Surgery For Acute Abdomen Research Articles

Laparoscopy for emergency abdominal surgery is associated with reduced physical functional decline in older patients: a cohort study

BackgroundAn increasing number of older patients require emergency abdominal surgery for acute abdomen. They are susceptible to surgical stress and lose their independence in performing daily activities. Laparoscopic surgery is associated with faster recovery, less postoperative pain, and shorter hospital stay. However, few studies have examined the relationship between laparoscopic surgery and physical functional decline. Thus, we aimed to examine the relationship between changes in physical function and the surgical procedure.MethodsIn this was a single-center, retrospective cohort study, we enrolled patients who were aged ≥ 65 years and underwent emergency abdominal surgery for acute abdomen between January 1, 2019, and December 31, 2021. We assessed their activities of daily living using the Barthel Index. Functional decline was defined as a decrease of ≥ 20 points in Barthel Index at 28 days postoperatively, compared with the preoperative value. We evaluated an association between functional decline and surgical procedures among older patients, using multiple logistic regression analysis.ResultsDuring the study period, 852 patients underwent emergency abdominal surgery. Among these, 280 patients were eligible for the analysis. Among them, 94 underwent laparoscopic surgery, while 186 underwent open surgery. Patients who underwent laparoscopic surgery showed a less functional decline at 28 days postoperatively (6 vs. 49, p < 0.001). After adjustments for other covariates, laparoscopic surgery was an independent preventive factor for postoperative functional decline (OR, 0.22; 95% CI, 0.05–0.83; p < 0.05).ConclusionsIn emergency abdominal surgery, laparoscopic surgery reduces postoperative physical functional decline in older patients. Widespread use of laparoscopic surgery can potentially preserve patient quality of life and may be important for the better development of emergency abdominal surgery.

The effect of seamless nursing combined with Roy adaptive psychological nursing on self-efficacy and bad mood of patients after acute abdomen surgery.

To explore the effect of seamless nursing combined with Roy adaptive psychological nursing on self-efficacy and bad mood of patients after acute abdomen surgery. According to the digital table method, 120 patients with acute abdomen who were treated and nursed in our hospital from June 2019 to June 2021 were selected as prospective research objects, and they were divided into a control group and an observation group with 60 cases each. Among them, the control group carried out seamless nursing, and the observation group carried out Roy adaptive psychological nursing on this basis, and compared the effects of self-efficacy, nursing ability and bad mood of the 2 groups of patients after surgery. Before nursing, the self-efficacy scale, quality of life scores, nursing ability scores, as well as bad mood were not statistically significant between the 2 groups ( P > .05). After nursing, the self-efficacy scale and nursing ability scores in the observation group were significantly higher than that in the control group ( P < .05); the social interaction score, anxiety score and depression score were significantly lower than that in the control group ( P < .001). Seamless nursing combined with Roy adaptive psychological nursing can effectively improve the quality of life of patients after acute abdomen surgery, reduce unhealthy emotions, and improve the nursing ability and self-efficacy of patients after surgery. It has a certain reference for the nursing of patients after acute abdomen surgery.

Surgery for acute abdomen in adult patients with severe motor and intellectual disabilities.

The present study aimed to examine the characteristics, outcomes, and problems related to surgery for acute abdomen in adult patients with severe motor and intellectual disabilities (MID). The clinical records of 35 adult patients with severe MID who received emergency surgery for acute abdomen between 2011 and 2020 were reviewed. The median duration from onset to surgery was 48 hours. There were 2 cases of in-hospital mortality (5.7%), and all the patients underwent surgery more than 72 hours after onset. The in-hospital mortality rate was significantly higher in patients who received surgery later than 72 hours after onset. Bowel obstruction was the most common disease among the acute abdomen cases (71.4%) and most often involved volvulus of the small bowel and cecum. Of the patients with bowel obstruction with severe MID, 72.0% had abdominal distention, 16.0% had abdominal pain, and 4.0% had vomiting. The median duration from onset to surgery was significantly longer in the patients with bowel obstruction with severe MID than in those without severe MID (24 hours vs. 16 hours). Acute abdomen in patients with severe MID was often due to bowel obstruction caused by volvulus. Because patients with severe MID have few symptoms, they are susceptible to adverse surgical outcomes associated with a prolonged duration from onset to surgery.

Risk Factors for Abscess Development in Patients with Endometrioma Who Present with an Acute Abdomen.

The objective of this study was to assess the potential risk factors for abscess development in patients with endometrioma who present with an acute abdomen. We retrospectively reviewed the records of 51 patients who underwent emergency surgery for acute abdomen involving an endometrioma at our hospital between April 2011 and August 2021. The patients were divided into an infected group (n = 22) and a control group (n = 29). We analyzed patient characteristics; imaging findings; clinical data, including bacterial cultures; and perioperative outcomes to assess for differences between groups. Patients in the infected group were significantly older than those in the control group (P = 0.03). They were more likely to have a history of endometriosis surgery (P = 0.04) and more likely to have undergone transvaginal manipulation within 3 months of presentation (P = 0.01). Body temperature on the day of admission was significantly higher in the infected group (P = 0.007), as were C-reactive protein levels on the day of admission and before surgery (P < 0.001; P = 0.018) and the white blood cell count on the day of admission (P = 0.016). Preoperative imaging showed significant thickening of the tumor wall (P < 0.001) and an enhanced contrast effect (P < 0.001) in the infected group. We identified several factors that suggest abscess in patients with an acute abdomen who have a complication of pathologically confirmed endometriosis. A recent vaginal procedure is a particular risk factor for abscess development in patients with endometriomas.

Computed Tomography Image Segmentation of the Proximal Colon by U-Net for the Clinical Study of Somatostatin Combined with Intestinal Obstruction Catheter.

Objective U-Net technology is implemented for image segmentation to diagnose cases of intestinal obstruction. To evaluate the application value of somatostatin combined with transanal intestinal obstruction decompression catheter in the treatment of distal colonic malignant intestinal obstruction and to explore the therapeutic effect of somatostatin on acute abdomen surgery in patients with intestinal obstruction. Methods After the segmentation technique, a retrospective analysis of 30 patients with acute and complete distal colonic malignant obstruction treated by surgery was divided into a control group and an observation group according to a random number table. The treatment efficiency, clinical symptoms, disappearance time after treatment, and the incidence of complications were compared between the two groups of patients. Results The image segmentation using U-Net can effectively assist in the medical diagnosis of the colon. Our study found that patients with combined treatment with somatostatin and anal intestinal obstruction catheter were relieved of preoperative abdominal pain and abdominal distension; compared with the abdominal circumference at the time of admission, the abdominal circumference was significantly reduced. Abdominal examination was performed 3 days after comprehensive treatment, and combined with computed tomography (CT), we observed that the measured maximum transverse diameter of the proximal colon was significantly smaller than that before treatment. Before treatment, all patients were divided into a control group and a treatment group. After treatment, the symptoms of the two groups of patients were alleviated. The treatment effective rate of the observation group was 93.3%, and the treatment effective rate of the control group was 73.3%. The effective rate was significantly higher than that of the control group, and the difference was statistically significant. Conclusions Through the use of image segmentation technology, somatostatin treatment of early inflammatory bowel obstruction after acute abdomen surgery can effectively improve the treatment efficiency of patients, shorten the disappearance of clinical symptoms, reduce the incidence of complications, and have a significant therapeutic effect, which is worthy of clinical application. Somatostatin combined with enteral obstruction catheter treatment is safe and effective for elderly patients with acute distal large bowel malignant intestinal obstruction. It has a higher completion rate of laparoscopic surgery and a first-stage anastomosis power, which reduces the risk of perioperative period and reduces the patient's financial burden.

Reconstruction Algorithm-Based Ultrasonic and Spiral CT Images in Evaluating the Effects of Dexmedetomidine Anesthesia for Acute Abdomen.

Objective The study focused on the application value of iteration reconstruction algorithm-based ultrasound and spiral computed tomography (CT) examinations, and the safety of dexmedetomidine anesthesia in acute abdominal surgery. Methods 80 cases having the acute abdomen surgery were selected as the research subjects. They were divided into group A (40 cases) and group B (40 cases) according to the anesthetic drugs used in the later period. The experimental group was injected with propofol, remifentanil, and atracurium combined with dexmedetomidine; the control group was injected with propofol, remifentanil, and atracurium only. After the operation, the patient was for observed for the pain, agitation, adverse reactions, heart rate (HR), and blood pressure. All patients received ultrasound and spiral CT examinations, and based on the characteristics of the back-projection algorithm, an accelerated algorithm was established and used to process the image, and according to which, the patient's condition and curative effects were evaluated. Results After image reconstruction, the ultrasound and spiral CT images were clearer with less noise and more prominent lesions than before reconstruction. Before image reconstruction, the accuracy rates of ultrasound and spiral CT in diagnosing acute abdomen were 92.3% and 91.1%, respectively. After reconstruction, the corresponding numbers were 96.3% and 98.1%, respectively. After reconstruction, the accuracy of the two methods in diagnosing acute abdomen was significantly improved compared with that before reconstruction, and the difference was statistically significant (P < 0.05). The Ramsay score of the experimental group was significantly higher than that of the control group at each time period, P < 0.05; the agitation score and visual analogue scale (VAS) score of the experimental group were significantly lower than the control group at each time period after waking up, P < 0.05. Conclusion Reconstruction algorithm-based ultrasound and spiral CT images have high application value in the diagnosis of patients with acute abdomen, and dexmedetomidine has good safety in anesthesia surgery.

Association of Preoperative Risk Factors and Mortality in Older Patients following Emergency Abdominal Surgery: A Retrospective Cohort Study.

BackgroundOlder patients undergoing emergency laparotomy have high morbidity and mortality rates. Preoperative risk assessment with good predictors is an appropriate measure in this population. Frailty status is significantly associated with postoperative outcomes in older adults. This study aimed to investigate the effect of preoperative risk factors and frailty on short-term outcomes following emergency surgery for acute abdomen in older patients.MethodsThis study included older patients (≥65 years of age) who underwent emergency abdominal surgery. We retrospectively analyzed their demographic and clinical variables and used the modified Frailty Index-11 to evaluate their frailty status. The primary outcome was the 30-day mortality rate. We also analyzed risk factors of mortality in these patients.ResultsThe study included 150 patients with a median age of 74 years. The mortality rate was 17.3% (n=26). We observed significantly higher mortality rates in patients who were obese and who had higher American Society of Anesthesiology (ASA grades) (p<0.05). Frailty status was worse in deceased group (p<0.001), when compared to individuals who survived. Septic shock was associated with the development of mortality (p<0.001). Multivariate regression analysis revealed that ASA grade was the only independent risk factor for mortality (odds ratio=19.642; 95% confidence interval, 3.886–99.274; p<0.001).ConclusionOlder patients with obesity and frailty presenting with higher ASA grades and septic shock had the worst survival following emergency abdominal surgery. The ASA grade was an independent risk factor for mortality.

Pattern and Outcome of Acute Appendicitis: Observational Prospective Study from a Teaching Hospital, Addis Ababa, Ethiopia.

BackgroundAcute appendicitis is the most common cause of acute abdomen surgery. Despite its commonness and the abundance of literature on the subject, its diagnosis remains challenging. Delay in intervention results in complications of the process leading to increased morbidity and mortality.MethodologyAn observational prospective cohort study was conducted, and all patients who had undergone appendectomy for a clinical diagnosis of appendicitis were included in the study. Data were analysed using Statistical Package for Social Sciences (SPSS) version 23.ResultsHalf of the study participants were in the age range of 18–25 years with male preponderance (63.9%). The mean duration of symptoms was 51.3 hours. The most common presenting symptom was abdominal pain (98.2%), while right lower quadrant tenderness was the most common sign (93.4%). Abdominal ultrasound was done in 81% of the study population with a sensitivity and specificity of 95.7% and 33.3%, respectively. Three-quarters (74.4%) of the patients had uncomplicated appendicitis, while 1.8% had a grossly normal appendix. None of the appendectomy specimens were sent for pathology. The mean hospital stay was 3.2 days. The morbidity and mortality rate were 3.8% and 0.4%, respectively.ConclusionAcute appendicitis was the most common emergency surgical procedure in the study period. Abdominal ultrasound was used in the majority of the patients as supplementary imaging for the diagnosis of acute appendicitis. Uncomplicated appendicitis took the major share of the intraoperative finding leading to acceptable morbidity and mortality rates.

The Role of Nutritional Access in Malnourished Elderly Undergoing Major Surgery for Acute Abdomen: A Propensity Score-Matched Analysis.

About 50% of the elderly undergoing emergency abdominal surgery are malnourished. The role of timely surgical nutritional access in this group of patients is unknown. We analyzed the National Inpatient Sample database from 2009 through the first three-quarters of 2015 of patients aged ≥65years who were malnourished and underwent major abdominal surgery for the acute abdomen within the first 2days of hospital admission. Of 3246721 patients analyzed, 4311 patients met inclusion criteria. Of these, only 507 (11.8%) patients had surgical nutritional access (gastrostomy or jejunostomy) (group I), while 3804 patients (88.2%) did not (group II). In the propensity score-matched population, there were 482 patients in each group. The patients in group I had lower odds of mortality and postoperative gastrointestinal complications (paralytic ileus, anastomotic dehiscence, and intestinal fistulae) (P-value <.01, respectively). Elderly who receive surgical nutritional access have lower rates of gastrointestinal complications and mortality.

A retrospective analysis of emergency surgery for cases of acute abdomen during cancer chemotherapy. Case series

BackgroundTreatment for acute abdomen during chemotherapy is frequently difficult because of the complicated status of the patients, and there have been only a few case series summarizing the outcomes of emergent surgery during chemotherapy. The aim of this study was to clarify the clinical outcomes of emergency surgery for acute abdomen during chemotherapy and identify predictive factors associated with mortality. MethodsWe retrospectively analyzed the records of patients who underwent emergency surgery for acute abdomen within 30-days after anti-cancer drugs administration between 2009 and 2020. ResultsThirty patients were identified. The primary malignancies were hematological (n = 7), colorectal (n = 4), lung (n = 4), stomach (n = 2), breast (n = 2), prostate (n = 2) and others (n = 5). Fifteen patients were treated with the regimen, including molecular-targeted anti-cancer drugs (Bevacizumab: 8 cases, Rituximab: 4, Ramucirumab: 2, and Gefitinib: 1). Indications for emergency surgery were perforation of the gastrointestinal tract (n = 24), appendicitis (n = 3), bowel obstruction (n = 2), and gallbladder perforation (n = 1). Severe morbidity (Clavien-Dindo IIIa or more) occurred in 8 cases (27%), and there were 6 in-hospital deaths (20%). Significant factors related to in-hospital death were age >70 years old (P = 0.029), poor performance status (ECOG score 1 or 2) (P = 0.0088), and serum albumin level <2.6 g/dl (P = 0.026). The incidence of acute abdomen (odds ratio 5.31, P = 0.00017) was significantly higher in the patients receiving anti-VEGF drugs than in those without anti-VEGF drugs. ConclusionThis study identified three predictive factors associated with in-hospital death after emergency surgery during chemotherapy: an older age, poor performance status, and low serum albumin level.

A study on the incidence of abdominal malignancies presenting as acute abdomen in an emergency department

Background: Acute abdomen is one of the most common symptoms that bring a patient to an emergency department. An abdominal malignancy may be the cause of acute abdomen at least in a number of cases. The problem with this is the poorer outcome associated with it due to the lack of preoperative evaluation and preparation and also possible contamination that occurs in case of a perforation. This study aimed at studying the incidence of abdominal malignancies in the patients presenting as acute abdomen and the various presentations in which they present.Methods: Patients who presented with non-traumatic acute abdominal pain in the emergency department at our hospital who required surgery for acute abdomen were taken for the study and the incidence of malignancy in these cases were statistically assessed.Results: Out of the 375 patients who were operated for non-traumatic acute abdomen 62 patients i.e. 16.53% were found to have intraabdominal malignancy. Carcinoma colon was the commonest malignancy, 51.6%. Carcinoma stomach and rectum were the next most common malignancy. Commonest presentation was as a case of intestinal obstruction, 72.6% followed by perforation, 20.9%.Conclusions: In the era were the incidence and early detection of abdominal malignancies are on a rise, a significant portion of these cases present with acute abdominal symptoms and the morbidity associated with such a presentation is of importance. Early detection of the disease by screening is the solution for this.

Evaluation of Predictive Value of P-POSSUM Score in Patients Operated for Acute Abdomen and Comparison of Scoring at Admission and Pre-operatively

Physiological and operative severity score for enumeration of mortality and morbidity (POSSUM), as reported by Copeland et al. (Br J Surg 78: 355–60, 1991) [1] and its Portsmouth modification (P-POSSUM) [2], as reported by Whiteley et al. (Br J Surg 83:812–15, 1996), remain one of the most widely accepted risk assessment scoring system in surgical patients and helps in apprising both the surgeon and the relatives with the involved risk. They have been extensively studied since their development for various surgical procedures, and though most aspects of the scoring are standardized, the timing of physiological scoring is variable (admission vs. pre-operatively) in most of the studies. Hence, we aim to evaluate the predictive value of the score in the defined patients in our setup and also to evaluate which timing of scoring is more accurate, whether at the time of admission or pre-operatively after initial resuscitation. One hundred patients, who underwent surgery for acute abdomen from November 2016 to March 2018 at our institute, were studied. Mortality and morbidity risk were calculated for each P-POSSUM score with physiological scoring done twice, i.e., at admission and pre-operatively. The ratio of observed to predicted death and morbidity (O:E) were calculated and compared for both scores using chi-square test. Area under the curve (AUC) analysis was used to compare the efficacy of both the scores. An observed to expected (O:E) ratio of 0.88 and 1.00 was obtained for mortality with physiological scoring at admission and pre-operatively. Similarly, the O:E values for morbidity were 0.85 and 0.87 respectively. P-POSSUM was found to give an accurate prediction of both mortality and morbidity in patients operated for acute abdomen. Moreover, physiological scoring done with pre-operative variables is superior in comparison to scoring at the time of admission and is a better predictor of outcome.

The use of emergency laparoscopy for acute abdomen in the elderly: the FRAILESEL Italian Multicenter Prospective Cohort Study.

As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.

Sensibilidad antimicrobiana en aislamientos de líquido peritoneal de niños intervenidos por abdomen agudo e infección intraabdominal

Introducción. La apendicitis aguda es causa frecuente de infección intraabdominal en pediatría. La elección del antibiótico se basa en los hallazgos quirúrgicos macroscópicos, el criterio médico, las guías locales o internacionales y, en pocas ocasiones, en el resultado de los aislamientos bacterianos en cultivos de líquido peritoneal y las tasas locales de resistencia. Se analizaron la frecuencia y la sensibilidad microbiológica de los cultivos de muestras de líquido peritoneal de pacientes de un mes a 16 años de edad con manejo quirúrgico por abdomen agudo con sospecha de infección intraabdominal. Materiales y métodos. Se llevó a cabo un estudio prospectivo de cohorte con análisis de las historias clínicas y de resultados de laboratorio de niños sometidos a cirugía por abdomen agudo, en la que el cirujano tomó muestra del líquido peritoneal para la tipificación y determinación de los perfiles de sensibilidad de los microorganismos aislados. Los datos se analizaron con el programa Stata™, versión15.0. Resultados. Se identificaron 303 casos, de los cuales el 93,6 % recibió profilaxis antibiótica con ampicilina-sulbactam y clindamicina-amikacina. El 95,3 % de los procedimientos fueron apendicectomías. Se tomó cultivo del 50 % de las apendicitis perforadas. Se aislaron 48 microorganismos; el más frecuente (2,7 %) fue Escherichia coli positiva para BLEE. El 100 % de los microorganismos resultaron ser sensibles a la amikacina, el 97,2 % al meropenem, y el 94,4 %, a la ciprofloxacina, el cefepime y el ceftazidime. La resistencia más frecuente (37,1 %) fue contra la combinación de ampicilina y sulbactam, en los gérmenes Gram negativos. Discusión. La evaluación de la sensibilidad antimicrobiana de los aislamientos de líquido peritoneal de los procedimientos quirúrgicos en pediatría, es una buena práctica clínica que orienta al cirujano en la adecuada selección del esquema antibiótico y, además, disminuye el riesgo de falla terapéutica temprana y la posibilidad de mayor resistencia o complicaciones infecciosas.

Comparison of P-POSSUM and E-POSSUM in defining prognosis in acute abdomen cases

Background: The study attempts to define prognosis in acute abdomen cases using elderly modification (E-POSSUM) and compares its performance with physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth modification- (P-POSSUM).Methods: A non-randomized, prospective study was conducted between January 2016-November 2018 in 260 patients, aged ≥60 years old, undergoing elective and emergency general surgeries. Baseline characteristics, PS at the time of admission, surgery and OS at the moment of the patient’s discharge was obtained after formal ethical consent. The follow up period was 30 days post-surgery, and complications if any, were noted.Results: When exponential analysis was applied, POSSUM over predicted morbidity in low risk group (&lt;30%), and though, it accurately predicted morbidity in higher risk strata, it was not statistically significant. Similarly, E-POSSUM accurately predicted morbidity for risk strata 60 -100 however, it was not significant when chi-square test was applied. However, when compared to POSSUM morbidity equation, E-POSSUM showed significant difference for risk strata 40-100 and 50-100. When exponential analysis was applied, E-POSSUM accurately predicted post-operative mortality similar to P-POSSUM. However, based on observed and expected ratio, E-POSSUM outperforms P-POSSUM in prediction of mortality.Conclusions: Exponential analysis of E-POSSUM better predicts morbidity and post-operative mortality risk in various acute abdomen cases when compared to POSSUM morbidity and P-POSSUM mortality equation. Hence, E-POSSUM is a valid scoring system for predicting morbidity and mortality risk in elderly patients undergoing elective and emergency surgery for acute abdomen.

Prevalence, causes and management outcome of intestinal obstruction in Adama Hospital, Ethiopia.

BackgroundIn Africa, acute intestinal obstruction accounts for a great proportion of morbidity and mortality. Ethiopia is one of the countries where intestinal obstruction is a major cause of morbidity and mortality. This study aims to determine prevalence, causes and management outcome of intestinal obstruction in Adama Hospital in Oromia region, Ethiopia.MethodA hospital based cross-sectional study design was used. Data covering the past three years were collected from hospital medical records of sampled patients. The collected data were checked for any inconsistency, coded and entered into SPSS version 16.0 for data processing and analysis. Descriptive and logistic regression analyses were used. Statistical significance was based on confidence interval (CI) of 95 % at a p-value of < 0.05.Result262 patients were admitted with intestinal obstruction. The prevalence of intestinal obstruction was 21.8 % and 4.8 % among patients admitted for acute abdomen surgery and total surgical admissions, respectively. The mortality rate was 2.5 % (6 of 262). The most common cause of small bowel obstruction was intussusceptions in 48 patients (30.9 %), followed by small bowel volvulus in 47 patients (30.3 %). Large bowel obstruction was caused by sigmoid volvulus in 60 patients (69.0 %) followed by colonic tumor in 12 patients (13.8 %). After controlling for possible confounding factors, the major predictors of management outcome of intestinal obstruction were: duration of illness before surgical intervention (adjusted odds ratio (AOR) = 0.49, 95 % CI: 0.25–0.97); intra-operative findings [Viable small bowel volvulus (SBV) (AOR = 0.08, 95 % CI: 0.01–0.95) and viable (AOR = 0.17, 95 % CI: 0.03–0.88)]; completion of intra-operative procedures (bowel resection & anastomosis (AOR = 3.05, 95 % CI: 1.04–8.94); and length of hospital stay (AOR = 0.05, 95 % CI: 0.01–0.16).ConclusionSmall bowel obstruction was more prevalent than large bowel obstruction. Intussusceptions and sigmoid volvulus were the leading causes of small and large bowel obstruction. Laparotomy was the most common methods of intestinal obstruction management. Bowel resection and anastomosis was the commonest intra-operative procedure done and is associated with postoperative complications. Wound infection in the affected area should be improved because it is the most common postoperative complication. This can be decreased by appropriate surgical technique and wound care with sterile techniques.

Ideal Time to Surgery for Acute Abdomen

Ideal Time to Surgery for Acute Abdomen

Nonobstructive Acute Renal Failure with a Large Solitary Fibroid.

A 38-year-old African American woman presenting with acute abdominal pain and nonobstructive renal failure was found to have an enlarged fibroid uterus. A differential for sepsis was considered. Lab evaluation revealed an elevated creatinine and myoglobin level at 3.9 mg/dL and 2140 ng/mL, respectively. Ongoing hemodynamic instability mandated surgery for acute abdomen. A 25 cm fibroid uterus was extirpated through a total abdominal hysterectomy. Immediate improvement of acute nephropathy mirrored the postoperative decline in serum myoglobin levels. Myoglobinemia from a massive degenerating fibroid is associated with nonobstructive acute renal failure.

CASO CLINICO: "APENDICITIS" POST- ABORTO

El presente caso, corresponde a la presentación atípica e infrecuente de una de las entidades más frecuentes de abdomen agudo que ameritan tratamiento quirúrgico. Una paciente teniendo el antecedente de haberse realizado maniobras abortivas once días antes, se presenta a Emergencia con una celulitis en el flanco derecho con irradiación a la región dorso-lumbar, formando un área de aproximadamente de 30 x 15 cm.; no refiriendo otra sintomatología. Veinticuatro horas después desarrolla signos de abdomen agudo, cuarenta y ocho horas más, luego de un examen bajo anestesia y legrado uterino se efectúa laparotomía; la causa de todo este cuadro: Apendicitis retrocecal perforada.

Meningitis por Staphylococcus aureus meticilino resistente proveniente de la comunidad. A propósito de un caso

Community-acquired Staphylococcus aureus (CA-SA) infections are becoming more frequent. Most cases present an infection of skin and soft tissue, and the most invasive forms observed are osteoarticular and pleuropulmonary infections. Meningitis is a rare manifestation of Staphylococcus aureus infections. We describe an unusual case of CA-MRSA infection. An infant of eight months presented with signs of irritability and 4 days duration fever, with alternating sensory and abdomen pain. Acute abdomen surgery was discarded and hospitalization was decided with diagnosis of sepsis due to probable enteral focus; antibiotics were indicated. Blood cultures and cerebrospinal fluid culture were positive for MRSA. Sepsis with meningitis by MRSA was diagnosed. On the 7th day of hospitalization the infant presented neurological signs and symptoms. On the resolution computed tomography and the magnetic resonance, images compatible with myelitis were observed. The patient complied with the 21 day endovenous treatment, and showed positive results, being discharged from hospital a month after the appearance of the symptoms.