Acute Abdominal Disease Research Articles

The application value of high-frequency ultrasound in the feasibility assessment of endoscopic retrograde appendicitis therapy in children with appendicitis

Acute appendicitis is one of the common acute abdominal diseases in pediatrics. However, the implementation of radiological examination guided endoscopic retrograde appendicitis therapy (ERAT) in adults is limited in children. Our previous research explored the non-invasive guidance of high-frequency ultrasound (HFUS) for ERAT and achieved good therapeutic effects. This study mainly focuses on exploring the application value of HFUS in the feasibility assessment of ERAT in children with appendicitis. 163 children with appendicitis received ERAT guided by HFUS were analyzed retrospectively. According to the parameters evaluated by HFUS before and during ERAT, the results indicated that the distance between the appendix orifice and the ileocecal valve significantly affected the time required for the guidewire to enter the appendix cavity (P < 0.05). The diameter and the texture of the fecalith, the thickness of the intestinal wall of the appendiceal orifice all had significant effects on the successful removal of the fecalith (P < 0.05). The success rate, treatment time and final flushing effect of the guidewire to reach the blind end of the appendix were significantly affected by the tortuosity of the appendix and whether there was adhesion with surrounding tissues (P < 0.05). HFUS can accurately assess the feasibility of ERAT in children with appendicitis.

Acute abdomen: clinical patterns and outcomes

The acute abdomen accounts for 5% to 25% of all emergency department visits of 5 to 10 million patient encounters in the United States annually. The main objective of this study was to assess the surgical treatment outcomes for clinicopathological patterns of acute abdomen. This prospective descriptive study was conducted on 84 consecutive patients who underwent surgery in Al-Gamhouria Hospital within a period between January and December 2016. The incidence of the acute abdomen was 12.03% (84) of the total population of the surgical emergency cases in the study period. The male to female ratio of 1.6:1 and the mean age was 29.13 ± 17.10 years. Acute appendicitis was the most common cause 63%. Out of 84 patients 18 (21%) had complications and surgical site infection was the most postoperative complication 7 (8%). Overall mortality in our study was 2.4% and the duration of hospital stay for ≤ 7 days was 83% and &gt;7 days was 17%. The recovery- rate from acute abdominal disease increases in proportion to the earliness of diagnosis and treatment.

Analysis of the influence of selected protein markers as markers of nutritional status and inflammation on the occurrence of eventration after laparotomy.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Eventration is a fairly rare complication after laparotomy, which consists of postoperative wound dehiscence and protrusion of the viscera outside the abdominal cavity. This complication is associated with a higher mortality rate. The known risk factors for this condition include malnutrition and the coexistence of inflammation or cancer.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The main aim of the study was to investigate the relationship between the occurrence of eventration after laparotomy and the patient&apos;s nutritional status with the intensity of inflammatory processes, expressed using selected protein markers.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and method:&lt;/b&gt; The study was based on the analysis of patients treated at our own center from January 2014 to December 2020. It included a group of patients who underwent laparotomy and who experienced eventration, as well as a control group of patients who underwent laparotomy but did not experience eventration after the procedure.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; The analysis showed that a lower serum albumin concentration is associated with a greater risk of eventration in patients who have undergone laparotomy due to acute abdominal disease. The study group and the control group differed significantly in the levels of: Hgb, serum total protein, CRP, lymphocytes, albumin, PCT, NRS.&lt;/br&gt.

СРАВНИТЕЛЬНАЯ ОЦЕНКА ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ РАНЕВОЙ БОЛИ С ПРИМЕНЕНИЕМ ТРАНСМЕМБРАННЫХ ТЕХНОЛОГИЙ ПОСЛЕ СРЕДИННОЙ ЛАПАРОТОМИИ

ntroduction. Pain syndrome remains an urgent problem for patients who have undergone median laparotomy in the early postoperative period. The use of modern opioid analgesics, in addition to effectively combating postoperative pain, has a number of negative systemic effects on the body, which requires the search for new methods of analgesia. Aim. To determine the effectiveness of the author’s device using semipermeable membranes for anesthesia of the median laparotomy wound in relation to the relief of pain syndrome in patients who have undergone abdominal surgery, in comparison with classical parenteral analgesia. Materials and methods. We analyzed the intensity of wound pain syndrome in 70 patients underwent a median laparotomy surgery for injuries and acute abdominal surgical diseases. A control group included 35 people. An experimental group had the similar number of patients. The control group received pain relief in the early postoperative period with systemic analgesics – opioid and non-steroidal anti- inflammatory drugs. In the study group, during the operation, the device was implanted in patients retromuscularly according to the author’s method using a semipermeable membrane, through which a transmembrane blockade of the sheaths of the rectus abdominis muscles was carried out with local anesthetics. Results and discussion. Opioid analgesics were not administered to all patients of the study group in the postoperative period due to a mild pain syndrome. Conclusion. The device for analgesia of the median laparotomy wound with the use of a semipermeable membrane provides relief of pain syndrome, which allows abandoning opioids and limiting the use of non-steroidal anti- inflammatory drugs significantly.

PREDICTION OF THE RISK OF SEVERE PERITONITIS IN ACUTE INFLAMMATORY DISEASES OF THE ABDOMINAL CAVITY

Abstract. Introduction. One of the most challenging problems of surgery is peritonitis, which can be a complication of acute inflammatory diseases of the abdominal cavity and is accompanied by high mortality. The development of prognostic models of peritonitis is a modern task of precision medicine.&#x0D; Aim. To determine the risk of severe peritonitis in patients undergoing surgery for acute abdominal diseases.&#x0D; Materials and methods. The study involved 139 patients who had been operated on for acute abdominal diseases (acute appendicitis and cholecystitis, perforated gastric or duodenal ulcer, etc.). Depending on the number of points on the modified APACHE II scale, patients were divided into two groups: Group 1 - 1-3 points (63 patients, 45.3%) and Group 2 - 4 or more points (76 patients, 54.7%). The rs1927911, rs2149356 and rs4986790 polymorphisms were determined by polymerase chain reaction using the Gene Amp® PCR System 7500 amplifier (Applied Biosystems, USA) and TaqMan Mutation Detection Assays Life-Technology (USA). Statistical processing of the study results was performed using the EZR v.1.54 software (Vienna, Austria).&#x0D; Results. Univariate regression analysis revealed a higher (p=0.008) risk of severe peritonitis for men (OR 2.56; 95% CI 1.29-5.11) compared with women; an increase (p=0.031) in the risk of severe peritonitis with patient age (OR 1.02; 95% CI 1.00-1.05). The risk of severe peritonitis increased (p&lt;0.05) with higher admission temperature, heart rate, international normalised ratio, and leukocytosis. A reduction (p=0.009) in the risk of severe peritonitis was found with a higher prothrombin index (OR 0.95; 95% CI 0.92-0.99). In addition, a decrease (p=0.015) in the risk of severe peritonitis was found in carriers of the G/A+A/A rs1927911 heterozygote of the TLR4 gene (OR 0.42; 95% CI 0.21-0.84) compared with carriers of the ancestral G/G genotype. The multivariate model included the rs1927911 genotype, age, sex, heart rate, and leukocytosis (AUC=0.83; 95% CI 0.75-0.89; p&lt;0.001); the model sensitivity was 68.4% (95% CI 56.7%-78.6%), and specificity was 88.9% (95% CI 78.4%-95.4%).&#x0D; Conclusion. Thus, prognostic risk factors for severe peritonitis were identified and a mathematical model for its prediction was developed using clinical, laboratory and genetic parameters.

Role of lncRNAs in acute pancreatitis: pathogenesis, diagnosis, and therapy.

Acute pancreatitis (AP) is one of the most common acute abdominal diseases characterized by an injury and inflammatory disorder of the pancreas with complicated pathological mechanisms. Long non-coding RNAs (lncRNAs) have been shown to play an important role in various physiological and pathological processes in humans, and they have emerged as potential biomarkers of diagnosis and therapeutic targets in various diseases. Recently, accumulating evidence has shown significant alterations in the expression of lncRNAs, which are involved in the pathogenesis of AP, such as premature trypsinogen activation, impaired autophagy, inflammatory response, and acinar cell death. Moreover, lncRNAs can be the direct target of AP treatment and show potential as biomarkers for the diagnosis. Thus, in this review, we focus on the role of lncRNAs in the pathogenesis, diagnosis, and therapy of AP and emphasize the future directions to study lncRNAs in AP, providing new insight into understanding the cellular and molecular mechanisms of AP and seeking novel biomarkers for the diagnosis and therapeutic targets to improve clinical management in the future.

Deep learning using computed tomography to identify high-risk patients for acute small bowel obstruction: development and validation of a prediction model : a retrospective cohort study.

To build a novel classifier using an optimized 3D-convolutional neural network for predicting high-grade small bowel obstruction (HGSBO). Acute SBO is one of the most common acute abdominal diseases requiring urgent surgery. While artificial intelligence and abdominal computed tomography (CT) have been used to determine surgical treatment, differentiating normal cases, HGSBO requiring emergency surgery, and low-grade SBO (LGSBO) or paralytic ileus is difficult. A deep learning classifier was used to predict high-risk acute SBO patients using CT images at a tertiary hospital. Images from three groups of subjects (normal, nonsurgical, and surgical) were extracted; the dataset used in the study included 578 cases from 250 normal subjects, with 209 HGSBO and 119 LGSBO patients; over 38000 CT images were used. Data were analyzed from 1 June 2022 to 5 February 2023. The classification performance was assessed based on accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve. After fivefold cross-validation, the WideResNet classifier using dual-branch architecture with depth retention pooling achieved an accuracy of 72.6%, an area under receiver operating characteristic of 0.90, a sensitivity of 72.6%, a specificity of 86.3%, a positive predictive value of 74.1%, and a negative predictive value of 86.6% on all the test sets. These results show the satisfactory performance of the deep learning classifier in predicting HGSBO compared to the previous machine learning model. The novel 3D classifier with dual-branch architecture and depth retention pooling based on artificial intelligence algorithms could be a reliable screening and decision-support tool for high-risk patients with SBO.

Assessment of a standing position during abdominal point-of-care ultrasound on abdominal fluid score in dogs.

To assess the use of a standing position during abdominal point-of-care ultrasound (POCUS) examination when evaluating dogs for peritoneal effusion. Randomized prospective study over 17months. Single-center, university veterinary teaching hospital. Thirty dogs presenting for acute abdominal disease. Eligibility included suspicion for free peritoneal effusion and the ability to stand. Dogs underwent standing abdominal POCUS, right lateral abdominal POCUS, and a full abdominal ultrasound. We originally had nothing listed. It now includes all three ultrasound evaluations that were performed for each patient. Patients underwent both a right lateral and standing abdominal POCUS via a previously described abdominal focused assessment with sonography for trauma (A-FASTrl and A-FASTs, respectively) technique in a randomized and sequential order followed by a full abdominal ultrasound (AUS-full). The A-FASTs examination included a right flank location in addition to the following standard views: subxiphoid, left flank, urinary bladder, and umbilicus. Five-second cine loops were obtained at each location for each examination and reviewed in the order they were obtained. Locations for both A-FAST exams were interrogated in the same order every time. The cine loops were scored for the degree of peritoneal effusion based on a previously published abdominal fluid scoring system by a board-certified radiologist, radiology resident, and radiology intern. The overall abdominal fluid score (AFS) was compared to a subjective full abdominal ultrasound score given by a board-certified radiologist. Six dogs had no peritoneal effusion, 13 had a small volume (AFS 1 or 2), and 11 had a moderate to large volume (AFS 3 or 4). Excellent agreement (intraclass correlation coefficient) was found between the A-FASTs and A-FASTrl techniques (0.95, 0.93, 0.94), good agreement between A-FASTs and AUS-full (0.80, 0.77, 0.82), and good agreement between A-FASTrl and AUS-full (0.80, 0.82, 0.84). The interobserver agreement was good (0.87) for the A-FASTs technique and excellent (0.91) for the A-FASTrl technique. Mean observer agreement score was excellent (0.94) when evaluating A-FASTrl to A-FASTs, good (0.86) when evaluating A-FASTs to AUS-full, and good (0.87) when evaluating A-FASTrl to AUS-full. Performing a standing abdominal POCUS examination may be a valid option for identifying and quantifying peritoneal effusion in situations when a more traditional right lateral approach cannot be performed.

Evolution and progress of surgical intervention strategies for acute pancreatitis

Acute pancreatitis is one of the common surgical acute abdominal diseases. Since people first recognized acute pancreatitis in the middle of the nineteenth century, a diversified minimally invasive treatment model with standardization has been formed today. According to the main line of surgical intervention of acute pancreatitis treatment,this period can be roughly divided into five stages:exploration stage, conservative treatment stage, pancreatectomy stage, debridement and drainage of the pancreatic necrotic tissue stage, and minimally invasive treatment as the first choice led by the multidisciplinary team mode stage. Throughout history, the evolution and progress of surgical intervention strategies for acute pancreatitis cannot be separated from the progress of science and technology, the update of treatment concepts and the further understanding of the pathogenesis. This article will summarize the surgical characteristics of acute pancreatitis treatment at each stage to explain the development of surgical treatment of acute pancreatitis,to help investigate the development of surgical treatment of acute pancreatitis in the future.

Comparison of the application value of transvaginal ultrasound and transabdominal ultrasound in the diagnosis of ectopic pregnancy.

Ectopic pregnancy (EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, seriously threatening the patient's life. Early diagnosis is the key to preventing and improving the prognosis of EP. Transabdominal ultrasound (TAS) and transvaginal ultrasound (TVS) are the main diagnostic methods for abdominal diseases. The purpose of this study is to explore the application value and effect of TAS and TVS in the diagnosis of EP, hoping to provide more valuable references for the diagnosis of EP. To explore the application value of TAS and TVS in the diagnosis of EP and to improve the level of clinical diagnosis. A total of 140 patients with EP admitted to our hospital from July 2018 to July 2020 were selected for this study. All patients were divided into two groups according to the examination methods. 63 patients who underwent abdominal ultrasound examination were set as the TAS group, while 77 patients who underwent TVS examination were set as the TVS group. We compared the diagnostic accuracy and misdiagnosis rates between the two types of ultrasound examinations, as well as the postoperative pathological results of the two diagnostic methods for different types of ectopic pregnancies. We also analyzed the sonograms for the presence of mixed ectopic masses, adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the ectopic sac shadow, and the detection of fluid in the rectal fossa of the uterus, such as the adnexal area, yolk sac, and embryo, etc. In addition, the diagnosis time, days of gestational sac appearance, operation time, endometrial thickness, and blood flow resistance index were compared as well. After performing both types of ultrasound examinations in 140 patients with EP, we found that the diagnostic accuracy of TVS was significantly higher than that of TAS, and the misdiagnosis rate was significantly lower than that of TAS. The differences were statistically significant (P < 0.05). In addition, the detection rate of TVS was better than that of TAS for the presence of mixed masses, adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the shadow of the ectopic sac, and sonograms such as the adnexal area, yolk sac, and embryo, etc. The coincidence rate of its postoperative pathological examination results was significantly higher than those of TAS. The diagnosis time and the days of gestational sac appearance by TVS were significantly shorter than that by TAS, and the operation time was earlier than that by TAS. What's more, the detection rates of the endometrial thickness £ 1.5 mm and blood flow resistance £ 0.5 were significantly higher in TVS diagnosis of EP than in TAS. All differences were statistically significant (P < 0.05). Compared with TAS, TVS has the advantages of high detection accuracy and good sonogram performance.

Beneficial herb-drug interaction of rhein in Jinhongtang and Imipenem/Cilastatin mediated by organic anion transporters

Ethnopharmacological relevanceJinhongtang as a traditional Chinese medicine (TCM) formula, has been widely used as a clinical adjuvant in the treatment of acute abdominal diseases and sepsis. Clinical benefits of the concurrent use of Jinhongtang and antibiotics have been observed, however, the mechanism has not been fully understood. Aim of the studyThe present study aimed to explore the effect of Jinhongtang on the antibacterial activity of Imipenem/Cilastatin and to clarify the underlying mechanism of herb-drug interaction (HDI). Materials and methodsA mouse model of sepsis induced by Staphylococcus aureus (S. aureus) was used to evaluate the pharmacodynamic interaction in vivo. In vitro antibacterial activity of Imipenem/Cilastatin was studied by determining minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC). Pharmacokinetic interaction was investigated by pharmacokinetic studies in rats and uptake assays using OAT1/3-HEK293 cells. The main constituents ingested into blood of rats were qualitatively identified by UHPLC-Q-TOF-MS. ResultsMice treated by Imipenem/Cilastatin and Jinhongtang exhibited higher survival rate, lower bacteria load and less inflammation in blood and lung tissues, compared with those treated by Imipenem/Cilastatin alone after injection of S. aureus. However, MIC and MBC of Imipenem/Cilastatin against S. aureus in vitro were not significantly changed in the presence of Jinhongtang. On the contrary, Jinhongtang increased the plasma concentration of Imipenem and decreased its urinary excretion in rats. CLr of Imipenem was reduced by 58.5%, while its half-life (t1/2) was prolonged for approximate 1.2 times after coadministered Jinhongtang. Furthermore, the extracts of Jinhongtang, single herb in the prescription, and main absorbable constituents inhibited cellular uptake of probe substrates and Imipenem by OAT1/3-HEK293 cells to different extents. Among them, rhein exhibited the strongest inhibition capacity with IC50 values of 0.08 ± 0.01 μM (OAT1) and 2.86 ± 0.28 μM (OAT3). Moreover, coadministration of rhein also significantly enhanced the antibacterial activity of Imipenem/Cilastatin in sepsis mice. ConclusionConcomitant administration of Jinhongtang enhanced antibacterial activity of Imipenem/Cilastatin in sepsis mice induced by S. aureus through reducing renal elimination of Imipenem via inhibition of OATs. Our investigation provided the insight of Jinhongtang as an effective supplement to enhance the antibacterial activity of Imipenem/Cilastatin and can be useful for future clinical studies.

Laparoscopic Surgery for Acute Appendicitis Complicated by Peritonitis

Introduction . Acute appendicitis (AA) is one of the most common acute abdominal surgical diseases. The current incidence, according to various authors, is 22.8 per 10,000 inhabitants. Annually, 50 to 70 thousand people die from AA and its complications around the world. Laparoscopy is generally accepted as the most effective method of differential diagnosis of AA. It is fundamentally significant to move from the diagnostic stage to the therapeutic one, i.e. to perform the elimination of the disease, including cases with other surgery-requiring pathology detected. Aim . To evaluate the role of video-endoscopic surgical methods in the surgical management of acute appendicitis complicated by peritonitis. Materials and methods . The analysis of recent publications and personal clinical experience revealed that diagnostic laparoscopy, unless contraindicated, should be performed as the initial step in suspected acute abdominal pathology. When the surgery is technically performable, laparoscopy also causes curative effect. Results and discussion. The use of laparoscopy in surgical treatment of acute appendicitis complicated by peritonitis has proven advantages for the patient over open surgery. An adequate appendectomy as a reliable method for elimination of the source of peritonitis is the key to successful treatment of patients. Laparoscopic lavage in the early postoperative period against the postoperative peritonitis with developing complications, is considered to be an alternative method to non-surgical treatment or delayed intervention and to have better ultimate results than percutaneous drainage or relaparotomy. Conclusion . The success of video-endoscopic technologies application depends not only on the technical aspects, but also on the correct choice of indications for such an intervention and their appropriate combination with open surgeries.

Th2/Th1 cytokine imbalance is associated with higher recurrent intussusception incidence in children: A 10-year retrospective study of 1657 patients.

Recurrent intussusception is one of the common acute abdominal diseases in infants, which seriously affects the physical and mental health of infants, but its risk factors have not been fully clarified. The objective of this study was to evaluate the relationship between Th2/Th1 cytokine imbalance and recurrent intussusception, so as to provide a theoretical basis for making a more comprehensive treatment strategy for patients with recurrent intussusception. A retrospective study was conducted between July 2012 and September 2022, enrolling patients with intussusception in Children's Hospital of Hebei Province. The patients were divided into recurrent group and non-recurrent group according to whether they suffered from recurrent intussusception. We summarized the clinical characteristics of recurrent intussusception and explored the role of T helper 2 (Th2)/T helper 1 (Th1) cytokine imbalance in it. A total of 2008 patients were initially enrolled and finally 1657 patients qualified for the study. The results showed that the incidence of recurrent intussusception was 18.41% and the Th2/Th1 cytokine imbalance was closely related to the incidence of recurrent intussusception. Th2/Th1 cytokine imbalance is a potential risk factor of recurrent intussusception and more likely to occur in children between the ages of 2 and 3. Future studies are needed to preemptively target the Th2/Th1 cytokine imbalance to formulate a reasonable treatment plan for children with intussusception to avoid recurrence.

Is enema reduction in pediatric intussusception with a history of over 48 h safe: A retrospective cohort study

BackgroundIntussusception is one of the most common acute abdominal diseases in children. Enema reduction is the first-line treatment for intussusception in good condition. Clinically, a history of disease over 48 h is usually listed as a contraindication for enema reduction. However, with the development of clinical experience and therapy, an increasing number of cases have shown that the prolongation of the clinical course of intussusception in children is not an absolute contraindication for enema treatment. This study aimed to analyze the safety and efficacy of enema reduction in children with a history of disease longer than 48 h. MethodsWe conducted a retrospective matched-pair cohort study of pediatric patients with acute intussusception between 2017 and 2021. All patients were treated with ultrasound-guided hydrostatic enema reduction. According to the length of history, the cases were classified into two groups: history <48 h (<48 h group) and history greater than or equal to 48 h (≧48 h group). We generated a 1:1 matched-pair cohort matched for sex, age, admission time, main symptoms, and concentric circle size on ultrasound. Clinical outcomes were compared between the two groups, including success, recurrence, and perforation rates. ResultsFrom January 2016 to November 2021, 2701 patients with intussusception were admitted to the Shengjing Hospital of China Medical University. A total of 494 cases were included in the ≧48 h group, and 494 cases with a history of <48 h were selected for matched comparison in the <48 h group. The success rates of the ≧48 h and <48 h groups were 98.18% vs. 97.37% (p = 0.388), and the recurrence rates were 13.36% vs. 11.94% (p = 0.635), showing no difference according to the length of history. The perforation rate was 0.61% vs. 0%, respectively, with no significant difference (p = 0.247).The comparison of the different history groups showed that in patients with bloody stools, the length of history had no significant effect on the enema reduction outcome(94.90% vs. 86.76%, p = 0.064). ConclusionsUltrasound-guided hydrostatic enema reduction is safe and effective for pediatric idiopathic intussusception with a history of ≧48 h.

Role of neutrophil extracellular traps in inflammatory evolution in severe acute pancreatitis.

Severe acute pancreatitis (SAP) is a life-threatening acute abdominal disease with two peaks of death: the first in the early stage, characterized by systemic inflammatory response-associated organ failure; and the second in the late stage, characterized by infectious complications. Neutrophils are the main immune cells participating in the whole process of SAP. In addition to the traditional recognition of neutrophils as the origination of chemokine and cytokine cascades or phagocytosis and degranulation of pathogens, neutrophil extracellular traps (NETs) also play an important roles in inflammatory reactions. We reviewed the role of NETs in the occurrence and development of SAP and its fatal complications, including multiple organs injury, infected pancreatic necrosis, and thrombosis. This review provides novel insights into the involvement of NETs throughout the entire process of SAP, showing that targeting NETs might be a promising strategy in SAP treatment. However, precision therapeutic options targeting NETs in different situations require further investigation.

Impact of late admission on mortality from acute abdominal diseases in the Central Federal District of the Russian Federation

To analyze the effect of late hospitalization on mortality from acute abdominal diseases in the Central Federal District of the Russian Federation. Analysis of late hospitalizations and in-hospital mortality was based on metadata (616.742 clinical observations between 2017 and 2021). Primary statistical data were obtained from reports of chief surgeons in 18 regions of the Central Federal District of the Russian Federation and presented in analytical collections «Surgical care in the Russian Federation». The number of patients admitted to surgical hospitals of the Central Federal District with acute abdominal diseases later than 24 hours from clinical manifestation varies depending on the underlying disease. The greatest number of late hospitalizations was observed in acute intestinal obstruction (50.82%), acute adhesive intestinal obstruction (48.49%) and acute pancreatitis (47.36%). In acute cholecystitis, gastrointestinal bleeding and acute appendicitis, admission after 24 hours was observed in 44.72, 38.65 and 33.83% of cases, respectively. Late hospitalization is even less typical for strangulated hernia (27.43%) and perforated ulcer (26.23%). In-hospital mortality significantly differs in both groups (within and after 24 hours) for all acute abdominal diseases. Extended surgery and widespread peritonitis increase these differences for strangulated hernia by 9.2 times (0.92% within 24 hours and 8.48% after 24 hours), for acute appendicitis by 8 times (0.05% within 24 hours and 0.40% after 24 hours) and for perforated ulcer by 6.3 times (4.50% within 24 hours and 28.59% after 24 hours). In the Central Federal District, about 25-50% of patients with acute abdominal diseases admitted to the hospital later than 24 hours after clinical manifestation depending on disease. We found the highest in-hospital mortality following late hospitalization in patients with strangulated hernia, acute appendicitis and perforated ulcers.

Acute pancreatitis - predicting the severity of the disease.

Acute pancreatitis (AP) is a serious acute abdominal disease. AP is often referred to as an unpredictable illness, which can take a mild to severe (fatal) course. 1) To identify clinical parameters that are significantly related to the clinical course of acute pancreatitis. 2) To compile a scoring system enabling the severity of AP to be predicted when the patient is first admitted to hospital. Analysis of available publications and clinical guidance, and retrospective analysis of data on patients hospitalised with AP at our clinic enable us to identify clinical details and laboratory results recorded at the time of patients' admission to hospital that are related to the subsequent severity of the disease. For the purposes of statistical analysis, the sample of patients was divided into two groups: group A (mild AP, without local or organ complications), group B (moderately severe and severe AP with local and/or organ complications). In total, between 01.01.2013 and 30.06.2022, 312 patients with acute pancreatitis were allocated to the retrospective-prospective study sample. 74 % (231/312) of these patients were allocated to group A and 26 % (81/312) were allocated to group B. Univariate analysis of the data collected on the patient sample identified 5 parameters that are statistically significantly associated with the severity of the clinical course of the disease. Presence of SIRS on admission (A vs B, Odds ratio 10.787, 95% CI 5.09-22.85, p < 0.0001), diabetes mellitus type 2 in case history (A vs B, Odds ratio 7.703, 95% CI 3.04-19.51, p 2 mmol/l (A vs B, Odds ratio 3.293, 95% CI 1.59-6.82, p = 0.0013).In order to develop a scoring system, each of these parameters was allocated a points value based on its Odds ratio (OR): presence of SIRS 3 points, hypocalcaemia 3 points, diabetes mellitus type 2 in case history 2 points, urea concentration > 8 mmol/l 1 point and lactate concentration > 2 mmol/l 1 point. The authors refer to their scoring system as The Acute Pancreatitis Admission Score (APAS). The accuracy of APAS was modelled for various cut off values. Across the whole sample, we ascertained that an APAS ≥ 4 points predicts moderately severe or severe AP with a sensitivity of 81 % (95% CI: 71 - 89 %) and specificity of 87 % (95 CI: 81 - 91 %). The positive predictive value (PPV) of APAS ≥ 4 is 0.68, while its negative predictive value (NPV) is 0.93 and accuracy 0.85 (95% CI 0.81 - 0.89). In this study we identify significant simple clinical and laboratory parameters that are commonly tested as part of an initial examination when admitting a patient with AP to hospital. Having identified these parameters we are able to establish a simple scoring system that is able to predict the severity of the course of AP at the moment of hospitalisation (Tab. 5, Fig. 2, Ref. 27).

In-hospital mortality in acute abdominal diseases in the Central Federal District of Russia depending on availability of laparoscopic procedures

To study in-hospital mortality in acute abdominal diseases in the Central Federal District and compared effectiveness of laparoscopic and open surgeries. The study was based on the previous data for 2017-2021. The odds ratio (OR) was used to assess significance of between-group differences. The absolute number of deceased patients with acute abdominal diseases increased significantly and exceeded 23 thousand in the Central Federal District between 2019 and 2021. This value approached 4% for the first time over the last 10 years. In-hospital mortality from acute abdominal diseases in the Central Federal District increased for 5 years and reached maximum value in 2021. The greatest changes occurred in perforated ulcers (mortality increased from 8.69% in 2017 to 14.01% in 2021), acute intestinal obstruction (from 4.7% to 9.0%) and ulcerative gastroduodenal bleeding (from 4.5% to 5.5%). In other diseases, in-hospital mortality is lower, but trends are similar. Laparoscopic surgeries are common in acute cholecystitis (71-81%). At the same time, in-hospital mortality is significantly lower in regions with more active use of laparoscopy (0.64% and 1.25% in 2020; 0.52% and 1.16% in 2021). Laparoscopic surgeries are significantly less actively used for other acute abdominal diseases. We analyzed availability of laparoscopic surgeries using the «Hype Cycle». Percentage range of introduction reached conditional «productivity plateau» only in acute cholecystitis. Most regions are stagnating in laparoscopic technologies for acute appendicitis and perforated ulcers. Laparoscopic operations are actively used for acute cholecystitis in most regions of the Central Federal District. Annual increase in the number of laparoscopic operations and their technical improvement are promising in reducing in-hospital mortality associated with acute appendicitis, perforated ulcers and acute cholecystitis.

Retracted: Role of CT Images in the Diagnosis of Common Acute Abdominal Diseases in General Surgery.

[This retracts the article DOI: 10.1155/2022/5732357.].

The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part II.

Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. The recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The second part of the guidelines covers sections 6 to12 and the following challenges for surgical practice: acute appendicitis, acute mesenteric ischemia, abdominal injuries, bowel obstruction, diverticulitis, laparoscopy in pregnancy and postoperative complications requiring a reoperation.