Acute Peritonitis and Pelvic Abscess Secondary to Abdominal Tuberculosis

Tuberculosis (TB), caused by Mycobacterium tuberculosis, continues to be a global health concern with high morbidity and mortality rates. Extrapulmonary TB (EPTB), which affects various organs beyond the lungs, presents a diagnostic challenge due to its diverse clinical and radiological manifestations. Herein, we describe the case of a middle-aged woman with severe lower abdominal pain, vomiting, night fevers, and other symptoms. Clinical and radiological examinations revealed pelvic abscesses and peritonitis. Exploratory laparoscopy uncovered intraabdominal adhesions, a pus-containing abscess cavities, and biopsies confirmed Mycobacterium tuberculosis infection. Post-operative pulmonology consultations comprising sputum cultures for TB detection were conducted, and the patient was started on anti-tuberculosis medications. This case highlights the complexity of diagnosing abdominal TB and the importance of a comprehensive diagnostic approach.

Complicated anorectal sepsis: Validation of scoring system for predicting anorectal sepsis severity

Anorectal sepsis is a common and potentially serious medical condition characterized by infection and inflammation of the anal canal and surrounding tissues. However, the lack of standardized and comprehensive scoring systems specifically tailored for predicting the severity of anorectal sepsis poses challenges in clinical practice. This study aimed to develop and validate a scoring system for predicting the severity of anorectal sepsis by incorporating relevant patient factors. A retrospective cohort study was conducted at Mansoura University Hospital, a tertiary care center, over a period of 5 years. The study population consisted of 330 patients diagnosed with anorectal sepsis during the study period. A scoring system was developed using multiple variables, with each variable assigned a specific score based on its clinical significance and weight in predicting disease severity. The developed scoring system's predictive performance was evaluated using receiver operating characteristic (ROC) analysis, calculating the area under the ROC curve to assess discriminative ability. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study population. Chi-square tests or t tests were performed to assess differences between non-severe and severe anal sepsis groups. The scoring system consisted of 12 variables, with a maximum total score of 18. The logistic regression analysis revealed significant associations between localized swelling, presentation within 72 hours, multiple drainage sessions, and severe anorectal sepsis. The ROC analysis showed an area under the curve of 0.85, indicating good discriminative ability of the scoring system. The scoring system was developed and validated in a single center, which may limit its generalizability to other settings. The scoring system demonstrated good predictive performance and can be a valuable tool for clinicians in assessing disease severity, guiding treatment decisions, and identifying high-risk patients.

Comparing stapler and sutured mesh fixation techniques for laparoscopic TAPP repair: a study on chronic groin pain on 3-year follow-up

Trans-abdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repairs are the available surgeries for inguinal hernias, with both methods of laparoscopic repairs requiring mesh applications. This study analyzes the correlation between sutured versus stapler mesh fixation in a laparoscopic TAPP for unilateral groin hernia regarding chronic pain during 3-year follow-up. A total of 130 patients with laparoscopic hernia undergoing TAPP repair were randomized into 2 groups based on their fixation technique-one with sutures and the other with stapler. Postoperative complications and chronic groin pain were noted for each technique. Equal number of participants was present in the stapler and suture groups, with the majority having an ASA score of one. The mean age was 42.50 ± 13.86 years, and the body mass index (BMI) was 27.47 ± 5.88. The stapler group presented a shorter mean operative time than the suture group. However, the stapler group had a significantly higher mean VAS score than the suture group. Most participants in the suture group (89.2%) had LOS for 1 day, while a 2-day LOS was significantly higher in the stapler group (12.3%) than in the suture group (9.2%). No patient reported mesh erosion, conversion, recurrence, testicular atrophy, and mesh infection. Early postoperative pain was more in stapler group along with long hospital stay, but both were non-significant. Chronic postoperative pain results and recurrence incidences over 3-year follow-up were also similar. Re-admission rates were minimal, no significant complications occurred.

Examining the Applicability of Surgical Coaching Rules for Resident Autonomy in Non-teaching Hospitals

INTRODUCTION

This retrospective study aims to analyze the impact of standardized rules for teaching in university hospitals on surgical resident autonomy and patient safety, as measured by patient outcomes, and also examines the learning curves for residents and their impact on patient outcomes in a non-teaching hospital.

METHODS

The data for the study was collected retrospectively from medical records of 2000 adult patients who went through surgical procedures from January 2020 to December 2022. Participants were categorized into two groups based on the supervision level provided by attending surgeons and residents. Appropriate statistical methods were used to analyze the data.

RESULTS

It was observed that operative times of cases handled by both attending and resident surgeons were less than those handled by residents alone. On the other hand, the former group had a significantly higher burden of comorbidities and higher rate of perioperative complications than the latter. These results have important implications for the training of medical residents and the overall delivery of healthcare services in university hospitals.

CONCLUSION

The findings will also help towards better understanding of the effectiveness of these rules and their potential for improving the quality of care provided by residents in these settings.

Laparoscopic Abdominal Surgery Under Thoracic Epidural Anesthesia in Patients with Interstitial Lung Disease: Retrospective Observational Cohort Study

BACKGROUND

Patients with interstitial lung disease who present with abdominal disease carry a perioperative risk of morbidity and mortality, including the risks of general anesthesia and postoperative pulmonary complications. We investigated the efficacy of laparoscopic surgery in such patients under epidural anesthesia.

MATERIALS AND METHODS

All patients with interstitial lung disease who underwent laparoscopic abdominal surgery were retrospectively studied. At 30 days, our primary end point was acute exacerbation of pulmonary complications. The second end point was nonpulmonary complications and 30-day hospital mortality.

RESULTS

Eighteen patients were enrolled in this study after reviewing their medical and surgical records. Our study revealed that none of the patients suffered from acute pulmonary exacerbations, and only 1 patient experienced a nonpulmonary event. There was no reported mortality. The conversion rate was low, with 1 patient necessitating conversion from laparoscopic to open surgery, which was conducted under epidural anesthesia. No conversions from epidural to general anesthesia were performed.

CONCLUSION

Epidural anesthesia is safe in a patient with interstitial lung disease, and laparoscopic surgery can be completed with low rate of conversion and, with minor complications.

Ruptured Heterotopic Pregnancy: A Rare Encounter in Acute Surgical Care Settings

Heterotopic pregnancy is a rare, life-threatening clinical entity with an overall incidence of about 1:30,000 in spontaneous natural conception cases, especially in cases of delayed diagnosis or conflicting clinical features. Here, we present an unusual case of heterotopic pregnancy in a 22-year-old multigravida presented to the emergency department (ED) with a clinical picture of the acute abdomen following recent abdominal trauma. Abdominal ultrasound revealed hemoperitoneum and a single viable intrauterine pregnancy at seven weeks' gestation. Following surgical exploration, the patient underwent removal of the ectopic pregnancy tissue with right salpingectomy. Since the presence of a conflicting history or equivocal physical signs and symptoms makes it difficult to diagnose heterotopic pregnancy, ED physicians and surgeons must consider the diagnosis even when dealing with viable intrauterine pregnancies. Besides, acute abdominal pain associated with shock should be regarded as suggestive of heterotopic pregnancy. Thus, prompt evaluation and a high index of suspicion are of paramount importance to prevent unwanted sequelae.