Surgical Emergency Department Research Articles

Management of acute colonic diverticulitis in the general and surgical emergency departments

Acute left colonic diverticulitis is a very common disease that primarily affects the older population in the Western world. The pathogenesis of acute inflammation of the diverticula may not be as simple as once thought, and the disease cascade could involve a combination of chronic inflammation and altered gut microbiota. Several lifestyle risk factors such as obesity, low-fibre diet, smoking, use of non-steroid anti-inflammatory drugs, inadequate physical activity and others have been associated with a higher risk for diverticulitis. It has been proven that uncomplicated diverticulitis in immunocompetent patients without systemic signs of infection can be treated symptomatically. Outpatient treatment with peroral antibiotics is effective for managing patients with uncomplicated diverticulitis and signs of systemic inflammation. New, less- invasive surgical options have been recognised as appropriate for a select group of patients with complicated diverticulitis. Laparoscopic lavage and drainage are suitable for abscesses where the bowel wall is intact. Resection with primary anastomosis with or without ileostomy is now considered an option for some patients that would historically have to undergo Hartmann’s procedure. The latter still remains the most common operating option even in tertiary referral centres around the world as it is suitable for more complicated cases and critically ill patients. Current evidence does not support routine colonoscopic evaluation for uncomplicated diverticulitis in younger patients without risk factors. Recurrent diverticulitis is now understood to be more benign than was previously thought. Elective resection of the sigmoid colon is therefore no longer a standard treatment for all patients with two or more episodes of acute diverticulitis.

Appendicitis after Appendectomy: A Rare Case

Acute appendicitis is the most common surgical emergency encountered in daily practice setting and appendectomy is most familiar surgical intervention performed in surgical emergency department. The correct diagnose remain tricky even though there are many options available for diagnosis. It becomes very difficult for surgeons to reach on exact diagnose when the patient gave history of previous history of appendectomy. Stump appendicitis is a very rare complication after appendectomy and leading causes of morbidity among children. Stump appendicitis is defined as acute infection of residual appendix. Stump appendicitis is very difficult to diagnose and required a competent surgical tool to quickly evaluate after appendectomy. Instead of having advancement in the field of technology and imaging sciences still the condition is prone to threat and cases of stump appendicitis have been underreported and undiagnosed.

Effect of COVID-19 Pandemic on Early Followup and Outcomes of Non-COVID Surgical Patients

Objectives: The present study evaluated the effect of COVID-19 pandemic on early post-operative follow-up of non-COVID surgical patients. Feasibility of telemedicine in providing early follow-up care was also assessed. Background: Pandemic associated disruption of routine health care services and transport may be associated with early discharge and poor patient follow-up. Telemedicine may act as a tool to provide follow-up advice in this scenario. Methods: The present observational study included all the non-COVID surgical patients discharged from the unit during 1st March 2020 to 30th Jun 2020. All the eligible patients were interviewed telephonically regarding their follow-up visit, post-operative complaints, complications and any medical attention they required. Results: A total of 80 patients were operated during the study period of which 65 (81.3%) underwent planned discharge while an early discharge was issued to 12 (15%) of them. Fifty-one (65.0%) patients came for follow-up in-person either to the surgical ward or emergency department. During telecommunication, 72 (90.0%) patients responded and medical advice was given for their queries. Approximately 88.0% of the patients received satisfactory suggestions with this mode of communication. Conclusion: Early follow up care of surgical patients was delayed in one-third of the cases. Telemedicine increased the proportion of patients receiving follow-up care.

A RARE FOREIGN BODY IN THE CHEST UNDER COVID-19 EPIDEMIC CONDITIONS

One of the negative factors of civilization around the world is the significant growth of injury rate. The manifestations of the latter include suicidal acts that occur in the process of social and individual life. Sometimes people commit suicide because of having incurable diseases. Alcohol addiction contributes to suicide risk. To share with the general medical community the rare case of suicidal trauma which seemed fatal but resolved favorably, though it was not immediately verified. Only after performing a radiological examination in two projections, the subject of suicidal action was detected. We observed a case of a suicide victim: a 55-year-old patient who, being impaired by alcohol, decided to commit suicide after learning about COVID-19 mortality. One hour later he was admitted to the emergency department. After stabbing himself with a kitchen knife, a 55-year-old patient called an ambulance and was delivered in satisfactory condition to the emergency surgical department 1 hour after the injury. There were no signs of bleeding or its consequences or manifestations of vena cava compression. Hemodynamics was stable; there were no external respiration disorders. Clinical blood test was within normal range. Revision of the wound in the lower neck was performed. At a depth of 2.5 cm, something perceived as a sternal notch was located manually, which later turned out to be a foreign body. Due to the location of the injury, it was decided to hospitalize the injured patient for observation. Plain and lateral radiography was performed. Longitudinal sternotomy was chosen for access. Under the entrance wound in the neck, in the lateral mediastinum above the root of the lung, a knife was found above the diaphragm penetrating the parenchyma of the lower lobe. After removing the knife, the lung wound was sutured. The postoperative period ended successfully. Before surgery, an imaging study with at least two different views is mandatory for all chest wounds. If possible, thoracotomy should be scheduled for the daytime.

Epidemiological profile of child victims of everyday life injuries versus road traffic accident

Unintentional injuries (UI) correspond to “unplanned” events; they include everyday life injuries (EDL), road traffic accident (RTA) and work accidents. In our pediatric context, the latter are excluded. Aim: Draw up an epidemiological profile of UI in children hospitalized for at least 24 hours and make a comparison between EDL and RTA. Material and Methods: A cross-sectional study conducted during four years, about children hospitalized for UI, in the pediatric surgical emergency department (PSE) of the children's hospital of Rabat, Morocco. Sociodemographic and medical data were analyzed by statistical software (JAMOVI). Results: 545 files were retained. EDL represented 81.9 % with a male predominance (70.4%). The median age was 8 years [4; 12] with predominance of school children (63.5%). Infants predominated in EDL (15.1%). Spring has a predominance in RTA (33%), while there is a reversal of the trend for the other seasons (p<0.05). As regards the accident, the majority occurred on weekdays. The injured body parts were multiple for the RTA (39.1%) and affected the limbs (58.5%) for the EDL (p <0.05). Radiological abnormalities were found in 79.6% of cases in EDL. The 24-hour hospital stay was for EDL (66.7%) while RTA is hospitalized beyond 48 hours (53.7%).

Surgical Management of Abdominal Trauma: Indications and Outcomes in Two Emergency Units with Limited Infrastructure Resources in Yaoundé (Cameroon)

Introduction: Abdominal trauma is a major public health concern. Their management is controversial and difficult. Operative indications are not codified in all situations. Patients and Methods: This was a descriptive cross- sectional study over a period of 5 years, carried out in the surgical emergency department of the Central Hospital of Yaounde and the Emergency Centre of Yaounde. We reviewed retrospectively medical records of patients who had laparotomy after abdominal trauma. Results: We collected 115 files. There was a male predominance (83.47%) and the average age was 33.8 years. The average time to admission was 12.3 hours and the aetiologies were dominated by road traffic accidents (53%). Abdominal contusions represented 69.56% of cases and abdominal wounds 30.44% of cases. Indications for surgery were hemodynamic instability, evidence of a lesion of a hollow viscus, the presence of evisceration or a gunshot wound, and initial non-operative treatment failure. Postoperative morbidity was 9.56% and overall mortality was 3.47%. Conclusion: Surgical management of abdominal trauma is frequent in our setting, mainly indicated for hemodynamic instability. Results are good with a low morbi-mortality.

Impact of containment following COVID -19 on hospitalization activities in the pediatric surgical emergencies department, children’s hospital of Rabat

The Covid-19 pandemic has put stress on the healthcare system with a major impact on access to healthcare. The aim is to study the impact of containment on the hospitalization of children in the pediatric surgical emergency department, Children’s Hospital of Rabat. Material and methods: A retrospective study was carried out of children admitted at the Pediatric Surgical Emergencies Department (PSE), over a period of 6 months. The data were entered and analyzed by statistical software Jamovi 1.6.23. A chi-square test was used to compare the variables between the two periods: before and during containment. Results: We identified 579 children hospitalized during the first semester of 2020. The median age was 5 years [1-10] with predominance of boys (66.1%). Admission diagnosis are represented by abdominal emergencies (36.8%), head trauma (22.6%). Burns represent only 5,7%. These diagnosis were divided into visceral surgical emergencies (42%), trauma emergencies (48%) and non-urgent pathologies (10%). Surgery was done in 45.6%. Visceral and trauma emergencies were equivalent before and during the containment. On the other hand, there was a slight increase for visceral emergencies (57% Vs 43%) while the number of scheduled patients fell from 94.3% before containment to 5,7% during the containment.

Unintentional Accidents among Children: Associated Factors with moderate /severe forms

Unintentional accidents are very common in children and are the main reason for consultation and hospitalization in paediatric surgery. Aim: To determine the factors associated with unintentional accidents resulting in hospitalization. Material and methods: This is a cross sectional study carried out in the Paediatric Surgical Emergency Department of the Children's Hospital of Rabat over a period of 4 years. We processed 1205 children's files; the data was collected and analysed by Jamovi. Results: for the 545 files selected, the median was 8 years [4; 12] and boys were predominant (70.4%). Sociodemographic factors were represented by low health insurance. In 95.1% of cases, the family lived in a house (50.1%) or an apartment (45%) compared to 4.9% who had insanitary house. For parents' level of education, fathers had a high school education (43.6%) or never attended school (16.9%), compared to 32.9% of mothers who did not attend school. No adult was present during the accident (54.6%). The accident occurred on weekdays (73.2%), especially on winter and summer (41.6% and 33.8%). The main lesions were fractures (53%). The lesions involved the limbs (52.5%) and the head (30.2%) and were multiple in 6.5% of cases. The outcome was simple in 96.1%.

Risk Factor Analysis And Method Development For Predicting The Recurrence Of Gastroduodenal Ulcer Bleeding

Objective — To clarify clinical, laboratory and endoscopic signs of a high recurrence risk of gastroduodenal ulcer bleeding (GDUB) and to develop a multifactorial method for its prediction. Material and Methods — The research was completed over 2019-2020. The study took place in two stages. At the first stage, 409 patients with GDUB, who were treated at the emergency surgical department of Saratov City Clinical Hospital No. 6 from 1991 to 2000, were included in the study. During that time, endoscopic hemostasis therapy was used in a few cases, while modern antisecretory therapy has not yet been developed and carried out. Two groups of patients were compared: with recurrent bleeding (104 patients) and without recurrent bleeding (305 patients). At the second stage, a retrospective analysis of the outcomes of treating 126 patients with GDUB, cared for at the clinic from 2001 to 2009, was carried out. During this period of time, assistance for this pathology was the most complete and matched all current standards. The analysis included 63 patients with recurrent bleeding and 63 patients without recurrent bleeding. We conducted a comparative analysis of the developed method for predicting bleeding recurrence versus the classifications by J.A. Forrest (1974) and G.P. Giderim (1992) in our original modification. Results — At the first stage of the study, the most significant signs for predicting recurrent bleeding were identified as unstable hemodynamics, severity of blood loss, nature of vomiting, presence of concomitant pathology, state of the ulcer surface sensu J.A. Forrest; and localization, size and depth of the ulcer. We determined their informative value in assessing the risk of recurrent bleeding and developed a novel method of its prediction. Taken alone, each of nine predictive signs has a correlation, comparable in the magnitude with patient allocation into each group (based on the absolute value of gamma, ranging 0.49–0.66); the prediction accuracy is 60–74%, with a positive predictive value of 35-49%. The measure of the gamma relationship for splitting patients among groups by the original method based on nine features in conjunction with each other was -0.79 (p<0.001). Conclusion — Prediction of recurrent bleeding by one or two signs is inferior in informational content (although insignificantly) to the multifactorial method. The developed method for predicting the recurrence of ulcer bleeding from nine signs has an optimal ratio of sensitivity and specificity, which ensures a prediction accuracy of over 70% and a positive predictive value of 68.9%.

Gynecological diseases in children and adolescents with the acute abdomen syndrome

Objective. The differential diagnostics of gynecological diseases with a picture of acute abdomen and acute appendicitis may be challenging and can cause a variety of complications, impaired reproductive function and infertility.Purpose. To assess outcomes after diagnosing and treating girls with the syndrome of “acute abdomen” in whom an acute gynecological pathology was revealed.Material and methods. Case histories of 85 girls with gynecological diseases who were hospitalized to the emergency surgical department of Children City Clinical Hospital No 9 in Yekaterinburg are analyzed. All children were admitted to the emergency department with a picture of “acute abdomen”.Results. All children were operated on laparoscopically, and the cause of their acute abdominal syndrome was clarified. Acute inflammatory diseases of the uterine adnexa prevailed in the structure of causes (59%). In 21% of cases, there was uterine adnexa torsion . The rest of children had apoplexy (11%) and ovarian cysts (9%).Conclusion. The differential diagnostics of acute appendicitis and acute gynecological pathologies is difficult due to various and similar clinical symptoms. Laparoscopy can not only identify the cause of pain syndrome, but also can help to chose a future curative tactics .

Endometriosis of the appendix presenting as acute appendicitis

Acute appendicitis is a surgical emergency and accounts for 27.5% of the surgical cases. It is a very common cause of non-gynecologic lower abdominal pain and may occur simultaneously with a variety of gynecologic diseases. We report a case of a 24 years old female, who presented to the surgical emergency department with complaints of acute pain in abdomen for the last 1 day with tenderness in right iliac fossa. Laboratory reports showed leucocytosis with neutrophilia, with presence of toxic granules. A provisional diagnosis of appendicitis was made and the patient was operated. The appendectomy specimen on histopathological examination showed ectopic endometrial glands and stroma in the serosa, based on which a diagnosis of appendiceal endometriosis was given. This case emphasizes the importance of considering the diagnosis of appendiceal endometriosis in a young female of child bearing age with a clinical diagnosis of appendicitis. Keywords: Appendicitis, Endometriosis, Endometrial glands, Stroma.

Where Have All the Emergencies Gone? The Impact of the COVID-19 Pandemic on Obstetric and Gynecologic Procedures and Consults at a New York City Hospital

Study ObjectiveThe purpose of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on surgical volume and emergency department (ED) consults across obstetrics-gynecology (OB-GYN) services at a New York City hospital.DesignRetrospective cohort study.SettingTertiary care academic medical center in New York City.PatientsWomen undergoing OB-GYN ED consults or surgeries between February 1, 2020 and April 15, 2020.InterventionsMarch 16 institutional moratorium on elective surgeries.Measurements and Main ResultsThe volume and types of surgeries and ED consults were compared before and after the COVID-19 moratorium. During the pandemic, the average weekly volume of ED consults and gynecology (GYN) surgeries decreased, whereas obstetric (OB) surgeries remained stable. The proportions of OB-GYN ED consults, GYN surgeries, and OB surgeries relative to all ED consults, all surgeries, and all labor and delivery patients were 1.87%, 13.8%, 54.6% in the pre–COVID-19 time frame (February 1–March 15) vs 1.53%, 21.3%, 79.7% in the COVID-19 time frame (March 16–April 15), representing no significant difference in proportions of OB-GYN ED consults (p = .464) and GYN surgeries (p = .310) before and during COVID-19, with a proportionate increase in OB surgeries (p <.002). The distribution of GYN surgical case types changed significantly during the pandemic with higher proportions of emergent surgeries for ectopic pregnancies, miscarriages, and concern for cancer (p <.001). Alternatively, the OB surgery distribution of case types remained relatively constant.ConclusionThis study highlights how the pandemic has affected the ways that patients in OB-GYN access and receive care. Institutional policies suspending elective surgeries during the pandemic decreased GYN surgical volume and affected the types of cases performed. This decrease was not appreciated for OB surgical volume, reflecting the nonelective and time-sensitive nature of obstetric care. A decrease in ED consults was noted during the pandemic begging the question “Where have all the emergencies gone?” Although the moratorium on elective procedures was necessary, “elective” GYN surgeries remain medically indicated to address symptoms such as pain and bleeding and to prevent serious medical sequelae such as severe anemia requiring transfusion. As we continue to battle COVID-19, we must not lose sight of those patients whose care has been deferred.

Predictors of surgical readmission, unplanned hospitalization and emergency department use in head and neck oncology: A systematic review.

To identify predictors of unplanned hospitalization and emergency department (ED) use among head and neck oncology patients. Peer reviewed publications were identified through a systematic search of MEDLINE, Embase and Cochrane CENTRAL. Studies describing a cohort of HNC patients that detailed predictors of unplanned hospitalization or ED use in risk-adjusted models were eligible for inclusion. The methodologic quality of included studies was assessed using the Quality In Prognostic Studies (QUIPS) tool and an adapted version of the GRADE framework. Of the 932 articles identified, 39 studies met our inclusion criteria with 31/39 describing predictors of surgical readmission and 10/39 describing predictors of ED use or unplanned hospitalization during radiation/chemoradiation treatment. Risk factors were classified into either 'patient-related', 'cancer severity' or 'process' factors. In the subset of studies looking at readmission following surgery wound complications (10/14 studies), presence of comorbidity (16/28 studies), low socioeconomic status (8/17 studies), cancer stage (9/14 studies), and prolonged hospital stay (7/18 studies) were the variables most frequently associated with readmission on multivariable analysis. Presence of comorbidity (6/10) and chemotherapy use (4/10) were more frequently associated with ED use and unplanned hospitalization. Several consistent predictors have been identified across a variety of studies. This work is a critical first step towards the development of readmission and ED prediction models. It also enables meaningful comparison of hospital readmission rates with risk adjustment in HNC patients.

The Impact of the COVID-19 Pandemic on Obstetric and Gynecologic Procedures and Consults at a Metropolitan Hospital in the Epicenter

Study ObjectiveThe purpose of this study was to assess the impact of the COVID-19 pandemic on surgical volume and emergency department (ED) consults across obstetric & gynecologic (OB/GYN) services at a hospital located in the national epicenter of the pandemic.DesignRetrospective cohort study.SettingTertiary-care academic medical center in a metropolitan city.Patients or ParticipantsWomen undergoing OB/GYN ED consults or surgical procedures.InterventionsMarch 16th institutional COVID-19 mandate to hold all elective surgeries.Measurements and Main ResultsThe volume and types of surgical cases and ED consults were compared before and after the COVID-19 mandate. During the pandemic, the volume of ED consults and GYN surgeries significantly decreased, while OB surgeries remained stable. The average weekly case volume for ED consults, GYN surgeries, and OB surgeries were 44.8, 34.8, and 38.6 cases respectively during the “pre-COVID” timeframe (February 1st to March 15th) versus 17.8, 7.2, and 40.9 cases respectively during the “post-COVID” timeframe (March 16th toApril 15th), representing a 60.3% decrease in ED consults (p=<0.01) and a 79.3% decrease in GYN surgical volume (p=<0.01). The distribution of GYN surgical case types also changed significantly during the pandemic with higher proportions of emergent surgeries for ectopics, miscarriages, and concern for cancer (p <0.001). Alternatively, the OB surgical volume and distribution of OB surgical case types remained relatively constant.ConclusionThis study highlights how the pandemic has impacted the ways OB/GYN patients access and receive care. The OB surgeries remained stable during the COVID-19 pandemic reflecting the non-elective and time-sensitive nature of obstetric care. In contrast, ED consults and GYN surgeries decreased significantly. As expected, institutional policies suspending elective surgeries affected the volume and types of GYN surgeries performed during the pandemic, and the “stay-at-home” policy and personal fears of COVID-19 infection likely affected ED consult volumes.

The Incidence and Surgical Approaches of Pancreatic Injuries Following Blunt and Penetrating Abdominal Trauma in Al-DiwaniyahTeaching Hospital

The pancreas is a long J-shaped, soft, lobulated retroperitoneal organ. Pancreatic injury is relatively uncommon, occurring in 0.2–2 % of all trauma patients and 3–12 % of patients with abdominal injury. All traumatic pancreatic injuries are associated with significant morbidity with an overall rate of morbidity nearing 40%, higher grade pancreatic injuries are associated with higher rates of morbidity and mortality . To evaluate of surgical management of blunt and penetrating pancreatic trauma. During the period from January 2015 to September 2018, thirty patients with blunt and penetrating abdominal trauma were managed in emergency surgical department in Al-Diwaniya Teaching Hospital and assigned in prospective a case control study. Patients with proved associated pancreatic injury (regardless of the degree) at the time of laparotomy were included in the study . The mean age of patients was 34.4 year (17- 57 years) among them there was 25 male (83.3 %) and 5 females (16. 7% The overall mortality rate is 20% (6 patients). The predominant mechanism of injury was penetrating 24 patients (80%) from gunshots and 6 patients with blunt abdominal trauma resulted from road traffic accidents). Pancreatic injury is infrequent in abdominal trauma. Its frequency is little different between blunt and penetrating abdominal trauma.

Right para duodenal hernia presenting as small bowel obstruction: a rare case report

Internal hernias are rare congenital anomalies. The most common internal hernias are para duodenal hernias (53%) followed by pericaecal hernias 13%. Para duodenal hernia, a rare congenital anomaly that arises from an error of rotation of the midgut, is the most common type of intra-abdominal hernia. There are two types, right and left para duodenal hernia, the right being less common. Here we present a case of a 21 years old male presented in surgical emergency department non-passage of flatus and stools since, 5 days with associated nausea, vomiting and abdominal pain. Abdominal CT demonstrated signs of small bowel obstruction. A midline laparotomy was performed. Intra operative findings suggestive of right sided para duodenal hernia. Careful reduction of hernia and plication of sacs done with new D-J flexure formation. Para duodenal hernias are rare congenital entities. Left para duodenal hernia is more common than right. The right para duodenal hernia occurs when the pre arterial limb of the mid gut loop fails to rotate around the superior mesenteric artery. Symptoms may vary according to degree of obstruction or gut ischemia. Reduction of contents of the sac and plication of the sac to prevent further hernia formation and resection of small bowel in cases of gut gangrene remains the mainstay of the treatment.

Outcome of primary repair in typhoid ileal perforation at Tertiary Care Hospital.

Typhoid ileal perforation is the common complication of typhoid fever in third week of its phase of progression. It is the most common cause of mortality in developing countries. Small perforations are dealt with primary repair and the more complicated disease is treated by multiple other options. Prognosis is good with primary repair with least postoperative complications. Objectives: To detect the outcome of typhoid ileal perforation treated by primary repair at tertiary care hospital. Study Design: Cross sectional study. Setting: Surgical Department of PMC Hospital Nawabshah. Period: From August 2017 to December 2018. Material &amp; Methods: This study included total 70 patients. All patients were admitted from surgical OPD and emergency department of PMCH Nawabshah. Out of 70, 45 (64.28%) were females and 25 (35.71%) were male patients. Age ranged from 27 to 52 and 24 to 47 in females and males respectively. The common presentation was pain in whole abdomen along with distention and fever, vomiting. Plain X ray chest/ Abdomen and ultra sonography showed gas under diaphragm. Primary repair was done and also other surgical options but our study included only the postoperative outcomes of primary repair of typhoid ileal perforation. A few complications were detected after primary repair of the gut perforation. Results: Total 70 patients were included in this study. 45 (64.28%) were females and 25 (35.71%) were male patients. In females, 25 (55%) were found single perforations of less than 1cm whereas 7 (15.5%) had size of perforation less than 1.5 cm. In 25 males, 11 (44%) had single perforations of less than 1cm in size. 2 (8%) had &lt; 1.5 cm size perforations and 12 (48%). Over all complication rate in this study was 26%. Conclusion: Primary repair is the best surgical option to treat typhoid ileal perforation in selected patients with least postoperative complications.

The Utility of Therapeutic Anticoagulation in the Perioperative Period in Patients Presenting in Emergency Surgical Department With Extremity Vascular Injuries

Extremity vascular trauma is a challenging surgical emergency in both civilian population and combat environment. It requires vigilant diagnosis and prompt treatment to minimize limb loss and mortality. A multidisciplinary team approach is required to deal with shock states, concomitant abdominal injuries, head injuries, and fractures with significant tissue loss and psychological stress.Anticoagulation is frequently used during traumatic vascular repair to avoid repair site thrombosis, postoperative deep venous thrombosis, and pulmonary embolism (PE). In this review article, we are going to search about how frequent is the use of anticoagulation in terms of limb salvage rates, and mortality rates or side effects of anticoagulation in terms of risk of bleeding episodes, and the need for future prospective studies.Extremity vascular trauma is managed by a variety of methods including open repairs, endovascular repairs, and nonoperative management. Most of the literature demonstrates the use of systemic or regional anticoagulation in the management of vascular injuries with the improvement in limb salvage rates and reduced morbidities but confounding factors lead to variable results. Some studies show an increased risk of bleeding in trauma patients with the use of anticoagulants in trauma settings without any significant effect on repair site thrombosis. More comprehensive studies and randomized controlled trials are needed to confirm the importance of perioperative anticoagulation while avoiding the confounding factors in terms of injury severity scores, ischemia time, demographics of patients, modes of injury, comorbidities, grades of shock, concomitant injuries that need anticoagulation like venous injuries or intracranial injuries that are contraindications to the use of anticoagulation, type of anticoagulation and expertise available as well as the experience level of the operating surgeon. Literature also reveals the use of new oral anticoagulants (e.g., dabigatran) to be associated with lesser bleeding episodes when compared to warfarin, so in future, we can check the feasibility of these agents to reduce the bleeding episodes and at the same time improve the limb salvage rates.

Laparotomy Due to War-Related Penetrating Abdominal Trauma in Civilians: Experience From Syria 2011-2017.

Penetrating abdominal trauma is one of the injuries that could affect civilians in wartime. This retrospective study investigates the commonly injured abdominal organs, and the impact of multiple injured organs on mortality. We reviewed the operating room (OR) logs of patients who presented to the surgical emergency department (SED) at Al-Mouwasat University Hospital with war-related abdominal penetrating trauma requiring exploratory laparotomy between April 1, 2011 and December 31, 2017. Of 7826 patients with traumatic injuries, 898 patients (11.5%) required exploratory laparotomy. Of all patients who had an exploratory laparotomy (n = 898), 58 patients (6.5%) died in the perioperative period. Regarding complete laparotomies (n = 873 patients), small intestines, large intestines, and liver were the most commonly affected organs (36.4%, 33%, 22.9%, respectively). A total of 92 patients (10.2%) had negative laparotomy in which all the abdominal organs were not injured. The perioperative mortality rate (POMR) increased when more organs/organ systems were injured per patient reaching a peak at 3 organs/organ systems injuries with a POMR of 8.3%. POMR was highest in patients with musculoskeletal injuries (18.2%), followed by vascular injuries (11.8%), and liver injuries (7%). The management of civilians' abdominal injuries remains a challenge for general and trauma surgeons, especially the civilian trauma team. The number and type of injured organs and their correlation with mortality should be considered during surgical management of penetrating abdominal injuries.

Serious Liver Trauma: Predictive Factors Of Therapeutic Choice And Prognostic Factors (About 65 Cases)

The charge of the severe hepatic traumas underwent a radical change from exclusive surgical treatment to non-operative-based conservative approach that benefited from the recent advances in the field of imagery as well as from the follow-up strategies of intensive care.&#x0D; A retrospective survey was carried out involving 65 patients treated for serious liver traumas in the surgical emergency department of Ibn Rochd university hospital of Casablanca.&#x0D; The aim of this study is to assess our act refunding SLT through the definition of the evolutionary, therapeutic, diagnostic, and epidemiological data.&#x0D; All the penetrating and blunt SLT were included in this survey. The seriousness was defined by the hemodynamic instability and a lesion stage higher to III according to the MIRVIS rating. The clinical and paraclinical data as well as morbidity and mortality were analysed.&#x0D; Traffic accidents were the main cause of SLT our series is mainly composed of young male subjects (54 men, 83%). There were 86% of blunt traumas (56 cases) there was common polytrauma (78,5%). Ultrasound and CT scans were performed to most patients (respectively 83% and 78%). Fifty one patients had non operative treatment (78,5%) whereas 14 patients underwent surgery. This option was due to their hemodynamic instability and not the hepatic trauma lesion stage in the operative group, the evolution was complicate in 35,7% of the operated patients whereas in the non operative group the complications supervened only in 23,5% of the cases. The mortality rate was respectively 28,5% versus 7,8% for the non operative treatment the NOT of the SLT allowed to obtain satisfactory results despite the seriousness of the hepatic lesions.&#x0D; It should be anted that the treatment choice was made mainly according to the hemodynamic condition and not to the radiological stage lesions&#x0D; A genuine and precocious agreement among the surgeon, the anesthesiologist and the interventional radiologist allowed to avoid the server complications following SLT so that the injured patient who could be initially rescued manage to escape first hour complications, and ultimately recover.