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Abstract The CIAO Study (“Complicated Intra-Abdominal infection Observational” Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012). Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 2,152 patients with a mean age of 53.8 years (range: 4–98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified. The overall mortality rate was 7.5% (163/2.152). According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission. Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.

Abstract The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012). This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period. Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 912 patients with a mean age of 54.4 years (range 4–98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified. The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality. White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.

Abstract Complicated intra-abdominal infections are frequently associated with poor prognoses and high morbidity and mortality rates. Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. In order to describe the clinical, microbiological, and management-related profiles of both community-acquired and healthcare-acquired complicated intra-abdominal infections (IAIs), the World Society of Emergency Surgery (WSES), in collaboration with the Surgical Infections Society of Europe (SIS-E) and other prominent European surgical societies, has designed the CIAO study. The CIAO study is a multicenter, observational study and will be carried out in various surgical departments throughout Europe. The study will include patients undergoing surgery or interventional drainage for complicated IAI.

Abstract Necrotizing fasciitis (NF) is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.

Introduction: This study describes the terrorist attacks on two synagogues (Beth Israel and Neve Shalom) in Istanbul, Turkey on November 15, 2003 and the terrorist attacks on the Hong Kong‐Shanghai Banking Corporation (HSBC) and British Consulate on November 20, 2003. Method: A retrospective descriptive study was performed using hospital records and open sources reports. Results: On November 15, the emergency services of 24 hospitals were incorporated in the action and 330 patients were treated. Eighty‐five (26%) patients were hospitalized for prolonged medical care, 10 of whom required intensive care unit (ICU) support. These 85 patients needed a total of 348 days of hospitalization and the mean hospitalization time was 4 days. One hundred and forty‐two (43%) patients were transported to the hospitals via ambulances and 188 (57%) patients were taken to the hospitals in various other vehicles. Twenty‐six patients died. On November 20, 34 hospitals were involved in the operation, and a total of 495 patients were admitted. Fifty‐nine patients were hospitalized, 10 of whom needed ICU support. These 59 patients were hospitalized for 370 days with a mean of 6.2 days. In all, 164 (33%) patients were transported to the hospitals via ambulances. Thirty‐four people died. Discussion: Mortality, injury and hospitalization rates were consistent with previous reports of terrorist bombings. Head and neck injuries were the most common injuries among the victims in both events. Trauma center and trauma physicians play a principal role in the management of disaster victims. All hospitals should have a disaster plan. It must always be remembered that the devastating impact and consequences of these episodes may be diminished with global collaboration. [ABSTRACT FROM AUTHOR]

Background: Gastroduodenal ulcers are still a common cause of severe upper gastrointestinal bleeding. Endoscopy has gained popularity worldwide over conventional open surgery for the treatment of upper gastrointestinal bleeding. This study aims to assess the efficacy of endoscopic injection of epinephrine in the treatment of gastroduodenal ulcer bleeding. Methods: This study was conducted between March 2000 and March 2003. We analyzed 107 consecutive patients admitted to our department of trauma and emergency surgery with upper gastrointestinal bleeding. Endoscopy was performed on all 107 patients and bleeding ulcers were treated with injection of diluted epinephrine. Results: Recurrent bleeding was seen in 21 patients (19.6%), all of whom underwent a second endoscopy. Four patients (3.7%) required a third endoscopy session and nine patients (8.5%) needed surgery after endoscopy failed. There were two mortalities (1.9%). The nine patients who required surgery and the two patients who died were all in the Forrest Ia and Ib groups of acute UGI hemorrhage. Discussion: Endoscopic injection therapy with epinephrine reduces operation rates and can be used safely in adequate hemostasis of gastroduodenal ulcers. [ABSTRACT FROM AUTHOR]

Objective: To investigate the role of a selective approach to the operative treatment of abdominal stab wounds. :Design: Retrospective study. :Setting: University hospital, Turkey. :Subjects: 387 patients with stab wounds of the abdomen, who presented between January 1992 and January 1995. :Interventions: After local exploration of the wound, 200 patients in whom the wound had penetrated the peritoneum, underwent diagnostic peritoneal lavage. The lavage fluid was examined for white cells, red cells, and amylase and alkaline phosphatase activity. The severity of the injury was evaluated with t he penetrating abdominal trauma index (PATI). :Main outcome measures: Morbidity and mortality. :Results: The main complications were wound infection (n = 15), wound dehiscence (n = 5), pneumonia (n = 3) and renal failure (n = 1). Five patients died. The median hospital stay was 6.1 days when patients were operated on, and 1.5 days when they were not. :Conclusions: We managed to minimise the number of negative and unnecessary laparotomies. We emphasise that the selective approach may easily be applied in teaching hospitals. [ABSTRACT FROM AUTHOR]

Context: Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, etiology and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms, and most cases are diagnosed at emergency laparotomy., Case Report: We present the diagnosis and management of our patient, a pregnant woman, who had adult intussusception due to a heterotopic pancreas., Conclusion: Although relatively rare, intussusception should be included in the differential diagnosis of small bowel obstruction.

Aim: To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia (AMI)., Methods: Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The indications for a second-look were low flow state, bowel resection and anastomosis or mesenteric thromboembolectomy performed during the first operation. Regardless of the clinical course of patients, the second-look laparoscopic examination was performed 72 h post-operatively at the bed side in the ICU or operating room., Results: The average time of admission to the hospital after the initiation of symptoms was 3 d (range, 5 h-9 d). In 14 patients, laparotomy was performed. In 11 patients, small and/or large bowel necrosis was detected and initial resection and anastomosis were conducted. A low flow state was observed in two patients and superior mesenteric artery thromboembolectomy with small bowel resection was performed in one patient. In 13 patients, a second-look laparoscopic examination revealed normal bowel viability, but in one patient, intestinal necrosis was detected. In two of the patients, a third operation was necessary to correct anastomotic leakage. The overall complication rate was 42.8%, and in-hospital mortality rate was 57.1% (n = 6)., Conclusion: Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis.

Background/aims: Dieulafoy's lesions are uncommon sources of upper gastrointestinal tract bleeding. Endoscopists must be aware of these lesions when evaluating patients with upper gastrointestinal tract bleeding., Methodology: The aim of this study is to analyze the results of active bleeding or recurrently bleeding Dieulafoy's lesions treated either by endoscopic injection therapy (EIT) or endoscopic band ligation (EBL). Fifteen patients who had active bleeding due to Dieulafoy's lesions were evaluated retrospectively with respect to demographic properties, comorbidities, endoscopic therapy procedures, and the success rate of the procedure., Results: The incidence of Dieulafoy's lesions was 4.5% in all cases of upper gastrointestinal tract bleeding. Among the 15 patients there were nine men and six women with a median age of 52 years (25-84 years). Eleven of these lesions were located in the stomach, two were in the duodenum, and two were in the distal esophagus. Eight patients were initially treated by EIT and seven patients had EBL therapy. There was no recurrent bleeding in any of the patients treated with EBL, but five patients (62.5%) treated with EIT bled again and were treated secondarily with EBL. Two of these patients required surgical intervention and one died on the 15th day of surgery due to myocardial infarction. No endoscopy-related complications were detected., Conclusions: Endoscopic methods should be the first choice in treating bleeding Dieulafoy's lesions. Both EIT and EBL are successful methods for achieving initial hemostasis. However, EIT therapy has a higher re-bleeding rate. EBL is a safe and effective method for the treatment of bleeding Dieulafoy's lesions.

Primary aorto-colic fistula is rarely reported in the literature. Although infrequently encountered, it is an important complication since it is usually fatal unless detected. Primary aorto-colic fistula is a spontaneous rupture of abdominal aortic aneurysm into the lumen of the adjacent colon loop. Here we report a case of primary aorto-colic fistula in a 54-year old male. The fistulated sigmoid colon was repaired by end-to-end anastomosis. Despite inotropic support, the patient died of sepsis and multiorgan failure on the first postoperative day.