Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

Zaza Demetrashvili,Ugo Boggi,Richard Ten Broek,Francesco Corradi,Belinda De Simone,Ramiro Manzano-Núñez ,Arda Işık ,Walter L. Biffl,Marja A. Boermeester ,Goran Augustin,Itani Kamal,Swati Dhingra ,Gennaro Perrone,Ernest E. Moore,Boris Sakakushev,Massimo Sartelli,Mircea Chirica,Luigi Bonavina,Imitiaz Wani,Miklosh Bala,Edward Tan,Matti Tolonen,Stefano Gitto,Oreste Romeo,Nicola De’angelis ,Dario Tartaglia,Robert G. Sawyer ,Ari Leppäniemi ,Enrico Cicuttin,Therèse M. Duane ,Fausto Catena,Salomone Di Saverio,Ines Rubio ,Andrew B. Peitzman ,Carlos A. Ordóñez ,Vishal G Shelat ,Marco Ceresoli,Kemal Raşa ,Antonio Tarasconi,Luca Ansaloni,Timothy Craig Hardcastle ,Manu L. N. G. Malbrain ,Andreas Hecker,Emmanuel Pikoulis ,Jean‐Louis Vincent ,Fikri M. Abu‐Zidan ,Mauro Podda,Francesco Forfori,Michael Sugrue,Raúl Coimbra ,Francesco M. Labricciosa ,Cui Y ,Mario Improta,Paola Fugazzola,Yoram Kluger,Francesco Di Marzo,Massimo Chiarugi,Philippe Montravers,Bruno Viaggi,Anastasia Pikoulis,Camilla Cremonini,Andrey Litvin,Carlos Augusto Gomes

doi:10.1186/s13017-021-00380-1

Abstract

Immunocompromised patients are a heterogeneous and diffuse category frequently presenting to the emergency department with acute surgical diseases. Diagnosis and treatment in immunocompromised patients are often complex and must be multidisciplinary. Misdiagnosis of an acute surgical disease may be followed by increased morbidity and mortality. Delayed diagnosis and treatment of surgical disease occur; these patients may seek medical assistance late because their symptoms are often ambiguous. Also, they develop unique surgical problems that do not affect the general population. Management of this population must be multidisciplinary.This paper presents the World Society of Emergency Surgery (WSES), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) joined guidelines about the management of acute abdomen in immunocompromised patients.

Highlights

Emergency surgery admissions carry a substantial risk of in-hospital death of 3.04% [1] and a chance of postoperative complication of 21%
Emergency surgery must be reserved only for those patients presenting with signs of toxic megacolon, fulminant colitis, perforation, or ischemia (GoR moderate based on low Level of evidence (LoE))
The epidemiology of acute surgical diseases varies, with gallbladder disease being one of the most common problems after heart and/or lung transplantation and intestinal perforation due to diverticulitis being the most common disease following kidney and liver transplants (GoR moderate based on intermediate LoE)

Summary

Introduction

Emergency surgery admissions carry a substantial risk of in-hospital death of 3.04% [1] and a chance of postoperative complication of 21%. Immunocompromised patients (IP) are a heterogeneous and diffuse category of patients frequently presenting to the emergency department (ED) with acute surgical diseases. Misdiagnosing of acute surgical disease in an IP may be followed by increased morbidity and mortality. There have been a few attempts to stratify these patients in the last 30 years, especially since a universally accepted definition of an immunocompromised state does not exist [2, 3]. Revision of all those conditions and diseases causing immunocompromission (IC) may lead to patient categorization into two groups: one with mild-moderate IC and another with severe IC (Table 1). Malignancy on chemotherapy Neutrophil count < 1000/mm guidelines about the management of acute abdomen in immunocompromised patients

Material and methods

Findings

Conclusions