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We retrospectively report a case of rapid exchange of a percutaneous radiologic gastrostomy tube (balloon-occluded type catheter) via off-label use of a pigtail catheter for nutrition supply during a very early episode of coronavirus disease 2019 (COVID-19) in an outpatient clinic. This case demonstrates that minimally invasive percutaneous procedures might be provided safely and effectively under appropriate precautions for preventing COVID-19 transmission during the pandemic.Copyright © 2023, Society of Gastrointestinal Intervention.
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Introduction: Abdominal wall surgery has been one of the major victims of the COVID-19 pandemic, with a large number of patients who have seen their surgery delayed and many are still waiting to be operated on today. On the other hand, botulinum toxin is one of the main protagonists in optimizing abdominal wall surgery, especially important in complex hernia, but we must not forget that it can have adverse effects. Case report: We present the case of a 54-year-old man with a history of obesity, diabetes, hypertension, chronic renal failure and kidney transplant in 2000, who presented a midline incisional hernia as a result of an epigastric hernia operated on in 2006 and subsequently two onlay permanent synthetic mesh in 2010 and 2015. In February 2020 he presented an incisional hernia M2-4W3R3 with a volume of 35%, botox was infiltrated as optimization for surgery and while awaiting placement of a pneumoperitoneum catheter, the surgery was suspended due to the COVID-19 situation. He returns to our clinics in 2022 with a growth of the hernia and a volume of 95%. Weight loss, botulinum toxin and preoperative pneumoperitoneum were indicated. We performed a reconstruction of the abdominal wall with bilateral transversus abdominal release and preperitoneal 45x60cm polyvinylidene fluoride mesh and abdominoplasty. Discussion(s): Botulinum toxin can facilitate abdominal surgery, especially in complex hernias, but we must not forget that blocking the abdominal muscles can have adverse effects. The COVID-19 pandemic has been especially hard on surgical waiting lists, delaying surgeries and aggravating pathologies.
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Surgical care in a mono-hospital for patients with COVID-19 leads to a number of organisational problems due to the lack of specialised departments. The article presents the experience of surgical treatment in a mono-hospital obtained from one and a half years of work in this mode. In total, approximately 400 surgeries were performed. The experience of treatment of 7 patients with acute intestinal obstruction has been summarised. In the abdominal cavity, a significant number of hematomas of varied localisation were found under the parietal and visceral peritoneum, as well as in the subcutaneous fat. This is possibly associated with anticoagulant therapy included in the treatment regimen for patients with COVID-19 according to the methodical recommendations by the Ministry of Health of the Russian Federation. As an illustration, a successful case of treating COVID-19 patient with strangulated hernia of the abdominal white line complicated by acute intestinal obstruction is presented.Copyright © 2022, Krasnoyarsk State Medical University. All rights reserved.
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Introduction: VCA transplantation is progressing despite challenges including the COVID-19 pandemic. Method(s): The OPTN cohort includes 108 VCA candidates listed and 66 recipients transplanted between 7/3/2014 - 4/30/2022. Result(s): Seven VCA candidates were listed in 2021: 3 abdominal wall (AW) and 4 uterus. One AW and 2 uterus candidates were listed in the first 4 months of 2022. AW registrations became the predominant registration type on the VCA waiting list in 2022, surpassing uterus registrations. As of 4/30/2022, the waiting list included 17 candidates: 6 AW, 5 uterus, 4 upper limb (UL;1 bilateral, 3 unilateral), 1 face, and 1 face/scalp. Since 7/3/2014, 66 recipients received 67 VCA transplants, including 14 UL (9 bilateral, 5 unilateral), 9 face, 1 bilateral UL and face, 1 scalp, 1 trachea, 2 AW, 36 uterus (14 deceased donor, 22 living donor), and 2 penis recipients. In 2021, 1 bilateral UL, 1 trachea, and 2 living donor uterus transplants were performed. In the first 4 months of 2022, 3 uterus transplants (2 deceased donor, 1 living donor) were performed. Discussion and Conclusion(s): The composition of the VCA waiting list is changing. VCA transplantation continues to advance despite the COVID-19 pandemic.
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We present a case of a four-year-old male with a history of giant omphalocele who underwent ultrasound-guided Botox injection to bilateral anterior abdominal wall musculature in preparation for definitive repair. Botox administration was successfully combined with preoperative subfascial tissue expanders to achieve definitive midline closure of the anterior abdominal wall defect. Our experience suggests that Botox can be safely used as part of the treatment plan for giant omphalocele repair.
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BACKGROUND: Though telemedicine has been identified as safe and feasible, data on patient reported experiences (PREs) are lacking. We sought to compare PREs between in-person and telemedicine-based perioperative care. METHODS: Patients evaluated from August-November 2021 were prospectively surveyed to assess experiences and satisfaction with care rendered during in-person and telemedicine-based encounters. Patient and hernia characteristics, encounter related plans, and PREs were compared between in-person and telemedicine-based care. RESULTS: Of 109 respondents (86% response rate), 55% (n = 60) utilized telemedicine-based perioperative care. Indirect costs were lower for patients using telemedicine-based services, including work absence (3% vs. 33%, P < 0.001), lost wages (0% vs. 14%, P = 0.003), and requirements for hotel accommodations (0% vs. 12%, P = 0.007). PREs related to telemedicine-based care were non-inferior to in-person care across all measured domains (P > 0.4). CONCLUSIONS: Telemedicine-based care yields significant cost-savings over in-person care with similar patient satisfaction. These findings suggest that systems should focus on optimization of perioperative telemedicine services.
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Telemedicine , Humans , Surveys and Questionnaires , Patient Satisfaction , Cost Savings , Patient Reported Outcome MeasuresABSTRACT
Aims: To describe combined neural and muscular interventions in post covid exacerbations of cancer pain with disabilities.To present a new perspective of neuromyopathy to explain Intractable CA pancreas pain. Introduction: Additional challenges in cancer pain management are due to cancer treatment complications (chemotherapy, radiotherapy). CA Pancreas pains routinely addressed with oral neuromodulators, opioids neurolytic coeliac plexus block (NCPB) or splanchnic nerve radiofrequency ablation (SRF). 75 years male, CA pancreas with spine, pelvic bone metastasis, post chemotherapy radiotherapy. 6 months bedridden with post covid exacerbations in pain (vas 10/10) received prior painkillers. Started oral pregabalin 75mg od, ultracet bd, myospaz bd. Result(s): With 15 days medications vas 6/10, patient could sit on wheelchair. Given sciatico-femoral block, pain reduced vas 2/10 but recurred in 7 day vas 5/10. Started USGDN of tight back and lower limb muscles with 32G solid needles.post3 sessions vas 2/10, able to walk with support after 4 weeks. Discussion(s): Viscerosomatic convergence at the dorsal horn neurons produces visceral pain referred to back and abdominal muscles led to muscle spasm with generation of myofascial trigger points(MTrPs)and pain. USGDN addresses MTrPs. Needle insertion produces local twitch reflex (LTR) followed by muscle relaxation with pain relief. Neural interventions addresses only visceral nociceptive afferents from celiac plexus which forms 10% of total spinal cord afferent input which sensitizes peripheral and central motor nociceptive pathway processing neuromyopathy. Conclusion(s): Viscerosomatic convergence with muscles involvement (neuromyopathy) proved to be effectively managed by using combined approaches, neuromoduation and USGDN in Ca pancreas pain with disabilities.Copyright © 2023
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Background: This research paper is an expression of a desire to view COVID 19 from the perspective of a spontaneous hemorrhage induced on different organ systems. Introduction of a stratified approach to the problem of hemorrhage has become an imperative in medical treatment. Aim(s): To determine the real figure of spontaneous hemorrhage cases in severe forms of infections caused by Covid 19. Material(s) and Method(s): The research included 745 patients that suffered from severe forms of infections caused by Covid 19 who were treated in a Respiratory clinic in Tuzla University Clinical Center during 2020 and 2021. The spontaneous hemorrhage was determined on the grounds of laboratory parameters of blood counts and CRP, hemodynamic monitoring of TA and pulse, and CT imagining diagnostic technique. Result(s): The study presents information about the medical treatment outcome in the case of 5 patients (0,67%) who experienced spontaneous hemorrhage as a part of Covid 19 infection in relation to the total number of 745 patients who were treated during that period in the Respiratory clinic as Covid patients with severe forms of infection. Out of 5 patients who acquired spontaneous hemorrhage 3 were operated. For 4 patients the outcome was lethal. One of the female patients who was in the group of those who were not operated and who had undergone a conservative treatment has survived. In our group of analyzed patients two patients suffered from the hematoma of the front abdominal wall, two had retroperitoneal hematoma and one patient acquired hemorrhage in the abdomen and thoracic with the developing DIC. Conclusion(s): Relatively low percentage of cases developing spontaneous hemorrhage 5 (0, 67%) but relatively high mortality rate in the cases where it did occur, 4 out of 5 monitored patients, requires certain suggestions that are being presented in this study as to how to approach the cases of spontaneous hemorrhage in the severe forms of Covid 19 infections in more consistent manner in order to improve the outcome of the medical treatment of these cases.Copyright © 2019 by Acta Medica Saliniana.
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Today the new coronavirus infection remains one of the most important problems of modern medicine. Among patients requiring hospital treatment, the development of various extrapulmonary complications is quite common. The work is devoted to the study of spontaneous hematomas of various localization against the background of a severe course of a new coronavirus infection treated in an infectious hospital in the period from 2020 to 2021. During the selected time, 17 patients had spontaneous hematomas of various localizations (anterior abdominal wall, retroperitoneal space, neck, hip, chest). The paper investigates the effectiveness of instrumental diagnostics - computed tomography in vascular mode is recognized as the optimal method, which helps to identify not only the location of the hematoma, but also in some cases its source. The basic principles of the tactics of choosing methods of hemostasis (medical, mechanical, surgical) to achieve its sustained effectiveness are described.Copyright © 2022 Authors. All rights reserved.
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Today the new coronavirus infection remains one of the most important problems of modern medicine. Among patients requiring hospital treatment, the development of various extrapulmonary complications is quite common. The work is devoted to the study of spontaneous hematomas of various localization against the background of a severe course of a new coronavirus infection treated in an infectious hospital in the period from 2020 to 2021. During the selected time, 17 patients had spontaneous hematomas of various localizations (anterior abdominal wall, retroperitoneal space, neck, hip, chest). The paper investigates the effectiveness of instrumental diagnostics - computed tomography in vascular mode is recognized as the optimal method, which helps to identify not only the location of the hematoma, but also in some cases its source. The basic principles of the tactics of choosing methods of hemostasis (medical, mechanical, surgical) to achieve its sustained effectiveness are described.Copyright © 2022 Authors. All rights reserved.
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Currently, the epidemic of novel coronavirus pneumonia (NCP) is still ongoing. The pathogen of this disease was newly named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hernia and abdominal wall diseases, as common disorders among population, are likely need emergency surgery. Under the new situation of NCP outbreak, surgeons who practice surgery for hernia and abdominal wall diseases should properly conduct the classified diagnosis and treatment of the hernia and abdominal wall disease, and select the appropriate surgical procedure, following the guidelines and routine diagnosis and treatment methods and complying with the guidelines for diagnosis and treatment of NCP;pay sufficient attention to self-protection according to different risk levels in the meantime of proper diagnosis and treatment and nursing process optimization. The patients with hernia or abdominal wall disease should also actively cooperate with the medical staff to complete the examination and inpatient surgical treatment in accordance with the process. © 2020 Authors. All rights reserved.
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Introduction: Thromboembolic manifestations is a common phenomenon in patients affected by Corona virus (SARS CoV-2). Recent studies have shown that patients with Acute Renal Failure are also at a greater risk of venous and arterial thromboembolism, 15-30% in ICU, 7% inpatient care. However, frequently unjudicial use of anticoagulant may develop severe life-threatening hematoma. In our Hospital settings we had a dedicated COVID Unit with Hemodialysis facility. Our Nephrology department had managed 381 patients being COVID positive along with renal impairment from March 2020 to January 2022. Among these patients, four patients developed spontaneous non traumatic hematoma in unusual sites. On admission all the patients received treatment according to our national guidelines for Covid-19. Method(s): It is a retrospective analysis in a single-centered hospital. Four cases with confirmed COVID-19 with acute kidney injury and on anticoagulant therapy had developed sudden concealed bleeding. These patients had no previous history of anticoagulant therapy before admission. Case 1: Developed hemorrhage in Right lower anterior paramedian deep parietal wall of abdomen, Case 2: Had hematoma in retroperitoneal space and in lower third of Iliopsoas, Case 3: Developed hemorrhage in left cerebral hemisphere, Case 4: Had Intramuscular Hematoma in left rectus abdominis. Out of these four patients two of them required Hemodialysis and one of them went into shock. Result(s): All patients included were male. The mean age was 57+/-19.64 years. All the four patients were initially managed conservatively with keen monitoring and with proper volume resuscitation, blood transfusion and discontinuation of the anticoagulants. Three of the patients survived with conservative management and one patient died due to sudden massive cardiac arrest. Conclusion(s): The use of therapeutic anticoagulant can increases the risk of bleeding in atypical sites and may exhibit higher patient death with COVID-19 if not identified at early stage. So a risk-benefit ratio of usage of anticoagulants should be kept in mind and further clinical trials needed to justify its random use in COVID-19. No conflict of interestCopyright © 2023
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The measures adopted worldwide by COVID-19 were mainly focused on social distancing. However, these measures affected the physical preparation of the members of the Ecuadorian Army. This research aimed to analyze the incidence of high intensity intervallic training in military personnel who were in confinement through a quasi-experimental study applying a virtual training plan to improve physical condition. For this purpose, VO2 max (maximum oxygen consumption that the organism can absorb), CORE resistance strength (abdominal, lumbar, pelvic and gluteal muscles) and upper body resistance strength were evaluated. The results were statistically analyzed through the Wilcoxon signed-rank test, obtaining significant differences that allowed concluding that the virtual training plan had a positive impact on the physical condition of the military personnel and that it constitutes an effective alternative for the physical preparation of members of the Army in the context that is currently being experienced due to the pandemic. Copyright © 2022, Anka Publishers. All rights reserved.
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The severe course of COVID-19 infection is usually complicated by hypercoagulability caused by excessive thrombin production and suppression of fibrinolysis, bleeding, in this situations, is rarely develops. The article presents clinical cases of the development of spontaneous hematomas and intra-abdominal bleeding in patients with severe COVID-19. Considering the risk of the development of spontaneous bleeding patients with COVID-19 need constant monitoring of the hemostasis system and ability to provide emergency surgical care must be present in infectious diseases hospitals. Copyright © 2022 Stavropol State Medical University. All rights reserved.
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Background: Specialization influences the way that surgeons deliver care and has a direct impact on doctors, healthcare systems and patients. Hernias impact around 2% of the population and repairs are among the most common procedures performed globally. The European Hernia Society recognizes a growing need for specialist surgeons as abdominal wall surgery becomes more complex with newer techniques and more challenging cases being encountered. At this trust, a new specialized hernia clinic was implemented in response to COVID backlogs and the growing need and proven benefits of specialization. The project's aim was to review the impact on procedure wait times and outcomes for hernia repairs. Method(s): A retrospective review of patients undergoing hernia repairs between June 2019 to June 2021 was compared to similar patients who attended the hernia clinic between February 2021 to March 2022. Included operations were inguinal, femoral, and umbilical hernia repairs. Data collected included diagnoses, percentage of day case and wait times. Result(s): 59 patients underwent surgery pre-intervention with average wait times of 191 days. 72 post-intervention patients had an average wait of 59 days. 59 patients were still awaiting surgery post-clinic. Open surgery incidence increased from 66% to 79%. 86% of patients post-intervention were day cases, compared to 78% of pre-intervention patients. Conclusion(s): The new hernia clinic has reduced wait times for surgery and improved day-case rates despite more cases being performed as open procedures. Following these results, the clinic system shows great promise and hernia surgery has the potential to evolve as a sub-specialty.
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Aim: Elective surgery services suffered significantly due to the COVID-19 pandemic. The aim of this study was to analyse the impact and outcomes of abdominal wall reconstruction (AWR) performed during the COVID-19 pandemic, assessing safety and sustainability. Material(s) and Method(s): A retrospective review of all patients undergoing AWR in a single NHS trust, multiple surgeons, between 23rd March 2020 and 22rd March 2022, the 2 years following U.K. Government imposed lockdown, was undertaken and compared with the pre-pandemic AWR activity. Procedures were initially undertaken at a cold site and when demonstrated to be safe, main site operating restarted. The primary outcome was 90 day mortality, secondary outcomes of COVID-19 infection within 7 days, length of stay, critical care requirement, and complication rate. Result(s): In the study period, 173 patients underwent AWR, compared with 99 cases in a single year preceding lockdown. 90 day mortality rate was zero. No patients returned positive COVID tests to the trust within 7 days of AWR, and no patients were readmitted for COVID related symptoms. Critical care admission was required in 7 patients, 3 of these were planned admissions pre-operatively. The surgical site occurrence rate was 9.8% (17), infection 5.8% (10), seroma 2.3% (4) and haematoma 1.7% (3). There were no recurrences reported, with follow up ranging between 1 and 18 months. Conclusion(s): Continuing AWR services during the COVID pandemic is feasible and safe. Peri-operative COVID infection rates are low, critical care requirements minimal, and there is no impact on patient morbidity or mortality.
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Introduction: A 54 years old lady who presented with constitutional symptoms of lethargy, weight loss and asthenia. She had been extensively evaluated for a possible gynaecological malignancy but with no definitive outcome. The symptoms were persistent and a decision had to be made towards Surgery in The present climate of The COVID19 pandemic. Method(s): Following oncology multi disciplinary meeting outcome she was taken up for a total abdominal hysterectomy and bilateral salpingo-oophrectomy. She was noted to have an incidental finding of an extensive tumour infiltrating The liver, colon, anterior abdominal wall and The urinary bladder. A surgical resection with ileostomy was performed on suspicion of an underlying malignancy. Result(s): The histopathological diagnosis revealed a picture of actinomycosis which had evaded us previously. Following this she was treated with prolonged course of antibiotics and has recovered well, thus altering our entire management plan. Conclusion(s): Actinomycosis albeit rare is an interesting mimic of tumours. This case also delves into The on-table decision making when in doubt about cancer.
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Aims: Many patients with symptomatic abdominal hernias have suffered delays and cancellations due to The reduction of elective operating lists. This waiting list study looks to examine what has happened to patients who were On The waiting list On The day of The first lockdown in March 2020, and whether there were any adverse outcomes. Method(s):We used coding data, TrakCare IT information and op notes to identify The outcomes of those patients between March 2020 and December 2021. We looked at whether elective surgery had been done, waiting times, if The patient had presented as an emergency, and if they had been removed from The list. We included any symptomatic abdominal hernia ie inguinal, incisional, paraumbilical, ventral. Result(s): There were 78 patients included. 33 had elective repair, min waiting time 6 months, max 18 months. There were 5 emergency presentations for operative repair (6.4%) including 1 death (3 inguinal, 2 incisional). A further 3 required expedited repair at 5, 8 and 9 months. 4 patients removed themselves due to improvement in symptoms and 27 patients remained On The list (min 19 months, max 27 months). Conclusion(s): Waiting lists for benign surgery have been adversely affected by The pandemic and this difficulty is seen clearly in our small district general. Patients who have been waiting a long time are at risk of emergency presentations and ongoing symptoms. Those with The fewest symptoms are waiting over two years and are at risk of continued waits due to ongoing service pressures.
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Background: Approximately 100,000 hernia repairs are performed in the UK annually, the vast majority in hospital usually under general anaesthetic. Due to increased pressure on hospital facilities especially after the COVID-19 pandemic the waiting times for non-emergency surgery for benign conditions has increased. This study outlines the development and feasibility of a dedicated ambulatory primary care hernia service and examines the outcomes achieved between November 2018 and November 2021. Method(s): We prospectively analysed of records of 212 patients who underwent hernia repair in a primary care centre during the above period. Inclusion criteria were a) BMI<35 b) uncomplicated inguinal or umbilical hernia c) non recurrent hernia. The techniques used were Lichtenstein mesh repair for inguinal hernias and a primary sutured repair for ventral hernias. All procedures were performed as day-cases under local anaesthesia without sedation. All patients were telephoned by a healthcare professional a day after their operation. The primary outcomes of the study were length of stay, immediate complications and the secondary outcome was cost effectiveness. Result(s): The median length of post-operative stay was 26 minutes. Complications were low and seen only in 5 patients and managed conservatively. The cost of hernia repair in primary care in UK is only 1012 when compared to 1800 in an NHS hospital. Conclusion(s): Routine elective abdominal wall hernia repairs can be performed in a primary care setting, safely, with good clinical outcomes and clear economic benefits. However, this depends on the availability of surgeons and adequate funds to establish the service.
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Despite being relatively uncommon, abdominal wall hematomas can occur due to blunt trauma, post-percutaneous procedures, anticoagulation, and even spontaneous bleeding. It can present with varying symptoms from acute abdominal pain to life-threatening bleeding causing hypovolemia and shock. With the coronavirus disease 2019 (COVID-19) pandemic, affected patients developed coagulopathy putting patients at risk of venous thromboembolism or excessive bleeding. Herein, we report a case of spontaneous multiple abdominal wall hematomas in a patient after a COVID-19 infection, which was managed conservatively.