Search

Background: Combat casualties are frequently injured in austere settings where modern imaging modalities are unavailable. Exploratory laparotomies are often performed in these settings when there is suspicion for intra-abdominal injury. Prior studies of combat casualties reported non-therapeutic laparotomy (NTL) rates as high as 32%. Given improvements in combat casualty care over time, we evaluated NTLs performed during later years of the wars in Iraq and Afghanistan. Methods: Military personnel with combat-related injuries (6/1/2009–12/31/2014) who underwent exploratory laparotomy based on concern for abdominal injury (i.e. not performed for proximal vascular control or fecal diversion) and were evacuated to Landstuhl Regional Medical Center (Germany) before being transferred to participating U.S. military hospitals were assessed. An NTL was defined as a negative laparotomy without substantial intra-abdominal injuries requiring repair. Characteristics, indications for laparotomy, operative findings, and outcomes were examined. Results: Among 244 patients who underwent laparotomies, 41 (16.8%) had NTLs and 203 (83.2%) had therapeutic laparotomies (i.e. positive findings). Patients with NTLs had more computed tomography scans concerning for injury (48.8% vs 27.1%; p = 0.006), less penetrating injury mechanisms (43.9% vs 71.9%; p < 0.001), and lower Injury Severity Scores (26 vs 33; p = 0.003) compared to patients with therapeutic laparotomies. Patients with NTLs were also less likely to be admitted to the intensive care unit (70.7 vs 89.2% for patients with therapeutic laparotomies; p = 0.007). No patients with NTLs developed abdominal surgical site infections (SSI) compared to 16.7% of patients with therapeutic laparotomies (p = 0.002). There was no significant difference in mortality between the groups (p = 0.198). Conclusions: Our proportion of NTLs was lower than reported from earlier years during the wars in Iraq and Afghanistan. No infectious complications from NTLs (i.e. abdominal SSIs) were identified. Nevertheless, surgeons should continue to have a low threshold for exploratory laparotomy in military patients in austere settings with concern for intra-abdominal injury. [ABSTRACT FROM AUTHOR]

Background: Intestinal tuberculosis (iTB) represents a potentially underrecognized clinical entity with limited clinical and radiological differentiating features. This study aims to assess the patterns of iTB clinical and radiological findings, along with the treatment approaches and the overall outcome. Methods: This retrospective cross-sectional study included patients with histopathologically confirmed iTB who presented with acute abdomen and were surgically managed between September 2005 and October 2023. Clinical and sociodemographic variables, imaging features, surgical treatments, and overall outcomes were retrospectively analyzed. Results: 96 patients with iTB were included, with a mean age of 36.1 ± 11.5 years and a relatively proportionate gender distribution. Abdominal pain was the most common presenting symptom (45.8%). The radiological features varied by the modality. Plain imaging showed non-specific findings, while ultrasonography showed loculated ascites (25%), and lymphadenopathy (22%). In computed tomography scans, multi-segmental symmetric intestinal thickening (53.1%) was the most prevalent finding. The most commonly performed surgical procedure was adhesiolysis (29.2%), with the ileocecal junction being the most commonly involved structure (39.6%). Histopathological examination of all the tissue biopsies revealed epithelioid granulomas. Postoperative complications occurred in 19 patients (19.8%), with surgical site infection being the most common complication (10.4%). Conclusion: Intestinal obstruction is an underrecognized manifestation of tuberculosis, particularly in endemic regions. The non-specific clinical presentation, coupled with the limited utility of laboratory and radiological tests, often leads to delayed recognition and treatment. Maintaining a high index of suspicion is essential, especially in younger patients, inhabitants of endemic areas, or those with laboratory findings indicative of chronic inflammation. Prompt recognition is crucial to ensure the timely initiation of anti-tuberculosis therapy and to optimize patient outcomes through appropriate follow-up. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We present a 20 years old male with no known comorbid in emergency complaining of pain localized to the right upper quadrant for two days, followed by fever (101F) with 15-16 episodes of vomiting, which were non-bilious and containing food particles. The patient was vitally stable on examination and had a mild jaundiced look; the abdomen was soft and tender over the right hypochondrium. Ultrasound of the abdomen showed a hypoechoic liver and thick-walled acalculous gall bladder along with pericholecystic fluid, suggesting acute cholecystitis. On further evaluation, the diagnosis of gangrenous cholecystitis was made, and an emergency exploratory laparotomy along with a cholecystectomy was performed.

Gastroepiploic artery aneurysms (GEAAs) are rare subtype of Splanchnic artery aneurysms (SAAs) with estimated prevalence of 0.4% out of total SAAs. Most common causes include atherosclerosis, trauma, vasculitis, infections, pancreatitis, biliary diseases etc. GEAAs are more common in male and the rupture occurs usually after 50 years. Spontaneous rupture of GEAAs in females are rare and very less cases have been reported till now. A 35 years old female with no significant past medical history and no history of trauma presented to ED with features suggestive of shock. CECT (axial and coronal plane) revealed a focal outpouching in right gastroepiploic artery with evidence of active contrast extravasation suggestive of spontaneous rupture of Right Gastroepiploic artery aneurysm. Patient was resuscitated and Exploratory Laparotomy along with ligation and aneurysmectomy. Spontaneous rupture of GEAAs in young female is very rare. Urgent treatment is needed in case of unstable patients because of high risk of rupture and higher mortality rates of GEAAs.

Purpose: This study aimed to evaluate the feasibility, safety, diagnostic yield, and technical aspects of percutaneous abdominal lavage cytology screening (PACS) in patients with resectable pancreatic cancer. Methods: This single-center, retrospective study included patients with resectable pancreatic cancer who underwent PACS before pancreatectomy between May 2022 and October 2023. The technical success rate, position of the drainage tube, volume of fluid administered, volume of fluid retrieved, fluid retrieval rate, and adverse events were evaluated. The cytological results of PACS were compared with those of surgical peritoneal lavage performed during pancreatectomy. Results: Forty-four patients were enrolled in this study. The technical success rate for PACS was 100%. Drainage tube placement was outside the pouch of Douglas in all patients in the right-sided abdominal approach group (n = 10), whereas the placement was in the pouch of Douglas in all patients in the suprapubic approach group (n = 34). The mean volume of fluid administered, mean volume of fluid retrieved, and fluid retrieval rate were 185.0 ± 22.9 ml vs. 97.1 ± 32.0 ml (p < 0.001), 36.8 ± 25.6 ml vs. 50.5 ± 21.6 ml (p = 0.059), and 19.0 ± 12.4% vs. 54.9 ± 21.9% (p < 0.001) in the right abdominal approach and suprapubic approach groups, respectively. No adverse events were reported. The cytological results were benign in 42 patients; no discrepancy was observed in the results of surgical peritoneal lavage (n = 36). Conclusion: PACS is a feasible and safe procedure that can be performed before pancreatectomy in patients with resectable pancreatic cancer. the suprapubic approach may be ideal and PACS could be a screening method to detect carcinomatous peritonitis [ABSTRACT FROM AUTHOR]

Background: Peptic ulcer perforation is a serious complication which affects 2–10% of peptic ulcer patients. Peptic ulcer perforation presents with an overall mortality of 10% although various authors had reported incidence between 1.3% and 20%. Being a life-threatening complication of peptic ulcer disease, it needs special attention with prompt resuscitation and appropriate surgical management if morbidity and mortality are to be contained. Aims and Objectives: The aim of the study was to the comparative study of Graham’s omentopexy versus modified Graham’s omentopexy in duodenal perforation. Materials and Methods: This prospective and single-center study was done in Birsa Munda, GMC Shahdol Madhya Pradesh from 2021 to 2023 for 2 years of periods. A total of 160 patients divided into two groups-Graham’s omentopexy 80 cases group “A” and modified Graham’s omentopexy 80 cases group “B.” Results: One hundred and forty-six (91%) were male and 14 (9%) were female with M:F Ratio 10:1. Most of the patients were 20–78 years of age in both groups. Post-operative leakage was 7.5% and 1.25%, respectively. Mortality rate in Group A (3.75%) and in Group B (1.25%). The overall mortality rate was 7.14%. In this study, average hospital stay was 12.4 days in Group A and 9.0 days in Group B. Conclusion: This study showed that modified Graham’s patch repair is as effective as Graham’s patch repair in terms of the mean operative time period, the timing of oral feed allow, and mean hospital stay timing.

A less common puerperal complication following a caesarean section is a bladder flap haematoma, characterised by the accumulation of blood in the vesico-uterine space. A young, unregistered primigravida was referred from a peripheral facility with preeclampsia and obstructed labour. Signs of obstructed labour were observed both before and intraoperatively, like dehydration, foetal distress, a stretched lower uterine segment, and oedematous bladder. The uterus was sutured in two layers to control bleeding, and the patient was closely monitored postoperatively. The diagnosis of haematoma was made by the increasing height of the uterus and a suprapubic bulge anterior to the uterus, along with postoperative haematuria. Imaging with ultrasonography and Computed Tomography (CT) helped to decide the management. The patient improved after exploratory laparotomy with haematoma drainage. No bladder injury was found during the cystoscopy. Early diagnosis and treatment were important in preventing complications such as haemodynamic instability, abscess formation, and sepsis. Authors present their experience in this patient with postcaesarean vesico-uterine haematoma, with frank haematuria, without an obvious bladder injury, who required re-exploration. The clinical presentation, course, and sonographic findings of this patient form the basis of this report.

A less common puerperal complication following a caesarean section is a bladder flap haematoma, characterised by the accumulation of blood in the vesico-uterine space. A young, unregistered primigravida was referred from a peripheral facility with preeclampsia and obstructed labour. Signs of obstructed labour were observed both before and intraoperatively, like dehydration, foetal distress, a stretched lower uterine segment, and oedematous bladder. The uterus was sutured in two layers to control bleeding, and the patient was closely monitored postoperatively. The diagnosis of haematoma was made by the increasing height of the uterus and a suprapubic bulge anterior to the uterus, along with postoperative haematuria. Imaging with ultrasonography and Computed Tomography (CT) helped to decide the management. The patient improved after exploratory laparotomy with haematoma drainage. No bladder injury was found during the cystoscopy. Early diagnosis and treatment were important in preventing complications such as haemodynamic instability, abscess formation, and sepsis. Authors present their experience in this patient with postcaesarean vesico-uterine haematoma, with frank haematuria, without an obvious bladder injury, who required re-exploration. The clinical presentation, course, and sonographic findings of this patient form the basis of this report. [ABSTRACT FROM AUTHOR]

Background: Peptic ulcer perforation is a serious complication which affects 2-10% of peptic ulcer patients. Peptic ulcer perforation presents with an overall mortality of 10% although various authors had reported incidence between 1.3% and 20%. Being a life-threatening complication of peptic ulcer disease, it needs special attention with prompt resuscitation and appropriate surgical management if morbidity and mortality are to be contained. Aims and Objectives: The aim of the study was to the comparative study of Graham's omentopexy versus modified Graham's omentopexy in duodenal perforation. Materials and Methods: This prospective and single-center study was done in Birsa Munda, GMC Shahdol Madhya Pradesh from 2021 to 2023 for 2 years of periods. A total of 160 patients divided into two groups-Graham's omentopexy 80 cases group "A" and modified Graham's omentopexy 80 cases group "B." Results: One hundred and forty-six (91%) were male and 14 (9%) were female with M:F Ratio 10:1. Most of the patients were 20-78 years of age in both groups. Post-operative leakage was 7.5% and 1.25%, respectively. Mortality rate in Group A (3.75%) and in Group B (1.25%). The overall mortality rate was 7.14%. In this study, average hospital stay was 12.4 days in Group A and 9.0 days in Group B. Conclusion: This study showed that modified Graham's patch repair is as effective as Graham's patch repair in terms of the mean operative time period, the timing of oral feed allow, and mean hospital stay timing. [ABSTRACT FROM AUTHOR]

We present a 20 years old male with no known comorbid in emergency complaining of pain localized to the right upper quadrant for two days, followed by fever (101F) with 15-16 episodes of vomiting, which were non-bilious and containing food particles. The patient was vitally stable on examination and had a mild jaundiced look; the abdomen was soft and tender over the right hypochondrium. Ultrasound of the abdomen showed a hypoechoic liver and thick-walled acalculous gall bladder along with pericholecystic fluid, suggesting acute cholecystitis. On further evaluation, the diagnosis of gangrenous cholecystitis was made, and an emergency exploratory laparotomy along with a cholecystectomy was performed. [ABSTRACT FROM AUTHOR]

Background: Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract. However, MD is rare in clinical practice, and perforation of a MD by a foreign body is even rarer. Preoperative diagnosis is difficult because there is often insufficient information; therefore it is usually diagnosed intraoperatively. Although rare, it should be considered as a differential diagnosis in patients who have ingested foreign bodies. Case presentation: The following is the case of a 52-year-old female patient who was admitted because of generalized abdominal pain for 5 days, related to nausea and vomiting. She also stopped passing gas. Inflammatory indicators were elevated, and computed tomography (CT) revealed gas–liquid levels in the small intestine and high-density objects in the ileum. Based on the patient's condition, laparotomy was performed instead because the laparoscopic procedure was difficult to perform. Intraoperatively, a foreign body perforated the diverticulum of the terminal ileum, resulting in the development of an abdominal abscess. Finally, we performed resection of the ileal diverticula and partial resection of the ileum. After the surgery, it was confirmed that the foreign bodies were two dentures accidentally eaten by the patient. Conclusion: A thorough understanding of the clinical presentation, imaging features, and treatment of MD and its complications will assist clinicians in making prompt and accurate diagnoses and providing symptomatic treatment. [ABSTRACT FROM AUTHOR]

Ovarian fibrosarcomas account for less than 1% of all ovarian malignancies. Clinical diagnosis is extremely difficult. A 20-year-old, illiterate, married nulliparous woman presented to our Outpatient Department Clinic (OPD) with chronic abdominal distension. Ultrasound and CT scan revealed a very large intra-abdominal mass, 23.8x27.8x35.7cm. She underwent a laparotomy and left salpingo-oophorectomy with her uterus and right adenexum conserved. After surgery, the mass weighed 11.1kg and measured 43x38x35cm. Histological findings were in line with a giant primary ovarian fibrosarcoma. To date, as far as we are aware, this is the largest ever recorded primary ovarian fibrosarcoma.

OBJECTIVE: To predict mortality using the APACHE II score in patients presenting with peritonitis and undergoing emergency exploratory laparotomy. Methodology: The prospective study was conducted in Civil Hospital Karachi's surgery department from April to September 2021, with a non-probability sampling technique. A total of 84 patients of either sex between the age of 16-70 years who met the diagnostic criteria of peritonitis were included consecutively. Patients with incomplete laboratory records and uncorrectable preoperative comorbidities were excluded. The APACHE II score was categorized into three groups, and demographic details and outcomes were calculated using SPSS version 20 for the data analysis. Post-stratification Chi-square test was applied, taking a p-value of < 0.05 as statistically significant. RESULTS: Out of 84 patients, 38 (45.2%), 37 (44%) and 09 (10.7%) had APACHE score < 10, 11-20 and ≥ 20 respectively. The total in-hospital mortality rate was 8.3%. In the patients with the lowest APACHE score < 10, a mortality rate of 2.6% was recorded. A mortality of 5.4% was recorded in patients with APACHE II group 2, while group 3 with APACHE II score > 20 had the highest mortality rate of 44%. The difference was statistically significant. (p=0.001). CONCLUSION: The results of the APACHE II score obtained in patients classified them into three different groups based on the severity of conditions in patients with peritonitis, which validated the Prediction of increased mortality with higher scores.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the digestive tract and arise from the interstitial cells of Cajal in the mesenteric plexus. These tumors can originate in any part of the GI tract; however, a higher burden has been observed in the stomach and small intestines. Mesenteric GISTs are exceedingly rare, with unique clinicopathological features and a poorer prognosis. Herein, we describe a unique case of a 66-year-old female with a remote history of appendectomy who presented to the emergency room complaining of severe abdominal pain and vomiting. On imaging, the patient was found to have a large inflammatory mass associated with small bowel loops, and the pathology confirmed a mesenteric GIST. The tumor was resected, and the genomic test results confirmed the KIT (exon 11) mutation. Although the tumor had a low mitotic rate, the tumor was large enough to warrant the initiation of adjuvant imatinib mesylate for 36 months with regular bloodwork and imaging. [ABSTRACT FROM AUTHOR]

Background: Peptic ulcer perforation is a serious complication which affects 2-10% of peptic ulcer patients. Peptic ulcer perforation presents with an overall mortality of 10% although various authors had reported incidence between 1.3% and 20%. Being a life-threatening complication of peptic ulcer disease, it needs special attention with prompt resuscitation and appropriate surgical management if morbidity and mortality are to be contained. Aim: -Was comparative study of Graham's omentopexy versus modified Graham's omentopexy in gastric perforation Methods: This prospective, single centre study done in Birsa Munda, GMC Shahdol Madhya Pradesh from 2021 to 2023 for two years of periods. Total 160 patients, Divided into two groups-Graham's omentopexy 80 cases group 'A'. & modified Graham's omentopexy 80 cases group 'B'. Results: 146 [91%] were males and 14[9%] were females with M:F Ratio 10:1. Most of the patients 20-78 years of age in both group. Post operative leakage was 7.5% and 1.25% respectively. Mortality rate in Group A (3.75%) and in Group B (1.25%). The overall mortality rate was 7.14%. In this study average hospital stay was 12.4 days in group A and 9.0 days in group B. Conclusion: This study showed that modified Graham's patch repair is as effective as Graham's patch repair in terms of mean operative time period, timing of oral feed allow and mean hospital stay timing. [ABSTRACT FROM AUTHOR]

Abstract Background Intra-abdominal pregnancies, while rare, present with unique diagnostic and management challenges. We present a case of a 25-year-old para 2 + 1, black African woman, who was referred from a peripheral Health Centre level IV in the Northern part of Uganda to a Regional Referral Hospital due to an abnormal presentation with easily palpable fetal parts. This case emphasizes the significance of prompt diagnosis, interdisciplinary collaboration, surgical planning, and managing the placenta in advanced intra-abdominal pregnancies. Case presentation A 25 year African black female, para 2 + 1 upon arrival at Regional Referral Hospital, a University Teaching Hospital during a weekend, an ultrasound was sourced from a nearby private clinic revealing an extra-uterine intra-abdominal pregnancy at 38 weeks of gestation and she was promptly sent back to the University Teaching Hospital. Following this diagnosis, the patient, who hailed from a remote village over 30 km away, returned to her family for discussions. After three days, she was readmitted. Emergency laparotomy unveiled an omental gestation sac with extensive placental attachment. A live female infant was delivered successfully, placenta was left in situ. The postoperative course was uneventful, with initial concerns about inadequate breast milk flow which resolved after placental removal during the second exploratory laparotomy. Conclusion This case highlights the uncommon occurrence of an advanced intra-abdominal pregnancies and emphasizes the importance of multi-disciplinary teamwork and placental management. The favorable outcome in the management was based on thorough assessment of the placental location, attachments and blood supply during surgery. It demonstrates the possibility of reduced risk of massive bleeding if there is a delayed removal of placenta with favorable attachment. This is particularly important for milk letdown as well as reducing the needs of blood transfusion in resource limited settings.

OBJECTIVE To compare the results of abdominal CT with exploratory laparotomy in the dog. ANIMALS 100 client-owned dogs from 1 academic institution. METHODS Medical records were searched for dogs that had undergone a preoperative abdominal CT scan read by a board-certified veterinary radiologist followed by an exploratory laparotomy. CT and surgical reports were compared. RESULTS The overall agreement between abdominal CT scan and exploratory laparotomy in all cases was 97%. Overall, there was no evidence that proportion agreement differed on the basis of body condition score, time interval between CT and surgery, or oncologic versus nononcologic disease. CLINICAL RELEVANCE Abdominal CT scan read by a board-certified diplomate is a sensitive presurgical diagnostic tool for surgical abdominal disease in the dog. When performing a specific abdominal surgery, it is acceptable for the surgeon to fully explore the abdomen or forego it for a smaller approach to the organ of interest if an abdominal CT was performed prior. [ABSTRACT FROM AUTHOR]

Background: Intra-abdominal pregnancies, while rare, present with unique diagnostic and management challenges. We present a case of a 25-year-old para 2 + 1, black African woman, who was referred from a peripheral Health Centre level IV in the Northern part of Uganda to a Regional Referral Hospital due to an abnormal presentation with easily palpable fetal parts. This case emphasizes the significance of prompt diagnosis, interdisciplinary collaboration, surgical planning, and managing the placenta in advanced intra-abdominal pregnancies. Case presentation: A 25 year African black female, para 2 + 1 upon arrival at Regional Referral Hospital, a University Teaching Hospital during a weekend, an ultrasound was sourced from a nearby private clinic revealing an extra-uterine intra-abdominal pregnancy at 38 weeks of gestation and she was promptly sent back to the University Teaching Hospital. Following this diagnosis, the patient, who hailed from a remote village over 30 km away, returned to her family for discussions. After three days, she was readmitted. Emergency laparotomy unveiled an omental gestation sac with extensive placental attachment. A live female infant was delivered successfully, placenta was left in situ. The postoperative course was uneventful, with initial concerns about inadequate breast milk flow which resolved after placental removal during the second exploratory laparotomy. Conclusion: This case highlights the uncommon occurrence of an advanced intra-abdominal pregnancies and emphasizes the importance of multi-disciplinary teamwork and placental management. The favorable outcome in the management was based on thorough assessment of the placental location, attachments and blood supply during surgery. It demonstrates the possibility of reduced risk of massive bleeding if there is a delayed removal of placenta with favorable attachment. This is particularly important for milk letdown as well as reducing the needs of blood transfusion in resource limited settings. [ABSTRACT FROM AUTHOR]

Ectopic pregnancy is a life-threatening condition that occurs when a fertilized egg implants outside the uterine cavity. While the classical presentation involves abdominal pain, vaginal bleeding, and amenorrhea, atypical manifestations can pose diagnostic challenges and lead to delayed intervention. We presented a case of a 26-year-old G2P1+0 female with a history of cesarean section nine months ago. She gave with ten days of lower abdominal pain and brownish vaginal discharge but without the classical triad of symptoms. She exhibited signs of distress on examination, and her pulse and blood pressure were elevated. Transvaginal ultrasonography revealed an empty uterus with a heterogeneous area in the pouch of Douglas. A diagnosis of ruptured ectopic pregnancy was made based on clinical and imaging findings, and exploratory laparotomy confirmed a ruptured right tubal ectopic pregnancy. Additionally, bleeding was observed from tissue attached to the lower posterior part of the uterus, which was excised during surgery. This case highlights the importance of considering atypical presentations of ectopic pregnancy and the necessity of timely diagnosis and intervention to prevent adverse outcomes. Healthcare providers should maintain a high index of suspicion for ectopic pregnancy, especially in women with positive pregnancy tests and pelvic symptoms, even without the classical triad. [ABSTRACT FROM AUTHOR]

Copyright of Revista Chilena de Urologia is the property of Sociedad Chilena de Urologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION: In low-and middle-income countries (LMICs), at least 60 percent of the surgical operations performed are for emergencies. Thus needs to diverts majority of the resources towards the emergency department. AIM: To assess the socio-demographic profile of emergency surgery, To assess the prevalence of different type of surgical emergencies, To assess the various complications of different type of emergency surgeries and outcome of emergency surgeries. METHOD: Study conducted on 300 patients aged 13 years and above at the Department of Surgery, S.P. Medical College and P.B.M Hospital, Bikaner from December 2019 to November 2021. Convenience sampling method was used for sampling of cases. All Patients of age 13 years and above, regardless of gender, admitted with clinical and/or radiological evidence of general surgical emergencies and undergoing surgical intervention, enrolled in the study. RESULT: Majority of patients in our study are males. The male to female ratio is 2.26 :1. Majority of patients in our study are from 21-40 years age group followed by 41-60 years age group. Most common surgical intervention done was exploratory laparotomy followed by appendectomy. CONCLUSION: Early diagnosis of surgical emergencies careful selection of cases for surgery, skilful operative management, proper technique during surgery and intensive post- operative treatment yield grateful results. [ABSTRACT FROM AUTHOR]

Background: Myomectomy is the surgical procedure of choice for symptomatic myoma in the reproductive age, especially if future fertility is desired. LM is the surgical removal of uterine myoma through small incisions in the abdomen. It is an appropriate, if not preferred, alternative to abdominal myomectomy in well-selected patients since it offers shorter hospitalization, short recovery period and resumption of activities within 1-2 weeks, reduced risk of blood transfusion, and intraoperative adhesions. Aim: The aim of the current study was to determine the diagnostic accuracy of different ultrasonographic characters of uterine myoma in predicting success of laparoscopic myomectomy. Methods: The present study was prospective interventional study that was carried out on 35 cases with Chronic pelvic pain. All patients had radiological evaluation by TVS and TAS. All Laparoscopic myomectomies done under general anaesthesia. Outcomes included determining ultra-sonographic predictors for successful laparoscopic myomectomy as regards site, size, and character of Myoma, presence of capsule and line of separation around myoma. Results: The most common complain among the studied cases was bleeding followed by pain and lastly infertility. Regarding location, the most common site was posterior followed by fundal, then anterior and lastly at the cornu. Operative times, blood loss amount, method of extraction, need laparoscopic suturing, complications during surgery recovery and hospital stay after operation demonstrated significant relation with outcomes. Myoma characters, numbers and type demonstrated insignificant relation with outcomes. Conclusion: The current study concluded that, myoma characters, numbers and type could not be used as predictors for successful LM; outcomes. However, operative times, blood loss amount, complications during surgery recovery and hospital stay after operation were less in successful LM than in LAM; and laparoscopic suturing and morcellation have less time consumption and better results than LAM. [ABSTRACT FROM AUTHOR]

Tuberculosis Peritonitis is a serious condition, whose diagnosis is established late due to the nonspecific nature of the clinical features, which delays the performance of imaging investigations and, implicitly, the setting of the diagnosis through biopsy and histopathological examination. We report the case of a 49-year-old man who presented in our clinic with nonspecific symptoms and significant nitrogen retention, with ascites fluid detected during the clinical–paraclinical examination, ultimately confirming the diagnosis of bacillary peritonitis. Confirmation of tuberculous etiology through biopsy and/or bacteriological examination is sovereign for the diagnosis. The therapeutic protocol includes three anti-tuberculostatic drugs, for a period of at least 6 months, with or without the combination of corticosteroid therapy during the first months of treatment. The patient evolution under treatment was initially favorable, but due to peritoneal adhesions, it underwent complications later. [ABSTRACT FROM AUTHOR]

Surgical procedures manifest immense risks to patients. One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection (SSI). Although several efforts are being undertaken to determine the proper means to reduce such complications, there is still a high incidence of SSI worldwide. Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site. This study tested the effectiveness of an operating room (OR) bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.

Ovarian tumours are diverse and lead to rare yet critical complications such as torsion. The ovary twists on its own axis and compromises blood flow. Ovarian torsion is uncommon and has considerable risk in women of reproductive age. The present case report elucidates the intricate nature of ovarian tumours, particularly emphasising the rare yet critical complication of torsion, where the ovary twists, compromising blood flow. The presented case involves a 35-year-old multiparous woman with acute abdominal pain, vomiting, and elevated Cancer Antigen 125 (CA-125) levels, leading to the diagnosis of a left ovarian cyst with torsion via Ultrasonography (USG). The subsequent surgical intervention, involving exploratory laparotomy, successfully confirmed and addressed the issue, resulting in detorsion and cystectomy. Histopathological examination further identified a benign serous cystadenoma. The present case underscores the diagnostic challenges associated with ovarian tumour-related torsion, highlighting the importance of symptom analysis and diagnostic imaging for early recognition. It also emphasises the effectiveness of surgical intervention, showcasing varied treatment options, from cystectomy to detorsion, contingent on individual circumstances. The present case report stresses the imperative of a multidisciplinary approach involving gynaecologists, radiologists and surgeons for optimal outcomes in managing this complex condition.

Intussusception refers to the invagination of a proximal loop of the bowel into an adjacent distal segment. This condition is rare in adults, especially when it involves a complete folding of the ileocecal area out of the body cavity. Meanwhile, enterogenous cysts are congenital malformations that are largely identified in childhood following symptoms of bowel obstruction. While surgical treatment is ultimately required for both diseases, deciding on the type of surgery and the right time to operate can be a challenge for clinicians. It is especially difficult to decide on treatment for an adult with the coincidental occurrence of both conditions and no definitive pathologic diagnosis prior to surgery. Here, we present the case study of a 19-year-old female patient who presented with a prolapsed anus due to intussusception caused by a large ileocecal mass. The patient was admitted to the emergency department with a “massive anal mass.” She remained symptomatic after receiving conventional conservative treatment and had to undergo emergency surgery after developing an intestinal obstruction. While the patient’s intraoperative condition also confirmed the preoperative CT findings, the situation became more complicated during surgery. The postoperative pathological report indicated the presence of an enterogenous cyst. After recovery from surgery, the patient was successfully discharged. Intussusception or intestinal obstruction caused by an intestinal mass is a surgical indication, and removal is the only way to cure the condition. This case study provides a helpful reference for general surgeons, especially anorectal surgeons, imaging physicians, and pathologists, and informs the diagnosis and treatment of this patient population.

Background: Trauma laparoscopy may provide a less invasive alternative to laparotomy by providing accurate diagnosis and minimally invasive management of selected trauma patients. The risk of missing injuries during the laparoscopic evaluation still refrains surgeons from using this approach. Our aim was to evaluate feasibility and safety of trauma laparoscopy in selected patients. Methods: We performed a retrospective review of hemodynamically trauma patients who underwent laparoscopic management in a tertiary center in Brazil due to abdominal trauma. Patients were identified by searching through the institutional database. We collected demographic and clinical data, focusing on avoidance of exploratory laparotomy, and missed injury rate, morbidity, and length of stay. Categorical data were analyzed using Chi-square, while numerical comparisons were performed using Mann–Whitney and Kruskal–Wallis test. Results: We evaluated 165 cases, of which 9.7% needed conversion to an exploratory laparotomy. One-hundred and twenty-one patients (73%) had at least one intrabdominal injury. Two missed injuries to retroperitoneal organs were identified (1.2%), of which only one was clinically relevant. Three patients died (1.8%), one of which was due to complications from an intestinal injury after conversion. No deaths were related to the laparoscopic approach. Conclusion: In selected hemodynamically stable trauma patients, the laparoscopic approach is feasible and safe, and reduces the need for exploratory laparotomy and its associated complications. [ABSTRACT FROM AUTHOR]

Iatrogenic bladder injuries are a cause of morbidity in pelvic surgeries. Bladder perforation could be extraperitoneal or intra-peritoneal. Clinicaly, extraperitoneal bladder perforation is diagnosed by suprapubic pain, extravasation of urine into scrotum, perineum and thighs and difficulty in voiding whereas intraperitoneal bladder injury is diagnosed by signs of lower abdominal pain resembling acute abdomen. The diagnosis of bladder injury is confirmed by Computerised Cystography. The management of extraperitoneal bladder injury is catheter drainage while intraperitoneal bladder injury is managed by open repair. We present a case of Extraperitoneal iatrogenic bladder injury in a patient who underwent exploratory laparotomy for Appendicular perforation.

Foreign body in gastrointestinal tract is a common problem in small animal practice, especially in domestic cats. A case report of recurrent ingested thread as a linear foreign body with the thread held back by the tongue and stuck causing further complications is presented in this case report. Interestingly, the radiographic results did not indicate the paisley shaped gas pattern which is characteristic of a linear foreign body. The final diagnosis was made by exploratory laparotomy which confirmed the presence of several threads in the small intestine. Therefore, this complex case was diagnosed based on history, clinical signs and results of radiography and confirmed by exploratory laparotomy. This is the first ever published case report of successful clinical management of a linear foreign body in UAE according to the authors’ knowledge.

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Surgical Site Infections(SSI) are defined as wound infections following an invasive surgical procedure. They remain a cause of major morbidity in patients undergoing surgical procedures despite advances in operative techniques. Triclosan [5-chloro-2-(2, 4-dichlorophenoxy) phenol] is a broad-spectrum bactericidal agent which acts by attacking different structures in the bacterial cytoplasm and cell membrane. Triclosan-coated sutures should theoretically result in the reduction of SSI. Aim & objective: The aim of this study is to ascertain the incidence of surgical site infections when antibiotic coated sutures are used versus conventional sutures in patients undergoing laparotomy and to compare the Post-operative pain and duration of hospitalization in both groups. Methods: A comparative study of 232 patients undergoing laparotomy in the General Surgery department with abdominal sub-cutaneous wound closure either with Triclosan coated Polyglactin 910 sutures(study group) or conventional Polyglactin 910 sutures (control group) (116 patients in each group). Results: There was no difference in demographic and preoperative profiles in both groups. There was a statistically significant reduction in the incidence of surgical site infection in the antibiotic coated-suture group compared to the control group. There was no difference in intensity of Post-Operative pain or duration of hospitalization. Conclusion: Development of Superficial Surgical Site Infections after laparotomy was decreased with the use of Triclosan Coated Sutures. Triclosan-coated sutures could be used to decrease the risk of surgical site infection after laparotomy along with other infection control measures. [ABSTRACT FROM AUTHOR]

Copyright of Equine Veterinary Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Trauma has been called the neglected disease of modern society and the most common cause of death under 45 years. Determining the optimal prospective course of action may be aided by the adoption of a scoring system to evaluate urgent laparotomy intervention. A quick and easy technique to identify whether there are any intra-abdominal injuries is to use the clinical abdominal scoring system (CASS). The objective of this study was to evaluate CASS in predicting the outcomes in patients with blunt abdominal trauma (BAT). Methods A retrospective observational study was conducted involving 80 patients with suspected BAT that arrived at the emergency department. All patients with suspected BAT were scored using CASS and radiological investigations that were done in the ED. The decision to proceed with the surgery would be made if the patient had CASS >12 and/or if the radiological investigation showed features of BAT such as air under the diaphragm. Results Mean CASS score was 10.28 ± 1.340. The majority of the subjects (75 or 93.5%) had successful laparotomies, whereas only five (6.3%) had unsuccessful ones. Injuries to the spleen (42.6%), and liver (32%), combined injuries to the spleen and liver (2.6%), intestine (16%), pancreas (1.3%), bladder (4%), and kidneys (1.5%) were all found in positive laparotomies. The CASS has specificity of 60%, sensitivity of 80%, PPV 96.7%, and NPV 16.6%. Conclusions According to our data results, The CASS has a poor ability to predict the need for laparotomy in cases of blunt abdominal injuries as it shows low specificity.

Introduction: Neonatal gastric perforation (NGP) is a life-threatening condition associated with high morbidity and mortality rates. Despite several proposed etiological theories, the causative principle is still unclear and controversial. Case presentation: A male neonate was born at 26 weeks 3 days gestation. The patient showed symptoms of acute respiratory failure and hypoxia and was admitted to the neonatal intensive care unit. On day of life (DOL) 2, a chest and abdominal radiography showed a large amount of free intraperitoneal air, for which exploratory laparotomy was performed. A small antimesenteric perforation in the distal ileum was found and repaired primarily. On DOL 7, a chest and abdominal radiography demonstrated recurrent pneumoperitoneum for which a repeat exploratory laparotomy was performed. The patient had global intestinal ischemia and a perforation in the anterior wall of the stomach, which was repaired. On DOL 12, a planned upper gastrointestinal water-soluble contrast study showed spillage of contrast into the anterior abdomen, for which the patient underwent a repeat exploratory laparotomy. We found a dehiscence of the prior gastric repair and closed it primarily. The remainder of the hospital course was uneventful and the patient reached full feedings on DOL 41. Conclusion: Premature neonates are at risk for gastric perforation. Gastric perforation should be in the differential diagnosis of a premature neonate who presents abdominal distension and pneumoperitoneum. Due to the fragility of the premature neonatal tissues, confirming the integrity of the gastric closure with a contrast study is recommended prior to initiating enteral feedings.

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus that emerged in late 2019. The COVID-19 pandemic has affected millions of people worldwide, causing severe respiratory distress, multi-organ failure, and death. Nevertheless, there are records of unusual presentations of COVID-19, which includes hemorrhagic complications. Retroperitoneal hemorrhage (RPH) is a rare but life-threatening complication that can occur in COVID-19 patients. In this paper, we present a case of a life-threatening spontaneous retroperitoneal haemorrhage who has successfully undergone an exploratory laparotomy and made a full recovery. We would like to highlight the importance of close monitoring and prompt recognition in patients with increased risk of bleeding. [ABSTRACT FROM AUTHOR]

Multisystem inflammatory syndrome in children (MIS-C) may develop as a rare complication following COVID-19. MIS-C presentation varies substantially, but fever and gastrointestinal symptoms are the most prominent. Indeed, gastrointestinal involvement may be severe enough to present as acute abdomen, posing challenges to clinicians. We present herein the case of a healthy five-year-old male who presented with fever, vomiting, and abdominal pain, resembling acute abdomen. The patient had no history of SARS-CoV-2 infection or exposure, and MIS-C diagnosis was initially surpassed unnoticed. The patient underwent exploratory laparotomy that only revealed mesenteric lymphadenitis. Postoperatively, the patient met the clinical and laboratory diagnostic criteria of MIS-C. SARS-CoV-2 exposure was serologically confirmed and MIS-C treatment was commenced, resulting in defervescence and a satisfactory outcome. In young patients presenting with acute abdomen, surgeons should be aware of MIS-C, so that earlier diagnosis and appropriate treatment are made prior to surgical interventions.

Background: Wound dehiscence is a serious surgical complication associated with exploratory laparotomy, often leading to significant morbidity and mortality. Identifying predictive parameters for wound dehiscence is essential for improving patient outcomes. This retrospective study aimed to evaluate the utility of plateau pressure, a parameter typically used in mechanical ventilation, as a predictive tool for wound dehiscence in patients undergoing exploratory laparotomy. Methods: Data were collected from 100 patients admitted to tertiary care Centre, Karad, between December 2020 and May 2022. Demographic characteristics, etiological aspects, preoperative albumin levels, and diabetes mellitus status were recorded. Plateau pressure values were obtained from mechanical ventilation records. The primary outcome was the occurrence of wound dehiscence. Statistical analysis included descriptive statistics, chi-squared tests, t-tests, Mann-Whitney U tests, and multivariate logistic regression. Results: Among the 100 patients, 12 (12%) developed wound dehiscence. Patients with plateau pressures greater than 25 cmH2O exhibited the highest incidence of wound dehiscence (53.6%). A significant association was found between higher plateau pressure values and an increased risk of wound dehiscence (p < 0.05). Multivariate logistic regression confirmed this association, adjusting for potential confounding factors. Conclusion: This study suggests that elevated plateau pressure may serve as a valuable predictive parameter for wound dehiscence in exploratory laparotomy patients. The findings highlight the potential clinical significance of incorporating plateau pressure into preoperative risk assessment and preventive strategies, ultimately contributing to improved patient care and outcomes. Further research is warranted to validate and expand upon these findings. [ABSTRACT FROM AUTHOR]

Background: An emergency exploratory laparotomy is a crucial surgical technique used to treat abdominal diseases that pose a risk to life. Optimizing patient treatment in this situation requires the identification of variables that predict post-operative results. A widely available biomarker called serum albumin has been suggested as a potential predictor of mortality, length of hospital stay, and post-operative problems. Methods: 100 patients who underwent emergency exploratory laparotomies between January 2021 and June 2022 were the subject of a prospective study. Clinical information was gathered along with measurements of the serum albumin levels prior to surgery. Post-operative outcomes were recorded, including complications, length of stay in the hospital, and mortality. Results: When compared to patients with normal albumin levels, those with low serum albumin levels (3.5 g/dL) had a greater incidence of post-operative problems (62% vs. 38%, p <0.05) and longer hospital admissions (12.7 days vs. 8.4 days, p< 0.001). Additionally, hypoalbuminemic individuals had considerably greater mortality (16% vs. 6%, p <0.05). Conclusion: In emergency exploratory laparotomies, pre-operative serum albumin level is a useful predictor of postoperative outcomes. Increased complications, extended hospital stays, and greater mortality rates are all linked to hypoalbuminemia. The therapeutic significance of serum albumin evaluation for risk stratification, preoperative planning, and wellinformed decision-making in this complex surgical scenario is highlighted by these findings. To validate these findings and investigate potential strategies to enhance outcomes, more study is required. [ABSTRACT FROM AUTHOR]

Objective: We retrospectively investigated the association between the imaging features of spontaneous isolated superior mesenteric artery dissection (SISMAD) accompanied by total true lumen occlusion and the clinical symptoms to identify the patients at high risk and establish personalized therapeutic options. Methods: Among 261 patients with SISMAD, we selected 37 with Yun's type III dissection; 35 patients underwent successful conservative management and 2 patients underwent exploratory laparotomy. After discharge, all patients were periodically followed up on an outpatient basis. We recorded patients' general condition, symptoms, time until symptom relief, imaging findings and follow-up results. Results: All patients experienced acute abdominal pain prior to admission, with an onset time of 29.95 ± 24.66 hours. The mean time until relief of abdominal pain in patients who received conservative treatment was 42.17 ± 38.09 hours. Correlation analysis revealed no correlation between the length of dissection or of the occluded segment and abdominal pain intensity. Pain scores were lower and time until pain relief was shorter in patients with a definite arc of Riolan (AOR) on admission than in those without an AOR. No collateral circulation was observed in the two patients who underwent exploratory laparotomy, and distal intestinal perfusion was poor in these cases. Complete and partial remodeling of the superior mesenteric artery (SMA) was observed in 6 and 16 patients, respectively at the 12-month follow-up. Although the SMA remained occluded in 12 patients, abundant collateral circulation was detected. Three patients were lost to follow-up. Conclusion: This study highlights that conservative treatment should be attempted as first-line therapy in most patients with Yun's type III SISMAD. Complete AOR can contribute to remission of clinical symptoms during the acute stage. Poor distal blood flow of occluded vessels may serve as an important indicator for identification of patients at high risk of ischemic intestinal necrosis. [ABSTRACT FROM AUTHOR]

Foreign body in gastrointestinal tract is a common problem in small animal practice, especially in domestic cats. A case report of recurrent ingested thread as a linear foreign body with the thread held back by the tongue and stuck causing further complications is presented in this case report. Interestingly, the radiographic results did not indicate the paisley shaped gas pattern which is characteristic of a linear foreign body. The final diagnosis was made by exploratory laparotomy which confirmed the presence of several threads in the small intestine. Therefore, this complex case was diagnosed based on history, clinical signs and results of radiography and confirmed by exploratory laparotomy. This is the first ever published case report of successful clinical management of a linear foreign body in UAE according to the authors' knowledge. [ABSTRACT FROM AUTHOR]

Background: Exploratory laparotomy is a major surgical procedure. Midline laparotomy is the most common technique of opening the abdomen as it is simple, provides adequate exposure to all four quadrants, and affords quick exposure with minimal blood loss. Laparotomy wounds have been closed in various ways in terms of continuous versus interrupted closure, single layer versus mass closure, and absorbable versus non-absorbable sutures. Aims and Objectives: The aim of the study was to find out the technique of rectus sheath closure in patients undergoing exploratory laparotomy that can reduce the burden of complications in post-operative period. Materials and Methods: It is a hospital-based prospective randomized observational study which was conducted in a rural-based tertiary care hospital and medical college with a time frame of about 1½ years. A total number of 74 patients of adult age group (21–70 yrs) admitted in general surgery ward of Bankura Sammilani Medical College and Hospital, undergoing exploratory laparotomy. Results: Thirty-seven (50%) patients of midline laparotomy were closed in continuous technique. Rest 37 (50%) patients were closed in interrupted technique. The hospital stay was similar in both groups. There was no significant difference in incidence of wound infection (P=0.4687). Wound dehiscence and requirement of burst abdomen repair was significantly higher in continuous suture group as compared to interrupted suture group, but mean closure time (P

Abstract Background Perforated peptic ulcer is a common surgical emergency condition worldwide, which is associated with significant morbidity and mortality if early diagnosis and immediate surgical management were not carried out. Perforation occurs in roughly 5% of PUD patients during their lifetime; this study aimed to explore the wide range of clinical presentations, associated risk factors, complications, and surgical management of perforated peptic ulcer patients. Methods A 5-year retrospective observational study on the clinical presentation and surgical management of perforated peptic ulcer is carried out in a tertiary hospital in Mogadishu, Somalia, Department of General Surgery, from January 2017 to December 2021. We included all patients undergoing operations with an intraoperative confirmed diagnosis of perforated peptic ulcer at the general surgery department. For operated patients, follow-up evaluation was performed in the outpatient department. Results Fifty-one patients underwent an emergency operation for perforated peptic ulcer during the study period. The sociodemographic distribution of patients was 45 (88.2%) males and 6 (11.8%) females, giving a male-to-female ratio of 7.5:1. The mean age of patients was 35.5 ± 16.8 years, and the peak frequency was in the third decade. The commonest presenting symptoms were sudden onset of severe epigastric pain in 42 (82.4%) patients. Patients who presented perforated peptic ulcer within 24 h of initiation of symptoms were free from complications. Age-group and delayed presentation > 48 h after onset of symptoms were linked to postoperative complications and were statistically significant (P 0.032 and P 0.005), respectively. Four patients died (mortality rate of 7.8%). Two patients were reoperated because of the failed primary repair, and 4 patients had > 5 cm intra-abdominal abscess image-guided percutaneous drainage, and the rest were given antibiotic therapy according to peritoneal fluid culture and sensitivity results. The most common microorganism isolated was E. coli 22% and Klebsiella 11%. Other rare microorganisms (pseudomonas, Staphylococcus aureus, and Candida spp.) were identified. In half (51%) of the patients with peritoneal fluid culture, no microorganism growth was seen. Conclusion The distribution of perforated peptic ulcer is common in the young age-group in the third decades of life. Delayed presentation of the disease is linked because most patients arrived from remote areas where proper facilities of health care and health education are not available and the patient might come to the hospital in an advanced stage of the disease. We suggest conducting further researches, health awareness related to complications over-the-counter drugs self-medication, and bad habit including smoking, and to improve health-seeking behaviors of society.

Abstract Background Pigs have an indiscriminate eating behavior placing them at high risk of developing foreign body (FB) obstructions. Objectives Describe the clinical and diagnostic features, treatments, and outcome of pet pigs diagnosed with gastrointestinal (GI) FBs. Medical and surgical treatments, pig outcomes, and post‐mortem findings were also investigated. Animals Seventeen pet pigs. Methods A multicenter retrospective study was conducted. Gastrointestinal FBs were defined as swallowed objects that became lodged within the gastrointestinal tract distal to the cardia identified during exploratory laparotomy. Results Common clinical signs were anorexia/hyporexia, tachypnea, vomiting, dehydration, tachycardia, and ileus. Diagnostic imaging identified the presence of a FB in 4 cases. Upon celiotomy, the FBs were in the stomach and small intestine in 17 cases and large colon in 2 cases. Types of FB included fruit pit, diaper, and metallic objects. Of the 17 pigs, 15 (88%) were discharged from the hospital and 2 (12%) were euthanized. Conclusion and Clinical Importance Clinical signs of GI FB were similar to those reported in obstipated pigs. Diagnostic imaging has limitations for detection of FB. Surgical removal of FBs in pigs carried a good prognosis.

Abstract Background Non-traumatic hemoperitoneum was a rare event with the risk of sudden death. Spontaneous rupture of hepatocellular carcinoma is the most intuitive diagnosis when hemoperitoneum occurs in cirrhotic patients who are not regularly followed up. However, other etiologies of hemoperitoneum, such as intra-abdominal varix rupture, should be kept in mind. Case presentation A 44-year-old man with alcoholic liver cirrhosis, Child–Pugh B was sent to our emergency department (ED) because of recurrent abdominal pain and hypovolemic shock. He had similar symptoms one month ago and was diagnosed as hepatocellular carcinoma (HCC) rupture with hemoperitoneum, therefore he underwent trans-arterial embolization (TAE). However, the follow-up magnetic resonance imaging (MRI) showed less possibility of hepatocellular carcinoma. Contrast enhanced abdominal computed tomography (CT) showed possible umbilical vein contrast agent extravasation. Exploratory laparotomy confirmed the diagnosis of rupture umbilical varix with hemoperitoneum. Conclusion Although umbilical varix rupture is a rare cause of hemoperitoneum, it should be kept in mind in cirrhotic patients with unexplained hemoperitoneum.

Tuberculosis Peritonitis is a serious condition, whose diagnosis is established late due to the nonspecific nature of the clinical features, which delays the performance of imaging investigations and, implicitly, the setting of the diagnosis through biopsy and histopathological examination. We report the case of a 49-year-old man who presented in our clinic with nonspecific symptoms and significant nitrogen retention, with ascites fluid detected during the clinical–paraclinical examination, ultimately confirming the diagnosis of bacillary peritonitis. Confirmation of tuberculous etiology through biopsy and/or bacteriological examination is sovereign for the diagnosis. The therapeutic protocol includes three anti-tuberculostatic drugs, for a period of at least 6 months, with or without the combination of corticosteroid therapy during the first months of treatment. The patient evolution under treatment was initially favorable, but due to peritoneal adhesions, it underwent complications later.

Context: Abdominal pain after surgery can occur for numerous reasons. Postoperative radiographs may be indicated to evaluate for ileus or other reasons for the pain. Whether outcomes are significantly different based on whether patients get radiographs following lateral lumbar interbody fusion (LLIF) are unclear. Aims: To investigate the postoperative outcomes of patients experiencing abdominal pain after LLIF. Settings and Design: This retrospective cohort study included patients at a tertiary academic medical center and surrounding affiliated hospitals. Materials and Methods: Patients >18 years of age who underwent elective LLIF at a single institution were retrospectively identified. Patients were stratified into two groups depending on whether they received a postoperative abdominal radiograph or computed tomography (CT) scan for postoperative abdominal pain. Statistical Analysis: Patient demographics, surgical characteristics, and surgical outcomes were compared between groups utilizing independent t-tests or Mann–Whitney U-tests for continuous variables or Pearson's Chi-square tests for categorical variables. Results: A total of 153 patients (18 with abdominal scans, 135 without) were included. Patients who received a postoperative abdominal radiograph or CT scan were more likely to undergo exploratory laparotomy (11.1% vs. 0.00%, P = 0.013). Ultimately, patients with abdominal scans had a longer hospital length of stay (6.67 vs. 3.79 days, P = 0.002) and were discharged home less frequently (71.4% vs. 83.7%, P = 0.002). Conclusions: Patients who received abdominal imaging after LLIF were more likely to undergo exploratory laparotomy, experience longer hospital length of stay, and were discharged home less frequently. Intra-abdominal air on postoperative imaging without corresponding physical exam findings consistent with bowel injury is not an appropriate indication for surgical intervention.