Negative Laparotomy Research Articles

Pattern of abdominal injuries, organ involved and rate of negative laprotomy in tertiary care hospital

Objective: This study was designed to evaluate the pattern of abdominal injuries the value of the surgery in assisting diagnosis, laparotomy and mortality rate. Methods: Out of 1923 total trauma patients 886 individuals were included in the study from a tertiary care hospital. Demographic , trauma-related traits, laparotomies with their indications, etiology and the organs affected were all collected. With SPSS 23 were used to evaluate data Results: The mean age patients were 27.05 years mostly male. Mortality and negative laparotomy rate were 5.9 and 15.4 percent respectively. Blunt injures were more than penetrating .Spleen was the frequent organ damage. Conclusion: Blunt trauma with spleen mostly involved organ. Mortality and negative laparotmy rate are comparable to other studies

Diagnostic accuracy of low dose CT-Scan abdomen in patients with clinical features of acute appendicitis.

Acute appendicitis is one of the commonest causes of acute abdominal pain presenting to emergency department (ED) and Computerized Tomography scan (CT) is considered gold standard for its diagnosis. Internationally Low Dose Computerized Tomography scan (LDCT) in emergency department is recommended as a beneficial tool to diagnose acute appendicitis with less exposure to radiation and reduction in the rate of negative laparotomy. Local trials are needed to determine the diagnostic accuracy of LDCT as the first line imaging test for acute appendicitis. Our objective was to determine the diagnostic accuracy of LDCT as the first line imaging test for acute appendicitis. An observational study was conducted over a sample of 147 patients presented with suspected acute appendicitis to the emergency department of Ziauddin University Hospital, Karachi from November 2018 till May 2019. Non-probability consecutive technique used. Aged ≥ 16 years presented in emergency department with the history (symptoms) and physical examination (Signs) suspecting acute appendicitis were included. Patients with contraindications to CT scan e.g. pregnant women. Patients with signs of Acute Peritonitis requiring immediate surgery. CT scan refused by the patient or patient's attendant were excluded. Histopathology was the gold standard in diagnosing acute appendicitis. The data was analyzed using open epi sample size calculator. One hundred forty six patients had positive findings on LDCT for acute appendicitis (99.3%) whereas only one patient had negative findings (0.7%). The sensitivity and specificity of LDCT for the detection of acute appendicitis were estimated as 96.45% and 16.67% by taking histopathology as gold standard. Negative predictive value (NPV) and positive predictive value (PPV) were estimated as 16.67% and 96.45% respectively. The overall accuracy of LDCT was 93.88%. Our study showed that for diagnosing acute appendicitis, LDCT is harmless, fast and economical imaging modality and has diagnostic accuracy with decrease in radiation dose.

Non-therapeutic laparotomies in military trauma (2009-2014).

Combat casualties are frequently injured in austere settings where modern imaging modalities are unavailable. Exploratory laparotomies are often performed in these settings when there is suspicion for intra-abdominal injury. Prior studies of combat casualties reported non-therapeutic laparotomy (NTL) rates as high as 32%. Given improvements in combat casualty care over time, we evaluated NTLs performed during later years of the wars in Iraq and Afghanistan. Military personnel with combat-related injuries (6/1/2009-12/31/2014) who underwent exploratory laparotomy based on concern for abdominal injury (i.e. not performed for proximal vascular control or fecal diversion) and were evacuated to Landstuhl Regional Medical Center (Germany) before being transferred to participating U.S. military hospitals were assessed. An NTL was defined as a negative laparotomy without substantial intra-abdominal injuries requiring repair. Characteristics, indications for laparotomy, operative findings, and outcomes were examined. Among 244 patients who underwent laparotomies, 41 (16.8%) had NTLs and 203 (83.2%) had therapeutic laparotomies (i.e. positive findings). Patients with NTLs had more computed tomography scans concerning for injury (48.8% vs 27.1%; p = 0.006), less penetrating injury mechanisms (43.9% vs 71.9%; p < 0.001), and lower Injury Severity Scores (26 vs 33; p = 0.003) compared to patients with therapeutic laparotomies. Patients with NTLs were also less likely to be admitted to the intensive care unit (70.7 vs 89.2% for patients with therapeutic laparotomies; p = 0.007). No patients with NTLs developed abdominal surgical site infections (SSI) compared to 16.7% of patients with therapeutic laparotomies (p = 0.002). There was no significant difference in mortality between the groups (p = 0.198). Our proportion of NTLs was lower than reported from earlier years during the wars in Iraq and Afghanistan. No infectious complications from NTLs (i.e. abdominal SSIs) were identified. Nevertheless, surgeons should continue to have a low threshold for exploratory laparotomy in military patients in austere settings with concern for intra-abdominal injury.

Pattern and Outcome of Abdominal Injury Management in Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia

Background: Abdominal injury is one of the major causes of trauma admissions. Evidence based information about causes of trauma related deaths is relevant for health policy making about prevention and control. The aim of the study was to identify the mechanism of trauma, commonly injured organs, patterns and outcome of abdominal trauma in Yekatit 12 Hospital Medical College. Method: ALongitudinal study design was conducted from April 2022 to May 2023 G.C Results: During the study, 42 patients were observed, with males comprising 83.3%. Most patients fell within the 20-29 age groups. Penetrating trauma was the most common mechanism (54.8%), with stabs (38.1%), RTAs (31.0%), and gunshots (14.3%) leading the causes. Negative laparotomy rate was 4.8%. Laparotomy was performed in 88.1% of cases, with the small bowel (33.3%) being the most commonly injured organ. Postoperative complication rate was 21.6%, mainly surgical site infections (10.8%). Complication rate was higher in penetrating injuries (62.5%) compared to blunt trauma (37.5%). Mortality rate for abdominal injury was 4.78%. Conclusion: Abdominal trauma predominantly impacts younger males. Stab wounds and road traffic accidents (RTAs) are the primary causes, emphasizing the importance of public awareness for preventing RTAs and similar injuries.

Patterns and outcomes of patients with abdominal injury: a multicenter study from Iran

BackgroundInjury is one of the leading causes of death worldwide, and the abdomen is the most common area of trauma after the head and extremities. Abdominal injury is often divided into two categories: blunt and penetrating injuries. This study aims to determine the epidemiological and clinical characteristics of these two types of abdominal injuries in patients registered with the National Trauma Registry of Iran (NTRI).MethodsThis multicenter cross-sectional study was conducted with data from the NTRI from July 24, 2016, to May 21, 2023. All abdominal trauma patients defined by the International Classification of Diseases; 10th Revision (ICD-10) codes were enrolled in this study. The inclusion criteria were one of the following: hospital length of stay (LOS) of more than 24 h, fatal injuries, and trauma patients transferred from the ICU of other hospitals.ResultsAmong 532 patients with abdominal injuries, 420 (78.9%) had a blunt injury, and 435 (81.7%) of the victims were men. The most injured organs in blunt trauma were the spleen, with 200 (47.6%) and the liver, with 171 (40.7%) cases, respectively. Also, the colon and small intestine, with 42 (37.5%) cases, had the highest number of injuries in penetrating injuries. Blood was transfused in 103 (23.5%) of blunt injured victims and 17 (15.2%) of penetrating traumas (p = 0.03). ICU admission was significantly varied between the two groups, with 266 (63.6%) patients in the blunt group and 47 (42%) in penetrating (p < 0.001). Negative laparotomies were 21 (28%) in penetrating trauma and only 11 (7.7%) in blunt group (p < 0.001). In the multiple logistic regression model after adjusting, ISS ≥ 16 increased the chance of ICU admission 3.13 times relative to the ISS 1–8 [OR: 3.13, 95% CI (1.56 to 6.28), P = 0.001]. Another predictor was NOM, which increased ICU chance 1.75 times more than OM [OR: 1.75, 95% CI (1.17 to 2.61), p = 0.006]. Additionally, GCS 3–8 had 5.43 times more ICU admission odds than the GCS 13–15 [OR:5.43, 95%CI (1.81 to 16.25), P = 0.002] respectively.ConclusionThis study found that the liver and spleen are mostly damaged in blunt injuries. Also, in most cases of penetrating injuries, the colon and small intestine had the highest frequency of injuries compared to other organs. Blunt abdominal injuries caused more blood transfusions and ICU admissions. Higher ISS, lower GCS, and NOM were predictors of ICU admission in abdominal injury victims.

Computed tomography benefits and cost in hemodynamically stable patients with blunt abdominal trauma at an Egyptian University Hospital

BackgroundTrauma is a significant cause of mortality, especially among individuals aged between 15 and 44 years, with a substantial burden falling on economically active populations. Low- and middle-income countries (LMICs) bear the burden of trauma-related deaths, accounting for over 90 % globally. In Egypt, trauma rates are increasing, primarily due to road traffic crashes (RTC), affecting males disproportionately. Blunt abdominal trauma, often caused by RTC, can lead to missed intra-abdominal injuries (IAIs) due to atypical symptoms. Computed Tomography (CT) offers high sensitivity and specificity in detecting IAIs, but concerns about cost and radiation exposure exist. MethodologyThis study investigates the roles of Focused Assessment with Sonography for Trauma (FAST) and CT in managing blunt abdominal trauma. A retrospective cohort study was conducted on hemodynamically stable patients. Data included patient demographics, trauma details, healthcare decisions, costs, and outcomes. ResultsComputed tomography significantly reduced unnecessary laparotomies (12.3% vs. 24.8 %, p = 0.001), shortened hospital stays (4.83±0.71 days vs. 6.15±1.28 days, p = 0.005), and reduced ICU admissions (8 vs. 32, p = 0.023) compared to FAST alone. Overall costs were lower in the CT & FAST Group ($2055.95 vs. $3488.7, p = 0.0001), with no significant difference in missed IAIs. ConclusionThis study highlights the limitations of relying solely on FAST for IAIs and underscores the value of CT in guiding healthcare decisions. Incorporating CT led to reduced negative laparotomies, shorter hospital stays, and fewer ICU admissions. While CT incurs initial costs, its long-term benefits outweigh expenditures, particularly in LMICs. This study provides insights into optimizing diagnostic approaches for blunt abdominal trauma in low-resource settings.

Penetrating abdominal stab and gunshot injuries: 10-year experience of a secondary public hospital located in a suburban area with solo surgeons.

Trauma care systems are life-saving significant implementations of a country's healthcare systems. Trauma care requires well-established trauma settings and organizations with experienced trauma teams including experienced emergency medicine, surgery and anesthesiology staff. This study aimed to investigate the outcomes of penetrating abdominal injuries treated by solo surgeons in a suburban area. Medical records of the patients who were admitted to the emergency department with penetrating abdominal injuries between January 2012 and December 2021 were retrospectively analyzed. Patients were evaluated based on their injury sites and treatment approaches. In total, 110 patients with anterior abdominal penetrating injuries were enrolled in the study; 83 (75.4%) were stabbed and 27 (24.6%) had gunshot wounds. According to the injury site, there were 90 (81.8%) anterior; 11 (11%) right thoracoabdominal and 9 (7.2%) left thoracoabdominal injuries. Fifty-one (61.4%) stab wounds were treated with immediate laparotomy and 21 (41.1%) of these operations resulted in negative or nontherapeutic laparotomy. Also, 32 (38.6%) stab wounds were managed nonoperatively; three (9.3%) failed conservative management and received delayed laparotomy. All gunshot wounds were treated with immediate laparotomy and 14.8% resulted in either negative or nontherapeutic laparotomy. On-call surgeons were found to be more prone to perform immediate laparotomy on weekends when they were on call for 48 or 72 hours. Being a solo surgeon may increase negative laparotomy rates of penetrating abdominal injuries. This high percentage (41.1%) of negative laparotomy rates can be reduced by establishing well-organized trauma teams.

The impact of acquired immune deficiency syndrome on colorectal surgery

The patients infected with the human immunodeficiency virus are not a homogeneous group and are generally living longer on human active antiretroviral therapy. They are amenable to the colorectal diseases in the general population for which colorectal surgery is safe and effective. Surgical intervention is obligatory in life-threatening surgical correctable disease, but aggressive surgical intervention must be undertaken with caution and adequate perioperative care is required. A close liaison between the human immunodeficiency virus/acquired immune deficiency syndrome physician and the surgeon will decrease negative laparotomies and exclude preterminal cases. The knowledge of anorectal sexually transmitted diseases is important, and the symptomatic improvement of anorectal pathology in acquired immune deficiency syndrome may render delayed wound healing an acceptable complication.

The Roles of USG and NCCT in the Diagnosis of Acute Appendicitis: A Study in a Tertiary Care Center in North Eastern India.

Acute appendicitis is a common cause of hospital admission and emergency laparotomy among children and young adults. Although the diagnosis is clinical, the use of radiological imaging has emerged over the past decades. Its principal use is as a problem-solving tool in equivocal cases. Owing to the increased use of imaging in the last few years, the negative appendicectomy rate has dropped significantly. In this prospective observational study, we compared the diagnostic accuracy of Ultrasonography and Non-Contrast Computed Tomography. One hundred and eighteen patients with clinically suspected appendicitis followed a designed protocol. Patients underwent appendicectomy after a first performed positive ultrasonography or after a positive Non-Contrast Computed Tomography when Ultrasonography was equivocal or nonspecific. When any other diagnosis was apparent in either imaging modality which could explain the symptomatology in the patient, they were considered negative for acute appendicitis and treated accordingly. The respective sensitivity, specificity, and accuracy for Ultrasonography, Non-Contrast Computed Tomography, and the whole diagnostic pathway for the diagnosis of acute appendicitis were 70.73%,80.83%, and 78.54; 100%,100%,100%, and 83.6%; and 100%,83.33% and 94.92%. Using Ultrasonography as the first-line diagnostic tool and Non-Contrast Computed Tomography as a complementary second-line diagnostic tool, appendicitis can be diagnosed with high accuracy and the negative laparotomy rate can be brought down significantly without any increase in the risk of complications. Computed Tomography is superior to Ultrasonography for the diagnosis of acute appendicitis.

Pandemi Sırasında Çocuklarda Negatif Laparotomi Oranlarının Değerlendirilmesi

Background/Aims: Emergency service referrals frequently depend on non-urgent problems which are easy to solve without emergency services. Emergency services should be used effectively to raise service quality, patient and personnel satisfaction. Approximately %30 of emergency service referrals are pediatric patients. Covid-19 pandemia affecting the whole world, caused a decrease in non-covid patient emergency service referral numbers, consequently medically non-emergent patient numbers decreased too. Although the number of patients with a prediagnosis of acute appendicitis did not decrease during the pandemic, negative laparotomy rates decreased due to the effective use of emergency services.&#x0D; &#x0D; Material and Method: In this study we compared patients with prediagnosis of acute appendicitis and undergone appendectomy in our pediatric emergency service between 1 March-1 September 2019 and 1 March-1 September 2020. Patient records were evaluated retrospectively. Histopathological diagnoses were accepted as the gold standard.&#x0D; Result: Decreasing referrals of medically non-emergent patients to emergency services during pandemic led to improvement in service quality, so negative laparotomy rates declined. Looking at the literature, negative laparatomy rates of pediatric patients with the pre-diagnosis of acute appendicitis are 8-30%. In the 6-month period in 2019 negative laparotomy rate of our clinic found as 11.2%. When we examine the 6-month data of 2020 during pandemic we noticed that this rate declined to 2.8%. There was also a statistically significant difference between 2019 and 2020 in terms of the length of stay in the hospital.&#x0D; Conclusions: Because of the decrease in referral numbers of medically non-emergent patients to emergency services during pandemic, much more qualified and scientific service was provided. Community education considering emergency service referral indications could reduce workload density and enhance service quality of emergency services.

Negative laparotomy rates and outcomes following blunt traumatic injury in the United States

IntroductionExploratory laparotomy remains the mainstay of treatment following blunt abdominal trauma. However, the decision to operate can be difficult in hemodynamically stable patients with unreliable physical exams or equivocal imaging findings. The risk of a negative laparotomy and the subsequent complications must be weighed against the potential morbidity and mortality of a missed abdominal injury. Our study aims to evaluate trends and the effect of negative laparotomies on morbidity and mortality in adults with blunt traumatic injuries in the United States. MethodsWe reviewed the National Trauma Data Bank (2007–2019) for adults with blunt traumatic injuries who underwent an exploratory laparotomy. Positive or negative laparotomy of abdominal injury was compared. We performed bivariate analysis and a modified Poisson regression to estimate the effect of negative laparotomy on mortality. A sub-analysis of patients who underwent computed tomography (CT) of the abdomen and pelvis was performed. Results92,800 patients met the inclusion criteria of the primary analysis. Negative laparotomy rates were 12.0% in this population, down-trending throughout the study. Negative laparotomy patients had a significantly higher crude mortality (31.1% vs. 20.5%, p < 0.001), despite lower injury severity scores (20 (10–29) vs. 25 (16–35), p < 0.001) than positive laparotomy patients. Patients that underwent negative laparotomy had a 33% higher risk for mortality (RR1.33, 95% CI 1.28–1.37, P < 0.001) than positive laparotomy patients after adjusting for pertinent covariates. Patients that underwent CT abdomen/pelvis imaging (n = 45,654) had a lower rate of negative laparotomy (11.1%) and decreased difference in crude mortality (22.6% vs. 14.1%, p < 0.001) compared to positive laparotomy patients. However, the relative risk for mortality remained high at 37% (RR 1.37, 95% CI 1.29 – 1.46, p < 0.001) for this sub-cohort. ConclusionNegative laparotomy rates in adults with blunt traumatic injuries are trending down in the United States but remains substantial and may show improvement with increased use of diagnostic imaging. Negative laparotomy has a relative risk for mortality of 33% despite lower injury severity. Thus, surgical exploration in this population should be thoughtfully undertaken with appropriate evaluation via physical exam and diagnostic imaging to prevent unnecessary morbidity and mortality.

Role of Diagnostic Laparoscopy in the Evaluation of Blunt Injury to Abdomen in Hemodynamically Stable Patients

BACKGROUND&#x0D; In this study, we wanted to evaluate the role of diagnostic laparoscopy in the management of blunt injury to abdomen in hemodynamically stable patients.&#x0D; METHODS&#x0D; This was a hospital based prospective observational clinical case study conducted among 30 patients who presented with blunt trauma of abdomen to the Department of General Surgery, Kamineni Academy of Medical Sciences and Research Centre, L.B. Nagar, Hyderabad, from September 2019 to September 2021 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. The aim of the study is to assess the role of Diagnostic Laparoscopy in the management of Blunt Injury to Abdomen in Hemodynamically Stable patients. Objective of the study were to assess the incidence of Hollow Viscus Injury not detected by clinical or radiological assessment, incidence of persistent bleed and to assess the incidence of Mesentery injury not detected by clinical or radiological assessment.&#x0D; RESULTS&#x0D; The most common mode of injury was road traffic accidents (23 cases) 76.66 %, followed by fall from height (3 cases) 9.99 %. Then accidents and assaults which were (2 cases) 2.22 % each. Ongoing bleeding from solid organ injuries was seen intra-operatively in 3 cases (9.99 %). P value = 0.0237 was calculated using Fischer’s exact test and was found to be significant P &lt; 0.05. Most common grade of liver injury was Grade 1- 37.75 % followed by grade 3 - 33.33 %, then grade 2 - 20.8 % and grade 4 - 8.33 %. Grade 1 and grade 2 splenic injuries were more common with 36.36 % (4 cases) each. Followed by grade 3 27.27 % (3 cases). Diagnostic laparoscopy ongoing bleed was noted in 9.99 % (3 cases), followed by mesenteric injury in 6.66 % (2 cases) and hollow viscous perforation in 3.33 % (1 case). Total of 6 therapeutic procedures were done after diagnostic laparoscopy. Out of which, 4 were carried out in laparoscopy (66.66 %) and two were converted from laparoscopy to laparotomy (33.33 %).&#x0D; CONCLUSIONS&#x0D; Diagnostic laparoscopy can be carried out in patients of blunt trauma of abdomen, who are hemodynamically stable without any increase in morbidity or mortality. It is a highly useful tool to detect injuries which could not be detected on CT scan. Laparoscopic surgery can be used both as a diagnostic and therapeutic modality. Laparoscopy helps in reducing the negative laparotomies and significant decrease in both morbidity and mortality. With advances in technology and increasing in expertise in laparoscopy, it can be concluded that diagnostic laparoscopy is a valuable modality in the diagnosis and management of patients with blunt trauma to abdomen.

Study on the Role of Diagnostic Laparoscopy in Undiagnosed Chronic Abdominal Pain- Prospective Study

Patients with chronic abdominal pain is the most difficult to diagnose and treat. Potentially it can be unrewarding for both patients and treating physicians. Thereby affecting patients both physically and mentally. Chronic abdominal pain is associated with poor quality of life and the onset of depressive symptoms. Most patients in this group have already undergone numerous diagnostic procedures, including upper and lower gastrointestinal endoscopies, Ct scans, and screening for undetected carcinomas, apart from routine blood investigations. This is the time when the surgeon is approached when all other non-invasive investigations have failed to reach a satisfying conclusion. Clearly diagnostic laparoscopy is an important intermediate option between refusing to explore a patient's abdomen and performing laparotomy. Diagnostic Laparoscopy with advances in optics gives the perfect visual of the whole abdomen and further gives therapeutic advantages as well, which include target biopsies, staging of cancers, and various gynaecological pathologies. Laparoscopy is as much a surgical procedure as an exploratory laparotomy, often just as informative, and a skilled laparoscopic surgeon affords a better view of the entire peritoneal cavity than usual exploratory laparotomy. Achieving a high rate of positive diagnosis from laparoscopy requires much more than trained hands, it requires a thorough background in surgery, sound clinical knowledge, and a perception of abdominal pathologies. Most importantly it avoids unnecessary negative laparotomy in many cases. Moreover, early recovery and ambulation of patients help them get back to daily chores and are a source of delight for treating doctors.

Pneumatosis Intestinalis in Children With Intestinal Failure: The Result of Intestinal Stress From Enteral Feeding?

The incidence and significance of pneumatosis intestinalis (PI) in children with a diagnosis of intestinal failure is not well understood. The aim of this study was to identify clinical and anatomical factors associated with the imaging findings of PI in patients with intestinal failure. We performed a retrospective review of all children with a diagnosis of intestinal failure at Children's Hospital Colorado between January 2019 and April 2022. Patients were stratified and compared based on the incidence of PI on abdominal imaging. Differences were compared using 2-sample Wilcoxon tests, chi-square, or Fisher exact tests. There were 111 patients identified with a diagnosis of intestinal failure and 30.6% (34) developed at least 1 instance of PI. There were no differences in etiology of intestinal failure or anatomy between those who developed PI and those who did not. Patients who developed PI, were less likely to be on total parental nutrition (60.6% vs 98.6%, P < 0.001) and more likely to be receiving any form of enteral feeds (87.9% vs 66.2%, P = 0.035) or tube feeds (75.8% vs 44.2%, P = 0.0045). Of the children with PI, 30.3% (10) were undergoing an enteral feed advancement at time of PI development. Three patients with PI underwent laparotomy for PI treatment, 2 of which were negative laparotomies. The development of PI in children with intestinal failure is likely a benign finding. It is associated with enteral feeding and may be due to increased intestinal stress.

Pattern of Presentation and Outcome of Adult Patients with Abdominal Trauma - A 7-Year Retrospective Study in a Nigerian Tertiary Hospital.

Abdominal trauma is a major cause of morbidity and mortality in low- and middle-income countries. There is a paucity of trauma data in this region and this study aimed to show the pattern of presentation and outcome of patients with abdominal trauma at a North-Central Nigerian Teaching Hospital. This was a retrospective, observational study of patients with abdominal trauma who presented at the University of Ilorin Teaching Hospital from January 2013 to December 2019. Patients with clinical and/or radiological evidence of abdominal trauma were identified, and data extracted and analyzed. A total of 87 patients were included in the study. There were 73 males and 14 females (5.2:1) with a mean age of 34.2 years. Blunt abdominal injury occurred in 53 (61%) patients with 10 patients (11%) having concomitant extra-abdominal injuries. A total of 105 abdominal organ injuries occurred in 87 patients with the small bowel being the most frequently injured organ in penetrating trauma, while in blunt abdominal injury, the spleen was most commonly injured. A total of 70 patients (80.5%) had emergency abdominal surgery with a morbidity rate of 38.6% and negative laparotomy rate of 2.9%. There were 15 deaths in the period accounting for 17% of patients with sepsis as the most common cause of death (66%). Shock at presentation, late presentation >12 h, need for perioperative intensive care unit admission, and repeat surgery were associated with a higher risk of mortality (P < 0.05). Abdominal trauma in this setting is associated with a significant amount of morbidity and mortality. Typical patients present late and with poor physiologic parameters often resulting in an undesirable outcome. There should be steps targeted at preventive policies focused on reducing the incidence of road traffic crashes, terrorism, and violent crimes as well as improving health care infrastructure to cater to this specific group of patients.

Overview of stab injuries in Far North Queensland: A new insight into the demographics, injury patterns and management

BackgroundCairns Hospital is the northernmost tertiary referral hospital in Far North Queensland (FNQ) and manages trauma from a large catchment area. A large burden of stab injuries occurs in at-risk patient groups, such as Indigenous and mental health patients, in this region. This research aims to present an overview of the demographics, injury patterns, management and outcomes for stabbings injuries in FNQ. MethodsA five-year retrospective single-centre study of all patients treated for neck, torso or junctional stab wounds in Far North Queensland was performed searching for all patients with a coded diagnosis of stabbing or knife injury from 1 March 2016 to 31 March 2021. Results214 knife injuries were identified and 50.5% of those injured identified as Aboriginal and/or Torres Strait Islander. Stabbing injury locations were most commonly the abdomen/flank/pelvis (n = 81) and the chest/thorax (n = 77). Two-thirds of injuries that breached abdominal fascia had concurrent intra-abdominal injury. Hollow viscus injury commonly involved the small bowel (n = 8), colon (n = 5) and stomach (n = 2), whilst the liver was the most frequently injured solid organ (n = 6). There were 19 vascular injuries, excluding the extremities. 89.2% received diagnostic imaging in the emergency department. FAST scan had 76% sensitivity and 100% specificity for intra-abdominal injury at operation. Overall, 35% of patients required an operation. There were only two in-hospital deaths. ConclusionStab injuries annually in FNQ are comparable to other centres in Australia. Overall injury severity was low, with excellent survival rates and outcomes for patients who reached hospital. Operative intervention rates for abdominal stab wounds were low in FNQ compared to available data and imaging again appears protective against negative laparotomy rate.

Application of alvarado scoring system in diagnosis of acute appendicitis

Acute appendicitis is a common cause of abdominal pain and can be difficult to diagnose, especially during the early stages. There is still appreciable morbidity and occasionally mortality which may be related to the failure of making an early diagnosis (1) As a result of their concern these surgeons create for themselves 'a surgical security zone which allows them to accept a 15-30% negative laparotomy rate with impunity (2), Although various aids exist to facilitate more accurate diagnosis and reduce the rate of negative appendectomy, many are complex. Whereas simple scoring systems have been available for some time, they have not been widely tested. The aim of this study was conducted to assess one of these scoring systems which were described by Alvarado in 19851(1), by comparing it to the histopathology results of operated patients. This retrospective study of consecutive patients admitted to the surgical ward at Benghazi Aljala hospital with suspicion of having acute appendicitis during the period of January 2008 to January 2010. The Alvarado scoring system was computed from admission notes and records correlated with histopathology, all cases with insufficient data or no histopathology result were excluded from the study Out of 153 patients, 90 underwent appendectomy with the intention to treat appendicitis and diagnosis was confirmed in 80 patients. The reliability of the system was assessed by calculating the negative appendectomy rate and positive predictive value which was 85%, and the normal appendectomy frequency was 12%. Alvarado scoring system is an easy, cheap, and useful tool in the preoperative diagnosis of acute appendicitis and can work effectively in routine practice.

GYNECOLOGICAL MALIGNANCIES

A large study of tumors of low malignant potential confirmed the favorable survival in this group of patients compared to invasive epithelial ovarian tumors. Only 8% of patients died with recurrent disease after surgery. Patients with stage IA borderline tumors with mucinous histology tended to recur later and carried a poorer prognosis than patients with serous histology and similar stage. The group at highest risk for relapse were age greater than 70, stage II or III tumors, and histology other than serous. Long-term survival in this group was less than 75%. This high-risk group of patients should be targeted for innovative adjuvant treatment strategies. This year several well-designed studies with large sample sizes showed DNA ploidy to be an important new independent prognostic factor in stage I ovarian carcinoma. In patients with well-differentiated early stage ovarian cancer, DNA flow cytometric analysis may indicate subgroups with less favorable prognostic characteristics. This method of analysis may be beneficial in determining the need for additional treatments after surgery for early stage ovarian carcinoma. Recommendations for the definitive management of early stage ovarian cancer awaits completion of current GOG and European randomized prospective studies. Paclitaxel given in combination with platinum-containing agents is an intense area of research for treatment of advanced stage disease. Early data from a prospective randomized trial of patients with advanced ovarian cancer showed a higher response rate and longer disease-free survival in patients treated with paclitaxel and cisplatin compared to a standard regimen of cyclophosphamide and cisplatin. The impact of this treatment on long-term survival awaits maturation of data. Preliminary results evaluating G-CSF in combination with paclitaxel and cisplatin for dose escalation was reported. Paclitaxel, 250 mg/m2, and cisplatin, 75 mg/m2, were the maximally tolerated doses, with peripheral neuropathy or myalgias the dose limiting toxicities. Further studies are now underway to test the effect of dose-response with escalation therapies and to determine the optimal dose and schedule for the management of patients with advanced ovarian cancer. IL-3 significantly ameliorated neutropenia but did not prevent cumulative platelet toxicity in a regimen utilizing high-dose carboplatin. This mild improvement in myelosuppression was obtained at the cost of significant toxicity. Nausea, vomiting, malaise, bone pain, headache, fever, chills and facial flushing were frequent. Intraperitoneal chemotherapy was tested as a means of consolidation treatment for patients after having a negative second-look laparotomy. These treatments were shown to be feasible; however, prospective randomized trials will be necessary to determine a benefit over operative therapy alone. Several studies addressed to problem of residual disease after primary surgery and adjuvant chemotherapy. A large phase II study conducted by the GOG confirmed the activity of salvage cisplatin-based intraperitoneal chemotherapy in patients with small-volume residual ovarian cancer with favorable pretreatment characteristics. Whether intraperitoneal platinum-based therapy represents an advantage over systemic platinum therapy is being addressed in a prospective SWOG study. The use of six additional cycles of CAP for treatment of residual disease after primary treatment of surgery and adjuvant chemotherapy did not significantly improve complete pathological response and survival. Prolonged duration of chemotherapy above six cycles is not likely to impact treatment for residual disease. A regimen of high dose carboplatin was compared to whole abdominal radiotherapy for treatment of residual disease after initial chemotherapy. There was no difference in survival or disease-free survival between treatments.(ABSTRACT TRUNCATED)

The presentation and the outcome of penetrating abdominal bullet injuries – Iraqi hospital based study

Background: In Iraq penetrating injuries to the abdomen caused by firearm are more common than stab wounds with remarkable mortality and morbidity. Early recognition of the injuries and immediate treatment are mandatory in saving the lives of many of those patients. Objective: To review the presentation and evaluate the early post-operative morbidity and mortality of abdominal bullet injuries in Baghdad teaching hospital. Patients and Methods: This prospective study was conducted on 132 patients admitted to second surgical unit in Baghdad teaching hospital after sustaining bullet injury to the abdomen during the time period of one year from October 2013 to September 2014. Results: The most vulnerable age group involved, between 21-30 years comprised 71.2% of total. Male to female ratio was 43:1(male comprised 97.73%). It was observed that the majority of the injured patients were military personnel (83%), associated with high velocity missiles (81%). It was seen that 96.6% of patients had positive findings during laparotomy; small intestine was involved in the majority of the patients 42.6% followed by large intestine in 35.65%, then liver in 20.86%. Majority of the patients had involvement of two organs (42%), followed by one organ in (28%). The major postoperative complications were wound infection (28.6%), followed by chest infection in (24.4%). The major cause of death was septicaemia in 80%. Conclusion: Explorative laparotomy continues to be the most accurate method used to diagnose the presence of penetrating intra-abdominal injuries with a negative laparotomy rate of 3.4%. The mortality rate tended to be related to the number of intra-abdominal organs injuries; high rates of surgical site and chest infections were found and septicaemia was the chief cause of death after 48 hours. Hospital stays in our study were prolonged in comparison to other developed countries.

The presentation and the outcome of penetrating abdominal bullet injuries – Iraqi hospital based study

Background: In Iraq penetrating injuries to the abdomen caused by firearm are more common than stab wounds with remarkable mortality and morbidity. Early recognition of the injuries and immediate treatment are mandatory in saving the lives of many of those patients.&#x0D; Objective: To review the presentation and evaluate the early post-operative morbidity and mortality of abdominal bullet injuries in Baghdad teaching hospital.&#x0D; Patients and Methods: This prospective study was conducted on 132 patients admitted to second surgical unit in Baghdad teaching hospital after sustaining bullet injury to the abdomen during the time period of one year from October 2013 to September 2014.&#x0D; Results: The most vulnerable age group involved, between 21-30 years comprised 71.2% of total. Male to female ratio was 43:1(male comprised 97.73%). It was observed that the majority of the injured patients were military personnel (83%), associated with high velocity missiles (81%). It was seen that 96.6% of patients had positive findings during laparotomy; small intestine was involved in the majority of the patients 42.6% followed by large intestine in 35.65%, then liver in 20.86%. Majority of the patients had involvement of two organs (42%), followed by one organ in (28%). The major postoperative complications were wound infection (28.6%), followed by chest infection in (24.4%). The major cause of death was septicaemia in 80%. &#x0D; Conclusion: Explorative laparotomy continues to be the most accurate method used to diagnose the presence of penetrating intra-abdominal injuries with a negative laparotomy rate of 3.4%. The mortality rate tended to be related to the number of intra-abdominal organs injuries; high rates of surgical site and chest infections were found and septicaemia was the chief cause of death after 48 hours. Hospital stays in our study were prolonged in comparison to other developed countries.