Required Emergency Surgery Research Articles

Combination of refl ux esophagitis, erosive gastroduodenitis with a blunt trauma of the trunk with a rupture of the duodenum in a child

We present a rare clinical observation of an 11-year-old boy who, as a result of a fall from a height, received a severe combined injury of the chest, abdomen, retroperitoneal space, which was accompanied by a contusion of the lungs with hydrothorax, contusion of the right kidney, pancreas and duodenal rupture with the development of traumatic shock of the III degree, bile peritonitis. It required emergency surgery, intensive care and was combined with the patient’s chronic reflux esophagitis with esophageal stenosis, erosive gastritis, duodenitis. The development of stenosis of the esophagus may have had a post-traumatic character.

Characteristics of pediatric ocular trauma in a pediatric emergency department in Japan

IntroductionPediatric ocular trauma is a common complaint in pediatric emergency departments (ED) and is a major cause of acquired monocular blindness. However, data on its epidemiology and management in the ED are lacking. The objective of this study was to describe the characteristics and management of pediatric ocular trauma patients who visited a Japanese pediatric emergency department (ED). MethodsThe present, retrospective, observational study was conducted in a pediatric ED in Japan between March 2010 and March 2021. Children younger than 16 years who visited our pediatric ED and received the diagnosis of ocular trauma were included. ED visits for follow-up examinations for the same complaint were excluded. The patients' sex, age, arrival time, mechanism of injury, signs and symptoms, examinations, diagnosis, history of urgent ophthalmological consultation, outcomes, and ophthalmological complications were extracted from electronic medical records. ResultsIn total, 469 patients were included; of these, 318 (68%) were male, and the median age was 7.3 years. The incident leading to trauma occurred most frequently at home (26%) and most often involved being struck in the eye (34%). In 20% of the cases, the eye was struck by some body part. Tests performed in the ED included visual acuity testing (44%), fluorescein staining (27%), and computed tomography (19%). Thirty-seven (8%) patients underwent a procedure in the ED. Most patients had a closed globe injury (CGI), with only two (0.4%) having an open globe injury (OGI). Eighty-five (18%) patients required an urgent ophthalmological referral, and 12 (3%) required emergency surgery. Ophthalmological complications occurred in only seven patients (2%). ConclusionMost cases of pediatric ocular trauma seen in the pediatric ED were CGI, with only a few cases leading to emergency surgery or ophthalmological complications. Pediatric ocular trauma can be safely managed by pediatric emergency physicians.

Renal Artery Aneurysm Rupture as a Dangerous Mimic of Ovarian Cyst Rupture: A Case Report.

Renal artery aneurysm rupture is a rare but morbid diagnosis, often requiring emergency surgery and nephrectomy. Clinical presentation can mimic more common pathology in non-pregnant women such as ruptured ovarian cyst. We present a case of a woman with a prior history of ovarian cyst presenting with a ruptured renal artery aneurysm. Prompt computed tomography (CT) imaging revealed a left renal artery aneurysm rupture with hemoperitoneum and renal infarct. She underwent emergency laparotomy and nephrectomy and was ultimately discharged in good condition. While ovarian cyst rupture is the most common cause of spontaneous hemoperitoneum in non-pregnant women of childbearing age, renal artery aneurysm rupture should be considered and prompt CT imaging obtained, particularly in cases of hemodynamic instability, to ensure prompt treatment.

Degenerative spinal conditions requiring emergency surgery: an evolving crisis in a publicly funded health care system.

Surgery for degenerative spine pathologies is typically performed on a scheduled basis; however, worsening symptoms may warrant emergency surgery. An increasing number of patients requiring emergency surgery has been observed (22.6% in 2006 to 34.8% in 2019). We sought to compare the outcomes of patients who received scheduled surgery and those who required emergency surgery. All patients treated between Jan. 1, 2006, and Dec. 31, 2019, were included. Retrospective comparisons were made between patients who were scheduled (elective) for surgery and those requiring emergency surgery, patients who were scheduled for surgery and those who decompensated while on the surgical waitlist and patients who presented as de novo emergencies and those who decompensated while on the surgical waitlist. Among the 6217 patients with degenerative pathologies, 4654 (74.9%) patients were scheduled (elective) for surgery and 1563 (25.1%) were patients requiring emergency surgery. Compared with patients who were scheduled, patients requiring emergency surgery had a longer length of stay (LOS) in hospital (5.1 d, interquartile range [IQR] 2.7-11.2 v. 3.6 d, IQR 1.3-6.4, p < 0.001) and lower rate of home discharge (78.6% v. 94.2%, p < 0.001). Patients requiring emergency surgery were 1.34 times more likely to have any adverse events (95% confidence interval [CI] 1.06-1.68, p = 0.01). When compared with patients who were scheduled for surgery, those who decompensated while on the surgical waitlist had longer LOS (7.0 d, IQR 3.3-15.0 v. 3.6 d, IQR 1.3-6.4, p < 0.001), less home discharge (77.6% v. 94.2%, p < 0.001) and were 2.5 times more likely to have any adverse events (95% CI 1.5-4.1, p < 0.001). Patients who decompensated had a 2.1 times higher risk of having any adverse events than patients who presented as de novo emergencies (95% CI 1.2-3.6, p < 0.001). We observed worse perioperative outcomes for patients requiring emergency surgery for degenerative spinal conditions than for patients who were scheduled for surgery. Patients who decompensated while on the surgical waitlist had the worst outcomes.

Successful prioritisation of inguinal herniotomies in children during the COVID-19 pandemic to minimise emergency presentations

BackgroundThe coronavirus disease 2019 (COVID-19) disrupted the delivery of elective surgery in children. We introduced guidance to mitigate this impact. By reviewing the outcomes for inguinal herniotomies, we aimed to determine if this guidance has enabled us to prevent an increase in the elective surgery wait time and therefore the need for emergency surgery for incarcerated hernias. This report aims to share our learnt lessons about responding to a crisis limiting accessibility to elective surgery.ResultsWe performed a retrospective review of all elective and emergency herniotomies performed between April 1 and September 30, 2019 (pre-COVID-19) and the same period in 2020 (post-COVID-19). We compared the data on wait time from referral to clinic review/elective surgery and incarceration rates. During the study period in 2019, 76 elective herniotomies were performed compared to 46 in 2020. We did not observe a simultaneous increase in emergency herniotomies in 2020 (27 [2020] vs 25 [2019], OR [95% CI] = 1.53 [0.79–2.9]; p = 0.2). The median time from referral to elective surgery in 2019 compared to 2020 did not differ (56 vs 59 days, respectively; p = 0.61). In 2020, 72% of children that required emergency surgery had not been previously referred to our service and the median age (interquartile range) at which they presented with an incarcerated hernia was 2.8 months (2.1–13.7 months).ConclusionBy adhering to local guidelines for resumption of elective activity, the pandemic did not result in children waiting longer to be seen by a surgeon for a suspected inguinal hernia. As a result, we did not perform more emergency herniotomies. Urgent prioritisation of hernias in infants, from birth up to 3 months old, was a beneficial strategy. Public health education on childhood hernias will improve outcomes.

Life-threatening complications in patients with thoracic and abdominal lymphatic malformations

The term «lymphatic malformations» (LMs) refers to a wide spectrum of disorders with clinical manifestations that can vary from asymptomatic to life‑threatening.&#x0D; Objective — to analyze the factors and pathological conditions that necessitate the use of emergency surgical procedures in patients with thoracic and abdominal LMs.&#x0D; Materials and methods. The retrospective study of medical charts of patients with LMs was performed for a period from 2012 to 2021. Among 240 patients with LMs, 55 (22.9%) were diagnosed with lesions of the abdominal or thoracic cavity. 5 (9.1%) required an emergency surgical procedure.&#x0D; Results. Among 38 patients with abdominal LMs, only one (2.6%) required emergency surgery. This patient underwent laparotomy and subtotal bowel resection for total mesenteric thrombosis. The postoperative period was complicated by short bowel syndrome. Mediastinal LMs were diagnosed in 17 patients, 14 (73.7%) of whom had neck LM extension. In 4 cases, mediastinal LMs were complicated by intrathoracic tension syndrome. It was caused by a lymphatic leak into the pleural cavity in 1 case and by sudden enlargement of LMs, resulting from intracystic hemorrhage, in 3 other cases. A pleural drain with subsequent sclerotherapy was used in a patient with chylothorax. Patients with intracystic hemorrhage underwent thoracotomy and partial LM resection. They also received an injection of a sclerosing agent into the residual cysts. In uncomplicated cases, minimally invasive methods were preferred, with laparoscopic resections of abdominal LMs in 22 (78.6%) patients and sclerotherapy under ultrasound guidance in 7 (36.8%) patients with mediastinal LMs.&#x0D; Conclusions. Intrathoracic tension syndrome and thrombotic complications are potentially dangerous and life‑threatening conditions that pose a risk to patients with visceral LMs and require emergency interventions. Minimally invasive technologies were preferred in uncomplicated cases of thoracic and abdominal LMs, whereas open surgeries were the method of choice in complicated cases.

Rare case of an acute liver torsion.

Torsion of an abdominal organ often leads to an acute abdomen requiring emergency surgery. This report describes the rare case of an acute liver torsion in a 76-year-old man. Surgery revealed dislocation of the left liver lobe, which was flipped over to the right upper abdomen. There was a hypermobile and long falciform ligament and absence of the triangular ligaments. The liver was manually flipped back with subsequent fixation of the umbilical ligament to the diaphragm to prevent reoccurrence. The patient had an uneventful recovery and is doing well 3 months after surgery with good liver function.

Major morbidity and mortality associated with delays to emergent surgery in children: a risk-adjusted analysis.

Delay of emergency surgery contributes to morbidity and mortality, and physiologic status affects outcomes of patients requiring emergent surgery. Our purpose was to determine whether delays to emergent surgery in children were associated with increased major morbidity or mortality in a risk-adjusted population. We performed a retrospective review of class 1 (≤ 60 min to operating room) surgical procedures from July 11, 2011, to July 30, 2016, at BC Children's Hospital, Vancouver. Data sources included the operating room database, patient charts, American Society of Anesthesiologists classification, Neonatal Acute Physiology (SNAP II) and Pediatric Risk of Mortality (PRISM III) scores, time from booking to operating room and outcome. Patients were classified as being at low or high risk for death. We defined major morbidity as unintended loss of an organ, limb or function related to surgery, and delay to surgery as more than 60 minutes from booking to in room. We used the χ2 test for univariate analysis and logistic regression for multivariate analysis. There were 384 cases (367 patients), 223 high-risk and 161 low-risk. The median age was 4 years (range 0 d-18 yr). Overall, 184 cases (47.9%) were delayed. Major morbidity occurred in 94 cases (24.5%), and 28 patients (7.6%) (all in the high-risk group) died. The mean time to the operating room was 1.46 hours for patients with major morbidity/mortality and 1.17 hours for those without. After adjustment for risk level, multivariate analysis showed delay to surgery to be associated with 85% increased odds of morbidity and/or mortality (adjusted odds ratio 1.85, 95% confidence interval 1.20-2.94) compared to no delay. Delay to emergent surgery was associated with a significant increase in major morbidity and/or mortality. Children who require emergency surgery need their care prioritized by not only operating room teams but also hospitals and government; otherwise, they will continue to experience unintended consequences.

A sealant with a hemostatic mechanism independent of the blood coagulation function was effective in both elective and emergency surgery for thoracic aorta

ObjectivesMatsudaito is a unique surgical sealant with a powerful hemostatic effect that works independent of a patient’s blood coagulation function. Because of its mechanism, this sealant is expected to be particularly useful in patients with a poor blood coagulation function, such as in cases of acute aortic syndrome requiring emergency surgery. We, therefore, evaluated the hemostatic static effect of the sealant in both emergency and elective surgery of the thoracic aorta.MethodsWe used data obtained from post-marketing surveillance of the sealant. Patients who underwent replacement of the thoracic aorta were enrolled. The hemostatic effect was evaluated as effective if a further hemostatic procedure was not performed after applying the sealant.ResultsFrom 46 hospitals in Japan, a total of 542 patients (327 elective and 215 emergency cases) were enrolled. Hospital mortality was 4.0% and 11.6% in elective and emergency cases, respectively (p < 0.05). Among the 1039 anastomoses (609 elective and 430 emergency cases), effective hemostasis was confirmed in 436 (71.6%) elective and 259 (60.2%) emergency cases. The data from the clinical trial of the sealant showed a hemostatic rate of 44.4% in elective control cases without the sealant.ConclusionGiven that the hemostatic rate in emergency surgery with the sealant seemed to be better than that in elective surgery without the sealant (determined from the clinical trial), we concluded that the sealant was effective in both emergency and elective thoracic surgery of the aorta.

Complicated and uncomplicated acute appendicitis in pregnancy: a single center experience

Objectives: Acute appendicitis is the most common non-obstetric pathology requiring emergency surgery on pregnant women. The aim of the study is to show the effect of uncomplicated and complicated acute appendicitis on pregnancy. Methods: This study was conducted retrospectively at the Department of General Surgery of Konya City Hospital. Pregnant patients who underwent surgery for acute appendicitis from January 1, 2020, through December 31, 2021, were included in the study. The cases were divided into two groups as complicated and uncomplicated appendicitis and compared. The demographic, clinical, and laboratory findings of the patients were obtained by screening the patient files. The cases were divided into two groups as complicated and uncomplicated appendicitis and compared. Results: The study included 46 pregnant patients with a mean age of 25.9 years. The mean gestational age of the patients at the time of surgery was 16.5 weeks. Of the patients, 47.8% were in the first trimester. Open appendectomy was performed in 35 (76.1%) patients, and laparoscopic appendectomy in eight (17.4%). Seven (15.2%) appendicitis cases were complicated. A negative appendectomy was performed in two (4.3%) patients. Preterm labor was seen at a rate of 28.6% in the complicated appendicitis group and 5.1% in the uncomplicated appendicitis group (p = 0.04), and the mean operative times were 65.8 and 46.1 minutes, respectively (p &amp;lt; 0.001). Conclusions: Both postoperative complications due to surgery and obstetric complications increase in patients with complicated appendicitis; therefore, it is particularly important to closely follow up these cases.

Usefulness of Intravenous Regional Anesthesia for Upper Extremity Arterial Injury Emergencies in Patients with COVID-19: A Case Series and Literature Review

The medical field has undergone many changes since the start of the coronavirus disease 19 (COVID-19) pandemic. In small- and medium-sized hospitals that lack negative pressure facilities for operating rooms, it is impossible to operate on patients infected with COVID-19. As a result, many patients requiring emergency surgery experience serious complications or die. The authors performed intravenous regional anesthesia (IVRA) and emergency surgery in an isolation room on three patients who needed prompt surgical management for upper extremity arterial injuries but could not enter the operating room due to COVID-19 infection. Anesthesia was successful in all cases. A minor anesthetic complication occurred in one patient, who recovered spontaneously. IVRA is a relatively safe and easy method for anesthesia. Moreover, since the tourniquet is inflated before anesthesia, it is well-suited for patients with arterial injury. The method is simple and therefore easy to perform in an isolation room where space and manpower are limited. IVRA can be a good option in emergency surgery for upper extremity artery injury.

Delaying surgery for optimization after colonic stent bridging is safe for left-sided malignant large bowel obstruction: Result from 10-year experience and risks factor analysis

AimTo evaluate the operative and oncological results after colonic stent bridging for left-sided malignant large bowel intestinal obstruction and the risk factors for survival and recurrence after definitive surgery. MethodologyConsecutive patients who underwent colonic stenting for malignant left-sided colonic obstruction were included. Patients for palliative stenting or emergency surgery, patient with low rectal tumour or peritoneal metastasis were excluded. The primary outcome was overall survival. Secondary outcomes included stent success rate, stenting related complications, rate of stoma formation and long-term oncological outcome including recurrence rate and recurrence free survival rate. ResultsFrom June 2011 to June 2021, a total of 222 patients underwent colonic stenting. 112 patients were bridged to surgery after initial stenting, but 7 patients dropped out. Overall survival was 35 months (IQR = 17.75–75.25 months) in the early operation group, 30 months (IQR = 17.5–49.5 months) in the delayed surgery group HR 0.981 (95%CI 0.70–1.395, p = 0.907). Sensitivity analysis performed by excluding stent complications and emergency surgery yielded the same conclusion. Overall stenting complications rate was 17.1%. 11 patients (10.4%) required emergency surgery. ConclusionThere was no difference between early and delayed surgery groups (>4weeks) in the overall survival and recurrence in patients who had stent-bridge to surgery for malignant left colonic obstruction. It is safe to defer definitive surgery to optimize patients and allow better recovery from initial obstruction after colonic stenting before definitive surgery without adversely affecting the oncological outcomes.

Case Report: Volvulus of the Cecum on Complete Common Mesentery

It is an anomaly of rotation of the digestive tract, It is characterized by the persistence of an embryonic anatomical arrangement secondary to an anomaly of rotation of the primitive umbilical loop, thus constituting a meso common to the entire intestinal loop and a root extremely short mesentery. This insufficiency of rotation is most often associated with a lack of attachment. Acute volvulus requires emergency surgery and CT is the key diagnostic test. We report the case of a 38-year-old patient who is followed for a metastatic thymus tumor under chemotherapy, appendectomy by a Mcburney, who presents to the emergency room for an acute occlusive syndrome, the CT scan was inconclusive on the etiology of occlusion. The diagnosis of cecal volvulus on complete common mesentery was made intraoperatively. The patient was operated having benefited from a resection of the mobile segment of the colon and stoma, with a good postoperative evolution.

Time to evacuation of acute subdural and extradural haematoma: prospective study before and after implementation of a major trauma centre

Purpose : Patients with Extradural (EDH) and Acute Subdural Haematomas (ASDH) represent a subgroup of head-injured patients that gain the most from timely treatment. While treatment times for head injury overall improved since the introduction of Major Trauma Centres (MTCs), no data exists describing how the time to treatment of EDH and ASDH has changed. We, therefore, compared the evacuation of ASDH and EDH before and after the implementation of a major trauma network. Methods : Data was collected prospectively between 1 May 2006 to 31 May 2007 and 1 March 2014 to 31 March 2016. The study was carried out at University Hospital Southampton, designated MTC in 2012. Patients over 18 with ASDH or EDH requiring emergency surgery were included. Results : The median time (IQR) for decompression was 4.8h (3.9–6.6) in 2006-7 and 4.4h (3.4–5.9) in 2014–16, p = 0.386. The proportion treated within 4 hours was 32% in 2006–7, and 33% in 2014-16 (p = 1.000). Analysis showed a decrease in time for CT scan (p = 0.01) and acceptance by neurosurgery (p < 0.001). There were increases in time for transferring to hospital (p = 0.005), awaiting operating theatre (p = 0.005), and operative time (p = 0.018). Conclusions : Since the introduction of MTCs, there has been no significant reduction in time to treat this select group of patients despite reductions in time to treatment of most other trauma and head-injured patients. This may be because parts of the pathway have improved, but others haven’t. It is also possible that while previously head injury was poorly served, resources were prioritised to this group so finding further gains is difficult.

Understanding and identifying the needs of parent caregivers of children with hydrocephalus: a qualitative study.

Hydrocephalus is inherently unpredictable. Most parents whose child is diagnosed with hydrocephalus do not anticipate the diagnosis, nor can anyone predict if or when a child's shunt will fail and require emergency surgery. Previous research has shown that children with hydrocephalus and their caregivers experience significant posttraumatic stress symptoms secondary to the diagnosis. This study aims to understand caregiver experiences and needs, identify gaps in resources/support, and determine opportunities to improve care. Semistructured interviews were conducted with parent caregivers of children with hydrocephalus to learn about their experiences with the hydrocephalus diagnosis, hospitalizations, surgeries, coping and support, challenges of caring for a child with hydrocephalus, and logistics for a proposed support program. De-identified interviews were audio-recorded, transcribed, and analyzed for themes. Thematic saturation was reached after 17 interviews. Five major themes emerged: 1) coping with the diagnosis, 2) received support, 3) hydrocephalus management, 4) implications for intervention, and 5) psychosocial stressors for caregivers. A top priority was balanced, trustworthy information delivered with compassion and updated throughout the child's life. Caregivers described a variety of coping strategies, but a majority reported a need for support in processing complex emotions and dealing with the uncertainty of their child's hydrocephalus. Most agreed that having a caregiver support network, medical professionals available for referrals and questions, and referrals to support services and therapies would facilitate feeling supported and providing the best care for their children. Parent caregivers are critical to the health and well-being of children with hydrocephalus, and it is essential to understand their experiences to improve care. Providing well-defined information, psychosocial support, and resources will help to equip parent caregivers to be advocates for their children and to improve both the caregiver and the child's quality of life.

P808 Risk of relapse after vedolizumab withdrawal in Inflammatory Bowel Disease for patients in histological remission

Abstract Background A key clinical question is whether we should be withdrawing advanced inflammatory bowel disease (IBD) medications after a period of sustained remission. There is data to suggest that risk of relapse on withdrawal of vedolizumab is higher than that of anti-TNF therapy1. Drug costs are still considerable and so withdrawal of medications will also have significant financial benefits. The aim was to review the outcomes of vedolizumab withdrawal in patients in remission, in particular for those where a clinical decision was made following confirmed histological remission of their IBD Methods This was a single-centre retrospective review of patients in the IBD clinic at a tertiary referral centre in London. We analysed all those who had stopped vedolizumab at least six months prior and were in either clinical, biochemical, radiological, endoscopic or histological remission. We assessed for evidence of a flare of disease following withdrawal of vedolizumab and the need of further biological treatment. Results 38 patients had vedolizumab withdrawal for remission with a median length of treatment of 36 months. 28 (74%) had a flare up of disease requiring medication change with 24 (63%) requiring biologics. 21 restarted vedolizumab and 79% responded to this medication. Importantly, 5 patients are still less than a year since stopping and so still at high risk of relapse. Of the 21 patients confirmed to be in histological remission, 17 (81%) had a flare of disease requiring further treatment, of which 15 (71%) required biologics. Median time to flare was 7 months with only two patients flaring after a year of cessation. All 15 were started on vedolizumab and 12 (80%) responded to this but one had a subsequent early secondary loss of response. Of those who did not respond to vedolizumab, one required emergency surgery, one responded to ustekinumab and one only has partial response to a third biologic. Conclusion Relapse following vedolizumab withdrawal occurs in a significant number of patients even when they have been in remission for a long period of time. It usually occurs quickly within the first year and having confirmed histological remission does not seem influence this risk. Recapture of response is reasonably good and occurs in four fifths of patients. Despite the significant cost savings of stopping vedolizumab, clinicians need to consider the risk to benefit ratio of stopping when relapse is such a common event. 1 Martin, A., Nachury, M., Peyrin-Biroulet, L., et al, GETAID-Vedo-STOP Study Group (2020). Maintenance of Remission Among Patients With Inflammatory Bowel Disease After Vedolizumab Discontinuation: A Multicentre Cohort Study. Journal of Crohn's &amp; colitis, 14(7), 896–903. https://doi.org/10.1093/ecco-jcc/jjaa005

P639 Percutaneous drainage vs surgery as definitive treatment for anastomotic leak after intestinal resection in patients with Crohn’s disease.

Abstract Background Anastomotic leak remains one of the most relevant complications after intestinal resection for Crohn’s disease (CD). While surgery has always been considered the standard treatment for perianastomotic abscess or collection, percutaneous drainage (PD) has been proposed as a potential alternative. The aim of this study was therefore to compare the success rate of percutaneous drainage with that of surgery for the management of anastomotic leak in CD patients. Methods Retrospective, single-centre study including all consecutive patients who were diagnosed with an anastomotic leak as a complication of intestinal resection for CD between 2004 and 2022. Patients requiring emergency surgery due to generalised peritonitis or clinical instability were excluded. Anastomotic leak was defined as a perianastomotic fluid collection confirmed by radiological findings within 30 days from surgery. Patients underwent either PD or surgery as a primary treatment for the complication. The success after PD was defined as the removal of the drainage with clinical and radiological resolution of the complication. The need for further surgical treatment was considered as a failure in both groups. Primary aim: to compare the success rate of PD vs surgery. Secondary aims: to compare the outcomes at 90 days after the procedures; to identify the variables associated with the indication to PD. Results Among the 47 patients included, 25 (53%) underwent PD and 22 (47%) surgery. Table 1 shows the outcomes by the procedure. Success rate was 84% in PD and 95% in surgery group (p=0.20). The median time to success was 14 days after PD (drainage removal) and 12.5 days after surgery (discharge) (p=0.92). Similar rates of post-procedure medical (12% vs 18%, p=0.55) and surgical (24% vs 36%, p=0.62) complications were shown. An ileostomy was required in 91% of surgery cases. At 90 days, similar rates of discharges (100% vs 95%, p=0.28), readmissions (8% vs 0%, p=0.18) and reoperations (16% vs 9%, p=0.48) were observed between PD and surgery cases, respectively. In the multivariate analysis (Table 2), PD was more likely to be performed in patients whose anastomotic leak was diagnosed later after surgery (OR 1.25, 95%CI 1.03-1.53, p=0.027), in those who underwent an ileo-colic anastomosis alone (OR 3.72, 95%CI 2.29-12.45, p=0.034) and in those who were treated after 2016 (OR 6.36, 95%CI 1.04-39.03, p=0.046). Conclusion The present study confirms that PD is a safe and effective procedure to treat anastomotic leak and perianastomotic abscess in CD patients. Surgery, in particular, is associated with a high risk of stoma formation, which would require a subsequent operation. PD should be indicated in all eligible patients as an effective alternative to surgery.

Sigmoid Volvulus and Ileosigmoid Knotting: An Update.

Sigmoid volvulus and ileosigmoid knotting are uncommon intestinal obstructions, which generally affect adult males. The etiology is multifactorial. Volvulus triad including abdominal pain/tenderness, distention, and obsti pation/constipation is the common clinical presentation. Although x-ray radiography helps with diagnosis, the current diagnostic procedure is computed tomography or magnetic resonance imaging in addition to flexible endoscopy in sigmoid volvulus. Endoscopic decompression is the primary treatment except for the presence of bowel gangrene and peritonitis in sigmoid volvulus, while such conditions and also ileosigmoid knotting require emergency surgery. The prognosis is relatively poor under these adverse circumstances and in ileosigmoid knotting.

Outcomes of the Bentall procedure at Hanoi Heart Hospital

Background: the Bentall procedure is one of the best options to deal with aortic root pathology. We retrospectively reviewed and evaluated the early and mid-term results of the Bentall procedure at Hanoi Heart Hospital.&#x0D; Methods: a longitudinal descriptive study. We retrospectively reviewed 52 patients who underwent the Bentall procedure at Hanoi Heart Hospital from January 2017 to December 2020. Data processing using SPSS 22 software.&#x0D; Results: type A aortic dissection accounted for 36.5%. The rate of emergency operation was 30.8%, all in patients with acute type A aortic dissection. Mechanical composite valve graft was implanted in 47 patients (90.4 %). The rate of postoperative resternotomy for bleeding was 7.7%, and the operative mortality was 3.8%. The mean follow-up duration was 31.29 ± 17.1 months. The Kaplan-Meier estimated overall survival rates were 96.2%, 92.2% and 73.7% at 1, 3 and 5 years, respectively.&#x0D; Conclusion: The Bentall procedure at Hanoi Heart Hospital provided good early and mid-term results, even in cases requiring emergency surgery due to acute type A aortic dissection.

Gastric volvulus associated with shrinkage of a gastrointestinal stromal tumor by neoadjuvant imatinib: a case report

BackgroundDuring neoadjuvant chemotherapy for giant gastrointestinal stromal tumors, changes in gastrointestinal stromal tumor size are rarely associated with events such as perforation and bleeding that require emergency surgery. Moreover, it is very rare for gastrointestinal stromal tumors to shrink and become mobile, resulting in gastric volvulus. Herein, we report a case of gastrointestinal stromal tumor shrinkage during neoadjuvant imatinib treatment, resulting in gastric volvulus that required surgery. To the best of our knowledge, this is the first reported occurrence of gastric volvulus during neoadjuvant imatinib treatment for a giant gastrointestinal stromal tumor.Case presentationA 58-year-old Japanese woman who was diagnosed with a giant gastric gastrointestinal stromal tumor and administered neoadjuvant imatinib presented to our hospital with complaints of abdominal pain and retching. Enhanced computed tomography revealed that the gastrointestinal stromal tumor had shrunk and shifted in position, and the stomach had organoaxially twisted. Accordingly, the patient was diagnosed with gastric volvulus caused by a gastric gastrointestinal stromal tumor. Conservative treatment did not improve the volvulus; hence, laparotomy was performed. The tumor developed from the lesser curvature of the stomach and caused rotation of the gastric body. The local gastric wall was resected. Histopathological examination confirmed the diagnosis of gastrointestinal stromal tumor. The patient received adjuvant imatinib for 3 years and has been alive for 5 years without recurrence.ConclusionsGastric volvulus can be caused by the laxity of the ligaments that hold the stomach and gastric ptosis or esophageal hernia and diaphragmatic hernia; therefore, gastric gastrointestinal stromal tumors rarely cause gastric volvulus. However, a risk of torsion exists if the gastrointestinal stromal tumor develops extramural to lesser curvature and attains a certain size.