Abdominal Emergency Research Articles

Post-Operative Follow-Up Of Abdominal Emergencies At The Niamey National Hospital

Introduction: Digestive surgical emergency is an important public health problem in terms of morbidity and mortality. It can be seen at any age. The prognosis depends on the precocity of treatment. Patients and Method: We carried out a prospective, descriptive and cross-sectional study involving 78 post-operative patients who underwent emergency abdominal surgery at the Niamey National Hospital over a period of one month from the 1st to March 31, 2023. Included in the study were all patients who consulted the emergency department of the HNN, who were operated on and hospitalized in the post-operative, intensive care and visceral surgery departments, during the study period. The variables studied were: Age, sex, origin, personal history and profession, treatment received preoperatively, postoperatively, evolution during treatment, duration of hospitalization and patient outcome. The data were entered and analyzed using Microsoft 2016 and Sphinx.v5 software.

Study of Risk Factors for Morbidity in Emergency Abdominal Laparoscopy Surgery

Introduction: Emergency laparoscopy is regarded as a challenging and high-risk domain due to the requisite expertise in both laparoscopic and emergency surgery. Additionally, the physical fatigue of surgical teams and the urgency context contribute to potential increased morbidity rates in emergency surgery. Furthermore, a primary concern with laparoscopy is the frequency of deep collections. The objective of our study was to evaluate the risk factors for morbi-mortality associated with laparoscopic intervention in non-traumatic acute abdominal emergencies. Materials and Methods: A descriptive, prospective, evaluative study was conducted between February 2018 and October 2021, encompassing 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Among the 337 operated patients, perioperative morbidity was 0.3%, and postoperative morbidity was 6.2% (21 patients). These postoperative complications were classified as grade I in 85.71% of cases (18 patients). The mean age of the patients was 38 years ± 15 years. Body mass index (BMI) was above 25 in 179 patients (53.11%). The mean operative time across all pathologies was 52.09 minutes ± 24.14 minutes (Range: 14-178 minutes). The average overall hospitalization duration was 1.5 days (Range: 1 to 8.5 days).The only factor correlated with the occurrence of postoperative complications was obesity (p=0.003). Conclusion: Emergency laparoscopy does not exacerbate morbidity and can be safely performed for the management of acute abdominal emergencies.

Ileocolic Intussusception in Radiological Imaging: A Case Report

Ileocolic intussusception is an abdominal emergency in infants and toddlers that requires immediate diagnosis and treatment. Aims: The aim of this case report is to explain how cases of ileocolic intussusception can be diagnosed and treated quickly. Methodology: This research is a descriptive study with a case report design on a patient. Results: A baby girl, 3 months old, weighing 6 kg, was referred to the emergency unit with symptoms of vomiting, jelly-red stools, excessive crying, but not bloating. There was no history of fever, trauma, or previous eating. Found of decreased intestinal gas on plain abdominal radiographs, and the appearance of a target sign also known as the doughnut sign and sausage shape on ultrasound examination. Ultrasound-guided hydrostatic reduction has been attempted as a first-line non-operative treatment but failed. The results of the operation it was finally discovered that the cause of the ilecolic intussusception was a polyp. Scientific Novelty: Reliability of ultrasound in finding and diagnosing ileocolic intussusception in infants. Conclusion: Ultrasonography is the gold standard in finding and diagnosing ileocolic intussusception. Ultrasound-guided hydrostatic reduction is the first non-operative treatment before surgery becomes an option. Unsuccessful ultrasound-guided hydrostatic reduction may indicate that the ilecolic intussusception is caused by a polyp.

Current status and therapeutic strategy of acute acalculous cholecystitis: Japanese nationwide survey in the era of the Tokyo guidelines.

This study aimed to clarify the incidence, therapeutic modality, and prognosis of acute acalculous cholecystitis and to reveal its optimal treatment strategy. As a project study of the Japanese Society for Abdominal Emergency Medicine, we performed a questionnaire survey of demographic data and perioperative outcomes of acute acalculous cholecystitis treated between January 2018 and December 2020 from 42 institutions. In this study, 432 patients of acute acalculous cholecystitis, which accounts for 7.04% of acute cholecystitis, were collected. According to the Tokyo guidelines severity grade, 167 (38.6%), 202 (46.8%), and 63 (14.6%) cases were classified as Grade I, II, and III, respectively. A total of 11 (2.5%) patients died and myocardial infarction/congestive heart failure was the only independent risk factor for in-hospital death. Cholecystectomy, especially the laparoscopic approach, had more preferable outcomes compared to their counterparts. The Tokyo guidelines flow charts were useful for Grade I and II severity, but in the cases with Grade III, upfront cholecystectomy could be suitable in some patients. The proportions of severity grade and mortality of acute acalculous cholecystitis were found to be similar to those of acute cholecystitis, and laparoscopic cholecystectomy is recommended as an effective treatment option. (UMIN000047631).

Ruptured abdominal aortic aneurysms early recognition, hemodynamic stabilization, and emergency vascular surgery

Ruptured abdominal aortic aneurysms (rAAAs) are extremely dangerous. Require attention. This thorough review explores the management of rAAA, focusing on the detection stabilizing blood flow and emergency vascular surgery. Recognizing symptoms such as intense abdominal pain, low blood pressure, a pulsating mass in the abdomen, signs of reduced blood flow to the lower limbs, and back pain is crucial for quick identification. Diagnostic imaging techniques like ultrasound and computed tomography angiography (CTA) play a role in confirming the diagnosis and assessing the risk involved. Properly managing hemodynamics by balancing resuscitation efforts with approaches is essential to control ongoing bleeding. Emergency vascular surgery options include aneurysm repair (EVAR) and open repair; the choice depends on factors like anatomy, stability of blood flow, and surgical expertise. Prioritizing optimization to address any health conditions and closely monitoring patients after surgery greatly contribute to overall success rates. A collaborative approach among healthcare professionals ensures a multidisciplinary strategy during the period emphasizing effective communication. This comprehensive approach aims for outcomes in dealing with challenging rAAAs while considering advancements in research and clinical practices.

The impact of chronic obstructive pulmonary disease on surgical outcomes after surgery for an acute abdominal diagnosis

PurposeThe current study was undertaken to describe the independent contribution of chronic obstructive pulmonary disease (COPD) to the risk of postoperative morbidity and in-hospital mortality among patients undergoing surgery for an acute abdominal diagnosis.MethodsPatients who underwent emergency abdominal procedures were identified from the electronic database of the Department of Visceral, Transplantation, Thoracic and Vascular Surgery of our institution. To evaluate differences in surgical risk associated with COPD, patients with COPD were matched for age, sex, and type of surgery with an equal number of controls who did not have COPD. Logistic regression was performed to evaluate the univariate and multivariate associations between the independent variables, including COPD and outcome variables.ResultsBetween January 2012 and December 2022, 3519 patients undergoing abdominal emergency surgery were identified in our abdominal surgical department. After removing ineligible cases, 201 COPD cases with an equal number of matched controls remained for analysis. The prevalence of COPD after the exclusion of ineligible cases was 5.7%. There were statistically significant differences in the rate of postoperative pulmonary complications (PPCs [57.7% vs. 35.8%; P < 0.001]), ventilator dependence (VD [63.2% vs. 46.3%; P < 0.001]), thromboembolic events (TEEs [22.9% vs. 12.9%; P = 0.009]), and in-hospital mortality (41.3% vs. 30.8%; P = 029) for patients with and without COPD. Independent of other covariates, the presence of COPD was not associated with a significantly increased risk of in-hospital mortality (OR, 1.16; 95% CI 0.70–1.97; P = 0.591) but was associated with an increased risk of PPCs (OR, 2.49; 95% CI 1.41–4.14; P = 0.002) and VD (OR, 2.26; 95% CI 1.22–4.17; P = 0.009).ConclusionsPreexisting COPD may alter a patient’s risk of PPCs and VD. However, it was not associated with an increased risk of in-hospital mortality.

Acute Colonic Diverticulitis: CT Findings, Classifications, and a Proposal of a Structured Reporting Template.

Acute colonic diverticulitis (ACD) is the most common complication of diverticular disease and represents an abdominal emergency. It includes a variety of conditions, extending from localized diverticular inflammation to fecal peritonitis, hence the importance of an accurate diagnosis. Contrast-enhanced computed tomography (CE-CT) plays a pivotal role in the diagnosis due to its high sensitivity, specificity, accuracy, and interobserver agreement. In fact, CE-CT allows alternative diagnoses to be excluded, the inflamed diverticulum to be localized, and complications to be identified. Imaging findings have been reviewed, dividing them into bowel and extra-intestinal wall findings. Moreover, CE-CT allows staging of the disease; the most used classifications of ACD severity are Hinchey's modified and WSES classifications. Differential diagnoses include colon carcinoma, epiploic appendagitis, ischemic colitis, appendicitis, infectious enterocolitis, and inflammatory bowel disease. We propose a structured reporting template to standardize the terminology and improve communication between specialists involved in patient care.

Profile of appendicitis patient: epidemiology, clinical, and laboratories evaluation in rural-urban area

Appendicitis is one of the most common abdominal inflammations in daily emergency cases. The diagnosis of appendicitis is often delayed because the symptoms resemble other abdominal emergencies. The present research aimed to describe the clinical and epidemiological profile of acute appendicitis patients. The research design is a cohort retrospective study employing appendicitis patients' medical record data at PKU Muhammadiyah Hospital from January 1, 2016, to December 31, 2020. The variables obtained through the patient records were age, gender, domicile location, vital signs, physical examination, blood laboratory, ultrasound, histopathology, postoperative diagnosis, the incidence of peritonitis, and length of stay. The median age value in patients with appendicitis was 27 years (0-95), and the largest group was young adults (19-44 years). Abdominal pain was found in almost all research subjects. The median of leukocytes was 10.1 (3.32-65.80)×10&lt;sup&gt;6&lt;/sup&gt;/ml and the neutrophil-lymphocyte ratio (NLR) was 3.52 (0.47-30.57)/μl. The median percentage of the neutrophil count was 70.7 (27.90-94.81). The final diagnosis of complicated appendicitis was more than uncomplicated appendicitis (51.2% vs. 48.8%). We conclude that several detailed parameters, such as the location of abdominal pain, leukocyte count, and NLR can help the physician diagnose appendicitis and guide surgeons in deciding the type of surgery.

Robotic Appendicectomy

Acute appendicitis is one of the most common abdominal emergencies. There has been an increasing news of robotic abdominal surgery. However, it remains underutilised in emergency settings. This study aimed to systematically review robotic appendicectomy (RA) feasibility. A 20-year systematic review was performed, along with quality assessment. The research protocol was registered with PROSPERO. The search yielded 1,242 citations, including 9 articles. The mean quality score was 10.72 ± 2.56. The endpoints across the studies were rate of conversion to open surgery, length of hospital stay, blood loss and operative time. RA is a safe, feasible technique that can be performed in elective and emergency settings with minimal blood loss. The operative time and hospital stay were within acceptable limits. Robotic surgery’s major drawback is its high cost and limited availability. Future studies evaluating RA with a focus on its application during emergencies and its cost-effectiveness are recommended. Keywords: Robot Surgery; Robotic-Assisted Surgery; Robot Enhanced Surgery; Robotic Surgical Procedure; Appendectomy; Appendicectomy; Gastrointestinal Surgical Procedure.

Peculiarities of the Provision of Surgical Care for Abdominal Emergencies in Hospitals Remodeled to Provide Medical Care to Patients with COVID-19 From the Perspective of a Systematic Review and Analysis of the Quality of Publications

Relevance. Due to the pandemic of the new coronavirus infection, changes have occurred in the work of most surgical hospitals aimed at optimizing and improving the provision of medical care. Performing acute and emergency surgical interventions in patients with confirmed COVID-19 infection dictates the need to review surgical tactics.Aim of study. To assess the quality of publications in the scientific press from the standpoint of systematic analysis on the provision of emergency surgical care in remodeled hospitals and to identify the main changes in surgical tactics in patients with abdominal emergency and COVID-19.Material and Methods. The analysis of data from publications dated from December 2019 to July 10, 2021 from electronic databases PubMed, Cochrane Library, Scopus, eLibrary. An analysis of numerous studies, recommendations of national and international surgical, urological, oncological, gynecological, endoscopic and anesthesiological communities and associations, the World Health Organization, temporary guidelines of the Ministry of Health of the Russian Federation on the prevention, diagnosis and treatment of new coronavirus infection was performed. The quality of the selected publications was assessed in accordance with the recommendations.Results. When analyzing the selected publications, it was revealed that most of them are retrospective, uncontrolled one-time studies and descriptions of clinical cases (level 4 evidence, level C recommendation). We found 1 combined (prospective-retrospective) multicenter and 1 retrospective comparative study on the treatment tactics of acute cholecystitis, 1 retrospective multicenter cohort study on acute pancreatitis, 1 retrospective study on acute intestinal obstruction and 2 studies on acute appendicitis, 1 case-control study on gastrointestinal tract and intestinal bleeding (level 3 evidence, level B recommendation).Conclusion. Currently, there are no high-level evidence or recommendations to change surgical tactics in patients with COVID-19 and abdominal emergency.

EGS P36 Scan every clinical appendicitis before operation. Can we prevent unnecessary operations in this era of CT?

Abstract Background Acute appendicitis is the most common abdominal surgical emergency in the world, with around 50,000 acute appendectomies performed annually in the UK. However, appendectomy has been associated with negative appendectomy rates (NARs) of 15%-39% in large series. On the other hand, CT scan is associated with radiations increasing the risk of cancer and considerable cost to the trust. Methods Notes of 25 patients admitted with suspicion of acute appendicitis were reviewed retrospectively by the auditors from their admission to the discharge from hospital and CT scan reports were evaluated. Results All of the patients seen by the surgical team had a CT scan to confirm the diagnosis of acute appendicitis before surgery. 15/25 patients had a diagnosis of acute appendicitis and all of the histology reports in these patients after the surgery confirmed the diagnosis. 10/25 patients had other diagnosis on CT despite clinical features suggestive of acute appendicitis. Colitis was the second most common cause of abdominal pain after acute appendicitis. 0% negative appendectomy rate was achieved when CT scan was done before the surgery. Conclusions This audit concludes that all the patients who present with the clinical suspicion of acute appendicitis should have a CT scan before the surgery to avoid the unnecessary operations however, an audit of 1 year or more would be more beneficial in formulating a clear picture and the development of guidelines.

Elevating healthcare through artificial intelligence: analyzing the abdominal emergencies data set (TR_ABDOMEN_RAD_EMERGENCY) at TEKNOFEST-2022.

The artificial intelligence competition in healthcare at TEKNOFEST-2022 provided a platform to address the complex multi-class classification challenge of abdominal emergencies using computer vision techniques. This manuscript aimed to comprehensively present the methodologies for data preparation, annotation procedures, and rigorous evaluation metrics. Moreover, it was conducted to introduce a meticulously curated abdominal emergencies data set to the researchers. The data set underwent a comprehensive central screening procedure employing diverse algorithms extracted from the e-Nabız (Pulse) and National Teleradiology System of the Republic of Türkiye, Ministry of Health. Full anonymization of the data set was conducted. Subsequently, the data set was annotated by a group of ten experienced radiologists. The evaluation process was executed by calculating F1 scores, which were derived from the intersection over union values between the predicted bounding boxes and the corresponding ground truth (GT) bounding boxes. The establishment of baseline performance metrics involved computing the average of the highest five F1 scores. Observations indicated a progressive decline in F1 scores as the threshold value increased. Furthermore, it could be deduced that class 6 (abdominal aortic aneurysm/dissection) was relatively straightforward to detect compared to other classes, with class 5 (acute diverticulitis) presenting the most formidable challenge. It is noteworthy, however, that if all achieved outcomes for all classes were considered with a threshold of 0.5, the data set's complexity and associated challenges became pronounced. This data set's significance lies in its pioneering provision of labels and GT-boxes for six classes, fostering opportunities for researchers. The prompt identification and timely intervention in cases of emergent medical conditions hold paramount significance. The handling of patients' care can be augmented, while the potential for errors is minimized, particularly amidst high caseload scenarios, through the application of AI. • The data set used in artificial intelligence competition in healthcare (TEKNOFEST-2022) provides a 6-class data set of abdominal CT images consisting of a great variety of abdominal emergencies. • This data set is compiled from the National Teleradiology System data repository of emergency radiology departments of 459 hospitals. • Radiological data on abdominal emergencies is scarce in literature and this annotated competition data set can be a valuable resource for further studies and new AI models.

Elevated total and direct bilirubin are associated with acute complicated appendicitis: a single-center based study in Saudi Arabia

BackgroundAppendicitis is the most common abdominal surgical emergency and up to our knowledge no previous studies have been conducted in Saudi Arabia particularly at Qassim region and this study aimed to determine a total and direct bilirubin as a predictor of acute complicated appendicitis.MethodsObservational retrospective study that included patients admitted under the general surgery department with a diagnosis of acute appendicitis at King Saud Hospital, Unaizah, Saudi Arabia. Data on age, gender, BMI, diabetes mellitus, total and direct bilirubin, AST, ALT, sodium, and WBCs levels were obtained.ResultAmong the overall study population of 158 patients, the age median [IQR] was 24.5 [19–31], males were 99 (62.7%), and complicated appendicitis was 33 (20.9%). The multivariable analysis revealed that both elevated total and direct bilirubin are associated with complicated appendicitis (aOR = 3.79, 95% CI: 1.67–8.48, P = 0.001) and (aOR = 4.74, 95% CI: 2.07–10.86, P < 0.001) respectively. A receiver operating characteristic curve showed the best cutoff value of total and direct bilirubin as ≥ 15 µmol/L and ≥ 5 µmol/L respectively, with a sensitivity of 57.6%, and specificity of 73.6% for elevated total bilirubin, and a sensitivity of 54.6%, and specificity of 80% for elevated direct bilirubin.ConclusionElevated total and direct bilirubin are associated with acute complicated appendicitis in this setting. However, it should be supportive factor for acute complicated appendicitis and not considered as standalone diagnostic test.

Emergency intestinal stomas incidence and early complications

Background: An intestinal stoma is a frequently performed procedure with a high percentage of complications. Even though creating an intestinal stoma is a procedure that can save lives while treating various gastrointestinal conditions, its accompanying morbidity and mortality have been the topic of many studies. This study was carried out in order to better understand a variety of complications in various types of intestinal stomas. Methods: A total of 60 patients with intestinal stoma construction in the general surgery emergency department at Kasr Al-Ainy emergency hospital Cairo, Egypt as an emergency procedure from December 2019 to May 2020 were included in this prospective cohort analysis. The inclusion criteria were all emergency cases undergoing intestinal stomas for treatment of either traumatic bowel injuries or acute abdominal surgical emergencies. Results: With a mean age of 45.18 years, 60 patients in all were evaluated. Males were 65% and females were 35%. End ileostomy with mucous fistula (33.3%) and loop transverse colostomy (18.30%) were the two stomas that were constructed most frequently. Intestinal obstruction (41.7%) was the most often reported indication of stoma formation. Complications of the peristomal skin made up the majority of cases (61.90%). Conclusions: This work significantly advances our understanding of stoma problems and their prevention to some extent through pre-operative soma site marking, good surgical technique, an experienced surgeon, a stoma therapy nurse, and patient education to enhance the care and quality of life for those who have stomas.

The Relationship between Neutrophil-Lymphocyte Ratio to Intestinal Viability in Invagination Patients at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Invagination is an acute condition in the pediatric abdomen that results in obstruction and constriction of blood vessels (strangulation) in the proximal intestinal mesenterium trapped in the distal intestine, allowing necrosis of surrounding tissue. Intestinal necrosis and perforation in children are causes of abdominal emergencies that require immediate surgery. In supporting examinations, neutrophil, lymphocyte, and biomarker combination ratios have been used for early detection of systemic inflammatory markers. The threshold value of several biomarkers should be investigated to assess the occurrence of strangulation in the pre-operative period in invaginated patients. This study aimed to determine the relationship between neutrophil-lymphocyte ratio and intestinal viability in pediatric patients with invagination.&#x0D; Methods: This study used retrospective analytic data collection from medical records of invagination patients at Dr. M. Djamil General Hospital Padang for the period January 1, 2020, to December 31, 2022.&#x0D; Results: The majority of subjects were male (53.8%) at the age of ≤ 1 year, with as many as 87.2% having a diagnosis of operative invagination (76.9%) and 56.4% having intestinal viability. The mean neutrophil, lymphocyte, and NLR values were 62.15±17.68, 19.03±8.97, and 3.74±1.55, respectively. The pathological NLR status was found to be 59%. The p-value for the association of diagnosis with intestinal viability was 0.002. The p-value for the relationship between NLR and intestinal viability was 0.001, and the r-calculated was -0.528.&#x0D; Conclusion: There is a significant relationship between NLR value and disease diagnosis on intestinal viability.

Uterine torsion with placental abruption and fetal death at term pregnancy: A case report and literature review

Background: Uterine torsion in pregnancy is a rare event that requires urgent recognition and management. Its presentation is non-specific and ranges from asymptomatic to severe life-threatening conditions such as placental abruption with hemorrhagic shock and maternal and fetal death. Here we describe our case and reviewed similar literature on gravid uterine torsion. To our knowledge, this is the first report of term uterine torsion complicated by placental abruption and fetal death in Africa. Case Presentation: A 28 years old Ethiopian woman gravida III, para II, presented at 37 weeks of gestation with acute severe abdominal pain, mild vaginal bleeding, absent fetal movement, and shock. Emergency cesarean section was decided with a presumptive diagnosis of placental abruption with hemorrhagic shock and intrauterine fetal demise. Intraoperatively, it was realized that the placenta and the dead fetus were delivered through an inadvertent posterior lower segment hysterotomy made on 1800 levo-rotated uterine torsion. Then the uterus was restored to its anatomic position and the posterior hysterotomy was closed. Despite medical measures, the uterus became atonic and a hysterectomy was required. The patient had an uneventful postoperative and postpartum course. Conclusion: Even if gravid uterine torsion is uncommon, it should be kept in mind as one of the differentials in pregnancy-related acute abdominal emergencies due to its non-specific nature and dangerous impact. Furthermore, it can be obscured and associated with other obstetric emergencies, especially placental abruption.

A Rare Case of Cecostomy Tube in Complicated Acute Appendicitis Leading to Fecal Peritonitis

The most common abdominal surgical emergency in the world in acute appendicitis. Most common age group involved is between first to second decades but patients at extreme age have higher mortality rate due to late presentation. We are presenting a case of appendicitis which was complicated as long history at time of first surgery which led to caecal injury which was managed with ceacostomy. 62 years gentleman was referred from private hospital with fecal discharge from the open appendectomy wound and cecostomy tube insitu. Patient was diagnosed as phlegmon sequelae of acute appendicitis. Patient underwent emergency laparotomy, peritoneal lavage, removal of cecostomy tube, primary repair of caecal perforation and diversion loop ileostomy. Patient recuperated well. This case report highlights the challenges faced and complexities associated with failure of cecostomy in managing caecal perforation following laparoscopic appendectomy. The conversion from a laparoscopic approach to an emergency open appendectomy followed with cecostomy proved to be a vital decision in the face of phlegmon sequelae of acute appendicitis. The phlegmonous nature of acute appendicitis should be managed conservatively otherwise leading to a more aggressive surgical intervention. Keywords: Acute appendicitis, cecostomy, ileostomy, fecal discharge, phlegmon, complicated appendicitis.

Diagnosis, risk factors, and treatment of pediatric benign pneumoperitoneum: A single‐center retrospective study

AbstractPneumoperitoneum is one of the common acute abdominal emergencies that leads to surgical exploration in children, but not all pneumoperitoneum require emergency surgery. This study evaluated the diagnostic methods, predisposing risk factors, and therapeutic options in children with benign pneumoperitoneum for accurate diagnosis and reducing the risk of adverse surgical consequences. A total of 63 cases of pneumoperitoneum diagnosed by the radiographs were involved in this study and were divided into the surgical pneumoperitoneum and benign pneumoperitoneum groups, respectively, from 2009 to 2021. The general information, abdominal signs, laboratory examination, therapies and outcomes, total hospitalization time, and comorbidities were analyzed. Logistic regression analysis assessed the risk factors and protective factors of benign pneumoperitoneum. Promising biomarkers underwent receiver operating characteristic curve analysis. Children with surgical pneumoperitoneum were younger than those with nonsurgical pneumoperitoneum in the study. The C‐reactive protein (CRP) level in the surgical pneumoperitoneum group was higher than that in the other group, albumin (ALB) was lower than that in the benign pneumoperitoneum group, and the ratio of ALB to CRP can be used as an effective indicator to predict whether the pneumoperitoneum is benign or whether surgery is needed. Pulmonary injury, pneumonia, and blunt abdominal injury are the major causes in patients with benign pneumoperitoneum. The establishment and management of clinical criteria for the diagnosis of benign pneumoperitoneum in children will be important for the treatment and recovery of children diagnosed with pneumoperitoneum.

Non-traumatic abdominal surgical emergencies in children in Dapaong (TOGO)

IntroductionSurgical abdominal emergencies in children are responsible for high morbidity and mortality. They are numerous and their management in Africa is difficult. The management of non-traumatic abdominal emergencies in children in a regional hospital in Togo is described. Methodand study setting: This was a single-center, retrospective and descriptive study conducted over a 12-month period. It included all children aged 0–15 years treated at the hospital for non-traumatic abdominal surgical emergencies. ResultsWe reported 217 cases of non-traumatic abdominal surgical emergencies in children. We noted a male predominance with a sex ratio of 1.57. Similarly, grandchildren were predominant (44.70 %). A low school attendance rate was noted (21.20 %) and the children were mostly from poor families (32.72 %). The average consultation time was 5.3 ± 1.03 days. Pain was the main symptom and was present in all children. An unprepared abdominal X-ray was the main imaging procedure performed (77.18 %). These conditions were dominated by peritonitis (56.68 %). These were mainly ileal perforations. All the children received surgical treatment. The postoperative course was marked by complications in 104 children (47,93 %) and 14 deaths (6,45 %). ConclusionNon-traumatic abdominal surgical emergencies in children are dominated by peritonitis in rural Togo. They could be related to poverty. An effective policy of universal access to health care is essential.

Severity of Acute Appendicitis is Predicted by Hyperbilirubinemia: A Clinical Clue

Background: One of the most frequent abdominal emergencies requiring emergency surgery is acute appendicitis, and appendectomy is the most common emergency procedure performed globally. There is an urgent need for a predictor of the severity of acute appendicitis since delayed identification and treatment of severe appendicitis are linked to higher risks of perforation and postoperative morbidity, mortality, and prolong hospital stay. Objectives: The aim of this study was to assess how the severity of acute appendicitis is predicted by hyperbilirubinemia. Methods: This descriptive cross-section study was carried out in the Department of Surgery at Combined Military Hospital (CMH), Cumilla, during March 2021 to Feb 2023. A total of 80 patients purposing were included in this study. Among them 30 were diagnosed as complicated appendicitis and rest 50 were simple appendicitis patients. Patients diagnosed with complicated appendicitis and simple appendicitis irrespective of age and sex were included in the study. Patients who were not given consent to participate in the study were excluded from the study. After taking consent and matching eligibility criteria, data were collected from patients on variables of interest using the predesigned structured questionnaire by interview, observation, clinical examination and hematological investigation of the patients. Statistical analyses of the results were obtained by using window based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-26), where required. Results: In complicated appendicitis 40% were male and 60% were female. In simple appendicitis 40% were male and 60% were female. The mean T-Bil in complicated appendicitis was 1.187mg/dL and 1.00 mg/dL in simple appendicitis. About 46.0% patients had hyperbilirubinemia in complicated appendicitis and 32.5% in simple appendicitis. Here, 58.0% had fever &gt;37.30C in complicated appendicitis and 33.5% in simple appendicitis. About 69.7% had positive ..........