ABSTRACT
Idiopathic pneumoperitoneum (IP) cases are rare and presents with varying symptoms, which makes propositions of standard treatments, clinically impracticable. There are limited IP therapies in the literature, necessitating a need, to continually highlight unique cases for the purpose of clinical education and training. This case describes an IP and management of a 34-year-old male who recently underwent a laparoscopic cholecystectomy. Patient presented to the emergency room with recurrent gastrointestinal (GI) symptoms. Despite two negative exploratory laparotomies without confirmatory evidence of GI perforations, the GI symptoms persisted, making it an unusual case. The surgeons elected to a multispecialty approach, detailing patient-specific symptoms, and corresponding treatments of the case. Based on the successful outcome of this patient, detailed knowledge of medical history, repeated physical assessments and patient-specific and comprehensive approach was shown to reduce unnecessary exploratory laparotomy, improved clinical outcomes and decrease in complications.
ABSTRACT
Enteroatmospheric fistula (EAF) is a relatively rare complication of patients undergoing open abdomen (OA) for damage control surgery. Mortality rates are high due to the increased risk of peritonitis, intraabdominal abscess, sepsis, and new perforations. There are a wide range of EAF management therapies in the literature, however, there are limited options on cases involving fistula-vaccum assisted closure (VAC) therapy. This case describes the treatment course of a 57-year-old, male admitted for blunt abdominal trauma secondary to a motor vehicle accident. Upon admission the patient underwent damage control surgery. The surgeons elected to have the patient's abdomen open, applying a mesh to promote healing. After several weeks of hospitalization an EAF was discovered in the abdominal wound subsequently managed by utilizing a fistula-VAC technique. Based on the successful outcome of this patient, fistula-VAC was shown as an effective way to promote wound healing while reducing the chances of complications.
ABSTRACT
CONTEXT: Osteopathic manipulative treatment (OMT) is a distinctive and foundational aspect of osteopathic medicine. Several studies have reported a decline in the use of OMT by practicing osteopathic physicians, but the reasons for this decline have not been fully investigated. OBJECTIVE: To investigate osteopathic medical students' attitudes and beliefs regarding osteopathic philosophy, including OMT. METHODS: A self-administered, 21-item, electronic questionnaire developed specifically for the current study was distributed to first- and second-year osteopathic medical students at 4 colleges of osteopathic medicine. The questionnaire contained items addressing student attitudes toward osteopathic philosophy, including OMT; perceptions of osteopathic predoctoral education; and plans for integrating OMT into future practice. RESULTS: Of 1478 questionnaires sent, 491 students completed the questionnaire for an overall response rate of 33%. Analysis of student responses revealed that a majority of first- and second-year osteopathic medical students (95%-76%, depending on the question asked) expressed agreement with osteopathic philosophy. Students who reported prior exposure to OMT had higher levels of agreement with osteopathic philosophy statements (P<.04) and with the intention to use OMT (P<.02) than students with no prior exposure. However, students who were drawn to an osteopathic medical school by the desire to become a physician regardless of degree reported lower levels of agreement with osteopathic philosophy and the intention to use OMT. Students' levels of agreement with osteopathic philosophy and intention to use OMT varied significantly based on the school that they attended, their current year of study, and whether or not they were participating in clinical rotations. CONCLUSION: The reason why a student decided to study osteopathic medicine was strongly associated with the level of agreement with osteopathic philosophy and the intention to use OMT in future practice. Prior experience receiving OMT, the medical school that a student attends, and the current year of study appear to be related to the students' levels of agreement with osteopathic philosophy and intention to use OMT.
