http://www.wjes.org The most accessed research articles published by World Journal of Emergency Surgery 2012-01-23T00:00:00Z 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 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 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 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 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 Substantial inflammatory disturbances following major trauma have been found throughout the posttraumatic course of polytraumatized patients, which was confirmed in experimental models of trauma and in vitro settings. As a consequence, the principle of damage control surgery (DCS) has developed over the last two decades and has been successfully introduced in the treatment of severely injured patients. The aim of damage control surgery and orthopaedics (DCO) is to limit additional iatrogenic trauma in the vulnerable phase following major injury. Considering traumatic brain and acute lung injury, implants for quick stabilization like external fixators as well as decided surgical approaches with minimized potential for additional surgery-related impairment of the patient's immunologic state have been developed and used widely. It is obvious, that a similar approach should be undertaken in the case of spinal trauma in the polytraumatized patient. Yet, few data on damage control spine surgery are published to so far, controlled trials are missing and spinal injury is addressed only secondarily in the broadly used ATLS® polytrauma algorithm. This article reviews the literature on spine trauma assessment and treatment in the polytrauma setting, gives hints on how to assess the spine trauma patient regarding to the ATLS® protocol and recommendations on therapeutic strategies in spinal injury in the polytraumatized patient. http://www.wjes.org/content/4/1/9 Oliver Schmidt Ralf Gahr Andreas Gosse Christoph Heyde World Journal of Emergency Surgery 2009, null:9 2009-03-03T00:00:00Z doi:10.1186/1749-7922-4-9 /content/figures/1749-7922-4-9-toc.gif World Journal of Emergency Surgery 1749-7922 ${item.volume} 9 2009-03-03T00:00:00Z 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 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 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 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