Study of acute intestinal obstruction management and its outcome

Background: Acute intestinal blockage (AIO) is a common abdominal emergency with a high morbidity and mortality rate. Early blockage diagnosis, skilled operative management, correct technique during surgery and intense postoperative therapy yield superior results. The aim was to study the aetiology, clinical presentation, therapy and outcomes of patients with IO who presented in the emergency department.Methods: This prospective study was conducted at the general surgery department from June 2019 to May 2021. The study comprised 60 patients with IO who presented to the OPD or emergency room and the data was analysed.Results: Among 60 patients with IO, peak incidence was observed in patients above 50 years of age, predominantly among males. Abdominal pain turned out to be the most common symptom of IO in our patients. Patients obstructed in the small intestine were found to be predominant. Post-operative adhesions were the most common cause of IO.Conclusions: Early diagnosis, proper preoperative hydration, fast investigations, and early operational intervention were found to increase survival in patients with intestinal obstruction in the current study.

Impact of Single-port Laparoscopic Approach on Postoperative Pain and Cosmesis for Acute Appendicitis: A Comparison with Multi-port Laparoscopic Approach

Background: Acute appendicitis is the most common surgical abdominal emergency. Single-port laparoscopic appendectomy (SPLA) has been suggested potential advantages including less postoperative pain and better cosmesis. The aim of this study was to compare the postoperative pain and cosmetic outcomes between SPLA and multi-port laparoscopic appendectomy (MPLA) for acute appendicitis.Materials and methods: The study included 47 patients who underwent SPLA and 51 patients who underwent MPLA for acute appendicitis between August 2014 and November 2017. The patient scar assessment questionnaire (PSAQ) was used to assess cosmetic outcomes. Results: MPLA involved a longer median operative time than MPLA (60 vs. 47.5 minutes, p=0.02). There were no apparent differences in the time before diet tolerance, length of hospital stay, inflammatory laboratory findings including C-reactive protein and white blood cell count, and postoperative complication rate. SPLA patients had a smaller total incision length (2.0 vs. 2.5 cm, p<0.001) and the total number of analgesics used on postoperative day 0 in the SPLA group was significantly lower than that of the MPLA group (1 vs. 1, p=0.011). The PSAQ scores showed that the SPLA group had a better overall outcome than the MPLA group with respect to total score (48 vs. 55; p = 0.026), appearance (15 vs. 18; p = 0.002) and consciousness (8 vs. 10; p = 0.005), but not in the satisfaction with appearance and symptoms subscales.Conclusion: SPLA is safe and feasible and provides better cosmetic outcomes and less analgesic requirements on the day of surgery compared to MPLA.

Volvulus with sigmoid necrosis in children: Two cases observed at Ignace Deen Hospital

Introduction: We report the clinical observation of 2 cases of volvulus with sigmoid necrosis in children. Observation: Two male patients, aged 12 and 15, were hospitalized with acute mechanical bowel obstruction. There was an asymmetric, motionless meteorism and rectal emptiness. X-rays of the abdomen revealed an arch. Laparotomy found volvulus with necrosis of the sigmoid colon. The Hartmann-type colostomy and the ideal colectomy were the surgical procedures. Conclusion: Sigmoid volvulus is a rare abdominal emergency in children and severe in the necrosis stage.

Impact of single-port laparoscopic approach on postoperative pain and cosmesis for acute appendicitis: a comparison with multi-port laparoscopic approach

Background: Acute appendicitis is the most common surgical abdominal emergency. Single-port laparoscopic appendectomy (SPLA) has been suggested potential advantages including less postoperative pain and better cosmesis. The aim of this study was to compare the postoperative pain and cosmetic outcomes between SPLA and multi-port laparoscopic appendectomy (MPLA) for acute appendicitis.Materials and methods: The study included 47 patients who underwent SPLA and 51 patients who underwent MPLA for acute appendicitis between August 2014 and November 2017. The patient scar assessment questionnaire (PSAQ) was used to assess cosmetic outcomes. Results: MPLA involved a longer median operative time than MPLA (60 vs. 47.5 minutes, p=0.02). There were no apparent differences in the time before diet tolerance, length of hospital stay, inflammatory laboratory findings including C-reactive protein and white blood cell count, and postoperative complication rate. SPLA patients had a smaller total incision length (2.0 vs. 2.5 cm, p<0.001) and the total number of analgesics used on postoperative day 0 in the SPLA group was significantly lower than that of the MPLA group (1 vs. 1, p=0.011). The PSAQ scores showed that the SPLA group had a better overall outcome than the MPLA group with respect to total score (48 vs. 55; p = 0.026), appearance (15 vs. 18; p = 0.002) and consciousness (8 vs. 10; p = 0.005), but not in the satisfaction with appearance and symptoms subscales.Conclusion: SPLA is safe and feasible and provides better cosmetic outcomes and less analgesic requirements on the day of surgery compared to MPLA.

EP.FRI.886 Clinicians’ compliance and diagnostic utility of digital rectal examination in acute abdominal emergencies: a prospective, blinded study

Aims One hundred years ago, Sir Zachary Cope described digital rectal examination (DRE) as ‘extremely important and informative’ in the assessment of the acute abdomen. Medical students have always been taught of the importance of including a DRE as part of the abdominal examination. It has however been observed that DRE is often omitted in clinical practice. The aims of the study are to determine how frequently DRE is carried out in acute abdominal emergencies and also to determine the diagnostic utility of DRE in this setting. Methods Patients over the age of 18 presenting to the on-call general surgeons in a teaching general hospital with any acute abdominal symptoms over a 15 day period were assessed prospectively. The performance of a DRE by any clinician at any point up to 24 hours post-admission was recorded, and the findings of DRE were analysed with respect to the final diagnosis. Results Out of the 168 patients presenting with an abdominal emergency, 41 (24.4%) had a rectal examination. 70.7% of DRE were done by surgical trainees and foundation doctors. Most DREs were performed when the presenting complaints were constipation, rectal bleeding, and suprapubic pain. The findings on DRE directly contributed to the final diagnosis in 11 patients. Conclusions DRE is only preformed selectively during the initial evaluation of surgical patients presenting with acute abdominal symptoms. However DRE remains a key part of clinical examination. The theoretical and practical skills in the performance of DRE should be safeguarded via continuing education and training.

Evolution of damage control surgery in non-traumatic abdominal pathology: a light in the darkness

Damage control surgery is based on temporal control of the injury, physiologic recovery and posterior deferred definitive management. This strategy began in the 1980s and became a formal concept in 1993. It has proven to be a strategy that reduces mortality in severely injured trauma patients. Nevertheless, the concept of damage control in non-traumatic abdominal pathology remains controversial. This article aims to gather historical experiences in damage control surgery performed in non-traumatic abdominal emergency pathology patients and present a novel management algorithm. This strategy could be a surgical option to treat hemodynamically unstable patients in catastrophic scenarios such as hemorrhagic and septic shock caused by peritonitis, pancreatitis, acute mesenteric ischemia, among others. Therefore, damage control surgery is light amid better short- and long-term results.

Abdominal emergency related to retro and intraperitoneal lesions caused by COVID-19

Digestive manifestations accompanying or preceding respiratory symptoms of coronavirus disease (COVID-19) caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) are frequent and appears to be associated with its most severe forms. In contrast, isolated digestive involvement in covid-19 is rare and misdiagnosed. It was found that nausea/vomiting, diarrhea, abdominal pain and loss of appetite are the main recognized digestive disorders in patients infected by SARS-COV-2. Acute abdomen with occlusive syndrome has never been reported in the literature to our knowledge. We report the case of a 60-year-old woman who was presented with an occlusive syndrome related to retro and intraperitoneal lesions caused by Covid-19 infection without any respiratory manifestations. She underwent an emergency surgery. The paucity of data about this unusual clinical presentation posed a serious diagnostic and therapeutic challenge.

SURGICAL INDICATION IN TRANSIENT OR RECURRENT INTUSSUSCEPTION IN PAEDIATRIC PATIENTS – A DILEMMA FOR MANAGEMENT

Background – Intussusception is one of the most common abdominal emergencies dealt in early childhood by Paediatric Surgeons. We paediatric surgeon dealt various abdominal emergency in early childhood, Intussusception is the one of them. The decision to operate on patients of intussusception may sometimes be difcult, such as when the patients have transient intussusception without features of intestinal obstruction, like abdominal distension. Decision for surgery in patients of intussusception is very difcult in some circumstances like patient have complaint of abdominal pain only or transient intussusception. No other sign and symptoms of intestinal obstruction, abdominal distention. So, we did this study in such circumstances. to study the patients of recurrent intussusception, trans Aims and objectives - ient intussusception or newly diagnosed intussusception without intestinal obstruction, who had abdominal pain either off and on or continuous for long time. this is a Methods – retrospective study. It was conducted between January 2020 to December 2020 at Department of Paediatric surgery, Sir Padampat Mother and Child health institute, S.M.S. Medical College, Jaipur. Patient of persiste Conclusion - nt abdominal pain due to recurrent transient intussusception with or without classical triad is the matter of surgical intervention in paediatric patients.

Serum Soluble CD40 Ligand in Predicting Simple Appendicitis and Complicated Appendicitis at Different Time Points in Children

Objectives: Appendicitis is a common abdominal emergency in children. It is difficult for clinicians to distinguish between simple appendicitis (SA), gangrenous appendicitis (GA), and ruptured appendicitis (RA) in children based on physical and current laboratory tests. Abdominal computed tomography with the disadvantage of excess radiation exposure is usually used in the emergency room for appendicitis surveys. Serum soluble CD40 ligand (sCD40L) is an inflammatory biomarker. This study aimed to use sCD40L to distinguish SA, GA, and RA.Methods: All patients aged &lt;18 years old with suspected appendicitis were tested once for serum sCD40L within 72 h of appendicitis symptoms. We compared sCD40L levels of SA, GA, and RA individually on days 1, 2, and 3 in patients with normal appendix (NA), a total of nine subgroups. Thereafter, the diagnostic performance of sCD40L in predicting appendicitis and the receiver operating characteristic curves were carried out.Results: Of 116 patients, 42 patients had SA, 20 GA, 44 RA, and 10 NA. We found six subgroups with significant p-values of sCD40L predicting appendicitis as follows: SA on day 2, GA on days 2 and 3, and RA on days 1–3. The sensitivity and specificity of sCD40L at the best cutoff point with 178 pg/mL in these six subgroups range from 0.75 to 1.00 and 0.90, respectively.Conclusions: SCD40L is a good predictor of pediatric appendicitis. Clinicians can use sCD40L to distinguish from SA, GA, and RA in children with suspected appendicitis.

Torsion of the wandering spleen as an abdominal emergency: a case report

Background Wandering spleen is a rare clinical entity with a less than 0.2% reporting incidence rate. In this case, the spleen is present abnormally in the abdominal or pelvic cavity instead of its normal anatomical location. The aetiology is either congenital or acquired. The condition is caused by the absence or maldevelopment of the spleen's suspensory ligaments, which holds the spleen static in the left hypochondrium. Case presentation A 27-year-old female patient presented to the emergency department with complaints of abdominal pain, fever, nausea, vomiting, and constipation for three days. A palpable movable mass was found during the physical examination, and torsion of the wandering spleen’s pedicle was confirmed by CT scan. Open splenectomy was performed, and the patient was recovered uneventfully. Conclusion Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.