Factors associated with delayed reporting for surgical care among patients with surgical acute abdomen attended at Muhimbili National Hospital: Tanzania.

BACKGROUND: Surgical acute abdomen is a sudden onset of severe abdominal symptoms (pain, vomiting, constipation etc.) indicative of a possible life-threatening intra-abdominal pathology, with most cases requiring immediate surgical intervention. Most studies from developing countries have focused on complications related to delayed diagnosis of specific abdominal problems like intestinal obstruction or acute appendicitis and only a few studies have assessed factors related to the delay in patients with acute abdomen. This study focused on the time from the onset of a surgical acute abdomen to presentation to determine factors that led to delayed reporting among these patients at the Muhimbili National Hospital (MNH) and aimed to close the knowledge gap on the incidence, presentation, etiology, and death rates for acute abdomen in Tanzania. METHODS: We conducted a descriptive cross-sectional study at MNH, Tanzania. Patients with a clinical diagnosis of the surgical acute abdomen were consecutively enrolled in the study over a period of 6 months and data on the onset of symptoms, time of presentation to the hospital, and events during the illness were collected. RESULTS: Age was significantly associated with delayed hospital presentation, with older groups presenting later than younger ones. Informal education and being uneducated were factors contributing to delayed presentation, while educated groups presented early, albeit the difference was statistically insignificant (p = 0.121). Patients working in the government sector had the lowest percentage of delayed presentation compared to those in the private sector and self-employed individuals, however, the difference was statistically insignificant. Family and cohabiting individuals showed late presentation (p = 0.03). Deficiencies in health care staff on duty, unfamiliarity with the medical facilities, and low experience in dealing with emergency cases were associated with the factors for delayed surgical care among patients. Delays in the presentation to the hospital increased mortality and morbidity, especially among patients who needed emergency surgical care. CONCLUSION: Delayed reporting for surgical care among patients with surgical acute abdomen in underdeveloped countries like Tanzania is often not due to a single reason. The causes are distributed across several levels including the patient's age and family, deficiency in medical staff on duty and lack of experience in dealing with emergency cases, educational level, working sectors, socioeconomic and sociocultural status of the country.

Does COVID-19 increase the incidence of spontaneous rectus sheath hematoma?

BACKGROUND: The COVID-19 pandemic started to affect Turkey in March 2020. In this study, we retrospectively investigated spontaneous rectus sheath hematoma (S-RSH) in patients with COVID-19 presenting with acute abdominal pain during the ongoing pandemic. METHODS: The demographic characteristics, laboratory findings, length of hospital stay, and treatment processes of COVID-19 cases with S-RSH detected between March and December 2020 were recorded. The rectus sheath hematoma diagnosis of the patients was made using abdominal computed tomography, and the patients were followed up. Low-molecular-weight heparin treatment, which was initiated upon admission, was continued during the follow-up. RESULTS: S-RSH was detected in 13 out of 220 patients with COVID-19 who were referred to general surgery for consultation due to acute abdominal pain. The mean age of these patients was 78±13 years, and the female-to-male ratio was 1.6. Mechanical ven-tilation support was applied to three patients, all of whom were followed up in the intensive care unit. Two patients died for reasons independent of rectus sheath hematoma during their treatment. Among the laboratory findings, the activated partial thromboplastin time (aPTT) values did not deviate from the normal range. While there was no correlation between the international normalized ratio (INR) and aPTT (p>0.01), a significant correlation was found between INR and interleukin-6 (IL-6) (p<0.002). None of the patients required surgical or endovascular interventional radiology procedures. CONCLUSION: In the literature, the incidence of S-RSH in patients presenting with acute abdominal pain is 1.8%. However, in our series, this rate was approximately 3 times higher. Our patients' normal INR and aPTT values suggest that coagulopathy was mostly secondary to endothelial damage. In addition, the significantly higher IL-6 values (p<0.002) indicate the development of vasculitis along with the acute inflammatory process. S-RSH can be more commonly explained the high severity of vasculitis and endothelial damage due to viral infection.

[Complications of surgical management of non-traumatic acute abdomens of digestive origin at the Yaoundé central hospital, Cameroon (November 2019 - July 2020)]. / Complications des prises en charge chirurgicales des abdomens aigus non traumatiques d'origine digestive à l'hôpital central de Yaoundé, Cameroun (novembre 2019 - juillet 2020).

Objective: Acute non-traumatic digestive surgical emergencies are a frequent cause of emergency in Africa. We undertook this study to investigate the morbidity and mortality of these patients in Cameroon, a developing country in Central Africa. Patients and methodology: This was an analytical cross-sectional study with prospective data collection, over a period of eight months (November 2019 to July 2020), at the Yaoundé central hospital (Cameroon). The latter is a second category (intermediate) public health facility in the Cameroon health pyramid, mainly welcoming patients without health insurance. All patients operated on for an acute non-traumatic digestive abdomen were included. The patients were followed up until the 12th postoperative week. We used Cox univariate regression to determine factors associated with the occurrence of postoperative complications. The significance threshold retained was 0.05. Results: We collected 120 patients, representing 14.6% of all surgical emergencies. The mean age of the patients was 37.6 ± 13.5 years. Eighty (66.7%) were male with a sex ratio of 2. The two main preoperative diagnoses were acute generalized peritonitis (n = 58 or 48.3%) and intestinal obstruction (n = 38 or 31.7%). The two main etiologies were peptic ulcer perforation (n = 35) and acute appendicitis (n = 24). The delay between the onset of symptoms and consultation was 1.9 day and an average of 36.8 hours elapsed between diagnosis and surgery. During postoperative time the morbidity and mortality rates were 33.3 and 10%, respectively. Postoperative complications were mostly minor according to the Clavien-Dindo classification, with 21 cases of grade I (33.8%) and 12 cases of grade II (19.3%). The main cause of death was sepsis (8 out of 12 cases). We identified seven factors significantly associated with an increased risk of postoperative complications among whom three were modifiable: The consultation delay greater than 72h (p = 0.02), the time between diagnosis and the surgical intervention greater than 48h (p = 0.01) and the operating time greater than 2h (p = 0.05). Conclusion: In our context, the results of the surgical management of acute non-traumatic abdomens of digestive origin are marked by high morbidity and mortality. The possible solutions are: the organization of public awareness campaigns to prompt rapid consultation in the event of acute abdominal pain, the establishment of universal health coverage as well as the improvement of technical platforms.

The effect of emergency surgery on acute abdomen patients with COVID-19 pneumonia: a retrospective observational study.

During the COVID-19 outbreak, some patients with COVID-19 pneumonia also suffered from acute abdomen requiring surgical treatment; however, there is no consensus for the treatment of such patients. In this study, we retrospectively reviewed 34 patients with acute abdomen who underwent emergency surgery during the COVID-19 outbreak. Among the 34 patients with acute abdomen, a total of six cases were found with COVID-19 pneumonia (clinical classification for COVID-19 pneumonia: all were the common type). On the premise of similar demographics between both groups, patients with COVID-19 pneumonia had worse indicators of liver and coagulation function. Compared with acute abdomen patients without COVID-19, patients with COVID-19 pneumonia had a longer hospital stay, but there were no significant differences in postsurgical complications (P = 0.58) or clinical outcomes (P = 0.56). In addition, an obvious resolution of lung inflammation after surgery was observed in five COVID-19 patients (83.3%). No new COVID-19 cases occurred during the patients' hospital stays. Therefore, for the common type of COVID-19 pneumonia, emergency surgery could not only improve the outcomes of COVID-19 pneumonia patients with acute abdomen, but also benefit the resolution of pulmonary inflammation.

Incidence of arcuate line hernia in patients with abdominal complaints: radiological and clinical features.

INTRODUCTION: Acute abdominal complaints are a frequent cause for consultation in the emergency department, with a large differential diagnosis. One cause is arcuate line herniation, but this entity is little known and rarely considered during initial analysis. The incidence of arcuate line herniation in this population is unknown. METHODS: A retrospective cohort study was performed. All patients who presented to the emergency department for surgical consultation during an 18-month period with abdominal complaints in who no diagnosis was found after analysis, and who had computed tomography imaging of the abdomen were included. CT scans were reviewed with a focus on abdominal wall pathology and correlated with clinical features. RESULTS: Eight hundred and ten patients presented with abdominal complaints, 415 of these had CT scans available for review and were included in the study. In 47 patients (11.3%), an arcuate line anomaly was found, and in 14 patients (3.4%), a frank arcuate line herniation (grades 2 or 3) was found. Retrospective correlation with clinical complaints was found in 50% of these patients. Patients with arcuate line hernia had a significantly higher BMI, and diabetes mellitus and aortic aneurysm were more prevalent in these patients. CONCLUSION: Arcuate line herniation has a higher incidence than previously thought in patients with acute abdominal complaints and should be considered when evaluating these patients.

Patients with End-Stage Renal Disease and Acute Surgical Abdomen: Opportunities for Palliative Care.

Background: End-stage renal disease (ESRD) is a life-limiting condition that is often complicated by acute abdominal emergency. Palliative care (PC) has been shown to improve the quality of life in patients with serious illness and yet is underutilized. We hypothesize that ESRD patients with abdominal emergency have high unmet PC needs. Objective: To characterize the outcomes of ESRD patients with acute surgical abdomen, define PC utilization patterns, and identify areas of unmet PC needs. Design: Retrospective study querying the National Inpatient Sample database (2009-2013). Setting and Subjects: Subjects were identified using ICD-9 codes for those aged ≥50 with preexisting diagnosis of ESRD with an acute abdominal emergency diagnosis of gastrointestinal perforation, obstruction, or ischemia. Measurements: Outcomes included PC rate, in-hospital mortality, discharge disposition, and intensity of care. Multivariable logistic regression analysis was used to identify predictors of PC. Results: A total of 9363 patients met the inclusion criteria; 24% underwent surgery, 16% died in hospital, and 43% were discharged to dependent living. Among in-hospital deaths, 23% received PC. Only 4% of survivors with dependent discharge received PC. Surgical mortality was 26%. PC was less utilized in surgical patients than nonsurgical patients. PC was associated with shorter hospital stay. Predictors of PC included increasing age, severity of underlying illness, white race, teaching hospitals, and the Western region. Conclusions: Patients with ESRD admitted for acute abdominal emergency have high risk for mortality and functional dependence. Despite this, few receive PC and have a high utilization of nonbeneficial life support at the end of life.

The diagnostic value of irisin in patients with acute abdominal pain: A preliminary study.

BACKGROUND: The aim of this study was to investigate the prognostic value of irisin by examining the serum level of this smooth muscle protein in patients presenting at the emergency department (ED) with acute abdominal pain. METHODS: This research was performed as a single-center, prospective, cross-sectional study. In all, 213 adult patients presenting at the ED with acute abdominal pain and 140 healthy controls were enrolled. The serum irisin level was correlated with the leukocyte, C-reactive protein, amylase, and creatine kinase values. The irisin level was compared between groups of those who were admitted or discharged, and those who received surgical or medical treatment. RESULTS: The mean irisin level of the 213 patients and the 140 controls was 6.81±3.17 mcg/mL vs. 5.69±2.08 mcg/mL. The mean irisin value of the hospitalized patients (7.98±3.11 mcg/mL) was significantly higher than that of the discharged patient group (6.38±3.09 mcg/mL) and the controls (control vs. discharged: p=0.202; control vs. hospitalized: p<0.001; discharged vs. hospitalized: p=0.001). When compared with that of the control group, the irisin level was significantly higher in patients with gall bladder diseases, urolithiasis, and acute appendicitis (p=0.001, p=0.007, p=0.007). CONCLUSION: The serum irisin level in patients with abdominal pain may serve as a guide in diagnostic decision-making and determining the prognosis for cases of acute abdominal pain involving luminal obstruction in tubular intra abdominal organs.

Acute abdominal pain-changes in the way we assess it over a decade.

AIMS: Acute abdominal pain accounts for 5-10% of all emergency department visits. Rapid and accurate diagnosis is critical to ensure optimal outcomes. In the last decade, increased use of CT scans and the introduction of surgical short stay units has changed the way this group of patients is managed. The aim of this study was to evaluate the effects of these changes on patient management. METHODS: A retrospective clinical study was undertaken including all patients admitted with abdominal pain under general surgery in the years 2004, 2009 and 2014. Two hundred from each of the three years were randomly selected and their care was reviewed. RESULTS: During the study period, more patients were admitted under general surgery, from 1,462 in 2004 to 2,737 in 2014 (P=0.001). There was an increase in the proportion of patients admitted with non-surgical abdominal pain (25% in 2004 vs 34% in 2014, P=0.035). More computed tomography (CT) scans were performed (26.0% in 2004 vs 45.0% in 2014, P=0.001). CONCLUSIONS: More patients were admitted under general surgery with abdominal pain and a greater proportion of these patients were admitted with non-surgical problems. Use of CT scans increased during the study period.

[Digestive surgical emergencies in Sub-Saharan Africa: a prospective study of a series of 622 patients at the National Hospital of Zinder, Niger]. / Urgences chirurgicales digestives en Afrique subsaharienne : étude prospective d'une série de 622 patients à l'Hôpital national de Zinder, Niger.

The purpose of this study was to describe the epidemiologic, therapeutic, and prognostic aspects of surgical acute abdomen at the National Hospital of Zinder (HNZ). This was a prospective study of patients undergoing digestive surgical emergencies in HNZ over 24 months (January 2013-December 2014). During the study period, 622 digestive surgical emergencies were operated. The mean age was 22.91 ± 18.14 years old, with a sex-ratio of 3:1. The average admission time was 64.31 ± 57.90 h. Abdominal pain was the main reason for admission in 61.90% (N = 385) of the cases, with or without fever throughout the course in 26.05% (N = 162) of the cases. The average time before surgery was 9.13 ± 5.97 h. Acute peritonitis accounted for 51.61% (N = 321) of cases, led by ileal perforation maybe from typhoid (N = 175). The acute intestinal obstruction and acute appendicitis accounted for 27.49% (N = 171) and 9.65% (N = 60) of the cases, respectively. Abdominal trauma had affected 53 patients (8.52%). The average length of hospital stay was 8.71 ± 5.29 days. Postoperative morbidity was 38.10% (N = 237). Septic complications (N = 187) were predominant. Overall lethality of 13.67% (N = 85), was associated with the delay of diagnosis and treatment (P < 0.001). The incidence and the high morbidity and lethality of digestive surgical emergencies in the Sub-Saharan context, could be avoided through prevention, early consultation, and adequate intra-hospital management.

Risk for lower intestinal perforations in patients with rheumatoid arthritis treated with tocilizumab in comparison to treatment with other biologic or conventional synthetic DMARDs.

OBJECTIVE: To investigate the risk of developing lower intestinal perforations (LIPs) in patients with rheumatoid arthritis (RA) treated with tocilizumab (TCZ). METHODS: In 13 310 patients with RA observed in the German biologics register Rheumatoid Arthritis: Observation of Biologic Therapy, 141 serious gastrointestinal events possibly associated with perforations were reported until 31 October 2015. All events were validated independently by two physicians, blinded for treatment exposure. RESULTS: 37 LIPs (32 in the colon/sigma) were observed in 53 972 patient years (PYs). Only two patients had a history of diverticulitis (one in TCZ). Age, current/cumulative glucocorticoids and non-steroidal anti-inflammatory drugs were significantly associated with the risk of LIP. The crude incidence rate of LIP was significantly increased in TCZ (2.7/1000 PYs) as compared with all other treatments (0.2-0.6/1000 PYs). The adjusted HR (ref: conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs)) in TCZ was 4.48 (95% CI 2.0 to 10.0), in tumour necrosis factor-α inhibitor (TNFi) 1.04 (0.5 to 2.3) and in other biologic DMARDs 0.33 (0.1 to 1.4). 4/11 patients treated with TCZ presented without typical symptoms of LIP (acute abdomen, severe pain). Only one patient had highly elevated C reactive protein (CRP). One quarter of patients died within 30 days after LIP (9/37), 5/11 under TCZ, 2/13 under TNFi and 2/11 under csDMARD treatment. CONCLUSIONS: The incidence rates of LIP under TCZ found in this real world study are in line with those seen in randomised controlled trials of TCZ and higher than in all other DMARD treatments. To ensure safe use of TCZ in daily practice, physicians and patients should be aware that, under TCZ, LIP may occur with mild symptoms only and without CRP elevation.

Opioid analgesic use among patients presenting with acute abdominal pain and factors associated with surgical diagnoses.

BACKGROUND: The prevalence of chronic opioid use among non-cancer patients presenting with acute abdominal pain (AAP) is unknown. The aim was to characterize opioid use, constipation, diagnoses, and risk factors for surgical diagnoses among non-cancer patients presenting with AAP to an emergency department (ED). METHODS: We performed a retrospective, observational cohort study of all (n=16,121) adult patients (88% from MN, IA and WI) presenting during 2014 with AAP. We used electronic medical records, and focused on 2352 adults with AAP who underwent abdominal CT scan within 24 hours of presentation. We determined odds ratios of association with constipation and features predicting conditions that may require surgery (surgical diagnosis). KEY RESULTS: There were 2352 eligible patients; 18.8% were opioid users. Constipation was more frequent in opioid (35.1%) compared to non-opioid users [OR 2.88 (95% CI 2.28, 3.62)]. Prevalence of surgical diagnosis in the opioid and non-opioid users was 35.3% and 41.7% respectively (P=.019). By univariate analysis, age and neutrophil count independently predicted increased risk, and chronic opioid use decreased risk of surgical diagnosis. Internal validation of logistic models using a randomly selected validation subset (25% of entire cohort, 587/2352) showed receiver operating characteristic (ROC) curves for the validation and full cohorts were similar. CONCLUSIONS AND INFERENCES: Approximately 19% of adults presenting with AAP were opioid users; constipation is almost three times as likely in opioid users compared to non-opioid users presenting with AAP. Factors significantly associated with altered risk of surgical diagnoses were age, opioid use, and neutrophil count.

Epidemiological characterization of ostomized patients attended in referral Center from the city of Maceió, Alagoas, Brazil / Caracterização epidemiológica de pacientes ostomizados atendidos em centro de referência, Maceió, Alagoas, Brasil

Introduction: Several clinical conditions imply the realization of a bowel ostomy, as a treatment option. However, the presence of a stoma is an important limitation in the quality of life of the ostomized patient. Aim: To define the epidemiological profile of patients enrolled in the Ostomy Program from two reference services in the city of Maceió, Alagoas, regarding gender, age, classification (as permanent or temporary), type of ostomy with respect to the bowel segment used, and causes. Method: This was a descriptive cross-sectional study whose data were obtained from registration forms of active patients in Ostomy Programs on May 2013. Results: Of 216 patients analyzed, 50.5% were female and 49.5% male. The age group with the highest number of cases was that between 60 and 69 years (23.6%) and the average age was 51.3 years. Colostomies accounted for 89.4% of the procedures performed, and 56.9% of procedures were temporary ostomies. As for the cause, the most prevalent was colorectal cancer (40.7%), followed by trauma (18.1%) and acute abdomen (12.0%). Conclusion: The study provides relevant data that can be used as input for prevention and strategies to improve the health of the ostomized population.

Introdução: Diversas condições clínicas implicam a realização de uma ostomia intestinal como opção de tratamento. Entretanto, a presença de um estoma é um importante limitador na qualidade de vida da pessoa ostomizada. Objetivo: Definir o perfil epidemiológico dos pacientes cadastrados no Programa de Ostomizados de dois serviços de referência em Maceió, Alagoas quanto a gênero, idade, classificação da ostomia em definitiva ou temporária, tipo de ostomia quanto ao segmento intestinal utilizado e causas. Método: Trata-se de um estudo transversal descritivo cujos dados foram obtidos de fichas cadastrais de pacientes ativos em Programas de Ostomizados no mês de maio de 2013. Resultados: Dos 216 pacientes analisados, 50,5% eram do gênero feminino e 49,5% do gênero masculino. A faixa etária com maior número de casos foi a de 60 a 69 anos (23,6%) e a média de idade foi de 51,3 anos. As colostomias representaram 89,4% dos procedimentos realizados e 56,9% das ostomias foram temporárias. Quanto à causa, a mais prevalente foi o câncer colorretal (40,7%), seguido dos traumatismos (18,1%) e do abdome agudo (12,0%). Conclusão: O estudo apresenta dados relevantes que podem ser utilizados como subsídio para ações de prevenção e estratégias de melhoria da saúde da população ostomizada.

To Study the Aetiological Factors and Outcomes of Urgent Re-Laparotomy in Himalayan Hospital.

BACKGROUND: Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Relaparotomy (UR), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing URs, their outcomes and factors that affect mortality. METHODS: Observational, Prospective Study. The study included all the patients who underwent urgent re-laparotomy following laparotomy (emergency, elective) in Himalayan Hospital from 01.01.2013 to 01.06.2014 and excluded those who underwent laparotomy outside. RESULTS: UR was performed for 40 out of 1050 patients (4.2%), of which males were 25 and females 15. The average time interval between the index laparotomy and urgent re-exploration was 6.4 days. The most common reason for mortality was multi organ failure with septic shock. The most common criteria for re-exploration were anastomotic leak (n=13), followed by pyoperitoneum (n=11) and persistent peritonitis (n=6). Comparing the index surgery, lower gastro-intestinal procedures were most usually involved (n=21, 47.7%), followed by hepato-pancreato-biliary surgeries (n=8, 18.2%). There were 6 cases of upper gastro-intestinal surgeries that reexplored (13.6%). CONCLUSION: UR that is performed following complicated abdominal surgeries has high mortality rates. In particular, they have higher mortality rates following GIS surgeries or when infectious complications occur.

ACUTE ABDOMEN IN ADULTS: A TWO YEAR EXPERIENCE IN MEKELLE, ETHIOPIA.

BACKGROUND: The term acute abdomen denotes any sudden spontaneous non traumatic disorder whose main manifestation is in the abdominal area. It is one of the most commonly encountered emergencies in the practice of general surgery but there is no much study regarding the magnitude and pattern in Ethiopia and in the study area in particular. OBJECTIVE: The study was aimed at assessing the causes, pattern and outcomes of surgical regimen of acute abdomen in the study area. METHODS: This is a descriptive retrospective study conducted in all adult patients with acute abdomen admitted in Mekelle hospital from Sept, 2008 to August, 2010. Patient demographics, clinical features, white cell count levels, operative findings and outcomes were adequately recorded. Adequate recording has been maintained in the hospital. The source.and the study groups (N-299) were patients of adult age categories. RESULTS: A total of 2628 surgical procedures were performed during the study period. Of these, 299 cases were surgical emergency conditions for acute abdomen accounting for (11.4%) of all surgeries. During the. study period, there were 989 adult surgical emergency procedures of which 299 (30.2%) cases were laparotomies for acute abdomen. The age ranged from 15 years to 95 years (mean = 31.5 years). The male to female ratio was (M: F; 4.1:1). In this series, the most common symptoms were abdominal pain, vomiting and abdominal distention accounting for 299 (100.0%), 149 (49.8%) and 38 (16.4%) respectively. The frequent. clinical signs were tenderness, localized guarding and rebound tenderness accounting for 287 (96.0%), 269 (90.0%) and 139 (46.4%) respectively. Acute abdomen was most common between 20-29 years of age at a rate of 96 (32.1%) with male 74 (24.7%) preponderance. Acute appendicitis was the leading cause of acute abdomen accounting for 159 (53.2%) followed by small bowel obstruction 48 (16.0%), sigmoid volvulus 38 (12.7%) and PPUD 13 (4.3%). Of the surgically treated patients for acute abdomen 92 (30.8%) had post-operative complications other than deaths. The three commonest immediate post-operative complications observed were wound infection (19.7%), pneumonia (9.0%) and sepsis (2.0%). In this series, there were 19 deaths giving an overall mortality rate of (6.4%). The low rate of mortality observed in study may be attributed to early presentation, early diagnosis and prompt surgical interventions. CONCLUSION: The present study has depicted that acute abdomen commonly occurred in the 2nd to 3rd decades of life, majority caused by acute appendicitis and males were predominantly affected than females. Small bowel obstruction, sigmoid volvulus, PPUD and incarcerated hernias were other observed causes of acute abdomen.

[Features of clinical course of primary peritonitis in children].

The article presents an analysis of the features of primary peritonitis in children. Medical reports of 182 patients with primary and appendicular peritonitis were analyzed. It was significant, that the sick girls aged 4-7 years often had the primary peritonitis after acute inflammatory processes, which took place a month earlier. Chronic infection foci were noted in these patients. The age-specific features of maturation of the immune and reproductive systems predisposed the disease.

Acute abdominal emergencies and spinal cord injury; our experiences: a retrospective clinical study.

STUDY DESIGN: Retrospective review of medical notes. OBJECTIVE: To describe clinical, laboratory and examination findings of acute abdominal emergencies (AAE) in Turkish patients with spinal cord injury (SCI) and to examine diagnosis and management of AAE in early stages. SETTING: Inpatient rehabilitation unit of tertiary research hospital. METHODS: The medical records of 237 SCI patients were reviewed. The SCI patients who were recruited in the study had been diagnosed with AAE and treated medically or surgically while they were inpatients at the rehabilitation clinic. RESULTS: Nine out of 237 SCI patients had been diagnosed with one of the AAE. Three patients were AIS A, three patients were AIS B and three patients were AIS C. The most common AAE was acute cholecystitis; three patients were diagnosed with this. The others were single cases of intra-abdominal hemorrhage, intra-abdominal abscess, tuba-ovarian abscess, subileus, Crohn's disease and cholangitis. Three of the patients were treated with surgery and six were treated medically. The most common symptoms in patients were fever, abdominal pain and abdominal discomfort (four of AAE). Three patients had abdominal tenderness and abdominal distension. The expected findings of AAE, rebound and defense, were positive only in two patients. CONCLUSION: Gall bladder disease is a common cause of AAE. The classic symptoms and examination findings will usually not facilitate acute abdomen diagnosis in the SCI group, so we should be aware of patients' subjective complaints and when necessary use advanced imaging techniques immediately.

[20 years emergency surgery of abdominal organs in Moscow].

The analysis of emergency surgical care in medical institution of Moscow for the last 20 years is presented in the article. There were 912 156 patients with acute appendicitis, strangulated hernia, perforated gastro-duodenal ulcer, gastro-duodenal bleeding, acute cholecystitis, acute pancreatitis, acute intestinal obstruction on treatment during this period. It was observed reduction overall and postoperative mortality. It was concluded that positive results are caused by development of material and technical base, transition on clock mode of diagnostic units, increase of patients? number hospitalized in department of intensive care for operation training and after it, using of modern diagnostic and therapeutic methods, edit documents regulating of health facilities activity according to medicine development.

Causa infrecuente de abdomen agudo hemorrágico / Rare cause of acute abdomen bleeding

La rotura espontanea de vasos uterinos es una rara causa de abdomen agudo hemorrágico durante el embarazo y una complicación potencialmente mortal. Las manifestaciones clínicas son: dolor abdominal súbito, shock hipovolémico y caída de hematocrito. Objetivos: Presentación de causa infrecuente de abdomen agudo hemorrágico. Reporte de Caso: Se presenta un caso de una mujer de 36 años primigesta, con embarazo de 27 semanas, con abdomen agudo, sin antecedentes traumáticos y signos de shock hipovolémico. Ecografía abdominal con líquido libre en cavidad. En laparotomíaexploradora se halla laceración de vena uterina derecha, se realiza hemostasia directa y cesárea de urgencia por bradicardia fetal severa. Discusión: Debe realizarse un correcto diagnóstico diferencial dado que el tratamiento de la rotura espontanea de los vasos uterinos es el manejo urgente del shock hipovolémico y la intervención quirúrgica a la brevedad...

Spontaneous rupture of uterine vessels is a rarecause of acute abdomen bleeding during pregnancy and apotentially fatal complication.Clinical manifestations include sudden abdominal pain,hypovolemic shock and fall of hematocrit.Objectives: Introducing rare cause of acute abdomen bleeding.Case Report: We presents case of a woman aged 36 with 27weeks pregnancy (first one), acute abdomen, without traumatichistory WITH signs of hypovolemic shock. Abdominal ultrasoundwith free fluid in the cavity. At laparotomy we found laceration ofthe right uterine vein, performing direct hemostasis andemergency cesarean for severe fetal bradycardia.Discussion: We have to make sure of doing a correct differentialdiagnosis because the treatment of spontaneous rupture of theuterine vessels is urgent for management of hypovolemic shockand surgery should be performed promptly...

Clinical outcomes of pediatric patients with acute abdominal pain and incidental findings of free intraperitoneal fluid on diagnostic imaging.

OBJECTIVES: The presence of free intraperitoneal fluid on diagnostic imaging (sonography or computed tomography [CT]) may indicate an acute inflammatory process in children with abdominal pain in a nontraumatic setting. Although clinical outcomes of pediatric trauma patients with free fluid on diagnostic examinations without evidence of solid-organ injury have been studied, similar studies in the absence of trauma are rare. Our objective was to study clinical outcomes of children with acute abdominal pain of nontraumatic etiology and free intraperitoneal fluid on diagnostic imaging (abdominal/pelvic sonography, CT, or both). METHODS: We conducted a retrospective review of medical records of children aged 0 to 18 years presenting to a pediatric emergency department with acute abdominal pain (nontraumatic) between April 2008 and March 2009. Patients with intraperitoneal free fluid on imaging were divided into 2 groups: group I, imaging suggestive of an intra-abdominal surgical condition such as appendicitis; and group II, no evidence of an acute surgical condition on imaging, including patients with equivocal studies. Computed tomograms and sonograms were reviewed by a board-certified radiologist, and the free fluid volume was quantitated. RESULTS: Of 1613 patients who underwent diagnostic imaging, 407 were eligible for the study; 134 (33%) had free fluid detected on diagnostic imaging. In patients with both sonography and CT, there was a significant correlation in the free fluid volume (r = 0.79; P < .0005). A significantly greater number of male patients with free fluid had a surgical condition identified on imaging (57.4% versus 25%; P < .001). Children with free fluid and an associated condition on imaging were more likely to have surgery (94.4% versus 6.3%; P < .001). CONCLUSIONS: We found clinical outcomes (surgical versus nonsurgical) to be most correlated with a surgical diagnosis on diagnostic imaging and not with the amount of fluid present.