Clinical characteristics and risk factors for acute abdomen in patients with abdominal lymphatic malformations.

OBJECTIVE: The diagnosis of abdominal lymphatic malformations (ALMs) is often overlooked in clinical practice. However, reports in the literature about ALMs are limited to case reports/series with small sample sizes. This study aimed to review our currently available data to describe the clinical characteristics of ALMs and evaluate the risk factors for acute abdomen caused by ALMs. METHODS: We reviewed the records of patients with ALMs who were diagnosed between December 2008 and January 2023 in our institution. The associations between acute abdomen and ALMs were analyzed based on single-factor and multivariate logistic regression analyses. RESULTS: This study included 345 patients with pathologically confirmed ALMs, with a slight female predominance of 1:1.4. Approximately 39.1% (135/345) of patients were asymptomatic, and 24.6% (85/345) presented with acute abdomen. Among the ALMs in the cohort, 42.6% (147/345) were retroperitoneal lymphatic malformations (LMs). The maximal lesion dimensions in patients with acute abdomen and nonacute abdomen were 10.0 cm and 7.8 cm, respectively, with no significant difference based on multivariate analyses. Children were more likely to develop acute abdomen than adults were (P=0.002; odds ratio [OR], 5.128; 95% confidence interval [CI], 1.835-14.326). ALMs accompanying acute abdomen were more common for lesions involving the small intestinal mesentery (P=0.023; OR, 2.926; 95% CI, 1.157-7.400). CONCLUSION: ALMs are rare with insidious onset, and retroperitoneal LMs are the most common ALMs, followed by jejunal MLMs. Our retrospective analysis suggested that young age and small intestinal mesenteric lymphatic malformation are independent risk factors for acute abdomen with ALMs.

Imaging the pancreas with photon-counting CT - A review of normal pancreatic anatomy.

PURPOSE: Compared to conventional energy integrating detector CT, Photon-Counting CT (PCCT) has the advantage of increased spatial resolution. The pancreas is a highly complex organ anatomically. The increased spatial resolution of PCCT challenges radiologists' knowledge of pancreatic anatomy. The purpose of this review was to review detailed macroscopic and microscopic anatomy of the pancreas in the context of current and future PCCT. METHOD: This review is based on a literature review of all parts of pancreatic anatomy and a retrospective imaging review of PCCT scans from 20 consecutively included patients without pancreatic pathology (mean age 61.8 years, 11 female), scanned in the workup of pancreatic cancer with a contrast enhanced multiphase protocol. Two radiologists assessed the visibility of the main and accessory pancreatic ducts, side ducts, ampulla, major papilla, minor papilla, pancreatic arteries and veins, regional lymph nodes, coeliac ganglia, and coeliac plexus. RESULTS: The macroscopic anatomy of the pancreas was consistently visualized with PCCT. Visualization of detailed anatomy of the ductal system (including side ducts), papillae, arteries, vein, lymph nodes, and innervation was possible in 90% or more of patients with moderate to good interreader agreement. CONCLUSION: PCCT scans of the pancreas visualizes previously unseen or inconsistently seen small anatomical structures consistently. Increased knowledge of pancreatic anatomy could have importance in imaging of pancreatic cancer and other pancreatic diseases.

Early recognition of pain: improving colic outcomes in horses in Senegal.

Background: Limited knowledge exists on recognition and treatment of equine abdominal pain in low- and middle-income countries. This study aimed at finding indicators for recognizing abdominal pain, evaluating responses to clinical and behavioral changes, and assessing the impact of timely referral on colic outcomes in a suburban region of Senegal. The final goal was to identify factors that may be leveraged to improve the outcome of horses presented for abdominal pain in Senegal. Study design: Retrospective, observational cohort study. Methods: Data from 26 foals and 40 adult horses referred for acute abdomen between 2013 and 2014 and the first semester of 2023 were reviewed. Signs of abdominal pain were grouped into behavioral, posture modification and animal interactions with the environment. Time to referral was defined as the time between the recognition of abdominal pain and referral. The association of time to referral and the outcome was calculated for each subpopulation and compared using logistic regression analysis as appropriate. Results: A significant proportion of owners (47%) and veterinarians (77.8%) relied on behavioral changes to detect abdominal pain in foals. Most owners referred foals within 24 h, while veterinarians referred within 12 h. Mortality in foals exceeded 50% when referral was delayed by 12 h or more. In adult horses, groomers often were the first noticing behavioral changes (79%), and they referred the horse within three hours, whereas owners typically delayed referral for 24 h or longer, leading to increased hospitalization expenses. Limitations: The study considered a limited cohort in an suburban area of Senegal. Sourcing complete data was challenging. Additionally, accurately assessing owner experience was difficult due to the participant group's heterogeneity. Absence of a reliable system to measure daily horse-owner interaction time and logistical challenges in the abdominal pain symptom alert chain were also limiting factors. Conclusions: Early detection is critical for positive colic outcomes in both foals and adult horses. Therefore, raising awareness and providing training to horse owners for prompt recognition of symptoms and referral is essential. This proactive approach aims to improve overall outcomes and reduce the financial burden of equine hospitalization in Senegal.

Sigmoid Perforation by an Ingested Foreign Body Mimicking Acute Appendicitis: A Case Report.

Lower abdominal pain is a common complaint for patients presenting for evaluation in the emergency department. Among other life-threatening complications, acute appendicitis needs to be ruled out in the case of right-lower quadrant pain (RLQ). Sigmoid perforation caused by an ingested foreign body is an uncommon cause of RLQ pain. This report presents the case of an otherwise healthy, 29-year-old male who presented to the emergency department with RLQ pain. His initial evaluation raised concern for acute appendicitis. However, during his exploratory laparoscopy, he was found to have a perforated sigmoid colon due to a skewer stick; the patient had no recollection of having ingested any foreign body. This paper highlights the importance of considering the possibility of sigmoid perforation by an ingested foreign body as a possible cause of RLQ pain. The article also reviews the most common causes of ingested foreign bodies, their potential complications and management.

Clinical and Epidemiological Profile of Patients Presenting With Acute Abdomen to the Emergency Department of a Tertiary Care Hospital.

BACKGROUND:  Acute abdomen is a common and urgent clinical condition requiring prompt diagnosis and treatment. This study determines the clinical and epidemiological profile of patients presenting with acute abdomen at a tertiary care hospital. OBJECTIVE: To describe the demographic characteristics, provisional diagnoses, treatment modalities, and pain management effectiveness in patients with acute abdomen. METHODS:  This prospective observational study was conducted in the Emergency Medicine department at Dr. D. Y. Patil Medical College, Hospital & Research Center, Pimpri, Pune, over a specified period. The study included patients presenting with acute abdomen, aged above 14 years, excluding those with traumatic acute abdomen and pregnant patients. A sample size of 146 was calculated based on the proportion of ureteric colic cases, with a 95% confidence interval and a 6% margin of error; however, a total of 176 patients were included in the study. Data collection involved recording demographic details, clinical features, provisional diagnoses, and pain scores, as well as performing required blood investigations and ultrasonography. Pain scores were assessed before and after treatment. Patients will be given non-steroidal anti-inflammatory drugs (NSAIDs) or opioid analgesia, depending on the clinical severity. Emergency medicine residents, in consultation with the on-call consultant, determined the disposition of patients, deciding if they required surgical or conservative management. RESULTS: The study found that the majority of patients, n = 130 (73.86%), were aged 26-50 years, with cases n = 103 (58.52%) being males and cases n = 73 (41.48%) females. Acute appendicitis was the most common diagnosis, n = 41 (24.43%), followed by urolithiasis n = 33 (18.75%). Surgical interventions were required for n = 78 (45.08%) of patients, highlighting the urgent nature of these conditions. Pain management was effective, with significant reductions in pain scores post-treatment (mean visual analog score (VAS) decreased from 6.22 to 2.33, and mean numerical rating score (NRS) from 6.05 to 2.10; p < 0.001). CONCLUSION:  The study underscores the high prevalence of gastrointestinal and renal conditions in patients with acute abdomen, particularly in middle-aged adults. The high rate of surgical interventions reflects the urgent nature of these conditions. Significant reductions in pain scores demonstrated effective pain management. Comprehensive care strategies are essential for optimizing patient outcomes. Future research with larger sample sizes and multi-center participation is recommended to validate these findings and enhance management protocols for acute abdomen.

Prevalence and risk factors of training-related abdominal injuries: A multicenter survey study.

PURPOSE: This study aims to identify the prevalence and risk factors of military training-related abdominal injuries and help plan and conduct training properly. METHODS: This questionnaire survey study was conducted from October 2021 to May 2022 among military personnel from 6 military units and 8 military medical centers and participants' medical records were consulted to identify the training-related abdominal injuries. All the military personnel who ever participated in military training were included. Those who refused to participate in this study or provided an incomplete questionnaire were excluded. The questionnaire collected demographic information, type of abdominal injury, frequency, training subjects, triggers, treatment, and training disturbance. Chi-square test and t-test were used to compare baseline information. Univariate and multivariate regression analyses were used to explore the risk factors associated with military training-related abdominal injuries. RESULTS: A total of 3058 participants were involved in this study, among which 1797 (58.8%) had suffered training-related abdominal injuries (the mean age was 24.3 years and the service time was 5.6 years), while 1261 (41.2%) had no training-related abdominal injuries (the mean age was 23.1 years and the service time was 4.3 years). There were 546 injured patients (30.4%) suspended the training and 84 (4.6%) needed to be referred to higher-level hospitals. The most common triggers included inadequate warm-up, fatigue, and intense training. The training subjects with the most abdominal injuries were long-distance running (589, 32.8%). Civil servants had the highest rate of abdominal trauma (17.1%). Age ≥ 25 years, military service ≥ 3 years, poor sleep status, and previous abdominal history were independent risk factors for training-related abdominal injury. CONCLUSION: More than half of the military personnel have suffered military training-related abdominal injuries. Inadequate warm-up, fatigue, and high training intensity are the most common inducing factors. Scientific and proper training should be conducted according to the factors causing abdominal injuries.

Comparison of ultrasound assisted and intraoperative diameter measurement in acute appendicitis.

Detailed anamnesis and systematic physical examination are often relevant in the diagnostic routine of acute appendicitis. However, physicians are increasingly motivated to obtain radiological approval. Inherent limitations due to radiologists' experience and the presenting anatomy may result in contradictory outcomes between the described and intraoperative findings. In this study, a comparison of anthropometric measurements of the appendix vermiformis obtained by radiologists and surgeons in children with acute appendicitis is discussed. The external appendiceal diameter in 53 patients who underwent surgery between April 2022 and January 2024 was measured at three different anatomical locations during preoperative ultrasound and intraoperatively with the help of Vernier calipers. Appendectomy materials were classified into negative, acute, and complicated appendicitis subgroups on the basis of histopathological results. The widest median diameter, expressed in millimeters, was analyzed statistically in terms of diagnostic accuracy. Histopathological analysis revealed negative appendectomy in 15.1%, acute appendicitis in 66%, and complicated appendicitis in 18.8% of the patients. The median age at presentation was 11.4 years (4-17.3 years), and 45.3% of the patients were females. The average median appendiceal diameter was 7.8 ± 2.4 mm according to the caliper and 7.9 ± 2.7 mm according to ultrasound (p > 0.05). The evaluation by the caliper revealed a much smaller diameter in 19 patients than did ultrasound. The appendiceal diameter of eight documented negative appendectomy samples was 7 mm or greater. US failed to identify the presence of an appendicolith in 11 cases (20.8%), all of which were disclosed during histopathological evaluation. It is possible to conclude that ultrasound and intraoperative anthropometric measurements correlate according to our study. Diagnostic accuracy, however, which is individually based on ultrasound appendix diameter values greater than 6 mm, is controversial. It is clear that comparison and further reinterpretation of such anthropometric measurements in light of histopathological consequences may help diminish the frequency of negative and perforated appendectomies.

Quality assessment of expedited AI generated reformatted images for ED acquired CT abdomen and pelvis imaging.

PURPOSE: Retrospectively compare image quality, radiologist diagnostic confidence, and time for images to reach PACS for contrast enhanced abdominopelvic CT examinations created on the scanner console by technologists versus those generated automatically by thin-client artificial intelligence (AI) mechanisms. METHODS: A retrospective PACS search identified adults who underwent an emergency department contrast-enhanced abdominopelvic CT in 07/2022 (Console Cohort) and 07/2023 (Server Cohort). Coronal and sagittal multiplanar reformatted images (MPR) were created by AI software in the Server cohort. Time to completion of MPR images was compared using 2-sample t-tests for all patients in both cohorts. Two radiologists qualitatively assessed image quality and diagnostic confidence on 5-point Likert scales for 50 consecutive examinations from each cohort. Additionally, they assessed for acute abdominopelvic findings. Continuous variables and qualitative scores were compared with the Mann-Whitney U test. A p < .05 indicated statistical significance. RESULTS: Mean[SD] time to exam completion in PACS was 8.7[11.1] minutes in the Console cohort (n = 728) and 4.6[6.6] minutes in the Server cohort (n = 892), p < .001. 50 examinations in the Console Cohort (28 women 22 men, 51[19] years) and Server cohort (27 women 23 men, 57[19] years) were included for radiologist review. Age, sex, CTDlvol, and DLP were not statistically different between the cohorts (all p > .05). There was no significant difference in image quality or diagnostic confidence for either reader when comparing the Console and Server cohorts (all p > .05). CONCLUSION: Examinations utilizing AI generated MPRs on a thin-client architecture were completed approximately 50% faster than those utilizing reconstructions generated at the console with no statistical difference in diagnostic confidence or image quality.

Torsion of Tubo-Ovarian Complex during Pregnancy: A Case Report.

Introduction: Adnexal torsion is characterised by the rotation of the ovary and, occasionally, the fallopian tube around their supporting ligaments by more than 45 degrees. It predominantly occurs during the first and second trimesters of pregnancy, with an incidence of up to 0.1% in the third trimester. Dermoid and functional ovarian cysts, most commonly associated with benign serous cystadenomas, are frequently identified among the torted adnexal masses. Case Presentation: We report the case of a 32-year-old primigravida with a known ovarian cyst diagnosed in the first trimester, which was managed conservatively throughout the pregnancy. At 36 weeks of gestation, she presented with abdominal pain and was subsequently managed with an emergency caesarean section at 37 weeks due to the development of an acute surgical abdomen. During the procedure, a torted left tubo-ovarian complex was excised, with partial preservation of the healthy-appearing ovarian tissue. Histopathological examination identified the mass as a benign serous cystadenoma. Conclusions: Ovarian torsion during pregnancy poses a significant diagnostic challenge. The decision between conservative management and surgical intervention is primarily guided by a high index of suspicion for torsion.

Pharmacokinetics of Piperacillin-Tazobactam in Critically Ill Patients with Open Abdomen and Vacuum-Assisted Wound Closure: Dosing Considerations Using Monte Carlo Simulation.

BACKGROUND: Open abdomen with vacuum-assisted wound closure therapy (OA/VAC) is frequently used in critically ill patients although the impact of OA/VAC on antibiotics pharmacokinetics (PK) remains unknown. We thus aimed to characterize the PK of piperacillin-tazobactam (PTZ) in critically ill patients with OA/VAC and assess the optimal dosing regimens based on pharmacodynamics (PD) target attainment. METHODS: Over a 15-month study period, 45 patients with OA/VAC treated with PTZ administered continuously and adapted to 24 h creatinine clearance (CLCR) underwent measurements of free concentrations in their plasma, urine, VAC exudate, and peritoneal fluid. Population PK modeling was performed considering the effect of covariates, and Monte Carlo simulations were employed to determine the probability of target attainment (PTA) for the PK/PD targets (100% fT > 16 mg/L) in the plasma and at the peritoneal site at steady state. RESULTS: Piperacillin concentrations were described using a two-compartment model, with age and total body weight as significant covariates for central volume of distribution (V1) and estimated renal function for clearance (CL). Tazobactam concentrations were described using a two-compartment model with estimated renal function as a significant covariate. The central volume of distributions V1 of piperacillin and tazobactam were 21.2 and 23.2 L, respectively. The VAC-induced peritoneal clearance was negligible compared to renal clearance. Most patients achieved the desirable PK/PD target when using a CLCR-pondered PTZ dosing regimen from 12 g/1.5 g/day to 20 g/2.5 g/day. CONCLUSIONS: Despite a wide inter-individual variability, the influence of OA/VAC on piperacillin and tazobactam PK parameters is not straightforward. The use of a CLCR-pondered PTZ dosing regimen from 12 g/1.5 g/day to 20 g/2.5 g/day is needed to reach a PTA > 85%.

Malrotated subhepatic caecum with subhepatic appendicitis: Diagnostic dilemma: A case report.

INTRODUCTION: Acute appendicitis is among common surgical emergency. Subhepatic appendicitis is rare and difficult to diagnose and manage. There are few case reports across the world. CASE PRESENTATION: We presented a case of 7 year's old child with no known medical illness presented with acute onset vague abdominal pain experienced for three days. he was symptomatically treated as Acute gastroenteritis and dyspepsia later diagnosed with acute appendicitis and underwent laparotomy. He has malrotated subhepatic cecum with Subhepatic gangrenous appendicitis Open appendectomy done and discharged improved. CLINICAL DISCUSSION: Subhepatic appendicitis is a condition where the appendix is abnormally located in the upper right abdomen. This atypical placement often leads to delayed diagnosis and complications due to its similar symptoms to other abdominal diseases. While ultrasound is a valuable tool for diagnosis, laparoscopic appendectomy is the preferred treatment method when available. However, in resource-limited settings without laparoscopic capabilities, open surgery is necessary. CONCLUSION: Subhepatic appendicitis is a rare occurrence and its infrequent location makes it difficult to diagnose. Awareness of various location of appendix, a high index of suspicion and radiological imaging is required for prompt diagnosis and management. Appendicitis in subhepatic appendix and high up cecum creates a lot of confusion in both diagnosis and surgical exploration which may lead in complication and delay in treatment.

Rectal Gastrointestinal Stromal Tumour: A Report of a Rare Case and Literature Review.

Gastrointestinal stromal tumours (GISTs), are an extremely uncommon form of different types of gastrointestinal (GI) malignant neoplasms. While GISTs are the most prevalent type of mesenchymal tumours in the GI tract, they are mainly located in the stomach. Gastrointestinal stromal tumours in the rectum are rarely observed. Some individuals may exhibit symptoms such as constipation, pain in the rectum, bleeding per rectum, or palpable growth, while others may be discovered incidentally. The prevalence of GISTs has been increasing, potentially as a result of developments in imaging techniques. In the present case report, we describe a 47-year-old male patient who initially complained of pain in the lower abdomen, rectum, and occasional constipation. A contrast-enhanced CT (CECT) scan revealed a well-defined hypodense, enhancing lesion with a small calcified area at its periphery in the rectum. The lesion caused a significant luminal narrowing of the rectum. During colonoscopy, a mass located in the submucosal region was identified on the side of the rectal wall, approximately 1 cm away from the anus. After performing the biopsy, the specimen was subjected to histological examination, which revealed a spindle cell tumour with a mild cellular appearance. This finding was in line with the diagnosis of a GIST located in the rectum. The purpose of the current case report is to highlight the significance of CT, colonoscopy, and biopsy in promptly identifying rare GISTs in the colon and rectum, emphasising the uncommon occurrence of GISTs along with their typical locations and imaging features.

Unmasking a Rare Cause of Acute Abdomen in Adults: A Case Report of an Infected Urachal Cyst.

The urachus is a remnant of the fetal duct that typically obliterates and becomes a fibrous cord after birth. However, in rare cases where this process fails, urachal cysts and other abnormalities can form, often remaining undiagnosed due to their asymptomatic nature. Infection is the primary complication and can be misdiagnosed due to the cyst's obscurity and varied presentations. Delayed diagnosis can lead to severe complications such as sepsis, fistula formation, and cyst rupture, potentially causing peritonitis. This paper discusses a 48-year-old male who consulted in the emergency department with acute abdominal symptoms, was diagnosed with an infected urachal cyst via imaging and successfully treated with antibiotics and subsequent surgical excision.

Laparoscopic Management of an Early Postoperative Pelvic Abscess Caused by Prevotella bivia Following a Deep Infiltrating Endometriosis Surgery.

Surgery for deep-infiltrating endometriosis (DIE) carries a high risk of complications, including pelvic abscesses. We would like to present the laparoscopic management of a pelvic abscess caused by Prevotella bivia following a radical hysterectomy in a DIE laparoscopic surgery. A 43-year-old G2P2 lady underwent a laparoscopic hysterectomy, bilateral ureterolysis, bilateral parametrial nodule extirpation, and rectal shaving following complaints of severe dysmenorrhea, dyspareunia, and chronic pelvic pain due to deep-infiltrating endometriosis (ENZIAN score: P2; 02/3; T2/2; A3; B3/2; C2; FA) (American Association of Gynecologic Laparoscopists (AAGL) score: 72, Stage 4). She received intravenous antibiotic treatment at the hospital with a diagnosis of pelvic inflammatory disease one month before the endometriosis surgery. After the extensive laparoscopic surgery, the early postoperative period was uneventful; however, starting on the fourth postoperative day, she was complaining of abdominal pain. On the seventh postoperative day, severe left-sided abdominal pain, fever, nausea, vomiting, rising levels of C-reactive protein (CRP > 200 mg/dL), and signs of septicemia were observed. The vaginal examination revealed a purulent discharge. Bacterial cultures were obtained from the vaginal cuff and peripheral vein. On the computerized tomography scan, neither a bowel nor ureter injury was found, but a pelvic abscess above the vaginal cuff and left ureteral compression below the pelvic brim were observed. Due to the clinical deterioration of the patient despite receiving piperacillin/tazobactam antibiotic therapy, the decision was made to perform a repeat laparoscopy to prevent septic shock and ureteral stent application for urinary tract obstruction. During the laparoscopy, purulent fluid was discovered around the pelvic peritoneum, and it was noted that the rectosigmoid colon was edematous and tightly adherent to the pelvic sidewalls. The rectosigmoid colon was carefully detached from the pelvic sidewalls; the left ureter was released, and the purulent abscess material from the vaginal cuff was aspirated. Every effort was made to remove as many yellowish plaques covering the pelvic peritoneum and rectum serosa as possible. Recovery following surgery was rapid. P. bivia was detected in the blood culture, and the patient was treated with piperacillin/tazobactam for an additional seven days, resulting in a complete resolution of the illness. Pelvic abscess is a rare but serious complication that can occur following laparoscopic deep-infiltrating endometriosis surgery. To prevent ending up with septicemia and septic shock, further laparoscopic surgery may be necessary.

Geometric evaluation and quantifying dosimetric impact of diverse deformable image registration algorithms on abdomen images with biomechanically modeled deformations.

PURPOSE: Deformable image registration (DIR) has been increasingly used in radiation therapy (RT). The accuracy of DIR algorithms and how it impacts on the RT plan dosimetrically were examined in our study for abdominal sites using biomechanically modeled deformations. METHODS: Five pancreatic cancer patients were enrolled in this study. Following the guidelines of AAPM TG-132, a patient-specific quality assurance (QA) workflow was developed to evaluate DIR for the abdomen using the TG-132 recommended virtual simulation software ImSimQA (Shrewsbury, UK). First, the planning CT was deformed to simulate respiratory motion using the embedded biomechanical model in ImSimQA. Additionally, 5 mm translational motion was added to the stomach, duodenum, and small bowel. The original planning CT and the deformed CT were then imported into Eclipse and MIM to perform DIR. The output displacement vector fields (DVFs) were compared with the ground truth from ImSimQA. Furthermore, the original treatment plan was recalculated on the ground-truth deformed CT and the deformed CT (with Eclipse and MIM DVF). The dose errors were calculated on a voxel-to-voxel basis. RESULTS: Data analysis comparing DVF from Eclipse versus MIM show the average mean DVF magnitude errors of 2.8 ± 1.0  versus 1.1 ± 0.7 mm for stomach and duodenum, 5.2 ± 4.0  versus 2.5 ± 1.0 mm for small bowel, and 4.8 ± 4.1  versus 2.7 ± 1.1 mm for the gross tumor volume (GTV), respectively, across all patients. The mean dose error on stomach+duodenum and small bowel were 2.3 ± 0.6% for Eclipse, and 1.0 ± 0.3% for MIM. As the DIR magnitude error increases, the dose error range increase, for both Eclipse and MIM. CONCLUSION: In our study, an initial assessment was conducted to evaluate the accuracy of DIR and its dosimetric impact on radiotherapy. A patient-specific DIR QA workflow was developed for pancreatic cancer patients. This workflow exhibits promising potential for future implementation as a clinical workflow.

Damage control surgery in non-traumatic abdominal emergencies: prognostic value of SOFA, APACHEII, and Mannheim peritonitis index.

This study aimed to analyze the prognostic value of the SOFA, APACHE II, and MPI (Mannheim Peritonitis Index) scores in the indication for Damage Control Surgery (DCS) in non-trauma. Retrospective analysis of patients undergoing DCS between 2014 and 2019. SOFA and APACHE II scores were calculated using parameters preceding DCS, while MPI was based on surgical descriptions. Statistical analysis: Qualitative variables were compared using the Chi-square test or Fisher's exact test, and quantitative variables using Pearson's correlation coefficient. The Student's T test was employed for mean comparisons. The sample comprised 104 patients (59 males), with a median age of 63.5 years, of whom 52 (50%) were ASA IV. Operative findings leading to DCS included peritonitis (54; 51.9%), intestinal ischemia (39; 37.5%), inability to close the abdomen (8; 7.6%), and bleeding (3; 2.9%). The mortality rate was 75% (78/104). Thirty patients (28.8%) died after DCS; the remainder underwent one (35; 33.6%), two (21; 20.2%); three (8; 7.7%), and four or more (10;9.7%) revision procedures. The median lengths of ICU and hospital stays were 12.5 and 20.5 days, respectively. The median score values were as follows: SOFA: 12 (0-38), APACHE II: 25 (2-47), and MPI: 26 (8-43). Besides ASA classification (p = 0.03), mortality risk was influenced by: age (≤ 65 years vs. > 65 years; p = 0.04), SOFA (≤ 10 vs. > 10; p = 0.03), APACHE II (≤ 25 vs. > 25; p = 0.04), and MPI (≤ 25 vs. > 25; p = 0.003). The SOFA, APACHE II, and MPI scores proved to be valuable tools in the prognostic assessment of patients undergoing DCS in non-traumatic abdominal emergencies.

Hereditary angioedema presented as isolated ascending and transverse colon swelling mimicking acute abdomen.

Hereditary angioedema (HAE) is a rare autosomal dominant condition characterized by C1-INH gene mutations, leading to recurrent angioedema episodes affecting various body parts, including the gastrointestinal tract. This case report describes a 24-year-old female presenting with symptoms mimicking an acute abdomen, characterized by severe abdominal cramps, anorexia, and diarrhea, with a significant past medical history of angioedema flares and emergency intubation for asphyxiation at age 11. Despite initial treatment with antihistamines showing no improvement, her symptoms spontaneously resolved. Further investigation revealed low complement C4 levels and reduced C1-INH function, confirming HAE with an unusual isolated involvement of the ascending and transverse colon. This case underscores the importance of considering HAE in patients presenting with acute abdominal symptoms, especially with a history suggestive of angioedema. It highlights the need for emergency physicians and gastroenterologists to be aware of HAE's clinical manifestations to avoid misdiagnosis and unnecessary interventions. Moreover, the case emphasizes the significance of patient education on recognizing symptoms and seeking timely medical attention to prevent severe complications. This report adds to the existing literature by detailing an uncommon presentation of HAE, aiming to enhance early diagnosis and management of this potentially life-threatening condition.

Iatrogenic Parasitic Leiomyoma in the Lower Right Abdomen: A Rare Case in Plastic Surgery.

A parasitic leiomyoma has no connection with the uterus itself and obtains its blood supply from the surrounding tissues. A parasitic leiomyoma that develops iatrogenically is called an iatrogenic parasitic leiomyoma. Clinical reports on parasitic leiomyoma are common in gynecology but not in plastic surgery. We report a rare case of an iatrogenic parasitic leiomyoma in a 46-year-old woman who was referred to our plastic surgery department. She presented with the main complaint of a subcutaneous mass in the lower right abdomen and had a history of laparoscopic myomectomy eight years ago. Magnetic resonance imaging showed two masses in the subcutaneous tissue of the lower right abdomen and the posterior rectus abdominis. The excision of these masses was performed through an abdominal wall incision. Histopathological examination revealed that the extracted mass was a leiomyoma. Plastic surgeons must keep in mind the appropriate management of rare cases of parasitic leiomyoma.

Vacuum-assisted wound closure and mesh-mediated fascial traction for temporary closure in open abdomen: A single-arm meta-analysis.

INTRODUCTION: Open abdomen (OA) therapy is used in the management of patients who require surgery for severe abdominal conditions. This meta-analysis aims to evaluate the VAWCM technique regarding short and long-term outcomes. METHODS: PubMed, Embase, and Cochrane Central were systematically searched for studies that analyzed VAWCM therapy in OA. Primary outcomes were the complete fascial closure rate and mean duration of OA treatment. Statistical analyses were performed using R statistical software. RESULTS: Seven studies comprising 535 patients were included. We found a complete fascial closure rate of 77.3 per 100 patients (80.1%; 95% CI 59.6-88.7; I2 = 76%), with an overall mortality of 30.3 per 100 (33.5%; 95% CI 9.3-19.4; I2 = 78%). The pooled mean duration of OA treatment was 14.6 days (95% CI 10.7-18.6; I2 = 93%), while the mean length of hospital stay was 43.3 days (95% CI 21.2-65.3; I2 = 96%). As additional outcomes, we found an enteroatmospheric fistula rate of 5.6 per 100 patients (5.4%; 95% CI 2.3-13.3; I2 = 45%) and incisional hernia rate of 34.7 per 100 (34.6%; 95% CI 28.9-41.1; I2 = 0%). The subgroup analysis of mesh materials (polypropylene or polyglactin) showed a higher complete fascial closure rate for the polyglactin (89.1% vs. 66.6%; p = 0.02). CONCLUSION: Our findings showed that VAWCM is a viable option for OA treatment, successfully reaching complete fascial closure, with a low duration of the technique, even though it presented a high heterogeneity between the studies.