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Alattar Z, Keric N. Evaluation of Abdominal Emergencies. Surg Clin North Am 2023; 103:1043-1059. [PMID: 37838455 DOI: 10.1016/j.suc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Early primary assessment and abdominal examination can often be enough to triage the patient with abdominal pain into those with less severe underlying pathologic condition from those with more acute findings. A focused history of the patient can then allow the clinician to develop their differential diagnosis. Once the differential diagnoses are determined, diagnostic imaging and laboratory findings can help confirm the diagnosis and allow for expeditious treatment and intervention.
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Affiliation(s)
- Zana Alattar
- University of Arizona College of Medicine-Phoenix, 1441 North 12th Street, First Floor, Phoenix, AZ 85006, USA
| | - Natasha Keric
- University of Arizona College of Medicine-Phoenix, Banner-University Medical Center Phoenix, 1441 North 12th Street, First Floor, Phoenix, AZ 85006, USA.
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Tee YS, Cheng CT, Wu YT, Hsu CP, Kang SC, Hsieh CH, Derstine BA, Su GL, Wang SC, Fu CY, Liao CH. Predicting outcomes of abdominal surgical emergencies in the elderly population using a CT muscle gauge. Aging Clin Exp Res 2021; 33:2479-2490. [PMID: 33818749 DOI: 10.1007/s40520-020-01769-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Frailty has been shown to be an independent negative predictor of surgical outcomes in geriatric patients. Traditional measurements of muscle strength and mass are impractical in emergency settings, and computed tomography (CT)-measured skeletal muscle mass has been proposed as an alternative. However, the cutoff values for low muscle mass are still unknown, and their impact on abdominal emergencies in the elderly population is unclear. METHODS A total of 462 young trauma patients aged 18-40 years were analyzed to establish sex-specific reference cutoff values for the CT-measured muscle index (MI) and muscle gauge (MG) values. The impacts of low MI and MG values were investigated in 1192 elderly patients (aged ≥ 65 years) undergoing abdominal surgery. RESULTS The sex-specific cutoff values for MI and MG were determined by adopting European Working Group on Sarcopenia in Older People 2 guidelines. The correlation between MG and aging was significantly stronger than that between MI and ageing. With regard to the MG, the L4 psoas muscle gauge (L4 PMG) was further investigated in an elderly cohort owing to its high predictive value and ease of use in the clinical setting. A low L4 PMG value was an independent risk factor for overall complications and mortality in elderly patients with abdominal emergencies. CONCLUSION The current study was the largest study investigating the correlations between MG values and aging in the Asian population. A low L4 PMG value may help surgeons during preoperative decision making regarding geriatric patients with abdominal emergencies.
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Affiliation(s)
- Yu-San Tee
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chi-Tung Cheng
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Yu-Tung Wu
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chih-Po Hsu
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Shih-Ching Kang
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chi-Hsun Hsieh
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC.
| | - Brian A Derstine
- Division of Acute Care Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Grace L Su
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Stewart C Wang
- Division of Acute Care Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
- Morphomic Analysis Group, University of Michigan, Ann Arbor, MI, USA
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
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Ariaya A, Ahmed M, Mindaye ET. Incidental peritoneal loose body in a polytrauma patient: The unnoticed scenario: A case report. Int J Surg Case Rep 2021; 85:106158. [PMID: 34273653 PMCID: PMC8287218 DOI: 10.1016/j.ijscr.2021.106158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Peritoneal loose bodies are rare, often asymptomatic lesions that can be found during radiologic examinations or abdominal surgery. They don't require specific treatment unless they are complicated. PRESENTATION OF CASE We present a rare case of incidentally diagnosed peritoneal loose body in a 38 years old man who undergone exploratory laparotomy for the diagnosis of hypovolemic shock secondary to acute intra-abdominal bleeding with solid organ injury secondary to blunt abdominal trauma and left proximal tibia fracture. DISCUSSION Symptomatic peritoneal loose bodies present with compressive symptoms of urinary system or bowel obstruction. As a result, they create diagnostic dilemmas in patients with previous history of abdominal surgery who present with acute abdominal pain, commonly confusing with retained foreign body. CONCLUSION Although most incidental loose bodies are diagnosed intraoperatively on laparatomies done for other indications, it's very unusual to suspect such findings in hemodynamically unstable polytrauma patient undergoing surgical exploration. Considering the diagnostic challenges they create in post-operative patients presenting with abdominal complaints, its better practice to consider such rare findings when exploring the abdomen in trauma settings.
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Affiliation(s)
- Abraham Ariaya
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Swaziland Street 1271, Addis Ababa, Ethiopia.
| | - Musse Ahmed
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Swaziland Street 1271, Addis Ababa, Ethiopia
| | - Esubalew Taddese Mindaye
- Department of Surgery, Saint Paul's Hospital Millennium Medical College, Swaziland Street 1271, Addis Ababa, Ethiopia
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Gorincour G, Monneuse O, Ben Cheikh A, Avondo J, Chaillot PF, Journe C, Youssof E, Lecomte JC, Thomson V. Management of abdominal emergencies in adults using telemedicine and artificial intelligence. J Visc Surg 2021; 158:S26-S31. [PMID: 33714710 DOI: 10.1016/j.jviscsurg.2021.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The terms "telemedicine" and "artificial intelligence" (AI) are used today throughout all fields of medicine, with varying degrees of relevance. If telemedicine corresponds to practices currently being developed to supply a high quality response to medical provider shortages in the general provision of healthcare and to specific regional challenges. Through the possibilities of "scalability" and the "augmented physician" that it has helped to create, AI may also constitute a revolution in our practices. In the management of surgical emergencies, abdominal pain is one of the most frequent complaints of patients who present for emergency consultation, and up to 20% of patients prove to have an organic lesion that will require surgical management. In view of the very large number of patients concerned, the variety of clinical presentations, the potential seriousness of the etiological pathology that sometimes involves a life-threatening prognosis, healthcare workers responsible for these patients have logically been led to regularly rely on imaging examinations, which remain the critical key to subsequent management. Therefore, it is not surprising that articles have been published in recent years concerning the potential contributions of telemedicine (and teleradiology) to the diagnostic management of these patients, and also concerning the contribution of AI (albeit still in its infancy) to aid in diagnosis and treatment, including surgery. This review article presents the existing data and proposes a collaborative vision of an optimized patient pathway, giving medical meaning to the use of these tools.
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Affiliation(s)
- G Gorincour
- Imadis Téléradiologie, Lyon, Bordeaux, Marseille, France; Elsan, Clinique Bouchard, Marseille, France.
| | - O Monneuse
- Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Service de Chirurgie d'Urgences et Chirurgie Générale, Lyon, France
| | - A Ben Cheikh
- Imadis Téléradiologie, Lyon, Bordeaux, Marseille, France; Ramsay, Clinique la Sauvegarde, Lyon, France
| | | | - P-F Chaillot
- Imadis Téléradiologie, Lyon, Bordeaux, Marseille, France; Groupe C2S, Clinique du Parc, Lyon, France
| | - C Journe
- Imadis Téléradiologie, Lyon, Bordeaux, Marseille, France; Groupe C2S, Clinique du Parc, Lyon, France
| | - E Youssof
- Imadis Téléradiologie, Lyon, Bordeaux, Marseille, France; Centre d'Imagerie Médicale Clinique du Parc/Pourcel/Bergson, Saint-Étienne, France
| | - J-C Lecomte
- Imadis Téléradiologie, Lyon, Bordeaux, Marseille, France; Centre hospitalier de Saintonge, Saintes, France; Centre Aquitain d'Imagerie Médicale, Bordeaux, France
| | - V Thomson
- Imadis Téléradiologie, Lyon, Bordeaux, Marseille, France; Ramsay, Clinique la Sauvegarde, Lyon, France
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Agresta F, Campanile FC, Podda M, Cillara N, Pernazza G, Giaccaglia V, Ciccoritti L, Ioia G, Mandalà S, La Barbera C, Birindelli A, Sartelli M, Di Saverio S. Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years. Surg Endosc 2016; 31:1785-1795. [PMID: 27572068 DOI: 10.1007/s00464-016-5175-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several authors have demonstrated the safety and feasibility of laparoscopy in selected cases of abdominal emergencies. The aim of the study was to analyse the current Italian practice on the use of laparoscopy in abdominal emergencies and to evaluate the impact of the 2012 national guidelines on the daily surgical activity. METHODS Two surveys (42 closed-ended questions) on the use of laparoscopy in acute abdomen were conducted nationwide with an online questionnaire, respectively, before (2010) and after (2014) the national guidelines publication. Data from two surveys were compared using Chi-square or Fisher's exact test, and data were considered significant when p < 0.05. RESULTS Two-hundred and one and 234 surgical units answered to the surveys in 2010 and 2014, respectively. Out of 144,310 and 127,013 overall surgical procedures, 23,407 and 20,102, respectively, were abdominal emergency operations. Respectively 24.74 % (in 2010) versus 30.27 % (in 2014) of these emergency procedures were approached laparoscopically, p = 0.42. The adoption of laparoscopy increased in all the considered clinical scenarios, with statistical significance in acute appendicitis (44 vs. 64.7 %; p = 0.004). The percentage of units approaching Hinchey III acute diverticulitis with laparoscopy in 26-75 % of cases (14.0 vs. 29.7 %; p = 0.009), those with >25 % of surgeons confident with laparoscopic approach to acute diverticulitis (29.9 vs. 54 %; p = 0.0009), the units with >50 % of surgeons confident with laparoscopic approach to acute appendicitis, cholecystitis and perforated duodenal ulcer, all significantly increased in the time frame. The majority of respondents declared that the 2012 national guidelines influenced their clinical practice. CONCLUSIONS The surveys showed an increasing use of laparoscopy for patients with abdominal emergencies. The 2012 national guidelines profoundly influenced the Italian surgical practice in the laparoscopic approach to the acute abdomen.
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Affiliation(s)
| | - Fabio Cesare Campanile
- Division of Surgery, Ospedale San Giovanni Decollato - Andosilla, Civita Castellana, VT, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari - General, Emergency and Laparoscopic Surgery - SS 554, Km 4.500, Monserrato, CA, Italy
| | - Nicola Cillara
- UOC Chirurgia Generale PO SS. Trinità ASL8CA, Via Is Mirrionis 92, 09121, Cagliari, Italy
| | - Graziano Pernazza
- General Surgery 1 Unit, Surgical Sciences Department, AO San Giovanni Addolorata, Rome, Italy
| | - Valentina Giaccaglia
- General Surgery Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy
| | - Luigi Ciccoritti
- UOC Chirurgia Generale PO Santa Maria della Stella Loc. Ciconia, 05018, Orvieto, TR, Italy
| | - Giovanna Ioia
- ASST Bergamo EST - Bolognini Seriate, Seriate, Italy
| | - Stefano Mandalà
- Unit of General Surgery, Noto-Pasqualino Hospital, Via Dante Alighieri n 330, 90141, Palermo, Italy
| | - Camillo La Barbera
- Unit of General Surgery, Noto-Pasqualino Hospital, Via Dante Alighieri n 330, 90141, Palermo, Italy
| | - Arianna Birindelli
- S. Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | | | - Salomone Di Saverio
- General, Emergency and Trauma Surgery Service, Maggiore Hospital Regional Trauma Center, AUSL Bologna, l.go Nigrisoli 2, 40100, Bologna, Italy.
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Jimenez Rodriguez RM, Segura-Sampedro JJ, Flores-Cortés M, López-Bernal F, Martín C, Diaz VP, Ciuro FP, Ruiz JP. Laparoscopic approach in gastrointestinal emergencies. World J Gastroenterol 2016; 22:2701-2710. [PMID: 26973409 PMCID: PMC4777993 DOI: 10.3748/wjg.v22.i9.2701] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/24/2015] [Accepted: 01/11/2016] [Indexed: 02/06/2023] Open
Abstract
This review focuses on the laparoscopic approach to gastrointestinal emergencies and its more recent indications. Laparoscopic surgery has a specific place in elective procedures, but that does not apply in emergency situations. In specific emergencies, there is a huge range of indications and different techniques to apply, and not all of them are equally settle. We consider that the most controversial points in minimally invasive procedures are indications in emergency situations due to technical difficulties. Some pathologies, such as oesophageal emergencies, obstruction due to colon cancer, abdominal hernias or incarcerated postsurgical hernias, are nearly always resolved by conventional surgery, that is, an open approach due to limited intraabdominal cavity space or due to the vulnerability of the bowel. These technical problems have been solved in many diseases, such as for perforated peptic ulcer or acute appendectomy for which a laparoscopic approach has become a well-known and globally supported procedure. On the other hand, endoscopic procedures have acquired further indications, relegating surgical solutions to a second place; this happens in cholangitis or pancreatic abscess drainage. This endoluminal approach avoids the need for laparoscopic development in these diseases. Nevertheless, new instruments and new technologies could extend the laparoscopic approach to a broader array of potentials procedures. There remains, however, a long way to go.
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