This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.wjes.org The latest articles from World Journal of Emergency Surgery (ISSN 1749-7922) published by BioMed Central Background: Perforation peritonitis is the most common surgical emergency encountered by the surgeons all over the world as well in Pakistan. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counter part. This study was conducted at Dow University of health sciences Civil Hospital Karachi (DUHS CHK) Pakistan, designed to highlight the spectrum of perforation peritonitis in the East and to improve its outcome. Methods: This was a prospective study includes three hundred consecutive patients of perforation peritonitis studied in terms of clinical presentations, Causes, site of perforation, surgical treatment, post operative complications and mortality. Conducted at (DUHS CHK) Pakistan over a period of two and half years. All patients were resuscitated underwent emergency exploratory laparotomy, on laparotomy cause of perforation peritonitis was found and controlled. Results: The most common cause of perforation peritonitis noticed in our series was perforated duodenal ulcer (43.6%) due to acid peptic disease followed by small bowel perforation, tuberculosis (21%), typhoid (17%) appendicitis (5%), and malignant perforations (2.6%). Overall mortality was (10.6%). Conclusion: The spectrum of perforation peritonitis continuously differs from western country. Highest number of perforations noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. Most common cause of perforation peritonitis was perforated duodenal ulcer, followed by small bowel tuberculosis, typhoid perforation and perforated appendix. Malignant perforation was less common in our setup. http://www.wjes.org/content/3/1/31 Shahida P Afridi, Phyza Malik, Shafiq Ur-Rahman, Shahid Shamim and Kuhrsheed A Samo World Journal of Emergency Surgery 2008, 3:31 2008-11-08 doi:10.1186/1749-7922-3-31 World Journal of Emergency Surgery 1749-7922 3 31 2008-11-08 Idiopathic segmental infarction of the greater omentum is an uncommon cause of acute abdomen. The etiology is still unclear and the symptoms mimic acute appendicitis. Its presentation simultaneously with acute appendicitis is still more infrequent. We present a case of a 47-year old woman without significant previous medical history, admitted with an acute abdomen, in which the clinical diagnosis was acute appendicitis and in whom an infarcted segment of right side of the greater omentum was also found at laparotomy. As the etiology is unknown, we highlighted some of the possible theories, and emphasize the importance of omental infarction even in the presence of acute appendicitis as a coincident intraperitoneal pathological condition. http://www.wjes.org/content/3/1/30 Luigi Battaglia, Filiberto Belli, Alberto Vannelli, Giuliano Bonfanti, Gianfrancesco Gallino, Elia Poiasina, Mario Rampa, Marco Vitellaro and Ermanno Leo World Journal of Emergency Surgery 2008, 3:30 2008-10-29 doi:10.1186/1749-7922-3-30 World Journal of Emergency Surgery 1749-7922 3 30 2008-10-29 Introduction and objectivesAbdominal sonography is regarded as a quick and effective diagnostic tool for acute abdominal pain in emergency medicine. However, final diagnosis is usually based on a combination of various clinical examinations and radiography. The role of sonography in the decision making process at a hospital with advanced imaging capabilities versus a hospital with limited imaging capabilities but more experienced clinicians is unclear.The aim of this pilot study was to assess the relative importance of sonography and its influence on the clinical management of acute abdominal pain, at two Swiss hospitals, a university hospital (UH) and a rural hospital (RH). Methods: 161 patients were prospectively examined clinically. Blood tests and sonography were performed in all patients. Patients younger than 18 years and patients with trauma were excluded. In both hospitals, the diagnosis before and after ultrasonography was registered in a protocol. Certainty of the diagnosis was expressed on a scale from 0% to 100%.The decision processes used to manage patients before and after they underwent sonography were compared. The diagnosis at discharge was compared to the diagnosis 2 – 6 weeks thereafter. Results: Sensitivity, specificity and accuracy of sonography were high: 94%, 88% and 91%, respectively.At the UH, management after sonography changed in only 14% of cases, compared to 27% at the RH. Additional tests were more frequently added at the UH (30%) than at the RH (18%), but had no influence on the decision making process-whether to operate or not. At the UH, the diagnosis was missed in one (1%) patient, but in three (5%) patients at the RH. No significant difference was found between the two hospitals in frequency of management changes due to sonography or in the correctness of the diagnosis. Conclusion: Knowing that sonography has high sensitivity, specificity and accuracy in the diagnosis of acute abdominal pain, one would assume it would be an important diagnostic tool, particularly at the RH, where tests/imaging studies are rare.However, our pilot study indicates that sonography provides important diagnostic information in only a minority of patients with acute abdominal pain.Sonography was more important at the rural hospital than at the university hospital. Further costly examinations are generally ordered for verification, but these additional tests change the final treatment plan in very few patients. http://www.wjes.org/content/3/1/29 Aristomenis K Exadaktylos, Charlotte Sadowski-Cron, Paul Mäder, Monika Weissmann, Hans Peter Dinkel, Marco Negri and Heinz Zimmermann World Journal of Emergency Surgery 2008, 3:29 2008-10-08 doi:10.1186/1749-7922-3-29 World Journal of Emergency Surgery 1749-7922 3 29 2008-10-08 Background: The metabolic changes in trauma patients with shock contribute directly to the survival of the patient. To understand these changes better, we made a rigorous analysis of the variations in the main examinations requested for seriously polytraumatized patients. Methods: Prospective analysis of patients with blunt or penetrating trauma with hypovolemic shock, with systolic arterial pressure (SAP) equal to or lower than 90 mmHg at any time during initial treatment in the emergency room and aged between 14 and 60 years old. The following exams were analyzed: sodium, potassium, blood test, glycemia and arterial gasometry. The tests were carried out at intervals: T0 (the first exam, collected on admission) and followed by T24 (24 hours after admission), T48 (48 hours after admission), T72 (72 hours after admission). Results: The test evaluations showed that there was a tendency towards hyperglycemia, which was more evident upon admission to hospital. The sodium in all the patients was found to be normal upon admission, with a later decline. However, no patient had significant hyponatremia; there was no significant variation in the potassium variable; the gasometry, low pH, BE (base excess) and bicarbonate levels when the first sample was collected and increased later with PO2 and PCO2 showing only slight variations, which meant an acidotic state during the hemorrhagic shock followed by a response from the organism to reestablish the equilibrium, retaining bicarbonate. The red blood count, shown by the GB (globular volume) and HB (hemoglobin) was normal upon entry but later it dropped steadily until it fell below normal; the white blood count (leukocytes, neutrophils and band neutrophil) remained high from the first moment of evaluation. Conclusion: In this study we demonstrated the main alterations that took place in patients with serious trauma, emphasizing that even commonly requested laboratory tests can help to estimate metabolic alterations. Suitable treatment for polytraumatized patients with hypovolemic shock is a challenge for the surgeon, who must be alert to endocrinal and metabolic changes in his patients. Based on these alterations, the surgeon can intervene earlier and make every effort to achieve a successful clinical result. http://www.wjes.org/content/3/1/28 Luiz CV Bahten, Fernando HO Mauro, Maria F Domingos, Paula H Scheffer, Bruno H Pagnoncelli and Marco AR Wille World Journal of Emergency Surgery 2008, 3:28 2008-10-06 doi:10.1186/1749-7922-3-28 World Journal of Emergency Surgery 1749-7922 3 28 2008-10-06 The current work attempts to highlight the various life threatening complications of Meckel's diverticulum and to present the surgical strategies used in the emergency conditions so far in the form of a review of the works presented in the literature. Our aim behind this presentation is to cover the possible indications, methods, their complications and the outcome of these surgical techniques. For this, we made an extensive literature search using Google and Pubmed with the words-"Meckel's diverticulum", "Complications", "Management" and "Emergency surgery". All the relevant articles containing the surgical aspects of symptomatic Meckel's diverticulum till May 2008 were collected and analyzed. Meckel's diverticulum is the remains of the prenatal yolkstalk (Vitellointestinal duct). Although it generally remains silent but life threatening complications may arise making it an important structure for having a detailed knowledge of its anatomical and pathophysiological properties to deal with such complications. http://www.wjes.org/content/3/1/27 Raj Kumar Sharma and Vir Kumar Jain World Journal of Emergency Surgery 2008, 3:27 2008-08-13 doi:10.1186/1749-7922-3-27 World Journal of Emergency Surgery 1749-7922 3 27 2008-08-13 Colonic Intussusception although common in children, is a rare cause of acute intestinal obstruction in adults. The etiology, clinical presentation and management of this condition is different in adults as compared to children. Pre-operative diagnosis is usually difficult due to the non specific and intermittent nature of the symptoms. CT scan can be a helpful adjunct in establishing the diagnosis. We present a case report of adult ileocolic intussusception with classical radiological signs and operative findings. A brief literature review is also presented with emphasis on the controversy of reduction of the intussusception before resection. http://www.wjes.org/content/3/1/26 Muhammad Najm Khan, Avi Agrawal and Paul Strauss World Journal of Emergency Surgery 2008, 3:26 2008-08-04 doi:10.1186/1749-7922-3-26 World Journal of Emergency Surgery 1749-7922 3 26 2008-08-04 Medial clavicle fractures are uncommon, accounting for approximately 5 percent of all clavicle fractures. Vascular injuries are uncommon but are recognised as either an immediate complication due to transection of the vessel by the displaced fracture, or as a late complication, secondary to compression from abundant callus formation. We present an unusual case of positional venous insufficiency in the upper limb as an immediate complication of a closed, minimally displaced clavicle fracture, with secondary subclavian venous thrombosis formation eleven days following the injury. http://www.wjes.org/content/3/1/25 Tony Kochhar, Chethan Jayadev, Jay Smith, Emmet Griffiths and Kamaljit Seehra World Journal of Emergency Surgery 2008, 3:25 2008-07-22 doi:10.1186/1749-7922-3-25 World Journal of Emergency Surgery 1749-7922 3 25 2008-07-22 A non cirrhotic patient with esophageal varices and portal vein thrombosis had recurrent variceal bleeding unsuccessfully controlled by endoscopy and esophageal transection. Emergency transhepatic portography confirmed the thrombosed right branch of the portal vein, while the left branch appeared angulated, shifted and stenotic. A stent was successfully implanted into the left branch and the collateral vessels along the epatoduodenal ligament disappeared. In patients with esophageal variceal hemorrhage and portal thrombosis if endoscopy fails, emergency esophageal transection or nonselective portocaval shunting are indicated. The rare patients with only partial portal thrombosis can be treated directly with stenting through an angioradiologic approach. http://www.wjes.org/content/3/1/24 Roberto Caronna, Mario Bezzi, Monica Schiratti, Maurizio Cardi, Giampaolo Prezioso, Michele Benedetti, Federica Papini, Simona Mangioni, Gabriele Martino and Piero Chirletti World Journal of Emergency Surgery 2008, 3:24 2008-07-21 doi:10.1186/1749-7922-3-24 World Journal of Emergency Surgery 1749-7922 3 24 2008-07-21 Spontaneous pneumothorax is usually caused by the rupture of subpleural blebs/bullae in the underlying lung and is one of the most common elective applications of video-assisted thoracoscopic surgery (VATS). VATS has been used as an alternative to thoracotomy in the treatment of spontaneous pneumothorax. Recurrent pneumothorax and persistent air leakage are quite often indications for spontaneous pneumothorax, and bilateral spontaneous pneumothorax is also considered to be an indication for surgical intervention. The goals of surgical intervention are to eliminate intrapleural air collection and prevent recurrence. Diverse procedures have been reported in the surgical treatment for spontaneous pneumothorax. We review the literature regarding the VATS approach for spontaneous pneumothorax. http://www.wjes.org/content/3/1/23 Hiroyuki Sakurai World Journal of Emergency Surgery 2008, 3:23 2008-07-21 doi:10.1186/1749-7922-3-23 World Journal of Emergency Surgery 1749-7922 3 23 2008-07-21 Endovascular stenting has been successfully employed in the management of aortic aneurysms; however, its use in managing peripheral arterial conditions remains questionable. We review the utility of endovascular technique in the management of peripheral arterial conditions like aneurysms, pseudoaneurysms and arterio-venous fistulas in the emergency setting. Though long term data about graft patency rates is not yet available, the endovascular approach appears to be a useful minimally invasive technique in situations where open repair is either difficult or not feasible. http://www.wjes.org/content/3/1/22 Umar Sadat, Peter J Kullar, Ayesha Noorani, Jonathan H Gillard, David G Cooper and Jonathan R Boyle World Journal of Emergency Surgery 2008, 3:22 2008-07-21 doi:10.1186/1749-7922-3-22 World Journal of Emergency Surgery 1749-7922 3 22 2008-07-21 Background: Portal vein gas is an ominous radiological sign, which indicates a serious gastrointestinal problem in the majority of patients. Many causes have been identified and the most important was bowel ischemia and mesenteric vascular accident. The presentation of patients is varied and the diagnosis of the underlying problem depends mainly on the radiological findings and clinical signs. The aim of this article is to show the clinical importance of portal vein gas and its management in emergency surgery. Methods: A computerised search was made of the Medline for publications discussing portal vein gas through March 2008. Sixty articles were identified and selected for this review because of their relevance. These articles cover a period from 1975–2008. Results: Two hundreds and seventy-five patients with gas in the portal venous system were reported. The commonest cause for portal vein gas was bowel ischemia and mesenteric vascular pathology (61.44%). This was followed by inflammation of the gastrointestinal tract (16.26%), obstruction and dilatation (9.03%), sepsis (6.6%), iatrogenic injury and trauma (3.01%) and cancer (1.8%). Idiopathic portal vein gas was also reported (1.8%). Conclusion: Portal vein gas is a diagnostic sign, which indicates a serious intra-abdominal pathology requiring emergency surgery in the majority of patients. Portal vein gas due to simple and benign cause can be treated conservatively. Correlation between clinical and diagnostic findings is important to set the management plan. http://www.wjes.org/content/3/1/21 Abdulzahra Hussain, Hind Mahmood and Shamsi El-Hasani World Journal of Emergency Surgery 2008, 3:21 2008-07-17 doi:10.1186/1749-7922-3-21 World Journal of Emergency Surgery 1749-7922 3 21 2008-07-17