Dataset Information

Diagnosis and management of jejunoileal diverticular haemorrhage: An update on the experience in a single centre.

ABSTRACT:

Introduction

Jejunoileal diverticular haemorrhage is a rare disease that is difficult to diagnose and treat. Despite advances in endoscopic technology, recommendations on diagnosis and management for jejunoileal diverticular haemorrhage have remained unchanged and these new options have not been compared against traditional surgical management.

Materials and methods

We retrospectively reviewed the diagnosis, management, and outcome for jejunoileal diverticular haemorrhage cases at our institution over the past 20 years. Data were organized and analysed by chi-square test, student t-test and Kaplan-Meier survival analysis.

Results

The most utilised diagnostic procedure was computed tomography, followed by enteroscopy, angiography, small bowel flow-through and surgery. Primary treatments included, in a decreasing order, medical therapy, surgery, endoscopy and radiology. Surgical treatment was not associated with rebleeding, but it did result in longer hospital stays and larger blood transfusions than non-surgical treatments. The bleeding-related mortality rate was very low. Notably, there was also little change in the diagnosis and treatment between decades.

Conclusion

We presented our experience with the diagnosis and management of jejunoileal diverticular haemorrhage, as well as long-term follow-up after treatments that have not been reported previously. Surgical treatment continues to dominate management for jejunoileal diverticular haemorrhage, but we support increasing the role of endoscopy for select patient groups.

SUBMITTER: Su HA

PROVIDER: S-EPMC7310693 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

Diagnosis and management of jejunoileal diverticular haemorrhage: An update on the experience in a single centre.

Su Hsuan-An HA Hsu Yu-Chun YC Siao Fu-Yuan FY Yen Hsu-Heng HH

PloS one 20200623 6

<h4>Introduction</h4>Jejunoileal diverticular haemorrhage is a rare disease that is difficult to diagnose and treat. Despite advances in endoscopic technology, recommendations on diagnosis and management for jejunoileal diverticular haemorrhage have remained unchanged and these new options have not been compared against traditional surgical management.<h4>Materials and methods</h4>We retrospectively reviewed the diagnosis, management, and outcome for jejunoileal diverticular haemorrhage cases at ...[more]

PMID: 32574171

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Project description:BACKGROUND:Emergency medical services regularly encounter severe burns. As standards of care are relatively well-established regarding their hospital management, prehospital care is comparatively poorly defined. The aim of this study was to describe burned patients taken care of by our physician-staffed emergency medical service (PEMS). METHODS:All patients directly transported by our PEMS to our burn centre between January 2008 and December 2017 were retrospectively enrolled. We specifically addressed three "burn-related" variables: prehospital and hospital burn size estimations, type and volume of infusion and pain assessment and management. We divided patients into two groups for comparison: TBSA <?20% and???20%. We a priori defined clinically acceptable limits of agreement in the small and large burn group to be ±5% and?±?10%, respectively. RESULTS:We included 86 patients whose median age was 26?years (IQR 12-51). The median prehospital TBSA was 10% (IQR 6-25). The difference between the prehospital and hospital TBSA estimations was outside the limits of agreement at 6.2%. The limits of agreement found in the small and large burn groups were?-?5.3, 4.4 and?-?10.1, 11, respectively. Crystalloid infusion was reported at a median volume of 0.8?ml/kg/TBSA (IQR 0.3-1.4) during the prehospital phase, which extrapolated over the first 8?h would equal to a median volume of 10.5?ml/kg/TBSA. The median verbal numeric rating scale on scene was 6 (IQR 3-8) and 3 (IQR 2-5) at the hospital (p <?0.001). Systemic analgesia was provided to 61 (71%) patients, predominantly with fentanyl (n =?59; 69%), followed by ketamine (n =?7; 8.1%). The median doses of fentanyl and ketamine were 1.7 mcg/kg (IQR 1-2.6) and 2.1?mg/kg (IQR 0.3-3.2), respectively. CONCLUSIONS:We found good agreement in burn size estimations. The quantity of crystalloid infused was higher than the recommended amount, suggesting a potential risk for fluid overload. Most patients benefited from a correct systemic analgesia. These results emphasized the need for dedicated guidelines and decision support aids for the prehospital management of burned patients.

Dataset Information

Diagnosis and management of jejunoileal diverticular haemorrhage: An update on the experience in a single centre.

Introduction

Materials and methods

Results

Conclusion

Publications

Diagnosis and management of jejunoileal diverticular haemorrhage: An update on the experience in a single centre.

Similar Datasets

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