Three patients with acute appendicitis diagnosis following blunt abdominal trauma

Objective: One of the most prevalent surgical emergencies is appendicitis, caused by different factors. However, its relation to trauma has not been well-known yet. Here we have described three cases with blunt abdominal trauma and a secondary diagnosis of appendicitis that were transferred to the operation room. Case Presentation: Three patients suffering from blunt trauma and abdominal pain were referred to the emergency department (ED). Of these patients, one of them was transferred to the operation room (OR) with a peritonitis diagnosis and the other two patients had appendicitis signs and symptoms. The abdominal pain and related signs and symptoms of these three patients were due to appendicitis. All three patients were discharged from the hospital with normal vital signs. Conclusion: Traumatic appendicitis might be regarded as one of the differential diagnoses of the patients referred to the ED with blunt abdominal trauma and abdominal pain; hence, appendicitis and blunt abdominal trauma have some unknown relations.

Preoperative Smoking Cessation and its Association with Postoperative Complications and Length of Hospital Stay in Patients Undergoing Herniorrhaphy

BACKGROUND

To assess the effect of preoperative smoking cessation on postoperative complications in patients undergoing herniorrhaphy.

MATERIALS AND METHODS

This prospective study was conducted on 163 consecutive patients, undergoing herniorrhaphy. Demographic characteristics and postoperative complications were compared between smokers (group A), patients who reduced smoking by 50% (group B), and patients who completely quit smoking (group C).

RESULTS

The mean age of the patients was 42.9 (SD=10.3) years. Group A (n=77), group B (n=27), and group C (n=59) were not significantly different in terms of age, body mass index (BMI), medical history, laboratory data, smoking habit, type of hernia, type of anesthesia, the American Society of Anesthesiologists (ASA) class, repair method, surgery approach, and duration surgery (P>0.05 for all). However, significant differences were observed between group B and group A, group C and group A, and group C and group B regarding postoperative complications, such as wound healing complications and length of hospital stay (LOS) (P<0.05 for all).

CONCLUSION

Decreased preoperative smoking is associated with the reduced risk of respiratory, cardiovascular, and wound healing complications and decreased LOS in patients undergoing herniorrhaphy.

Spontaneous perforation as a fatal presentation of esophageal tuberculosis: A case report

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Esophageal perforation due to tuberculosis should be considered in countries with high prevalence of Tuberculosis.

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Antibiosis for tuberculosis coverage should be initiated in appropriate group of patients with esophageal perforation with no response to conventional antibiotics and adequate surgical source control.

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In patient with perforation and sepsis due to acute mediastinitis, surgical intervention should be considered.

Introduction

Tuberculosis is a multisystematic disease and is the most common cause of infectious disease–related mortality worldwide. Gastrointestinal tract is an uncommon site for extrapulmonary tuberculosis (TB). Esophageal TB is exceedingly rare.

Presentation of case

We report a 22-years-old male with esophageal TB that presented in septic shock from esophageal perforation. Despite all measures including surgical intervention and aggressive support in the intensive care unit, patient passed away.

Discussion

The most common mechanism for esophageal involvement is secondary to direct spread from mediastinal structures and/or spreading the inoculation of swallowed sputum, or hematogenous or lymphatic spread. Once the diagnosis of TB is established, antibiosis is the cornerstone of treatment. Surgery is reserved only for complications of TB such as fistula, abscess, strictures or perforation. Less than 50% of cases are diagnosed within 24 h, and delay in diagnosis lead to significant increases in the mortality.

Conclusion

In countries with high prevalence of TB, this diagnosis should be considered in those with esophageal perforation with no underlying etiology and medical treatment for TB should be initiated in addition to conventional treatment in appropriate group of patients.

COVID-19 outbreak and surgical practice: The rationale for suspending non-urgent surgeries and role of testing modalities

One-hundred years after the 1918-19 H1N1 flu pandemic and 10 years after the 2009 H1N1 flu pandemic, another respiratory virus has now inserted itself into the human population. Severe acute respiratory syndrome coronavirus has become a critical challenge to global health with immense economic and social disruption. In this article we review salient aspects of the coronavirus disease 2019 (COVID-19) outbreak that are relevant to surgical practice. The emphasis is on considerations during the pre-operative and post-operative periods as well as the utility and limitations of COVID-19 testing. The focus of the media during this pandemic is centered on predictive epidemiologic curves and models. While epidemiologists and infectious disease physicians are at the forefront in the fight against COVID-19, this pandemic is also a "stress test" to evaluate the capacity and resilience of our surgical community in dealing with the challenges imposed to our health system and society. As recently pointed out by Dr. Anthony Fauci, the virus decides the timelines in the models. However, the models can also change based on our decisions and behavior. It is our role as surgeons, to make every effort to bend the curves against the virus' will.

Changes in antibiotic use in a general surgery unit over a 5-year period

Concerns have been expressed about the overuse of antibiotics in inpatient settings. We compared the pattern of antibiotic use in 2010 in a surgical unit of a university hospital in the Islamic Republic of Iran with similar data from 2006. Defined daily doses per 100 bed-days (DBD) were calculated. Overall use of antibiotics in our surgical unit increased significantly from a mean of 4.9 (SD 5.1) DBD in 2006 to 7.7 (SD 10.3) DBD in 2010. This increase was mainly due to increases in the use of antibiotics for treatment of infections; the prophylactic use of antibiotics did not show a significant increase. There was an increase in the consumption of ceftriaxone, imipenem, cefalotin, metronidazole and vancomycin, a decrease in the use of erythromycin and ceftazidime and no change in the use of ciprofloxacin and clindamycin. Ceftriaxone showed the greatest increase (5.1-fold) and erythromycin the sharpest decrease (8-fold) in use.

Comparing the efficacy of preoperative magnetic resonance cholangiopancreatography with intra-operative cholangiography in patients suspicious to biliary stones

AIM

This study was performed to compare the efficacy of preoperative magnetic resonance cholangiopancreatography (MRCP) and intra-operative cholangiography (IOC) methods in patients suspicious to gall stones.

BACKGROUND

According to previous studies, it is recommended that common bile duct investigation should be done in order to rule out choledocholithiasis in all patients with symptomatic cholelithiasis. IOC is an invasive procedure with probable complications, it would seem that MRCP could replace the direct cholangiography.

PATIENTS AND METHODS

In a diagnostic clinical trial, Fifty-nine patients with symptomatic biliary stones or cholecystitis were recruited in this study. The included patients had normal size biliary ducts in sonography but high serum alkaline phosphatase level. Preoperative MRCP and IOC were performed for the patients and the obtained results were analyzed and compared.

RESULTS

The positive predictive value for IOC was 88% and for MRCP was 43%. The diagnostic accuracy of IOC and MRCP were 98% and 85% respectively, suggesting that IOC is much more diagnostically accurate. There were no significant difference in specificity and sensitivity of these two methods.

CONCLUSION

According to the results, we can conclude that MRCP may not obviate the need for IOC. The suggestion for routine use of MRCP instead of IOC and as a substitution of that procedure needs further investigations on more patients.

Evaluation of efficacy, survival rate and complications of peritoneal catheter placement of patients with end-stage renal disease

OBJECTIVE

Peritoneal dialysis (PD) as an equivalent to hemodialysis (HD) is one renal replacement therapy (RRT), which has several advantages compared to hemodialysis. However, most nephrologists are reluctant to apply this method. The purpose of this study is to assess the catheter efficiency, survival rate and complications of PD catheter placement in end-stage renal disease (ESRD) patients.

METHODS

From September 2002 to September 2003, 21 patients were operated by PD catheter placement in Imam Hossein Hospital, Tehran, Iran. The kind of catheter and surgical technique were identical in all patients. After surgery, patients were observed for 6 months.

RESULTS

Out of the 21 patients, 13 (61%) were males and 8 (39%) were females. Diabetes and hypertension were the most common cause of nephropathy, mean age was 51.2 years and mean time between operation and from the beginning of PD was 9 days (range 1-14 days). In 8 (38%) patients, the 2 weeks break-in period was ignored. Complications observed were as follows: peritonitis in 2 (9.5%), leak of dialysate in 2 (9.5%), abdominal wall hernia in 2 (9.5%), catheter malfunction in 2 (9.5%) and abdominal wall hematoma in 2 cases (9.5%). The catheter lasted 6 months in all cases. However, 12 patients who previously received hemodialysis were more satisfied with PD.

CONCLUSION

From the point of prevalence, our complications were not significantly different from previous studies. The 6-month survival rate and efficiency of catheter was very high. In addition, the rate of satisfaction of patients who received PD was also high. We suggest that more accurate studies on ESRD patients should be carried out to evaluate the use of PD in the primary stage of ESRD instead of HD.

Pancreaticoduodenectomy with closing the pancreatic stump vs. standard Whipple's procedure: a non-anastomotic technique

BACKGROUND/AIMS

Pancreaticoduodenectomy is commonly used for the surgical treatment of malignancies of the ampulla of Vater, duodenum, head of pancreas, and distal common bile duct (CBD). Pancreatic fistula and anastomotic leakage are the common fatal complications of the procedure. Management of the remaining stump is the most important part of pancreaticoduodenectomy in preventing fistula and leakage. We describe a non-anastomotic procedure that has fewer complications.

METHODOLOGY

Wirsung's duct was ligated with interrupted sutures after pancreaticoduodenectomy. Cut edge of pancreatic stump was then sutured. Drainage of the stump field was performed with a Petzer drain.

RESULTS

Of 6 patients who were studied 3 were men and 3 were woman. The mean age was 59.19 years. There was no pancreatic fistula, anastomotic leakage, significant weight loss, far elevation in serum amylase, pancreatitis and oral intake serious problems within the follow-up months (median=7 months, min=2 months, max=20 months).

CONCLUSIONS

Non-anastomotic options such as this necessitate the use of pancreatic enzyme supplementation, but low rate of complications and simplicity of the procedure make it an operation of choice.