World Journal of Emergency Surgery最新文献

{"title":"Artificial intelligence in emergency surgery: a scoping review within the artificial intelligence in emergency and trauma surgery (ARIES) project.","authors":"Belinda De Simone, Lucienne Kasongo, Andrew A Gumbs, Fabrizio Vecchio, Alberto De Franceschi, Nicola DèAngelis, Andrew W Kirkpatrick, Juan P Wachs, Tyler J Loftus, Fikri M Abu-Zidan, Rifat Latifi, Genevieve Deeken, Elie Chouillard, Andrey Litvin, Massimo Sartelli, Desiree Pantalone, Ari Leppäniemi, Mehmet Eryilmaz, Kemal Rasa, Arda Isik, Haytham M Kaafarani, Gustavo Fraga, Raul Coimbra, Ernest E Moore, Walter L Biffl, Fausto Catena","doi":"10.1186/s13017-026-00674-2","DOIUrl":"https://doi.org/10.1186/s13017-026-00674-2","url":null,"abstract":"<p><strong>Aim: </strong>To map and critically appraise the current literature on Artificial Intelligence (AI) applications in emergency general surgery, with a focus on clinical decision-support tools for preoperative risk stratification and intraoperative assistance, and to identify ethical, structural, and regulatory barriers to implementation.</p><p><strong>Methods: </strong>A scoping review was conducted within the ARIES project, following established methodological frameworks. Relevant studies evaluating AI-based tools in emergency surgical settings were systematically identified and analyzed.</p><p><strong>Results: </strong>The literature describes AI applications mainly in two domains: preoperative decision support, including risk prediction and diagnostic or triage models for acute abdominal and traumatic conditions, and intraoperative assistance, largely focused on computer vision-based systems for anatomical recognition, safety guidance, and navigation in minimally invasive emergency procedures. Additional contributions address training and telementoring platforms, as well as cross-cutting ethical, legal, and regulatory considerations relevant to AI adoption in emergency surgical care.</p><p><strong>Conclusions: </strong>AI has the potential to complement emergency surgeons' clinical judgment, but its routine adoption in emergency surgical practice remains limited. Addressing methodological, ethical, and regulatory challenges, together with the development of robust data infrastructures and targeted training pathways, is essential to support safe, effective, and equitable implementation in acute care settings. In addition, the lack of dedicated investment and sustainable funding models for large-scale clinical implementation and prospective evaluation represents a critical barrier to the translation of AI from research into routine emergency surgical practice.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumoperitoneum without significant bowel perforation in patients with blunt trauma: a systematic review and meta-analysis.","authors":"Emad Masuadi, Yasir Ahmed Mohammed Elhadi, Osman S Abdelhamed, Zainab M Alkharas, Linda Östlundh, Gamila Ahmed, Ashraf F Hefny","doi":"10.1186/s13017-026-00673-3","DOIUrl":"https://doi.org/10.1186/s13017-026-00673-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Free intraperitoneal air (FIA) after blunt trauma is traditionally considered a radiological marker of hollow viscus perforation requiring urgent laparotomy. However, emerging reports have described pneumoperitoneum without surgically meaningful bowel injury, raising concerns about unnecessary operations. This systematic review and meta-analysis aimed to quantify the proportion of patients with blunt trauma with computed tomography (CT)-detected FIA who had no significant bowel perforation, defined as either (1) non-therapeutic laparotomy with no identified macroscopic perforation or (2) successful nonoperative management without subsequent clinical deterioration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42020202174). PubMed, Embase, Scopus, and Web of Science were searched through November 13, 2025, for observational studies reporting the outcomes of patients with blunt trauma with CT-detected FIA. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed to estimate the pooled proportion of FIA cases without significant perforation. Heterogeneity was assessed using I-squared statistic (measure of heterogeneity) and τ&lt;sup&gt;2&lt;/sup&gt;; small-study effects were examined using contour-enhanced funnel plots and Egger's regression. Case reports meeting eligibility criteria were narratively summarized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fourteen studies comprising 8,972 patients with blunt trauma were included. Among them, 239 (2.7%) had CT-detected FIA. In the FIA subgroup, 117 patients (49.0%) had surgically confirmed bowel perforation, whereas 122 (51.0%) had no significant perforation, defined as a non-therapeutic laparotomy or a stable nonoperative clinical course. Among patients without FIA on CT, 56 of 8,733 (0.6%) had bowel perforation identified during surgery. The pooled analysis showed that 34% (95% CI 14-63%) of patients with FIA had no significant perforation. Substantial heterogeneity was observed (I-squared statistic = 80.3%, τ&lt;sup&gt;2&lt;/sup&gt; = 3.26, p &lt; 0.001), reflecting variations in CT acquisition, diagnostic criteria, and operative thresholds. Funnel plot asymmetry suggested potential small-study effects. Additionally, 19 case reports (20 patients) published between 1999 and 2025 illustrated that benign pneumoperitoneum most often occurred in young men following high-energy trauma, commonly associated with pneumothorax or pneumomediastinum; most underwent nontherapeutic laparotomy, whereas several were successfully managed nonoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A noteworthy subgroup of patients with blunt trauma with CT-detected FIA did not exhibit clinically significant bowel perforation","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the initial impact: troponin patterns frequently reveal delayed cardiac injury in polytrauma patients.","authors":"Larissa Sztulman,Victoria Pfeiffer,Miriam Saenger,Ruth Brenner,Lea Usov,Ingo Marzi,Birte Weber","doi":"10.1186/s13017-026-00672-4","DOIUrl":"https://doi.org/10.1186/s13017-026-00672-4","url":null,"abstract":"BACKGROUNDCardiac troponin serves as a biomarker for diagnosing myocardial contusion following blunt chest trauma and for differentiating between types of myocardial infarction. However, its interpretation in polytrauma remains challenging due to overlapping pathophysiological mechanisms. This study aims to improve troponin-based cardiac risk stratification to more accurately identify high-risk patients and enhance prognostic assessment.METHODSThis prospectively performed study included polytraumatized patients (ISS ≥ 16) admitted to a German Level 1 trauma center between January 2024 and July 2025. For each patient, six blood samples collected over ten days were analyzed for Troponin T (TnT) and NT-proBNP; and two transthoracic echocardiograms (24 h and 48 h) and ECGs were evaluated by a cardiologist. Data were correlated with clinical records, trauma-dependent and -independent cardiac risk factors, including the cardiovascular risk score (SCORE2).RESULTSSeventy-seven patients were included (mean age 52 years; 73% male; mean ISS 29). TnT was elevated in 44% at admission and in 73% after 24 h. 13% of the patients were diagnosed with a cardiac contusion. TnT elevation was associated with age ≥ 40 years, higher SCORE2, thoracic injuries, ISS ≥ 25, preclinical arrhythmias, catecholamine therapy, and surgery at admission. Two distinct TnT patterns were found: Group 1 (44%)-elevation already at admission, mirrored the overall risk profile but showed more persistent elevation in patients ≥ 60 years, with very high SCORE2 or catecholamine therapy and was especially linked to sternal fractures. Group 2 (26%)-delayed TnT rise after 24 h, associated with thoracic trauma, ISS ≥ 25, surgery and catecholamine therapy. Complications, including new-onset arrhythmias and higher mortality, occurred in both groups.CONCLUSIONCardiac involvement in polytrauma is multifactorial and often underrecognized. TnT elevation was associated with higher age, high SCORE2, severe injury, thoracic trauma, arrhythmias, and resuscitation, with a distinct subgroup showing delayed elevation after 24 h. This delayed phenotype is clinically relevant, as most of these patients had thoracic trauma and underwent early surgery, aligning with recommendations for perioperative screening for myocardial infarction. Our findings emphasize routine peri-traumatic and peri-operative troponin measurement and highlight the value of TTE and continuous ECG for detecting evolving cardiac dysfunction. Systematic follow-up is needed to assess long-term outcomes and refine cardiac risk stratification in this vulnerable population.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"143 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146089065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of blunt adrenal gland injury (BAGI) in major trauma: a systematic review and meta-analysis.","authors":"Laura Benuzzi,Stefano P B Cioffi,Stefano Granieri,Giada Panagini,Michele Altomare,Andrea Spota,Francesco Virdis,Roberto Bini,Andrea Mingoli,Osvaldo Chiara,Stefania Cimbanassi","doi":"10.1186/s13017-025-00654-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00654-y","url":null,"abstract":"BACKGROUNDBlunt adrenal gland injuries (BAGI) are rare and typically reflect high-energy trauma. Despite suggestions that BAGI may be a marker of increased injury severity and mortality, evidence remains conflicting. We conducted a systematic review and meta-analysis to assess the impact of BAGI on trauma severity, in-hospital mortality, and hospital length of stay (LOS).METHODSA systematic search of PubMed, Scopus, and Embase was performed up to August 31, 2024. Studies comparing adult blunt trauma patients with and without BAGI were included. Data on Injury Severity Score (ISS), in-hospital mortality, and LOS were extracted. The risk of bias was assessed using ROBINS-E; certainty of evidence was evaluated via GRADE. Random and fixed effects models were applied based on heterogeneity levels.RESULTSEight retrospective studies involving 379,070 patients, including 15,990 with BAGI, met inclusion criteria. BAGI patients had significantly higher ISS (mean difference [MD]: 7.18; 95 % CI 2.59-11.76; p = 0.012). In-hospital mortality was not initially different (OR 1.10; 95 % CI 0.69-1.73), but sensitivity analysis excluding heterogeneity-influencing studies showed increased mortality in BAGI patients (OR 1.51; 95 % CI 1.2-1.91; p = 0.007). No significant difference in LOS was observed (MD: 3.26 days; 95 % CI - 1.56-8.10; p = 0.13). Evidence certainty was moderate for ISS and mortality, and low for LOS.CONCLUSIONSBAGI is associated with higher trauma severity and, potentially, increased mortality. While not independently predictive, its presence should prompt awareness of severe polytrauma. Standardized injury grading and prospective data are needed to clarify BAGI's prognostic role.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"30 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dogma, data, and decision-making: a history of treatment for small-bowel obstruction.","authors":"Gary A Bass,Christopher J McLaughlin,Lewis J Kaplan,Matt J Lee","doi":"10.1186/s13017-025-00670-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00670-y","url":null,"abstract":"BACKGROUNDMechanical small-bowel obstruction (SBO) has been recognized since antiquity. We systematically review the evolution of its diagnosis and treatment, with emphasis on surgical milestones, influential surgeons, and procedural advances alongside the development of imaging and non-operative therapy.METHODSWe searched primary historical texts, monographs, and PubMed-indexed articles (inception to July 2025) for descriptions of mechanical SBO management. Data on key innovations, figures, outcomes, and global knowledge sharing were extracted and chronologically synthesized. Narrative synthesis followed SANRA criteria for scholarly reviews with emphasis on clarity of scope, critical interpretation, and structured presentation of key developments.RESULTSEarly sources solely describe non-surgical measures. In one of the first invasive interventions, Praxagoras of Cos (circa 350 BCE) reportedly advocated for surgical intervention in cases of intestinal obstruction, describing a decompressive enterocutaneous fistula as a therapeutic measure when purgation failed. Operative release of strangulated hernia was re-introduced by Ambroise Paré in the sixteenth century. Ether anesthesia (1846) and antisepsis (1867) enabled safe laparotomy; shortly thereafter, Sir Frederick Treves formalized the core operative principles in 1884. Plain abdominal radiography (1900s) improved diagnosis while Owen Wangensteen's nasogastric suction (1931) reduced mortality from > 60% to ~ 5%. Antibiotics, intravenous fluids, and stapled anastomoses further enhanced outcomes. Computed tomography (1980s) became the diagnostic gold standard, guiding selective non-operative management with enteral decompression and hyperosmolar contrast administration. Minimally invasive adhesiolysis, first embarked upon in the 1990s, now benefits carefully selected patients.CONCLUSIONSMechanical SBO care has evolved from basic supportive measures to structured, evidence-based therapy. Each advance addressed a specific clinical barrier: anesthesia enabled laparotomy, radiography enabled diagnosis, and decompression enabled non-operative management. As a result, SBO now exemplifies how iterative innovation can transform a once highly morbid emergency into a condition amenable to algorithmic, protocol-driven care. This historical arc offers instructive parallels for current surgical challenges.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"96 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Small versus large bore chest tube in traumatic hemothorax, hemopneumothorax, and pneumothorax-external validity, endpoint heterogeneity, and trial sequential analysis assumptions : Author.","authors":"Sithdharthan Ravikumar","doi":"10.1186/s13017-025-00669-5","DOIUrl":"10.1186/s13017-025-00669-5","url":null,"abstract":"<p><strong>Background: </strong>Granieri and colleagues compared small-caliber chest drains (14 Ch or smaller) with large-bore chest tubes (28 Ch or larger) for traumatic hemothorax, hemopneumothorax, and pneumothorax and combined conventional meta-analysis with trial sequential analysis.</p><p><strong>Main points: </strong>While the pooled effect estimate suggested no clear difference in treatment failure, clinical translation requires caution. First, the randomized trials largely represent selected, stable thoracic trauma rather than high-risk phenotypes (for example, massive hemothorax, ventilated patients, or severe polytrauma). Second, the primary endpoint (\"failure\") groups reinterventions that vary in clinical impact and are sensitive to local imaging and escalation thresholds (for example, second drain versus video-assisted surgery). Third, trial sequential analysis conclusions depend strongly on prespecified assumptions (baseline event rate and the smallest clinically important effect), which should be explicitly justified and, where possible, explored in sensitivity analyses.</p><p><strong>Conclusion: </strong>These clarifications may reduce overgeneralization, better align conclusions with the included trial populations, and inform pragmatic multicenter trial design with standardized protocols and patient-centered outcomes.</p>","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"21 1","pages":"2"},"PeriodicalIF":5.8,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12781418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute cholecystitis: a new technique to use carefully.","authors":"Adriana Toro,Martina Rapisarda,Davide Maugeri,Alessandro Terrasi,Luisa Gallo,Luca Ansaloni,Fausto Catena,Isidoro Di Carlo","doi":"10.1186/s13017-025-00662-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00662-y","url":null,"abstract":"This manuscript responds to a commentary published in the World Journal of Emergency Surgery in 2025;20:9 in which the authors criticized a new technique for the treatment of acute cholecystitis. Therefore, the authors of the manuscript published in the World Journal of Emergency Surgery in 2024;19:6, titled \"Acute Cholecystitis: How to Avoid Subtotal Cholecystectomy-Preliminary Results,\" provide a critical point-by-point response and explain why this technique represents a new addition to the surgeon's armamentarium for very severe cholecystitis.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"2 1","pages":"90"},"PeriodicalIF":8.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of delayed displacement and biomechanical analysis of unstable rib fractures postsurgical.","authors":"Guangqi Dong,Pengzhi Zhu,Zhiyong Su,Zhongyi Sun,Yongmin Zhang,Haiquan Zhang,Hao Gong,Jihui Zhang,Tianshuo Jiang,Dongbin Wang,Honggang Xia","doi":"10.1186/s13017-025-00666-8","DOIUrl":"https://doi.org/10.1186/s13017-025-00666-8","url":null,"abstract":"BACKGROUNDRib fractures, particularly multiple fractures, are common in patients with chest trauma and can lead to complications and an increased risk of mortality. Surgical treatment can improve patient prognosis, but fixation of nondisplaced fractures is often overlooked, and nonfixed nondisplaced fractures may undergo delayed displacement postsurgery. This study explored the risk of delayed displacement of nonfixed fractures during surgical treatment and its biomechanical mechanisms.METHODSA total of 105 patients with multiple rib fractures were included. CT scans were used to assess fracture displacement, and finite element analysis was applied to simulate the effect of thoracic movement on displacement.RESULTSPostoperatively, 56.1% of patients experienced delayed displacement, with posterior rib fractures being the most prone to displacement. Finite element analysis revealed that the posterior ribs exhibited the most significant displacement at the end of inspiration. Statistical analysis indicated that posterior rib fractures were associated with delayed displacement (OR = 0.225, p = 0.025).CONCLUSIONNonfixed, nondisplaced rib fractures are at high risk of delayed displacement postsurgery, particularly in the posterior rib region. Attention should be focused on posterior rib fractures to reduce delayed displacement and improve patient prognosis.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"125 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severely displaced rib fractures are independently associated with reduced pulmonary function at 3 months.","authors":"Yu-Hao Wang,Szu-An Chen,Yu-San Tee,Ling-Wei Kuo,Chi-Tung Cheng,Sheng-Yu Chan,Shih-Ching Kang,Chi-Hsun Hsieh,Fausto Catena,Chien-An Liao","doi":"10.1186/s13017-025-00667-7","DOIUrl":"https://doi.org/10.1186/s13017-025-00667-7","url":null,"abstract":"INTRODUCTIONMultiple rib fractures are common injuries resulting from blunt chest trauma. However, the effect of rib fracture displacement on pulmonary ventilation remains unclear. This study aimed to investigate the effect of severely displaced ribs on pulmonary ventilation function (PVF) 3 months post-trauma.MATERIALS AND METHODSThis retrospective case-control study was conducted at Chang Gung Memorial Hospital. Patients with multiple rib fractures (≥ 3) who underwent chest computed tomography (CT) from January 2019 to September 2023 were included. Patient demographics, injury severity, and rib fracture morphology were assessed. Displaced rib fractures were defined as bicortical displacements observed on CT. PVF was measured using forced vital capacity (FVC) and forced expiratory volume in 1 s. Univariate and multivariate logistic and linear regression analyses were performed to determine whether displaced rib fractures significantly affected PVF 3 months post-trauma.RESULTSOverall, 111 patients with multiple rib fractures were included. Displaced rib fractures were identified as an independent risk factor for having FVC < 80% at 3 months post-trauma, with each additional severely displaced rib increasing the odds by 31% (odds ratio: 1.31, 95% CI 1.09-1.57, p = 0.004). Subgroup analysis revealed that this effect was particularly significant in patients with non-flail chests. The receiver operating characteristic curve and Youden index identified that the optimal cutoff value for significantly displaced rib fractures affecting PVF was three or more fractures.CONCLUSIONSeverely displaced rib fractures significantly impact PVF 3 months post-trauma.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"5 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How are duodenal trauma managed? A French nationwide study.","authors":"Sébastien Frey,Imad Bentellis,Sébastien Gaujoux,Edouard Girard,Julio Abba,Mircea Chirica,Martin Bertrand,Etienne Boutry,Diane Mège,Mathilde Aubert,Arnaud Alves,Emmanuel Hornez,Andrea Mulliri,Raffaele Brustia,Hassen Hentati,Lelde Lauka,Alexis Laurent,Daniele Sommacale,Célia Turco,Maude Dezeustre,Melinda Bajul,Antoine Castel,Olivier Facy,Robin Grellet,Laurent Sulpice,Fabrice Ménégaux,Maxime Delestre,Emilie Lermite,Tristan Monchal,Rida Amrou,Ophélie Bacoeur-Ouzillou,Denis Pezet,Jeremy Bonnet,Emmanuel Buc,Guillaume Passot,Anne-Sophie Schneck,David Jérémie Birnbaum,Pierre-Yves Blanc,Bertrand Le Roy,Olivier Monneuse,Quentin Rodriguez,Bertrand Suc,Patrick Baqué,Vincent Dubuisson,Damien Massalou","doi":"10.1186/s13017-025-00661-z","DOIUrl":"https://doi.org/10.1186/s13017-025-00661-z","url":null,"abstract":"BACKGROUNDDuodenal injuries are rare, associated with a significant morbidity. Their management is challanging and remains controversial.METHODSA retrospective study of all consecutive patients with duodenal trauma managed in 21 French trauma centers from 2004 to 2023. Clinical data, trauma mechanisms, injury severity, treatment modalities and outcomes were collected. Specific attention was given to surgical techniques such as damage control laparotomy, primary repair only and duodenal diversion. Statistical analysis was performed to identify factors associated with duodenal leak, severe morbidity and mortality.RESULTSOne hundred and thirty-five patients (71.7% male, mean age 35 years) were included, 64% with blunt trauma. Duodenal AAST grades I-II occurred in 68.2% and grades III-V in 31.8%. A discrepancy between radiologic evaluation and intraoperative observations was present in 30.8% of cases, underestimating injury severity in 29.1%. Initial management was nonoperative for 12.7%. Damage control laparotomy was required in 36.6%. Operated patients underwent direct suture (69.2%), duodenal resection (24.4%), duodenal diversion (35.8%). Duodenal leaks occurred in 23.7%, significantly increased by hemodynamic instability (OR = 3.08, p = 0.015) and associated pancreatic trauma (OR = 2.44, p = 0.044). Reoperation rate was 18.5%, for missed duodenal injury (16%) and/or for duodenal leak (32%). Mean length of stay was 27 days. Major morbidity was 27.4% and 30-day mortality 10.4%. The injury severity score was the only predictive factor of major morbidity and mortality.CONCLUSIONSDuodenal trauma remains a severe condition managed mostly with primary repair, where duodenal leak-significantly associated with hemodynamic instability and pancreatic injury, is a major driver of reintervention.TRIAL REGISTRATIONThis study was registered on Clinical Trials under the registration numbe NCT06058975.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"52 1","pages":"89"},"PeriodicalIF":8.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}