Surgical Emergency Research Articles

Effect of anemia with surgical emergency laparotomy in a peripheral set-up of Punjab.

Objective: To determine the effect of anemia in patient undergoing emergency laparotomy and post-operative complications. Study Design: Prospective observational study. Setting: We monitored individuals having emergency laparotomies at a tertiary care hospital. Period: June 2021 to May 2023. Methods: Patients undergoing emergency laparotomies for various reasons. Post-operative complications were the main variable noted in this study. Estimation of risk for complications analyses by using Poisson regression method in patient with anemia. Approval was obtained from the local ethics committee with reference number: SMC/0058. Results: About 76 patients, mostly male (79.3) with median age of 42 years. Complications were noted in 16.3% (12). 14 patients (23%) were pre-operatively anemic at time of operation. Patients with moderate to severe anemia had more complications post-operatively (96% CI). Conclusion: Anemia increase the risk of complications and morbidity of patients undergoing emergency laparotomies due to various reasons but anemia is amenable to increase the morbidity and complications post-operatively.

An Uncommon Cause of Peritonitis: Perforation of Undiagnosed Gastric Cancer

Gastric cancer, while common, rarely presents as an acute surgical emergency, with perforation occurring in less than 5% of cases. This report details a 53-year-old male who presented with abdominal pain and vomiting, leading to a diagnosis of perforated gastric adenocarcinoma confirmed by imaging and subsequent total gastrectomy. The case underscores the challenges of diagnosing perforated gastric cancer, which often mimics benign conditions. Effective imaging, especially CT scans, is crucial for timely diagnosis and management. Given the high mortality associated with surgical interventions, further research is needed to establish standardized treatment guidelines for this rare complication.

Acute adnexa with preserved flow to the ovary: Could isolated tubal torsion be the cause?

Isolated tubal torsion (ITT) is a surgical emergency that is less well characterized than ovarian torsion and presents with its own diagnostic challenges. We retrospectively examined patients with ITT and compared them to patients with ovarian torsion to better understand the unique features of this pathophysiologic process. The medical records of patients who were identified as having ITT or ovarian torsion intraoperatively between January 2019 and November 2022 were reviewed. Patient demographics, clinical documentation, diagnostic imaging reports, operative reports, and pathology results were collected. A total of 82 patients met inclusion criteria of which 62 (75.6%) had ovarian torsion and 20 (24.4%) had ITT. Most patients (63.4%) underwent 2 or more imaging studies prior to the operating room. A diagnosis of torsion occurred more often on preoperative imaging for the ovarian torsion group (67.7% ovarian torsion vs 35.0% ITT, p=0.01). Doppler flow to the ovary was expectedly absent in 65.9% of ovarian torsion patients but interestingly also absent in 25% of ITT patients (p=0.01). Patients with ovarian torsion were more likely to have ovarian cysts (56.5% vs 10.0%, p<0.001), while patients with ITT were significantly more likely to have a paratubal cyst (90.0% vs 38.7%, p<0.001). ITT is a surgical emergency that poses a risk to future fertility. Ultrasound studies, including doppler, may not be as definitive in patients with ITT and early cross-sectional imaging should be considered. When there is a high clinical suspicion for ovarian torsion or ITT, there should be a low threshold for diagnostic laparoscopy.

What matters in testicular torsion? Association of hospital transfer, race and socioeconomic factors with testicular outcomes in a single center experience

IntroductionTesticular torsion is a surgical emergency that is managed with either septopexy-only or tunica vaginalis flap with septopexy if the testis is potentially viable or orchiectomy if not. Minimizing time from ischemia onset to surgery maximizes the likelihood of testicular preservation. While factors such as time from door to OR can be easily targeted, others such as inequalities in access to care are more difficult to address. ObjectiveWe sought to determine whether patient transfer affects testicular outcomes intraoperatively and in the long-term. Secondary goals included investigating the impact of race and Child Opportunity Index (COI) on testicular torsion outcomes and defining the optimal time cutoff from symptom onset to presentation that predicts salvage. MethodsWe reviewed our prospective testicular torsion database to identify boys who underwent operative intervention for testicular torsion between January 2015 and March 2022. The association of race and COI with testicular salvage, defined as septopexy-only, was evaluated with univariate and multivariate logistic regression controlling for time to presentation, while the association of transfer with salvage was evaluated with univariate and multivariate logistic regression controlling for age, time to presentation, and time to OR. To determine the optimal cutoff for time to presentation to predict testicular salvage, the Youden index was calculated. ResultsRace and COI were not associated with testicular salvage on either univariate or multivariate logistic regression that controlled for time to presentation. Transfer status was not associated with salvage, while age, time from symptoms to presentation, and time from institutional arrival to OR were associated with salvage. The optimal time cutoff to predict salvage using the Youden index was 10.5 hours from symptom onset to presentation and 14.5 hours from symptom onset to detorsion. DiscussionTime to presentation was the strongest, modifiable risk factor associated with testicular salvage. As it may be difficult for children to accurately communicate their symptoms, diagnosis and prompt management of testicular torsion can be delayed. Improvement in outcomes can be achieved by placing greater efforts into patient, parental, and primary care provider education of the signs and symptoms of testicular torsion. ConclusionsRace, COI, and transfer status were not found to have a statistically significant effect on testicular salvage outcomes in patients presenting with testicular torsion. Despite the common premise of a six-hour window until testicular loss, we found that intervention within the acute window of 14.5 hours from symptom onset is still associated with salvage.

WhatsApp: A Blessing or Bane for Communication between Emergency Physicians and Vascular Surgeons?

Abstract The integration of WhatsApp (WhatsApp Inc., Mountain View, CA, USA) into the health-care sector is transforming the dynamics of medical communication. Launched in 2009 and incorporated into the Facebook suite of companies in 2014, WhatsApp has become a pivotal platform for health-care professionals. It allows for quick, personal, and group messaging, which is increasingly used to exchange patient information, discuss cases, and make timely decisions. The app’s end-to-end encryption is critical for maintaining patient confidentiality, ensuring that sensitive data are only accessible to the intended recipients. This security feature and the group sharing format enable health-care teams to communicate confidentially and efficiently, bolstering the oversight capabilities of attending senior consultants or physicians over their junior peers. The real-time exchange of information is crucial in providing continuous supervision and facilitating immediate feedback, which is indispensable in clinical training and patient care. However, the widespread adoption of WhatsApp also comes with challenges and potential drawbacks, which have been the focus of past research. These studies assessed the impact of WhatsApp on health-care delivery, considering both the enhancement of communication it offers and the issues it may present, such as data security beyond encryption and the blurring of professional and personal boundaries. In this “medical opinion” from an academic tertiary care center in Muscat, we explored how emergency medicine physicians can effectively use WhatsApp to expedite or bypass referral processes for emergency cases, particularly those involving vascular and other surgical emergencies.

Unusual causes of Small bowel obstruction: a review of the literature and revisited cross-sectional imaging checklist.

Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent evaluation to avoid complications such as bowel gangrene, perforation, or peritonitis. Imaging is necessary in most cases of suspected bowel obstruction, to take an appropriate decision, for apt patient management. Among the common causes of small bowel obstruction, adhesions, external herniae, malignancies, and Crohn's disease top the chart. Imaging helps in determining the presence of obstruction, the severity of obstruction, transition point, cause of obstruction, and associated complications such as strangulation, bowel gangrene, and peritonitis. This review is based on the cases with unusual causes of bowel obstruction encountered during our routine practice and also on the extensive literature search through the standard textbooks and electronic databases. Through this review we want our readers to have sound knowledge of the imaging characteristics of the uncommon yet important causes of bowel obstruction. We have also revisited and structured a checklist to simplify the approach while reporting a suspected case of small bowel obstruction. Imaging plays a key role in the diagnosis of small bowel obstruction and in determining the cause and associated complications. Apart from the common causes of small bowel obstruction, we should also be aware of the uncommon causes of small bowel obstruction and their imaging characteristics to make an accurate diagnosis and for apt patient management.

Application of Community Detection Methods to Identify Emergency General Surgery–Specific Regional Networks

There is growing interest in developing coordinated regional systems for nontraumatic surgical emergencies; however, our understanding of existing emergency general surgery (EGS) care communities is limited. To apply network analysis methods to delineate EGS care regions and compare the performance of this method with the Dartmouth Health Referral Regions (HRRs). This cross-sectional study was conducted using the 2019 California and New York state emergency department and inpatient databases. Eligible participants included all adult patients with a nonelective admission for common EGS conditions. Interhospital transfers (IHTs) were identified by transfer indicators or temporally adjacent hospitalizations at 2 different facilities. Data analysis was conducted from January to May 2024. Admission for primary EGS diagnosis. Regional EGS networks (RENs) were delineated by modularity optimization (MO), a community detection method, and compared with the plurality-based Dartmouth HRRs. Geographic boundaries were compared through visualization of patient flows and associated health care regions. Spatial accuracy of the 2 methods was compared using 6 common network analysis measures: localization index (LI), market share index (MSI), net patient flow, connectivity, compactness, and modularity. A total of 1 244 868 participants (median [IQR] age, 55 [37-70 years]; 776 725 male [62.40%]) were admitted with a primary EGS diagnosis. In New York, there were 405 493 EGS encounters with 3212 IHTs (0.79%), and 9 RENs were detected using MO compared with 10 Dartmouth HRRs. In California, there were 839 375 encounters with 10 037 IHTs (1.20%), and 14 RENs were detected compared with 24 HRRs. The greatest discrepancy between REN and HRR boundaries was in rural regions where one REN often encompassed multiple HRRs. The MO method was significantly better than HRRs in identifying care networks that accurately captured patients living within the geographic region as indicated by the LI and MSI for New York (mean [SD] LI, 0.86 [1.00] for REN vs 0.74 [1.00] for HRR; mean [SD] MSI, 0.16 [0.13] for REN vs 0.32 [0.21] for HRR) and California (mean [SD] LI, 0.83 [1.00] for REN vs 0.74 [1.00] for HRR; mean [SD] MSI, 0.19 [0.14] for REN vs 0.39 [0.43] for HRR). Nearly 27% of New York hospitals (37 of 139 hospitals [26.62%]) and 15% of California hospitals (48 of 336 hospitals [14.29%]) were reclassified into a different community with the MO method. Development of optimal health delivery systems for EGS patients will require knowledge of care patterns specific to this population. The findings of this cross-sectional study suggest that network science methods, such as MO, offer opportunities to identify empirical EGS care regions that outperform HRRs and can be applied in the development of coordinated regional systems of care.

Percutaneous Cholecystostomy for Acute Cholecystitis During Spaceflight

INTRODUCTION: Acute calculous cholecystitis is a common surgical emergency and cholecystectomy is the gold-standard treatment. However, alternative drainage modalities such as percutaneous cholecystostomy tube (PCT) placement have been proposed for poor surgical candidates or in remote environments, such as space. We reviewed the literature to assess the theoretical utility of PCT to treat acute cholecystitis during long-duration spaceflight or on the Moon or Mars. METHODS: A systematic review of 16 peer-reviewed articles published since 2018 was completed to describe the terrestrial efficacy of PCT placement for acute calculous cholecystitis. RESULTS: The mean initial clinical success rate after PCT was 89.9% (range 82.2–100.0%). Duration of indwelling PCT ranged from median 6 to 58 d. Mean rate of recurrent cholecystitis was 15.8% (range 5.0–36.4%). A mean 35.6% of patients (range 18.0–61.0%) required interval cholecystectomy. Mean 30-d mortality was 9.6% (range 5.8–14.0%). A mean 18.6% of patients (range 7.2–30.0%) required repeat percutaneous intervention due to PCT placement complications. DISCUSSION: While PCT achieves high rates of early resolution of cholecystitis, the long-term outcomes after PCT are relatively poor, with risk of recurrent cholecystitis, need for cholecystectomy, and frequent postprocedural complications requiring repeat procedural interventions. In cislunar space, the return to Earth for cholecystectomy following PCT may be achieved, eliminating some of these concerns. However, with long-duration space travel such as a mission to Mars, PCT is likely inadequate for the long-term treatment of cholecystitis. Prophylactic cholecystectomy, developing surgical capabilities in space, or preflight screening ultrasound for cholelithiasis should be seriously considered for long-duration spaceflight. Lazow SP, Siu M, Brown L, Kamine TH. Percutaneous cholecystostomy for acute cholecystitis during spaceflight. Aerosp Med Hum Perform. 2024; 95(10):771–776.

The validity of emergency surgery score in predicting mortality and complications in general surgical emergencies.

The validity of emergency surgery score in predicting mortality and complications in general surgical emergencies.

Management of Gynecological and Obstetrical Peritonitis in the General Surgery Department of the Hospital National Ignace Deen Conakry University Hospital (Guinea)

Aim: Was to highlight the methods of management of gynecological and obstetric peritonitis. Patients and Methods: This was a retrospective and descrıptive study analyzing the records of patients operated on for peritonitis of gynecological or obstetric origin in the general surgery department of the Ignace Deen National Hospital, CHU of Conakry during the period from January 2020 to December 2022. The parameters studied were epidemiological, sociodemographic, clinical and therapeutic. Results: Gynaecological and obstetric peritonitis accounted for 15.6% (n= 58) of all peritonitis. The mean age of the patients was 27.9 years, with extremes of 17 and 46 years. The majority of patients were married, with multiple gestations, and the average consultation time was 13.4 days. The etiology most frequently encountered was uterine perforation (34%), and the surgical procedure most frequently performed was drainage (all patients) and uterine suture (63.4%). We recorded 3 cases of death (5.2%). Conclusion: Gynecological and obstetric peritonitis are both medical and surgical emergencies, mainly affecting sexually active young women, with considerable mortality.

EVALUATING C-REACTIVE PROTEIN AND TOTAL LEUKOCYTE COUNT AS PREDICTIVE MARKERS FOR COMPLICATED APPENDICITIS

Background and Aims:Appendicitis is a common surgical emergency, yet its still difficult to tell the difference between simple and complex cases. More severe forms of appendicitis, such gangrenous or perforated instances, have worse consequences and need prompt medical attention. In order to distinguish between simple and complex appendicitis, this study sought to assess the diagnostic accuracy of total leukocyte count (TLC) and C-reactive protein (CRP). Methods:This hospital-based observational research was undertaken at F.H. Medical College, Agra, from September 2022 to March 2024. After obtaining informed permission, 88 patients, ages 18 to 60, who were scheduled for appendicectomy were included. To quantify CRP (&gt;60 mg/L) and TLC (&gt;11,000/cumm), blood samples were obtained. For diagnosis, histopathological results constituted the gold standard. SPSS version 25.0 was used to analyze the data, and chi-square and ANOVA tests were used for statistical comparisons. To evaluate the diagnostic performance, Receiver Operating Characteristic (ROC) curves were created, with a significance threshold of p&lt;0.05. Results:CRP demonstrated superior diagnostic accuracy with an AUC of 0.95 (p&lt;0.001), sensitivity of 85.7%, and specificity of 90.9%. TLC showed an AUC of 0.66 (p=0.046), with 94.4% sensitivity but lower specificity at 37.1%. The projected cut-off for CRP was &gt;94 mg/L and for TLC, &gt;12,222/cumm. CRP also had a higher accuracy (90%) compared to TLC (48.9%). Conclusion:CRP emerged as a more reliable marker than TLC in predicting complicated appendicitis, with greater diagnostic accuracy and specificity. Larger multi-center studies are recommended to further validate these findings and establish universal cut-off values.

Effectiveness and Safety of Cholecystectomy Versus Percutaneous Cholecystostomy for Acute Cholecystitis in Older and High-Risk Surgical Patients: A Systematic Review.

Acute cholecystitis (AC) is a prevalent surgical emergency, particularly among elderly individuals who present with high perioperative risks. While early cholecystectomy (CCY) is the standard treatment, percutaneous cholecystostomy (PC) isproposedas an alternative for high-risk patients. This systematic review aims to evaluate the comparative safety and efficacy of CCY versus PC in managing AC among elderly and high-risk surgical patients. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted across multiple electronic databases, including PubMed/Medline, Cochrane Central Register of Controlled Trials (CENTRAL), ScienceDirect, Europe PMC, ClinicalTrials.gov, and EBSCO Open Dissertations, from July 1to 15, 2024. Studies published from January 2019 to July 15, 2024, were included if they focused on patients aged 65 and older or those classified as high-risk surgical candidates. The review encompassed 72,366 participants across 22 studies, predominantly observational. Key outcomes assessed included postoperative complications, readmission rates, recurrence of cholecystitis, and mortality rates. This study highlights the need for individualized treatment strategies for managing AC in elderly populations. While CCY remains the preferred approach when feasible, PC offers a critical alternative for high-risk patients. Future research is necessary to optimize outcomes for this vulnerable population.

EFFECTIVENESS OF TOTAL LEUKOCYTE COUNT (TLC) AND C-REACTIVE PROTEIN (CRP) IN THE DIAGNOSIS OF ACUTE APPENDICITIS

Acute appendicitis is a typical surgical emergency. Diagnosing it can be challenging due to variable symptoms. Total leukocyte count (TLC) and C-reactive protein (CRP) are commonly used to assess inflammation and guide treatment. This study evaluates the diagnostic accuracy of TLC and CRP in acute appendicitis to determine appropriate management. Objective: This study aimed to assess the diagnostic accuracy of TLC and CRP in predicting acute appendicitis and their role in determining the proper management approach, either conservative or surgical. Methods: This prospective observational cohort study was conducted in the Department of General Surgery at Dow University of Health Sciences (DUHS), Ojha Campus, from July 2023 to March 2024. A total of 87 adult patients with clinical signs of appendicitis and an Alvarado score of greater than 4 were enrolled. Data was analyzed using SPSS version 22. Variables included socio-demographic characteristics, clinical presentations, and levels of TLC and CRP. Both conservative and surgical management approaches were analysed, with laparoscopic appendectomy being the most common procedure. Results: Among the 87 patients, most were male. TLC and CRP levels were similar across genders, with notable variations in socio-demographic characteristics. CRP levels were more frequently elevated in patients managed conservatively compared to those managed surgically. Both TLC and CRP were elevated in 43 patients (49.4%), highlighting the value of using both markers together. Surgical intervention, primarily laparoscopic appendectomy, was the preferred treatment, with suppurative inflammation being the most common histopathological finding. Conclusion: The combination of TLC and CRP significantly improves the diagnostic accuracy for acute appendicitis. TLC correlates more strongly with the need for surgical intervention, whereas CRP did not show a significant association with management type. Both markers are useful in assessing the duration of the complaint, but they are not substitutes for clinical judgment. Further research is warranted to refine their diagnostic utility and evaluate their impact on surgical care availability in resource-limited settings.

Microbiological profiles and clinical outcomes of critically ill surgical patients with lower gastrointestinal perforation in Japan: a single-center retrospective observational study

BackgroundLower gastrointestinal perforation (LGP) is a surgical emergency disease that can result in secondary bacterial peritonitis. Microbiological studies on LGP are rare. The present study aimed to ascertain the microbiological profile of LGP in patients admitted to the intensive care unit (ICU) at our institute after surgery. In addition, we investigated whether initial empirical therapy with vancomycin was associated with in-hospital mortality, duration of ICU stay, and duration of ventilator support.MethodsThis single-center, retrospective, observational study was conducted at Kobe City Medical Center General Hospital, Japan. The study population included all patients diagnosed with LGP who were admitted to the ICU after emergency surgery between 2017 and 2023. The primary outcome assessed was the microbiological profile of microorganisms isolated from ascites fluid and blood of the participants. The secondary end-points were in-hospital mortality, duration of ICU stay, and duration of ventilator support. We performed univariate and multivariate regression analyses to evaluate the end-points.ResultsDuring the study period, 89 patients were included in the analysis. The most commonly identified pathogen from the ascites cultures was Escherichia coli (65.2%), followed by Enterococcus spp. (51.7%). E. faecium was identified in 16 (18.0%) ascites samples. The microbiological profile of critically ill patients with LGP admitted to the ICU after surgery was similar to that of previous studies on intra-abdominal infection (IAI). Therefore, the initial empirical therapy in the IAI guidelines is more appropriate for LGP. Multivariate regression analysis suggested that the combination of initial empirical therapy with vancomycin was not associated with in-hospital mortality (odds ratio [OR] = 0.96, 95% confidence interval [CI] 0.23–3.00, p = 0.955), duration of ICU stay (coefficient=-0.92, 95% CI -3.04–1.21, p = 0.393), or duration of ventilator-support (coefficient=-9.03, 95%CI -49.69–31.63, p = 0.659).ConclusionThe microbiological profile of critically ill patients with LGP admitted to the ICU after surgery was similar to that of previous studies on IAI. However, the frequency of E. faecium in the present study was higher than that in previous studies. Initial empirical therapy with drugs such as meropenem in combination with vancomycin for E. faecium was not associated with in-hospital mortality, duration of ICU stay, and duration of ventilator support, after adjusting for confounding factors.

Acute Appendicitis at the Bougouni Reference Health Center

Introduction: Acute appendicitis is an acute inflammation of the vermicular appendix. The objective was to describe the epidemiological, clinical, anatomo-pathological, and therapeutic aspects of appendicitis. Methodology: We carried out a prospective study from January 2020 to December 2020. Results: We listed 60 cases of acute appendicitis which represented 34.4% of surgical emergencies. The average age was 30.9 years. There is a predominance of men with a sex ratio of 1.61. The average consultation time was 2 days. The clinical manifestation was pain in the right iliac fossa. Abdominal ultrasound revealed thickening of the appendicular wall in 55 (91.67%) of cases. The blood count showed hyperleukocytosis in 59 (98.3%). The Alvarado score was between 08 -10 in 57 (95%) of cases. The appendix was laterocecal in 36 (60%) of cases. Appendectomy with burial of the stump was performed in 40 (66.7%), appendectomy without burial in 20 (33.3%). The postoperative complication was parietal abscess 1 (1.66%). Mortality was 0%. Conclusion: Acute appendicitis is the most common abdominal surgical emergency in our department. Early treatment would help reduce complications.

ACUTE APPENDICITIS, PANORAMIC REVIEW

Introduction: appendicitis is distinguished by inflammation of the vermiform appendix and usually shows acutely within the first 24 hours. Acute appendicitis is the main source of abdominal surgery in children and the most common abdominal surgical emergency around the globe. Objective: to detail the current information related to acute appendicitis, etiology, epidemiology, pathophysiology, histopathology, anamnesis, physical examination, evaluation, treatment and complications of the disease. Methodology: a total of 37 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 25 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: acute appendicitis, abdominal pain, appendix, abdominal surgery, acute abdominal treatment. Results: appendectomy by open laparotomy or laparoscopy is the standard treatment for acute appendicitis, however, intravenous antibiotics are exceptionally considered as first line therapy in individuals. The incidence of acute appendicitis varies from 100 to 223 new cases per 100,000 people per year. This disease can occur at any age, however it is most commonly seen in the age range of 5 to 45 years. The lifetime incidence of acute appendicitis is 8.6% in men and 6.7% in women. The risk of appendiceal rupture may vary with 2% of cases being frequently perforated 36 hours after the onset of symptoms. Conclusions: It is of vital importance to recognize the etiology, epidemiology, pathophysiology, clinical picture and tests that support the diagnostic decision in any case of acute abdomen, especially in cases of acute appendicitis, because an accurate diagnosis will lead us to a rapid intervention, adequate treatment, reducing the risk of mortality and the risk of potential complications in the affected individual. Diagnostic tests and scales play an important role in the diagnosis. The efficacy of antibiotics as primary treatment for uncomplicated acute appendicitis has been extensively investigated, with conflicting and mixed results and conclusions. Comparing the results between individuals who underwent laparoscopic appendectomy and those who underwent open appendectomy, the former group showed a lower incidence of wound infection, a lower level of postoperative analgesic requirement and shorter postoperative hospital stays in the former group, with the main disadvantage being the longer operative time. KEY WORDS: appendicitis, pain, appendix, surgery.

Early surgical outcomes of children with mechanical intestinal obstruction at Moi teaching and referral hospital, Kenya

Background: Intestinal obstruction constitutes the largest proportion of abdominal surgical emergencies in the paediatric and adult patients in Sub-Saharan Africa, including Kenya. It is associated with high postoperative surgical complication and mortality rate in low resource healthcare systems. Methods: A prospective mixed methods study with consecutive sampling procedure was carried out from September 2021 to June 2023. Pediatric patients from birth to 14 years, with mechanical intestinal obstruction were included in the study. Categorical data was analyzed in frequencies and percentages and continuous data was analyzed using measures of central tendency and measures of dispersion. Bivariate and multivariate associations between the dependent and independent variables were assessed with a p value of less than 0.05 being statistically significant. Results: The final study population was 318 participants. Majority of participants were male with neonates comprising almost one third of participants. Classical symptoms were present in a majority of patients at initial presentation. Intussusception (34.6%) was the leading acquired aetiology of paediatric mechanical intestinal obstruction. Operative surgical management was in 94.6% of participants. Surgical complications were present in 61.1% of participants. The commonest surgical complication was surgical site infection in 16.9%. Overall mortality rate was 10.2% with 23.3% among neonates and 4.9% in older children. Referral status was statistically associated with mortality (p&lt;0.001). Intestinal atresia had the highest case-specific mortality rate. Age, presence of comorbidity were factors associated to postoperative complications and mortality (p&lt;0.05). Conclusions: The overall mortality rate was 10.2%. A higher mortality was seen among neonates compared to older children.

Hemoperitoneum: Frequency, Management and Prognostic Factors in the General Surgery Department Hospital National Ignace Deen, CHU de Conakry, Guinea

&amp;lt;i&amp;gt;Aim&amp;lt;/i&amp;gt;: To report our experience in the management of haemoperitoneum in the general surgery department of the Ignace Deen National Hospital. &amp;lt;i&amp;gt;Patients and methods&amp;lt;/i&amp;gt;: This was a retrospective descriptive and analytical study, covering a period of 5 years, from January 2017 to December 2021, carried out in the general surgery department of the Ignace Deen National Hospital. All records of patients admitted for hemoperitoneum were included. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: During the five (5) years, 120 cases of hemoperitoneum were collected, representing 1.1% of all abdominal surgical emergencies. The mean age of the patients was 24 ± 16.83 years. The patients were predominantly male, with a sex ratio M/F: 1,05. The average admission time was 32.1 hours. Haemoperitoneum was traumatic in 58.33% of cases. Road traffic accidents accounted for 35.83% of cases. Treatment was surgical in 81 patients (69.23%). The main anatomopathological lesions found were: rupture of ectopic pregnancy (33.33%), rupture of the spleen (17.5%). The procedures performed were: salpingectomy (61.72%), splenectomy (23.45%). The prognostic factors were: age greater than 30 years, admission time greater than 48 hours, large haemoperitoneum. Post-operative management was straightforward in 92.50% of cases with a death rate of 4.17%. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: Hemoperitoneum is a frequent occurrence in the department. Treatment was surgical with hemostasis, salpingectomy and splenectomy. Prognostic factors were age, admission time and quantity of hemoperitoneum.

OUTCOME OF GRAHAM PATCH OMENTOPEXY IN THE MANAGEMENT OF PERFORATED DUODENAL ULCER

Perforated duodenal ulcer remains a surgical emergency with significant morbidity and mortality. Graham’s patch omentopexy is a commonly performed procedure for its management. Evaluating the outcomes of this technique is crucial for improving patient care. Objective: To examine the outcomes of Graham’s patch omentopexy in managing perforated duodenal ulcers, focusing on postoperative complications. Methods: This study included 45 patients diagnosed with perforated duodenal ulcers who underwent Graham’s patch omentopexy from June 2023 to December 2023. The outcomes were assessed in terms of postoperative complications, including wound infection, wound dehiscence, pneumonia, bile leakage, abdominal abscess, and mortality. Results: The mean age of the patients was 46.49 ± 9.58 years. Postoperative complications included wound infection in 14 patients (31.3%), wound dehiscence in 13 patients (28.9%), pneumonia in 6 patients (13.3%), bile leakage in 5 patients (11.1%), abdominal abscess in 6 patients (13.3%), and mortality in 1 patient (2.2%). Conclusion: Graham’s patch omentopexy is an effective technique for managing perforated duodenal ulcers; however, complications such as wound infection, dehiscence, pneumonia, bile leakage, abdominal abscess, and mortality can occur. Further studies are needed to identify factors associated with these complications to optimize patient outcomes.

Role of Ultrasonography in the Diagnosis of Acute Appendicitis

Introduction: Acute appendicitis is still prevalent as a major surgical emergency. Due to the fast progress of the ailment, surgery is often the most sensible approach to manage it. But any surgery comes with its fair share of risk. If the diagnosis of the disease can be made more accurate prior to surgery, the error rate of negative appendectomy can be greatly reduced. Aim of the study: The aim of the study was to evaluate the role of ultrasonography in the diagnosing acute appendicitis. Methods: This prospective cross-sectional study was conducted at the Institute of Nuclear Medicine &amp; Allied Sciences (INMAS), Rangpur with Department of Surgery &amp; Department of Pathology of Rangpur Medical College Hospital, Rangpur, Bangladesh. The study duration was 02 years, from 01January 2022 to 31 December 2023. A total of 100 cases were selected from those patients were come for ultrasound examination, send from the hospital with pain in the right lower quadrant of the abdomen for the purpose of this study. Result: Among the 100 participants of the study, histopathological diagnosis showed that 86% were acute appendicitis cases and 14% had normal appendicitis. Gender or age had no significant association with histopathological diagnosis, but male prevalence was observed in the study, with a high prevalence of young adults. The original site of pain was periumbilical pain shifted to the right iliac fossa for half the participants. Pain duration was between 18-24 hours for 36% of the cases. All participants presented with pain, fever, anorexia, and nausea had a high prevalence among participants. The sensitivity and specificity of high-resolution ultra-sonogram were 84.9% and 85.7% respectively. Conclusion: Appendicitis is a disease of the young, and can occur in participants of both genders. Histopathological diagnosis has no significant association with patient age or gender. Ultra-sonogram has high sensitivity and specificity ratio in diagnosing acute appendicitis and also h