An integrated model of care between general surgery and general medicine rationalizes and enhances the care of older surgical patients.

BACKGROUNDS: There is growing evidence on the benefits of integrated models of care between surgeons and physicians in non-orthopaedic surgery. We implemented a new General Surgery/General Medicine care model, for all emergency General Surgery patients aged 75 years and older. We compared rates of goals of care (GOC) documentation, hospital-acquired complications (HAC), mortality, and hospital length of stay (LOS). METHODS: This is a non-randomized trial, with data collected prospectively in phase 1 (2021-2022), where patients received the traditional standard of care (case-by-case referral to a General Physician), and in phase 2 (2022-2023) where patients received integrated care. Variables were compared between phase 1 and phase 2 using Generalized Linear Models (GLMs). RESULTS: Five hundred and forty-nine patients, 188 in phase 1 and 361 in phase 2, participated in the study. On univariate analysis, there was a significant increase in patients treated non-surgically in phase 2 (58.5% vs. 69.0%). Patients treated non-surgically had significantly shorter LOS, experienced less HACs (P < 0.001). Other variables did not significantly differ after implementation of the service. The multivariate GLM revealed a significant reduction in admissions with undocumented GOC in phase 2 (P = 0.037). CONCLUSION: This study showed that an integrated care model resulted in a greater proportion of patients being treated non-surgically with a comparable rate of HAC and mortality, as well as better documentation of patients' GOC. As the number of older surgical patients will continue to rise, the call for such service to become standard of care in non-orthopaedic surgery is pressing.

Novel procedure for hepatic venous outflow block after liver resection: A case report.

BACKGROUND: Postoperative complications like remnant hepatic vein (HV) outflow block and liver torsion can occur after right hepatectomy. Hepatic falciform ligament fixation is typically used to prevent liver torsion. We report a novel procedure to manage outflow block. CASE SUMMARY: An 80-year-old man developed HV outflow block after remnant right hepatectomy, despite liver fixation and intraoperative HV flow check. He had a history of cholangiocellular carcinoma and had undergone posterior segmentectomy and choledojejunostomy. The falciform ligament fixation was inadequate to maintain liver position. Emergency surgery was performed, using an omental flap and mobilized right side colon with ileocecal region to prevent liver dislocation due to intraabdominal adhesion. His postoperative course was uneventful. CONCLUSION: This is the first report providing a novel surgical procedure when the falciform ligament is insufficient for remnant liver fixation.

Exploring Rural-Urban Differences in the Receipt of Nonelective Cancer-specific Gastrointestinal Surgery Using a Multilevel Mixed-Effects Approach.

BACKGROUND: Rural communities constitute a populace marked by various social challenges influencing health outcomes. As such, nonelective surgeries for cancer may have a disproportionate impact on rural populations. We explored patient and county-level factors contributing to differences in the receipt of nonelective cancer-specific surgery between rural and urban residents. METHODS: This retrospective study included adult patients captured in the SEER-Medicare data between January 2008 and December 2015 with an incident stage I-IV cancer of the stomach, liver/intrahepatic bile duct, pancreas, gallbladder/other biliary origin, or small intestine who underwent a cancer-specific surgery. The primary outcome was nonelective cancer-directed surgery among rural versus urban residents. We conducted a multivariable mixed-effects logistic regression model to adjust for confounders while accounting for county-level clustering. RESULTS: The sample included 10,136 patients who underwent a surgical intervention; 2,941 (29%) were nonelective. The incidence of nonelective surgery was lower among rural compared tourban patients [351 (27%) and 2590(29%); p= 0.05]. There was no statistically significant difference in the unadjusted and adjusted odds of nonelective surgery between rural and urban residents [OR 0.88, 95% CI (0.76-1.03); p= 0.11] and [aOR 0.86, 95% CI (0.72-1.02); p= 0.080]. Additionally, high social vulnerability index counties or Black race was significantly associated with increase odds of nonelective surgery [aOR 1.33, 95% CI (1.07-1.65); p=0.009] and [aOR 1.49, 95% CI (1.26-1.77); p<0.0001], respectively. CONCLUSION: This study found no difference in the odds of receiving nonelective surgery for GI foregut cancers between rural and urban populations. However, Black race and high SVI were associated with higher odds of the receipt of nonelective surgery. Further research is warranted to explore if disparities in clinical outcomes exist despite the comparable likelihood of receiving nonelective surgery between rural and urban communities.

Surgery for non-Meckel's small-bowel diverticular perforation: two case reports and a literature review.

BACKGROUND: Similar to colonic diverticula, small-intestinal diverticula are often asymptomatic, but may cause life-threatening acute complications. Non-Meckel's small-bowel diverticular perforation is rare, and the rate of mortality is high. However, there is currently no consensus regarding its therapeutic management. CASE PRESENTATION: Case 1: A 73-year-old Japanese man with localized lower abdominal pain was referred to our hospital. Enhanced computed tomography (CT) revealed diverticulitis of the small intestine, which was managed conservatively. Four days after admission, abdominal pain worsened, and repeat CT revealed extraintestinal gas. Emergency surgery was performed for the segmental resection of the perforated jejunum with anastomosis. Case 2: A 73-year-old Japanese woman was transferred to our hospital with small-bowel perforation. CT revealed scattered diverticula in the small intestine and extraintestinal gas around the small-intestinal diverticula. Emergency surgery was performed for the segmental resection of the perforated jejunum with anastomosis. CONCLUSIONS: Conservative treatment for small-bowel diverticular perforation may be attempted in mild cases; however, surgical intervention should not be delayed. Segmental resection of the affected intestinal tract with an anastomosis is the standard treatment. Residual diverticula should be documented because of the possibility of diverticulosis recurrence.

Assessment of Complications and Length of Hospital Stay Associated With Surgical Emergencies in Patients With Concurrent COVID-19 Infection.

The delivery of surgical services was profoundly affected by the COVID-19 pandemic, resulting in the postponement of elective surgeries and a shift in focus to essential emergency procedures. Our study aimed to assess the impact of concurrent COVID-19 infection on complications, hospital stay, and recovery following emergency surgery. A retrospective matched cohort study was conducted between July 2020 and February 2022 at a tertiary care hospital in India. Data from 48 patients with COVID-19 infection in the immediate preoperative period was compared with 48 matched controls not infected with the virus. The data collected included patient demographics, surgical procedures, duration of hospital stay, and postoperative complications. Patients with concurrent COVID-19 infection had notably longer mean hospital stays (13.44 days) than the controls (6.63 days) (P = 0.002). An elevated proportion of COVID-19-positive patients experienced discharge delays (36 out of 48, 75%), compared to just six of the 48 non-COVID-19 patients (12.5%) (P ≤ 0.001). Postoperative findings in the COVID-positive cohort revealed elevated rates of pulmonary complications (5/48, 10.4%), higher rates of postoperative ICU admissions (8/48, 16.7%), and persistently elevated D-dimer levels extending beyond postoperative day seven (18/48, 37.5%). This suggests that emergency surgery in patients with COVID-19 is linked to significantly lengthier hospital stays, increased discharge delays, and a greater prevalence of adverse events in the postoperative period when compared to controls. These findings underscore the need for enhanced perioperative strategies and preparedness for potential future pandemics.

Effect of Preoperative Geriatric Nutritional Risk Index on Prognosis in Patients after Surgery for Lower Gastrointestinal Perforation.

INTRODUCTION: Geriatric Nutritional Risk Index (GNRI) is a reliable index derived from serum albumin levels, height, and weight. Although various prognostic factors have been studied, the effect of preoperative nutritional status on surgical outcomes remains unexplored. This study aimed to evaluate the efficacy of the GNRI in predicting postoperative outcomes of lower gastrointestinal perforation. METHODS: Eighty patients treated at our institution between January 2016 and December 2022 were retrospectively analyzed. This study primarily focused on the correlation between preoperative GNRI and two key outcomes: postoperative hospital stay duration and 1-year mortality rate. RESULTS: Our findings revealed a significant association between low GNRI scores and increased 1-year mortality (odd ratio 4.0, 95% confidence interval [CI] 1.1-16, p = 0.025). Kaplan-Meier analysis and log-rank test showed that patients in the low GNRI group had markedly poorer overall survival rates than those in the high GNRI group (12-month survival rate 0.88 [95% CI: 0.75-0.95] vs. 0.65 [95% CI: 0.47-0.78]; p = 0.018). Additionally, both univariate and multivariate analyses indicated that lower GNRI scores were associated with prolonged hospital stays. CONCLUSION: We showed that a low GNRI score was associated with high mortality and prolonged hospital stay after emergency surgery for lower gastrointestinal perforation.

Impact of routine pre-operative risk assessment on patients undergoing emergency major abdominal surgery in a regional Victorian hospital.

BACKGROUND: Routine preoperative risk assessment (RPRA) using objective risk prediction tools may improve the perioperative outcomes of emergency major abdominal surgery (EMAS). This project aims to identify whether the introduction of RPRA with the 'National Emergency Laparotomy Audit (NELA) Calculator' as standard-of-care for EMAS at a regional Victorian hospital has improved postoperative outcomes, reduced unplanned postoperative critical care unit (CCU) admission rates, and impacted the 'no-lap' rate. METHODS: An audit was performed including all adult general surgery patients who required EMAS at Bendigo Health between September 2017 and August 2022, including those palliated up-front. Patients requiring surgery for uncomplicated appendicitis, cholecystitis, trauma, and diagnostic laparoscopy were excluded. Patient demographics, preoperative NELA score, CCU admission data and postoperative outcomes were collected and compared between patients undergoing surgery before and after the introduction of RPRA. RESULTS: Six hundred and ninety-one patients were included in the analysis. Median NELA score was 5 (IQR 1.5-11.75). 2.60% of patients were palliated up-front and did not proceed to surgery. Among the 673 operative patients, 30-day mortality was 5.20%. Following the introduction of RPRA there was a significant reduction in the unplanned CCU admission rate, from 9.14% to 3.48% (P = 0.04). There was no change in postoperative mortality, severe complication rate or planned CCU admission rate. CONCLUSION: RPRA reduced rate of unplanned CCU admissions. Postoperative mortality and complication rates did not change following introduction of RPRA. RPRA appears useful in guidance of preoperative palliative decision-making, but further study is required to validate its use in this context.

C-reactive Protein/Albumin Ratio Predicts Short-term Postoperative Outcomes and Intraabdominal Abscess Formation in Colorectal Perforation.

Objectives: This study aimed to investigate preoperative factors, including the C-reactive protein (CRP)/albumin ratio (CAR), associated with postoperative outcomes in patients with colorectal perforation who underwent emergency surgery to improve postoperative prognosis. Methods: Twenty-eight consecutive patients who underwent emergency surgery for colorectal perforations were included. We retrospectively investigated the clinical factors associated with their postoperative outcomes. Results: The median patient age was 69.5 years (range, 46.0-93.0 years); 13 patients (46.4%) were males and 15 (53.6%) were females. Colorectal cancer (8 [28.6%]) was the most common cause of colorectal perforation. Postoperative complications were diagnosed in 18 patients (64.3%), with intraabdominal abscess as the most common (6 [21.4%]). Multivariate analysis revealed that CAR (odds ratio, 1.357; 95% confidence interval, 1.056-1.743; p=0.017) was an independent risk factor for postoperative complications. A cutoff value of 4.9 was selected to predict the development of postoperative complications based on the CAR. The proportion of all postoperative complications (p=0.016), postoperative complications of Clavien-Dindo classification grade II or higher (p=0.002), and death during hospitalization (p=0.049) were significantly higher in the group of patients with CAR ≥ 4.9 than in those with CAR < 4.9. Additionally, intraabdominal abscess (p=0.049) was significantly higher in the group of patients with a non-improvement in CAR on postoperative day 3 than in those with an improvement in CAR on postoperative day 3. Conclusions: Perioperative CAR could be a predictor of perioperative complications and death and might be useful in improving the postoperative prognosis of colorectal perforations.

Appendectomy for suspected appendicitis during pregnancy- a retrospective comparative study of 99 pregnant and 1796 non-pregnant women.

INTRODUCTION: Suspected appendicitis is the most common indication for non-obstetric surgery during pregnancy. Diagnosis and management of these patients can be challenging. Atypical clinical presentation has been described before, but the current literature consists mostly of small case series. Therefore, we conducted a large retrospective study to analyze the frequency and diagnostic accuracy of clinical signs, laboratory findings and imaging modalities in pregnant woman undergoing surgery for suspected appendicitis compared to a control group of non-pregnant women of childbearing age. We further describe intra- and postoperative findings in both groups. METHODS: Data from consecutive patients who underwent appendectomy for suspected appendicitis during pregnancy were retrieved from the electronic patient database and analyzed. Preoperative clinical, laboratory and imaging findings as well as intra- and postoperative characteristics were compared between pregnant and non-pregnant women. RESULTS: Between January 2008 and June 2023, 99 pregnant woman and 1796 non-pregnant woman between the ages of 16 and 49 underwent emergency surgery for suspected appendicitis. Pregnant women were less likely to have right lower quadrant tenderness (p = 0.002), guarding (p = 0.011) and rebound tenderness (p = 0.097). A greater percentage of pregnant women had a symptom duration of more than 24 h before presentation (p = 0.003) Abdominal ultrasound showed a reduced diagnostic accuracy in pregnant women (p = 0.004). MRI was used in eight pregnant women and showed a diagnostic accuracy of 100%. Pregnant women had a longer operating time (p = 0.006), a higher rate of open appendectomies or conversion (p < 0.001) and a longer postoperative hospital stay (3.2 days vs. 2.2 days, p < 0.001). The perforation rate was also higher in pregnant women at 16% vs. 10% (p = 0.048). CONCLUSION: The diagnosis of acute appendicitis during pregnancy presents a challenge for the clinician. Our data confirm the paradigm of "atypical presentation" which should lead to an extended diagnostic workup. Ultrasound showed less diagnostic accuracy in pregnant women in our study. MRI is a useful tool to reduce uncertainty and the rate of negative appendectomies.

Not your typical abdominal pain: Case report of a fisherman presenting to the trauma & emergency surgery department with intestinal perforation due to an eel fish.

BACKGROUND: Traumatic intestinal perforation by foreign bodies is rare, with cases involving live fish being exceedingly uncommon, with only one reported case to date. We present a unique case of a 55-year-old fisherman who presented to the Emergency Department with traumatic intestinal perforation due to an eel fish accidentally entering his rectum. Despite initial reluctance to seek medical attention, prompt intervention was crucial to addressing peritonitis. CASE PRESENTATION: The patient presented with severe abdominal pain and signs of peritonitis. X-ray findings confirmed pneumoperitoneum. Urgent laparotomy revealed a live eel fish and a 5 cm sigmoid colon perforation, necessitating a sigmoid colostomy. DISCUSSION: Early recognition of traumatic intestinal perforation is vital for prompt management. Diagnosis can be challenging, emphasizing the need for thorough history-taking and imaging. Surgical intervention aims to repair the intestinal perforation, prevent complications and promote healing. CONCLUSION: This case highlights the importance of considering unusual causes of abdominal pain, particularly in relevant occupational history. Prompt surgical intervention is crucial for favorable clinical outcomes.

Misleading Mercedes-Benz sign: A case report of misdiagnosed cholecysto-hydatid cyst fistula in acute cholecystitis.

INTRODUCTION: Liver hydatid cysts represent a significant health concern globally, particularly in endemic regions like Tunisia. While they often lead to complications such as biliary fistulas, diagnostic errors can arise from radiologic signs like the "Mercedes Benz sign," which indicates gas within the gallbladder. This report highlights the challenge of diagnosing a rare cholecysto-hydatid cyst fistula, where the presence of gas in the gallstones initially suggested a fistula. CASE PRESENTATION: A 30-year-old female presented with right hypochondrium pain and fever. Ultrasound suggested cholecystitis and identified two cystic formations in liver segments IVb and VII. CT scan revealed intravesicular air bubbles, suggesting a cholecysto-hydatid fistula. Emergency surgery was performed. Intraoperatively, there was an acute cholecystitis. The liver hydatid cyst of segment IVb communicated with the biliary tree and there was no cholecysto-hydatid fistula. We performed a cholecystectomy, cholangiography, and a total pericystectomy for the two liver hydatid cysts. The postoperative follow-up was uneventful. DISCUSSION: The "Mercedes Benz sign," often indicating gas within gallstones, is rare but can mislead the diagnosis toward a cholecysto-hydatid cyst fistula. This case highlights the diagnostic challenge posed by this radiological feature, which led to initial suspicion of a fistula. Hydatid cysts, though common in endemic regions, can lead to diagnostic dilemmas, especially when atypical signs are present. CONCLUSIONS: The presence of gas in the gallbladder can mislead the diagnosis, particularly when the "Mercedes Benz sign" is present, as it may suggest a rare cholecysto-hydatid cyst fistula. However, this is not always the case. Prompt and accurate evaluation, including intraoperative findings, to reinforce clinical suspicion and decision-making in endemic regions.

Successful emergency surgery for accidental ingestion of multiple neodymium magnets in an Argentine tegu (Salvator merianae).

A large Argentine tegu (Salvator merianae) presented with anorexia. Initial radiographs revealed a metallic foreign body in the stomach. The tegu vomited and became inactive two days later. A follow-up radiograph revealed the persistence of the foreign body in the same region. The foreign body was identified as a cluster of multiple magnets resembling neodymium magnets reported missing by the owner. An emergent laparotomy was performed due to gastrointestinal perforations caused by the multiple magnets. The surgical intervention revealed perforations in the walls of the stomach and small intestine and progressing acute peritonitis. Three magnets were extracted from the abdominal cavity and the tegu showed recovery. At 200 days postoperatively, the tegu continued to demonstrate good appetite and energy levels.

Balancing Urgency and Strategy in the Surgical Management of a Complex Case of Gallstone Ileus: A Surgical-Video-Based Case Report of a 60-Year-Old Female.

Gallstone ileus is an uncommon but potentially life-threatening complication of gallstone disease, characterized by the obstruction of the gastrointestinal tract by a gallstone, typically at the ileocecal valve. This condition predominantly affects elderly patients and carries a high risk of morbidity and mortality due to delayed diagnosis and the complexity of associated comorbidities. We report the case of a 60-year-old woman with a history of hypertension and cholelithiasis who presented with a four-day history of intermittent epigastric pain, nausea, vomiting, and an inability to pass stool or flatus. Initial imaging studies, including ultrasonography and computed tomography, revealed a biliary-enteric fistula with a large obstructing gallstone at the ileocecal valve. Despite conservative management with intravenous fluids, nasogastric tube suction, and antibiotics, the patient's symptoms persisted, necessitating surgical intervention. A midline laparotomy was performed, during which the gallstone was successfully removed via enterotomy. The patient recovered without complications and was discharged in stable condition. The complexity of management, particularly in elderly patients with multiple comorbidities, necessitates careful consideration between the one-stage and two-stage surgical approaches. In this case, the decision to perform an enterotomy without immediate cholecystectomy reflects a two-stage strategy, aimed at minimizing operative risk while addressing the immediate obstruction. This approach underscores the need for individualized management plans, where the choice between one-stage and two-stage surgery is guided by the patient's overall clinical status.

Appendectomy: Cross-sectional study of the effects of COVID-19 in a hospital in South Brazil.

Background: COVID-19 has further burdened the Brazilian healthcare system, especially emergencies. Patients may have delayed seeking care for surgical abdominal pain. Delays in the approach may have impacted clinical evolution and outcomes. This study evaluated appendectomies and their complications performed by the public system during one-year follow-up of COVID-19 in a hospital in southern Brazil. Materials and methods: In this hospital-based cross-sectional study, we included adult patients who underwent appendectomy from March 2019 to April 2021 (n = 162). Patients were divided into pre-pandemic (n = 78) and pandemic (n = 84) groups based on the surgery date. The analyzed variables included hospitalization duration, intensive care unit (ICU) admission, surgical approach, histopathological findings, COVID-19 testing, patient outcomes, and 30-day survival rate. Results: The cohorts exhibited similar epidemiology, with the sex ratio and average age being maintained. No statistical difference was found in the 30-day survival rate and clinical outcomes. Of the four patients admitted to the ICU, three belonged to the pandemic cohort and tested negative for COVID-19. Only 47.6 % of the patients in the pandemic cohort underwent COVID-19 polymerase chain reaction examination; one tested positive (2.5 %). Conclusion: This study demonstrated that there was no increased risk for appendectomies during the first wave of the pandemic. Surgeries were safe during this period. Patients continued to access the emergency service despite surgical abdominal pain and restrictive measures imposed by health authorities. The similar results observed across cohorts are attributed to the readiness of the teams and the availability of medical surgical equipment in safe quantities.

Bringing the operating room to the field: lessons learned from on-scene field amputations.

INTRODUCTION: Complicated field extrication may require the assistance of a surgical team to perform an on-scene limb amputation. Although a rare event, when needed, an organized and efficient response is critical to successful outcomes. METHODS: The Los Angeles County Hospital Emergency Response Team (HERT) program and the organization of the team is described, and a multidisciplinary quality improvement process reviewed and analyzed two cases and identified areas for performance improvement. RESULTS: Experience shapes policy and procedures within the HERT program. The timeliness of HERT activation has a major influence on the success of extrication, and regular drills of the multidisciplinary team consisting of trauma surgeons, emergency physicians, nurses, paramedics, and fire department allow for rapid, effective activation. Post-event quality improvement process reviews the timeline of events, provider activation, communication across field and hospital providers, in-hospital events, and medical decision making throughout. Critical analysis of every step helps prepare for any subsequent encounter. CONCLUSION: A well-organized and rehearsed protocol to streamline activation and transportation of a well-trained, designated team, in addition to pre-packaged surgical supplies and an effective communication tree are essential elements of a HERT program.

High-risk factors for massive haemorrhage in medical abortion patients with missed miscarriage.

BACKGROUND: Recently, the incidence of missed miscarriage has gradually increased, and medical abortion is a common method to terminate a pregnancy. In the process of medical abortion, massive vaginal bleeding takes place, leading to emergency surgical haemostasis. Emergency surgery may produce infection and organ damage. Our study aimed to investigate the high-risk factors for massive haemorrhage during a medical abortion. METHODS: A total of 1062 missed miscarriage patients who underwent medical abortion participated in this retrospective study. According to the amount of bleeding, the patients were divided into a massive haemorrhage group and a control group. By comparing the general conditions of the two groups, such as fertility history, uterine surgery history, uterine fibroids, etc., the high-risk factors for massive haemorrhage during medical abortion were identified. RESULTS: Relative to the control group, the massive haemorrhage group exhibited a higher proportion of patients with a previous artificial abortion (51.9% vs. 38.1%, P = 0.001). Additionally, the massive haemorrhage group had a lower percentage of first-time pregnant women (32.1% vs. 40.4%) and a higher proportion of women with shorter pregnancy intervals (44.9% vs. 33.1%, P = 0.03). Furthermore, there were notable differences between the two groups regarding maximum fibroid size, the duration of amenorrhea, and gestational week (P < 0.05). CONCLUSION: In this study, we determined that a history of artificial abortion and an amenorrhea duration of > 11 weeks represented high-risk factors for massive vaginal bleeding during medical abortion in missed miscarriage patients.

Uterine artery pseudoaneurysm presenting with subcutaneous hematoma and vaginal bleeding following cesarean delivery.

We present a rare case of uterine artery pseudoaneurysm (UAP) following an emergency cesarean section, which led to severe vaginal bleeding and subcutaneous hematoma. The patient, a 40-year-old woman with no history of hemophilia or hemostasis disorders, presented with sudden profuse vaginal bleeding and multiple subcutaneous hematomas at the site of the cesarean scar ten days postoperation. Ultrasound and CT scan confirmed the presence of a pseudoaneurysm in the right uterine artery. Due to the unavailability of radiological embolization, surgical ligation of the right internal iliac artery was performed. Postoperative follow-up showed successful resolution of the pseudoaneurysm and cessation of bleeding. This case highlights the importance of considering UAP in the differential diagnosis of postpartum hemorrhage and demonstrates the efficacy of surgical intervention when embolization is not available.

Emergency Artery Ligation and Distal Revascularization for a Limb-Threatening Brachial Artery Mycotic Aneurysm Rupture.

Brachial artery mycotic aneurysms are very rare and even more uncommon to present initially with bleeding or rupture. Initial presentation of ruptured brachial artery mycotic aneurysm in an active intravenous drug abuser is managed with brachial artery ligation with an option of revascularization later. Distal circulation is not commonly threatened as there is a presence of collaterals to perfuse the distal limb. In this case report, we present a case of limb-threatening brachial artery mycotic aneurysm rupture that needed emergency revascularization surgery.

Emergency surgery influences oncological outcome in small intestinal neuroendocrine tumors.

BACKGROUND AND AIMS: Patients with small intestinal neuroendocrine tumors (siNETs) frequently present emergently due to bowel ischemia or bowel obstruction. The influence of emergency surgery on the prognosis of siNET remains controversial. The aim of this study was to investigate the association between type of presentation (emergency/elective) and oncological outcome. METHODS: Clinicopathological data of patients who underwent bowel resection and were treated due to siNET at the Charité - Universitätsmedizin Berlin, Germany were analyzed retrospectively. RESULTS: A total of 165 patients underwent bowel resection for siNET. Of these, 22.4% (n = 37) were emergency and 77.6% (n = 128) were elective procedures. A preoperative known diagnosis was less common in patients with emergency surgery (48.6% vs 85.2%; p < 0.001) and complete resections of all tumor manifestations were performed less often (32.4% vs 50.8%; p = 0.049), while more completion operations had to be performed (24.3% vs 11.1%; p = 0.049). Overall survival (OS) and progression-free survival (PFS) of emergently operated patients were reduced (5-year OS: 85.2% vs 89.5% (p = 0.023); 5-year PFS: 26.7% versus 52.5% (p = 0.018)). In addition, emergency surgery was negatively associated with OS after multivariable regression analysis. CONCLUSION: Emergency surgery in siNET patients is associated with adverse oncological outcomes including shorter OS and PFS. Prevention of emergency conditions should be emphasized in advanced disease.