World Journal of Emergency Surgery - Latest Comments

Role of routine CT scan in pelvic fractures - an cost effective essential tool?

JOHN GRIFSON — 2009-09-18T10:36:33Z

Pelvic fractures account for only 3-8% of all fractures in polytrauma patients.However the mortality remains high (15-20%)(1).Most of the patients who present with unstable fractures have positive finding on pelvic examination.These patients with unstable fractures will require surgical stabilization.Rest of those who present with stable fractures will rarely require surgery if there are any associated injuries.Therefore the role of routine pelvic radiography in trauma has been questioned(2).Therefore CT scan will remain a cost effective tool if reserved for patients in whom associated injuries are suspected on clinical basis.

1)Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group:Unfallchirurg. 1996 Mar;99(3):160-7

2)Unnecessary use of pelvic x-ray in blunt trauma.: J Trauma. 1995 Oct;39(4):722-5.

Letter to the editor

Alvaro Montiel-Jarquín — 2009-09-18T10:35:31Z

To the editor:

Letter to be considered for publication in the journal

The term chronic apendicitis remains uncertain, and is caused by multiple causes and divided more specifically into: chronic appendicitis, recurrent appendicitis and appendiceal colic pain, deppending this on its evolution and clinical presentation (1).
Mycobacterium tuberculosis is a bacilum that can cause tuberculosis in the vermiform appendix. Its diagnosis is made by histopathology with a Ziehl Nielssen stain in order to demostrate the presence of the bacilus in the studied tissue (2).
Regarding this article, we have the following points to be considered:
In the title, the word tubercular referers to an infection caused by the Mycobacterium tuberculosis bacillum but in this article, there is no way to demonstrate its aetiology because authors did not make the Ziehl Nielssen stain. With this, authors only demonstrate a granulomatous appendicitis instead of an apendicular tuberculosis (3).
The title in this case, must had been: Granulomatous - Unespecific inflamation of the vermifor appendix. A case report.

Bibliography:
1.- Montiel-Jarquín A, Gómez-Conde E, Reyes-Páramo P, Romero-Briones C, Mendoza-García A, García-Ramírez U. Apendicitis crónica. Caso clínico. Rev Med Inst Mex Seguro Soc 2008; 46 (4): 431-434.
2.- Tucker ON, Healy V, Jeffers M, Keane FB Granulomatous appendicitis Surgeon. 2003 Oct;1(5):286-9.
3.- Sanjay Gupta, Robin Kaushik, Amanjit Kaur, Ashok Kumar Attri Tubercular appendicitis – a case report. World Journal of Emergency Surgery 2006, 1:22 doi:10.1186/1749-7922-1-22.

Best regards

Miguel Ángel Pérez-Corro, Álvaro Montiel-Jarquín, Gonzalo Pérez-Chávez.
All from Instituto Mexicano del Seguro Social, and Departamento de Posgrado y estudios de Investigación, Benemérita Universidad Autónoma de Puebla, México.

Interesting Association

Alfie Kavalakat — 2009-02-10T15:08:08Z

It is an interesting association which you have reported. Through a limited right iliac fossa incision when the appendix is found to be inflamed, the omental infarction is likely to be missed. You could identify both since you went through a right para-rectal incision. But I wonder why you went through a right para-rectal incision in the absence of generalized peritonitis.

We agree with your comment that omental infarction is more common than usually thought of. More cases are being reported now. We feel that this is because of the increasing popularity of laparoscopy¹.

1. Kavalakat AJ, Varghese CJ. Laparoscopic management of an uncommon cause for right lower quadrant pain: a case report. Cases J. 2008 Sep 19;1(1):164.

Acute abdomen - still a mystifying condition?

JOHN GRIFSON — 2007-12-19T17:17:46Z

Acute abdomen is known for its complex perplexing presentations.Prompt diagnosis and timely decision for surgical or conservative therapeutic measures is essential to reduce morbidity and mortality.Furthermore we should bear in mind that common surgical emergencies are known for their dubious presentations.A old man with sudden onset pain abdomen may lack signs of peritonism but still may have pneumoperitoneum in abdominal x-ray.The classical signs of appendicitis may be lacking in a patient with inflamed retrocecal appendix but still may warrant surgery.A recent work done by Covarelli et al insist the good old fact that supplementation of blood and imaging studies can help to avoid useless surgical procedure or potentially

dangerous delay in administering treatment(1).Therefore I would like to emphasise that precise history and complete physical examination supplemented by blood investigations and imaging studies form a vital triad in the effective management of acute abdomen.

REFERENCE

1)Covarelli P, Cristofani R, Bussotti C, Scalercio V, Boselli C, Petrina A, Noya G.

Acute abdomen: experience with 196 consecutive cases

Chir Ital. 2007 May-Jun;59(3):291-7. Italian.

Very interesting

Anita balakrishnan — 2007-04-14T14:10:59Z

An extremely interesting case report, great pictures.