@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD General mgmt
❗️early recognition
❗️endoscopic vs surgical mgmt
❗️Rx life-threatening complications
🆘 Tension pneumothorax/ pneumoperitoneum – needle decompression
🆘 Subcut emphysema and airway obstruction – ET intubation
🆘 Peritonitis – surgical eval
#ScopingSundays
❗️early recognition
❗️endoscopic vs surgical mgmt
❗️Rx life-threatening complications
🆘 Tension pneumothorax/ pneumoperitoneum – needle decompression
🆘 Subcut emphysema and airway obstruction – ET intubation
🆘 Peritonitis – surgical eval
#ScopingSundays
@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD Tips on encountering a perf:
✅ IV abx
✅ Suction and clear area of enteric contents
✅ Upper GI perfs: PPI
✅ Diversion of enteric contents (NG/NJ)
✅ Switch to low flow CO2 if not already!
Check out mnemonic by Singh et al, 2018: RAPID CLOSuRE 🤓
#ScopingSundays
✅ IV abx
✅ Suction and clear area of enteric contents
✅ Upper GI perfs: PPI
✅ Diversion of enteric contents (NG/NJ)
✅ Switch to low flow CO2 if not already!
Check out mnemonic by Singh et al, 2018: RAPID CLOSuRE 🤓
#ScopingSundays
@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD Diagnosis:
⬆️ clinical suspicion is key
🩻X-rays (not preferred)
☑️CT x contrast: unstable pt
💦Add water-soluble oral contrast:
⬆️ accuracy
⏺ show site of extravasation
❌ barium: risk of mediastinitis
❔Rarely may use dilute Barium if no leak seen with water contrast
⬆️ clinical suspicion is key
🩻X-rays (not preferred)
☑️CT x contrast: unstable pt
💦Add water-soluble oral contrast:
⬆️ accuracy
⏺ show site of extravasation
❌ barium: risk of mediastinitis
❔Rarely may use dilute Barium if no leak seen with water contrast
@ScopingSundays @JamesHaddadMD @TomTielleman @tareksawas @BilalMohammadMD @AhmadBazarbashi @RobertoSimonsMD @SanchezLunaMD @vaibhav_manu @rmulkimd @NnekaUfereMD @LizzieAbyMD @DrMalSimons @JacquelineChuMD When to consider surgery ✂️
‼️Peritonitis
‼️Unstable patients
‼️Large perfs ≥2.5 cm
🥼Absence of experienced endoscopists
😢Failed endoscopic repair
@AmerGastroAssn suggests ✂️ consultation be considered in ALL cases even when endoscopic repair is technically successful 👥
‼️Peritonitis
‼️Unstable patients
‼️Large perfs ≥2.5 cm
🥼Absence of experienced endoscopists
😢Failed endoscopic repair
@AmerGastroAssn suggests ✂️ consultation be considered in ALL cases even when endoscopic repair is technically successful 👥
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