Successful Non-Operative Management of Extensive Pneumatosis Cystoides Intestinalis Due to Graft Versus Host Disease

Graft versus host disease is a serious complication of allogenic stem cell transplants and can manifest with gastrointestinal complications including pneumatosis cystoides intestinali (PCI). A 43-year-old male with a history of acute myeloid leukemia presented to the hospital with abdominal pain and sepsis. The patient was intubated and admitted to the ICU. His CT scan demonstrated extensive colonic pneumatosis. He was high risk for laparotomy so was treated non-operatively. He improved and his abdominal exam remained benign. With aggressive resuscitation, close monitoring, and antibiotics, the patient was able to avoid major abdominal surgery. pneumatosis cystoides intestinali is a concerning finding that often leads to surgical interventions. Concurrent sepsis, gut ischemia, and frank perforation often lead to surgical intervention. In patients with high surgical risk and lack of critical bowel findings, non-operative management can be successful.

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

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.

Management of pediatric blunt abdominal trauma: تدبير رضوح البطن الكليلة عند الأطفال

Aim of study: Evaluating a non- operative treatment of pediatric blunt abdominal trauma and avoiding unnecessary surgical intervention in Tishreen University Hospital. Methods: During years (2016- 2020) a retroprospective study was conducted on 62 children who had isolated blunt abdominal trauma or associated with other injuries, most of them were managed by non- operative treatment but some required surgical management. Results: Non- operative management of pediatric blunt abdominal injuries was applied for 59 patients, three patients required a surgical procedure, the spleen was the most organ exposed to injury (40) child, followed by liver (26) child, kidney (4) and (1) pancreatic injury. Non- operative management was successful in most solid organs injuries with grades 1, 2 and 3, but it failed in 5 grade splenic injury. one out of two hollow viscus injuries required surgical intervention. There were no statistical differences between the study groups in age, gender and injury mechanism. Hospital length of stay was significantly longer in patients who underwent a laparotomy (6) days compared to other non- operative patients (3) days, one complication occurred during non- operative management as pseudocyst after pancreatic injury, (4) patient died in the non- operative group due to hemodynamic instability and associated severe cerebral injuries. Conclusion: It is safe to treat most children with blunt abdominal injuries non- operatively if monitoring is adequate with hemodynamic stability.

On the black slope: analysis of the course of a blunt renal trauma collective in a winter sports region

Purpose The aim of this study was to analyze the injury patterns and clinical course of a winter sport dominated by blunt renal trauma collective. Methods Blunt renal trauma cases (N = 106) treated in a Level 1 Trauma Center in Austria were analyzed. Results We encountered 12.3% grade 1, 10.4% grade 2, 32.1% grade 3, 38.7% grade 4 and 6.6% grade 5 renal traumata classified according to the American Association for the Surgery of Trauma (AAST). The mechanisms of injury (MOI) did not have an influence on the frequency of HG trauma (i.e., grade 4 and 5). No concomitant injuries (CIs) were found in 57.9% of patients. The number of patients without CIs was significantly higher in the sports associated trauma group compared to other MOIs (p < 0.01). In 94.3% the primary treatment was a non-operative management (NOM) including 56.6% conservative, 34.0% endourological, and 3.8% interventional therapies. A follow-up computed tomography (FU-CT) was performed in 81.1%, 3.3 days after trauma. After FU-CT, the primary therapy was changed in 11.4% of cases (grade ≥ 3). Comparing the Hb loss between the patients with grade 3 and 4 kidney trauma with and without revision surgery, we find a significantly increased Hb loss within the first 96 h after the trauma in the group with a needed change of therapy (p < 0.0001). The overall rate of nephrectomy (primary or secondary) was 9.4%. Independent predictors of nephrectomy were HG trauma (p < 0.01), age (p < 0.05), and sex (p < 0.05). The probability of nephrectomy was lower with (winter) sports-associated trauma (p < 0.1). Conclusions Sports-associated blunt renal trauma is more likely to occur isolated, and has a lower risk of severe outcomes, compared to other trauma mechanisms. NOM can successfully be performed in over 90% of all trauma grades.

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

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.

Osteochondritis dissecans of the humeral trochlea in two pediatric athletes: two cases and review of literature

We herein report two unusual cases of osteochondritis dissecans (OCD) of the trochlea. The injury consisted of a focal alteration of subchondral bone secondary to repetitive micro trauma from overhead maneuvers (pitching) in two male adolescents. Only 23 other cases of OCD affecting the trochlea have been reported. We comment on this discrepancy, explore the radiographic features, and detail the non-operative management that was undertaken. We substantiate our report with a systematic review of all OCD cases of the trochlea and provide information on patient demographics, sport type, management, recuperation and finally significance of radiographic grading.