Erratum to: The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections.

[This corrects the article DOI: 10.1186/s13017-017-0141-6.].

2016 WSES guidelines on acute calculous cholecystitis.

Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of "high risk" patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.

Erratum to: 2016 WSES guidelines on acute calculous cholecystitis.

[This corrects the article DOI: 10.1186/s13017-016-0082-5.].

Management of the intermediate severity duodenal injury.

The management of intermediate severity duodenal injuries remains a controversial issue. This report details our experience with 34 patients who underwent operations for duodenal trauma in the past 3 years. Seventy-two percent had penetrating injuries. Seven patients (28%) were managed with by duodenorrhaphy and Penrose drainage, nine (36%) with duodenal diversion (pyloric exclusion with gastrojejunostomy), two (8%) with resection and anastomosis, and one (4%) with pancreaticoduodenectomy. A comparison with a previous report from our institution. in 1978 discloses (1) more severe injuries in the current series, (2) more frequent use of duodenal diversion with a corresponding decreased use of tube decompression, (3) increased nutritional support, and (4) fewer complications. Based on this experience we advocate the use of duodenal diversion and needle catheter jejunostomy for intermediate severity duodenal wounds.

Changing trends in the management of pancreatic trauma.

Forty-four patients were operated on for pancreatic trauma during the past three years. Twenty-one patients (48%) were treated by drainage alone, nine (21%) by distal resection, eight (19%) by duodenal diversion, and one (2%) by pancreatoduodenectomy. Active sump drainage was used in 27 patients (71%) and early enteral feeding by needle catheter jejunostomy in 24 (63%) postoperatively. Of the 38 patients who survived the initial operation, two (5%) died postoperatively. Pancreas-related complications occurred in 13 patients (34%). Comparison with earlier findings from our institution reveals (1) more frequent use of active sump drainage, (2) continued use of distal resection for suspected ductal injuries of the body or tail, (3) earlier postoperative nutrition by needle catheter jejunostomy, and (4) increased use of duodenal diversion for concurrent pancreatic and duodenal trauma.

Terror bombing-mechanisms, consequences and implications.

Our objective in this review is to describe the unique features of bombing injury and to outline some special elements of their management. This is to allow the timely improvement and adjustment of existing mass casualty protocols. Forensic studies, detonation and explosion, mechanisms of injury in explosion and their bodily effects, chemical effects of the explosive, site of the explosion and the wounding potential, the Multidimensional Injury Pattern, diagnostic evaluation of Multidimensional Injury Pattern, and surgical and treatment dilemmas associated with it are described and discussed.

Esophageal atresia in father and son.

This is a report of the first known case of congenital tracheoesophageal fistula in father and son.

Air embolism after central venous catheterization.

Air embolism--the most dangerous complication of central venous catheterization--may occur in several ways. The most frequent is from disconnection of the catheter from the related intravenous tubing. An embolism may present with a sucking sound, tachypnea, air hunger, wheezing, hypotension and a "mill wheel" murmur. A later manifestation is severe pulmonary edema. In a review of 24 patients, the mortality was 50 per cent. Among the survivors, five (42 per cent) had neurologic damage. Immediate treatment includes placing the patient in the left lateral and Trendelenberg positions, administration of oxygen and aspiration of air from the heart. Cardiac massage and emergency cardiopulmonary bypass may be necessary. Most instances can be prevented by inserting the cannula with the patient in the Trendelenberg position, occluding the cannula hub except briefly while the catheter is inserted, fixation of the catheter hub to its connections and occlusive dressing over the track after removal of the catheter.

Inferior vena cava injuries--a continuing challenge.

The mortality from abdominal vena cava trauma remains in excess of 33% despite advances in prehospital and intraoperative care. During the 7-year period ending December 1981, 58 patients with vena cava injuries were treated at our institution. Thirty-nine (67%) were due to gunshot wounds, nine to stab injuries, and ten to blunt trauma. Overall mortality was 38%. Predictors of poor survival were: 1) presence of shock upon hospital arrival; 2) multiple abdominal vascular injuries; and 3) injuries in the retrohepatic segment. Only two (17%) of 12 patients survived retrohepatic wounds despite various shunting techniques. Of the remaining 12 deaths, 11 (92%) had associated major vascular trauma that included four portal system, three aortic, and three iliac artery injuries. This contrasts to a 96% survival rate for the 28 patients without associated abdominal vascular injuries. Our experience underscores the importance of rapid resuscitation, early operation, and searching for associated vascular injuries before a time-consuming repair of the vena cava is undertaken. Improving the survival of patients with blunt retrohepatic cava and hepatic vein trauma remains a dilemma.

Major abdominal vascular trauma--a unified approach.

Advances in prehospital emergency care have increased the numbers of patients arriving at the hospital with immediate life-threatening trauma. This is a review of our recent 6-year experience with 161 major abdominal vascular injuries in 123 patients. The distribution by injury site and respective mortality were: 18, aortic (56%); 39, aortic branch (37%); 51, inferior vena cava (39%); 30, inferior vena cava branch (45%); and 23, portal venous system (39%). The overall death rate was 37%. Forty-six patients presented with unobtainable blood pressure and 19 (41%) survived. Left thoracotomy and temporary aortic occlusion were required in the resuscitation of 45 patients; when applied in the emergency department the salvage rate was 7%, and in the operating room, 35%. Forty-four patients had more than one major vascular injury and 17 (39% recovered, compared to a survival rate of 76% with single vascular trauma. Others have emphasized that most deaths from major abdominal vascular injury are a result of hemorrhage. In our study although 89% of mortality was due to bleeding, half occurred after control of the major bleeding sites. These findings suggest that coagulopathy, hypothermia, and acidosis are complicating factors which demand as much attention by the surgeon as the initial resuscitation and operative control classically emphasized.