scholarly journals Impact of Inter-Hospital Transfer on Outcomes in Patients Undergoing Emergency Abdominal Surgery: A Tertiary Referral Center’s Perspective

2021 ◽  
Author(s):  
Joël L. Lavanchy ◽  
Jean-Baptiste Dubuis ◽  
Alice Osterwalder ◽  
Sebastian Winterhalder ◽  
Tobias Haltmeier ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Surgical Stress ◽  
Bowel Ischemia ◽  
Care Hospital ◽  
Hollow Viscus ◽  
Hospital Transfer ◽  
Transfer Group ◽  
Perforation Group ◽  
Emergency Abdominal Surgery ◽  
Hollow Viscus Perforation

Abstract Background In trauma patients, the impact of inter-hospital transfer has been widely studied. However, for patients undergoing emergency abdominal surgery (EAS), the effect of inter-hospital transfer on outcomes is largely unknown. Methods This is a single-center, retrospective observational study. Outcomes of transferred patients undergoing EAS were compared to patients primarily admitted to a tertiary care hospital from 01/2016 to 12/2018 using univariable and multivariable analyses. The primary outcome was in-hospital mortality. Results Some 973 patients with a median (IQR) age of 58.1 (39.4–72.2) years and a median body mass index of 25.8 (22.5–29.3) kg/m2 were included. The transfer group comprised 258 (26.3%) individuals and the non-transfer group 715 (72.7%). The population was stratified in three subgroups: (1) patients with low surgical stress (n = 483, 49.6%), (2) with hollow viscus perforation (n = 188, 19.3%) and (3) with potential bowel ischemia (n = 302, 31.1%). Neither in the low surgical stress nor in the hollow viscus perforation group was the transfer status associated with mortality. However, in the potential bowel ischemia group inter-hospital transfer was a predictor for mortality (OR 3.54, 95%CI 1.03–12.12, p = 0.045). Moreover, in the hollow viscus perforation group inter-hospital transfer was a predictor for reduced hospital length of stay (RC -10.02, 95%CI −18.14/−1.90, p = 0.016) and reduced severe complications (OR 0.38, 95%CI 0.18–0.77, p = 0.008). Conclusion Other than in patients with low surgical stress or hollow viscus perforation, in patients with potential bowel ischemia inter-hospital transfer was an independent predictor for higher mortality. Taking into account the time sensitiveness of bowel ischemia, efforts should be made to avoid inter-hospital transfer in this vulnerable subgroup of patients.

scholarly journals Post-traumatic hollow viscus perforation with mesenteric and bowel ischemia

2021 ◽  
Author(s):  
Niharika Prasad
Keyword(s):  
Mesenteric Ischemia ◽  
Young Male ◽  
Acute Mesenteric Ischemia ◽  
Exploratory Laparotomy ◽  
Bowel Ischemia ◽  
Hollow Viscus ◽  
Cross Sectional ◽  
Occlusive Mesenteric Ischemia ◽  
Partial Colectomy ◽  
Hollow Viscus Perforation

Abstract BackgroundHollow viscus perforation and acute mesenteric ischemia are life-threatening conditions that must be recognized and managed appropriately. Computed tomography (CT) helps to visualize the bowel wall directly, as well as in the timely diagnosis of secondary signs of bowel ischemia.Case PresentationA young male presented with blunt trauma to the upper abdomen. A supine radiograph was suspicious of pneumoperitoneum and CT was performed to rule out perforation. The above finding was confirmed on CT, in addition, lack of enhancement of a segment of colon and non-occlusive mesenteric ischemia was evident. He was managed with exploratory laparotomy and repair of the perforation with partial colectomy.ConclusionsThe radiologist should be familiar with signs of pneumoperitoneum on supine radiographs for detection of hollow viscus perforation. These must be viewed with an index of high suspicion in symptomatic patients, post-trauma, and, further cross-sectional imaging may still be required.

scholarly journals Comparative analysis of clinical, radiological and operative findings in acute abdomen

2019 ◽  
Vol 6 (3) ◽  
pp. 806
Author(s):  
Mir Zeeshan Ali ◽  
Vamsee Krishna Maddu
Keyword(s):  
Abdominal Pain ◽  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Diagnostic Utility ◽  
Common Symptom ◽  
Care Hospital ◽  
Hollow Viscus ◽  
Hollow Viscus Perforation

Background: The term acute abdomen refers to signs and symptoms of abdominal pain and tenderness that often requires emergency surgical therapy. The objective of the present study is to compare pre-operative diagnosis based on clinical examination with the operative diagnosis in acute abdomen.Methods: Total 60 cases of acute abdomen who underwent laparotomy in a tertiary care hospital   were analysed prospectively regarding clinical features and also assessed the diagnostic utility of radiological investigations like plain abdominal radiographs, ultrasonography and computed tomography.Results: Acute abdomen was most common in males and 2nd to 5th decade of life. Appendicitis was most common cause of acute abdomen followed by hollow viscus perforation and intestinal obstruction. Abdominal pain was the most common symptom. Tenderness was the most common sign. Diagnostic utility of x-ray is more in hollow viscus perforation and intestinal obstruction, whereas ultrasonography is diagnostic in 64.3%. Ultrasonography accurately diagnosed acute appendicitis in 74.2%, hollow viscus perforation in 50%, and intestinal obstruction in 60% of patients. 95% clinical accuracy was found when compared to intra operative diagnosis. Kappa is 0.912 (p<0.0001).Conclusions: Clinical judgement is key to diagnosis of acute abdomen and investigations are only supplementary and cannot replace the clinical decision.

scholarly journals A rare case of Pseudomonas aeruginosa bacteremia in a newborn with 58 perforations in the small intestine

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuanyuan Xu ◽  
Danqun Jin ◽  
Huan Ye ◽  
Youfeng Liang
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Small Intestine ◽  
Early Detection ◽  
Abdominal Surgery ◽  
Rare Case ◽  
Venous Blood ◽  
Case Presentation ◽  
Systemic Infections ◽  
Emergency Abdominal Surgery ◽  
Timely Treatment

Abstract Background Community-acquired infections of Pseudomonas aeruginosa (P. aeruginosa) occur very rarely. Case presentation P. aeruginos was detected in cultures of venous blood and peritoneal exudate of a newborn with 58 perforations in the small intestine. Intravenous administration of imipenem cilastratin sodium and emergency abdominal surgery were performed. The patient fully recovered and was discharged 17 days after the operation. Conclusions Mild symptoms of systemic infections in newborns may delay the diagnosis. Early detection and timely treatment are the key to improved prognosis.

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