A Proposed Algorithm on the Modern Management of Rectus Sheath Hematoma: A Literature Review

Rectus sheath hematoma (RSH) is a common entity with no clearly established protocol for management. Existing literature on RSH is outdated and does not incorporate modern technological advances in medicine and imaging. A total of 21 studies were included in this literature review based on PubMed and Google Scholar searches. Modern literature was selected from the last 10 years with the inclusion of three past pieces of literature. We performed a literature review to identify the latest research on RSH management and to consolidate an algorithm to help guide modern RSH treatment. Current RSH classification, scoring system, algorithm, and other predictors for treatment plan are discussed. The best RSH management requires early recognition of RSH followed by the appropriate implementation of conservative management and procedural intervention. The decision on picking the treatment of choice is assisted with the use of predictors, such as hematoma size, rate of hemoglobin drop, and the number of blood transfusions. Further studies are needed to clearly establish predictors among the different types of procedural intervention, and we hope the consolidated algorithm on current literature can help promote the standardization of protocol in the future.

Conservative Management of Madelung Deformity of the Wrist in a 15-Year-Old Male: A Case Report

A 15-year-old boy presented to an outpatient sports medicine clinic with mysterious wrist pain for three months. Imaging diagnosed this mysterious wrist pain as a Madelung deformity, a rare condition characterized primarily by the early cessation of growth in the volar-ulnar distal physis of the radius. Patients may present with restricted wrist range of motion, pain, and ulnar tenderness, but they may also be asymptomatic. Traditionally, treatment is surgical, but this case was managed with conservative measures primarily, with improvements in both function and outcomes. This case report should serve as a reminder to include rare diagnoses in the differential when working up joint pain and to show the role of conservative management in Madelung deformity.

Bacteremia Secondary to Epiploic Appendagitis (EA)

Epiploic appendages are fat-filled sacs that are generally located along the surface of the large intestine. In most cases, epiploic appendagitis (EA) is described as an ischemic infarction of an epiploic appendage as the result of torsion or spontaneous thrombosis of the central draining vein of the epiploic appendage. The patient described in this report presented with a sudden onset of diffuse abdominal pain, nausea, and fever. CT scan of the abdomen and pelvis with oral contrast revealed EA of the sigmoid colon. Along the course of the admission, the patient became septic with blood cultures growing E. coli. In this case, we present a rare presentation of E. coli sepsis in the setting of EA, a usually uncomplicated and self-resolving presentation of abdominal pain.

Optimizing Physiotherapeutic Effects With the Maitland Mobilization Technique to Boost the Functional Capacities of a Rotator Cuff Syndrome Patient: A Case Report

Rotator cuff (RC) muscles give the shoulder joint stability in addition to movement. The case report outlines the physical rehabilitation therapy, condition evaluation, and diagnostic testing that was given to a 62-year-old female field worker who had been complaining of pain in her left shoulder. To improve functional mobility and lessen discomfort, the patient underwent physiotherapy. In this instance, a physical therapy program was put in place to treat rotator cuff syndrome (RCS), enhance range of motion (ROM), and promote long-term recovery. Part of the assessment included a detailed examination of the biomechanics and potential mitigating variables for the persistent problems. The intervention plan's multimodal approach comprised physical therapy, stretching, and strengthening exercises, as well as patient counseling and health management education. Throughout the physiotherapy sessions, the patient's functional mobility improved and their level of discomfort gradually decreased. This case adds to the body of knowledge regarding successful physiotherapy techniques for RC injuries by emphasizing the value of a comprehensive approach to help patients with chronic shoulder pain achieve favorable outcomes. It also highlights how crucial it is to treat chronic RCS with a customized physical therapy program that takes into account the patient's unique preferences and characteristics that can exacerbate the problem.

The Assessment of Patient-Reported Outcomes in the Medical Management of Patients With Benign Prostatic Hyperplasia

Background Benign prostatic hyperplasia (BPH) is a prevalent condition that a large portion of the male population develops with aging, in which the prostate gland enlarges and results in urinary symptoms. Objective The objective of this article is to assess patient-reported outcomes (PRO) of medical management of benign prostate hyperplasia in terms of international prostate symptoms score (IPSS), BPH impact index (BPHII), and treatment satisfaction score (TSS). Methods This descriptive study included 114 patients who received medical management for BPH during the period 5th May 2021 till 30th December 2023, at the Department of Urology, Institute of Kidney Disease Peshawar. Patient-reported outcomes were measured in terms of IPSS, BPHII, and TSS. Readings were recorded at the start of treatment and at three months of treatment and then compared. Data was analyzed using SPSS v.25 (IBM Inc., Armonk, New York). Results The mean age of the patients was 64.33 ± 6.12 years. The mean prostate size was 77.35 ± 12.83 ml. Overall mean pre-treatment and post-treatment IPSS was 24.82 ± 4.90 versus 15.57 ± 5.15, respectively (p-value 0.00). Mean pre-treatment and post-treatment BPHII were 11.98 ± 1.02 and 7.12 ± 2.46, respectively (p-value 0.000). The overall mean treatment satisfaction score was 6.89 ± 1.44. Conclusion Medical management improved symptomatology in BPH patients. This study is a step in the direction of the development of larger and longer-term PRO studies in BPH management.

Tuberculosis Presenting As Spontaneous Pneumothorax: A Case Report

Secondary spontaneous pneumothorax (SSP) is one of the rare and crucial complications of pulmonary tuberculosis (TB) and can become a fatal condition if it progresses to tension pneumothorax. This case report describes a 32-year-old male who presented with sudden onset chest pain and shortness of breath for the past three hours. On examination, he exhibited tachypnea and hypoxia at rest, and chest imaging revealed a right-sided pneumothorax. Immediate intercostal chest tube insertion was performed and subsequent computed tomography (CT) of the chest was conducted after lung expansion to determine the underlying cause, most likely TB. The patient was subsequently managed conservatively with intercostal chest drain and anti-TB therapy.

Esophageal Perforation During Transesophageal Echocardiography Managed Conservatively: A Case Report With a Review of the Literature on Management

Transesophageal echocardiography (TEE) is one of the cornerstones of cardiac imaging in inpatient and intra-operative settings. TEE is considered a safe procedure, but it may result in serious complications, such as esophageal injury, vocal cord paralysis, arrhythmia, hypotension, seizure, and cardiac arrest. Herein, we discuss one of the rare complications, esophageal perforation, and a conservative approach to managing the patient in a 64-year-old female who underwent a TEE prior to a scheduled valvular surgery. The same day, she returned to the emergency department with complaints of neck and left-sided chest pain. Further evaluation revealed an esophageal perforation. It was managed conservatively, with the use of antibiotics and nil-by-mouth placement. This case demonstrates that depending on the size of the defect, conservative approaches of management are a reasonable option and that not all cases will necessitate an emergent surgery.

Conservative Management of Intraperitoneal Bladder Injury During the Transurethral Resection of a Bladder Tumor: A Case Report

Bladder injury can be intraperitoneal or extraperitoneal due to multiple mechanisms, with surgical repair as the mainstream management in intraperitoneal injuries. We present a case of iatrogenic intraperitoneal bladder injury during transurethral resection of a bladder tumor located in the superior bladder wall. Many cases reported the role of conservative management of intraperitoneal injuries that included intraperitoneal drain, urethral catheterization, and continued monitoring of vital signs and serial abdominal examination. Still, conservative management of intraperitoneal bladder injury is not established yet, with a clinically accepted role in many cases reported.