Comparison of the long-term outcome of two therapeutic strategies for the management of abdominal abscess complicating Crohn's disease: percutaneous drainage or immediate surgical treatment.

AIM: The management of abdominal abscesses complicating Crohn's disease is complex and involves a difficult choice between medical, radiological and surgical procedures. The long-term outcome was compared for two strategies for the management of abdominal abscess: percutaneous drainage (PD) followed by rescue surgery in the case of failure vs direct immediate surgery (IS). We also compared the results of IS with surgery performed after PD failure. METHODS: We retrospectively identified 44 patients with Crohn's disease with an abdominal abscess from January 2000 to December 2009. Therapeutic success was defined as abscess resolution and no reappearance within 1 year of follow-up. RESULTS: The first therapeutic approach was PD in 22 cases and IS in the other 22 cases. IS had a higher therapeutic success rate than PD (95.5% vs 27.2% respectively; P < 0.001). PD was the only independent variable related to treatment failure in the multivariate analysis after adjustment for possible confounders such as abscess size, multilocularity, presence of fistula and corticosteroid use (OR 88.26, 95% CI 7.38-1055.36; P < 0.001). Surgery after failure of PD (n = 16) was associated with longer total hospitalization (56.12 ± 35.89 vs 27.52 ± 15.11 days; P = 0.017) and longer postoperative stay (44.0 ± 83.7 vs 14.3 ± 30 days; P = 0.179) and needed a second operation more often (5/16, 31% vs 1/22, 4.5%; P = 0.065) than IS. CONCLUSIONS: Percutaneous drainage provided durable abscess resolution in only one-third of the patients compared with more than 90% of those treated with IS. In addition, surgery performed after PD failure results in a poorer outcome than IS.

Use of non-invasive positive pressure ventilation in emergency departments of hospitals in Spain.

A survey was undertaken of the use of non-invasive ventilation (NIV) in Spain. 45.7% of emergency departments use NIV. The average time it has been in use is 4 years. Public hospitals use NIV more frequently (89.5%) as well as teaching hospitals (78.1%). Emergency physicians are the professionals who most frequently use NIV (68.8%). High flux continuous positive airway pressure (58.4%) and facial masks (63.5%) are most commonly used. Only 18.9% of hospitals have quality registration in NIV and 35.6% have protocols for using NIV. The method is underused by technicians working in hospital emergency services and there is a lack of uniform protocols with other departments involved.

Epidemiology of appendectomy and appendicitis in the Valencian community (Spain), 1998-2007.

BACKGROUND/AIMS: Our purpose was to study the incidence of appendectomy and appendicitis in the Valencian community (Spain) during a period of 10 years (1998-2007). METHODS: Data on discharge diagnoses of appendectomy and appendicitis were downloaded from all public hospitals in the Valencian community. RESULTS: We identified 44,683 cases of appendectomies and 42,742 cases of appendicitis (95.7%) during the study period. The age-standardized incidence rates among men ranked between 132.1 cases per 100,000 population in 2003 and 117.46 cases per 100,000 population in 2000 without a clear trend through the study period. The appendiceal perforation rate was 12.1% and the negative appendectomy rate 4.3%. The global mortality was 0.38%. CONCLUSIONS: The incidence of appendectomy in our community presents a slight descending trend. This decline is more intense in females. The appendix perforation rate is lower than in other studies. The death rate is similar to other studies; however, it is very low in patients of younger age.

Association between tonsillectomy, adenoidectomy, and appendicitis.

INTRODUCTION: Tonsillectomy, with or without adenoidectomy, is one of the most frequent surgical procedures generally performed, especially in young patients. Several studies suggest that there is a relationship between tonsillectomy and altered MALT immune system. OBJECTIVE: To examine the possible association between tonsillectomy or adenoidectomy and the risk of subsequent appendicitis. MATERIAL AND METHOD: A cross-sectional study was performed in 650 patients admitted to the emergency department of a general hospital in Valencia, Spain. Previous history of tonsillectomy and/or adenoidectomy was related to a history of appendectomy. A descriptive study and an analysis of the relationship between previous operations and appendicitis was performed. A multivariable analysis controlled for age and sex was also performed, including the possible interaction of the gender variable. The independent effect of each of the procedures (tonsillectomy, adenoidectomy) was tested. RESULTS: The 25.5% of patients had undergone tonsillectomy and 11.5% adenoidectomy; 17.5% had had an appendectomy. On average, women were operated on more frequently than men. In the bivariate analysis, both tonsillectomy and adenoidectomy were significantly associated with subsequent appendectomy. In the multivariate analysis, this association was only maintained for tonsillectomy (OR: 3.23; 95% CI: 2.11-4.94). A stratified analysis controlling for sex showed a modification of this effect, with a higher association in women (OR: 5.20; 95% CI: 2.91-9.28) than in men (OR: 1.74; 95% CI: 0.90-3.39). CONCLUSIONS: A clear association has been found, especially in women, between previous tonsillectomy and subsequent acute appendicitis. Due to a lack of data on acute appendicitis there should be further studies to explain the findings of this study, as this could be the first described risk factor of acute appendicitis.

Asociación entre amigdalectomía, adenoidectomía y apendicitis / Association between tonsillectomy, adenoidectomy, and appendicitis

Introduction: tonsillectomy, with or without adenoidectomy,is one of the most frequent surgical procedures generally performed,especially in young patients. Several studies suggest thatthere is a relationship between tonsillectomy and altered MALTimmune system.Objective: to examine the possible association between tonsillectomyor adenoidectomy and the risk of subsequent appendicitis.Material and method: a cross-sectional study was performedin 650 patients admitted to the emergency department of a generalhospital in Valencia, Spain. Previous history of tonsillectomyand/or adenoidectomy was related to a history of appendectomy.A descriptive study and an analysis of the relationship betweenprevious operations and appendicitis was performed. A multivariableanalysis controlled for age and sex was also performed, includingthe possible interaction of the gender variable. The independenteffect of each of the procedures (tonsillectomy,adenoidectomy) was tested.Results: the 25.5% of patients had undergone tonsillectomyand 11.5% adenoidectomy; 17.5% had had an appendectomy.On average, women were operated on more frequently than men.In the bivariate analysis, both tonsillectomy and adenoidectomywere significantly associated with subsequent appendectomy. Inthe multivariate analysis, this association was only maintained fortonsillectomy (OR: 3.23; 95% CI: 2.11-4.94). A stratified analysiscontrolling for sex showed a modification of this effect, with ahigher association in women (OR: 5.20; 95% CI: 2.91-9.28) thanin men (OR: 1.74; 95% CI: 0.90-3.39).Conclusions: a clear association has been found, especially inwomen, between previous tonsillectomy and subsequent acute appendicitis.Due to a lack of data on acute appendicitis there shouldbe further studies to explain the findings of this study, as this couldbe the first described risk factor of acute appendicitis

Traumatismos colorrectales por cuerpos extraños introducidos por prácticas sexuales: actitud diagnóstico-terapéutica / Colorectal trauma caused by foreign bodies introduced during sexual activity: diagnosis and management

Objetivo: este trabajo trata de exponer la experiencia de 17 casos de cuerpos extraños colorrectales introducidos por prácticas sexuales, los cuales han sido recogidos por los autores a lo largo de veinte años (1980-2000), y establecer las pautas diagnósticas y terapéuticas ante estas situaciones. Material y métodos: un total de 17 pacientes fueron tratados de traumatismos rectales por introducción de cuerpos extraños, por prácticas sexuales no habituales. La extracción del cuerpo extraño del recto se consiguió en 10 casos por vía anal mediante diversas técnicas (pinzas ginecológicas, sondas de Foley, etc.), y 7 pacientes requirieron intervención quirúrgica, siendo necesaria una colostomía de protección en 5 pacientes, y sutura de la lesión rectal en los 2 restantes. Resultados: mortalidad nula. Postoperatorio sin complicaciones. Cierre de la colostomía en todos los casos a los 3-6 meses de la intervención. No hubo ningún caso de incontinencia anal. Conclusiones: es fundamental realizar una correcta anamnesis y exploración física del paciente, a parte de todas las exploraciones complementarias que sean necesarias, para un correcto diagnóstico y tratamiento de las lesiones. Habrá que tomar grandes precauciones en la extracción del cuerpo extraño para que no se produzca la rotura de éste en el recto, convirtiendo un problema relativamente simple en uno más complejo (AU)

Colorectal trauma caused by foreign bodies introduced during sexual activity: diagnosis and management.

PURPOSE: The aim of this study is to describe 17 cases of colorectal foreign bodies introduced during sexual activity, gathered by the authors over the past twenty years (1980-2000), and to establish diagnostic and therapeutic guidelines for these situations. MATERIAL AND METHODS: A total of 17 patients were treated for rectal trauma caused by foreign bodies due to unusual sexual practice. The extraction of the foreign body was possible through the canal anal in 10 cases using different techniques (gynecological forceps, Foley catheters, etc.), whereas 7 patients required surgical treatment; in five patients a protective colostomy was needed, and in the other two a simple suture of the rectal lesion was performed. RESULTS: There were no deaths and no post-operative complications. In all cases the colostomy was closed 3-6 months after surgery. There were no cases of anal incontinence. CONCLUSIONS: A detailed clinical history and physical examination are essential for the diagnosis and management of these lesions, in addition to any other diagnostic techniques that might be necessary. Great care should be taken when extracting the foreign body so as to avoid its breakage inside the rectum, which would complicate a rather simple problem.