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Surgical Emergency (surgical + emergency)
Selected AbstractsCurrent management of esophageal perforation: 20 years experienceDISEASES OF THE ESOPHAGUS, Issue 4 2009A. Eroglu SUMMARY Esophageal perforations are surgical emergencies associated with high morbidity and mortality rates. No single strategy has been sufficient to deal with the majority of situations. We aim to postulate a therapeutic algorithm for this complication based on 20 years of experience and also on data from published literature. We performed a retrospective clinical review of 44 patients treated for esophageal perforation at our hospital between January 1989 and May 2008. We reviewed the characteristics of these patients, including age, gender, accompanying diseases, etiology of perforation, diagnosis, location, time interval between perforation and diagnosis, treatment of the perforation, morbidity, hospital mortality, and duration of hospitalization. Perforation occurred in the cervical esophagus in 14 patients (31.8%), thoracic esophagus in 18 patients (40.9%), and abdominal esophagus in 12 patients (27.3%). Management of the esophageal perforation included primary closure in 23 patients (52.3%), resection in 7 patients (15.9%), and nonsurgical therapy in 14 patients (31.8%). In the surgically treated group, the mortality rate was 3 of 30 patients (10%), and 2 of 14 patients (14.3%) in the conservatively managed group. Four of the 14 nonsurgical patients were inserted with covered self-expandable stents. The specific treatment of an esophageal perforation should be selected according to each individual patient. To date, the most effective treatment would appear to be operative management. With improvements in endoscopic procedures, the morbidity and mortality rates of esophageal perforations are significantly decreased. We suggest that minimally invasive techniques for the repair of esophageal perforations will be very important in the future treatment of this condition. [source] GS14P ROUTINE USE OF MEDICAL EMERGENCY TEAMS IN MANAGING SURGICAL EMERGENCIESANZ JOURNAL OF SURGERY, Issue 2007H. K. Kim Introduction Trauma teams and cardiac arrest teams provide an urgent and expert multi-disciplinary response to time critical emergencies. The present study documents the contribution of a medical emergency team (MET) to managing non-trauma surgical emergencies. Materials and Methods Data was prospectively collected over a two year period concerning the contribution of medical emergency teams to the resuscitation of all patients with non-trauma surgical emergencies and altered vital signs in hospital wards. Results Over the study period, the details of 19 patients with surgical emergencies were recorded. 63% of emergencies occurred outside of normal working hours. In 53% of cases, the surgical registrar was off-site or physically unavailable to attend the emergency immediately. In 11% of cases, the medical emergency team was activated prior to the arrival of the surgical registrar. In 26% of cases, the patient was left unattended whilst awaiting arrival of the surgical registrar. The medical emergency team provided resuscitation procedures and arranged urgent investigations in all patients, physically transported the patient to the operating theatre in 16% of patients and prepared for general anaesthetic in the operating theatre in 11% of cases. The surgical registrar complemented the medical emergency team response by liaising with consultant surgeons, anaesthetists and operating theatre staff in all cases. All patients received definitive treatment within 30 minutes of MET response. Conclusion Routine use of medical emergency teams in the initial resuscitation of patients with surgical emergencies expedites definitive management. [source] 6 The AERIS Course: a Focused Abdominal CT Interpretation Course for Abdominal Emergencies Requiring Immediate SurgeryACADEMIC EMERGENCY MEDICINE, Issue 2008Eric Schultz Emergency physicians rely heavily on CT scanning to guide their clinical decisions. A significant number of EDs do not have radiology coverage, especially at night, so the EM physician may be called on to interpret their own CT scans to guide patient management. Many EM physicians look at their CT scans but have never had any formal training. Especially in the setting of acute surgical emergencies such as expanding abdominal aortic aneurysms (AAAs), ruptured spleen or perforated viscus, delay for a radiologist interpretation may result in significant morbidity and mortality. In a collaboration between emergency medicine and radiology, our team created a systematic approach to abdominal CT interpretation designed to help EM physicians perform wet reads on CT scans in the setting of acute surgical emergencies. First, a general survey is done covering all of the important organs such as the aorta, liver, spleen, kidneys, pancreas, stomach and bowel, then a focused scan into the suspected pathology. We put this system onto a Power Point presentation. The two hour presentation covered basic CT anatomic pathology then taught the presentations of common surgical emergencies such as appendicitis, nephrolithiasis and surgical catastrophes such as ruptured AAAs and mesenteric ischemia. The Abdominal Emergencies Requiring Immediate Surgery (AERIS) scan is only intended to be a focused scan for acute surgical pathology, and not to replace the diagnostic scan of a radiologist. This course was given at a single University program, and will be given at residency programs throughout the New York metro area. Eventually we hope that focused CT interpretation will become part of the standardized EM curriculum. [source] Bilious vomiting in the newborn: 6 years data from a Level III CentreJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2010Atul Malhotra Background: Bilious vomiting in the newborn is an urgent condition that frequently requires neonatal and paediatric surgical involvement. Investigations involve abdominal X-ray and contrast imaging in most cases. We aimed to describe the prevalence of surgical intervention in this cohort and assess the reliability of contrast imaging in accurate prediction of underlying condition. Methods: A retrospective audit of data from December 2001 to October 2007 was undertaken. Data on newborns admitted to a level III unit with bilious vomiting was extracted. Infants with bilious aspirates but no vomiting were excluded. Results: Sixty-one infants were admitted to the unit during the period with bilious vomiting. Most of them were out born (83.6%). Mean (and standard deviation) gestation was 38.3 weeks (±3.2); weight was 3173.5 grams (±717.6); day of admission was 3.68 days (1,28); and length of stay in the unit was 9.96 days (1,48). There were 52 (85.2%) abnormal X-rays and 21 (34.4%) abnormal contrast studies. Sixteen (26.6%) babies had laparotomies of which 6 were malrotations with volvulus, 2 small bowel obstructions, 2 meconium ileus, 2 Hirschsprung's disease, 2 other findings, while 2 were normal. Positive predictive value (number of accurate predictions of surgical findings) for barium contrast studies was 85.7% in this series. Conclusion: Bile stained vomiting is a surgical emergency and prompt investigation is the key in the management. Contrast studies still form the backbone of such investigations. [source] Antipsychotic drugs and short-term mortality after peptic ulcer perforation: a population-based cohort studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2008C. CHRISTIANSEN Summary Background, Peptic ulcer perforation is a serious surgical emergency with a substantial short-term mortality, but the influence of antipsychotic drug use on the prognosis remains unknown. Aim, To examine the association between antipsychotic drug use and 30-day mortality following peptic ulcer perforation. Methods, This cohort study comprised 2033 patients with a first-time hospitalization with peptic ulcer perforation, in Northern Denmark, between 1991 and 2004. Data on preadmission use of antipsychotics and other medications, psychiatric disease, other comorbidities and mortality were obtained through population-based medical databases. We used Cox regression analyses to compute adjusted mortality rate ratios (MRRs). Results, One hundred and sixteen (5.7%) patients with peptic ulcer perforation were current users of antipsychotic drugs at the time of hospital admission and 205 (10.1%) were former users. The overall 30-day mortality was 27%. Among current users of antipsychotics 30-day mortality was 39%. The adjusted 30-day MRR for current users of antipsychotic drugs compared with non-users was 1.7 (95% CI: 1.2,2.3). Former use was not a predictor of mortality. The increase in mortality was equal in users of conventional and atypical antipsychotics. Conclusion, Use of antipsychotic drugs is associated with substantially increased mortality following peptic ulcer perforation. [source] Mycotic pseudoaneurysm following a kidney transplant: A case report and review of the literaturePEDIATRIC TRANSPLANTATION, Issue 5 2009Ignacio Osmán Abstract:, Vascular complications represent a significant cause of morbidity and mortality following a kidney transplant. Pseudoaneurysms are rare, occurring in approximately 1% of cases. We present a 15-yr-old patient who received a kidney transplant in the right iliac fossa. Thirty-six days following the transplant, the patient was admitted to the hospital because of a marked increase in serum creatinine levels, arterial hypertension, scrotal edema, and lower right limb pain. The patient did not present fever or raised inflammatory markers. A pseudoaneurysm was diagnosed by means of a Doppler echography and a CT. By a selective arteriography of the right iliac artery, we placed a 8 × 5 cm stent to isolate the pseudoaneurysm, due to the high risk of an extensive defect occurring in the arterial wall. Forty-eight h later the patient underwent transplant nephrectomy. Seven days following surgery, the patient experienced febrile syndrome and therefore another CT was carried out which showed a large abscess around the stent. So we decided to perform another intervention in order to drain this abscess. Due to the extensive loss of the arterial wall where the prosthesis was largely exposed, we ligated the common iliac and external iliac arteries, removed the prosthesis and performed a femoro-femoral bypass with the usual subcutaneous positioning of the prosthesis (separate from surgical site). The stent and mural thrombus were sent for culture analysis and Candida albicans was observed. The diagnosis of a pseudoaneurysm in these types of patients continues to be considered as a surgical emergency by the majority of authors. Transplantectomy is the most frequently used treatment technique. Positioning a stent prior to transplantectomy avoids ligature of the iliac artery in the majority of cases. [source] Clinical practice guidelines for the management of acute limb compartment syndrome following traumaANZ JOURNAL OF SURGERY, Issue 3 2010Christopher J. Wall Abstract Background:, Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Methods:, Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Results:, Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Conclusions:, Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes. [source] SURVEY OF MANAGEMENT OF ACUTE, TRAUMATIC COMPARTMENT SYNDROME OF THE LEG IN AUSTRALIAANZ JOURNAL OF SURGERY, Issue 9 2007Christopher J. Wall Background: Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency and is associated with significant morbidity if not diagnosed promptly and treated effectively. Despite the urgency of effective management to minimize the risk of adverse outcomes, there is currently little consensus in the published reports as to what constitutes best practice in the management of acute limb compartment syndrome. Methods: A structured survey was sent to all currently practising orthopaedic surgeons and accredited orthopaedic registrars in Australia to assess their current practice in the management of acute, traumatic compartment syndrome of the leg. Questions were related to key decision nodes in the management process, as identified in a literature review. These included identification of patients at high risk, diagnosis of the condition in alert and unconscious patients, optimal timeframe and technique for carrying out a fasciotomy and management of fasciotomy wounds. Results: A total of 264 valid responses were received, a response rate of 29% of all eligible respondents. The results indicated considerable variation in management of acute compartment syndrome of the leg, in particular in the utilization of compartment pressure measurement and the appropriate pressure threshold for fasciotomy. Of the 78% of respondents who regularly measured compartment pressure, 33% used an absolute pressure threshold, 28% used a differential pressure threshold and 39% took both into consideration. Conclusions: There is variation in the management of acute, traumatic compartment syndrome of the leg in Australia. The development of evidence-based clinical practice guidelines may be beneficial. [source] Post-partum pneumoperitoneum: Not a surgical emergencyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Mohamed A. MOHAMED No abstract is available for this article. [source] | ||||||||||