http://www.wjes.org The latest research articles published by World Journal of Emergency Surgery 2012-01-23T00:00:00Z After years of initial aggressive surgical treatment and a subsequent shift to Damage Control Surgery, NOM has be shown to be safe and effective and in the 90's it became the gold standard for liver injuries in hemodynamically stable patients, regardless of injury grade and degree of hemoperitoneum, allowing better outcomes with fewer complications and lesser transfusions. Nevertheless concerns have been raised regarding continuous monitoring need, safety in higher grades and general applicability of NOM to all hemodynamically stable patients. Similarly, in the same period and following promising results obtained with splenic salvage by using several surgical techniques such as splenorraphy, high intensity ultrasound, hemostatic wraps and staplers, NOM became the treatment of choice for blunt splenic injuries. However it was immediately clear that NOM failure in adults was significantly higher than that observed in children (17% vs 2%). The incidence of immune system sequelae and OPSI, and their real clinical impact in the overall population including children, is perhaps difficult to establish. http://www.wjes.org/content/7/1/3 Salomone Di Saverio Ernest Moore Gregorio Tugnoli Noel Naidoo Luca Ansaloni Stefano Bonilauri Michele Cucchi Fausto Catena World Journal of Emergency Surgery 2012, null:3 2012-01-23T00:00:00Z doi:10.1186/1749-7922-7-3 /content/figures/1749-7922-7-3-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 3 2012-01-23T00:00:00Z PDF Background: To determine the diagnostic Accuracy of Focused Assessment Sonography for Trauma (FAST) and repeated FAST in the patients with blunt abdominal trauma. Methods: In this retrospective study we collected the data of all patients from September 2007 to July 2011 with gastrointestinal injury. The intraoperative outcome was compared with FAST technique and the repeated or delayed sonography. Results: A total number of 1550 patients with blunt abdominal trauma underwent FAST in a period of 4 years in our hospital. Eighty-eight (5.67%) patients were found to have gastrointestinal injury after exploratory laparotomy. Fifty-five (62.5%) patients had isolated gastrointestinal injury and 33 (37.5%) patients had concomitant injury to the other solid organs. In those with isolated gastrointestinal injury, the sensitivity of FAST was 38.5%. Repeated ultrsonography was performed in 34 patients with false negative initial FAST after 12-24 hours. The sensitivity of repeated ultrasonography in negative initial FAST patients in detection of gastrointestinal injury was 85.2% (95% CI, 68.1%, and 94.4%). Conclusion: Repeated sonography after 12 to 24 hours in patients with negative initial FAST but sustain abdominal symptom can facilitated a diagnosis of GI tract injury and can be as effective method instead of Computed tomography in developing country. http://www.wjes.org/content/7/1/2 Afshin Mohammadi Mohammad Ghasmi-rad World Journal of Emergency Surgery 2012, null:2 2012-01-20T00:00:00Z doi:10.1186/1749-7922-7-2 /content/figures/1749-7922-7-2-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 2 2012-01-20T00:00:00Z PDF The gastric fundal diverticulae are rare. They can present with variable symptoms. We are enclosing a literature review on gastric fundal diverticulum. Lessons have emerged which may help in the management of this rare condition in future. http://www.wjes.org/content/7/1/1 Farhan Rashid Ahmed Aber Syed Ifthikar World Journal of Emergency Surgery 2012, null:1 2012-01-18T00:00:00Z doi:10.1186/1749-7922-7-1 /content/figures/1749-7922-7-1-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 1 2012-01-18T00:00:00Z PDF Necrotizing fasciitis (NF) is an uncommon soft tissue infection, usually caused by toxin-producing virulent bacteria. It is characterized by widespread fascial necrosis primarily caused by Streptococcus hemolyticus. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal and/or urogenital tracts. Early diagnosis with aggressive multidisciplinary treatment is mandatory. We describe three clinical cases with NF. The first is a 69 years old man with diabetes mellitus type II, who presented with NF on the posterior chest wall, shoulder and arm. He was admitted to the intensive care unit (ICU) with a clinical picture of severe sepsis. Outpatient treatment and early surgical debridement of the affected zones (inside 3 hours after admittance) and critical care therapy were performed. The second case is of a 63 years old paraplegic man with diabetes mellitus type I. Pressure sores and perineal abscesses progressed to Fournier's gangrene of the perineum and scrotum. He had NF of the anterior abdominal wall and the right thigh. Outpatient treatment and early surgical debridement of the affected zones (inside 6 hour after admittance) and critical care therapy were performed. The third patient was a 56 year old man who had NF of the anterior abdominal wall, flank and retroperitoneal space. He had an operation of the direct inguinal hernia, which was complicated with a bowel perforation and secondary peritonitis. After establishing the diagnosis of NF of the abdominal wall and retroperitoneal space (RS), he was transferred to the ICU. There he first received intensive care therapy, after which emergency surgical debridement of the abdominal wall, left colectomy, and extensive debridement of the RS were done (72 hours after operation of inquinal hernia). On average, 4 serial debridements were performed in each patient. The median of serial debridement in all three cases was four times. Other intensive care therapy with a combination of antibiotics and adjuvant hyperbaric oxygen therapy (HBOT) was applied during the treatment. After stabilization of soft tissue wounds and the formation of fresh granulation tissue, soft tissue defect were reconstructed using simple to complex reconstructive methods. http://www.wjes.org/content/6/1/46 Zdravko Roje Zeljka Roje Dario Matic Davor Librenjak Stjepan Dokuzovic Josip Varvodic World Journal of Emergency Surgery 2011, null:46 2011-12-23T00:00:00Z doi:10.1186/1749-7922-6-46 /content/figures/1749-7922-6-46-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 46 2011-12-23T00:00:00Z PDF Background: Ovarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women. A high index of suspicion is required in order to diagnose this unusual cause of abdominal pain.Case presentationA 19-year-old woman at three days postpartum was admitted to our hospital because of severe right lower quandrant abdominal pain and fever 38.5'C. Physical examination revealed an acutely ill patient and right lower quadrant tenderness with positive rebound and Giordano signs. The patient underwent appendectomy which proved to be negative for acute appendicitis. Postoperatively fever and pain persisted and abdominal CT-scan with intravenous contrast agent demonstrated a thrombosed right ovarian vein. The patient was initiated on low-molecular weight heparin (LMWH) and antibiotic treatment and a month later a new abdominal CT-scan showed a patent right ovarian vein.DiscussionPathophysiologically, OVT is explained by Virchow's triad, because pregnancy is associated with a hypercoagulable state, venous stasis due to compression of the inferior vena cava by the uterus and endothelial trauma during delivery or from local inflammation. Common symptoms and signs of OVT include lower abdomen or flank pain, fever and leukocytosis usually within the first ten days after delivery. The reported incidence of OVT ranges 0,05-0,18% of pregnancies and in most cases the right ovarian vein is the one affected. Anticoagulation and antibiotics is the mainstay of treatment of OVT. Complications of OVT include sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main source of mortality due to OVT. Conclusions: OVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen. http://www.wjes.org/content/6/1/45 Nikolaos Arkadopoulos Dionysios Dellaportas Anneza Yiallourou Andreas Koureas Dionysios Voros World Journal of Emergency Surgery 2011, null:45 2011-12-23T00:00:00Z doi:10.1186/1749-7922-6-45 /content/figures/1749-7922-6-45-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 45 2011-12-23T00:00:00Z XML Heterogeneity of patients affected by acute cholecystitis, and their co-morbidities make very difficult to standardize the therapy for this very common condition. The staging system suggested in the recent "Tokyo guidelines", did not show a relevant impact on the management of patients and on the outcome of the disease. The relation among local pathological picture, patient clinical status and treatment algorithm, has to be better studied. http://www.wjes.org/content/6/1/44 Fabio Campanile Fausto Catena Federico Coccolini Marco Lotti Dario Piazzalunga Michele Pisano Luca Ansaloni World Journal of Emergency Surgery 2011, null:44 2011-12-22T00:00:00Z doi:10.1186/1749-7922-6-44 /content/figures/1749-7922-6-44-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 44 2011-12-22T00:00:00Z PDF IntroductionThough animal-related injuries and fatalities have been documented throughout the world, the variety of attacks by wild animals native to rural East Africa are less commonly described. Given the proximity of our northwestern Tanzania hospital to Lake Victoria, Lake Tanganyika, and the Serengeti National Park, and presentation of several patients attacked by bush animals and suffering a variety of complex injuries, we sought to report the pattern of attacks and surgical management in a resource-limited setting.Materials and methodsFour patients who were admitted to the northwestern Tanzania tertiary referral hospital, Bugando Medical Centre (BMC), in 2010-2011 suffered attacks by different bush animals: hyena, elephant, crocodile, and vervet monkey. These patients were triaged as trauma patients in the Casualty Ward, then admitted for inpatient monitoring and treatment. Their outcomes were followed to discharge. Results: The age and gender of the patients attacked was variable, though all but the pediatric patient were participating in food gathering or guarding activities in rural locations at the time of the attacks. All patients required surgical management of their injuries, which included debridement and closure of wounds, chest tube insertion, amputation, and external fixation of an extremity fracture. All patients survived and were discharged home.DiscussionThough human injuries secondary to encounters with undomesticated animals such as cows, moose, and camel are reported, they often are indirect traumas resulting from road traffic collisions. Snake attacks are well documented and common. However, this series of unique bush animal attacks describes the initial and surgical management of human injuries in the resource-limited setting of the developing world. Conclusion: Animal attacks are common throughout the world, but their pattern may vary in Africa throughout jungle and bush environmental settings. It is important to understand the management of these attacks in resource-limited health care environment. Further, the growing population and human encroachment on previously wild habitats such as the northwestern Tanzania bush argues for increased community awareness to assist in prevention of human injuries by animals. http://www.wjes.org/content/6/1/43 Katrina Mitchell Vihar Kotecha Alphonce Chandika World Journal of Emergency Surgery 2011, null:43 2011-12-22T00:00:00Z doi:10.1186/1749-7922-6-43 /content/figures/1749-7922-6-43-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 43 2011-12-22T00:00:00Z XML Intramural Duodenal Haematoma (IDH) is an uncommon complication of blunt abdominal trauma. IDH's are most often treated non-operatively. We describe laparoscopic treatment of an IDH after failed conservative management. To our knowledge, successful laparoscopic drainage of an IDH in an adult has not been described previously in the literature. http://www.wjes.org/content/6/1/42 Gregory Nolan Cino Bendinelli Jon Gani World Journal of Emergency Surgery 2011, null:42 2011-12-20T00:00:00Z doi:10.1186/1749-7922-6-42 /content/figures/1749-7922-6-42-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 42 2011-12-20T00:00:00Z XML Chest compressions have saved the lives of countless patients in cardiac arrest as they generate a small but critical amount of blood flow to the heart and brain. This is achieved by direct cardiac massage as well as a thoracic pump mechanism. In order to optimize blood flow excellent chest compression technique is critical. Thus, the quality of the delivered chest compressions is a pivotal determinant of successful resuscitation. If a patient is found unresponsive without a definite pulse or normal breathing then the responder should assume that this patient is in cardiac arrest, activate the emergency response system and immediately start chest compressions. Contra-indications to starting chest compressions include a valid Do Not Attempt Resuscitation Order. Optimal technique for adult chest compressions includes positioning the patient supine, and pushing hard and fast over the center of the chest with the outstretched arms perpendicular to the patient's chest. The rate should be at least 100 compressions per minute and any interruptions should be minimized to achieve a minimum of 60 actually delivered compressions per minute. Aggressive rotation of compressors prevents decline of chest compression quality due to fatigue. Chest compressions are terminated following return of spontaneous circulation. Unconscious patients with normal breathing are placed in the recovery position. If there is no return of spontaneous circulation, then the decision to terminate chest compressions is based on the clinical judgment that the patient's cardiac arrest is unresponsive to treatment. Finally, it is important that family and patients' loved ones who witness chest compressions be treated with consideration and sensitivity. http://www.wjes.org/content/6/1/41 Taufiek Rajab Charles Pozner Claudius Conrad Lawrence Cohn Jan Schmitto World Journal of Emergency Surgery 2011, null:41 2011-12-10T00:00:00Z doi:10.1186/1749-7922-6-41 /content/figures/1749-7922-6-41-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 41 2011-12-10T00:00:00Z XML Complicated intra-abdominal infections are frequently associated with poor prognoses and high morbidity and mortality rates.Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.In order to describe the clinical, microbiological, and management-related profiles of both community-acquired and healthcare-acquired complicated intra-abdominal infections (IAIs), the World Society of Emergency Surgery (WSES), in collaboration with the Surgical Infections Society of Europe (SIS-E) and other prominent European surgical societies, has designed the CIAO study.The CIAO study is a multicenter, observational study and will be carried out in various surgical departments throughout Europe. The study will include patients undergoing surgery or interventional drainage for complicated IAI. http://www.wjes.org/content/6/1/40 Massimo Sartelli Fausto Catena Luca Ansaloni Daniel Lazzareschi Korhan Taviloglu Harry van Goor Pierluigi Viale Ari Leppaniemi Carlo De Werra World Journal of Emergency Surgery 2011, null:40 2011-12-09T00:00:00Z doi:10.1186/1749-7922-6-40 /content/figures/1749-7922-6-40-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 40 2011-12-09T00:00:00Z XML