Peritonitis Research Articles

Impact of Peritoneal Neutrophil Extracellular Traps on Peritoneal Characteristics and Technical Failure in Patients Undergoing Peritoneal Dialysis

Introduction: Peritoneal dialysis (PD) is an effective home therapy for end-stage kidney disease. However, continuous exposure to PD fluids with high glucose concentration and recurrent peritonitis may lead to the activation of cellular and molecular processes of peritoneal damage, including inflammation and fibrosis. In particular, recent studies have highlighted the role of neutrophils in chronic inflammation. This study explores how neutrophil extracellular traps (NETs) affect peritoneal membrane function and contribute to technical failures in PD patients. Methods: We conducted a prospective observational study involving 250 non-infectious and 30 acute peritonitis patients. NETs were measured using nucleosome and myeloperoxidase DNA levels in PD fluids. Monocyte chemoattractant protein-1 (MCP-1) and matrix metalloproteinase-8 (MMP-8) were also measured to assess peritoneal inflammation and damage. Results: A significant increase in peritoneal NETs, as determined by nucleosome and myeloperoxidase DNA levels, was observed in patients with acute peritonitis compared to patients without peritonitis. Even in non-infectious samples, NET levels were widely distributed and closely correlated with levels of MCP-1 and MMP-8. Higher levels of peritoneal NETs were closely associated with increased 4-hour dialysate/peritoneal (D/P) creatinine ratio and 1-hour D/P sodium levels, indicating a higher prevalence of fast transport and limited free water transport. These factors were associated with a higher risk of technical failure. During a mean follow-up of 34 months, 39.2% (98 patients) switched from PD to hemodialysis, with higher NET levels significantly increasing the risk by 1.9 times (95% confidence interval 1.27-2.83, p=0.020). Conclusions: This study suggests the importance of peritoneal NETs not only as markers of acute inflammation but also as significant immunological predictors of chronic peritoneal membrane inflammation and dysfunction, and as potential risk factors for technical failure.

Acute abdominal pain in general practice

Acute abdominal pain (AAP) represents the 9th most common complaint in general practice. The etiologies are multiple: a third are non-specific, but around 10% require hospital treatment. An accurate history enables a correct diagnosis in 76% of cases, and abdominal palpation can detect a possible surgical abdomen. This article summarizes the intra- and extra-abdominal causes of AAP, the diagnostic strategies, and the most appropriate complementary examinations. It lists the most common causes in general practice, as well as their management and reviews the warning signs not to be missed.

IDENTIFICATION OF THE AETIOLOGY OF GASTROINTESTINAL PERFORATION: CLINICAL AND MDCT CLUES

A common medical emergency that has a high fatality rate between 30 and 50 % is perforation of the gastrointestinal tract (GIT). Oesophageal perforations can cause rapid chest pain, odynophagia, and vomiting gastroduodenal perforations can cause acute, severe abdominal pain and colonic perforations typically advance more slowly, resulting in localized abscesses or secondary bacterial peritonitis. Sepsis, an abscess that resembles an abdominal mass, or delayed symptoms are among the subsets of people who may present. Ancillary findings may indicate underlying problems that require more examination after initial closure of the ruptured bowel, while direct multidetector computed tomography (MDCT) findings confirm the diagnosis and localize the perforation site. Findings from MDCT scans include extraluminal gas, gut wall thickening, apparent discontinuity in the intestinal wall, extraluminal contrast, aberrant mural enhancement, localized fat stranding and/or free fluid, and localized abscess or phlegmon in confined perforations. In order to highlight the MDCT and clinical signs suggestive of the underlying aetiology and localization of the perforated site, this paper will examine the range of MDCT results found in GIT perforation. I. KEY POINTS Extraluminal gas, wall discontinuity or thickness, and fat stranding are signs of a GIT perforation. There is a spectrum of abundance to absence in pneumoperitoneum and extraluminal oral contrast. Additional observations include masses, faecal impaction, ischemia, foreign substances, and excessive wall thickening. The presence of a ruptured peptic ulcer suggests supramesocolic pneumoperitoneum and hyperenhancing gastric wall. Iatrogenic perforation is indicated by ascites and/or persistent or growing free air after surgery.

Case of colon perforation due to segmental absence of intestinal musculature accompanied by cancer treated with colonic resection and anastomosis

BackgroundSegmental absence of intestinal musculature (SAIM) is a partial defect of intestinal muscularis propria without diverticulum. Many reports indicate that the increase in intestinal pressure caused by enemas or endoscopic examinations leads to bowel perforation, but there are few reports involving malignant tumors. Moreover, few reports have had good outcomes after performing one-stage intestinal anastomosis.Case presentationA 60-year-old male came to the office with right-side abdominal pain, and was diagnosed with acute generalized peritonitis caused by ascending colon perforation. Emergency laparotomy was performed, and oval and smooth perforation at the ascending colon was observed, which caused ascites with feces. In addition, there was a tumor on the distal side. The terminal ileum was not dilated, so the cause of the perforation was more likely the SAIM-related thin intestinal wall rather than increased internal intestinal pressure due to obstruction of the tumor. Therefore, a right hemicolectomy with functional end-to-end anastomosis (FEEA) between the ascending colon and ileum was performed, rather than creating a stoma. On pathological examination, the resected bowel segments had a partial defect of intestinal muscularis propria around the perforation, leading to the diagnosis of SAIM. The patient had a favorable postoperative course without anastomotic issues and was discharged safely.ConclusionsThis case implies that initial intestinal anastomosis can be performed without creating a stoma when SAIM is suspected from the shape of the perforation and proximal intestine. This case report suggests surgeons should keep SAIM in mind during operations for colon perforations.

A Multimodal Approach to the Management of Diverticular Abscess with Paraesophageal Hernia Complication

This study aims to evaluate the management of acute diverticulitis complicated by hernia and the role of electroacupuncture in managing postoperative ileus. The case involved a 51-year-old male patient who presented with left lower abdominal pain, fever, and defecation disorder. Physical examination showed signs of infection with localized peritonitis, while laboratory tests revealed neutrophilia. CT scan showed diverticulitis with abscesses in the descending and sigmoid colon, as well as free air around the colon and perihepatic region, and paraesophageal hernia. The patient underwent left hemicolectomy with Hartmann's procedure. Postoperatively, the patient developed ileus which was treated using electroacupuncture. The results showed that the relationship between diverticulosis and hernia is due to connective tissue changes. Approximately 10-20% of diverticulosis cases progress to acute diverticulitis. CT scan is the gold standard for diagnosis, staging and management of diverticulitis. In cases of Hinchey III diverticulitis, laparoscopic washing does not give better results compared to colonic resection. The Hartmann procedure is recommended for patients with multiple comorbidities. Electroacupuncture proved to be an effective adjunctive therapy in managing postoperative ileus. The conclusion of this study is that a multimodal approach, including surgery and complementary therapies such as electroacupuncture, is essential in the management of diverticulitis and its complications. The implication of this study is the need for a holistic approach in managing patients with acute diverticulitis, especially in cases with multiple comorbidities and risk of postoperative complications.

Primary signet ring cell carcinoma of the appendix presenting as gangrenous appendicitis with peritonitis: A case report

Introduction and clinical importance: Primary signet ring cell carcinoma (SRCC) of the appendix is an exceedingly rare malignancy with a non-specific clinical manifestations, and it often masquerades as acute appendicitis. Case presentation A 76-year-old man presented with acute abdominal pain and peritonitis. Abdominal computed tomography revealed relative acute appendicitis with peritonitis, and emergency laparoscopic partial cecectomy with appendectomy revealed gangrenous appendicitis with perforation. A histopathological examination revealed a primary appendiceal signet ring cell carcinoma (PASRCC). Clinical discussion: This case highlights the importance of considering appendiceal malignancies in the differential diagnosis of acute appendicitis. SRCC is a histological variant commonly associated with multiple malignancies of the gastrointestinal tract, particularly gastric and colorectal cancers. Conclusion: PASRCC is a rare malignancy presenting with symptoms indistinguishable from those of acute appendicitis. Clinicians should maintain a high index of suspicion for appendiceal malignancy, particularly in older patients with atypical clinical presentations. Early recognition, accurate diagnosis by histopathological and immunohistochemical examinations, and appropriate management are essential for optimizing the outcomes in these patients.

Mid-jejunal diverticulitis with closed-loop bowel obstruction, strangulation, and contained perforation.

Closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis is rare and should be included in the differential diagnosis of acute abdomen. The association between polymyalgia rheumatica and diverticular disease requires further research but may prompt clinicians to consider appropriate therapies in patients with both diseases. Jejunal diverticulosis is a sac-like outpouching of the intestinal wall that can cause complications such as diverticulitis, obstruction, abscess, perforation, or fistula formation. Complicated jejunal diverticulosis may present with acute abdomen and nonspecific symptoms which can lead to misdiagnosis and delayed treatment. A 76-year-old male with a remote history of polymyalgia rheumatica (PMR) presented with sudden onset abdominal pain, fever, nausea, vomiting, and inability to pass flatus. Physical exam revealed a distended and diffusely tender abdomen with signs of peritonitis. Laboratory test results were significant for neutrophil-dominant leukocytosis and elevated inflammatory markers. CT scan of the abdomen with IV contrast revealed a contained perforation and a closed-loop small bowel obstruction in the mid-abdomen. The patient underwent emergent exploratory laparotomy and resection of 100 cm of mid-jejunum which was found to have numerous diverticula surrounding the closed-loop obstruction and contained perforation. Pathology findings showed evidence of acute on chronic jejunal diverticulitis. Jejunal diverticulosis with complications may present with an acute abdomen and peritonitis. Closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis is uncommonly thought of and should be considered in the differential diagnosis. Additionally, the association between PMR and diverticular disease is notable. While the patient had a remote history but no active PMR on presentation, studies suggest a possible association between gut inflammation and rheumatologic disease. This association should prompt clinicians to consider appropriate therapies and bear in mind the potential risk for diverticular perforation if glucocorticoids are given to treat PMR. Jejunal diverticulosis with multiple complications such as closed-loop bowel obstruction and contained perforation secondary to acute on chronic jejunal diverticulitis is rare and may present with an acute abdomen and nonspecific symptoms. Including rare pathologies as such in the differential diagnosis may prevent misdiagnosis and delayed treatment. While further investigation is needed, the association between diverticulosis and PMR is noteworthy as patients who present with both diseases would require mindful management due to the potential risk of diverticular perforation after treatment with steroids.

Phytochemistry and Evaluation of the Anti-Inflammatory Activity of the Hydroethanolic Extract of Virola elongata (Benth.) Warb. Stem Bark.

Previous studies of the hydroethanolic extract of Virola elongata inner stem bark (HEVe) have demonstrated its antioxidant, gastroprotective, and antiulcer properties, but have not evaluated its anti-inflammatory potential. HEVe was obtained by maceration and phytochemically analyzed. Its systemic anti-inflammatory activity was assessed by its effect on lipopolysaccharide (LPS)-induced peritonitis in mice. HEVe gel (HEgVe) was employed to evaluate topical anti-inflammatory activity by measuring the ear edema resulting from croton-oil-induced dermatitis in mice. A cell viability assay was conducted to determine the non-cytotoxic concentrations of the HEVe. RAW 264.7 cells were stimulated by LPS to determinate cytokine and nitric oxide production. A phytochemical analysis of the HEVe revealed the presence of phenolic acids, neolignans, flavonoids, and monomeric catechins. The oral treatment of acute peritonitis with HEVe reduced the total leukocytes, neutrophils, TNF-α, and IL-1β and elevated IL-10 levels. The application of the HEgVe reduced local edema. The HEVe on the RAW 264.7 cells exhibited no cytotoxicity, and the cells with HEVe displayed reduced TNF-α, IL-1β, and NO levels and increased IL-13 levels. HEVe demonstrated systemic and topical multitarget anti-inflammatory activity, likely due to the combined effects of secondary metabolites. HEVe emerges as a promising herbal remedy for inflammation with minimal cytotoxicity, emphasizing its potential therapeutic significance.

ProT-Diff: A Modularized and Efficient Strategy for De Novo Generation of Antimicrobial Peptide Sequences by Integrating Protein Language and Diffusion Models.

Antimicrobial peptides (AMPs) are a promising solution for treating antibiotic-resistant pathogens. However, efficient generation of diverse AMPs without prior knowledge of peptide structures or sequence alignments remains a challenge. Here, ProT-Diff is introduced, a modularized deep generative approach that combines a pretrained protein language model with a diffusion model for the de novo generation of AMPs sequences. ProT-Diff generates thousands of AMPs with diverse lengths and structures within a few hours. After silico physicochemical screening, 45 peptides are selected for experimental validation. Forty-four peptides showed antimicrobial activity against both gram-positive or gram-negative bacteria. Among broad-spectrum peptides, AMP_2 exhibited potent antimicrobial activity, low hemolysis, and minimal cytotoxicity. An in vivo assessment demonstrated its effectiveness against a drug-resistant E. coli strain in acute peritonitis. This study not only introduces a viable and user-friendly strategy for de novo generation of antimicrobial peptides, but also provides potential antimicrobial drug candidates with excellent activity. It is believed that this study will facilitate the development of other peptide-based drug candidates in the future, as well as proteins with tailored characteristics.

Scaffold hopping-driven optimization for the identification of NLRP3 inhibitors as potential gout therapeutics

Gout as a common inflammatory arthritis seriously affects the quality of life of a large number of people. Targeting NLRP3 inflammasome has been certified as a promising therapeutic strategy for gout. This study, a series of new imidazolidinone derivatives were validated as NLRP3 inhibitors by scaffold hopping from the reported NLRP3 inhibitor CSC-6. In contrast to the poor physicochemical properties of the template molecule, the representative compound 23 showed good plasma stability, water solubility, and no significant inhibitory toxicity to CYP450 enzymes. Surface plasmon resonance and immunoblotting experiments showed that compound 23 binds NLRP3 and inhibits NLRP3 activation. Finally, compound 23 showed good anti-inflammatory and analgesic effects in acute peritonitis and arthritis. Overall, the present study provides NLRP3 inhibitors with favorable pharmacological properties, which may not only serve as a tool molecule for studying NLRP3-related functions, but also may further facilitate the gout treatment.

Case Report: A 31-Year-Old Man with Relapsing Complicated Diverticulitis after Initial Conservative Treatment

BACKGROUND: There is controversy regarding the surgical approach for severe complications of diverticular disease. The classical approach has been a Hartmann’s procedure, but laparoscopic lavage and drainage has been suggested as an alternative. We present a patient who initially responded to conservative management of complicated diverticulitis, but had a recurrence that was managed surgically. CASE PRESENTATION: A 31-year-old man presented with Hinchey Stage I diverticulitis and was discharged from the hospital after medical management. Six days later, he returned to the hospital with radiographic evidence of a pericolonic abscess. The patient was taken to the operating room for laparoscopic drainage with placement of a drain in the abscess cavity. He required reoperation with sigmoid colon resection, primary anastomosis, and diverting ileostomy. DISCUSSION: Despite requiring reoperation, the authors believe that initial conservative management possibly prevented progression to generalized feculent peritonitis. If this had occurred, the patient may have required Hartmann’s procedure, which is associated with more complications than primary anastomosis with protective ileostomy. CONCLUSION: The patient had recurrence of complicated diverticular disease that was initially managed conservatively and then with laparoscopic drainage, followed by primary anastomosis with protective ileostomy. Given individual patient factors, the authors believe that he was managed optimally. There is currently controversy between the use of laparoscopic lavage and drainage versus Hartmann’s procedure for the management of complicated colonic diverticular disease and more investigation is required on the subject.

Enhancing Hospital Reimbursement Through a Pediatric Surgery Resident Orientation Program: A Focus on Accurate Diagnosis Code Documentation for Acute Appendicitis

BackgroundThe usage of specific ICD-10 diagnosis codes significantly influences hospital reimbursement compared to non-specific codes. This study hypothesized that a formal orientation program for pediatric surgery residents would enhance the selection of accurate and specific diagnosis codes for acute appendicitis such as K35.30 for “Acute appendicitis with localized peritonitis” rather than K35.80 for “Unspecified acute appendicitis,” thereby improving hospital reimbursement. MethodsWe implemented a comprehensive orientation for pediatric surgery residents at our institution in late 2020, a component of which emphasized the importance of having specific ICD-10 diagnosis codes. We conducted a retrospective analysis of laparoscopic appendectomy billing data for pediatric patients, comparing the use of specific versus unspecified diagnosis codes and associated hospital reimbursement rates before (2020) and after (2022) the program's initiation. Patients without payment were excluded. Statistical significance was determined by a two-tailed p-value of ≤0.05. ResultsAnalysis of 267 patient records showed a significant increase in the use of the specific diagnosis code (K35.30) from 3.6% in 2020 to 87.5% in 2022 (p < 0.0001). Adjusted for inflation and billing changes, mean hospital reimbursement per case increased by $661 (from $4414 to $5,075, p = 0.027), totaling an additional $84,616 in 2022, just for a single subset of appendicitis patients. ConclusionsA targeted resident orientation program significantly improves the use of specific ICD-10 codes for acute appendicitis, leading to increased hospital reimbursement. Such programs represent a valuable approach for enhancing the financial outcomes of pediatric surgical care while reinforcing the importance of accurate medical documentation. Study DesignRetrospective. Level of EvidenceIII.

Feasibility and safety of endoscopic full-thickness resection for submucosal tumors in the upper gastrointestinal tract, including predominantly extraluminal submucosal tumors (with video).

Endoscopic full-thickness resection (EFTR) for submucosal tumors (SMTs) has been technically challenging. This retrospective study aimed to evaluate the feasibility, safety, and efficacy of EFTR for upper gastrointestinal (GI) SMTs, including extraluminal lesions. We retrospectively investigated 232 patients with SMTs who underwent EFTR from January 2014 to August 2023. Clinicopathologic characteristics, procedure-related parameters, adverse events (AEs), and follow-up outcomes were assessed in all patients. The en-bloc resection and en-bloc with R0 resection rates were 98.7% and 96.1%, respectively. The average endoscopic tumor size measured 17.2 ± 8.7 mm, ranging from 6 to 50 mm. The resection time and suture time were 49.0 ± 19.4 min and 22.5 ± 11.6 min, respectively. In all, 39 lesions (16.8%) exhibited predominantly extraluminal growth. Gastrointestinal stromal tumors (GISTs) were the predominant pathology, accounting for 78.4% of the cases. Twenty-one patients (9.1%) encountered complications, including pneumothorax (1/232, 0.43%), hydrothorax (1/232, 0.43%), localized peritonitis (3/232, 1.29%), and fever (16/232, 6.9%). Although the incidence of postoperative fever was notably higher in the predominantly extraluminal group (7/39, 17.9%) compared to the predominantly intraluminal group (9/193, 4.7%, P = 0.008), there were no significant differences in outcomes of the EFTR procedure. No instances of recurrence were observed during the mean follow-up period of 3.7 ± 2.3 years. EFTR was found to be feasible, safe, and effective for resecting upper GI SMTs, including lesions with predominantly extraluminal growth. Further validation in a prospective study is warranted.

EP202 - Mesh-Mediated Fascial Traction (MMFT) and Negative Pressure Abdominal Dressing (ABTHERA): Useful in Difficult Open Abdomens?

Abstract Background Challenging abdominal surgical emergencies may require an 'Open Abdomen (OA)' as a life-saving procedure. OA has serious complications: wound infection, fluid and protein loss, catabolic state, loss of abdominal domain, and entero-atmospheric fistula. To assess the efficacy of mesh-mediated fascial traction (MMFT) &amp; Abthera Dressing in achieving definitive abdominal closures. Patients and Method Retrospective analysis of prospectively collected data of 6 patients managed between August and November 23 in a large DGH. Following laparotomy and management of primary pathology, Abthera Dressing combined with bilateral continuous 2-0 PDS suture fixation at 0.5cm gap of macroporous Prolene (Merinium, Meril Life) meshes to each rectus sheath followed by sequential midline mesh traction closure over a time period that allowed subsequent definitive abdominal wound closure. Data collection included patient demographics (age, sex, BMI, ASA), intervention details for OA, wound characteristics, follow-up, and outcome. Results Six included M: F 4:2, age 61* (40-76 ) years, BMI 30* ( 24-35), ASA 3. Three were strangulated incisional hernia, 2 burst abdomens from faecal peritonitis, and 1 necrotizing fasciitis. Initial wound length 25*(20-32) cm, width 12.5* (4-17) cm after management of primary pathology reduced to width 4.5* (0-9) cm through MMFT and Abthera Dressing followed by definitive abdominal closure. Relook surgery required were 4* (1-9) with one full and 4 bridged mesh closures. Length of stay 39* (14-74) days. One death from respiratory failure. Conclusion The study highlights the benefit of MMFT &amp; Abthera Dressing in achieving definitive abdominal closure for challenging OA where primary abdominal closure was not possible. * Median

EP267 - Patient with Pneumomediastinum and Pneumoperitoneum – Importance of Human Factors

Abstract Clinical assessment 70-year-old lady presents with one-day history of dyspnoea, chest and abdominal pain. She was recently discharged following a three-week hospital admission with fall related traumatic rib fractures and hospital acquired pneumonia. Her abdomen was soft and non-tender. CT scan with oral and IV contrast demonstrates pneumomediastinum and pneumoperitoneum with connection at diaphragmatic crura. Management Patient was managed conservatively however two days after admission her CRP climbed to 150 and clinical suspicion remained high. Repeat CT scan over the weekend demonstrated increase in the pneumoperitoneum and decrease in the pneumomediastinum with a collection around sigmoid colon. Trainee raised concern to consultant and a laparotomy was done. Operative findings showed perforated sigmoid colon with faeculent peritonitis of unclear cause. Hartmann’s procedure was done and patient continued post recovery in ITU. Discussion This case demonstrates the complex varying presentations of our elderly co-morbid population. The presence of air in thoracic and abdominal cavities with unknown cause weeks after the fall was suspicious. Hence, the team communicated well from top-down and likewise from weekday to weekend. Low threshold for escalation and high index of suspicion enabled a re-scan which proved to be life-saving for this patient. Identifying complicated cases where errors can occur is a critical first step. Clear communication among staff, accurate documentation and addressing the patient concerns enabled the surgical team to navigate the complex disease process and ensure safe patient care.

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.

Digestive Surgical Emergencies at Tominian: Therapeutic Aspects

Purpose: To describe the therapeutic aspects of digestive surgical emergencies at the Tominian referral health center. Methodology: This was a prospective cross-sectional study from December 1, 2022 to November 30, 2023, i.e. 12 months, in the general surgery department of Tominian CS Réf. We enumerated 116 patients during our study period, and included in this study all patients received and operated on for digestive surgical emergencies. The parameters studied were etiologies, duration of disease evolution, treatment and postoperative follow-up. Results: Digestive surgical emergencies (n=116) accounted for 22.97% of all procedures (n=505). Men accounted for 73.3% (n=85) and women 26.7% (n=31), with a sex ratio of 2.74. Mean age was 29.25 years, with extremes of 4 and 71 years. 61.2% (n=71) consulted between 49 and 72 hours of disease evolution. The main etiologies were acute appendicitis 47.4% (n=55), acute peritonitis 29.3% (n=34). The surgical procedures performed were appendectomy 47.4% (n=55), appendectomy + lavage 13.8% (n=16), perforation suture 12.9% (n=15). Postoperative follow-up was uncomplicated 87.9% (n=102), complicated by surgical site infection 7.8% (n=9). There were 3.4% (n=4) deaths. Hospital stay was 8 to 14 days in 49.1% of cases (n=57). Conclusion: Digestive surgical emergencies are numerous in Tominian. Their management requires multiple and varied therapeutic means, the rapid initiation of which guarantees a good oronostic outcome.

Establishment of a postoperative bowel adhesion model in Rats

Postoperative adhesive bowel obstruction is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive bowel obstruction can be managed non-operatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive bowel obstruction. Treatment recommendations are still controversial. Intestinal adhesions commonly occur in patients after abdominal surgery, often between intestines, between intestines and the abdominal wall, or within the peritoneum. Adhesions can lead to symptoms such as abdominal pain, constipation, and bloating, and may result in serious complications such as intestinal obstruction, bowel necrosis, acute peritonitis, and sepsis, which can be life-threatening. Therefore, reducing the occurrence of intestinal adhesions is crucial for abdominal surgery. To minimize adhesions, endoscopic techniques can be employed to reduce the abdominal opening area and thus decrease the probability of adhesion formation. However, this approach requires specialized equipment and surgical skills, making it somewhat challenging. Alternatively, anti-adhesion products can be used to lower the risk of adhesion formation. In this study, a murine cecal abrasion adhesion model was established and will be simulated common adhesion scenarios observed in patients after abdominal surgery. The efficacy of anti-adhesion gel materials will be then evaluated to assess their anti-adhesion properties. The record of gross adhesion severity assessment was performed. The adhesion status between the cecum and abdominal wall was observed on postoperative days 3 and 14. The results was shown that three days post-surgery operation, the group exhibited more severe adhesions upon gross examination. By day 14 post-surgery operation (at animal sacrifice), the histopathological analysis revealed that the group exhibited thicker fibrous tissue thickness, increased neovascularization, and higher collagen accumulation in the peritoneum. Therefore, based on the results of this experiment, a postoperative bowel adhesion rat is reliable and can be safely used to test the efficacy of novel anti-adhesive formulations to prevent intra-abdominal adhesions by using this model.

Analysis of patients with acute surgical abdomen due to trauma and evaluation of factors affecting mortality and the impact of COVID-19 pandemic process on patient admissions

Objective: To analyze the patients who developed acute surgical abdomen due to trauma, to evaluate the factors affecting mortality and to examine the impact of the COVID-19 pandemic process on patient admissions. Materials and Methods: The study was conducted retrospectively by analyzing the patients who applied to the emergency department of a secondary healthcare institution between 01.01.2019-31.12.2023 (5 years) and developed an emergency surgical abdomen secondary to trauma and were hospitalized and treated. All age groups were included in the study. Demographic data, type of trauma, type of treatment, site of injury, laboratory data, length of hospitalization and mortality status were analyzed. Comparative analysis of the injured regions according to the type of trauma was performed. Data of patients who were discharged and those who died were compared. Data collection was performed through hospital electronic data. Results: 123 patients were evaluated in the study. 78.9% (n=97) of the patients were male. The mean age was 36.43±14.81 years and the most common age range was 21-40 years (60.2%, n=74). At the time of presentation to the emergency department, the most common Glasgow Coma Score was 11-15 (83%, n=102). The most common reason for presentation was traffic accident (40.7%, n=50). Post-traumatic injuries to more than one organ or region in the abdomen were most common (28.5%, n=35). Surgical procedures were performed in 65.9% (n=81) of the patients. The mean duration of hospitalization was 7.14±5.40 days. Hemoglobin and platelet levels were found to be significantly lower at the time of admission in the patients who died (p

Cholecystopleural fistula: A case report and literature review.

Gallstone with acute cholecystitis is one of the most common diseases in the clinic. If the disease is serious, gallbladder gangrene, perforation, and sepsis may be caused. Gallbladder diseases rarely cause thoracic-related complications, especially pleural fistula, which is very rare in clinical practice. A 52-year-old male patient was admitted to the emergency department for 1 month with recurrent right middle and upper abdominal pain. Computed tomography diagnosis: cholecystitis and peri-inflammation, small abscess around the base of the gallbladder, local peritonitis, and bilateral pleural effusion. After admission, conservative treatment was given. On the 4th day of admission, the symptoms worsened, and an emergency catheter drainage was performed on the right thoracic cavity to extract 900 mL of dark yellow effusion. After the operation, a large amount of bili-like fluid was continuously drained from the thoracic drainage tube. After the iatrogenic biliary fistula caused by thoracic puncture was excluded, cholecystopleural fistula was considered to be cholecystopleural fistula. On the 6th day of admission, endoscopic retrograde cholangiopancreatography (ERCP) + cholecystography + Oddi sphincterotomy + laminating biliary stent was performed in the emergency department, and cholecystopleural fistula was confirmed during the operation. The patient recovered well after surgery, computed tomography examination on the 20th day after surgery indicated that pleural effusion was significantly reduced, and the patient was cured and discharged. The patient returned to the hospital 8 months after the ERCP operation to pull out the bile duct-covered stent. The patient did not complain of any discomfort after the postoperative follow-up for 3 years, and no recurrence of stones, empyema, and other conditions was found. Cholecystopleural fistula is one of the serious complications of acute cholecystitis, which is easy to misdiagnose clinically. If the gallbladder inflammation is severe, accompanied by pleural effusion, the pleural effusion is bili-like liquid, or the content of bilirubin is abnormally elevated, the existence of the disease should be considered. Once the diagnosis is clear, active surgical intervention is needed to reduce the occurrence of complications. Endoscopic therapy (ERCP) can be used as both a diagnostic method and an important minimally invasive treatment.