Pub Date : 2022-03-30DOI: 10.31491/csrc.2022.03.086
M. O. Beyaz, Burcu Sadikoglu Lale, Sefer Kaya, Dilan Oruç, Serhat Hakkoymaz, Senem Urfali, I. Fansa
Excisional atherectomy alone or followed by balloon angioplasty in patients with infra-inguinal peripheral artery disease is an acceptable and appropriate treatment strategy. In this article, a case study of a 67-year-old man who had an intravascular foreign body removed due to an aterectomy device fracture while performing atherectomy due to peripheral arterial disease in the Cardiovascular Surgery Unit of our hospital is presented. The foreign body was demonstrated by a digital subtraction angiography examination. Access to the superficial femoral artery was made by an incision on the anterior 1/3 of the right thigh, and the broken atherectomy part was excised. Surgical intervention may be required to remove the intravascular foreign body that is broken during peripheral artery atherectomy. Keywords: Peripheral artery disease; atherectomy; foreign body
{"title":"The rare patient with infrainguinal stent restenosis a complication: Atherectomy device fracture","authors":"M. O. Beyaz, Burcu Sadikoglu Lale, Sefer Kaya, Dilan Oruç, Serhat Hakkoymaz, Senem Urfali, I. Fansa","doi":"10.31491/csrc.2022.03.086","DOIUrl":"https://doi.org/10.31491/csrc.2022.03.086","url":null,"abstract":"Excisional atherectomy alone or followed by balloon angioplasty in patients with infra-inguinal peripheral artery disease is an acceptable and appropriate treatment strategy. In this article, a case study of a 67-year-old man who had an intravascular foreign body removed due to an aterectomy device fracture while performing atherectomy due to peripheral arterial disease in the Cardiovascular Surgery Unit of our hospital is presented. The foreign body was demonstrated by a digital subtraction angiography examination. Access to the superficial femoral artery was made by an incision on the anterior 1/3 of the right thigh, and the broken atherectomy part was excised. Surgical intervention may be required to remove the intravascular foreign body that is broken during peripheral artery atherectomy. Keywords: Peripheral artery disease; atherectomy; foreign body","PeriodicalId":158678,"journal":{"name":"Clinical Surgery Research Communications","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134402257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-30DOI: 10.31491/csrc.2022.03.088
Martín Falla-Jimenez, Luis Aguilar-Villena, Lourdes Huanca-Amesquita, Mercedes Bravo-Taxa, V. Castro-Oliden, Juan Haro-Varas, Marco Velarde-Mendez, Julio Abugattas-Saba, J. Cotrina-Concha
Background: Clear cell sarcoma (CCS) of soft tissue is a rare disease with a high risk of metastasis to regional lymph nodes and distant organs and a poor survival rate. The aim of this study is to determine the rate of lymph node involvement, the effectiveness of treatment, the risk of recurrence and progression after surgery. Methods: We collected data from twenty patients diagnosed with CCS and treated in our institute, between 1998 and 2018. Subsequently, survival rates were determined according to local, regional and distant involvement, as well as the prognostic factors. Results: Twenty patients with CCS were included. The 2-year survival rate was 20%, and the 5-year survival rate was 5%. Patients with CCS with local stage and with tumor size < 5.0 cm were more likely to have a good survival rate. Conclusion: The initial management is crucial for the prognosis of the disease, with surgery being the mainstay of treatment. This study revealed a high rate of lymph node metastasis, so regional lymph node dissection should be done. Finally, the role of chemotherapy and/or radiotherapy for survival is still unclear. Keywords: Sarcoma; clear cell sarcoma; soft tissue tumors
{"title":"Clear cell sarcoma: 20 years of experience at Instituto Nacional de Enfermedades Neoplasicas (INEN)","authors":"Martín Falla-Jimenez, Luis Aguilar-Villena, Lourdes Huanca-Amesquita, Mercedes Bravo-Taxa, V. Castro-Oliden, Juan Haro-Varas, Marco Velarde-Mendez, Julio Abugattas-Saba, J. Cotrina-Concha","doi":"10.31491/csrc.2022.03.088","DOIUrl":"https://doi.org/10.31491/csrc.2022.03.088","url":null,"abstract":"Background: Clear cell sarcoma (CCS) of soft tissue is a rare disease with a high risk of metastasis to regional lymph nodes and distant organs and a poor survival rate. The aim of this study is to determine the rate of lymph node involvement, the effectiveness of treatment, the risk of recurrence and progression after surgery. Methods: We collected data from twenty patients diagnosed with CCS and treated in our institute, between 1998 and 2018. Subsequently, survival rates were determined according to local, regional and distant involvement, as well as the prognostic factors. Results: Twenty patients with CCS were included. The 2-year survival rate was 20%, and the 5-year survival rate was 5%. Patients with CCS with local stage and with tumor size < 5.0 cm were more likely to have a good survival rate. Conclusion: The initial management is crucial for the prognosis of the disease, with surgery being the mainstay of treatment. This study revealed a high rate of lymph node metastasis, so regional lymph node dissection should be done. Finally, the role of chemotherapy and/or radiotherapy for survival is still unclear. Keywords: Sarcoma; clear cell sarcoma; soft tissue tumors","PeriodicalId":158678,"journal":{"name":"Clinical Surgery Research Communications","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127967855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-30DOI: 10.31491/csrc.2022.03.087
W. S. Felix Wong, Lian Zhang
Ultrasound-guided HIFU (USgHIFU) ablation is now a new non-invasive surgical procedure that developed rapidly in China, with vast clinical experience accumulating in treating uterine fibroids, adenomyosis, and other gynecological diseases with great success. However, there were limited collaborative and randomized studies, except those from China. Then the success rate of this new surgery requires more validations. Therefore, to advance this new surgical approach, the paper calls for collaborative validation from reports of large randomized, multi-center studies on treating uterine fibroids, adenomyosis, and other gynecological diseases. Keywords: FUS; HIFU; USgHIFU; uterine fibroids; adenomyosis; validation
{"title":"Focused ultrasound surgery in gynaecology – a call to validate a new surgical approach","authors":"W. S. Felix Wong, Lian Zhang","doi":"10.31491/csrc.2022.03.087","DOIUrl":"https://doi.org/10.31491/csrc.2022.03.087","url":null,"abstract":"Ultrasound-guided HIFU (USgHIFU) ablation is now a new non-invasive surgical procedure that developed rapidly in China, with vast clinical experience accumulating in treating uterine fibroids, adenomyosis, and other gynecological diseases with great success. However, there were limited collaborative and randomized studies, except those from China. Then the success rate of this new surgery requires more validations. Therefore, to advance this new surgical approach, the paper calls for collaborative validation from reports of large randomized, multi-center studies on treating uterine fibroids, adenomyosis, and other gynecological diseases. Keywords: FUS; HIFU; USgHIFU; uterine fibroids; adenomyosis; validation","PeriodicalId":158678,"journal":{"name":"Clinical Surgery Research Communications","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126435237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-29DOI: 10.31491/csrc.2021.12.084
Eva Campos-Pereira, J. Vale, Tiago Amorim-Barbosa, F. Rodrigues, Arnaldo Sousa, Pedro Teixeira Mota, Vânia Oliveira, Alexandre Pereira, P. Cardoso
The distal radius is the third most common site of giant cell tumor of bone (GCTB). The local aggressive invasion of this rare neoplasm requires reconstructive solutions after wide excision. The authors present two cases of patients diagnosed with Campanacci grade III GCTB of the distal radius successfully treated with en-bloc excision and translocation of the ipsilateral ulna. Pre-operative application of denosumab was given for one year to both patients. At one year of follow-up, both patients are disease-free and reported satisfactory results on Quick - Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and modified Musculoskeletal Tumor Society (MSTS) score. Although a challenge, the reported procedure offers good oncological and functional outcomes. Keywords: Giant cell tumor of bone; distal radius; en-bloc excision; translocation; ipsilateral ulna; wrist arthrodesis
{"title":"En-bloc excision of Giant Cell Tumors of the distal radius and arthrodesis of the translocated ipsilateral ulna: A report of two cases","authors":"Eva Campos-Pereira, J. Vale, Tiago Amorim-Barbosa, F. Rodrigues, Arnaldo Sousa, Pedro Teixeira Mota, Vânia Oliveira, Alexandre Pereira, P. Cardoso","doi":"10.31491/csrc.2021.12.084","DOIUrl":"https://doi.org/10.31491/csrc.2021.12.084","url":null,"abstract":"The distal radius is the third most common site of giant cell tumor of bone (GCTB). The local aggressive invasion of this rare neoplasm requires reconstructive solutions after wide excision. The authors present two cases of patients diagnosed with Campanacci grade III GCTB of the distal radius successfully treated with en-bloc excision and translocation of the ipsilateral ulna. Pre-operative application of denosumab was given for one year to both patients. At one year of follow-up, both patients are disease-free and reported satisfactory results on Quick - Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and modified Musculoskeletal Tumor Society (MSTS) score. Although a challenge, the reported procedure offers good oncological and functional outcomes. Keywords: Giant cell tumor of bone; distal radius; en-bloc excision; translocation; ipsilateral ulna; wrist arthrodesis","PeriodicalId":158678,"journal":{"name":"Clinical Surgery Research Communications","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124970126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-29DOI: 10.31491/csrc.2021.12.085
Feron Getachew Tefera
Background: Fine needle aspiration cytology (FNAC) cannot differentiate between benign and malignant conditions in cytologically indeterminate thyroid lesions. Therefore, a minimum of diagnostic lobectomy is required for definitive diagnosis. The objective of this study is to identify the rate of malignancy and clinical features that may possibly predict malignancy in patients with these lesions, in Ethiopian hospitals. Methods: This was a retrospective review of the medical records of patients who underwent surgery for cytologically indeterminate thyroid lesions in three referral hospitals between September 2015 and September 2020. Results: Of 85 patients with indeterminate cytology findings, 56 (63.5%) were follicular, and 29 (34.1%) were reported to be hurthle cell neoplasms. Follicular lesions of undetermined significance (FLUS) and suspicious for follicular neoplasm were each reported in single cases (1.7%). Malignant disease was diagnosed in 19 (22.4%) of patients. A follicular variant of papillary cancer was detected in 7 (11.5%) patients. Hard nodule consistency was reported in 9 of 11 malignant lesions and 5 of 66 benign lesions. In multivariate binary logistic regression, hard nodule consistency was found to be associated with malignancy (P = 0.012, AOR = 7.28 (1.5, 34.54) 95% CI ). The ill-defined surface of a nodule was found to be associated with malignancy though the association was not statistically significant (P = 0.088, AOR = 0.162 (0.020, 1.313) 95% CI. Ultrasound evaluation of thyroid nodule was performed only in 41 (47.7%) of patients. Conclusion: The rate of malignancy in thyroid nodules with indeterminate cytology was 22.4%. The risk of malignancy was higher in patients with hard thyroid nodule consistency and ill-defined surface. Despite the established benefits of ultrasound for the evaluation of thyroid nodules, the current practice of its use in our setup is suboptimal. Keywords: Follicular; hurthle cell; indeterminate cytology; predictors of malignancy
{"title":"Rate and Clinical Predictors of Malignancy in Thyroid Nodules with Indeterminate Cytology","authors":"Feron Getachew Tefera","doi":"10.31491/csrc.2021.12.085","DOIUrl":"https://doi.org/10.31491/csrc.2021.12.085","url":null,"abstract":"Background: Fine needle aspiration cytology (FNAC) cannot differentiate between benign and malignant conditions in cytologically indeterminate thyroid lesions. Therefore, a minimum of diagnostic lobectomy is required for definitive diagnosis. The objective of this study is to identify the rate of malignancy and clinical features that may possibly predict malignancy in patients with these lesions, in Ethiopian hospitals. Methods: This was a retrospective review of the medical records of patients who underwent surgery for cytologically indeterminate thyroid lesions in three referral hospitals between September 2015 and September 2020. Results: Of 85 patients with indeterminate cytology findings, 56 (63.5%) were follicular, and 29 (34.1%) were reported to be hurthle cell neoplasms. Follicular lesions of undetermined significance (FLUS) and suspicious for follicular neoplasm were each reported in single cases (1.7%). Malignant disease was diagnosed in 19 (22.4%) of patients. A follicular variant of papillary cancer was detected in 7 (11.5%) patients. Hard nodule consistency was reported in 9 of 11 malignant lesions and 5 of 66 benign lesions. In multivariate binary logistic regression, hard nodule consistency was found to be associated with malignancy (P = 0.012, AOR = 7.28 (1.5, 34.54) 95% CI ). The ill-defined surface of a nodule was found to be associated with malignancy though the association was not statistically significant (P = 0.088, AOR = 0.162 (0.020, 1.313) 95% CI. Ultrasound evaluation of thyroid nodule was performed only in 41 (47.7%) of patients. Conclusion: The rate of malignancy in thyroid nodules with indeterminate cytology was 22.4%. The risk of malignancy was higher in patients with hard thyroid nodule consistency and ill-defined surface. Despite the established benefits of ultrasound for the evaluation of thyroid nodules, the current practice of its use in our setup is suboptimal. Keywords: Follicular; hurthle cell; indeterminate cytology; predictors of malignancy","PeriodicalId":158678,"journal":{"name":"Clinical Surgery Research Communications","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129664602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wandering spleen is a rare clinical occurrence characterized by the absence of spleen in its normal anatomic place. Patients may present with acute abdomen, abdominal mass, and chronic abdominal pain. Prompt diagnosis and intervention are necessary. Here, we report a case of a woman who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. Keywords: Wandering spleen; torsion; splenectomy
{"title":"Wandering spleen with torsion presenting as a rare case of acute abdomen","authors":"Solomon Bekele Abebe, Yonas Ademe Teferi, Henok T/Silassie Zeleke","doi":"10.31491/csrc.2021.12.083","DOIUrl":"https://doi.org/10.31491/csrc.2021.12.083","url":null,"abstract":"Wandering spleen is a rare clinical occurrence characterized by the absence of spleen in its normal anatomic place. Patients may present with acute abdomen, abdominal mass, and chronic abdominal pain. Prompt diagnosis and intervention are necessary. Here, we report a case of a woman who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. Keywords: Wandering spleen; torsion; splenectomy","PeriodicalId":158678,"journal":{"name":"Clinical Surgery Research Communications","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127016638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-29DOI: 10.31491/csrc.2021.09.081
Mercedes Bravo-Taxa, L. Taxa-Rojas, Aldo López-Blanco
Primary sarcomas of the vulva are rare, with an incidence of 1.5% to 5% of all vulvar malignancies. There are only 41 cases described in the English literature of proximal epithelioid sarcoma of the vulva, which also constitutes a highly aggressive neoplasm with a high rate of recurrence and metastasis. We are reporting the first case of vulvar epithelioid sarcoma reported in our country, Peru, and Latin America. We present the case of a 53-year-old woman with no significant history who presented a large tumor mass of 25 cm in the left hemivulva of 2 years of evolution, associated with intense pain. She underwent radical surgical resection with left inguinopelvic lymphadenectomy and reconstruction of Rectus Abdominal Muscle Myocutaneous Flaps (TRAM).
{"title":"Proximal epithelioid sarcoma of the vulva: A case report and review of the literature","authors":"Mercedes Bravo-Taxa, L. Taxa-Rojas, Aldo López-Blanco","doi":"10.31491/csrc.2021.09.081","DOIUrl":"https://doi.org/10.31491/csrc.2021.09.081","url":null,"abstract":"Primary sarcomas of the vulva are rare, with an incidence of 1.5% to 5% of all vulvar malignancies. There are only 41 cases described in the English literature of proximal epithelioid sarcoma of the vulva, which also constitutes a highly aggressive neoplasm with a high rate of recurrence and metastasis. We are reporting the first case of vulvar epithelioid sarcoma reported in our country, Peru, and Latin America. We present the case of a 53-year-old woman with no significant history who presented a large tumor mass of 25 cm in the left hemivulva of 2 years of evolution, associated with intense pain. She underwent radical surgical resection with left inguinopelvic lymphadenectomy and reconstruction of Rectus Abdominal Muscle Myocutaneous Flaps (TRAM).","PeriodicalId":158678,"journal":{"name":"Clinical Surgery Research Communications","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132949137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-29DOI: 10.31491/csrc.2021.09.080
Dawit Gebregiorgis, B. Nega, N. Seyoum
Background: Extremity vascular injuries are one of the major causes of limb loss and potentially preventable deaths after trauma. Although it is a major challenge, especially in countries with a less established trauma center, early diagnosis, and intervention are important for a better outcome. The aim of this study was to describe the epidemiology, management strategies, and outcomes of extremity vascular trauma in the Ethiopian setting. Methods: A retrospective observational study was conducted among all extremity vascular trauma patients who were admitted and treated at Tikur Anbessa Specialized Hospital (TASH) Between June 2015 and May 2020. Result: A total of 85 patients with extremity vascular trauma, predominantly male (90.6%), were included in the study. The mean age was 27 ± 9 years. Penetrating trauma caused 89.4% of extremity vascular injuries. The majority of the injuries are caused by stab/sharp (40%), bullet (29.4%) and road traffic accidents (17.7%). The brachial artery was the commonest vessel injured accounting for 36.5% followed by femoral artery injury of (22.4%). The commonest types of vascular injuries were complete transection (74.1%), laceration (15.3%), and partial transection (8.2%). The most commonly used method of vascular reconstruction was reverse interposition venous graft accounting for 45.9%. Other methods were ligation & hemostasis (20%), primary repair with End-to-End Anastomosis (17.7%), primary simple repair (15.3%), and venous patch (1.2%). A limb salvage rate of 91.8% was achieved despite a 67.1% of late presentation (>6 hours). Conclusion: Vascular injuries are mainly due to violence and road traffic accidents. Limb loss and mortality due to this injury can be mitigated by improving health policies, implementing emergency ambulatory systems, and provision of vascular services with better training centers.
{"title":"A perspective of extremity vascular trauma epidemiology and its management in a resource limited set up","authors":"Dawit Gebregiorgis, B. Nega, N. Seyoum","doi":"10.31491/csrc.2021.09.080","DOIUrl":"https://doi.org/10.31491/csrc.2021.09.080","url":null,"abstract":"Background: Extremity vascular injuries are one of the major causes of limb loss and potentially preventable deaths after trauma. Although it is a major challenge, especially in countries with a less established trauma center, early diagnosis, and intervention are important for a better outcome. The aim of this study was to describe the epidemiology, management strategies, and outcomes of extremity vascular trauma in the Ethiopian setting. Methods: A retrospective observational study was conducted among all extremity vascular trauma patients who were admitted and treated at Tikur Anbessa Specialized Hospital (TASH) Between June 2015 and May 2020. Result: A total of 85 patients with extremity vascular trauma, predominantly male (90.6%), were included in the study. The mean age was 27 ± 9 years. Penetrating trauma caused 89.4% of extremity vascular injuries. The majority of the injuries are caused by stab/sharp (40%), bullet (29.4%) and road traffic accidents (17.7%). The brachial artery was the commonest vessel injured accounting for 36.5% followed by femoral artery injury of (22.4%). The commonest types of vascular injuries were complete transection (74.1%), laceration (15.3%), and partial transection (8.2%). The most commonly used method of vascular reconstruction was reverse interposition venous graft accounting for 45.9%. Other methods were ligation & hemostasis (20%), primary repair with End-to-End Anastomosis (17.7%), primary simple repair (15.3%), and venous patch (1.2%). A limb salvage rate of 91.8% was achieved despite a 67.1% of late presentation (>6 hours). Conclusion: Vascular injuries are mainly due to violence and road traffic accidents. Limb loss and mortality due to this injury can be mitigated by improving health policies, implementing emergency ambulatory systems, and provision of vascular services with better training centers.","PeriodicalId":158678,"journal":{"name":"Clinical Surgery Research Communications","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127789045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-29DOI: 10.31491/csrc.2021.09.082
Abel Tesfaye, T. Henock, Selase
Background: Peritonitis is one of the commonest causes of acute abdomen in Ethiopia. One of the causes of high morbidity and mortality is persistent intraabdominal infection. The two essential approaches for managing post-op collection are laparotomy on-demand and planned Relaparotomy. Despite multiple studies, both have comparative mortality. This study aimed to identify clinical variables that are predictive of persistent intraabdominal infection. Methods: A retrospective study was conducted on patients who were operated on from Sept 2018 to April 2020 at two affiliated referral hospitals of AAU, college of Medicine; Yekatit 12 hospital Medical College and Minilik II referral Hospital. All of the patients were cases of secondary peritonitis. Clinical progress of the patients from admission to discharge/death was documented. Multiple preoperative and intraoperative variables were analyzed to develop the predictive clinical model. Results: Out of 172 laparotomy cases for secondary peritonitis, 40 (23.3%) required relaparotomy for postop collection. From Patients who developed postop collection, 45% of them were diagnosed after pus/Gi content leaked through the surgical wound. The mortality rate of patients who develop postop collection and undergone relaparotomy was 27.5 % and 4.5% for those without postop collection. Logistic regression identified 4 variables as having significant predictive value: Duration of illness more than 5 days, Systolic BP 1000 ml, and small bowel as a source of contamination. Overall prediction successes of the above model is 88.4% (sensitivity 53.3%, specificity 96.8%). Conclusion: Management of persistent intra-abdominal infection is challenging. We have identified 4 clinical variables that predict persistent intraabdominal infection requiring relaparotomy. These sets of variables can be a milestone for future validation study before being inserted in today to day clinical practice.
{"title":"Predictors of relaparotomy for persisting intra abdominal infection in secondary peritonitis","authors":"Abel Tesfaye, T. Henock, Selase","doi":"10.31491/csrc.2021.09.082","DOIUrl":"https://doi.org/10.31491/csrc.2021.09.082","url":null,"abstract":"Background: Peritonitis is one of the commonest causes of acute abdomen in Ethiopia. One of the causes of high morbidity and mortality is persistent intraabdominal infection. The two essential approaches for managing post-op collection are laparotomy on-demand and planned Relaparotomy. Despite multiple studies, both have comparative mortality. This study aimed to identify clinical variables that are predictive of persistent intraabdominal infection. Methods: A retrospective study was conducted on patients who were operated on from Sept 2018 to April 2020 at two affiliated referral hospitals of AAU, college of Medicine; Yekatit 12 hospital Medical College and Minilik II referral Hospital. All of the patients were cases of secondary peritonitis. Clinical progress of the patients from admission to discharge/death was documented. Multiple preoperative and intraoperative variables were analyzed to develop the predictive clinical model. Results: Out of 172 laparotomy cases for secondary peritonitis, 40 (23.3%) required relaparotomy for postop collection. From Patients who developed postop collection, 45% of them were diagnosed after pus/Gi content leaked through the surgical wound. The mortality rate of patients who develop postop collection and undergone relaparotomy was 27.5 % and 4.5% for those without postop collection. Logistic regression identified 4 variables as having significant predictive value: Duration of illness more than 5 days, Systolic BP 1000 ml, and small bowel as a source of contamination. Overall prediction successes of the above model is 88.4% (sensitivity 53.3%, specificity 96.8%). Conclusion: Management of persistent intra-abdominal infection is challenging. We have identified 4 clinical variables that predict persistent intraabdominal infection requiring relaparotomy. These sets of variables can be a milestone for future validation study before being inserted in today to day clinical practice.","PeriodicalId":158678,"journal":{"name":"Clinical Surgery Research Communications","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125642834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-29DOI: 10.31491/csrc.2021.09.079
E. Oseni-Momodu, H. Shehu, Jae-Jeong Lee
Background: Volvulus involves the twisting of an air-liquid stool-filled thin-walled segment of an intestine around its necessarily narrow mesenterial base, thereby strangulating the blood vessels, which often causes necrosis of this redundant intestinal segment. Intestinal volvulus had always been supposed to be a disease of the blacks from West African and the Bushmen natives of South Africa. The West African subset became the index region. Surgery was the best treatment for the full-blown disease. Conservative methods of management have only just been developed and studied in the Scandinavian countries. Scandinavian early rectosigmoidoscopic reductions of the twisted colonic segment have offered some valuable alternative helps. Methods: We studied the documents of all the 44 patients who had a presumptive diagnosis of acute or subacute colonic volvulus and were admitted to surgical management. Biostatistics, exact history taking of the patients, carefully structured physical examination, and a good digital scout X-ray investigation of the abdomen helped to make a rapid diagnosis. Laparotomies confirmed such a diagnosis. We did not regularly attempt to do recto-sigmoidoscopic untwisting of the volvuli. All had Hartmann’s procedure surgeries with terminal colostomies. Results: Of the 41 patients admitted to surgical management, 31 were males and 10 were females with a ratio of 3:1. The timing of surgery influenced mortalities and morbidities greatly. Conclusion: The diagnosis of acute volvulus was simple. We needed to record the medical history, took the proper physical examination, correctly explained the examination results, and only studied the abdominal X-ray film without resorting to advanced computer tomography.
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