Conservative Medical Management Research Articles

Care for the patient with hip pain.

Hip pain is a common and sometimes disabling condition that affects adults in the primary care setting. The NP must understand the assessment, diagnosis, and treatment options for patients with hip pain. Proper care of these patients often involves conservative medical management and coordination with physical therapy.

A Case of Mucormycosis with Covid-19 with a Conservative Medical Management, a Rare Management Approach

Mucormycosis is an infection caused by fungi belonging to the order Mucorales. It has been reported in many patients following COVID-19 infection, particularly in those with Diabetes Mellitus and in those treated with steroids. The most common type in patients with diabetes, rhino-orbito-cerebral mucormycosis, is associated with various neurological complications. In this report, we describe the case of a 71-year-old female with diabetes and hypertension, who presented one week after recovering from Covid-19 infection, with symptoms of severe headache and, right eye ptosis, ophthalmoplegia and decreasing visual aquity. Brain CT scan showed features of maxillary sinusitis. Nasal biopsy and cultures revealed mucormycosis. She was managed with Amphotericin-B with improvement in headache and persistence of eye complications. Three months after discharge, she presented to the emergency department complaining of left-sided weakness. Brain MRI showed an acute ischemic infarction with totally occluded right internal carotid artery, progressive boney destruction of the right maxillary sinuses, and inflammation of the right orbit and cavernous sinus. As she refused surgical debridement, she was admitted and managed conservatively with Amphotericin-B.

Intraoperative electrical stimulation for persistent, post-traumatic facial paralysis.

Approximately 7-10% of temporal bone fractures result in facial nerve paralysis. Treatment is dependent upon the severity of the nerve trauma and can range from conservative medical management to surgical intervention. A study by Hato et al. detailed the relationship between surgical timing and recovery rate for patients with facial nerve palsy secondary to temporal bone trauma. The rates of complete recovery and good recovery decline that the longer surgical intervention is delayed. We present the case of a 14-year-old male with a temporal bone fracture and delayed onset right-sided facial paralysis. This patient was treated with a transmastoid middle cranial fossa (MCF) approach with intraoperative electrical stimulation of the perigeniculate portion of the facial nerve. Despite a 53-day delay between trauma and surgical intervention, the patient's facial function improved from House Brackmann (HB) grade VI to grade II within 6months. Intraoperative facial nerve stimulation, which we have previously used for unresolved Bell's palsy, may be useful for patients with post-traumatic, persistent facial paralysis.

TCTAP A-020 Rate of Rehospitalizations and It’s Causes in Octogenarians Following Acute Coronary Syndrome: Percutaneous Coronary Intervention vs. Conservative Medical Management, Long-Term Follow Up

TCTAP A-020 Rate of Rehospitalizations and It’s Causes in Octogenarians Following Acute Coronary Syndrome: Percutaneous Coronary Intervention vs. Conservative Medical Management, Long-Term Follow Up

Interstitial and Cornual Ectopic Pregnancy: A Review of the Management Options

Interstitial or cornual ectopic pregnancies are a rare form of ectopic pregnancy which account for 2% to 4% of all ectopic pregnancies. While it is a rare type of ectopic pregnancy, the mortality rate is 6–7 times higher than other ectopic pregnancies. Therefore, early recognition and accurate diagnosis of an interstitial or cornual ectopic pregnancy is critical for the safety and wellbeing of the patient especially due to the increased risk of massive hemorrhage. Treatment options include conservative medical management with methotrexate or surgical intervention with laparoscopy or laparotomy.

A Six-Year Retrospective Study of Microbiological Characteristics and Antimicrobial Resistance in Specimens from a Tertiary Hospital's Surgical Ward.

Surgery has revolutionized the practice of medicine by allowing the treatment of conditions amenable to conservative medical management with some of them pathophysiologically involving the prevalence of pathogenic microorganisms. On the other hand, infections such as surgical site infections or urinary tract infections may complicate patients hospitalized in surgical wards leading to considerable morbidity, mortality, and increased healthcare-associated costs. The aim of this study was to present the microbiological characteristics and antimicrobial resistance of all isolates identified in microbiological specimens from a surgical ward of a tertiary hospital in Greece during a six-year period. Only specimens that yielded at least one microorganism were included in the analysis. In total, 1459 strains in 789 positive cultures were isolated. The most common sample sent to the microbiology department was pus from surgical wounds. The most common pathogens among all 1459 strains isolated were Enterobacterales at 33% (n = 482), however, the most common genus was Enterococcus at 22.3% (n = 326). Antimicrobial resistance against third-generation cephalosporins was 23% (n = 111/482) among Enterobacterales, while, the rate of vancomycin-resistant enterococci (VRE) was 18.5% (n = 60/324) among Enterococcus species and was increasing in the last years of the study. Antimicrobial resistance of Acinetobacter baumannii to carbapenems was 68.8% (n = 11/16), which was lower than the corresponding rate in other wards in Greece. The antimicrobial resistance rates noted herein raise questions regarding the appropriateness of currently suggested antimicrobials in guidelines and imply that a revision could be required. Practicing clinicians should always be aware of local microbiological data that allow the selection of appropriate antimicrobials for the management of infections. Finally, the increasing rates of VRE noted herein mandate further actions from the point of infection control and antimicrobial stewardship.

A COMPARATIVE STUDY OF LATERAL INTERNAL SPHINCTEROTOMY WITH FISSURECTOMY VS WITHOUT FISSURECTOMY IN FISSURE IN ANO IN A TERTIARY CARE HOSPITAL.

An anal ssure is dened as a longitudinal split in the distal anoderm which extends from the anal verge to the dentate line. A high percentage of acute ssures heal spontaneously within three weeks with conservative medical management comprising of a high bre diet, warm sitz bath, and topical analgesic with steroids. The lateral internal sphincterotomy (LIS) is one of the most practiced treatments for chronic anal ssure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. Fissurectomy is one of the options among those techniques which address the issues with LIS. The present study was conducted to compare the outcomes of lateral internal sphincterotomy with ssurectomy and lateral internal sphincterotomy in the treatment of chronic anal ssure and compare recurrence and postoperative complications among both the procedures

Best Practice Recommendations for Implantable Neuromodulation Therapies for Pain: Spinal Cord Stimulation

Chronic pain has a huge global prevalence of 20% and in a country like India which has been labeled by the UN as the most populous country in April 2023, the problem is likely to explode and pose a huge challenge to Indian Practitioners. An addition to this can also be due to an expected doubling of individuals over 65 years of age by rises in the aging population. Pharmacotherapy which is the mainstay for conservative medical management (CMM) often seems to be inadequate and/or has a potential for a range of side effects. The patients who are refractory to all forms of CMM move up on the treatment algorithm for pain interventions. Implantable neuromodulation therapies can be of considerable help in patients who have significantly impaired quality of life due to unremitting severe pain, despite CMM and simpler pain interventions. These implanted devices provide ongoing satisfactory pain relief in select patients. This is for the 1st time that practice recommendations are published to guide practitioners offering this treatment in India. This can also be a reference for selecting the most appropriate patients to optimize outcomes. This can also provide motivation to start collecting information in their local database and also to convince our reimbursement agencies about incorporating this useful modality in the gamut of approved therapies.

A rare case of Prostatic abscess in an adolescent managed effectively by conservative medical management with antibiotics

A rare case of Prostatic abscess in an adolescent managed effectively by conservative medical management with antibiotics

Best Practice Recommendations for Implantable Neuromodulation Therapies for Pain II: Intrathecal Drug Delivery Systems; Peripheral Nerve Stimulation; Sacral Neuromodulation

This is a part II of the best practice recommendations for implantable neuromodulation therapies for pain. Part I has already covered Spinal cord stimulation (SCS). We shall be be covering Intrathecal drug delivery systems (IDDS), Peripheral nerve stimulation (PNS) and Sacral nerve neuromodulation (SNM) in this article. Chronic pain has a huge global prevalence of 20% and in a country like India which has been labeled by the UN as the most populous country in April 2023, the problem is likely to explode and pose a huge challenge to Indian Practitioners. In addition to this can also be due to an expected doubling of individuals over 65 years of age by rising aging population. Patients failing conservative medical management (CMM) can be benefited from advanced pain therapies, including neuromodulation. This is for the first time that practice recommendations are published to guide practitioners offering this treatment in India. This can also be a reference for selecting the most appropriate patients to optimize outcomes. This can also provide motivation to start collecting information in the local database and also to convince our reimbursement agencies about incorporating this useful modality in the gamut of approved pain interventions.

Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.

Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.

Role of Decompressive Craniectomy/ Hemicraniectomy in the Management of Traumatic Brain Injury: A Retrospective Study

Introduction: Head injury is one of the most common outcomes of any kind of trauma becoming the major cause of morbidity and mortality worldwide. The critical element in the treatment of patients with severe head injuries is to prevent the progression of the condition and secondary insult to brain cells. Various protocols are followed for the treatment of severe head injury starting from conservative medical management to surgical approaches like DC/hemicraniectomy (DC). The DC is a surgical method of removal of part of skull bone so that the brain parenchyma gets space to expand and the Intracranial Pressure (ICP) can get reduced. There are various factors that contribute to the outcome of DC. Aim: To determine the various factors that affect the outcome of DC/hemicraniectomy. Materials and Methods: A retrospective descriptive study was conducted in the Institute of Gandhi Medical College and associated Hamidia hospital, Madhya Pradesh, India from May 2017 to April 2021. Hundred patients with moderate to severe head injury who underwent primary DC were included in this study. The variables such as age, preoperative GCS, the timing of surgery, preoperative pupillary reaction, and MidLine Shift (MLS) were compared in terms of survival/death and favourable/ unfavourable outcomes using the chi-square test. Results: The mean age of participants was 45±14 years. Statistical analysis showed significant results for the variables like age, preoperative the Glasgow Coma Scale (GCS), timing of the surgery, pupillary reaction at presentation, and preoperative MLS in terms of survival/death and favourable/ unfavourable outcomes. Conclusion: Younger age group, better preoperative GCS, early surgery, reactive pupils at presentation, and less preoperative MLS have positive outcome benefits with the DC/ hemicraniectomy to reduce the raised ICP.

131: ANOMALOUS RIGHT CORONARY ARTERY WITH AN INTERARTERIAL COURSE ORIGINATING FROM THE LEFT CORONARY CUSP

Introduction: Anomalies of coronary arteries arising from the opposite sinus are extremely rare, with an estimated prevalence of anomalous right coronary arteries arising from the left coronary cusp varying between 0.026 and 0.25%. While largely incidental, symptomatic patients vary in presentation. This case describes a young patient with no cardiac history who presented with acute coronary syndrome and was found to have an anomalous origin of the right coronary artery (RCA). Methods: Data was collected during the admission and follow-up a year later. Results: A 27-year-old male with a history of recent cocaine use presented to the hospital with several hours of chest pain described as constant, substernal, pressure-like, exertional, and with radiation to both arms. Laboratory analysis on admission showed normal cardiac biomarkers but the ECG showed ST-elevations in multiple inferior leads. Emergent cardiac catheterization with coronary angiography showed no epicardial or occlusive coronary artery disease; however, it did show an abnormal origin of the RCA. Subsequent CT angiogram of the coronary arteries confirmed an anomalous origin of the RCA from the left coronary cusp with an interarterial course between the aorta and the pulmonary artery, with concerns for impingement. Troponin level trended up to 21 ng/mL; however, we were unsure whether this was secondary to cocaine-induced vasospasms, RCA impingement, or a combination of both. Echocardiogram (ECHO) showed a normal ejection fraction with no valvular or wall motion abnormalities. Patient tolerated the stress test well, tolerating 11+ METS, which revealed no significant ECG changes and minimal areas of ischemia. Following discussion with all the cardiac specialties involved, the patient decided to hold off surgery at this time and continue with conservative medical management. Cocaine abstinence was advised. The patient has had no recurrent episodes in over a year. Conclusions: Coronary anomalies should be suspected in symptomatic young patients with acute coronary syndrome. Given the rarity of this condition, many physicians may be unaware of this disease and should consider this as a differential diagnosis. While surgical intervention is considered first line treatment in many cases, medical management remains a suitable option in select patients.

Cap Polyposis: An Elusive Diagnosis in a Pediatric Patient Successfully Managed With Endoscopic Treatment

Cap polyposis is a rare condition of the rectum or sigmoid colon manifested by inflammatory polyps covered by a thick layer of fibrinopurulent mucus. This condition typically presents as mucoid diarrhea and rectal bleeding, and patients are often prescribed antibiotics (such as those for Helicobacter pylori), steroids, infliximab, or aminosalicylates. Surgical management is an option for unresponsive disease, but endoscopic management has been rarely reported. For cases of cap polyposis in which conservative medical management fails, wide-field endoscopic mucosal resection is a viable option.

EE69 Cost Utility and Budget Impact Analyses of Closed Loop Upper Airway Stimulation (UAS) for the Treatment of Moderate to Severe Obstructive Sleep Apnea From an Australian Health Care System Perspective

This study aimed to assess the cost-effectiveness and budget impact of closed loop upper airway stimulation (UAS) versus conservative medical management for patients with moderate to severe obstructive sleep apnea (OSA) who have failed or are intolerant to continuous positive airway pressure (CPAP) therapy in Australia.

Abstract 12150: Acute Type B Aortic Dissection a 15-Year, Single-Center Experience

Introduction: Treatment of acute type B aortic dissection (ATBAD) has evolved with the use of endovascular technology. This study evaluates the short and long-term outcomes of patients with ATBAD over a 15-year period. Methods: A retrospective review identified patients with ATBAD at our institution between 2006 and 2020. Patients were analyzed based on presentation status (complicated vs. uncomplicated) and treatment. Complicated ATBAD (cATBAD) included malperfusion of any vascular bed, intractable pain, rupture, or rapid expansion. Postoperative outcomes were evaluated within the initial 30 days after diagnosis when managed medically or within thirty days of surgical intervention. Descriptive statistics was performed to assess short-term outcomes. Kaplan-Meier survival was performed to assess long-term mortality. Results: A total of 296 patients presented with ATBAD in the study period. Out of those, 121 patients presented with cATBAD, while 175 patients presented with uncomplicated ATBAD (uATBAD). Out of the cATBAD group, 89 were treated with TEVAR, and 32 were treated with medication only. The cATBAD group was younger than the uCTBAD group (62.0 vs. 65.2, p=0.05). Early mortality was more common in cATBAD than uATBAD (9.9% vs 2.3%, p=0.013). When comparing cATBAD who underwent TEVAR vs conservative medical management, early mortality was higher in the medication only group (12.5% vs 9.0% p = 0.013). Permanent paraplegia occurred in 1.1% (1/89)of patients undergoing TEVAR. Kaplan-Meier survival analysis demonstrated no significant difference in long-term mortality between the cATBAD and uATBAD groups (Logrank p = 0.23). Among the uATBAD patients, 10.3% (18/175) required future intervention for type B dissection (12 TEVAR, 6 open). Among the TEVAR patients, 20.2% (18/89) required re-operations (11 endovascular repairs, 7 open). Conclusions: ATBAD is associated with significant morbidity and mortality, especially in the setting of a complicated presentation. While uATBAD is associated with better short-term outcomes, the diminishing difference in long-term outcome between cATBAD and uATBAD calls for reevaluation of our indications for intervention and may suggest that the remodeling associated with TEVAR could have long term benefit.

Outcomes of SBRT for Symptomatic Benign Tumors of the Spine

<h3>Purpose/Objective(s)</h3> Benign spinal tumors (BSTs) are rare, present across the age spectrum, and may be associated with significant neurologic morbidity. While conservative medical management may be sufficient, many patients experience progression requiring escalated interventions, including surgery. Stereotactic body radiotherapy (SBRT) may be an additional effective management approach for BSTs in the upfront or adjuvant setting. We report our institutional experience of SBRT in management of BSTs. <h3>Materials/Methods</h3> Patients with symptomatic BSTs treated at a single institution with SBRT from 2010-2020 were retrospectively reviewed. Treatment outcomes including symptom and radiographic response were recorded from the electronic health record and presented with descriptive statistics and analyzed by chi-square and univariate logistic regression. <h3>Results</h3> In total, 31 patients with 36 symptomatic BSTs receiving SBRT were identified. Median age at presentation was 57 (IQR: 43-63). Pain was the primary symptom at presentation (92%), followed by paresthesias (28%) and weakness (19%). Histologies were schwannoma (39%), meningioma (33%), hemangioma (22%), and other (6%). Treated spine levels were cervical (44%), thoracic (36%), lumbosacral (19%). 47% of patients had prior surgery at the treated site. Median SBRT prescription dose was 25 Gy (range: 18-40 Gy in 3-5 fractions) treated on consecutive days. Median PTV was 6.0 cc (IQR: 3.5-19.4 cc). Median thecal sac max (0.03 cc) dose was 26.2 Gy (range 0.4-30.2). Interval imaging cadence following treatment was q3-6 months. Median radiographic f/u was 28 months (IQR 9-60). 58% of patients reported durable symptom improvements. 44% of patients experienced acute toxicity from treatment including fatigue, esophagitis, regional pain flare (all grade≤2). One patient developed symptomatic radiation-induced mid-thoracic level myelitis at 6 mo following SBRT with neurologic improvement following protracted (>3 mo) steroid administration with taper. 50% of patients demonstrated radiographic response at last follow-up while 3% showed progression and 47% remained stable. There was no significant association between treatment response or acute/late toxicity and lesion location, dose, or prior surgery. <h3>Conclusion</h3> SBRT for BST, as definitive therapy or for salvage following surgery, was largely effective and safe, with limited high-grade toxicity. Most patients demonstrated symptomatic and/or radiographic response following spine-lesion directed SBRT.

Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series.

Severe viral keratitis with hypopyon and retrocorneal plaques is easily misdiagnosed as it mimics fungal or bacterial keratitis and is more likely to undergo emergency therapeutic penetrating keratoplasty (TPK) in the presence of active infection, resulting in poor outcomes. This case series offers some important insights for the management strategy of severe viral keratitis. This retrospective case series involved five patients with unilateral severe infectious keratitis with hypopyon over 3mm and retrocorneal endothelial plaques. Testing for corneal sensation, microscopy, culture, and anterior segment optical coherence tomography (ASOCT) were performed. At presentation, all five cases had visual acuity of counting fingers (CF) or worse, large centrally located ulcer with clean ulcer surface, hypopyon, and retrocorneal plaques with reduced corneal sensation. ASOCT demonstrated the presence of retrocorneal plaques with clear space between corneal endothelium and plaques. All cases received systemic and topical ganciclovir and topical steroids. Two patients received intravenous immunoglobulin (IVIG) weekly for 2weeks. Complete resolution was achieved in all cases except one patient who underwent TPK because of diffuse anterior synechiae of the iris, with recurrence of infection after 10days. The patients who received IVIG showed resolution earlier compared to the other patients. Evaluation of characteristics of retrocorneal plaques by ASOCT and reduced corneal sensation are valuable aids in diagnosis of complicated viral keratitis. Conservative medical management may be a viable option even in severe cases. IVIG may have a role in speedy resolution of severe cases, but more research is needed to confirm this.

Clinical Implications of the “Broken Line” Angiographic Pattern in Patients With Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute myocardial infarction. Coronary angiography remains the best diagnostic tool; however, clinical suspicion and experience is required to interpret angiographic findings. This study sought to assess the clinical implications of the "broken line" (BKL) angiographic pattern in a large, nationwide, cohort of patients with SCAD. The Spanish SCAD registry (NCT03607981) prospectively enrolled consecutive patients with SCAD. All angiograms were centrally analyzed and the BKL pattern was systematically assessed. The BKL angiographic pattern was found in 64 of 389 patients (16%). Patients with the BKL appearance were more frequently female (97 vs 87%, p <0.05), presented more often as intramural hematoma (83 vs 58%, p <0.001), had longer lesions (47 ± 29 vs 36 ± 22 mm, p <0.01), and had severe tortuosity (25 vs 10%, p <0.01) but showed better initial coronary flow (thrombolysis in myocardial infarction flow 2.6 ± 0.8 vs 2.1 ± 1.2, p <0.01). Patients with BKL received more frequently conservative medical management (91 vs 76%, p <0.01). At late clinical follow-up (median 29 months, interquartile range 17 to 38) predefined adverse events (death, myocardial infarction, revascularization, recurrent SCAD, or stroke) occurred less frequently (3.5 vs 15%, p <0.05) in patients with the BKL appearance. The better clinical outcomes of patients in the BKL group persisted after adjusting for potential confounders (adjusted hazard ratio 0.2, 95% confidence interval 0.1 to 0.9, p <0.05). In conclusion, patients with SCAD presenting the BKL angiographic pattern are more frequently female and present more often as intramural hematoma with longer lesions and severe vessel tortuosity but have better coronary flow. Patients with the BKL morphology have a favorable prognosis (NCT03607981).

S3673 Successful Non-Surgical Management of Emphysematous Gastritis: A Rare Diagnosis

Introduction: Emphysematous gastritis (EG) is a rare condition characterized by the presence of gas within the gastric wall in association with clinical sepsis. This uncommon entity has a high mortality rate, and early diagnosis and treatment are essential to prevent progression of this potentially fatal condition. Here we describe a rare case of EG in a middle-aged female presenting with diffuse abdominal pain and vomiting. By providing the clinical course and presentation of this rare disease, we can help guide future clinician understanding and management of EG. Case Description/Methods: A 64-year-old female with no pertinent gastrointestinal history presented to the emergency department with a one-week history of generalized abdominal pain and non-bloody emesis. On arrival, she was tachycardic with a heart rate of 112 beats per minute but was otherwise hemodynamically stable and afebrile. Physical examination was significant for diffuse tenderness to palpation in all four abdominal quadrants. Initial complete blood count revealed a white blood cell count of 14,100 per microliter of blood and complete metabolic panel revealed no abnormal values. Abdominal and pelvic computed tomography showed air within the wall of the gastric body and gastric fundus with findings most consistent with emphysematous gastritis. The patient underwent treatment with bowel rest, intravenous fluid resuscitation, a proton-pump inhibitor, and broad-spectrum antibiotic therapy. Her symptoms gradually improved, her diet was advanced, and she was discharged without complaints (Figure 1). Discussion: Emphysematous gastritis is a rare, but potentially fatal condition caused by gas-forming microorganisms with a mortality rate of 55-61%. Due to its rarity, no guidelines have been established for the management of EG. However, early diagnosis and initiation of conservative medical management has been shown to reduce mortality and the need for surgical intervention. Surgical exploration is reserved for patients who demonstrate signs of clinical deterioration, perforations, peritonitis, uncontrolled disseminated sepsis or who have failed optimal medical management. Here we describe a case of EG in a female presenting with manifestations of sepsis that was treated successfully with conservative medical management. This case report adds to the limited literature on the clinical course and treatment of this rare disease by supporting the notion that surgical intervention may be foregone if the patient is stabilized and medical management is successful.Figure 1.: Abdominal and pelvic computed tomography without contrast showing air within the wall of the gastric body and gastric fundus representative of emphysematous gastritis.