Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the sequential organ failure assessment score in nonocclusive mesenteric ischemia: a multicenter retrospective cohort study.

BACKGROUND: Several large-scale studies have assessed endovascular and surgical treatment methods for nonocclusive mesenteric ischemia (NOMI); however, the prognostic factors for NOMI remain unclear. Therefore, this study aimed to evaluate risk factors for in-hospital mortality among patients with NOMI who underwent laparotomy and to examine therapeutic strategies that may improve the prognosis. MATERIALS AND METHODS: In this multicenter retrospective study, the authors reviewed the electronic medical records retrieved from the inpatient database of patients with NOMI at eight district general hospitals between January 2011 and January 2021. A total of 88 patients who underwent laparotomies were divided into survivor and nonsurvivor groups, and statistical analysis was performed to determine clinical and physiological factors. RESULTS: Exploratory laparotomy based on second-look surgery was the first treatment choice. The overall mortality rate was 48.8%, with a male-to-female ratio of 1.1:1. The median Sequential Organ Failure Assessment (SOFA) score was 8 [interquartile range: 3.75-14.2], and the median SOFA scores were 5 [3-7] in the survivor group and 13 [9-17.5] in the nonsurvivor group. Univariate analysis revealed a significant difference in BMI ( P <0.001), hypoglycemia ( P =0.0012), previous cardiovascular surgery ( P =0.0019), catecholamine use ( P <0.001), SOFA score ( P <0.001), platelet count ( P =0.0023), and lactate level ( P <0.001). Logistic regression analysis using the factors with significant differences revealed that SOFA score ≥10 (odds ratio 23.3; 95% CI: 1.94-280.00; P =0.013) was an independent prognostic factor. In addition, catecholamine use was suggested as a factor with a SOFA score greater than or equal to 10. CONCLUSION: This study confirmed that a SOFA score of greater than or equal to 10 may be associated with increased mortality. While closely monitoring low blood pressure and renal dysfunction, survival rates may be improved if surgical intervention is performed before the SOFA score reaches greater than or equal to 10.

A rare trigger for acute appendicitis leading to small bowel obstruction: traditional serrated adenoma of the appendiceal foramen.

This is the first documented case of traditional serrated adenoma (TSA) of the appendiceal foramen that triggered acute appendicitis resulting in small bowel obstruction (SBO). An 88-year-old Japanese man presented with abdominal pain, distension, and appetite loss. Computed tomography demonstrated distended ileum adherent to cecum with thickened walls. He was diagnosed with SBO, and open ileoceal resection was eventually performed. Pathological examination revealed that a pedunculated polyp had obstructed the appendiceal foramen and triggered acute appendicitis, thus leading to SBO. Histopathological examination of the polyp revealed that the long fronds of the adenoma were lined by dysplastic epithelial cells, which is a characteristic feature of TSA. This case report illustrates that a tiny TSA can trigger the obstruction of the appendiceal foramen and lead to acute appendicitis and SBO. We underline the need for the resection of the polyps in this region regardless of their size.