Peritonitis Research Articles

Is damage control surgery useful in the treatment of colorectal perforation? A single-center case-control study.

From January 2013 to December 2019, 131 patients with colorectal perforation underwent emergency surgery at our hospital. Among these, 95 patients required postoperative intensive care unit management and were included in this study; of these patients, 29 (31%) underwent DCS, and 66 (69%) underwent primary abdominal closure (PC). Patients who underwent DCS had significantly higher Acute Physiology and Chronic Health Evaluation II (23.9 [19.5-29.5] vs. 17.6 [13.7-22]; P<0.0001) and Sequential Organ Failure Assessment (SOFA) (9 [7-11] vs. 6 [3-8]; P<0.0001) scores than did those who underwent PC. The initial operation time was significantly shorter for DCS than for PC (99 [68-112] vs. 146 [118-171]; P<0.0001). The 30-day mortality and colostomy rates were not significantly different between the two groups. The results suggest that DCS is useful in the management of acute generalized peritonitis caused by colorectal perforation.

Acute left colonic diverticulitis in the emergency setting: from diagnosis to treatment.

Acute left colonic diverticulitis (ALCD) is a common clinical condition encountered by physicians in the emergency setting. Clinical presentation of ALCD ranges from uncomplicated acute diverticulitis to diffuse fecal peritonitis. ALCD may be diagnosed based on clinical features alone, but imaging is necessary to differentiate uncomplicated from complicated forms. In fact, computed tomography scan of the abdomen and pelvis is the highest accurate radiological examination for diagnosing ALCD. Treatment depends on the clinical picture, the severity of patient's clinical condition and underlying comorbidities. Over the last few years, diagnosis and treatment algorithms have been debated and are currently evolving. The aim of this narrative review was to consider the main aspects of diagnosis and treatment of ALCD.

STUDY OF THE ROLE OF HEMOCOAGULATION DISBALANCE AS A KEY PATHOGENETIC PREDICTORS IN THE FORMATION OF SYSTEMIC DISORDERS IN EXPERIMENTAL PERITONITIS

Background. Peritonitis today continues to be one of the most difficult problems of both abdominal surgery and theoretical pathophysiology. One of the leading pathogenetic mechanisms of peritonitis is disorders in the hemostasis system and the development of dissemination vascular syndrome. Blockade of microcirculation caused by the development of dissemination vascular syndrome leads to tissue hypoxia and, as a result, to dysfunction of organs and body systems.&#x0D; Aim: is to study changes in vascular-platelet and coagulation hemostasis under conditions of experimental fecal peritonitis in rats.&#x0D; Materials and methods. Experimental studies were conducted on 24 non-linear laboratory rats, which were divided into 2 groups: 1 group – intact control (animals received distilled water), 2 group – animals of the control pathology group. According to the "Methodological recommendations for preclinical study of medicinal products", experimental peritonitis was studied on the model of V. A. Lazarenko. Indicators of vascular-platelet and coagulation hemostasis were determined according to generally accepted methods.&#x0D; Results. On the first day of experimental peritonitis, a sharp increase in the rate of blood clotting and changes in the quality properties of platelets were noted, affecting their aggregation ability and retraction of an already formed blood clot. On the 4th day of the experiment, changes in the vascular-platelet link were established, indicating the exhaustion of the platelet potential, due to a decrease in blood clotting time, platelet aggregation ability, and blood clot retraction against the background of a probable increase in the number of blood platelets, which probably by now had time "get" to the bloodstream from the depot. Changes in the coagulation hemostasis system against the background of experimental fecal peritonitis indicate the development of hypercoagulation already on the first day, which is replaced by a hypocoagulation state, which indicates the exhaustion of the enzymatic systems of blood coagulation potential (as early as on the 4th day), which lasted until the end of the experiment.&#x0D; Conclusion. In the development of disorders of the hemostasis system in fecal peritonitis, the key role belongs to both the internal and external mechanisms of activation of the blood coagulation system.

Chondroitin Sulfate from Oreochromis niloticus Waste Reduces Leukocyte Influx in an Acute Peritonitis Model

Oreochromis niloticus (tilapia) is one of the most cultivated fish species worldwide. Tilapia farming generates organic waste from fish removal processes in nurseries. Visceral waste can damage natural ecosystems. Therefore, the use of this material as a source of biomolecules helps reduce environmental impacts and improve pharmacological studies. Tilapia viscera were subjected to proteolysis and complexation with an ion-exchange resin. The obtained glycosaminoglycans were purified using ion exchange chromatography (DEAE-Sephacel). The electrophoretic profile and analysis of 1H/13C nuclear magnetic resonance (NMR) spectra allowed for the characterization of the compound as chondroitin sulfate and its sulfation position. This chondroitin was named CST. We tested the ability of CST to reduce leukocyte influx in acute peritonitis models induced by sodium thioglycolate and found a significant reduction in leukocyte migration to the peritoneal cavity, similar to the polymorphonuclear population of the three tested doses of CST. This study shows, for the first time, the potential of CST obtained from O. niloticus waste as an anti-inflammatory drug, thereby contributing to the expansion of the study of molecules with pharmacological functions.

Study of the polymorphism of the ADRB2 molecular structure and its influence on the development of chronic postsurgical pain in children

Introduction. Pain is a signal to any aggression that leads to cellular damage and requires a defensive response. Uncontrolled acute perioperative visceral pain can lead to the development of pain chronicity. By studying the characteristics of chronic pain, some scientists have identified relationships with single-nucleotide polymorphisms of the beta2-adrenergic receptor (ADRB2) gene. Purpose - to study the dependence of pain expression in the postoperative period in children on the polymorphism of the molecular structure of the ADRB2 receptor. Materials and methods. The study involved 42 children (20 boys and 22 girls) aged 7 to 18 years who were treated in the surgical department in 2020-2022 for acute appendicitis and peritonitis. Results. Based on the results of examining all the subjects under study, 13 children had the Arg16Gly polymorphism, 15 children had the Arg16Gly polymorphic variant, and 14 children were diagnosed with the homomorphic Gly16Gly polymorphism in the ADRB2. The data obtained confirmed the trend of the preliminary analysis and proved better body response to pain relief and reduced pain intensity in individuals with the Arg16Arg variant of the ADRB2. Analysis of the dependence between the polymorphism of the ADRB2 molecular structure and Visual Analogue Scale (VAS) scores in children in the postoperative period proved that the presence of Arg in the receptor phenotype had a strong negative correlation with the VAS score on discharge day (r=-0.822, p&lt;0.001), while the presence of Gly in the receptor phenotype had a strong positive correlation with the Visual Analogue Scale score on discharge day (r=0.814, p&lt;0.001). In regression analysis, the presence of Gly in the receptor phenotype was associated with a 1.917-fold increase in the VAS score at hospital discharge (OR: 1.917; 95% CI: 1.448-2.385; р&lt;0.001). Conclusions. The presence of the homomorphic Arg16Arg variant of the ADRB2 in children who underwent anterior abdominal wall surgery was accompanied by rapid response to analgesics. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Laparoscopic Graham Patch for Anterior Duodenal Perforation in a 6-Year-Old.

Peptic ulcer disease causing perforation is extremely rare in children and primarily affects teenagers. We present a case of a perforated peptic ulcer in a 6-year-old with abdominal pain and emesis with CT findings of moderate pneumoperitoneum and pelvic free fluid without a distinct cause. He was emergently transferred, found to be peritonitic, and taken to the operating room for diagnostic laparoscopy revealing an anterior duodenal ulcer, and underwent laparoscopic Graham patch repair. Postoperatively, the child had positive fecal antigen for H. pylori. He was treated with triple therapy and underwent subsequent testing to confirm eradication. Perforated peptic ulcer is an uncommon pediatric surgical problem, and imaging may not be diagnostic as in the case presented here. Thus, clinicians need to maintain a high index of suspicion when evaluating children with free air and a surgical abdomen in the setting of long-standing abdominal pain.

The Role of the Mannheim Peritonitis Index for Predicting Outcomes in Patients With Perforation Peritonitis in a Rural Hospital in India.

Introduction Acute secondary peritonitis due to hollow viscus perforation is a life-threatening surgical condition with significant morbidity and mortality, depending on the severity with outcomes that differ in the Western and developing world. Various scoring systems have been developed to assess the severity and its relation to morbidity and mortality. We conducted this study to evaluate the role of the Mannheim peritonitis index (MPI) in predicting outcomes in perforation peritonitis patients in a rural hospital in India. Materials and methods A prospective study of 50 patients with hollow viscus perforation with secondary peritonitispresented to the emergency department, Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, from 2016 to 2020. Each operated patient was scored according to the MPI to predictmortality. Results The majority of the patients were discharged uneventfully and about 16% (8/50) of the patients expired. The patients with an MPI score of more than 29 had maximum mortality of 62.5%. Mortality was seen in 37.5% of the patients with MPI scores between 21 and 29, whereas no mortality was recorded in patients with an MPI score of 21. Higher mortality was associated with age greater than 50 years (p=0.007), the presence of malignancy (p=0.013), colonic perforation (p=0.014), and fecal contamination (p=0.004). There was no significant correlation with gender (p=0.81), the presence of organ failure (p=1.6), delayed presentation, i.e., preoperative duration >24 hours (p=0.17), and the presence of diffuse peritonitis (p=0.25). Conclusion MPI is a specific, easily reproducible, and less cumbersome scoring method for predicting mortality in patients with hollow viscus perforation (secondary) peritonitis with minimal laboratory investigations. Higher scores correlate with a poorer prognosis and need intensive management, making use of MPI in clinical practice relevant and beneficial, especially in resource-poor settings.

Morphological Aspects of Intestinal Failure in Experimental Peritonitis And Correction

Our studies show that pathomorphological changes in the small intestine in acute experimental peritonitis are characterized by dystrophic, inflammatory-destructive and vascular disorders in the vascular tissue structures of the small intestine wall. In the pathogenesis of damage to the small intestine, deep inflammatory and destructive changes in the vessels of the microhemocirculatory bed, which subsequently lead to disruption of cell trophism, tissue hypoxia, damage to cellular elements, disruption of cellular metabolism, deficiency of energy and plastic materials, accumulation of perverted metabolic products in cells and tissues, are of great importance. . The use of the “Zerotox“ enterosorbent in the treatment complex for the treatment of endogenous intoxication and toxemia had a positive effect on the morphofunctional status of the small intestine, on the clinical course of the disease, on the composition of the intestinal microflora, indicators of local immunological protection, improved clinical and laboratory signs of endogenous intoxication, reduced the recovery period bowel function, reduced the number of postoperative complications

Dual-Mechanism Glycolipidpeptide with High Antimicrobial Activity, Immunomodulatory Activity, and Potential Application for Combined Antibacterial Therapy.

Bacterial drug resistance is becoming increasingly serious, and it is urgent to develop effective antibacterial drugs. Antimicrobial peptides (AMPs), as potential candidates against bacteria, have a broad prospect for development. Herein, a series of AMPs with biological characteristics (net positive charge, amphiphilicity, and α-helix), an AXA motif recognized by membrane bound serine protease type I signal peptidases (SPase I), an FLPII motif to reduce hemolysis, and a monosaccharide motif to improve the stability and activity were designed and synthesized, and among which, the glycolipidpeptide GLP6 (glycosylated LP6 lipopeptide) had excellent antibacterial and immunomodulatory activity, good stability and biocompatibility, and excellent biofilm eradication and membrane penetrating activity. The positively charged spherical aggregates formed by self-assembly of GLP6 could encapsulate tetracycline (TC) to form GLP6@TC with a sustained-release effect, which could enhance the sensitivity of bacteria to the antibiotic and realize combined sterilization. The results of acute peritonitis and bacterial keratitis showed that GLP6@TC had a good combined antibacterial effect and the ability to inhibit interleukin-2 (IL-2), which could significantly reduce the inflammatory response while treating bacterial infection, and it had great potential for application. The results of computer molecular docking showed the AXA motif could effectively bind to SPase I, which was consistent with the results of biological experiments. In general, the study could provide a perspective for the design of AMPs and combined antibacterial therapy.

Immune mechanisms in the pathogenesis of acute peritonitis G.V. Bulava

Acute inflammation of the peritoneum – peritonitis – often develops after injury to hollow visceral organs, intestinal necrosis, failure of anastomosis, or tumor processes. Subsequent microbial contamination of the abdominal cavity leads to infection, in response to which immune mechanisms are activated. The pathogenesis of inflammatory processes in the abdominal cavity and their features are largely determined by the structure and function of the peritoneum, as well as its close connection with the omentum. An important point in resolving peritonitis is to maintain the balance of cytokines, the activity of immunocytes and complement functioning in the immune lymphoid clusters of the peritoneum and omentum, and their collaborative action during inflammation. The review presents data on the structure and function of the peritoneum and omentum, the role of neutrophil, macrophage, lymphocytic links of the immune system, as well as those of pro- and anti-inflammatory cytokines and complement in the development and cessation of acute inflammation in the abdominal cavity.

Torted Wondering Spleen

Background: Wandering spleen was first mentioned by Van Horne in 1667. Wandering spleen (floating, ectopic, ptotic, hypermobile or splenoptosis) may float anchored only by its vascular pedicle with no hooking to the nearby structuresand it is induced by the lengthening of the spleen’s holding ligaments. Although it is rare (less than 0.2%) but it affects mostly children and female adults of active reproductive age. It features as a mass in the abdomen without clinical signs or with intermittent abdominal discomfort due to torsion and spontaneous detorsion of the spleen. Case Report: A 34-year-old male presented to the emergency department with complaints of abdominal pain, distension of the abdomen and vomiting with constipation for two days. There was no past history of any surgery. On general examination, patient was afebrile (temperature of 37°c), pulse rate of 80 bpm and blood pressure of 110/70 mmHg. An abdominal examination revealed mild abdominal distension with mild diffuse abdominal tenderness and guarding. A tender lump sizing 10 × 9 cm with smooth surface, well defined margins and firm consistency was found. Digital rectal examination was normal. Laboratory parameters showed hemoglobin 14.5 gm/dl and white blood cells 12000/mm3. The platelet count was normal. Ultrasonography (USG) showed a solid mass and the absence of the spleen from its normal location. A computed tomography (CT) scan of the abdomen showed large torted spleen at mid abdomen with partial or no enhancement of splenic shape mass on contrast-enhanced CT scan and the patient was scheduled for an exploratory laparotomy for surgical acute abdomen. During laparotomy, a mass measuring 11 × 9 × 3 cm and weighing approximately 280 g was found. The mass was identified as the spleen by visualizing its notch and the absence of the spleen from its normal position. All splenic ligamentous attachments were completely absent. The spleen was found to be partly infarcted due to twisting of the spleen .....

Variations in clinical course and surgical outcomes of acute appendicitis during COVID-19 Pandemic: a multicenter cohort study

BackgroundCOVID-19 pandemic has led to changes in the presentation and treatment of surgical pathologies. Therefore, we aim to describe the influence of the COVID-19 pandemic on the clinical presentation and management of acute appendicitis (AAp) and its surgical outcomes.Study designA multicenter cohort study with prospectively collected databases. Three high-volume centers were included and all patients over 18 years of age who underwent appendectomy for AAp were included. Multiple logistic regression and multinomial logistic regression were performed, and odds ratio, relative risk, and B-coefficient were reported when appropriate, statistical significance was reached with p-values < 0.05.Results1.468 patients were included (709 in the pre-pandemic group and 759 in the COVID-19 group). Female patients constituted 51.84%. Mean age was 38.13 ± 16.96 years. Mean Alvarado’s score was 7.01 ± 1.59 points. Open surgical approach was preferred in 90.12%. Conversion rate of 1.29%. Mortality rate was 0.75%. There was an increase of perforated and localized peritonitis (p 0.01) in the COVID-19 group. Presence of any postoperative complication (p 0.00), requirement of right colectomy and ileostomy (p 0.00), and mortality (p 0.04) were higher in the COVID-19 group. Patients in the pre-pandemic group have a lesser risk of mortality (OR 0.14, p 0.02, 95% CI 0.02–0.81) and a lesser relative risk of having complicated appendicitis (RR 0.68, p 0.00, 95% CI 0.54–0.86).ConclusionComplicated appendicitis was an unexpected consequence of the COVID-19 pandemic, due to surgical consultation delay, increased rates of morbidity, associated procedures, and mortality, influencing the clinical course and surgical outcomes of patients with AAp.

Calculated inflammatory markers derived from complete blood count results, along with routine laboratory and clinical data, predict treatment failure of acute peritonitis in chronic peritoneal dialysis patients

Background & Aims Complete blood count (CBC)-derived inflammatory markers are predictive biomarkers for the prognosis of many diseases. However, there was no study on patients with peritoneal dialysis-associated peritonitis (PDAP). We aimed to investigate the value of these markers in predicting treatment failure of acute peritonitis in chronic PD patients. Methods The records of 138 peritonitis episodes were reviewed and divided into treatment success or failure groups in a single center for 10 years. CBC-derived markers and other routine data were recorded before peritonitis treatment was initiated. Univariate and multivariate regression analyses and the receiver operating characteristic (ROC) curve about the predictors of treatment outcomes were performed. Results Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and derived NLR were significantly higher in the failure group. Univariate logistic regression results showed that NLR and PLR were risk factors of treatment outcomes. The backward stepwise multivariate logistic regression results demonstrated that NLR [adjusted odds ratio (aOR), 1.376; 95% confidence intervals (CI), 1.105–1.713; p = .004], PLR (aOR, 1.010; 95%CI, 1.004–1.017; p = .002) were risk factors, but hemoglobin-to-lymphocyte ratio (HLR) (aOR, 0.977; 95%CI, 0.963–0.991; p = .001), and SII (aOR, 0.999; 95%CI, 0.998–1.000; p = .040) were protective factors. A combination of age, PD vintage, Gram-positive peritonitis, staphylococcus aureus, culture-negative, NLR, PLR, HLR, and SII would improve prognostic performance. The area under this ROC curve was 0.85, higher than other factors. Conclusions NLR, PLR, HLR, and SII were associated with PDAP outcomes. Age, PD vintage, NLR, and PLR were significant risk factors in PDAP patients.

Hypercoagulability status, operative mortality, and long-term survival in patients operated on for mesenteric venous thrombosis

ObjectiveMesenteric venous thrombosis (MVT) is a rare cause of acute surgical abdomen, with high mortality. The aim of this study was to analyze long-term outcomes and possible factors influencing its prognosis. MethodsAll patients who underwent urgent surgery for MVT from 1990 to 2020 in our center were reviewed. Epidemiological, clinical, and surgical data; postoperative outcomes; origin of thrombosis; and long-term survival were analyzed. Patients were divided into two groups: primary MVT (hypercoagulability disorders or idiopathic MVT) and secondary MVT (underlying disease). ResultsFifty-five patients, 36 (65.5%) men and 19 (34.5%) women, mean age 66.7 years (standard deviation: ±18.0 years), underwent surgery for MVT. Arterial hypertension (63.6%) was the most prevalent comorbidity. Regarding the possible origin of MVT, 41 (74.5%) patients had primary MVT and 14 (25.5%) patients had secondary MVT. From these, 11 (20%) patients had hypercoagulable states, 7 (12.7%) had neoplasia, 4 (7.3%) had abdominal infection, 3 (5.5%) had liver cirrhosis, 1 (1.8%) patient had recurrent pulmonary thromboembolism, and 1 (1.8%) had deep venous thrombosis. Computed tomography was diagnostic of MVT in 87.9% of the cases. Intestinal resection was performed in 45 patients due to ischemia. Only 6 patients (10.9%) had no complication, 17 patients (30.9%) presented minor complications, and 32 patients (58.2%) presented severe complications according to the Clavien-Dindo classification. Operative mortality was 23.6%. In univariate analysis, comorbidity measured by the Charlson index (P = .019) and massive ischemia (P = .002) were related to operative mortality. The probability of being alive at 1, 3, and 5 years was 66.4%, 57.9%, and 51.0%, respectively. In univariate analysis of survival, age (P < .001), comorbidity (P < .001), and type of MVT (P = .003) were associated with a good prognosis. Age (P = .002; hazard ratio: 1.05, 95% confidence interval: 1.02-1.09) and comorbidity (P = .019; hazard ratio: 1.28, 95% confidence interval: 1.04-1.57) behaved as independent prognostic factors for survival. ConclusionsSurgical MVT continues to show high lethality. Age and comorbidity according to the Charlson index correlate well with mortality risk. Primary MVT tends to have a better prognosis than secondary MVT.

Factors associated with delayed reporting for surgical care among patients with surgical acute abdomen attended at Muhimbili National Hospital: Tanzania

BackgroundSurgical acute abdomen is a sudden onset of severe abdominal symptoms (pain, vomiting, constipation etc.) indicative of a possible life-threatening intra-abdominal pathology, with most cases requiring immediate surgical intervention. Most studies from developing countries have focused on complications related to delayed diagnosis of specific abdominal problems like intestinal obstruction or acute appendicitis and only a few studies have assessed factors related to the delay in patients with acute abdomen. This study focused on the time from the onset of a surgical acute abdomen to presentation to determine factors that led to delayed reporting among these patients at the Muhimbili National Hospital (MNH) and aimed to close the knowledge gap on the incidence, presentation, etiology, and death rates for acute abdomen in Tanzania.MethodsWe conducted a descriptive cross-sectional study at MNH, Tanzania. Patients with a clinical diagnosis of the surgical acute abdomen were consecutively enrolled in the study over a period of 6 months and data on the onset of symptoms, time of presentation to the hospital, and events during the illness were collected.ResultsAge was significantly associated with delayed hospital presentation, with older groups presenting later than younger ones. Informal education and being uneducated were factors contributing to delayed presentation, while educated groups presented early, albeit the difference was statistically insignificant (p = 0.121). Patients working in the government sector had the lowest percentage of delayed presentation compared to those in the private sector and self-employed individuals, however, the difference was statistically insignificant. Family and cohabiting individuals showed late presentation (p = 0.03). Deficiencies in health care staff on duty, unfamiliarity with the medical facilities, and low experience in dealing with emergency cases were associated with the factors for delayed surgical care among patients. Delays in the presentation to the hospital increased mortality and morbidity, especially among patients who needed emergency surgical care.ConclusionDelayed reporting for surgical care among patients with surgical acute abdomen in underdeveloped countries like Tanzania is often not due to a single reason. The causes are distributed across several levels including the patient’s age and family, deficiency in medical staff on duty and lack of experience in dealing with emergency cases, educational level, working sectors, socioeconomic and sociocultural status of the country.

A rare and severe complication after minimally invasive esophagectomy: First case of a left-sided tension pneumothorax caused by intrathoracic perforation of the herniated transverse colon. Case report and literature review

Nowadays, a minimally invasive surgical approach is increasingly being chosen to treat distal esophageal tumors. Here, postoperative hiatal herniation has been identified as a potentially severe complication. In such cases, it is still not known whether surgical or conservative treatment is preferable. In this report, we elaborate the case of a 62-year-old male patient who presented at our emergency department with severe chest pain. This patient had undergone minimally invasive esophagectomy with gastric pull-up 2 years prior to this event. Emergency computed tomography revealed a left-sided tension pneumothorax based on transhiatal herniation of the transverse colon causing an intrathoracic closed-loop obstruction with subsequent perforation. Immediate surgical treatment was initiated and the transverse colon could be successfully repositioned and resected. Nevertheless, the patient died due to postoperative septic shock in the setting of fecal peritonitis, mediastinitis, and pleuritis within 48 hours after surgery. We provide a detailed description of this rare case and provide a review of the literature concerning intrathoracic colonic herniations.

Percutaneous cholecystoduodenal stent as a definite treatment for acute cholecystitis in elderly or comorbid patients: a bicentric retrospective study

To investigate the safety and efficacy of percutaneous cholecystoduodenal stent (CDS) placement to prevent recurrence of acute cholecystitis in patients who were unfit for cholecystectomy. Between April 2016 and January 2022, 46 patients [median age (range) = 81 (37-99) years; men = 15] with acute cholecystitis who were unfit for surgery underwent percutaneous cholecystostomy followed by a CDS placement in two institutions. Plastic stents of three different materials were used [polyethylene, polyurethane (PU), and polycarbonate (PCB)-based PU]. Clinical outcomes, including technical and clinical success rates and early (<30 days) and delayed adverse events, were retrospectively assessed by stent type. CDS placement was technically successful in 39 patients. Clinical success, defined as cholecystostomy catheter removal, was achieved in 35 of 39 patients. Immediate complications, such as acute pancreatitis and peritonitis, occurred in two patients. Two patients experienced recurrent cholecystitis during a 113-day follow-up (range, 3-1,723). Three-stent groups had significantly different delayed complications on Fisher's exact test (P = 0.021). The Bonferroni post-hoc analysis showed the PCB-PU group tended to have fewer complications than the PU group (P = 0.060). CDS placement is applicable in treating acute cholecystitis patients who were initially unfit for surgery, but further investigation is needed. Although it was not statistically significant, a PCB-PU stent can be suitable for this use because it tends to have fewer delayed complications and is equipped with a drawstring and side holes.

Can we predict death using scoring systems in patients with local peritonitis ? A retrospective study

Prognostic scores in patients with local peritonitis (LP) have not yet been studied exhaustively. We, therefore, aimed in this study to evaluate the ability of several scoring systems to predict death in LP. A retrospective analysis including 68 patients with LP was conducted at Prof. Dr. Stoyan Kirkovich University Hospital in Stara Zagora from January 2017 to August 2021. Clinical and laboratory data needed for calculating the scoring systems were collected at admission or postoperatively. We compared the prognostic performance of WSES SSS, MPI, SIRS, and qSOFA using area under the receiver operation characteristics (AUROC) curves and bivariate correlation analysis. The observed mortality rate was 8.8%. Among all scores, MPI showed the best prognostic performance (AUROC=0.805, 95%CI 0.660-0.950). A threshold MPI >25 points permitted prediction of adverse outcome with a sensitivity of 66.7% and a specificity of 80.6%. The only significant correlation was found between outcome and MPI (p=0.012, r=0.302).Conclusions: The MPI has the ability to prognosticate mortality in patients with LP unlike WSES SSS, qSOFA and SIRS.

DIAGNOSTIC AND TREATMENT OF DIVERTICULAR DISEASE OF THE COLON

The purpose of the work: to analyse clinical cases and the results of treatment of patients with diverticulosis of the large intestine in order to prevent complications.&#x0D; Materials and methods.&#x0D; The results of diagnosis and treatment of 75 patients with diverticulosis of the large intestine for the years 2016-2022, who were in the Clinical highly specialised surgical center with minimally invasive technologies in the Vinnytsia Regional Clinical Hospital named after M. I. Pyrogov of the Vinnytsia Regional Council.&#x0D; Research results and their discussion.&#x0D; We analysed the results of diagnosis and treatment of 75 patients with diverticulosis of the large intestine for the years 2016-2022, who were in the Clinical highly specialised surgical center with minimally invasive technologies in the Vinnytsia Regional Clinical Hospital named after M. I. Pyrogov of the Vinnytsia Regional Council. Colon diverticular disease was clinically and instrumentally confirmed and the following forms of the disease were established: diverticular bleeding - in 46 (61.33%), intestinal perforation with the development of diffuse fecal peritonitis - in 2 (2.66%), diverticulitis - in 12 (16%), asymptomatic diverticulosis - in 2 patients (2.66%), and in 13 patients there was a combination: diverticulitis and paracolic abscess - in 8 (10.66%), diverticulitis and limited purulent peritonitis - in 2 (6.66 %), diverticulitis and intestinal obstruction - in 3 (4%). There were 36 (48%) male patients, 39 (52%) female patients. The age of the patients ranged from 40 to 90 years. The average age was 65±2 years.

Diagnosis and surgical treatment of local secondary peritonitis

Objective. To improve the results of diagnosis and treatment of local secondary peritonitis.&#x0D; Materials and methods. In the Department of Surgery of the Ivano-Frankivsk Regional Clinical Hospital in the 2016 – 2022 yrs period 101 patients with secondary peritonitis were examined and treated.&#x0D; Results. Such indices of the cytokines regulation, as the levels of CD3+, CD4+, CD8+, CD11a+, CD162+, CD95+, CD16+, HLA-DR+, as well as of interleukins-2, 4, 6 have been differed in the investigated groups statistically significantly (p&lt;0.001), demonstrating their high sensitivity in diagnosis and prognostication of the local secondary peritonitis development. Miniinvasive operative interventions were performed in 77 (76.2%) patients, and open operative interventions - in 24 (23.8%). In 46 (59.7%) patients laparoscopic sanation with draining of peritoneal abscess was done. The abdominal abscess draining, using catheter-stiletto, was performed under ultrasonographic investigation control in 31 (40.3) patients.&#x0D; Conclusion. Application of such indices of the cytokines regulation, as the levels of CD3+, CD4+, CD8+, CD11a+, CD162+, CD95+, CD16+, HLA-DR+, interleukins-2, 4, 6, have improved diagnosis of local secondary peritonitis significantly, promoted its early surgical treatment and priority of the miniinvasive technologies application, what reduced the average value of the stationary stay days and index of postoperative lethality down to 8.3%.