Abdominal Signs Research Articles

Interventional Management of Visceral Artery Aneurysms: Simple to Complex

AbstractVisceral artery aneurysms (VAAs) are uncommon but potentially life-threatening vascular disorders that can involve the celiac, superior, and inferior mesenteric arteries or their branches. They are often asymptomatic but can present with vague abdominal pain, secondary effects, or signs of hemorrhage. The most common site of involvement is the splenic artery, followed by the hepatic artery, the celiac axis, and mesenteric arterial branches. VAAs can be classified into two types: true aneurysms (TAs) and pseudoaneurysms (PSAs). Imaging, particularly multidetector computed tomography angiography, is the cornerstone in diagnosing VAAs. Treatment decisions are based on the risk of rupture and clinical deterioration in a patient with a VAA. The endovascular approach remains the mainstay in the treatment of VAAs. As a general guideline, PSAs, even when asymptomatic, should always be treated. TAs are treated based on their size and location. Deconstructive and reconstructive strategies are the standard treatment options for any VAA, and assessing the vascular anatomy and collateral circulation is paramount for treatment decisions.

8063 Cystic Parathyroid Adenoma: A Rare Cause Of Severe Hypercalcemia

Abstract Disclosure: M. Owrangi: None. F. Hasan: None. Introduction: Parathyroid adenomas are the most common cause of primary hyperparathyroidism, but within this category, a rare subtype exists - cystic parathyroid adenomas (CPAs). Comprising only 0.5-1% of all parathyroid lesions, CPAs present unique diagnostic and therapeutic challenges. We report a case of a female patient presenting with severe hypercalcemia caused by a CPA. Case presentation: A 44-year-old African American female with a history of nephrolithiasis presented with abdominal pain and signs of dehydration. Labs were remarkable for serum calcium 13.2 mg/dL, albumin 4.0 g/dL, phosphorus 1.8 mg/dL, iPTH 617.7 pg/mL, 25-OH vit D 12.1 ng/mL, creatinine 0.85 mg/dL. She was initially resuscitated aggressively with IV fluids resulting in an improvement in serum calcium level to 10.3 mg/dL. Thyroid US showed a cystic nodule deep to the left thyroid lobe. Sestamibi parathyroid scan was consistent with a left superior parathyroid adenoma. She underwent 2 gland parathyroidectomy 3 months after the initial presentation. Intraoperatively serum PTH decreased by 91% after resection of the 2 parathyroid adenomas. Pathology confirmed the presence of 2 parathyroid adenomas, the larger one measuring 2.8 cm and weighing 3.8 g. Discussion: We describe a case of a middle-aged female presenting with severe hypercalcemia due to CPA. Her initial presentation was concerning for parathyroid carcinoma given the severity of hypercalcemia. However, the radiologic findings, coupled with surgical pathology, indicated that she had CPA. CPAs can be either functional, causing primary hyperparathyroidism (PHPT) with elevated serum calcium levels, or non-functional, remaining asymptomatic. Clinical features of PHPT associated with CPAs are similar to those with solid adenomas and include fatigue, GI symptoms, nephrolithiasis, bone pain, and neuropsychiatric manifestations. However, CPAs may exhibit certain distinct presentations: i) higher pre-operative serum calcium levels; and ii) increased risk of symptomatic hypercalcemia. Despite their rarity, CPAs deserve special attention due to their unique presentation, challenging diagnosis, and potential for severe hypercalcemia. Surgical parathyroidectomy is the definitive treatment for functional CPAs. Accurate localization and complete excision of the adenoma are crucial to avoid recurrence. Most CPAs occur in the fourth and fifth decade of life and are more common in women (female to male ratio of 2.5:1). 65-85% of cases are located in the neck and the majority arise from the inferior parathyroid glands and are left-sided, and may very rarely be intrathyroidal. Presentation: 6/2/2024

Summary of the Best Evidence for Tube Feeding Intolerance in Critically Ill Children

Objective: To summarize the evidence of tube feeding intolerance in critically ill children, aiming to provide evidence-based information for clinical nursing staff. Methods: Evidence search was done in Chinese and English databases to guide network and professional associations at home and abroad. The search time limit was from January 2014 to January 2024, nearly 10 years of relevant literature, mainly including guidelines, consensus, expert advice, best practice, evidence summary, system evaluation, and meta-analysis. Literature quality evaluation and evidence extraction were independently performed by two researchers. Results: This paper included 13 articles, including three guidelines, three systematic evaluations, three expert opinions, and four expert consensus. Twenty-six pieces of evidence were summarized from 10 aspects of feeding intolerance definition, team building, nutritional assessment, nutritional preparation, feeding protocol, feeding route, feeding management, pipeline management, gastric residual volume, and drug application. Conclusion: This paper summarized the evidence of tube feeding intolerance in critically ill children, which can provide evidence-based information for clinical practice. The abdominal signs should be closely observed when evaluating feeding intolerance, focusing on the prevention and reduction of feeding interruption.

Initial signs in patients with ruptured abdominal aortic aneurysms: time for an expanded triad?

Background and objectiveMisdiagnosis of ruptured abdominal aortic aneurysms (rAAA) contributes to delayed treatment and potentially higher mortality. The symptomatology in patients with rAAA is complex and challenging, 25–50% presumably fulfill the criteria of the standard triad of signs (STS). The objective was to determine the initial signs registered for patients with verified rAAAs, and to investigate if an expanded diagnostic triad could increase the diagnostic accuracy.MethodsA population-based study was conducted among all patients presenting with verified rAAAs in Stockholm County, Sweden, from January 2010 to October 2021. Patients were identified with ICD code 171.3 (rAAA). The STS was defined as (1) abdominal pain, (2) syncope and (3) the finding of a pulsatile abdominal mass, the prevalence of STS was investigated. An expanded triad included similar and related signs commonly registered for patients with rAAA, and was referred to as the modified abdominal aortic aneurysm rupture signs (MARS). The MARS-signs encompassed (1) the registered pain-associated symptoms or signs, (2) all hypovolemic associated signs, and (3) pulsatile abdominal mass and/or ultrasound finding, and the prevalence was similarly investigated. Finally, the STS and MARS were compared to evaluate the usefulness and performance of the MARS-score.ResultsA total of 216 patients were identified. The majority were men (77%) with a median age of 78 years. The dominating symptom was abdominal pain (84%), followed by dizziness (50%). Few patients presented with three STS (13%), two STS were found in 37% and one STS in almost half of the patients (41%). By contrast, when applying MARS 35% presented with the complete expanded triad, 47% with two and 17% with one. Comparison of accuracy favored MARS (13 vs. 35% with 3 signs, P < 0.001 for STS vs. MARS) (2 or 3 signs, 48 vs. 82% STS vs. MARS, P < 0.001).ConclusionsThe expanded MARS-signs could aid in easier and faster identification of rAAA patients, thus facilitating the first step with accurate diagnosis into the lifesaving rAAA care chain. Supportive diagnostic mnemonics and tools are especially important when targeting fatal diagnoses such as rAAA. Further studies are needed to investigate the implementation of the MARS-signs in various clinical settings.

Findings of Abdominal Computed Tomography In COVID-19 Patients with Abnormal Abdominal Symptoms In Siriraj Hospital

Background: The coronavirus (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Chest imaging findings of COVID-19 disease have been widely published. Only a few studies of abdominal imaging findings have been documented. The majority of these studies demonstrate thrombotic events associated with COVID-19. Previous studies were mainly conducted in the USA, Europe and China which limited the applicability in Southeast Asia (SEA) including Thailand. Objective: To provide a summary of various abdominal imaging findings of COVID-19 patients admitted to xxx Hospital with findings associated with clinical outcomes. Materials and Methods: All CT abdominal imaging of adult patients who tested positive for COVID-19 performed from January 1st, 2020 to August 31st, 2022 were retrospectively reviewed. We collected clinical data, abdominal signs and symptoms, laboratory data and various CT findings, for example; bowel-wall thickening, bowel ischemia, fluid-filled colon and bleeding manifestations. The clinical outcomes were gathered as death confirmation, invasive mechanical ventilation, days of invasive mechanical ventilation and days of hospitalization. Results: A large number of patients who had stage 3-5 chronic kidney disease (CKD), abdominal distension, abnormal bowel findings and longer days of hospitalization were significantly observed in a group with worse clinical outcomes. Abnormal intestinal imaging findings were related to a higher risk of worse outcomes, invasive mechanical ventilation, death and days of hospitalization without statistical significance. Conclusion: Abdominal CT scans performed on COVID-19 patients frequently revealed abnormal bowel findings, which were strongly associated with poor clinical outcomes. Radiologists need to be concerned about abnormal bowel findings and point them out to clinicians and surgeons.

Diagnostic Approach of Mesenteric Cyst in Children: A Case Report

Background: Mesenteric cysts are intra-abdominal masses that arise from obstructed lymphatic drainage within the mesentery. Early diagnosis can be challenging, as it is often difficult to recognize based solely on clinical findings. The diagnosis is frequently made following imaging studies or during surgery. Despite their generally benign nature, delayed diagnosis can lead to serious complications. This case report aims to share our experience on the diagnostic approach for mesenteric cysts in children. Case: A 2-year-old boy presented with a 14-month history of slowly progressive abdominal distension and signs of bowel obstruction, including weight loss. Abdominal ultrasound revealed thin-walled, well-demarcated, septated fluid sacs consistent with a cyst. Abdominal CT-Scan showed massive ascites filling the intraperitoneal cavity and pushing the intestine upward along the thickened mesentery, causing bowel obstruction. Histopathological examination confirmed the diagnosis of cyst lymphangioma derived from mesentery. The cyst was successfully excised via laparotomy, and histological examination confirmed it as a cystic lymphangioma. Discussion: Our diagnostic approach focused on exclusion of differential diagnosis for abdominal distention in children, including ascites, abdominal tuberculosis, mesenteric cysts, and intra-abdominal masses. The absence of constitutional symptoms and lack of response to anti-tuberculosis therapy made it an unlikely diagnosis. While the CT-scan suggested ascites, the ultrasound results suggested a mesenteric cyst. Despite its large size, a complete excision of the cyst was successfully performed via laparotomy. Conclusion: The nonspecific nature of mesenteric cysts often delays diagnosis, making abdominal ultrasound an essential initial imaging modality for patients suspected of having this condition.

Diagnosis and surgical treatment of obturator hernia in the recent decade with long-term follow-up: A single center experience.

Obturator hernia (OH) is a rare and dangerous disease that can lead to life-threatening consequences, and pelvic computed tomography (CT) is widely used for its diagnosis. There is no consensus regarding the surgical approach and repair methods. Retrospective analysis of the clinical and follow-up data of 15 cases of incarcerated hernias patients admitted to the Department of General Surgery, affiliated to Taicang Affiliated Hospital of Soochow University, from January 2011 to December 2022. OH could be precisely diagnosed with pelvic CT scan, except for occult OH and non-strangulated OH. Thirteen patients underwent emergency surgery, with a total complication rate of 76.9% and no mortality. Ten patients underwent open surgery, and 3 patients underwent laparoscopic surgery, which had advantages in terms of total cost and postoperative hospital stay (P < .05). Emergency patients all underwent simple peritoneal closure, and hernial sac excision was simultaneously performed in 6 of them. A recurrence (7.7%) was detected at 38 months after the first operation. There was no statistically significant difference between the 2 tissue repair methods in terms of recurrent rate. Pelvic CT can be used as a gold standard for the diagnosis of incarcerated OH, but it has limited value in occult OH and non-strangulated OH. Laparoscopic surgery is recommended for patients with a short onset time and no abdominal physical signs. Tissue repair is sufficient for incarcerated OH and hernial sac excision may be unnecessary.

Cancer masquerading as an intussusception: Experience at tertiary care rural hospital

One segment of the intestine telescopes into another, resulting in obstruction or intestinal ischemia. A pathological lead point, such as a tumor, causes the disease. A pathologic lead point in the lumen, wall, or outside the wall can cause adult intussusception (AI). Retrospective case series of eight patients diagnosed with AI over 18 years in a tertiary rural tertiary a decade (2010-2020). Out of 8 AI cases6 were women, and 2 were men. The median age at diagnosis was 44 years. AI was verified by USG (25%), with CT scan being (100%) sensitivity preoperatively. AI distribution (2 in the small bowel, four at the ileocecal region, and 2 in the colon). The most commonly reported presenting symptom was abdominal pain. (8/8,100%). 75% (6/8) of patients underwent urgent surgery after presenting with acute intestinal obstruction. At the same time, two cases underwent elective surgery. Out of them, five cases were malignant (adenocarcinoma) (62.5%), and three cases were benign tumors (37.5%). (Inflammatory myofibroblastic tumor, a Meckel’s diverticulum, and appendicitis). Due to the lack of specific symptoms, the diagnosis of AI by clinicians and surgeons is frequently missed out. When dealing with acute abdominal pain and signs of bowel obstruction, it's important to consider this less common diagnostic possibility because intussusception is a surgical emergency with high mortality rates in the case of delayed treatment. A surgical approach must be practiced to avoid missing underlying causes like neoplasm.

Predictive parameters for early detection of clinically relevant abdominal trauma in multiple-injury or polytraumatised patients: a retrospective analysis

Diagnosis of relevant organ injury after blunt abdominal injury (AI) in multiple-injury/polytraumatised patients is challenging. AI can be distinguished between injuries of parenchymatous organs (POI) of the upper abdomen (liver, spleen) and bowel and mesenteric injuries (BMI). Still, such injuries may be associated with delays in diagnosis and treatment. The present study aimed to verify laboratory parameters, imaging diagnostics, physical examination and related injuries to predict intraabdominal injuries. This retrospective, single-centre study includes data from multiple-injury/polytraumatised patients between 2005 and 2017. Two main groups were defined with relevant abdominal injury (AI+) and without abdominal injury (AI−). The AI+ group was divided into three subgroups: BMI+, BMI+/POI+, and POI+. Groups were compared in a univariate analysis for significant differences. Logistic regression analysis was used to determine predictors for AI+, BMI+ and POI+. 26.3% (271 of 1032) of the included patients had an abdominal injury. Subgroups were composed of 4.7% (49 of 1032) BMI+, 4.7% (48 of 1032) BMI+/POI+ and 16.8% (174 of 1032) POI+. Pathological abdominal signs had a sensitivity of 48.7% and a specificity of 92.4% for AI+. Transaminases were significantly higher in cases of AI+. Pathological computed tomography (CT) (free fluid, parenchymal damage, Bowel Injury Prediction Score (BIPS), CT Grade > 4) was summarised and had a sensitivity of 94.8%, a specificity of 98%, positive predictive value (PPV) of 94.5% and, negative predictive value (NPV) of 98.2% for AI+. The detected predictors for AI+ were pathological abdominal findings (odds ratio (OR) 3.93), pathological multi-slice computed tomography (MSCT) (OR 668.9), alanine (ALAT) ≥ 1.23 µmol/ls (OR 2.35) and associated long bone fractures (OR 3.82). Pathological abdominal signs, pathological MSCT and lactate (LAC) levels ≥ 1.94 mmol/l could be calculated as significant risk factors for BMI+. For POI+ pathological abdominal MSCT, ASAT ≥ 1.73 µmol/ls and concomitant thoracic injuries had significant relevance. The study presents reliable risk factors for abdominal injury and its sub-entities. The predictors can be explained by the anatomy of the trunk and existing studies. Elevated transaminases predicted abdominal injury (AI+) and, specifically, the POI+. The pathological MSCT was the most reliable predictive parameter. However, it was essential to include further relevant parameters.

Correlation between abdominal computed tomography signs and postoperative prognosis for patients with colorectal cancer.

Patients with different stages of colorectal cancer (CRC) exhibit different abdominal computed tomography (CT) signs. Therefore, the influence of CT signs on CRC prognosis must be determined. To observe abdominal CT signs in patients with CRC and analyze the correlation between the CT signs and postoperative prognosis. The clinical history and CT imaging results of 88 patients with CRC who underwent radical surgery at Xingtan Hospital Affiliated to Shunde Hospital of Southern Medical University were retrospectively analyzed. Univariate and multivariate Cox regression analyses were used to explore the independent risk factors for postoperative death in patients with CRC. The three-year survival rate was analyzed using the Kaplan-Meier curve, and the correlation between postoperative survival time and abdominal CT signs in patients with CRC was analyzed using Spearman correlation analysis. For patients with CRC, the three-year survival rate was 73.86%. The death group exhibited more severe characteristics than the survival group. A multivariate Cox regression model analysis showed that body mass index (BMI), degree of periintestinal infiltration, tumor size, and lymph node CT value were independent factors influencing postoperative death (P < 0.05 for all). Patients with characteristics typical to the death group had a low three-year survival rate (log-rank χ 2 = 66.487, 11.346, 12.500, and 27.672, respectively, P < 0.05 for all). The survival time of CRC patients was negatively correlated with BMI, degree of periintestinal infiltration, tumor size, lymph node CT value, mean tumor long-axis diameter, and mean tumor short-axis diameter (r = -0.559, 0.679, -0.430, -0.585, -0.425, and -0.385, respectively, P < 0.05 for all). BMI was positively correlated with the degree of periintestinal invasion, lymph node CT value, and mean tumor short-axis diameter (r = 0.303, 0.431, and 0.437, respectively, P < 0.05 for all). The degree of periintestinal infiltration, tumor size, and lymph node CT value are crucial for evaluating the prognosis of patients with CRC.

Prospective multicenter study to validate the gastrointestinal dysfunction score (GIDS) in intensive care patients: Study protocol for Part A of the international GUTPHOS study

BackgroundWhile gastrointestinal (GI) dysfunction is commonly encountered among critically ill patients, a uniform prospectively validated scoring system is lacking. The present study aims to validate the recently developed Gastrointestinal Dysfunction Score (GIDS) in a multicenter, prospective cohort of consecutive adult patients admitted to intensive care units (ICU). MethodsGUTPHOS is a prospective, multicenter, non-interventional cohort study in which at least 1400 consecutive adult patients (age ≥18 years) admitted to the ICU will be monitored daily for abdominal signs and symptoms of GI dysfunction. The previously developed GIDS constructed from these signs and symptoms will be tested in relation to mortality and duration of ICU dependency and parenteral nutrition (PN) dependency. Between January and June 2024, each participating clinical site will include 50-120 consecutive patients over an eight-week period. Study data will be collected in three phases: baseline data upon ICU admission, daily observations throughout a maximum of 7 days in ICU or until discharge, and a follow-up period of 90 days. The primary outcomes are 28- and 90-day all-cause mortality. Secondary outcomes include ICU and hospital mortality, ICU and hospital length of stay, days alive and free of ICU by day 28 and day 90, days alive and free of hospital by day 28 and day 90, and days alive and free of organ support and PN dependency by day 28. DiscussionThe GUTPHOS study will be the first worldwide, multicenter, prospective, observational cohort study to validate the GIDS in adult patients admitted to ICUs against 28- and 90-day mortality. The availability of a validated tool will allow its use in interventional studies that are currently hindered by the lack of a validated measurement tool for GI dysfunction. Clinical trial registryNCT05909722

Storia di una porpora timida e infida

The author describes a case of Henoch-Schönlein purpura in a 4-year-old child who, before showing cutaneous signs (the classic palpable purpura on the lower limbs), developed abdominal signs (pain, vomiting and loss of appetite).

Efficacy and safety analysis of AcoStream thrombus aspiration device in the treatment of acute superior mesenteric artery embolism.

Acute superior mesenteric artery embolism is a life-threatening disease caused by the abrupt interruption of mesenteric blood circulation, and the prognosis is very poor. Several studies have confirmed the efficacy and safety of percutaneous mechanical thrombectomy in acute superior mesenteric artery embolism, however, there are currently no literature reports on the latest percutaneous mechanical thrombectomy device-AcoStream™. In the present report, we summarize a series of cases and share our surgical experiences. The clinical data of 10 patients (six men and four women, mean age 77.6 ± 7.4years) with acute superior mesenteric artery embolism treated by AcoStream™ in our center from December 2022 to December 2023 were retrospectively analyzed. Based on the literature, we summarized the diagnosis, therapy, and surgical experience of acute superior mesenteric artery embolism. Percutaneous mechanical thrombectomy was performed for all the patients. The success rate of surgery reached 100% and no perioperative complications occurred. Abdominal pain was significantly relieved and the abdominal signs gradually disappeared in eight patients, while the other two patients still complained of abdominal pain during hospitalization, and eventually, they underwent resection of necrotic bowel. All the patients' symptoms were significantly relieved and they were smoothly discharged from the hospital. As shown in the present study, percutaneous mechanical thrombectomy using AcoStream™ is minimally invasive, safe, and efficient in the initial stage of acute superior mesenteric artery embolism. We believe that percutaneous mechanical thrombectomy can be a promising alternative in selected cases.

Cases with Recurrent Hospitalization due to Unexplained Ileus: Paraduodenal Hernia

Internal hernia is one of the rare causes of surgical pathologies in the abdomen.Paraduodenal hernia (PDH) is the most frequent subtype of internal hernia. There are no specific clinical and laboratory findings for diagnosis. This situation may cause delays in diagnosis and adverse clinical outcomes in patients. Computed Tomography (CT) is an imaging method that can help in the diagnosis of internal hernia. A case report of our two patients who were followed up in the clinic, who had been hospitalized with similar complaints in the past and operated for paraduodenal hernia (PDH) has been prepared. Internal herniation is one of the pre-diagnoses that should be kept in mind, especially in the history of unexplained and recurrent hospitalization in patients with abdominal pain and signs of intestinal obstruction. Observation of hernia sac on CT and observing small intestinal loops trapped in it are the only objective findings that can help us in the diagnosis of internal herniation.

Management of Perforated Sigmoid Diverticulitis with Associated Retroperitoneal Abscess and Generalized Peritonitis

Introduction: Diverticulitis represents a relatively common pathology within the gastrointestinal tract. While diverticula can occur throughout the digestive system, their prevalence is notably higher in the left colon, particularly in the sigmoid region. This condition predominantly affects middle-aged and elderly males. The most effective diagnostic methods for this disease are colonoscopy and computed tomography (CT) with contrast. Although severe complications of diverticulitis are infrequent, the optimal classification of these complications has been described by Hinchey.&#x0D; The article aims to show the case of a young patient with complicated diverticulitis with perforation and generalized peritonitis, classified as stage III-IV, according to Hinchey.&#x0D; Case report: A 43-year-old female patient was urgently admitted to the General Surgery Clinic at Tetovo Clinical Hospital, presenting with severe generalized abdominal pain and signs of peritoneal irritation. Comprehensive diagnostic imaging revealed a large retroperitoneal abscess located above the psoas muscle, accompanied by a significant accumulation of free fluid, suspected to be pus, in the abdominal cavity. Following initial resuscitation, surgical intervention was undertaken. Intraoperative findings included advanced inflammatory changes in the sigmoid colon, characterized by thickened fibrotic walls and a partially constricted lumen. A large abscess was also identified in the retroperitoneal space between the spleen and left kidney. Given these findings, resectioning the distal descending colon and most of the sigmoid colon was considered necessary. The retroperitoneal abscess was incised, its contents aspirated, and a thorough cavity debridement was performed. Subsequently, the Hartmann procedure was executed. Postoperatively, due to the patient's deteriorating condition, she was transferred to the intensive care unit for continued treatment. The patient was discharged from the hospital in stable condition on the tenth day following the surgery.&#x0D; Conclusion: While complications from sigmoid diverticula are uncommon, they can occasionally be extremely severe and pose a significant risk to patient survival.

Hepatocellular Carcinoma (HCC): A Case of Ruptured Hepatocellular Carcinoma Associated with Liver Schistosomiasis

Background: Hepatocellular carcinoma (HCC) makes up 75% of liver cancer cases and is recognized as the sixth most common cancer worldwide. Ruptured HCC can occur in 3 to 15% of cases, and it is the third most common cause of mortality in patients with HCC. Most patients are present with acute presentation of abdominal pain and signs of hemorrhagic shock. Nevertheless, the 5-year survival rate is between 5% and 15%, reflecting these patients' challenging management. We report a ruptured HCC, successfully treated with hepatic wedge resection.

Perforated Jejunal Diverticulitis: A Rare Cause of Abdominal Pain

Cases of small intestinal diverticulosis are rare and mostly asymptomatic. Occasionally, a small bowel diverticulum may perforate. We describe the case of an 80-year-old male who presented with abdominal pain and signs of localized peritonitis. The ultimate diagnosis was confirmed to be perforated jejunum diverticula. Perforation of the jejunal diverticulum should be considered as part of the differential diagnosis of acute abdomen in elderly patients, and appropriate treatment options, ranging from early surgery to conservative measures, should be tailored to the patient's presenting condition and their overall physiology.

Complete gastroduodenal transaction in a blunt abdominal trauma patient: a rare case report

Complete gastroduodenal transaction following blunt abdominal trauma in a road side accident is a rare and potentially life-threatening condition. The course of management and choice of surgical intervention depends on clinical presentation; site, size, nature of defect; amount of tissue and blood loss. In this case report, the clinical presentation, diagnostic evaluation, surgical management and postoperative course of an 18-year adult male patient who presented to the emergency room with complaints of generalized abdominal pain, vomiting and signs of peritonitis following a road side accident suggesting bowel injury. The patient was diagnosed with complete gastroduodenal transaction following blunt abdominal trauma based on radiological imaging and intraoperative findings. The patient underwent emergency laparotomy and primary repair of gastroduodenal transaction with Witzel jejunostomy for better outcome. This case report underscores the early recognition, diagnosis and prompt surgical intervention in cases of complete gastroduodenal transaction following blunt abdominal trauma to achieve favourable patient outcomes.

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.

Outcomes of abdominal pain among children presenting to the Emergency Department of a tertiary hospital in the Republic of Ireland before and during the COVID-19 pandemic.

Acute abdominal pain in paediatric patients is a common presentation to the Emergency Department (ED). The COVID-19 pandemic had a significant impact on the health care sector leading to a decline in hospital attendance. We compare the burden of paediatric abdominal pain 1year before and after the start of the COVID-19 pandemic in an Irish ED. A retrospective cohort study was conducted in a tertiary hospital. Ethical approval was obtained. Data was collected from January 1 to June 30, 2019, and 2021. Patients' charts were accessed using Therefore® software. Key variables were extracted and summarised in Microsoft Excel tables. Univariate and multivariate data analysis were conducted in SPSS® software. Six hundred sixty-one (2019) and 479 (2021) patient records were evaluated. There was a 28% reduction in case presentations during pandemic months. Age group, sex and attending discipline were similar for both years. Rates of imaging were significantly higher in 2021 (22.5% vs. 10.6%). Overall admission rate was higher in 2021 (37% vs. 25%, p < 0.001). Viral gastroenteritis decreased (13%) and non-specific diagnosis increased (46%) in 2021. Fewer children re-presented in 2021 (13%). The COVID-19 pandemic had an impact on the presentation, investigations and admission rates of abdominal pain in the ED. Our study highlights the need for increased awareness of severe abdominal pain signs and symptoms in paediatric patients and importance for diagnostic accuracy. Improving patient flow through the ED and having clear guidelines for staff and parents can optimise clinical practice and improve patient outcomes.