Browsing by Author "Varinthip Thongchai"

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    Can we omit surgery in patients with isolated free fluid following blunt abdominal injury? A systematic review and meta-analysis
    (2021-05-01) Tatchakorn Promboon; Chonlada Krutsri; Preeda Sumritpradit; Pongsasit Singhatas; Panuwat Lertsitthichai; Panjapon Kitgrongpaibul; Varinthip Thongchai; Pattawia Choikrua; Napaphat Phoprom; Ramathibodi Hospital
    Background: Management of isolated free fluid following blunt abdominal injury in hemodynamically stable patients is still controversial with respect to nonoperative management (NOM) versus immediate laparotomy. This meta-analysis was performed to identify significant intra-abdominal injuries that require therapeutic laparotomy, thus helping in decision-making during initial management. Method: We systematically reviewed the PubMed and SCOPUS databases from 2000 to 2020. The primary outcome of interest was identification of significant intra-abdominal injuries requiring therapeutic laparotomy. We performed the meta-analysis using a random-effects model. Results: Eight studies involving 7763 patients were evaluated. Isolated free fluid was present in 722 (9.3%) patients. Their median age was 35.82 years, and their average Injury Severity Score was 17.1. The major mechanism of injury was motor vehicle accidents (31.2%). Of 722 patients, 490 underwent initial NOM and 232 underwent immediate laparotomy. The success rate of initial NOM was 98% [95% confidence interval (CI), 0.959–1.002]. The failure rate of initial NOM was 7.4% (95% CI, 0.023–0.126). Significant intra-abdominal injuries were identified in 39.2% of patients (95% CI, 0.127–0.657). Most of the significant intra-abdominal organ injuries were mesenteric injury in 23% of patients (95% CI, −0.004–0.463) and bowel injury in 18.4% (95% CI, 0.098–0.271). A moderate to large amount of fluid on computed tomography and abdominal tenderness were associated with laparotomy (p = 0.000 and 0.040, respectively), but neither was a significant risk factor for therapeutic laparotomy or significant intra-abdominal injury. Conclusions: Isolated free fluid following blunt abdominal injury in hemodynamically stable patients does not mandate immediate or delayed laparotomy. Initial NOM can be considered with hemodynamic monitoring of early warning signs of sepsis (e.g., using the Quick Sequential Organ Failure Assessment), and serial abdominal examination might help to detect significant intra-abdominal injury requiring therapeutic laparotomy. In patients suspected to have injury after initial NOM and in patients who cannot cooperate, diagnostic laparoscopy will play an important role in minimally invasive diagnosis.
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    Is Urgent Diagnostic Colonoscopy still Necessary in Lower Gastrointestinal Bleeding?: A Retrospective Study from 2 Centers of Ramathibodi Hospital
    (2021-12-01) Tatchakorn Promboon; Chonlada Krutsri; Pongsasit Singhatas; Preeda Sumritpradit; Sitthichart Harntaweesup; Panjapon Kitgrongpaibul; Varinthip Thongchai; Tharin Thampongsa; Samart Phuwapraisirisan; Jakrapan Jirasiritham; Goragoch Gesprasert; Pattawia Choikrua; Ramathibodi Hospital
    Background: An urgent colonoscopy within 24 hours in acute lower gastrointestinal bleeding (LGIB) is now controversy with limited of benefit compare to elective colonoscopy. An alternative modality such as CT angiogram or CT whole abdominal has play an important role in diagnosed and localised bleeding site in emergency setting. Objective: This study is aim to report a descriptive data of incidence and prevalence of acute LGIB and therapeutic modality from 2 centers of Ramathibodi Hospital. Materials and Methods: A retrospective reviewed of adult patients who had acute LGIB in 4 years of Acute Care Surgery service of Ramathibodi Hospital and one year service of Chakri Naruebodindra Medical Institute. An exclusion criteria were patients who had associated gastrointestinal perforation or dead on arrival. A descriptive data were analysed and reported. Results: A 127 patients were enrolled, an average age is 69 year-old. Of these, there are 74.01% admitted without hemorrhagic shock. An average hospital stay is 3 days (1 to 5). Anti-coagulant and anti-platelet usage are 40.16%. Average haemoglobin on admission is 9.69±2.43 g/dL. Overall mortality rate is 4.72%. Most common cause of acute LGIB are diverticular bleeding 34.65% and colitis 17.32%. Only 9.82% underwent urgent colonoscopy. There are 95.28%, 1.57%, 0.79%, and 1.57% of successful nonoperative management, therapeutic endoscopy, transarterial catheter embolization and surgery, respectively. Only patients who had post-polypectomy bleeding underwent urgent therapeutic endoscopy intervention. Conclusion: In hemodynamic stable, urgent colonoscopy is not mandate in routine. In acute massive LGIB which hemodynamic unstable, the CT angiography follow by arterial embolisation or urgent colonoscopy are recommend for diagnosed, localised the bleeding site, and also endoscopic intervention especially in post-procedure bleeding.