly journals 90 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Shalaby ◽  
M Ibrahim ◽  
T El Faioumy ◽  
M Elmessiry
Keyword(s):  
Abdominal Trauma ◽  
Operative Management ◽  
The Other ◽  
University Hospital ◽  
Organ Injury ◽  
Low Grade ◽  
Trauma Patients ◽  
Solid Organ ◽  
Penetrating Abdominal Trauma ◽  
Non Operative Management

Abstract Aim to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient’s candidates for non-operative management. Method In this comparative study 40 abdominal stab victims (admitted to Emergency Department of Alexandria Main University Hospital) were selected during 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome. Results In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications. Conclusions Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.

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