World Journal of Emergency Surgery via MedWorm.com

Non Operative Management of liver and spleen traumatic injuries: a giant with clay feet

World Journal of Emergency Surgery — Mon, 23 Jan 2012 05:00:00 +0100

After years of initial aggressive surgical treatment and a subsequent shift to Damage Control Surgery, NOM has be shown to be safe and effective and in the 90's it became the gold standard for liver injuries in hemodynamically stable patients, regardless of injury grade and degree of hemoperitoneum, allowing better outcomes with fewer complications and lesser transfusions. Nevertheless concerns have been raised regarding continuous monitoring need, safety in higher grades and general applicability of NOM to all hemodynamically stable patients. Similarly, in the same period and following promising results obtained with splenic salvage by using several surgical techniques such as splenorraphy, high intensity ultrasound, hemostatic wraps and staplers, NOM became the treatment of choice for bl...

Evaluation of gastrointestinal injury in blunt abdominal trauma "FAST is not reliable": The role of repeated ultrasonography

World Journal of Emergency Surgery — Fri, 20 Jan 2012 05:00:00 +0100

Conclusion: Repeated sonography after 12 to 24 hours in patients with negative initial FAST but sustain abdominal symptom can facilitated a diagnosis of GI tract injury and can be as effective method instead of Computed tomography in developing country. (Source: World Journal of Emergency Surgery)

A review on gastric diverticulum

World Journal of Emergency Surgery — Wed, 18 Jan 2012 05:00:00 +0100

The gastric fundal diverticulae are rare. They can present with variable symptoms. We are enclosing a literature review on gastric fundal diverticulum. Lessons have emerged which may help in the management of this rare condition in future. (Source: World Journal of Emergency Surgery)

Ovarian vein thrombosis mimicking acute abdomen: A case report and literature review

World Journal of Emergency Surgery — Fri, 23 Dec 2011 05:00:00 +0100

Conclusions: OVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen. (Source: World Journal of Emergency Surgery)

Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

World Journal of Emergency Surgery — Fri, 23 Dec 2011 05:00:00 +0100

We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were ...

The need for new "patient-related" guidelines for the treatment of acute cholecystitis.

World Journal of Emergency Surgery — Thu, 22 Dec 2011 05:00:00 +0100

Heterogeneity of patients affected by acute cholecystitis, and their co-morbidities make very difficult to standardize the therapy for this very common condition. The staging system suggested in the recent "Tokyo guidelines", did not show a relevant impact on the management of patients and on the outcome of the disease. The relation among local pathological picture, patient clinical status and treatment algorithm, has to be better studied. (Source: World Journal of Emergency Surgery)

Bush Animal Attacks: Management of complex injuries in a resource-limited setting

World Journal of Emergency Surgery — Thu, 22 Dec 2011 05:00:00 +0100

Conclusion: Animal attacks are common throughout the world, but their pattern may vary in Africa throughout jungle and bush environmental settings. It is important to understand the management of these attacks in resource-limited health care environment. Further, the growing population and human encroachment on previously wild habitats such as the northwestern Tanzania bush argues for increased community awareness to assist in prevention of human injuries by animals. (Source: World Journal of Emergency Surgery)

Laparoscopic drainage of an intramural duodenal haematoma: a novel technique and review of the literature

World Journal of Emergency Surgery — Tue, 20 Dec 2011 05:00:00 +0100

We describe laparoscopic treatment of IDH after failed conservative management. To our knowledge, successful laparoscopic drainage of an IDH in an adult has not been described previously in the literature. (Source: World Journal of Emergency Surgery)

Technique for Chest Compressions in Adult CPR

World Journal of Emergency Surgery — Sat, 10 Dec 2011 05:00:00 +0100

Chest compressions have saved the lives of countless patients in cardiac arrest as they generate a small but critical amount of blood flow to the heart and brain. This is achieved by direct cardiac massage as well as a thoracic pump mechanism. In order to optimize blood flow excellent chest compression technique is critical. Thus, the quality of the delivered chest compressions is a pivotal determinant of successful resuscitation. If a patient is found unresponsive without a definite pulse or normal breathing then the responder should assume that this patient is in cardiac arrest, activate the emergency response system and immediately start chest compressions. Contra-indications to starting chest compressions include a valid Do Not Attempt Resuscitation Order. Optimal technique for adult c...

Complicated Intra-Abdominal Infections Observational European Study (CIAO Study)

World Journal of Emergency Surgery — Fri, 09 Dec 2011 05:00:00 +0100

Complicated intra-abdominal infections are frequently associated with poor prognoses and high morbidity and mortality rates.Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.In order to describe the clinical, microbiological, and management-related profiles of both community-acquired and healthcare-acquired complicated intra-abdominal infections (IAIs), the World Society of Emergency Surgery (WSES), in collaboration with the Surgical Infections Society of Europe (SIS-E) and other prominent European surgical societies, has designed the CIAO study.The CIAO study is a multicenter, observational study and will be carried out in various surgical departments throughout Europe. The stud...

Role of Clinical Judgment and Tissue Harmonic Imaging Ultrasonography in Diagnosis of Paediatric Acute Appendicitis

World Journal of Emergency Surgery — Wed, 16 Nov 2011 05:00:00 +0100

The objective of this study was to investigate the hypothesis that the use of a modified clinical practice and harmonic ultrasonographic grading scores (MCPGS) may improve the accuracy in diagnosing acute appendicitis in the pediatric population.Patients & Methods:Main outcome measures: Sensitivity, specificity, and accuracy of the modified scoring system. Five hundred and thirty patients presented with suspected diagnosis of acute appendicitis during the period from December 2000 to December 2009 were enrolled in this study. Children's data that have already been published of those who presented with suspected diagnosis of acute appendicitis- to whom a special clinical practice grading scores (CPGS) incorporating clinical judgment and results of gray scale ultrasonography (US) was applied...

Ten-year experiences with Tracheostomy at a University teaching hospital in Northwestern Tanzania: A retrospective review of 214 cases

World Journal of Emergency Surgery — Thu, 10 Nov 2011 05:00:00 +0100

Conclusion: Upper airway obstruction secondary to trauma and laryngeal tumors still remains the most common indication for tracheostomy in our centre and tracheostomy is still a life saving procedure in the surgical management of airway despite complications which are seen more commonly in paediatric patients. Most of tracheostomy related complications can be avoided by meticulous attention to the details of the technique and postoperative tracheostomy care by skilled and trained staff. (Source: World Journal of Emergency Surgery)

An Observational Study of the Etiology, Clinical Presentation and Outcomes Associated with Peritonitis in Lilongwe, Malawi

World Journal of Emergency Surgery — Tue, 08 Nov 2011 05:00:00 +0100

IntroductionPeritonitis is a life-threatening condition with a multitude of etiologies that can vary with geographic location. The aims of this study were to elucidate the etiology, clinical presentation and outcomes associated with peritonitis in Lilongwe, Malawi. Methods: All patients admitted to Kamuzu Central Hospital (KCH) who underwent an operation for treatment of peritonitis during the calendar year 2008 were eligible. Peritonitis was defined as abdominal rigidity, rebound tenderness, and/or guarding in one or more abdominal quadrants. Subjects were identified from a review of the medical records for all patients admitted to the adult general surgical ward and the operative log book. Those who met the definition of peritonitis and underwent celiotomy were included. Results: 190 sub...

Appendicular Perforation at the base of the Caecum, a Rare Operative Challenge in Acute Appendicitis, A Literature Review

World Journal of Emergency Surgery — Fri, 04 Nov 2011 04:00:00 +0100

Conclusion: There are limited studies to compare these two surgical options in the literature. A larger prospective study is needed to compare both approaches and long term outcome. (Source: World Journal of Emergency Surgery)

A technical modification for percutaneous tracheostomy: prospective case series study on one hundred patients

World Journal of Emergency Surgery — Wed, 02 Nov 2011 04:00:00 +0100

The purpose of this study is to describe a technical modification of percutaneous tracheostomy that combines principles of the Percu TwistTM and the Griggs-Portex(R) methods in a reusable kit. One hundred patients underwent the procedure. There were no false passage, tube misplacement, or deaths related to the procedure. There were two minor bleedings managed conservatively. The technical modification described in this study is safe and simple to execute. (Source: World Journal of Emergency Surgery)

Intramedullary nailing of the femur and the systemic activation of monocytes and neutrophils.

World Journal of Emergency Surgery — Mon, 31 Oct 2011 04:00:00 +0100

Conclusions: Multitrauma patients were characterized by a marked activation of the systemic inflammatory response, associated with a systemic activation of the monocyte and PMN compartments. IMN particularly affected the monocyte arm of the systemic innate immune system. (Source: World Journal of Emergency Surgery)

Analytical review of 664 cases of penetrating buttock trauma

World Journal of Emergency Surgery — Thu, 13 Oct 2011 04:00:00 +0100

A comprehensive review of data has not yet been provided as penetrating injury to the buttock is not a common condition accounting for 2-3% of all penetrating injuries. The aim of the study is to provide the as yet lacking analytical review of the literature on penetrating trauma to the buttock, with appraisal of characteristics, features, outcomes, and patterns of major injuries. Based on these results we will provide an algorithm. Using a set of terms we searched the databases Pub Med, EMBASE, Cochran, and CINAHL for articles published in English between 1970 and 2010. We analysed cumulative data from prospective and retrospective studies, and case reports. The literature search revealed 36 relevant articles containing data on 664 patients. There was no grade A evidence found. The injury...

Reexpansion Pulmonary Edema following a Posttraumatic Pneumothorax: A case report and review of the literature

World Journal of Emergency Surgery — Thu, 01 Sep 2011 23:00:00 +0100

We describe a patient who presented with a post-traumatic right pneumothorax. After the insertion of a chest tube he developed a reexpansion pulmonary edema, witch had to be treated by an intubation. Additionally, a review of the literature regarding case reports of reexpansion pulmonary edema is presented. (Source: World Journal of Emergency Surgery)

Clinical profile and Outcome of Surgical treatment of perforated peptic ulcers in Northwestern Tanzania: A Tertiary hospital experience

World Journal of Emergency Surgery — Thu, 25 Aug 2011 23:00:00 +0100

This study was conducted to evaluate the clinical presentation, management and outcome of patients with peptic ulcer perforation in our setting and to identify predictors of outcome of these patients. Methods: This was a combined retrospective and prospective study of patients who were operated for perforated peptic ulcers at Bugando Medical Centre between April 2006 and March 2011. Data were collected using a pre-tested and coded questionnaire and analyzed using SPSS computer software version 15.0. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study. Results: A total of 84 patients were studied. Males outnumbered females by a ratio of 1.3: 1. Their median age was 28 years and the modal age group was 21-30 years. The median durati...

Post-traumatic Diaphragmatic Herniation of the Liver, Examined by Positron Emission Tomography: Case report

World Journal of Emergency Surgery — Fri, 19 Aug 2011 23:00:00 +0100

We present a case of post-traumatic diaphragmatic herniation of the liver, which mimicked an intrathoracic tumor. After an automobile accident, the patient underwent thoracotomies for hemothorax and lung cancer in the right chest. Seven months later, computed tomography (CT) demonstrated a round tumor in the thorax adjacent to the right diaphragm with a higher density than the liver parenchyma. An intrathoracic tumor including a primary or metastatic lung cancer was suspected. However, positron emission tomography (PET) showed that the uptake of fluorine-18-fluorodeoxyglucose (FDG) was identical to that in the liver, and the tumor appeared to be contiguous with the liver. Thus, we suspected liver herniation. Core needle biopsy revealed liver cells without neoplastic tissue. Upon surgical e...

Breast Gangrene

World Journal of Emergency Surgery — Thu, 18 Aug 2011 23:00:00 +0100

Conclusion: Breast gangrene occurs rarely. Etiology is variable and mutifactorial. Teeth bite while lactation and the iatrogenic trauma by needle aspiration of breast abscess under unsterlised conditions could be causative. Uncontrolled diabetes can be one more causative factor for the breast gangrene. Belladonna application as a topical agent could be inciting factor. Sometimes gangrene of breast can be idiopathic. Treatment is antibiotics and debridement. (Source: World Journal of Emergency Surgery)

Limb salvage after gas gangrene: A case report and review of the literature.

World Journal of Emergency Surgery — Tue, 16 Aug 2011 23:00:00 +0100

Gas gangrene is a necrotic infection of soft tissue associated with high mortality, often necessitating amputation in order to control the infection. Herein we present a case of gas gangrene of the arm in an intravenous drug user with a history of intramuscular injections with normal saline in the shoulder used to provoke pain for recovery after drug induced coma. The patient was early treated with surgery and antibiotics rendering possible the preservation of the limb and some of its function. Additionally, a review of the literature regarding case reports of limb salvage after gas gangrene is presented. (Source: World Journal of Emergency Surgery)

Spontaneous adrenal pheochromocytoma rupture complicated by intraperitoneal hemorrhage and shock.

World Journal of Emergency Surgery — Sun, 14 Aug 2011 23:00:00 +0100