scholarly journals A Multidisciplinary Algorithm in the Non-Operative Management of Upper GI Complications – A Retrospective Cohort Study

2018 ◽  
Vol 3 (1) ◽  
pp. 1-4
Author(s):  
Koshy RM ◽  
JLH Wong ◽  
VS Menon
Keyword(s):  
Retrospective Cohort ◽  
Multidisciplinary Approach ◽  
Effective Means ◽  
Operative Management ◽  
Median Number ◽  
Oesophageal Perforation ◽  
Management Algorithm ◽  
Cancer Group ◽  
Early Endoscopy ◽  
Non Operative Management

Introduction: The non-operative management of UGI complications lacks consensus, despite being the subset that requires a concerted multidisciplinary approach. The aim of this study is to propose an algorithm of management, with early endoscopy and interventional radiology as adjuncts to surgical interventions.Methods: This retrospective cohort describes the management of 37 patients over a 5 year period with the evolution of a multidisciplinary team and an algorithm of management in a tertiary UGI centre. The cohort included 15 bariatric, 12 Cancer and 10 Oesophageal perforation patients. The primary outcome was the morbidity profile and mortality the secondary outcome.Results: The median number of stents used per patient across the groups was two. The leak resolution time was 34, 52.5 and 60.5 days among the cancer, bariatric and perforation groups, respectively. Radiological drains were required in about 36% of patients across the groups. Nutritional access was established with Naso-Jejunal tubes with overlapping TPN in the bariatric and perforation groups, while the cancer group had Feeding Jejunostomy tubes inserted during their resections. The mean duration of hospital stay was 29.5, 41.5 and 63 days respectively. Three (8%) patients developed major stent-related complications (Clavien-Dindo Grade 3b) requiring reoperation. There were no mortalities in the cohort.Conclusion: Though heterogeneous, UGI complications have common management principles. The non-operative management algorithm with endoscopy and adjuncts is still an aggressive, yet conservative approach with prompt control of sepsis and establishment of early nutrition. This multidisciplinary approach is an effective means of resolution with minimal morbidity and mortality.

scholarly journals Neonatal oesophageal perforation: The role for non-operative management

2018 ◽  
Vol 54 (8) ◽  
pp. 872-874
Author(s):  
Kate Hodgson ◽  
Andrea Togo ◽  
Aideen M Moore ◽  
Amanda Moody ◽  
Sebastian K King ◽  
...  
Keyword(s):  
Operative Management ◽  
Oesophageal Perforation ◽  
Non Operative Management

scholarly journals A Retrospective Cohort and Systematic Review of Non-Operative Management of Exposed Calvaria Post-Radiotherapy

Cureus ◽  
2020 ◽  
Author(s):  
Pinkal Patel ◽  
James Edward Massey Young ◽  
Mark McRae ◽  
Jenny Santos ◽  
Carolyn Levis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Retrospective Cohort ◽  
Operative Management ◽  
Non Operative Management

scholarly journals Appendicitis during the COVID-19 pandemic: lessons learnt from a district general hospital

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heather C. M. Pringle ◽  
Urszula Donigiewicz ◽  
Melissa-Rose Bennett ◽  
Eleanor Walker ◽  
George E. Fowler ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Medical Records ◽  
Inflammatory Markers ◽  
Retrospective Cohort ◽  
District General Hospital ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management

Abstract Background The COVID-19 pandemic dramatically influenced the delivery of healthcare. In line with the UK Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy when operative management (OM) was sought. We describe our experience of the presentation, management and outcomes for these patients to inform care for future viral pandemics. Methods This retrospective, cohort study compared patients diagnosed with AA between March and July 2019 with those during the pandemic period of March to July 2020. Medical records were reviewed to obtain demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS) and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohorts respectively. 14 patients (9.4%) had NOM in 2019 versus 31 (24.8%) in 2020 (p = 0.001). In the 2019 operative management (OM) group 125 patients (92.6%) had laparoscopic appendicectomy versus 65 (69.1%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days in 2019 and 3 days in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who received OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one tested negative. Conclusion During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

Oesophageal perforation following ingestion of over-the-counter ibuprofen capsules

2008 ◽  
Vol 122 (8) ◽  
pp. 864-866 ◽  
Author(s):  
N P Singh ◽  
J G Rizk
Keyword(s):  
Case Report ◽  
World Literature ◽  
Operative Management ◽  
Sudden Onset ◽  
Oesophageal Perforation ◽  
Over The Counter ◽  
Retrosternal Pain ◽  
Oesophageal Injury ◽  
Enhanced Computed Tomography ◽  
Non Operative Management

AbstractObjective:We present a rare case of oesophageal perforation following ingestion of over-the-counter ibuprofen capsules.Method:Case report and literature review of pill oesophagitis.Case report:A previously well, 18-year-old man presented with sudden onset, severe, retrosternal pain, dysphagia and odynophagia following ingestion of over-the-counter ibuprofen capsules. Plain X-ray films and a contrast-enhanced computed tomography scan indicated the diagnosis. The patient was successfully treated with non-operative management.Conclusion:To our knowledge, this is the first report in the world literature concerning oesophageal perforation with ibuprofen. We discuss pill-induced oesophageal injury and its prevention. Manufacturers, clinicians and patients can all take steps to avoid this potentially life-threatening complication.

Impact of endoscopic assessment and treatment on operative and non-operative management of acute oesophageal perforation

2011 ◽  
Vol 98 (6) ◽  
pp. 818-824 ◽  
Author(s):  
M. K. Kuppusamy ◽  
C. Felisky ◽  
R. A. Kozarek ◽  
D. Schembre ◽  
A. Ross ◽  
...  
Keyword(s):  
Operative Management ◽  
Oesophageal Perforation ◽  
Assessment And Treatment ◽  
Endoscopic Assessment ◽  
Non Operative Management

scholarly journals Damage Control in Penetrating Liver Trauma: Fear of the Unknown

2020 ◽  
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Mauricio Millan ◽  
Yaset Caicedo ◽  
Monica Guzman ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Liver Trauma ◽  
Solid Organ ◽  
Severely Injured ◽  
Management Algorithm ◽  
Liver Injuries ◽  
Non Operative Management

The liver is the most commonly affected solid organ in cases of abdominal trauma. Management of penetrating liver trauma is a challenge for surgeons but with the introduction of the concept of damage control surgery accompanied by significant technological advancements in radiologic imaging and endovascular techniques, the focus on treatment has changed significantly. The use of immediately accessible computed tomography as an integral tool for trauma evaluations for the precise staging of liver trauma has significantly increased the incidence of conservative non-operative management in hemodynamically stable trauma victims with liver injuries. However, complex liver injuries accompanied by hemodynamic instability are still associated with high mortality rates due to ongoing hemorrhage. The aim of this article is to perform an extensive review of the literature and to propose a management algorithm for hemodynamically unstable patients with penetrating liver injury, via an expert consensus. It is important to establish a multidisciplinary approach towards the management of patients with penetrating liver trauma and hemodynamic instability. The appropriate triage of these patients, the early activation of an institutional massive transfusion protocol, and the early control of hemorrhage are essential landmarks in lowering the overall mortality of these severely injured patients. To fear is to fear the unknown, and with the management algorithm proposed in this manuscript, we aim to shed light on the unknown regarding the management of the patient with a severely injured liver.

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