Hollow Viscus Research Articles

A Study on Hollow Viscus Perforation in a Tertiary Care Hospital in South India

A Study on Hollow Viscus Perforation in a Tertiary Care Hospital in South India

Antibiotic Prophylaxis for Surgical Site Infection After Traumatic Hollow Viscus Injury

This cohort study investigates the association between antibiotic prophylaxis and surgical site infection after traumatic hollow viscus injury.

Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT)

BackgroundEnhanced recovery after surgery(ERAS) is a set of multiple perioperative care component not a rigid protocol with improved outcomes for elective surgeries. This study aimed to assess the feasibility and outcomes in trauma patients undergoing laparotomy. Study designProspective single-centre randomized controlled trial(RCT). Patients undergoing emergency laparotomy following trauma were randomized into ERAS(early removal of catheters, early mobilization and initiation of diet, use of opioid-sparing multimodal analgesia) and conventional care groups 24 ​h post-surgery. Outcome measures included length of hospitalization(LOH), recovery of bowel function, duration of removal of catheters and 30-day complications(Clavien-Dindo). ResultsFifty patients were randomized into ERAS(n ​= ​25) and conventional care(n ​= ​25) groups. Ninety-two percent of patients were young males, 58 ​% had blunt trauma to the abdomen and the most common indication of surgery was hollow viscus injury(88 ​%). ERAS group had a reduced median LOH(days) (6 versus 8, p ​= ​0.007), early recovery of bowel function(p ​= ​0.010) and shorter times for nasogastric tube(p ​= ​0.001), urinary catheter(p ​= ​0.007) and drain(p ​= ​0.006) removal. The complications were comparable in both groups except for deep surgical site infection[significantly lower in ERAS group(p ​= ​0.009)]. ConclusionERAS is safe and significantly reduces LOH in select trauma patients undergoing laparotomy.

Contrast-enhanced CT scan (CECT) for the detection of hollow viscus and mesenteric injuries in blunt trauma - an updated systematic review of the literature and meta-analysis of diagnostic test accuracy.

Despite improved awareness of blunt traumatic hollow viscus and mesenteric injuries (THVMI), the accuracy of contrast-enhanced CT (CECT) varies considerably among studies. This systematic review and meta-analysis of test accuracy aims to explore the diagnostic performance of CECT in detecting THVMI in blunt trauma. The study was conducted according to the Cochrane recommendations searching the PubMed, Scopus, and Cochrane Library datasets from 2000 to 8 September 2023 (PROSPERO ID: CRD42023473041). Surgical exploration, autopsy, and discharge from the hospital after monitoring were set as reference standard. To explore the diagnostic accuracy of CECT in detecting THVMI hierarchical models were developed. The risk of bias in individual studies was assessed with the QUADAS-2 tool. Sensitivity analysis was conducted to detect sources of heterogeneity. Twelve studies, for a total of 4537 patients, were deemed eligible. After identification of outliers and sensitivity analysis, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.85 (95% CI: 0.69-0.93), 0.94 (95% CI: 0.8-0.98), 14.65 (95% CI: 4.22-50.85), 0.16 (95% CI: 0.07-0.34), 92.3 (95% CI: 29.75-286.34), respectively. The Area under the HSROC curve was 0.95 (95% CI: 0.92-0.96). Meta-regression analysis identified the year of publication as a covariate significantly associated with heterogeneity. A high risk of bias was detected in the "patient selection" domains. CECT has a fundamental role in identifying THVMI with high specificity but suboptimal sensitivity. Clinical criteria are still of paramount importance, especially in cases of ambiguous initial CECT images.

Surgical Exploration for Intestinal Perforation in Extreme Preterm Neonates

Gastrointestinal perforation and peritonitis in preterm infants are most often due to necrotizing enterocolitis. These neonates are usually critically ill with multiorgan involvement and pose a challenge with regard to timing for definitive surgery. Peritoneal drainage is only a temporizing measure. Meticulous pre- and intra-op stabilization is mandatory for timely surgery. We describe a sick 710 g neonate where the perforation was the aftermath of intestinal obstruction from a mid-small bowel intussusception. This lays emphasis on considering other differentials for hollow viscus perforation even in extreme preterm neonates; these require surgical exploration and correction. The baby recovered well after primary resection anastomosis and several weeks of intensive care.

Effect of Wound Irrigation with Povidone Iodine Versus Normal Saline on Superficial Incisional Surgical Site Infection Following Laparotomy for Peritonitis

Abstract Background: Peritonitis is a surgical emergency arising mostly from the perforation or rupture of an abdominal hollow viscus. Surgical operations for peritonitis are often attended by high morbidity and sometimes mortality in severe cases. Surgical site infection (SSI) is perhaps the most common post-operative morbidity following laparotomy for peritonitis. Objective: To compare the rate of SSI in abdominal operations for peritonitis following wound irrigation with povidone iodine versus normal saline at a tertiary health institution in Nigeria. Materials and Methods: This was a prospective, comparative hospital-based study over a year. Consecutive consenting adult patients were randomised into two groups in this study. The first group (A) used 500 mL of 1% povidone iodine for subcutaneous wound irrigation, while the second group (B) used 500 mL of normal saline for subcutaneous wound irrigation. Wound irrigation was done after an appropriate surgical procedure had been carried out based on the pathology. Wounds were assessed for SSI for up to 30 days after operation using the definition criteria by the Centre for Disease Control and Prevention (CDC). SSI rates were compared between the two groups. Result: Fifty-eight consecutive patients with generalised peritonitis over a one-year period were enrolled in this study, but 53 patients who completed the study were analysed. Thirty patients were males and 23 were females, and their mean age was 40.83 ± 17.96 years. Overall, 15 (28.3%) patients had incisional SSI. There were nine (34.6%) cases in the povidone group, while there were six (22.2%) in the saline group. This difference was not statistically significant (P = 0.32). Klebsiella species were the dominant organisms isolated from the infected wounds. Conclusion: Wound irrigation with povidone iodine after laparotomy for peritonitis did not reduce the rate and severity of surgical site infection more when compared to normal saline. We suggest further studies with a large number of patients in a multi-centre study to explore further the effect of povidone iodine versus normal saline wound irrigation on SSI following laparotomy for peritonitis.

Emphysematous liver abscess: Variable clinical presentations, management challenges and outcomes-a case series

Emphysematous liver abscesses (ELAs), characterized by the presence of gas within the hepatic parenchyma, are an uncommon and potentially lifethreatening entity. ELAs with clinical presentations mimicking hollow viscus perforation pose a diagnostic conundrum for clinicians. This series highlights the diagnostic challenges posed by such atypical presentations and emphasizes the importance of considering hepatic pathology in the differential diagnosis of pneumoperitoneum. Our objective is to provide a comprehensive analysis of the diverse clinical presentations, diagnostic challenges, and therapeutic strategies employed in managing this unique subset of liver abscesses.

Quality ofIntegration ofAir Force Trauma Surgeons Within the Center forSustainment ofTrauma andReadiness Skills, Cincinnati: A Pilot Study.

While previous studies have analyzed military surgeon experience within military-civilian partnerships (MCPs), there has never been an assessment of how well military providers are integrated within an MCP. The Center for Sustainment of Trauma and Readiness Skills, Cincinnati supports the Critical Care Air Transport Advanced Course and maintains the clinical skills of its staff by embedding them within the University of Cincinnati Medical Center. We hypothesized that military trauma surgeons are well integrated within University of Cincinnati Medical Center and that they are exposed to a similar range of complex surgical pathophysiology as their civilian partners. After Institutional Review Board approval, Current Procedural Terminology (CPT) codes were abstracted from billing data for trauma surgeons covering University of Cincinnati Hospitals in 2019. The number of trauma resuscitations and patient acuity metrics were abstracted from the Trauma Registry and surgeon Knowledge, Skills, and Abilities clinical activity (KSA-CA) scores were calculated using their CPT codes. Finally, surgeon case distributions were studied by sorting their CPT codes into 23 categories based on procedure type and anatomic location. Appropriate, chi-squared or Mann-Whitney U-tests were used to compare these metrics between the military and civilian surgeon groups and the metrics were normalized by the group's full-time equivalent (FTE) to adjust for varying weeks on service between groups. Data were available for two active duty military and nine civilian staff. The FTEs were significantly lower in the military group: military 0.583-0.583 (median 0.583) vs. civilian 0.625-1.165 (median 1.0), P = 0.04. Per median FTE and surgeon number, both groups performed a similar number of trauma resuscitations (civilian 214 ± 54 vs. military 280 ± 13, P = 0.146) and KSA-CA points (civilian 55,629 ± 25,104 vs. military 36,286 ± 11,267; P = 0.582). Although the civilian surgeons had a higher proportion of hernia repairs (P < 0.001) and laparoscopic procedures (P = 0.006), the CPT code categories most relevant to combat surgery (those relating to solid organ, hollow viscus, cardiac, thoracic, abdominal, and tissue debridement procedures) were similar between the surgeon groups. Finally, patient acuity metrics were similar between groups. This is the first assessment of U.S. Air Force trauma surgeon integration relative to their civilian partners within an MCP. Normalized by FTE, there was no difference between the two groups' trauma experience to include patient acuity metrics and KSA-CA scores. The proportion of CPT codes that was most relevant to expeditionary surgery was similar between the military and civilian partners, thus optimizing the surgical experience for the military trauma surgeons within University of Cincinnati Medical Center. The methods used within this pilot study can be generalized to any American College of Surgeons verified Trauma Center MCP, as standard databases were used.

Study of Pattern and Management of Abdominal Trauma Patients at a University Hospital of Nepal

Background: Injury related death is a leading cause of death globally. Abdominal injuries may occur in up to one third of patients with trauma. Road traffic accidents have become the commonest mechanism of trauma. Materials and Methods: This was a hospital based retrospective descriptive study conducted at Dhulikhel Hospital-Kathmandu University Hospital. Patients admitted with abdominal trauma from July 2021 to December 2023 were included in this study. Results: This study included 60 patients with abdominal trauma. Mean age of patients was 35.60 ± 15.81 (10-76) years. Majority of patients belonged to age group 21-40 years (n=32, 53.3%) with male predominance (Male:female ratio=3.6:1). Blunt abdominal trauma (n=58, 96.7%) was more common than penetrating abdominal trauma (n=2, 3.3%). Road traffic accident (n=31, 51.7%), fall from height (n=22, 36.7%) and physical assaults (n=7, 11.7%) were the mechanisms of injury. In our study, commonly injured organs were spleen(n=19, 30.64%), liver(n=15, 24.19%) and small bowel(n=14, 22.58%). Among the patients with penetrating abdominal trauma, one patient had rectal injury and next patient had stab injury with protruding omentum through the wound. Thirty four patients (56.7%) were managed conservatively and 26 patients (43.3%) underwent operative management. The mortality rate was 8.33% (n=5) of which 4 (80%) had undergone operative management and 1 (20%) was being managed conservatively. Conclusion: Majority of patients with solid organ injury can be managed conservatively while hollow viscus injury undergoes operative treatment. Physically active male population is the most affected group. Road traffic accidents are the leading cause of abdominal trauma followed by fall from height and physical assaults.

Role of Laparoscopy in Evaluation of Various Blunt Abdominal Trauma

Introduction with Objective: The aim of the present study was to assess the role of laparoscopy in evaluation of various Blunt abdominal trauma (BTA) in tertiary care teaching hospital. Materials and Methods: A prospective observational study was conducted from 21st June 2016 to 21st December 2017 among 50 abdominal blunt trauma patients attending at Casualty Block, Dhaka Medical College Hospital, Dhaka, after obtaining requisite consent from the patients attendant. Data were collected through the assessment and investigation report of abdominal blunt trauma patients in the Casualty Department. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the role of laparoscopy in evaluation of various blunt abdominal trauma. Results: Most of the patients were from 21-30 years (36%) of age group followed by 11-20 years (32%). The median age of this study population is 27 years. Of the study population, 84% (n=42) were male and 16% (n=8) were female. Male-female ratio was 84:16. In this study, 62% (n=31) of patients underwent only laparoscopy and 38% of patients (n=19%) underwent laparoscopy followed by laparotomy. Perforation of gas containing hollow viscus (94.73%) is responsible for conversion of laparoscopy into laparotomy in patients with blunt abdominal trauma. Among 50 patients 14 patients (28%) developed post operative complications. Rate of wound infection was higher laparoscopy followed by laparotomy (n=11). One patient developed post operative collection following laparoscopy. The accuracy rate is 100% in laparoscopic evaluation of BTA in this study. Conclusion: laparoscopy is a useful modality for evaluating and managing hemodynamically stable blunt abdominal trauma patients. Medicine Today 2024, Vol.36 (2): 95-98

Associations between hollow viscus injury and acute kidney injury in blunt abdominal trauma: A national trauma data bank analysis.

It is well established that hollow viscus perforation leads to sepsis and acute kidney injury (AKI) in non-trauma patients. However, the relationship between traumatic hollow viscus injury (HVI) and AKI is not well understood. Utilizing data from the National Trauma Data Bank, we investigated whether HVI serves as a risk factor for AKI. Additionally, we examined the characteristics of AKI in stable patients who underwent conservative treatment. We reviewed blunt abdominal trauma (BAT) cases from 2012 to 2015, comparing patients with and without AKI. Significant factors from univariate analysis were tested in a multivariate logistic regression (MLR) to identify independent AKI determinants. We also analyzed subsets: patients without HVI and stable patients given conservative management. Out of the 563,040 BAT patients analyzed, 9073 (1.6%) developed AKI. While a greater proportion of AKI patients had HVI than those without AKI (13.3% vs. 5.2%, p<0.001), this difference wasn't statistically significant in the MLR (p=0.125). Notably, the need for laparotomy (odds=3.108, p<0.001) and sepsis (odds=13.220, p<0.001) were identified as independent risk factors for AKI. For BAT patients managed conservatively (systolic blood pressure >90mmHg, without HVI or laparotomy; N=497,066), the presence of sepsis was a significant predictor for the development of AKI (odds=16.914, p<0.001). While HVI wasn't a significant risk factor for AKI in BAT patients, the need for laparotomy was. Stable BAT patients managed conservatively are still at risk for AKI due to non-peritonitis related sepsis.

Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia.

Despite the high incidence of abdominal stab injuries, the rate of nontherapeutic laparotomies and the predictors of therapeutic laparotomies have rarely been studied in low-income settings. This multicenter retrospective study involved three of the largest academic medical centers in central Ethiopia. All patients who sustained an anterior abdominal stab injury and underwent exploratory laparotomy, regardless of the intraoperative findings, were included over the 3-year course of the study. Of the 117 patients who underwent exploratory laparotomy, 35 patients (29.9%) underwent nontherapeutic laparotomies. Three factors predicted therapeutic laparotomy: hollow viscus evisceration (adjusted odds ratio [AOR], 5.77; 95% confidence interval [CI], 1.16-28.64; P=0.032), localized and generalized peritonitis (AOR, 4.77; 95% CI, 1.90-11.93; P=0.001), and white blood cell count ≥11,500/mm3 (AOR, 2.77; 95% CI, 1.002-7.650; P=0.049). The overall positive predictive value of the therapeutic predictors was 80.2%, while the negative predictive value of all predictor-negative patients was 58.1%. The predictors would have prevented 51.4% of the nontherapeutic laparotomies. Close to one-third of the patients had a nontherapeutic laparotomy. The clinical predictors of therapeutic laparotomy were shown to have a high positive predictive value despite a lower negative predictive value. Further prospective studies that involve all patients who sustain anterior abdominal stab injuries are needed to potentially improve on the negative predictive value of the predictors suggested by our study.

An Abdominal Seat Belt Sign is Associated With Similar Incidence of Hollow Viscus Injury but Increased In-Hospital Mortality in Older Adult Trauma Patients: A PCSA Multicenter Study.

The abdominal seat belt sign (SBS) is associated with an increased risk of hollow viscus injury (HVI). Older age is associated with worse outcomes in trauma patients. Thus, older trauma patients ≥65 years of age (OTPs) may be at an increased risk of HVI with abdominal SBS. Therefore, we hypothesized an increased incidence of HVI and mortality for OTPs vs younger trauma patients (YTPs) with abdominal SBS. This post hoc analysis of a multi-institutional, prospective, observational study (8/2020-10/2021) included patients >18 years old with an abdominal SBS who underwent abdominal computed tomography (CT) imaging. Older trauma patients were compared to YTPs (18-64 years old) with bivariate analyses. Of the 754 patients included in this study from nine level-1 trauma centers, there were 110 (14.6%) OTPs and 644 (85.4%) YTPs. Older trauma patients were older (mean 75.3 vs 35.8 years old, P < .01) and had a higher mean Injury Severity Score (10.8 vs 9.0, P = .02). However, YTPs had an increased abdominal abbreviated-injury scale score (2.01 vs 1.63, P = .02). On CT imaging, OTPs less commonly had intraabdominal free fluid (21.7% vs 11.9%, P = .02) despite a similar rate of abdominal soft tissue contusion (P > .05). Older trauma patients also had a statistically similar rate of HVI vs YTPs (5.5% vs 9.8%, P = .15). Despite this, OTPs had increased mortality (5.5% vs 1.1%, P < .01) and length of stay (LOS) (5.9 vs 4.9 days P < .01). Despite a similar rate of HVI, OTPs with an abdominal SBS had an increased rate of mortality and LOS. This suggests the need for heightened vigilance when caring for OTPs with abdominal SBS.

Pneumoperitoneum Due to Spontaneous Uterine Perforation Caused by Pyometra – A Rare Finding and a Diagnostic Challenge

Background: Spontaneous perforation of uterus resulting in generalized peritonitis in postmenopausal women is a very rare entity usually caused by pyometra and is associated with high morbidity and mortality. The clinical picture of uterine perforation secondary to pyometra are similar to hollow viscus perforation which makes preoperative diagnosis difficult. A correct and definitive diagnosis can be made with laparotomy or laparoscopy. Case: We report a case of 64-years-old female patient who presented with pain abdomen and distension and inability to pass flatus/motion with signs suggestive of acute generalised peritonitis and genital prolapse with pneumoperitoneum underwent Total Abdominal Hysterectomy with bilateral salpingo-oophorectomy. Results: Despite the surgical intervention, Total Abdominal Hysterectomy with bilateral salpingo-oophorectomy and use of several antibiotics, this patient did not improve and died post-operatively. Conclusions: This case report aim for awareness of the many etiologies for peritonitis is of great importance and to alert the surgeons to the possibility that uterine perforation secondary to pyometra also shows air under diaphragm apart from hollow viscus perforation. Correct diagnosis and proper treatment are essential for survival of patients.

Effectiveness of Mannheim's Peritonitis Index in Patients With Peritonitis Secondary to Hollow Viscus Perforation in a Tertiary Care Hospital in Jharkhand, India.

Introduction Peritonitis refers to the inflammation of the peritoneum and peritoneal cavity. Causes of peritonitis can be bacterial (gastrointestinal or non-gastrointestinal), chemical, traumatic, or ischemic. Peritonitis can be localized or diffuse, acute or chronic. Peritonitis can be primary, secondary, or tertiary, according to the pathogenesis. Peritonitis developed secondary to hollow viscus perforation is a life-threatening condition and a common cause of emergency surgery in India. The Mannheim peritonitis index (MPI) is a simple scoring system that can accurately predict the outcome of peritonitis.This study aimed to evaluate the effectiveness of MPI in predicting mortality risk or prognosis in patients with peritonitis due to hollow viscus perforation. Materials and methods This observational cross-sectional study at the Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, involved 111 patients with peritonitis due to hollow viscus perforation from December 2021 to March 2022. Detailed history, clinical examination, relevant blood tests, and radiological investigations established a diagnosis of perforation peritonitis, followed by a score assessment. Data were analyzed using SPSS software (IBM Corp., Armonk, NY, USA). Results Patients >50 years had higher mortality (i.e., 18/43) than patients <50 years (i.e., 13/68). Overall mortality was 31, which included one in low risk, 12 in intermediate risk, and 18 in the high-risk group. Mortality was lowest in the low-risk group (i.e., 1/30), highest in the high-risk group (i.e., 18/40), and 12/41 in the intermediate-risk group; the p-value was <0.05, which was highly significant. Mortality was higher in patients presenting after 24 hours, having organ failure, and non-colonic sepsis. Conclusion The MPI scoring system is simple, easy to calculate, cost-effective, precise, and effective in assessing mortality and morbidity risk in patients with peritonitis due to hollow viscus perforation. It can also guide further management strategies.

Small Bowel Perforation Due to an Unusual Foreign Body

Gastrointestinal perforation is one of the most common causes of acute abdomen presenting to the casualty. However, gastrointestinal perforation due to ingestion of foreign body is rare and is usually encountered in children, psychiatric patients and in alcoholics. Most of the foreign bodies pass through the GI tract without any complications. Only about 1% are known to cause complications such as perforation. Fish or chicken bones, dentures, toy parts, coins, toothpicks are the most commonly encountered foreign bodies. In this report, we present a case of a 60-year-old male who presented to the emergency department with acute abdomen secondary to ingestion of an unusual foreign body that lead to perforation and underwent exploratory laparotomy for removal of the foreign body.&#x0D; Gastrointestinal perforation is one of the most common causes of acute abdomen presenting to the casualty that needs a timely surgical intervention.[1] Important sites of gastrointestinal perforation are stomach, duodenum, small bowel (jejunum, small intestine), appendix, colon and rectum.&#x0D; The most common causes of gastrointestinal perforation include peptic ulcer disease, diverticulitis, carcinomas, IBD, ischemia of bowel wall and infrequently foreign bodies.[2]&#x0D; Foreign body ingestion as seen in children is unintentional and can be deliberate in psychiatric patients.[3] In general, many of these foreign bodies travel through the gastrointestinal tract without causing complications. Only about 1% cases of ingested foreign bodies cause complications such as hollow viscus obstruction and/ or perforation which are usually life threatening and have poorer outcomes if diagnosis is delayed.[4,5] CT is the imaging tool of choice. Such conditions require immediate surgical intervention such as exploratory laparotomy or laparoscopic or endoscopic removal can be attempted in case of stomach or duodenal foreign bodies.&#x0D; Here in the following case report, we present an atypical case who arrived at the emergency room with acute abdomen following a foreign body consumption and underwent exploratory laparotomy for retrieval of foreign body.

Hollow viscus perforation in blunt abdominal trauma: A 14-year experience from a trauma center.

Isolated perforations of hollow viscus (HV) represent less than 1% of injuries in blunt abdominal trauma (BAT). When they do present, they are generally due to high-impact mechanisms in the segments of the intestine that are fixed. The aim of this study is to determine the incidence of major HV injuries in BAT at the "Dr. Domingo Luciani" General Hospital (HDL), and address the literature gap regarding updated HV perforations following BAT, especially in low-income settings. A retrospective review was conducted on the medical records of patients admitted to our trauma center with a diagnosis of complicated BAT with HV perforation over 14years. Seven hundred sixty-one patients were admitted under the diagnosis of BAT. Of them, 36.79% underwent emergency surgical resolution, and 6.04% had HV perforation as an operative finding. Almost half (44.44%) of these cases presented as a single isolated injury, while the remaining were associated with other intra-abdominal organ injuries. The most common lesions were Grade II-III jejunum and Grade I transverse colon, affecting an equal proportion of patients at 13.33%. In recent years, an increased incidence of HV injuries secondary to BAT has been observed. Despite this, in many cases, the diagnosis is delayed, so even in the presence of negative diagnostic studies, the surgical approach based on the trauma mechanism, hemodynamic status, and systematic reevaluation of the polytraumatized patient should prevail.

Comparison of Clinical Characteristics, Therapy, and Short-Term Prognosis between Blunt and Penetrating Abdominal Trauma: A Multicentric Retrospective Cohort Study.

Large-scale studies on the characteristics and management of abdominal trauma in megacities in China are lacking. The aim of this study was to analyze and present the clinical patterns and treatment status of abdominal trauma in regional medical centers. Cases of abdominal trauma treated at seven medical centers in Beijing from 2010 to 2021 were collected. Clinical information about age, sex, injury cause, geographic distribution, abbreviated injury scale/injury severity score (AIS/ISS) value, injury-hospital time, preoperative time, surgically identified organ injuries, type of surgery, causes of reoperation and 90-day mortality was included in this study. Clinical characteristics, treatment methods, and short-term prognoses (90-days survival) were compared between blunt abdominal trauma (BAT) and penetrating abdominal trauma (PAT) cases. Non-normally distributed data are described as medians (IQR), and the Mann‒Whitney U test was performed; qualitative data were analyzed using the X2 test. Univariate and multivariate survival analyses were performed by the Cox proportional hazards model. A total of 553 patients (86.98% male) with a median age of 36.50 (27.00-48.00) years were included. The BAT group had a significantly higher proportion of serious injury (P=0.001), lower initial hemoglobin level (P=0.001), and a lower laparoscopy surgery rate (P=0.044) compared to the PAT group. Additionally, more BAT cases were from the area around Beijing (P=0.008) and a longer injury-regional hospital time (10.47 (5.18-22.51) hours vs. 7.00 (3.80-15.38) hours, P=0.001). In the hollow viscus injury subgroup, the BAT group had a significantly longer injury-regional hospital time and preoperative time compared to the PAT group (injury-regional hospital time: 10.23 (6.00-21.59) hours vs. 7.07 (3.99-13.85) hours, P=0.002; preoperative time: 3.02 (2.01-5.58) hours vs. 2.81 (1.85-3.63) hours, P=0.047). The overall 90-day mortality was 11.9%, and longer injury-regional hospital time (HR: 1.01, 95% CI: 1.00-1.02, P=0.008), receipt of ICU treatment (HR: 4.69, 95% CI: 2.54-8.65, P=0.001), and severe ISSs (ISS > 25 vs. ISS < 16, HR: 2.78, 95% CI: 1.38-5.601, P=0.004) had a worse impact on survival. More patients with BAT were transferred to higher-level hospital, leading to significantly longer prehospital and preoperation time. In the subgroup of hemodynamically stable individuals, more patients with BAT experienced hollow viscus injuries. For those patients, aggressive diagnostic laparoscopic exploration may be beneficial. Patients with longer injury-regional hospital intervals, the need for ICU care, and higher injury severity scores (ISSs) suffered from worse prognoses.

Evaluation of predictive factors for i-CLARAS (intraoperative complications in laparoscopic renal and adrenal surgery): a multicentre international retrospective cohort study

The laparoscopic approach represents the standard of treatment for renal and adrenal diseases, and its use is increasing even outside referral centres. Although most procedures are routinely performed, intraoperative complications do not occur, and the rate and predictive factors of these complications have not been established. The aim of this study was to evaluate the incidence and type of intraoperative complications and to identify predictive factors in patients undergoing laparoscopic renal and adrenal surgery. This was a cohort, multicentre, international retrospective study. Patients who underwent laparoscopic renal and adrenal surgeries between April 2017 and March 2022 were included in the study. Bivariate analysis was performed using contingency tables and the χ2 test for independent samples to compare qualitative variables and the T test and Mood test for continuous variables. Multivariate analysis was performed using a logistic regression model to obtain adjusted odds ratios. A total of 2374 patients were included in the study. Intraoperative complications were reported for 8.09% of patients who underwent renal surgery, with the most common complications reported being hollow viscus and vascular complications, and for 6.75% of patients who underwent adrenal surgery, with the most common complication reported being parenchymatous viscous complications. Multivariate analysis revealed that both adrenal and renal surgery radiological preoperative factors, such as invasive features during adrenalectomy and the RENAL score during nephrectomy, are predictive factors of intraoperative complications. In contrast to existing data, surgeon experience was not associated with a reduction in the incidence of perioperative complications.

Hollow viscus injury due to blunt abdominal trauma: a tertiary trauma center experience.

Hollow viscus injuries (HVIs) present less frequently than solid organ injuries in patients with blunt abdominal trauma, potentially leading to significantly increased morbidity and mortality rates. Modern imaging equipment, confidently used for diagnosing solid organ injuries, may fail to identify hollow viscus injuries. In this study, we aim to present our tertiary center's experience with this entity. Patients treated in our clinic from April 2011 to December 2021 for hollow viscus injury following blunt abdominal trauma were included in this study. We recorded and retrospectively evaluated patients' demographic data, injury site and mechanism, preoperative and perioperative findings, and mortality rates in a prospective database. Of the 607 blunt trauma patients, 35 (5.8%) had hollow viscus injuries, with 88.6% being male. Motor vehicle accidents were the leading cause of injury (80%). The mean duration between admission and surgical exploration was 26±21.2 hours. The mean Injury Severity Score was 21.8±13.6. Rigidity was the most frequent clinical finding (60%). The jejunum and ileum were the most frequently injured organs (54.1%). Mortality and morbidity rates were 11.4% and 17.1%, respectively. Nondeclining white blood cell (WBC) counts within 24 hours of admission, alongside any physical or radiological finding indicating an HVI, should prompt immediate surgical exploration.