The American surgeon
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The American surgeon · Aug 1998
Colonoscopy: the initial test for acute lower gastrointestinal bleeding.
Despite literature showing safety, accuracy, and therapeutic capability of emergency colonoscopy for acute lower gastrointestinal (LGI) bleeding, surgical literature suggests that this examination is difficult to perform in the acute setting. In contrast to currently accepted protocols, we believe that unprepared colonoscopy within 24 hours of presentation can be performed safely with a high rate of success in localizing and often treating the specific cause of LGI bleeding. We report results over a 7-year period in our institution using early colonoscopy as the primary investigative method for the diagnosis and treatment of LGI bleeding. ⋯ Additionally, the pattern, amount, and location of blood in the unprepared colon all give clues as to source and rate of bleeding. In experienced hands, morbidity and mortality of emergent colonoscopy is very low. High accuracy, safety, and therapeutic capability makes colonoscopy the initial diagnostic test of choice for acute LGI hemorrhage.
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The American surgeon · Aug 1998
Case ReportsPreoperative diagnosis of isolated penetrating gallbladder injury in an asymptomatic patient: the role of hepato-iminodiacetic acid scan as the definitive diagnostic test.
The decision for nonoperative treatment of abdominal stab wounds is usually based on clinical examination findings. It is important, however, to identify patients who may suffer occult injuries and, therefore, be benefited from further diagnostic evaluation. ⋯ A high index of suspicion and appropriate selection of imaging studies may lead to early identification. Hepato-iminodiacetic acid scan can be used as the definitive diagnostic imaging test in such occasions.
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The American surgeon · Aug 1998
Computed tomographic grading is useful in the selection of patients for nonoperative management of blunt injury to the spleen.
Although nonoperative management of blunt splenic injury (NMBSI) has an established role in the overall management of adult patients with blunt splenic injury, the criteria by which patients are selected continue to be debated. The purpose of this study is to establish the effectiveness of a defined set of criteria that includes CT grading for the selection of patients for NMBSI by examining the outcomes of patients managed in this manner 1 year before with those 1 year after the implementation of this specific set of selection criteria. All patients hospitalized at St. ⋯ In Group II, after the implementation of selection criteria that included CT grade, no patient required delayed operation. Eleven underwent immediate operation, whereas 18 were successfully managed nonoperatively. We conclude that, in the hemodynamically stable patient without clinical indication for laparotomy, CT grading of the splenic injury is a reliable criterion by which patients may be selected for nonoperative management.