An analysis of missed cases with surgical emergencies admitted in non-surgical departments. Case series and а review of the literature.

INTRODUCTION: The delayed diagnosis in emergency surgery can be associated with significant morbidity and mortality and often lead to litigations. The aim of the present work is to analyse the outcome in cases with non-trauma surgical emergencies wrongly admitted in non-surgical departments. METHODS: A retrospective trial in two independent University hospitals was conducted. The first group encompassed the patients worked-up in the Surgical unit of Emergency department (2014-2018). The second one included all cases visited Emergency department (2018). Only cases with acute abdomen and delayed diagnosis and operation were included. The analysis included the proportion of the delayed diagnosis, time between admission and operation, intraoperative diagnosis, complications and mortality rate. RESULTS: In the first group there were 30 194 visits in the surgical unit with 15 836 hospitalizations (52.4%). Twenty patients of the last (0.13%) were admitted in the Clinic of Infectious disease and subsequently operated. The mean delay between hospitalization and operation was 3 days (1-10). Seventeen patients (85%) were operated with mortality of 10%. In the second group, there were a total of 22 760 visits with 11 562 discharged cases. Of the last, 1.7% (n=192) were re-admitted in a surgical ward, 25 of which underwent urgent surgery (0.2%). CONCLUSIONS: The missed surgical cases represent only a small proportion of the patients in emergency department. The causes for wrong initial admissions in our series were misinterpretation of the symptoms, insufficient clinical examination and underuse of US and CT. The careful clinical assessment, point-of care US and CT may decrease the rate of the delayed diagnosis.

[Technics for laparoscopic cholecystectomy--their use and results]. / Tekhniki za laparoskopska kholetsistektomiia--prilozhenie i rezultati.

In mini-invasive surgery mainly two operative techniques for laparoscopic cholecystectomy are familiar and implemented in practice--"American" and "French" technique. Over the period May 1993 to September 1997, in the two surgical clinics of H. M. I.--Pleven a total of 311 laparoscopic cholecystectomies are performed. Of them 218 are done according to the "American" technique, 87--according to the "French" technique, and six patients are operated using the so-called "lifting" technique. In the appear submitted the advantages and shortcomings of the two techniques for laparoscopic cholecystectomy are comparatively studied. The timing of operative intervention CO2 quantity expenditure and intraoperative complications are analyzed. The choice of technique for laparoscopic cholecystectomy depends on the surgeon's personal judgement, but under given situations one of the two techniques or a combination thereof should be mandatorily used.

[The role of the surgeon in treating multiple organ failure]. / Roliata na khirurga pri tretiraneto na mnogoorgannata nedostatuchnost.

Over the period 1990 through 1995, thirty-five patients with multiorgan insufficiency (MOI) undergo treatment. Abdominal operations are performed in all of them, except for one male patient aged 31 years, dying of bilateral pneumonia and metabolic disorders resulting from duodenal stenosis. Overall mortality rate amounts to 77 per cent (20 cases). Programmed peritoneal lavage (PPL) is done in seventeen patients with lethality 77 per cent (13 cases). In two instances iatrogenic damage to the spleen contribute to fatal septic complications development. All PPL treated patients with fatal outcome have bilateral pneumonia. MOI prevention is still closely linked to prophylaxis against the complications producing it. Programmed peritoneal lavage in immunocompromised and malnourished patients is a risk factor equally serious as the septic noxa being attacked, and what is more it runs the risk of inflicting additional iatrogenic noxae. General endotracheal anesthesia in PPL is likewise a factor demanding further clarification.