http://www.wjes.org The most accessed research articles published by World Journal of Emergency Surgery 2012-05-11T00:00:00Z Establishing a secure airway in a trauma patient is one of the primary essentials of treatment. Any flaw in airway management may lead to grave morbidity and mortality. Maxillofacial trauma presents a complex problem with regard to the patient's airway. By definition, the injury compromises the patient's airway and it is, therefore, must be protected. In most cases, the patient undergoes surgery for maxillofacial trauma or for other, more severe, life-threatening injuries, and securing the airway is the first step in the introduction of general anaesthesia. In such patients, we anticipate difficult endotracheal intubation and, often, also difficult mask ventilation. In addition, the patient is usually regarded as having a "full stomach" and has not been cleared of a C-spine injury, which may complicate airway management furthermore. The time available to accomplish the task is short and the patient's condition may deteriorate rapidly. Both decision-making and performance are impaired in such circumstances. In this review, we discuss the complexity of the situation and present a treatment approach. http://www.wjes.org/content/4/1/21 Amir Krausz Imad Abu el-Naaj Michal Barak World Journal of Emergency Surgery 2009, null:21 2009-05-27T00:00:00Z doi:10.1186/1749-7922-4-21 /content/figures/1749-7922-4-21-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 21 2009-05-27T00:00:00Z XML Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients.Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials.Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection.Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures.The cornerstones in the management of complicated intra-abdominal infections are both source control and antibiotic therapy.The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections, because inadequate and late control of septic source may have a negative effect on the outcomes.Recent advances in interventional and more aggressive techniques could significantly decrease the morbidity and mortality of physiologically severe complicated intra-abdominal infections, even if these are still being debated and are yet not validated by limited prospective trials.Empiric antimicrobial therapy is nevertheless important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance.Antimicrobial management is generally standardised and many regimens, either with monotherapy or combination therapy, have proven their efficacy. Routine coverage especially against Enterococci and candida spp is not always recommended, but can be useful in particular clinical conditions. A de escalation approach may be recommended in patients with specific risk factors for multidrug resistant infections such as immunodeficiency and prolonged antibacterial exposure.Therapy should focus on the obtainment of adequate source control and adequate use of antimicrobial therapy dictated by individual patient risk factors. Other critical issues remain debated and more controversies are still open mainly because of the limited number of randomized controlled trials. http://www.wjes.org/content/5/1/9 Massimo Sartelli World Journal of Emergency Surgery 2010, null:9 2010-03-19T00:00:00Z doi:10.1186/1749-7922-5-9 /content/figures/1749-7922-5-9-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 9 2010-03-19T00:00:00Z XML Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications. Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis. The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection. We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum. http://www.wjes.org/content/3/1/16 Oguzhan Karatepe Osman Bilgin Gulcicek Gokhan Adas Muharrem Battal Yasar Ozdenkaya Idris Kurtulus Merih Altiok Servet Karahan World Journal of Emergency Surgery 2008, null:16 2008-04-21T00:00:00Z doi:10.1186/1749-7922-3-16 /content/figures/1749-7922-3-16-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 16 2008-04-21T00:00:00Z XML ObjectiveThis study aimed to investigate clinical features of abdominal emergency surgery in elderlypatients, and to determine factors predicting mortality in these patients. Methods: The study population included 94 patients aged 80 years or older who underwent emergencysurgery for acute abdominal diseases between 2000 and 2010. Thirty-six patients (38.3%)were male and fifty-eight patients (61.7%) were female (mean age, 85.6 years). Mainoutcome measures included background of the patient's physical condition (concomitantmedical disease, and performance status), cause of disease, morbidity and mortality, anddisease scoring system (APACHE II, and POSSUM). Prognostic factors affecting mortalityof the patient were also evaluated by univariate analysis using Fisher's exact test and Mann-Whitney U-test, and by multivariate analysis using multiple logistic regression analysis. Results: Of the 94 patients, 71 (75.5%) had a co-existing medical disease; most patients hadhypertension (46.8%). The most frequent surgical indications were acute cholecystitis in 23patients (24.5%), followed by intestinal obstruction in 18 patients (19.1%). Forty-one patients(43.6%) had complications during hospital stay; the most frequent were surgical site infection(SSI) in 21 patients (22.3%) and pneumonia in 12 patients (12.8%). Fifteen patients died(overall mortality, 16%) within 1 month after operation. The most common causes of deathwere sepsis related to pan-peritonitis in 5 patients (5.3%), and pneumonia in 4 patients(4.3%). Multiple logistic regression analysis showed that time from onset of symptoms tohospital admission and the POSSUM scoring system could be prognostic factors formortality. Conclusions: Mortality in elderly patients who underwent emergency surgery for acute abdominal diseasecan be predicted using the disease scoring system (POSSUM) and on the basis of delay inhospital admission.Keywords http://www.wjes.org/content/7/1/12 Naoto Fukuda Joji Wada Michio Niki Yasuyuki Sugiyama Hiroyuki Mushiake World Journal of Emergency Surgery 2012, null:12 2012-05-11T00:00:00Z doi:10.1186/1749-7922-7-12 /content/figures/1749-7922-7-12-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 12 2012-05-11T00:00:00Z PDF Intra-abdominal infections are still associated with high rate of morbidity and mortality.A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections.This document represents the executive summary of the final guidelines approved by the consensus conference. http://www.wjes.org/content/6/1/2 Massimo Sartelli Pierluigi Viale Kaoru Koike Federico Pea Fabio Tumietto Harry Van Goor Gianluca Guercioni Angelo Nespoli Cristian Trana Fausto Catena Luca Ansaloni Ari Leppaniemi Walter Biffl Frederick Moore Renato Poggetti Antonio Daniele Pinna Ernest Moore World Journal of Emergency Surgery 2011, null:2 2011-01-13T00:00:00Z doi:10.1186/1749-7922-6-2 /content/figures/1749-7922-6-2-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 2 2011-01-13T00:00:00Z XML Acute appendicitis represents a rare presentation of carcinoma of cecum. Neoplastic lesion of cecum may cause appendicitis by mechanical obstruction at the orifice of the vermiform appendix. The dilatation and perforation of appendix may produce a peri-appendicular abscess. A radical surgical approach of cecal masses, with intra-operative abscess drainage and resection should be performed in elderly patients, fit for surgery, to avoid the risk of unrecognising malignant lesion as well as to achieve a safe and adequate treatment. We describe a case of right iliac fossa abscess initially diagnosed with acute appendicitis that, at surgical exploration, resulted from a cecal tumour causing appendicitis for an obstructive mechanism. http://www.wjes.org/content/1/1/11 Irene Fiume Vincenzo Napolitano Gianmattia Del Genio Alfredo Allaria Alberto Del Genio World Journal of Emergency Surgery 2006, null:11 2006-04-04T00:00:00Z doi:10.1186/1749-7922-1-11 /content/figures/1749-7922-1-11-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 11 2006-04-04T00:00:00Z XML Sigmoid volvulus is a rare surgical complication occurring in pregnancy and puerperium.Only 84 cases of sigmoid volvulus in pregnancy have been reported in the English literatureso far. We have reviewed the available literature on this subject and present another caserecently managed at our institution. The available literature suggests that over the years, therehas been an improvement in the maternal and fetal outcome for this critical condition, butdelay in presentation and a further delay in diagnosis remain a challenge for the treatingphysicians. Our patient was a 30-week pregnant lady, who presented late with 6 days historyof abdominal pain, distension and absolute constipation. She had evidence of multi-organdysfunction at presentation due to complicated sigmoid volvulus. She was resuscitated andsurgical exploration revealed gangrenous large bowel. Bowel resection with divertingileostomy was performed, but she succumbed to the septic shock due to late presentation.Acute surgical pathology may be overlooked in pregnant patients due to reluctance inradiological workup and a high index of suspicion is essential for enhanced outcome. There isa need to increase the awareness amongst the obstetricians and general practitioners. Earlydiagnosis and referral and timely surgical intervention could significantly improve theoutcome of this surgical and obstetric catastrophe. http://www.wjes.org/content/7/1/10 Muhammad Khan Sameer ur Rehman World Journal of Emergency Surgery 2012, null:10 2012-05-02T00:00:00Z doi:10.1186/1749-7922-7-10 /content/figures/1749-7922-7-10-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 10 2012-05-02T00:00:00Z PDF Necrotizing fasciitis (NF) is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy. http://www.wjes.org/content/2/1/19 Korhan Taviloglu Hakan Yanar World Journal of Emergency Surgery 2007, null:19 2007-08-07T00:00:00Z doi:10.1186/1749-7922-2-19 /content/figures/1749-7922-2-19-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 19 2007-08-07T00:00:00Z XML Background: Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education. Methods: The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion. Results: A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm. Conclusion: The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage. http://www.wjes.org/content/4/1/43 Allison Weisbrod Forest Sheppard Mildred Chernofsky Charles Blankenship Fred Gage Gary Wind Eric Elster William Liston World Journal of Emergency Surgery 2009, null:43 2009-11-25T00:00:00Z doi:10.1186/1749-7922-4-43 /content/figures/1749-7922-4-43-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 43 2009-11-25T00:00:00Z XML 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 XML