Cause Of Abdominal Emergencies Research Articles

Diagnostic Efficacy Study Comparing Tzanakis Scoring System With Alvarado Scoring System in Effective Diagnosis of Acute Appendicitis.

Objective Among the common causes of abdominal emergencies, acute appendicitis ranks at the top, particularly in the young population. While negative appendectomy is not uncommon, the risk of appendicular perforation is substantial if the diagnosis is missed or delayed. This study evaluated the diagnostic efficacy of the Tzanakis scoring system for acute appendicitis, comparing it with the Alvarado scoring system, considering the histopathological finding as the gold standard. Materials and methods This prospective observational study, conducted in the General Surgery department in a tertiary care hospital in India, included clinically diagnosed acute appendicitis cases posted for open or laparoscopic appendicectomy. Results The mean age for the 60 participants included in the study was30.97±13.44, and the median was 24.5 yrs. The sensitivity ofultrasonography (USG)in diagnosing histopathological positive acute appendicitis was 89%, and the specificity was 50%. The sensitivity, specificity, positive, and negative predictive values of the Tzanakis score were 87%, 50%, 96%, and 22%, respectively, and those of the Alvarado score were 54%, 75%, 96%, and 10%, respectively. Conclusion The receiver operator characteristic (ROC) curve for the Alvarado and Tzanakis scores showed that the area under the curve (AUC) was greater for the Tzanakis scoring system (0.670) than for the Alvarado scoring system (0.598). Differences between the AUCs were not statistically significant. Although the Tzanakis scoring system is more sensitive than the Alvarado scoring system in diagnosing acute appendicitis, studies with larger samples are needed to show the superiority of this scoring system over the Alvarado scoring system.

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.
 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.
 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.
 Conclusion: There is a significant relationship between NLR value and disease diagnosis on intestinal viability.

Post-operative Intussusception, a rare case in pediatric, National Center for Paediatric Surgery, Gezira State, Sudan; 2021

Intussusception is defined by Treves in 1899 as invagination of segment of bowel into adjacent segment usually proximal into distal. It’s a common cause of abdominal emergencies especially in children two years of age and younger. It accounts for 1 in 2000 infants and children and results in intestinal obstruction. Post-operative intussusception is one of the rare etiologies of intestinal obstruction that represents 0.01 to 0.25% after laparotomies and 5 -10% of all early postoperative intestinal obstructions. Our case is a ten years old female presented to the National Center for Pediatric Surgery; Gezira state; Sudan; February 2021 complaining of abdominal distention and constipation for 6 days. She had past history of acute appendicitis due to which she underwent emergency opened appendectomy. Her condition started one day after appendectomy. O/E : patient looks ill, febrile, not pale or jaundice; PR:140b/m; RR:25c/m; abdominal examination show: distended abdomen with full flanks, unhealed lanz incision with small amount of pus discharge; no dilated veins or visible peristalsis; hernia orifice were intact; lower abdomen was tense & tender; no palpable mass; DRE: rectum contains impacted hard stool. Emergency explorative laparotomy was done. Findings: Ileocecal intussusception, bowel was healthy and viable. Simple reduction was done. Conclusion and Recommendations: Post-operative intussusception usually associated with bowel ischemia and necrosis which is not consistent with our case. We highly recommended abdominal ultrasonography, CT scan; when there is a high index of suspicion.

Spontaneous unscarred uterine rupture in a primigravid patient at 11weeks of gestation managed surgically: A rare case report.

IntroductionSpontaneous rupture of the primigravid uterus is a rare but catastrophic obstetrical emergency. It usually occurs late in pregnancy or during labour, mainly in multiparous women. But, spontaneous unscarred uterine rupture in a primigravid patient that also in first trimester is very rare. There are only 12 papers in Pub Med database regarding spontaneous unscarred uterine rupture in primigravid in early pregnancy.Case presentationA 23-year-old primigravid female at 11th week of pregnancy, with no significant medical or surgical history, presented with sudden onset of generalised abdominal pain for four hours with multiple episodes of vomiting. On physical examination, patient was pale, in haemorrhagic shock with diffuse abdominal tenderness. Ultrasonography showed extra uterine gestational sac with massive haemoperitoneum. Eventually, patient was subjected to emergency laparotomy after resuscitation.Clinical discussionSpontaneous rupture of unscarred gravid uterus is a catastrophic rare condition that can be missed leading to maternal and foetal mortality. There are no pathognomonic features indicating the condition therefore it should be differentiated from other causes of acute abdominal emergencies.ConclusionSpontaneous rupture of unscarred gravid uterus should be differentiated from other acute abdominal emergencies. Patient may land up in emergency department in the state of shock, emergency physicians should be aware of its symptoms or presentations.

Small Bowel Obstruction by CT Scan

Case Report: CT is an effective tool in evaluation of small bowel obstruction. Small bowel obstruction is common cause of abdominal emergency. Diagnosis helps effective management and prevent complication. The small bowel faces sign is a finding observed in small bowel obstruction on helical CT scan. It's defined as presence of faces like material in the lumen of dilated loops of small bowel proximal to the site of obstruction this section will illustrate the small bowel faces sign with examples. Small bowel obstruction is common cause of acute abdomen. It account approximately 4% of patient with acute abdomen. Clinical signs and symptoms are not always diagnostic. Identifying the cause of obstruction is important for early management. Many other clinical condition like a dynamicileus, intra-abdominal abscess and gastroenteritis present with same clinical presentation

Convolutional-neural-network-based diagnosis of appendicitis via CT scans in patients with acute abdominal pain presenting in the emergency department

Acute appendicitis is one of the most common causes of abdominal emergencies. We investigated the feasibility of a neural-network-based diagnosis algorithm of appendicitis by using computed tomography (CT) for patients with acute abdominal pain visiting the emergency room (ER). A neural-network-based diagnostic algorithm of appendicitis was developed and validated using CT data from three institutions who visited the ER with abdominal pain and underwent abdominopelvic CT. For input data, 3D isotropic cubes including the appendix were manually extracted and labeled as appendicitis or a normal appendix. A 3D convolutional neural network (CNN) was trained to binary classification on the input. For model development and testing, 8-fold cross validation was conducted for internal validation and an ensemble model was used for external validation. Diagnostic performance was excellent in both the internal and external validation with an accuracy larger than 90%. The CNN-based diagnosis algorithm may be feasible in diagnosing acute appendicitis using the CT data of patients visiting the ER with acute abdominal pain.

A Comparative Study between the Outcome of Primary Repair versus Loop Ileostomy in Traumatic and Non traumatic Ileal Perforation

Introduction: Ileal perforation is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these regions. Methods: The study was conducted in department of surgery LLR hospital, Kanpur. One hundred ten patients, fulfilling the including criteria, admitted to Surgical Emergency department were taken up for emergency surgery. The surgical management was done as primary repair (group A) and loop ileostomy (group B). The patients were assigned into two groups by even and odd method. Results: An increased rate of postoperative complications was seen in group B when compared with group A. In group A, 4 (9.09%) patients landed up in peritonitis secondary to leakage from primary repair requiring reoperation. In group B, 22 (39.29%) patients developed wound infection, 12 (21.43%) burst abdomen and 2 (3.57%) retraction of ileostomy. Mortality in primary repair was 3 (6.81%) and in loop ileostomy was 5 (8.9%). Conclusion: Patients presenting within 48 hours of ileal perforation, primary repair is better than loop ileostomy.

Fatal Intussusception in a 2-month-old Infant: A Post Mortem Experience

Introduction: Intussusception, the invagination or telescoping of a proximal segment of bowel into an adjacent distal segment of bowel is the second commonest cause of abdominal emergency in children after appendicitis. It is important to note that intussusception though a relatively benign condition, can cause unexpected death due to misdiagnosis or delayed referral resulting in intestinal perforation.

Case–control study on intestinal intussusception: implications for anti-rotavirus vaccination

ABSTRACTBackground: Intussusception represents the most common cause of abdominal emergency among young children but nearly 75% of cases are still considered idiopathic.Research design and methods: A case–control study was conducted among Sicilian children aged 0–59 months with a hospital admission for intussusception between 2009 and 2015 to identify factors associated with intussusception onset.Results: Overall, 125 cases and 190 controls were recruited for the study. Birth order (OR 1.49, 95%CI: 1.10, 2.02, P = 0.02) and having had gastroenteritis or having taken antibiotics during the 30 days prior to hospitalization (OR 11.55, 95%CI: 3.23, 41.23, P < 0.001; 3.09, 95%CI: 1.17, 8.12, P = 0.009, respectively) were significantly associated with intussusception. On the other hand, exclusive breastfeeding for at least two months was a protective factor (OR 0.48, 95%CI: 0.23, 0.99, P = 0.009). Anti-rotavirus vaccination did not correlate with risk of intussusception (OR 0.96, 95% CI: 0.41, 2.25, P = 0.92).Conclusions: These findings increase the awareness of intussusception among clinical and public health service providers to obtain a better susceptibility profile. Moreover, identifying children at higher risk of intussusception could be useful in vaccination counselling to intercept early symptoms and to reduce the number of serious cases.

Surgical audit of current management practices of ileal perforations presenting in a tertiary care institute of North India

Background: Small bowel perforation is one of the commonest causes of abdominal emergency in India and other tropical countries mostly due to high incidence of enteric fever and tuberculosis. Surgical approach to these patients is standard but the choice of procedure continues to be debated. It is very important to find the appropriate management of these patients to reduce high mortality and morbidity.Methods: This prospective study on 50 patients of perforation peritonitis with small bowel perforation. After initial resuscitation with intravenous fluids and antibiotics surgery was done by midline incision and three modalities of surgical techniques were compared i.e. primary closure of perforation, resection and anastomosis and ileostomy depending upon the general condition of patient and local condition of gut.Results: Out of 50 patients, ten underwent primary repair of perforation, four patients were managed with ileal resection and end to end anastomosis and rest 36 patient required faecal diversion in form of ileostomy. Two patients expired in post-operative period that were cases of abdominal tuberculosis.Conclusion: Primary closure of perforation is preferable in patients with single small perforation with healthy surrounding bowel. Resection anastomosis is advocated in multiple perforations of any size with localized peritonitis of diseased segment pertaining to good general condition of patient. Ileostomy is lifesaving procedure particularly in patients of fulminant enteritis and peritonitis of long duration with associated co-morbidities but requires second surgery for closure.

Acute Physiological and Chronic Health Evaluation II Score and its Correlation with Three Surgical Strategies for Management of Ileal Perforations.

Introduction:Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these management based on Acute Physiological and Chronic Health Evaluation II (APACHE II) score.Methods:The following study was conducted in the Department of General Surgery, Government Medical College, Patiala. A total of 57 patients were studied and divided in to Group I, II, and III. APACHE II score accessed and score between 10 and 19 were blindly randomized into three procedures primary closure, resection-anastomosis, and ileostomy. The outcome was compared.Results:Ileal perforations were most commonly observed in the third and fourth decade of life with male dominance. APACHE II score was accessed and out of total 57 patients, 6 patients had APACHE II score of 0–9, 48 patients had APACHE II score of 10–19, and 3 patients had APACHE II score of ≥20. In APACHE II score 10–19, 15 patients underwent primary closure, 16 patients underwent resection-anastomosis, and 17 patients underwent ileostomy.Discussion and Conclusion:Primary closure of perforation is advocated in patients with single, small perforation (<1 cm) with APACHE II score 10–19 irrespective of duration of perforation. Ileostomy is advocated in APACHE II score 10–19, where the terminal ileum is grossly inflamed with multiple perforations, large perforations (>1 cm), fecal peritonitis, matted bowel loops, intraoperative evidence of caseating lymph nodes, strictures, and an unhealthy gut due to edema.

A Comparative Study between the Outcome of Primary Repair versus Loop Ileostomy in Ileal Perforation.

Introduction. Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these regions. Methods. Sixty proven cases of ileal perforation patients admitted to Surgical Emergency were taken up for emergency surgery. Randomisation was done by senior surgeons by picking up card from both the groups. The surgical management was done as primary repair (group A) and loop ileostomy (group B). Results. An increased rate of postoperative complications was seen in group A when compared with group B with 6 (20%) patients landed up in peritonitis secondary to leakage from primary repair requiring reoperation as compared to 2 (6.67%) in ileostomy closure. A ratio of 1 : 1.51 days was observed between hospital stay of group A to group B. Conclusion. In cases of ileal perforation temporary defunctioning loop ileostomy plays an important role. We recommend that defunctioning ileostomy should be preferred over other surgical options in cases of ileal perforations. It should be recommended that ileostomy in these cases is only temporary and the extra cost and cost of management are not more than the price of life.

Necrotising enterocolitis complicated by gastrocolic and jejunocolic fistulas

Necrotising enterocolitis (NEC) is a major cause of abdominal emergencies in premature newborns While NEC is commonly associated with stricture formation occuring in approxiamately 25% of cases, enteric fistulisation is a rare complication of NEC with only isolated reports in the literature As the survival rate of infants with severe NEC is improving the incidence of complications like enteric fistulas will increase. Symptoms in an infant following the resolution of NEC, with a nonspecific bowel gas pattern on plain film should raise the possibility of an existing fistula, prompting appropriate investigation and treatment of this significant complication.

Role of myosin light chain kinase in intestinal epithelial barrier defects in a rat model of bowel obstruction

BackgroundBowel obstruction is a common cause of abdominal emergency, since the patients are at increased risk of septicemia resulting in high mortality rate. While the compartmentalized changes in enteric microfloral population and augmentation of bacterial translocation (BT) have already been reported using experimental obstruction models, alterations in epithelial permeability of the obstructed guts has not been studied in detail. Myosin light chain kinase (MLCK) is actively involved in the contraction of epithelial perijunctional actinomyosin ring and thereby increases paracellular permeability. In the current study we attempt to investigate the role of MLCK in epithelial barrier defects using a rat model of simple mechanical obstruction.MethodsWistar rats received intraperitoneal injection of ML-7 (a MLCK inhibitor) or vehicle at 24, 12 and 1 hrs before and 12 hrs after intestinal obstruction (IO). The distal small intestine was obstructed with a single ligature placed 10 cm proximal to the ileocecal junction in IO rats for 24 hrs. Sham-operated rats served as controls.ResultsMucosal injury, such as villous blunting and increased crypt/villus ratio, was observed in the distal small intestine of IO rats. Despite massive enterocyte shedding, intestinal villi were covered with a contiguous epithelial layer without cell apoptosis. Increased transmural macromolecular flux was noticed in the distal small intestine and the proximal colon after IO. The bacterial colony forming units in the spleen and liver of IO rats were significantly higher than those of sham controls. Addition of ML-7 ameliorated the IO-triggered epithelial MLC phosphorylation, mucosal injury and macromolecular flux, but not the level of BT.ConclusionsThe results suggest that IO-induced premature enterocytic sloughing and enhanced paracellular antigenic flux were mediated by epithelial MLCK activation. In addition, enteric bacteria may undergo transcytotic routes other than paracellular paths to cross the epithelium.

ACUTE ABDOMINAL SURGICAL EMERGENCY IN ELDERLY PATIENTS (A PROSPECTIVE STUDY)

Background: Longer life expectancy has created an increasing demand for surgical care of the elderly. In addition, abdominal surgical emergencies are potentially serious and life threatening for this age group of patients. Aim: The aim of this study is to know the type of common surgical abdominal emergencies, mode of treatment, complications and outcome in elderly patients. Patients and methods: One hundred patients aged 60 years and above who had been admitted to the surgical department in Basrah General Hospital were prospectively evaluated according to the demographic features, causes of abdominal emergencies they presented with, post operative clinical course and outcome. Results: Out of 100 patients included in the study 60% were males and 40% were females, with an average age of 67.39 years (range from 60-83 years). The causes of acute surgical abdominal emergencies were intestinal obstruction (55%), hollow viscus perforation (17%), acute cholecystitis (12%), mesenteric vascular occlusion (9%), and acute appendicitis (7%). Most of the cases of intestinal obstruction were due to adhesion, while perforated DU was the main cause of hollow viscus perforation. Twenty patients (20%) died in the early post operative period with mesenteric vascular occlusion being the leading cause of death (35%). Conclusions: Acute intestinal obstruction and hollow viscus perforation appear to be the main causes of acute abdominal surgical emergencies. Obstructed hernia which constituted 14% of the causes is generally preventable. Acute mesenteric ischaemia and bowel obstruction secondary to colonic tumour had a worse prognosis in elderly patients.

Jejunogastric Intussusception: A Rare Cause of Life-Threatening Hematemesis

Jejunogastric Intussusception: A Rare Cause of Life-Threatening Hematemesis