World Journal of Emergency Surgery最新文献

{"title":"ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings.","authors":"Simone Frassini, Lorenzo Cobianchi, Paola Fugazzola, Walter L Biffl, Federico Coccolini, Dimitrios Damaskos, Ernest E Moore, Yoram Kluger, Marco Ceresoli, Raul Coimbra, Justin Davies, Andrew Kirkpatrick, Isidoro Di Carlo, Timothy C Hardcastle, Arda Isik, Massimo Chiarugi, Kurinchi Gurusamy, Ronald V Maier, Helmut A Segovia Lohse, Hans Jeekel, Marja A Boermeester, Fikri Abu-Zidan, Kenji Inaba, Dieter G Weber, Goran Augustin, Luigi Bonavina, George Velmahos, Massimo Sartelli, Salomone Di Saverio, Richard P G Ten Broek, Stefano Granieri, Francesca Dal Mas, Camilla Nikita Farè, Jacopo Peverada, Simone Zanghì, Jacopo Viganò, Matteo Tomasoni, Tommaso Dominioni, Enrico Cicuttin, Andreas Hecker, Giovanni D Tebala, Joseph M Galante, Imtiaz Wani, Vladimir Khokha, Michael Sugrue, Thomas M Scalea, Edward Tan, Mark A Malangoni, Nikolaos Pararas, Mauro Podda, Belinda De Simone, Rao Ivatury, Yunfeng Cui, Jeffry Kashuk, Andrew Peitzman, Fernando Kim, Emmanouil Pikoulis, Gabriele Sganga, Osvaldo Chiara, Michael D Kelly, Ingo Marzi, Edoardo Picetti, Vanni Agnoletti, Nicola De'Angelis, Giampiero Campanelli, Marc de Moya, Andrey Litvin, Aleix Martínez-Pérez, Ibrahima Sall, Sandro Rizoli, Gia Tomadze, Boris Sakakushev, Philip F Stahel, Ian Civil, Vishal Shelat, David Costa, Alain Chichom-Mefire, Rifat Latifi, Mircea Chirica, Francesco Amico, Amyn Pardhan, Vidya Seenarain, Nikitha Boyapati, Basil Hatz, Travis Ackermann, Sandun Abeyasundara, Linda Fenton, Frank Plani, Rohit Sarvepalli, Omid Rouhbakhshfar, Pamela Caleo, Victor Ho-Ching Yau, Kristenne Clement, Erasmia Christou, Ana María González Castillo, Preet K S Gosal, Sunder Balasubramaniam, Jeremy Hsu, Kamon Banphawatanarak, Michele Pisano, Toro Adriana, Altomare Michele, Stefano P B Cioffi, Andrea Spota, Fausto Catena, Luca Ansaloni","doi":"10.1186/s13017-023-00511-w","DOIUrl":"10.1186/s13017-023-00511-w","url":null,"abstract":"<p><p>Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"42"},"PeriodicalIF":6.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10373269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines.","authors":"Federico Coccolini,&nbsp;Massimo Sartelli,&nbsp;Robert Sawyer,&nbsp;Kemal Rasa,&nbsp;Bruno Viaggi,&nbsp;Fikri Abu-Zidan,&nbsp;Kjetil Soreide,&nbsp;Timothy Hardcastle,&nbsp;Deepak Gupta,&nbsp;Cino Bendinelli,&nbsp;Marco Ceresoli,&nbsp;Vishal G Shelat,&nbsp;Richard Ten Broek,&nbsp;Gian Luca Baiocchi,&nbsp;Ernest E Moore,&nbsp;Ibrahima Sall,&nbsp;Mauro Podda,&nbsp;Luigi Bonavina,&nbsp;Igor A Kryvoruchko,&nbsp;Philip Stahel,&nbsp;Kenji Inaba,&nbsp;Philippe Montravers,&nbsp;Boris Sakakushev,&nbsp;Gabriele Sganga,&nbsp;Paolo Ballestracci,&nbsp;Manu L N G Malbrain,&nbsp;Jean-Louis Vincent,&nbsp;Manos Pikoulis,&nbsp;Solomon Gurmu Beka,&nbsp;Krstina Doklestic,&nbsp;Massimo Chiarugi,&nbsp;Marco Falcone,&nbsp;Elena Bignami,&nbsp;Viktor Reva,&nbsp;Zaza Demetrashvili,&nbsp;Salomone Di Saverio,&nbsp;Matti Tolonen,&nbsp;Pradeep Navsaria,&nbsp;Miklosh Bala,&nbsp;Zsolt Balogh,&nbsp;Andrey Litvin,&nbsp;Andreas Hecker,&nbsp;Imtiaz Wani,&nbsp;Andreas Fette,&nbsp;Belinda De Simone,&nbsp;Rao Ivatury,&nbsp;Edoardo Picetti,&nbsp;Vladimir Khokha,&nbsp;Edward Tan,&nbsp;Chad Ball,&nbsp;Carlo Tascini,&nbsp;Yunfeng Cui,&nbsp;Raul Coimbra,&nbsp;Michael Kelly,&nbsp;Costanza Martino,&nbsp;Vanni Agnoletti,&nbsp;Marja A Boermeester,&nbsp;Nicola De'Angelis,&nbsp;Mircea Chirica,&nbsp;Walt L Biffl,&nbsp;Luca Ansaloni,&nbsp;Yoram Kluger,&nbsp;Fausto Catena,&nbsp;Andrew W Kirkpatrick","doi":"10.1186/s13017-023-00509-4","DOIUrl":"https://doi.org/10.1186/s13017-023-00509-4","url":null,"abstract":"<p><p>Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"41"},"PeriodicalIF":8.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10362628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9869589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guided blood transfusion of trauma patients with rotational thromboelastometry: a single-center cohort study.","authors":"Mina Salehi, Rajan Bola, Nenke de Jong, Andrew W Shih, Naisan Garraway, Philip Dawe","doi":"10.1186/s13017-023-00508-5","DOIUrl":"10.1186/s13017-023-00508-5","url":null,"abstract":"<p><strong>Background: </strong>Rotational thromboelastometry (ROTEM) is a blood test used to measure in vitro clot strength as a surrogate for a patient's ability to form clots in vivo. This provides information about induction, formation, and clot lysis, allowing goal-directed transfusion therapy for specific hemostatic needs. We sought to evaluate the effect of ROTEM-guided transfusion on blood product usage and in-hospital mortality among patients with a traumatic injury.</p><p><strong>Methods: </strong>This was a single-center observational cohort analysis of emergency department patients in a Level 1 trauma center. We compared blood usage in trauma patients in whom ratio-based massive hemorrhage protocols were activated in the twelve months before the introduction of ROTEM (pre-ROTEM group) to the twelve months following the introduction of ROTEM (ROTEM-period group). ROTEM was implemented in this center in November 2016. The ROTEM device allowed clinicians to make real-time decisions about blood product therapy in resuscitation for trauma.</p><p><strong>Results: </strong>The pre-ROTEM group contained 21 patients. Forty-three patients were included from the ROTEM-period, of whom 35 patients received ROTEM-guided resuscitation (81% compliance). The use of fibrinogen concentrate was significantly higher in the ROTEM-period group (pre-ROTEM mean 0.2 vs. ROTEM-period mean 0.8; p = 0.006). There was no significant difference in the number of units of red blood cells, platelets, cryoprecipitate, or fresh frozen plasma transfused between these groups. There was no significant difference in the mortality rate between the pre-ROTEM and ROTEM-period groups (33% vs. 19%; p = 0.22).</p><p><strong>Conclusions: </strong>The introduction of ROTEM-guided transfusion at this institution was associated with increased fibrinogen usage, but this did not impact mortality rates. There was no difference in the administration of red blood cell, fresh frozen plasma, platelet, and cryoprecipitate. Future research should focus on increased ROTEM compliance and optimizing ROTEM-guided transfusion to prevent blood product overuse among trauma patients.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"40"},"PeriodicalIF":8.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advantages of using a polymeric clip versus an endoloop during laparoscopic appendectomy in uncomplicated appendicitis: a randomized controlled study.","authors":"Kil-Yong Lee, Jaeim Lee, Youn Young Park, Seong Taek Oh","doi":"10.1186/s13017-023-00507-6","DOIUrl":"10.1186/s13017-023-00507-6","url":null,"abstract":"<p><strong>Background: </strong>Polymeric clips are easy to apply, but whether they present more advantages than endoloops is unclear. This single-center, open-label, randomized controlled trial study was conducted to compare the advantages of using a polymeric clip versus an endoloop in terms of the surgical time.</p><p><strong>Methods: </strong>Adult patients who were diagnosed with acute appendicitis without perforation on preoperative abdominal computed tomography and underwent laparoscopic appendectomy between August 6, 2019, and December 26, 2022, were included. Single-blinded randomization was performed in a 1:1 ratio between the endoloop and polymeric clip groups. The primary endpoint was the difference in surgery time between the polymeric clip and endoloop groups. The secondary endpoints were the difference in the application time of each instrument, difference in operation and anesthesia fees, as well as the frequency of complications.</p><p><strong>Results: </strong>The completed trial included 104 and 103 patients in the polymeric clip and endoloop groups, respectively. The median surgery time with a polymeric clip was shorter than that with an endoloop; however, the difference was not significant (18 min 56 s vs 19 min 49 s, p = 0.426). Interestingly, the median time from applying the instrument to appendiceal cutting in the polymeric clip group was significantly shorter than that in the endoloop group (49.0 s vs 84.5 s, p < 0.001). No significant difference was observed between the two groups in terms of surgical (p = 0.120) and anesthetic (p = 0.719) costs, as well as the total number of postoperative complications (p > 0.999).</p><p><strong>Conclusion: </strong>A polymeric clip is a safe instrument that can reduce the time from applying the instrument to appendiceal cutting, although it does not affect the overall surgical time and operation fee when performing laparoscopic appendectomy for uncomplicated appendicitis.</p><p><strong>Trial registration: </strong>KCT0004154.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"39"},"PeriodicalIF":8.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10311724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9793007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing and managing frailty in emergency laparotomy: a WSES position paper.","authors":"Brian W C A Tian, Philip F Stahel, Edoardo Picetti, Giampiero Campanelli, Salomone Di Saverio, Ernest Moore, Denis Bensard, Boris Sakakushev, Joseph Galante, Gustavo P Fraga, Kaoru Koike, Isidoro Di Carlo, Giovanni D Tebala, Ari Leppaniemi, Edward Tan, Dimitris Damaskos, Nicola De'Angelis, Andreas Hecker, Michele Pisano, YunfengCui, Ron V Maier, Belinda De Simone, Francesco Amico, Marco Ceresoli, Manos Pikoulis, Dieter G Weber, Walt Biffl, Solomon Gurmu Beka, Fikri M Abu-Zidan, Massimo Valentino, Federico Coccolini, Yoram Kluger, Massimo Sartelli, Vanni Agnoletti, Mircea Chirica, Francesca Bravi, Ibrahima Sall, Fausto Catena","doi":"10.1186/s13017-023-00506-7","DOIUrl":"10.1186/s13017-023-00506-7","url":null,"abstract":"<p><p>Many countries are facing an aging population. As people live longer, surgeons face the prospect of operating on increasingly older patients. Traditional teaching is that with older age, these patients face an increased risk of mortality and morbidity, even to a level deemed too prohibitive for surgery. However, this is not always true. An active 90-year-old patient can be much fitter than an overweight, sedentary 65-year-old patient with comorbidities. Recent literature shows that frailty-an age-related cumulative decline in multiple physiological systems, is therefore a better predictor of mortality and morbidity than chronological age alone. Despite recognition of frailty as an important tool in identifying vulnerable surgical patients, many surgeons still shun objective tools. The aim of this position paper was to perform a review of the existing literature and to provide recommendations on emergency laparotomy and in frail patients. This position paper was reviewed by an international expert panel composed of 37 experts who were asked to critically revise the manuscript and position statements. The position paper was conducted according to the WSES methodology. We shall present the derived statements upon which a consensus was reached, specifying the quality of the supporting evidence and suggesting future research directions.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"38"},"PeriodicalIF":8.0,"publicationDate":"2023-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9712886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving clinical suspicion of acute mesenteric ischemia among patients with acute abdomen: a cross-sectional study from an intestinal stroke center.","authors":"Alexandre Nuzzo,&nbsp;Katell Peoc'h,&nbsp;Prabakar Vaittinada Ayar,&nbsp;Alexy Tran-Dinh,&nbsp;Emmanuel Weiss,&nbsp;Yves Panis,&nbsp;Maxime Ronot,&nbsp;Lorenzo Garzelli,&nbsp;Philippine Eloy,&nbsp;Iannis Ben Abdallah,&nbsp;Yves Castier,&nbsp;Olivier Corcos","doi":"10.1186/s13017-023-00505-8","DOIUrl":"https://doi.org/10.1186/s13017-023-00505-8","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis of acute mesenteric ischemia (AMI) is essential for a favorable outcome. Selection of patients requiring a dedicated multiphasic computed tomography (CT) scan remains a clinical challenge.</p><p><strong>Methods: </strong>In this cross-sectional diagnostic study conducted from 2016 to 2018, we compared the presentation of AMI patients admitted to an intestinal stroke center to patients with acute abdominal pain of another origin admitted to the emergency room (controls).</p><p><strong>Results: </strong>We included 137 patients-52 with AMI and 85 controls. Patients with AMI [median age: 65 years (interquartile range 55-74)] had arterial and venous AMI in 65% and 35% of cases, respectively. Relative to controls, AMI patients were significantly older, more likely to have risk factors or a history of cardiovascular disease, and more likely to present with sudden-onset and morphine-requiring abdominal pain, hematochezia, guarding, organ dysfunction, higher white blood cell and neutrophil counts, and higher plasma C-reactive protein (CRP) and procalcitonin concentrations. On multivariate analysis, two independent factors were associated with the diagnosis of AMI: the sudden-onset (OR = 20, 95%CI 7-60, p < 0.001) and the morphine-requiring nature of the acute abdominal pain (OR = 6, 95%CI 2-16, p = 0.002). Sudden-onset and/or morphine-requiring abdominal pain was present in 88% of AMI patients versus 28% in controls (p < 0.001). The area under the receiver operating characteristic curve for the diagnosis of AMI was 0.84 (95%CI 0.77-0.91), depending on the number of factors.</p><p><strong>Conclusions: </strong>Sudden onset and the need for morphine are suggestive of AMI in patients with acute abdominal pain and should prompt multiphasic CT scan including arterial and venous phase images for confirmation.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"37"},"PeriodicalIF":8.0,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10246417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9679641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis.","authors":"Ioannis Panagiotis Kyriazidis,&nbsp;Dominik A Jakob,&nbsp;Juliana Alexandra Hernández Vargas,&nbsp;Oscar H Franco,&nbsp;Elias Degiannis,&nbsp;Patrick Dorn,&nbsp;Sjaak Pouwels,&nbsp;Bijendra Patel,&nbsp;Ian Johnson,&nbsp;Christopher John Houdlen,&nbsp;Graham S Whiteley,&nbsp;Marion Head,&nbsp;Anil Lala,&nbsp;Haroon Mumtaz,&nbsp;J Agustin Soler,&nbsp;Katie Mellor,&nbsp;David Rawaf,&nbsp;Ahmed R Ahmed,&nbsp;Suhaib J S Ahmad,&nbsp;Aristomenis Exadaktylos","doi":"10.1186/s13017-023-00504-9","DOIUrl":"https://doi.org/10.1186/s13017-023-00504-9","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains.</p><p><strong>Aim of the study: </strong>To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician.</p><p><strong>Methods: </strong>A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I² and the QUADAS-2 tool was used to assess bias of the studies.</p><p><strong>Results: </strong>This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4-36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8-98.2%) and sensitivity of 86.7% (range 40-99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832-7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries.</p><p><strong>Conclusion: </strong>Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"36"},"PeriodicalIF":8.0,"publicationDate":"2023-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9678209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complex duodenal fistulae: a surgical nightmare.","authors":"Ari Leppäniemi,&nbsp;Matti Tolonen,&nbsp;Panu Mentula","doi":"10.1186/s13017-023-00503-w","DOIUrl":"https://doi.org/10.1186/s13017-023-00503-w","url":null,"abstract":"<p><strong>Introduction: </strong>A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. This study analyzes the results of different management options with emphasis on successful fistula closure rates.</p><p><strong>Methods: </strong>A retrospective single academic center study of adult patients treated for complex duodenal fistulas over a 17-year period with descriptive and univariate analyses was performed.</p><p><strong>Results: </strong>Fifty patients were identified. First line treatment was surgical in 38 (76%) cases and consisted of resuture or resection with anastomosis combined with duodenal decompression and periduodenal drainage in 36 cases, rectus muscle patch, and surgical decompression with T-tube in one each. Fistula closure rate was 29/38 (76%). In 12 cases, the initial management was nonoperative with or without percutaneous drainage. The fistula was closed without surgery in 5/6 patients (1 patient died with persistent fistula). Among the remaining 6 patients eventually operated, fistula closure was achieved in 4 cases. There was no difference in successful fistula closure rates among initially operatively versus nonoperatively managed patients (29/38 vs. 9/12, p = 1.000). However, when considering eventually failed nonoperative management in 7/12 patients, there was a significant difference in the fistula closure rate (29/38 vs. 5/12, p = 0.036). The overall in-hospital mortality rate was 20/50 (40%).</p><p><strong>Conclusions: </strong>Surgical closure combined with duodenal decompression in complex duodenal leaks offers the best chance of successful outcome. In selected cases, nonoperative management can be tried, accepting that some patients may require surgery later.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"35"},"PeriodicalIF":8.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10199491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9679619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WSES consensus guidelines on sigmoid volvulus management.","authors":"Brian W C A Tian,&nbsp;Gabriele Vigutto,&nbsp;Edward Tan,&nbsp;Harry van Goor,&nbsp;Cino Bendinelli,&nbsp;Fikri Abu-Zidan,&nbsp;Rao Ivatury,&nbsp;Boris Sakakushev,&nbsp;Isidoro Di Carlo,&nbsp;Gabriele Sganga,&nbsp;Ronald V Maier,&nbsp;Raul Coimbra,&nbsp;Ari Leppäniemi,&nbsp;Andrey Litvin,&nbsp;Dimitrios Damaskos,&nbsp;Richard Ten Broek,&nbsp;Walter Biffl,&nbsp;Salomone Di Saverio,&nbsp;Belinda De Simone,&nbsp;Marco Ceresoli,&nbsp;Edoardo Picetti,&nbsp;Joseph Galante,&nbsp;Giovanni D Tebala,&nbsp;Solomon Gurmu Beka,&nbsp;Luigi Bonavina,&nbsp;Yunfeng Cui,&nbsp;Jim Khan,&nbsp;Enrico Cicuttin,&nbsp;Francesco Amico,&nbsp;Inaba Kenji,&nbsp;Andreas Hecker,&nbsp;Luca Ansaloni,&nbsp;Massimo Sartelli,&nbsp;Ernest E Moore,&nbsp;Yoram Kluger,&nbsp;Mario Testini,&nbsp;Dieter Weber,&nbsp;Vanni Agnoletti,&nbsp;Nicola De' Angelis,&nbsp;Federico Coccolini,&nbsp;Ibrahima Sall,&nbsp;Fausto Catena","doi":"10.1186/s13017-023-00502-x","DOIUrl":"https://doi.org/10.1186/s13017-023-00502-x","url":null,"abstract":"<p><p>Sigmoid volvulus is a common surgical emergency, especially in elderly patients. Patients can present with a wide range of clinical states: from asymptomatic, to frank peritonitis secondary to colonic perforation. These patients generally need urgent treatment, be it endoscopic decompression of the colon or an upfront colectomy. The World Society of Emergency Surgery united a worldwide group of international experts to review the current evidence and propose a consensus guidelines on the management of sigmoid volvulus.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"34"},"PeriodicalIF":8.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10186802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9679609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The unrestricted global effort to complete the COOL trial.","authors":"Andrew W Kirkpatrick,&nbsp;Federico Coccolini,&nbsp;Matti Tolonen,&nbsp;Samuel Minor,&nbsp;Fausto Catena,&nbsp;Emanuel Gois,&nbsp;Christopher J Doig,&nbsp;Michael D Hill,&nbsp;Luca Ansaloni,&nbsp;Massimo Chiarugi,&nbsp;Dario Tartaglia,&nbsp;Orestis Ioannidis,&nbsp;Michael Sugrue,&nbsp;Elif Colak,&nbsp;S Morad Hameed,&nbsp;Hanna Lampela,&nbsp;Vanni Agnoletti,&nbsp;Jessica L McKee,&nbsp;Naisan Garraway,&nbsp;Massimo Sartelli,&nbsp;Chad G Ball,&nbsp;Neil G Parry,&nbsp;Kelly Voght,&nbsp;Lisa Julien,&nbsp;Jenna Kroeker,&nbsp;Derek J Roberts,&nbsp;Peter Faris,&nbsp;Corina Tiruta,&nbsp;Ernest E Moore,&nbsp;Lee Anne Ammons,&nbsp;Elissavet Anestiadou,&nbsp;Cino Bendinelli,&nbsp;Konstantinos Bouliaris,&nbsp;Rosemarry Carroll,&nbsp;Marco Ceresoli,&nbsp;Francesco Favi,&nbsp;Angela Gurrado,&nbsp;Joao Rezende-Neto,&nbsp;Arda Isik,&nbsp;Camilla Cremonini,&nbsp;Silivia Strambi,&nbsp;Georgios Koukoulis,&nbsp;Mario Testini,&nbsp;Sandy Trpcic,&nbsp;Alessandro Pasculli,&nbsp;Erika Picariello,&nbsp;Fikri Abu-Zidan,&nbsp;Ademola Adeyeye,&nbsp;Goran Augustin,&nbsp;Felipe Alconchel,&nbsp;Yuksel Altinel,&nbsp;Luz Adriana Hernandez Amin,&nbsp;José Manuel Aranda-Narváez,&nbsp;Oussama Baraket,&nbsp;Walter L Biffl,&nbsp;Gian Luca Baiocchi,&nbsp;Luigi Bonavina,&nbsp;Giuseppe Brisinda,&nbsp;Luca Cardinali,&nbsp;Andrea Celotti,&nbsp;Mohamed Chaouch,&nbsp;Maria Chiarello,&nbsp;Gianluca Costa,&nbsp;Nicola de'Angelis,&nbsp;Nicolo De Manzini,&nbsp;Samir Delibegovic,&nbsp;Salomone Di Saverio,&nbsp;Belinda De Simone,&nbsp;Vincent Dubuisson,&nbsp;Pietro Fransvea,&nbsp;Gianluca Garulli,&nbsp;Alessio Giordano,&nbsp;Carlos Gomes,&nbsp;Firdaus Hayati,&nbsp;Jinjian Huang,&nbsp;Aini Fahriza Ibrahim,&nbsp;Tan Jih Huei,&nbsp;Ruhi Fadzlyana Jailani,&nbsp;Mansoor Khan,&nbsp;Alfonso Palmieri Luna,&nbsp;Manu L N G Malbrain,&nbsp;Sanjay Marwah,&nbsp;Paul McBeth,&nbsp;Andrei Mihailescu,&nbsp;Alessia Morello,&nbsp;Francesk Mulita,&nbsp;Valentina Murzi,&nbsp;Ahmad Tarmizi Mohammad,&nbsp;Simran Parmar,&nbsp;Ajay Pak,&nbsp;Michael Pak-Kai Wong,&nbsp;Desire Pantalone,&nbsp;Mauro Podda,&nbsp;Caterina Puccioni,&nbsp;Kemal Rasa,&nbsp;Jianan Ren,&nbsp;Francesco Roscio,&nbsp;Antonio Gonzalez-Sanchez,&nbsp;Gabriele Sganga,&nbsp;Maximilian Scheiterle,&nbsp;Mihail Slavchev,&nbsp;Dmitry Smirnov,&nbsp;Lorenzo Tosi,&nbsp;Anand Trivedi,&nbsp;Jaime Andres Gonzalez Vega,&nbsp;Maciej Waledziak,&nbsp;Sofia Xenaki,&nbsp;Desmond Winter,&nbsp;Xiuwen Wu,&nbsp;Andee Dzulkarnean Zakaria,&nbsp;Zaidi Zakaria","doi":"10.1186/s13017-023-00500-z","DOIUrl":"https://doi.org/10.1186/s13017-023-00500-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) ( https://clinicaltrials.gov/ct2/show/NCT03163095 ). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of \"damage control\"; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registrat","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"18 1","pages":"33"},"PeriodicalIF":8.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10173926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9680455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}