The Challenges to Abdominal and Cardiac Surgeons: Emergency Splenectomy after LVAD Implantation—A Case Report

The paper presents collaboration of an abdominal surgeon and heart team in deciding upon surgical management of a patient with the implanted left ventricular assist device, who has undergone emergency abdominal operation for spleen rupture. The paper focuses on the significance of prompt diagnostics, clinical challenges of hemodynamic and anticoagulant treatment, abdominal organ exposure along the placed left ventricular assist device driveline, identification of vascular structures in conditions of continuous blood flow, and reconstruction of the surgical wound in the driveline projection.

Misdiagnosed Appendicitis in Children

Background: Appendicitis is the one of the most common emergency abdominal operation in children. It is estimated that appendicitis is diagnosed in about 2 % of children who present to emergency department because of acute abdominal pain1. Timely diagnosis and appendectomy can prevent abscess formation, perforation as well as reducing early and late postoperative complication.Methods: This study is a retrospective review of all children diagnosed with acute appendicitis in our emergency department between January 2015 – 2018. We have compared the clinical features and the results of examinations between two group of patients - those who were diagnosed correctly and have been operated,and those who were misdiagnosed and operated later respectively more than 24 hours after initial control.Results: This study includes fifty-nine children less than sixteen years old, admitted in our clinic and operated due to acute appendicitis. Fifty three (89.9%) of them were hospitalized after the first control, whereas the remining six (10.1 %) were discharged home after the initial control. The misdiagnosed patients were returned in our department less than twenty hours after the first control. Compared with the patients in which the diagnosis was made correctly the misdiagnosed patients in general had lower levels of leukocytes, CRP and temperature.Conclusion: The diagnosis of appendicitis in children can be very difficult because of the atypical features. According to our experience and the data from other studies, still there is not a single test or combination of clinical and laboratory examinations, able to discriminate children with and without acute appendicitis with a high percentage of accuracy.

Indications for emergency abdominal surgery in Cape Coast, Ghana

Background: Emergency abdominal surgery continues to form a major workload of the general surgeon. As a result of variation of causes, there is need to revisit and review the pattern of presentation, management and outcome. There had been previous studies from Korle Bu Teaching hospital and Komfo Anokye Teaching Hospital both in Ghana, but this is from Cape Coast Teaching Hospital (CCTH), Central Region, Ghana. The objective is to determine the pattern of presentation and indications for surgery in patients who had emergency abdominal surgical operation in CCTH.Methods: All patients who had emergency abdominal surgical operations at the Cape Coast Teaching Hospital from 1st January 2011 to 25th October 2012 were retrospectively reviewed.Results: Four hundred and eleven patients had emergency abdominal operation over a period of 22 months. The mean age at presentation was 36.3 years (SD 19.3). Male to Female ratio was 2.3:1. Intestinal obstruction was the commonest indication for surgery followed by appendicitis and typhoid ileal perforation. Obstructed abdominal wall hernia was the commonest cause of intestinal obstruction.Conclusions: Early reporting in hospital and access to hernia repair will reduce the morbidity and mortality known to be associated with this condition.