RESUMO
This meta-analysis aims to evaluate the comparative outcomes of drain insertion versus no drain after appendicectomy for complicated appendicitis. A systematic search of PubMed, Cochrane Library and Scopus was conducted, and all studies comparing drain versus no drain after appendicectomy for complicated appendicitis were included. Abdominal collection, surgical site infection (SSI), bowel obstruction, faecal fistula, paralytic ileus, length of hospital stay (LOS) and mortality were the evaluated outcome parameters for the meta-analysis. Seventeen studies reporting a total number of 4,255 patients who underwent appendicectomy for complicated appendicitis with (n=1,580) or without (n=2,657) drain were included. There was no significant difference between the two groups regarding abdominal collection (odds ratio (OR)=1.41, P=0.13). No-drain group was superior to the drain group regarding SSI (OR=1.93, P=0.0001), faecal fistula (OR=4.76, P=0.03), intestinal obstruction (OR=2.40, P=0.04) and paralytic ileus (OR=2.07, P=0.01). There was a difference regarding mortality rate between the two groups (3.4% in the drain group vs 0.5% in the no-drain group, risk difference (RD)=0.01, 95% CI (-0.01, 0.04), P=0.36). In conclusion, this meta-analysis has shown that drains have no effect on the development of intra-abdominal collections in complicated appendicitis, but it can significantly increase the risk of postoperative complications such as fistula, surgical site infection (SSI), bowel obstruction, ileus and length of hospital stay.
RESUMO
[This corrects the article DOI: 10.1093/jscr/rjab040.].
RESUMO
Caecal volvulus is an uncommon condition and represents only 10% of all colonic volvulus. The mechanism is due to hypermobile cecum twisting around it is own mesentery. A 40-year-old female who was previously fit and well-attended hospital with 2 days history of intermittent abdominal pain, mild distention and constipation. X-rays showed twisted and dilated loops of bowel with right hepato-diaphragmatic bowel loops entrapment. A computed tomography scan was the only confirmatory test of caecal volvulus with intermittent bowel symptoms. Emergency laparotomy revealed complex intraoperative bowel loops malrotation with congenital bands and abnormal position of Duodeno-Jejenal flexure. Open right hemicolectomy was the operation of choice for this complex case. Caecal volvulus must be considered as one of the important differential diagnosis of acute abdomen during initial assessment of patients with intermittent bowel symptoms in emergency department in order to avoid any therapeutic delay.
