scholarly journals Nonoperative Management for Peri-Appendiceal Abscesses after Percutaneous Drainage Without Interval Appendectomy

2021 ◽  
Author(s):  
Chang Sung Park ◽  
In A Lee ◽  
Yun Tae Jung ◽  
Jae Gil Lee
Keyword(s):  
Medical Records ◽  
Percutaneous Drainage ◽  
Operative Management ◽  
Right Hemicolectomy ◽  
Interval Appendectomy ◽  
Telephone Contact ◽  
Mean Size ◽  
Non Operative Management ◽  
Underlying Diseases

Abstract Background: Initial non-operative management (NOM) with percutaneous drainage for peri-appendiceal abscesses has been proven to be safe and effective. However, the appropriateness of interval appendectomy after NOM is still a matter of debate. The aim of this study was to investigate the feasibility of NOM without performing interval appendectomy.Methods: A retrospective review of medical records was performed for patients who were admitted with peri-appendiceal abscesses between January 2009 and December 2019. After percutaneous drainage for the abscesses, whether to undergo interval appendectomy was decided by the patients. Their clinical courses were reviewed thoroughly through their medical records. Telephone contact with these patients was made when necessary. Results: Twenty-seven patients were enrolled, with a mean age of 63.1 years (± 11.9 years). The median follow-up period was 25.7 months. The most common co-morbidities were cardiovascular disorders (eight patients) and underlying malignancies (eight patients). The mean size of the abscesses was 5.4 x 4.1 ㎝. Three patients consequently received surgery for the recurrence of appendicitis or peri-appendiceal abscesses. One patient received a right hemicolectomy, and another two received open appendectomies. Four patients (14.8%) died within the follow-up period due to underlying diseases.Conclusion: Initial NOM without interval appendectomy was a safe option in selected patients with peri-appendiceal abscess.

scholarly journals Renal Shell injuries with Retaining renal shell fragments due to improvised explosive devices. Acute conservative approach and long term follow-up

2021 ◽  
Author(s):  
Murat Zor ◽  
Bahadir Topuz ◽  
Engin Kaya ◽  
Sercan Yilmaz ◽  
Sinan Akay ◽  
...  
Keyword(s):  
Renal Injury ◽  
Medical Records ◽  
Operative Management ◽  
Complication Rates ◽  
Long Term Follow Up ◽  
Grade 3 ◽  
One Year ◽  
Non Operative Management ◽  
Shell Fragments

Abstract Introduction: Among penetrating injuries, renal shrapnel injuries consist of a rarity of renal gunshot injuries. Due to the paucity of cases reported in the literature, there is no consensus regarding the management of renal shrapnel injuries and retaining renal shell fragments. In this study we aimed to report our non-operative management experience of renal shrapnel injuries who had also retaining renal shell fragments.Material and Methods: We retrospectively evaluated the medical records of renal shrapnel injuries that had also retaining renal shell fragments. All hemodynamically stable patients managed non-operatively and included to the study. The medical records of age, renal injury grade according to AAST, presenting pulse, systolic blood pressure, transfusion requirement, complications and need for adjuvant procedures, non-operative management success and mortality was reviewed. Complication rates due to retaining renal shell fragments were assessed by interviewing via telephone at the end of the first year of injury. The patients asked for plumbism symptoms and any surgical intervention for these foreign bodies.Results: A total of 8 patients with retaining renal shell fragments due to renal shrapnel injuries were included to the study. Mean patient age was 27,8 years. Mean follow-up period was 38.7±15.1 months. All patients were male. AAST renal injury scores were grade 1 one, grade 2 two, grade 3 four, grade 4 one patient. All patients were successfully managed non-operatively and discharged on the 7th day without any complication. No symptoms of plumbism and surgery necessity secondary to retaining renal shell fragments were seen in at least one year follow-up.Conclusion: Our study demonstrates that non-operative management of renal shrapnel injuries with retaining renal shell fragments lead low complication rates and high chance of renal preservation. However, we must keep in mind that this kind of management is safe in experienced trauma centers that have experienced staff.

scholarly journals Testicular appendage torsion managed non-operatively

2017 ◽  
Vol 4 (4) ◽  
pp. 1201
Author(s):  
Masimba Nyandowe ◽  
Alfred Egedovo
Keyword(s):  
Emergency Department ◽  
Medical Records ◽  
Operative Management ◽  
Inclusion Criteria ◽  
Viable Option ◽  
Testicular Pain ◽  
Non Operative Management

Background: Acute testicular pain is one of the commonest reasons of testicular exploration. Testicular appendage torsion is one of conditions presenting with testicular pain. If the diagnosis is certain this can be managed conservatively. Operative management is reserved for those patients in whom non-operative management fails. The objective of this study was to ascertain the success of conservative management.Methods: The medical records of thirty-four consecutive patients who were diagnosed with testicular appendage torsion, were managed non-operatively and satisfied the inclusion criteria were retrospectively analysed.  Results: The average age of patients was 16.3 years. 94% of the patients were successfully managed non-operatively. Pain not controlled by analgesia was the main reason for representing to the emergency department. All patients were discharged from any further follow up by day 9.Conclusions: Where the diagnosis of testicular appendage torsion is confidently made, non-operative management is a viable option. Larger studies are required to confirm these findings.

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 Outcome of Inferonasal Conjunctival Autograft in Pterygium Surgery

2021 ◽  
Vol 23 (4) ◽  
pp. 319-323
Author(s):  
Pragati Gautam Adhikari ◽  
Sagun Narayan Joshi
Keyword(s):  
Medical Records ◽  
Demographic Variables ◽  
Inclusion Criteria ◽  
Conjunctival Autograft ◽  
Donor Area ◽  
Mean Size ◽  
Pterygium Surgery ◽  
The Mean ◽  
Pterygium Excision

This study was done to evaluate the outcome of pterygium excision with inferonasal conjunctival autograft at a tertiary eye care centre. Retrospective analysis of medical records of primary pterygia patients operated by a single surgeon between 2017 to 2020 were analyzed. A total of 43 patients who met the inclusion criteria were included in the study. The demographic variables, along with size of pterygium and recurrence over a period of six month follow up was noted. The mean age of patients was 46.97 years (29-74 years). The mean size of pterygium was 3.17 mm. Recurrence was seen in 3 eyes over a period of 6 months. Graft edema was observed in 11 patients and graft hemorrhage along with congestion was seen in 8 cases which resolved over a 3 weeks follow up period. Mild conjunctival scarring was seen over donor area in 5 of the eyes. Pterygium excision with inferior conjunctival autograft is an effective alternative technique to superotemporal autograft technique.

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