Hollow Viscus Perforation Research Articles

Damage-control surgery in patients with non-traumatic abdominal emergencies: A meta-analysis

Abstract Objective After the successful implementation in trauma patients, damage control surgery (DCS) is being increasingly used in non-traumatic abdominal emergencies, too. However, non-trauma DCS (NT-DCS) is currently a matter of debate and has not yet been comprehensively assessed. The aim of this meta-analysis was to investigate the effect of NT-DCS on mortality in patients with abdominal emergencies. Methods Systematic literature search using PubMed. Original articles addressing mortality in patients undergoing NT-DCS or non-trauma conventional surgery (NT-CS) for abdominal emergencies were included. Descriptive statistics and two meta-analyses were performed. Meta-analysis 1 compared mortality in patients undergoing NT-DCS vs. NT-CS. Meta-analysis 2 assessed the observed vs. expected mortality rate, based on APACHE, POSSUM and SAPS scores, in the NT-DCS group. Continuous and categorical variables were reported as weighted means and proportions. Effect sizes were described as risk differences (RD) with 95% confidence intervals (CI). Results Literature search revealed 1314 articles. Of these, 21 studies published 2004-2019 were included. NT-DCS was performed in 1238 and NT-CS in 936 patients. In the NT-DCS vs. NT-CS group mean age was 61.0 vs. 64.9 years and the proportion of male patients 58.6% vs. 52.9%, respectively. Most frequent indications for NT-DCS were hollow viscus perforation (28.4%), mesenteric ischemia (26.5%), anastomotic leak (19.6%), haemorrhage (18.4%), abdominal compartment syndrome (17.4%), bowel obstruction (15.5%), and pancreatitis (13.1%). In meta-analysis 1, mortality was not significantly different in the NT-DCS vs. NT-CS group (RD 0.09, 95% CI -0.06/0.24). Meta-analysis 2 revealed a significantly lower observed than the expected mortality rate in patients undergoing NT-DCS (RD -0.18, 95 % CI -0.29/-0.06). Heterogeneity of included studies was high in both meta-analyses (I2=89.0% and 79.9%, respectively). Conclusion This meta-analysis revealed no significantly different mortality in patients with abdominal emergencies undergoing NT-DCS vs. NT-CS. However, observed mortality was significantly lower than the expected mortality rate in the NT-DCS group, suggesting a benefit of the DCS approach. Based on these results, the effect of DCS in patients with non-traumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted.

Pattern of illnesses presenting as acute abdomen: surgical study in 118 patients

Background: Acute abdomen is an important clinical entity and represents a symptom complex; of which, pain in the abdomen is a predominant feature. It is the result of some underlying condition and is a very common reason for patients reporting to emergency department. Pattern of illnesses presenting as ‘acute abdomen’ can vary from mild to life threatening in severity and management can similarly vary from just symptomatic relief to emergency operative intervention. It poses a significant challenge for the clinician since he is required to untangle the issue in a limited time frame and formulate a management plan. The aim of the study was finding the pattern of underlying conditions which had resulted in patients presenting with acute abdominal pain.Methods: A prospective observational study was carried out on 118 patients who reported with ‘acute abdomen’, from August 2015 to February 2017.Results: In this study, pattern of illnesses reflected that benign biliary disease was the commonest condition in the study population. This was followed by urolithiasis. An important observation was that ‘non-specific abdominal pain’ (NSAP) was the reason for acute abdomen in about 14% patients. Many other conditions like acute appendicitis, hollow viscus perforation, intestinal obstruction and pancreatitis presented with similar symptom complex in which abdominal pain was the main feature.Conclusions: At the end of the study, we had a better knowledge of the conditions presenting as acute abdomen in the source population and the same can be utilized for further research in the field of this important clinical entity.

Pre-operative Intraperitoneal Drainage Under Local Anesthesia: A Promising Resuscitation Tool in Peritonitis Secondary to Hollow Viscus Perforation During the Corona Pandemic.

IntroductionTo study the role of intraperitoneal drainage in the resuscitation of patients with perforation peritonitis during the corona pandemic.Materials and methodsThis retrospective study was conducted in the general surgery department of Nishtar Medical University/Hospital Multan from April 2020 to September 2020. Patients of peritonitis who presented with bilateral pulmonary crepitations, SpO2 less than 92%, PaO2 less than 60 mmHg on arterial blood gas (ABG), and chest x-ray (CXR) finding of bilateral infiltrates are included. Due to high suspicion of associated coronavirus infection such patients needed polymerase chain reaction (PCR) for virus detection and special measures were required for resuscitation before any definitive treatment. A delay of six to eight hours is usually encountered while ensuring proper safety measures and dedicated operation theaters. Initial resuscitation started with intravenous fluids and broad-spectrum antibiotics were given to all patients. Twenty-seven patients were resuscitated with preoperative intraperitoneal drainage while waiting for PCR and 13 patients were resuscitated without drainage. Data analysis was carried out using the statistical package for the social sciences (SPSS) version 19 software. The mean was calculated for age while frequency and percentages were calculated for gender, comorbidities, and causes of delay. The mortality was compared using the chi-square test.ResultsThe mean age of patients was 43.73 ± 16.04 years. The common cause of peritonitis were perforations due to duodenal ulcer, typhoid, tuberculous (TB), and biliary origin. The variables that led to suspicion of coronavirus were SpO2 < 92%, PaO2 <60mmHg and bilateral infiltrates on chest x-ray. PCR for coronavirus was positive in nine patients. Mortality was 29.6% in those resuscitated with intraperitoneal drainage before the definitive procedure and 54% in those not resuscitated with intraperitoneal drainage.ConclusionsThe surge of coronavirus infection has put the healthcare staff at great risk. This has led to strict protocols and precautionary measures in the management of patients with perforation peritonitis with suspected corona infection. The local guidelines for the management of patients with acute abdomen should include aggressive measures right from the start during the corona pandemic. Intraperitoneal drainage, early in the management of perforation peritonitis decreases morbidity and mortality in suspected corona infected patients.

RISK FACTORS ASSOCIATED WITH POOR PROGNOSIS IN PATIENTS WITH SECONDARY PERITONITIS ADMITTED TO THE INTENSIVE CARE UNIT (ICU)

Abstract INTRODUCTION Secondary peritonitis is still associated mortality higher than 20% and the risk factors associated with mortality are different and variable according to the different studies. The objective is to analyse clinical, analytical, surgical, microbiological and physiological factors associated with poor prognosis, within a cohort of ICU patients with the diagnosis of secondary peritonitis. MATERIAL AND METHODS Retrospective single-centre observational cohort study from January 2015 to June 2018. Patients included suffered secondary peritonitis due to hollow viscera perforation. Multivariate analysis with binary backward stepwise logistic regression was performed. Odds ratio of the predictor variables of ICU mortality and bad prognosis are shown. RESULTS 130 patients were recruited. Median age of 65 years (55-74). 45% were women. SAPS 3 median of 53.5 (43 - 65), ICU median stay 7 days (4 - 12) and ICU hospital stay 14 days (8 - 21). Readmission rate of 6.2%. ICU mortality 5.4% and hospital mortality 9.2%. In the multivariate analysis, endocrine comorbidity showed an OR 3.611 (CI 95%: 1.217-10.715; p = 0.021), need for mechanical ventilation OR 12.275 (CI 95%: 1.974-76.327; p = 0.007), need for parenteral nutrition OR 5.747 (CI 95%: 1. 565-21,101; p = 0.008), faecal peritonitis OR 2,908 (CI 95%: 1,176- 7,192; p = 0.021), need for new surgery after peritonitis OR 79,746 (CI 95%: 6,718- 946,643; p = 0.001) and SOFA at day 1 above 7 OR 6,939 (CI 95%: 2,208-21,814; p = 0.001). Microbiological variables showed no correlation with bad prognosis. CONCLUSIONS Clinical, physiological and surgical characteristics showed a relationship with poor prognosis of patients with secondary peritonitis. Microbiological variables didńt.

Effectiveness of Mannheim peritonitis index scoring system in predicting the morbidity and mortality in peritonitis due to hollow viscous perforation

Background: To study the spectrum and prognostic factor in perforation peritonitis. To evaluate the outcome of patients and identification of high risk patients using Mannheim peritonitis index.Methods: 80 patients with hollow viscous perforation admitted in the Dept. of Surgery Adhichuchanagiri Institute of Medical sciences from January 2019 to June 30 2020 were included in the study. Necessary data was collected; MPI score was calculated for each patient and analysis done.Results: The number of post-operative complications, hospital stay and mortality proportionately increased with the MPI score. In our study Age &gt;50 years, Organ failure at admission pre operatively and MPI scoring found to be statistically significant. Out of the 8 variables used in this scoring system, age more than 50 years and organ failure on admission carried more significance in predicting the morbidity and mortality in the post operative period than the other variables.Conclusions: Mannheim peritonitis index is a simple and effective method in predicting the mortality and morbidity of patients with hollow viscous perforation.

Evaluation of Mannheim's Peritonitis Index in Prediction of Mortality in Patients with Non-traumatic Hollow Viscus Perforation Peritonitis.

Hollow viscus perforation peritonitis is one of the commonest surgical emergencies with high mortality and morbidity. The objective of this study was to evaluate the effectiveness of Mannheim's peritonitis index in prediction of mortality in these patients. This is a retrospective, observational cohort study in these patients managed in a single-center from January 1, 2013 to December 30, 2019. Total index scores were plotted in the receiver operating characteristic curves to find out the cut-off point. Sensitivity, specificity, relative risk, positive and negative predictive values were calculated. The individual risk factors were analyzed for mortality as well. Case records of 395 cases of non-traumatic hollow viscus perforation peritonitis were available, there were 33 mortalities (8.2%), mean score was 22.96 (+7.6) points (range 10-43 points). The sensitivity and specificity with score cut-off of 25 came to be 75.8% and 56.35%; positive and negative predictive value being 13.7% and 96.2%. Risk of patients for mortality with scores >25 was 3.62 times those with scores <25 for mortality. Mortality rate was 2.4% with scores <21, 8.9% with 21-29 and 20.9% with >29 respectively (p-value <0.05). Univariate analysis showed age >50 years, presence of organ dysfunction, diffuse peritonitis, non-colonic origin and character of exudates were significant factors; multivariate analysis showed only organ failure as significant. Mannheim peritonitis index is very useful in stratification of severity of the disease and prediction of mortality in patients with peritonitis, and should be included in management of all these patients.

Perforated duodenal ulcer after laparoscopic roux-y gastric bypass. Case report

Introduction: Gastric bypass is one of the strategies that have shown better results in the management of obesity, since this technique is the one that strikes a better balance between risk, side effects and long-term results. It consists in the creation of a gastric reservoir that anastomosis to the jejunum, reducing the size of the gastric chamber and thus the patient tolerates less food and decreasing its intake. One of the less frequent late complications is duodenal perforation. For this reason, we present this case report, according to the CARE guideline. Case presentation: 47-year-old male patient with a history of gastric bypass due to obesity, who consults for sudden onset of abdominal pain. Physical examination showed signs of peritoneal irritation and systemic inflammatory response. Exploratory laparoscopy was performed with suspected hollow viscus perforation, hich evidenced a 1 cm ulcer on the anterior aspect of the duodenal bulb, requiring omentoplasty by aparotomy. Conclusions: Perforated duodenal ulcer in patients with a history of gastric bypass is a rare diagnosis. It has a non-specific clinical presentation, which is why exploratory laparoscopy is considered a valid diagnostic and herapeutic strategy.

To Study the Efficacy of Mannheim’s Peritonitis Index in Patients of Perforation Peritonitis

Introduction-Despite advances in critical care medicine, prognosis in peritonitis due to hollow viscousperforation remains poor especially when associated with multi-organ dysfunction. Various grading systemsare available to analyze and stratify patients by different parameters and predict outcome. In a prospectivenon-randomized observational study, the efficacy of Mannheim peritonitis Index (MPI) was analyzed inpredicting the outcome in patients who were treated for peritonitis due to hollow viscous perforation.Method -A prospective study to assess the efficacy of Mannheim’s peritonitis index in 100 patientswhopresented with perforation peritonitis from August 2016 to July 2017 in LLRM medical college, Meerut.Result -100 patients were included in the study , patients were divided into 3 categories according to MPIscore 29. In category 1 mortality was around8.33%,category 2 had 28.8% mortalityand category 3 had 53.7% mortality.Thus increase in MPI score due to cumulative effect of all 8 parametersresulted in increased risk of mortality in perforation peritonitis .Conclusion – In this study all the parameters of Mannheim’s peritonitis index behave in expected manner,but there were no patient of malignancy and all patient were having generalized peritonitis and femalepatients were only 20. Therefore this study should be done for longer period of time to access all parameterof MPI score.

EFFICACY OF MANNHEIM PERITONITIS INDEX IN PREDICTION OF MORTALITY AND MORBIDITY IN PATIENTS WITH SECONDARY PERITONITIS

Background: Acute generalized peritonitis following hollow viscus perforation is a potentially life threatening condition leading to a cascade of infective processes, sepsis, disseminated intravascular coagulation, multi organ failure and death in the presence of irreversible damage to the vital organs. Grading the severity of acute peritonitis can contribute in better management of patients with perforation peritonitis. The Mannheim Peritonitis Index (MPI) scoring system takes into account various characteristics like age of the patient, gender, duration of peritonitis, organ failure, Malignancy, colonic sepsis, extent of spread and character of the peritoneal uid. The Objective of this study was to determine the Prognostic value of MPI in patients with Secondary Peritonitis. Methods: In this study conducted at SMI Hospital, Dehradun, Over a period of 1 year, all patients presenting with features of Peritonitis due to hollow viscus perforation were included. MPI score of all the patients were calculated and categorized into three groups; less than 21, 21-29 and more than 29. Mortality of patients from each group was calculated and predictive value of each factor was determined. Results:Total 150 patients were included in this study. There were total 21 mortalities. For patients with a score &lt;21, the mortality rate was 0%; for score 21–29, it was 4.3%; and for score &gt;27, it was 67.9% (P &lt; 0.001). Age&gt; 50 years, presence of organ failure, malignancy, presentation after 24 hours, generalized peritonitis and Fecal exudate were associated with higher mortality rates. Conclusions: MPI is a simple and useful scoring system to determine the prognosis and complications in patients with perforation peritonitis.

A comparative study of subcutaneous negative pressure versus simple closure of skin incision following surgery for hollow viscus perforation

Background: Surgical site infection (SSI) is a significant problem associated with open abdominal surgery resulting in increased morbidity, mortality, and cost of treatment. Surgical site infection is one of the most common post-operative complications, occurring in at least 5% of all patients undergoing surgery and 30-40% of patients undergoing abdominal surgery, depending on the level of contamination. This study compares the subcutaneous single closed suction drain and simple conventional closure of skin incision in emergency laparotomy for hollow viscus perforation.Aim: The aim of the study is to determine whether the insertion of a subcutaneous closed suction drain at the incisional site reduces the incidence of post-operative surgical site infection in emergency laparotomy for hollow viscus perforation.Methodology: This is a prospective study. Fifty patients was enrolled, Patients diagnosed to have acute abdomen clinically and radiologically were planned for emergency exploratory laparotomy. They were further allocated alternately to Group I with subcutaneous closed suction drain and Group II without drain. All the patients underwent laparotomy. Postoperatively wound complications and hospital stay was recorded.Conclusion: Our study shows that subcutaneous negative pressure drainage significantly reduces the post- operative surgical site infection and duration of hospital stay following surgery for hollow viscus perforation. This helps in early recovery, better wound healing, and decreases the financial burden on patients by decreasing hospital stay and infection. As post-operative complications depend on the level of contamination, we recommend use of closed negative pressure subcutaneous drain in all patients with contaminated or dirty wounds.

Anesthetic management of a patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock

Hemorrhagic shock is a form of hypovolemic shock in which severe blood loss leads to inadequate oxygen delivery at the cellular level. Death from hemorrhage represents a substantial global problem, with more than 60,000 deaths per year in the United States and an estimated 1.9 million deaths per year worldwide, 1.5 million of which result from physical trauma. This case report aims to stress the need of handling cases of hemorrhagic shock in accordance with damage control protocol.&#x0D; Hemorrhagic shock management using permissive hypotension management, bleeding control, massive transfusion protocol (MTP), minimal crystalloid therapy, and adjuvant therapy is the best approach to get optimal outcome to prevent triad of death. In this case, the application of damage control resuscitation has not been fully implemented because of several constraints.&#x0D; Key words: Hemorrhage; Hemorrhagic shock; Permissive hypotension; Massive Transfusion Protocol; MTP; Resuscitation; Damage control&#x0D; Citation: Pohan DK, Sudjud RW, Kurniawan MB, Ramila HN. Anesthetic management on patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock. Anaesth. pain intensive care 2021;25(2):217-221. DOI: 10.35975/apic.v25i2.1474&#x0D; Received: 11 January 2021, Reviewed: 15 January 2021, Accepted: 16 February 2021

Evaluation of abdominal wound closure using continuous versus interrupted sutures in patients of perforation peritonitis

Background: The type of wound closure plays a critical role in patients of perforation peritonitis, since many of these patients also have poorly controlled co-morbidities and risk factors for wound dehiscence. Though many studies have evaluated abdominal wound closures in the elective scenario, similar studies in the emergent scenario are rather scarce. Hence, we have dealt with this issue in patients presenting with hollow viscus perforation peritonitis.Methods: This was a prospective randomized case control single-centre study with 120 patients performed at St. Stephen’s Hospital, New Delhi, India between February 2016 and January 2019. These patients were randomized divided into two groups; group A comprising those patients in whom, the abdominal wound was closed with continuous sutures, and group B comprising those in whom it was closed with interrupted sutures. Informed consent was taken from all the patients. A detailed proforma included all parameters. Follow up was conducted at 2, 4, 6 and 12 weeks from the date of surgery. Data analysis was done using S.P.S.S. version 17.Results: The time taken for continuous suture fascial closure was significantly less than the interrupted technique. There were no significant differences in other parameters, immediately or on follow-up.Conclusions: The continuous method of abdominal closure was faster than interrupted suturing on account of the use of only two terminal knots, this difference being statistically significant. The outcomes were comparable to other studies that have dealt with this issue in elective surgeries.

Gastrojejunal fistula caused by magnet beads ingestion in a 2 -year-old boy

Abstract Foreign body (FB) ingestions are common events in infants and toddlers. Magnet ingestion increases in the last decades among children and it may be catastrophic if not detected. A 2-year-old-boy was brought to an emergency department for bilious vomiting for five days associated with abdominal pain and constipation. An erect abdominal X-ray showed a radiopaque chain of beads in the upper abdomen, gastric and duodenal gas bubbles with air fluids levels, and a gasless abdomen. Exploratory laparotomy through upper midline incision was performed. In our case, the magnet beads were just beyond the ligament of Treitz and made the jejunal loop as an omega shape that fistulized to the posterior wall of the stomach through the mesentery of the transverse colon. All magnet beads were extracted and the perforations in the jejunum and posterior wall of the stomach were both closed primarily. Conclusion It is crucial to intervene early in symptomatic patients with multiple magnets ingestion, especially if it is located beyond the stomach, to prevent future complications like hollow viscus perforations, fistula formation, and even short bowel syndrome.

Comparative study between POMPP score versus Boey score to predict morbidity and mortality in peptic perforation peritonitis

Background: Peptic ulcer disease (PUD) results from an imbalance between stomach acid-pepsin and mucosal defense barriers. It affects 4 million people worldwide annually. Peptic ulcer perforation is one of the most common surgical emergencies and is associated with a high rate of morbidity and mortality. This is due to presence of various risk factors among the population like H. pylori infection, long term NSAID use, alcohol ingestion, smoking and steroid use. Peptic ulcer perforation peritonitis usually requires an emergency surgical intervention and hence the need for this study, to compare POMPP and Boey scores as predictors of morbidity and mortality in patients with peptic perforation peritonitis.Methods: This prospective observational study was conducted in the hospitals attached to Bangalore Medical College and Research Institute from November 2018 to May 2020. All patients above 18 years with features of hollow viscus perforation with per-operative finding of perforated peptic ulcer were included in the study. Patients with histopathology suggestive of malignancy were excluded.Results: A total of 65 patients were included in the study. On analysis of the data by Chi-square test, P value of both POMPP and Boey scores was found to be &lt;0.05 which is statistically significant. The most important predictive factors of mortality and morbidity were duration of perforation &gt;24 hours, age &gt;65 years and pre-operative shock.Conclusions: Both scoring systems are easy to use and can assist in accurate and early identification of high-risk patients and are important in predicting mortality and morbidity in patients with peptic ulcer perforation.

Unplanned readmission after emergency laparotomy: A post hoc analysis of an EAST multicenter study

BackgroundHospital readmission is an important quality-of-care indicator. We sought to examine the rates and predictors of unplanned readmission for the high-risk non-trauma emergency laparotomy patient. MethodsThis is a post hoc analysis of a multicenter prospective observational study. Between April 2018 and June 2019, a total of 19 centers enrolled all adult patients undergoing emergency laparotomies and systematically collected preoperative, operative, and 30-day postoperative variables. For the purpose of this study, we defined unplanned readmission as a readmission occurring within 30 days from discharge and one that was immediately preceded by an emergency department visit. Patients were excluded if they died during the index admission, were discharged to hospice, or were transferred to other hospitals. Predictors of unplanned readmission were evaluated using a multivariable logistic regression model, adjusting for patient demographics, comorbidities, laboratory variables, and preoperative acuity of disease variables. ResultsA total of 1,347 patients were included, of which 234 (17.4%) had an unplanned readmission. The median patient age was 60 y, 49.4% were male, and 71.4% were white. The most common diagnoses were hollow viscus perforation (28.1%) and small bowel obstruction (24.5%). Predictors of unplanned readmission included patient factors (eg, disseminated cancer [odds ratio: 2.22, confidence interval: 1.35–3.64, P = .002], weight loss >10% in the past 6 months [odds ratio: 1.65, confidence interval: 1.07–2.54, P = .023], dyspnea at baseline [odds ratio: 1.62, confidence interval: 1.06–2.48, P = .026], wound complications [odds ratio: 2.23, confidence interval: 1.55–3.19, P < .001], and discharge to nursing homes [odds ratio: 1.68, confidence interval: 1.02–2.80, P = .044]). ConclusionUnplanned readmission after emergency laparotomies are common, especially for patients with wound complications or requiring nursing homes. These system factors are potential quality improvement targets to reduce readmissions.

Spontaneous Pneumoperitoneum due to Intra-abdominal Drain- A Case Report

Pneumoperitoneum is most commonly caused by hollow viscus perforation which requires an emergency surgical intervention. However, this is not always the case. Pneumoperitoneum which is not due to hollow viscus perforation is called Spontaneous or “non-surgical” pneumoperitoneum. Rarely, it can present with peritonitis but non-surgical pneumoperitoneum usually follows a benign course and can be managed conservatively. A case of 53-year-old male, non-smoker, non-alcoholic, hypertensive known to have decompensated chronic liver disease, since one year with portal hypertension and ascites was presented. The patient underwent uneventful laparoscopic cholecystectomy for acute calculous cholecystitis and developed spontaneous pneumoperitoneum due to intra-abdominal drain one week postprocedure. Pneumoperitoneum was successfully managed conservatively. A thorough history, physical examination and imaging are crucial in identifying patients with non-surgical pneumoperitoneum and to prevent unnecessary laparotomies. In present case, pneumoperitoneum was due to intra-abdominal drain which resolved after removing the drain. So, it is of utmost importance to rule out non-surgical causes of pnemoperitoneum, especially in surgeries where drain are kept in-situ.

Role of diagnostic laparoscopy in blunt abdominal trauma

Background: The appropriate treatment for patients with blunt abdominal trauma depends on the precise diagnosis of the presence and severity of intra-abdominal injuries. Laparotomy, however, has remained the management of choice in certain situations following blunt abdominal trauma such as in patients who have free intraperitoneal fluid of uncertain origin, signs indicating intestinal ischemia caused by mesenteric bleeding, and signs indicating hollow viscus perforation. The objective of the study is to determine the role of diagnostic laparoscopy in blunt abdominal injuries.Method: A prospective study was conducted in general surgery department in Sree Mookambika Institute of Medical Sciences, kulasekharam, Tamil Nadu., a tertiary care center including all patients with blunt trauma abdomen who underwent diagnostic laparoscopy during the time period from June 2019 to December 2020.Results: 27 males and 3 females were selected in this study. The most common mode of injury was vehicle collision. Out of 30 diagnostic laparoscopies,12 patients had solid organ injury, 5 patients had bleeding with no organ injury, 2 patients had mesenteric vascular injury, 2 patients had small bowel perforation. There were no findings in laparoscopy in 7 patients. Laparoscopy was converted to open Laparotomy in 3 patients. Therapeutic Laparoscopy were done in 20 patients.Conclusion: Laparoscopy can play an important role in diagnosis and treatment of blunt and penetrating trauma in hemodynamically stable patients. Low missed injury rates, reduced duration of hospital stay, faster recovery and reduced cost make it an attractive and safe alternative to classical trauma laparotomy.

PERFORATIVE PERITONITIS IN NEWBORNS: INSTRUMENTAL AND MORPHOLOGICAL EXAMINATION FINDINGS

The aim: To study and analyze the results of instrumental diagnostic measures and morphological verification of perforations of abdominal viscera in peritonitis in newborns, their importance in timely diagnosis, as well as to present authors’ experience of examining newborns with PP, taking into account the complexity of diagnosis and treatment of these patients. Materials and methods: The study is based on the results of examining 59 newborns with PP of various etiologies. Instrumental methods that were used in the diagnosis of PP and differential diagnosis of other emergencies involved the following: radiological examination (plain abdominal radiography), abdominal and retroperitoneal ultrasound, neurosonography, echocardiography, diagnostic abdominal paracentesis. Morphological verification of hollow viscus perforations was performed by methods of histologic examination in 54 newborns who underwent surgery. Results: It is emphasized that perforations in NEC and spontaneous gastrointestinal perforations have clinical and morphological differences. The analysis of morphological data showed absence of intestinal musculature or muscular wall defect in spontaneous gastrointestinal perforations. Perforations in NEC had massive gastric or bowel wall necrosis. Morphogenesis of gastrointestinal perforations in newborns is crucial for developing correct treatment strategy and choosing surgical approach. Conclusions: Diagnosis of PP in newborns should be comprehensive and include modern instrumental studies that enable to reliably establish the cause of peritonitis and indications for surgical treatment. Differential diagnosis of PP in newborns with other diseases aims to differentiate PP from a number of similar clinical symptoms of urgent conditions in order to conduct adequate preoperative preparation and appropriate surgery. Diagnostic markers of PP involve the following: pneumoperitoneum, free fluid in the abdomen, sentinel loop (intestinal distention), fixed bowel loop, cloudy brown or greenish intra-abdominal fluid with a large number of leukocytes and bacteria.

Diagnostic validity of x-rays in detection of hollow viscus perforation

Diagnostic validity of x-rays in detection of hollow viscus perforation

Clinical Study on Hollow Viscus Perforation

Clinical Study on Hollow Viscus Perforation