ABSTRACT
BACKGROUND: The open abdomen or laparostomy is a great advance of surgery based on the concept of damage control surgery. Aim of the study is to review the laparostomy outcomes of non-trauma emergency surgery patients in a district general hospital and identify parameters affecting early definite primary fascial closure. METHODS: The records of all non-trauma emergency surgical patients who underwent laparostomy in a three-year period in a single institute were studied retrospectively. Outcomes included length of stay, morbidity, mortality, readmission rates, number of re-look operations, rate of definite primary fascial closure and time to closure. RESULTS: Thirty-two patients were included. Morbidity was 84.4% and mortality rates were 21.9% (in-hospital), 18.8% (30-day) and 46.9% (overall). Median length of hospital stay was 22 days. Rate of primary fascial closure was 87.5% and median time to closure was two days. The number of relook operations was the only independent prognostic factor of definite early primary fascial closure, with higher rates of closure in patients with 1-2 relooks. CONCLUSIONS: Although the open abdomen has been demonstrated to improve survival, the precise role in abdominal sepsis has not been elucidated. Current consensus does not support use of open abdomen routinely, however in selected situations it becomes unavoidable. Laparostomy is a valid option in non-trauma emergency surgery and can be managed safely in a district hospital. High closure rates can be achieved if one or two re-look operations are performed with an early attempt for closure.
Subject(s)
Fasciotomy , Open Abdomen Techniques , Adult , Aged , Aged, 80 and over , Emergencies , Fascia , Fasciotomy/statistics & numerical data , Female , Hospital Mortality , Hospitals, District , Hospitals, General , Humans , Laparotomy/adverse effects , Laparotomy/mortality , Length of Stay , Male , Middle Aged , Open Abdomen Techniques/mortality , Open Abdomen Techniques/statistics & numerical data , Patient Readmission/statistics & numerical data , Postoperative Complications/epidemiology , Retrospective Studies , Second-Look Surgery/statistics & numerical data , Time Factors , Treatment Outcome , Young AdultABSTRACT
A 61-year-old man attended an outpatient colorectal clinic for a chronic, non-specific abdominal pain, associated with rectal bleeding. He underwent a number of investigations including a CT pneumocolon, which revealed an incidental finding of 20 cm of additional sigmoid colon. This case is interesting because tubular sigmoid duplication is an extremely unusual condition, rarely diagnosed in adults; only a few cases have been reported of this condition in the adult population. Our team chose to treat this patient conservatively, in order to avoid putting the patient at risk of an unnecessary surgery.
Subject(s)
Colon, Sigmoid/abnormalities , Sigmoid Diseases/congenital , Abdominal Pain/etiology , Colon, Sigmoid/diagnostic imaging , Colonoscopy , Conservative Treatment , Humans , Incidental Findings , Male , Middle Aged , Sigmoid Diseases/therapy , Tomography, X-Ray ComputedABSTRACT
Chinese medicine is becoming widely used in the UK to treat many medical conditions, including acne. We report a case in which Chinese medicine, Lian Qiao Bai Du Wan, was used to treat acne in a teenage boy. The patient then suffered severe diarrhoea with blood and mucus per rectum. Examination of the stool revealed Clostridium difficile infection. Treatment with oral metronidazole improved his symptoms.
