Pub Date : 2026-01-14DOI: 10.1186/s13017-025-00670-y
Gary A Bass,Christopher J McLaughlin,Lewis J Kaplan,Matt J Lee
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.
{"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}
Pub Date : 2026-01-08DOI: 10.1186/s13017-025-00669-5
Sithdharthan Ravikumar
Background: 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.
Main points: 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.
Conclusion: 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.
{"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}
Pub Date : 2025-12-16DOI: 10.1186/s13017-025-00662-y
Adriana Toro,Martina Rapisarda,Davide Maugeri,Alessandro Terrasi,Luisa Gallo,Luca Ansaloni,Fausto Catena,Isidoro Di Carlo
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.
{"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}
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.
背景：肋骨骨折，尤其是多发骨折，在胸部外伤患者中很常见，可导致并发症和死亡风险增加。手术治疗可改善患者预后，但非移位骨折的固定常被忽视，非固定非移位骨折术后可能发生延迟移位。本研究探讨手术治疗中非固定骨折延迟移位的风险及其生物力学机制。方法分析105例多发性肋骨骨折患者的临床资料。CT扫描评估骨折位移，并应用有限元分析模拟胸部运动对位移的影响。结果56.1%的患者术后发生迟发性移位，其中后肋骨折最容易发生移位。有限元分析显示，吸气结束时后肋移位最明显。统计学分析显示后肋骨骨折与迟发性移位相关（OR = 0.225, p = 0.025）。结论非固定、非移位肋骨骨折术后迟发性移位的风险较高，尤其是后肋区。应重视后肋骨折，以减少迟发性移位，改善患者预后。
{"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}
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.
多处肋骨骨折是钝性胸部外伤引起的常见损伤。然而，肋骨骨折移位对肺通气的影响尚不清楚。本研究旨在探讨严重移位肋骨对创伤后3个月肺通气功能（PVF）的影响。材料与方法本回顾性病例对照研究在长庚纪念医院进行。纳入2019年1月至2023年9月接受胸部计算机断层扫描（CT）的多发肋骨骨折（≥3）患者。评估患者人口统计学、损伤严重程度和肋骨骨折形态。移位性肋骨骨折定义为CT上观察到的双皮质移位。采用用力肺活量（FVC）和用力呼气量（1s）测定PVF。进行单因素和多因素logistic和线性回归分析，以确定移位的肋骨骨折是否在创伤后3个月显著影响PVF。结果共纳入111例多发肋骨骨折患者。移位的肋骨骨折被认为是创伤后3个月FVC < 80%的独立危险因素，每增加一根严重移位的肋骨，发生率增加31%（优势比：1.31,95% CI 1.09-1.57, p = 0.004）。亚组分析显示，这种效果在非连枷胸患者中尤为显著。患者工作特征曲线和约登指数表明，影响PVF的显著移位肋骨骨折的最佳临界值为三处或更多处骨折。结论严重移位性肋骨骨折对PVF有显著影响。
{"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}
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.
背景：十二指肠损伤很少见，但发病率很高。它们的管理具有挑战性，而且仍存在争议。方法对2004年至2023年在法国21家外伤中心连续治疗的所有十二指肠外伤患者进行回顾性研究。收集临床资料、创伤机制、损伤严重程度、治疗方式和结果。特别注意的手术技术，如损伤控制剖腹手术，初级修复和十二指肠分流。统计分析确定与十二指肠渗漏、严重发病率和死亡率相关的因素。结果共纳入135例患者，男性71.7%，平均年龄35岁，其中64%为钝性外伤。十二指肠AAST I-II级占68.2%，III-V级占31.8%。30.8%的病例放射学评估与术中观察存在差异，29.1%的病例低估了损伤的严重程度。12.7%的患者未采取手术治疗。36.6%的患者需要行损伤控制剖腹手术。术后直接缝合（69.2%）、十二指肠切除术（24.4%）、十二指肠分流（35.8%）。23.7%发生十二指肠渗漏，血流动力学不稳定（OR = 3.08, p = 0.015）和相关胰腺损伤（OR = 2.44, p = 0.044）显著增加十二指肠渗漏。再手术率为18.5%，十二指肠漏伤（16%）和/或十二指肠漏伤（32%）。平均住院时间为27天。重度发病率为27.4%，30天死亡率为10.4%。损伤严重程度评分是主要发病率和死亡率的唯一预测因素。结论十二指肠创伤仍然是一种严重的疾病，主要通过初级修复来治疗，其中十二指肠渗漏与血流动力学不稳定和胰腺损伤密切相关，是再次干预的主要驱动因素。本研究在Clinical Trials上注册，注册号为NCT06058975。
{"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}
Pub Date : 2025-12-06DOI: 10.1186/s13017-025-00660-0
Francesco Paolo Prete,Giuseppe Massimiliano De Luca,Lucia Ilaria Sgaramella,Elisabetta Poli,Silvia Malerba,Giuliana Rachele Puglisi,Maria Moschou,Bruna Saponara,Luigi Marano,Angela Gurrado,Federico Coccolini,Fausto Catena,Mario Testini
BACKGROUNDDamage control surgery(DCS) is a well-established approach in emergency laparotomy when physiologic instability necessitates an abbreviated operation. In severe intraabdominal infections(IAI), open abdomen(OA) with Negative Pressure Wound Therapy(NPWT) has shown significant efficacy to help reducing morbidity and mortality. Early definitive abdominal closure is recommended to minimize complications, though not always achievable.METHODSFrom 108 cases of DCS and OA with NPWT performed between February 2015 and February 2024, 72 consecutive patients treated for severe IAI were retrospectively reviewed. We comparatively analyzed clinical and perioperative data of patients treated with OA for ≤ 7 days(short OA) or for > 7 days(long OA), focusing on late OA closure(> 7 days). Primary outcome was overall 30-day survival, secondary outcome the primary fascial closure rate.RESULTSThe main indication for OA was abdominal contamination. Fifty-six patients had short OA, 16 long OA. Overall mortality was 23.6%, with APACHE II score the only independent predictor (OR 1.9, 95% CI 1.25-2.92, p = 0.003). Fifty-two patients survived to achieve early closure and 12 late closure, respectively. Overall PFC rate was 92.2% (59 patients), 75% within late closure (p = 0.001). Compared to short OA, in long OA nine patients (56.3%, p < 0.001) experienced intraabdominal complications including enteroatmospheric fistula (EAF-3, 18.8%) and frozen abdomen (7, 43.8%); in 10 patients (87.5%, p < 0.001) NPWT regimen was modified to isolate and divert effluent or clean a contaminated field.CONCLUSIONSLate closure of the OA for IAI may significantly associate with EAF and frozen abdomen. In these challenging scenarios NPWT specific properties may be leveraged to address complex anatomical situations, extensive contamination, or the need for targeted wound-healing responses.
背景损伤控制手术（DCS）是一种完善的方法，在紧急剖腹手术时，生理不稳定需要一个简短的手术。在严重腹内感染（IAI）中，开腹（OA）联合负压伤口治疗（NPWT）已显示出显著的疗效，有助于降低发病率和死亡率。建议尽早确定腹部闭合以减少并发症，尽管并不总是可行。方法回顾性分析2015年2月至2024年2月期间108例DCS和OA合并NPWT的患者，其中72例连续接受严重IAI治疗。我们比较分析OA≤7天（短OA）和OA≥70天（长OA）患者的临床和围手术期资料，重点分析OA闭合晚期（≥71天）。主要终点是总30天生存率，次要终点是初次筋膜闭合率。结果OA的主要指征为腹部污染。短骨关节炎56例，长骨关节炎16例。总死亡率为23.6%，APACHE II评分是唯一的独立预测因子（OR 1.9, 95% CI 1.25-2.92, p = 0.003）。52例患者存活，分别实现早期闭合和12例晚期闭合。总PFC率为92.2%（59例），晚期PFC率为75% （p = 0.001）。与短性OA相比，长性OA有9例（56.3%,p < 0.001）出现腹腔内并发症，包括肠-大气瘘（EAF-3, 18.8%）和腹部冷冻（7例，43.8%）；10例患者（87.5%,p < 0.001）修改了NPWT方案，以隔离和转移废水或清洁污染场地。结论IAI的OA闭合可能与EAF和冰冻腹部有显著相关性。在这些具有挑战性的情况下，可以利用NPWT的特定特性来解决复杂的解剖情况，广泛的污染或需要靶向伤口愈合反应。
{"title":"Late closure of the open abdomen in emergency abdomino-pelvic surgery: Advanced indications to negative pressure wound therapy?","authors":"Francesco Paolo Prete,Giuseppe Massimiliano De Luca,Lucia Ilaria Sgaramella,Elisabetta Poli,Silvia Malerba,Giuliana Rachele Puglisi,Maria Moschou,Bruna Saponara,Luigi Marano,Angela Gurrado,Federico Coccolini,Fausto Catena,Mario Testini","doi":"10.1186/s13017-025-00660-0","DOIUrl":"https://doi.org/10.1186/s13017-025-00660-0","url":null,"abstract":"BACKGROUNDDamage control surgery(DCS) is a well-established approach in emergency laparotomy when physiologic instability necessitates an abbreviated operation. In severe intraabdominal infections(IAI), open abdomen(OA) with Negative Pressure Wound Therapy(NPWT) has shown significant efficacy to help reducing morbidity and mortality. Early definitive abdominal closure is recommended to minimize complications, though not always achievable.METHODSFrom 108 cases of DCS and OA with NPWT performed between February 2015 and February 2024, 72 consecutive patients treated for severe IAI were retrospectively reviewed. We comparatively analyzed clinical and perioperative data of patients treated with OA for ≤ 7 days(short OA) or for > 7 days(long OA), focusing on late OA closure(> 7 days). Primary outcome was overall 30-day survival, secondary outcome the primary fascial closure rate.RESULTSThe main indication for OA was abdominal contamination. Fifty-six patients had short OA, 16 long OA. Overall mortality was 23.6%, with APACHE II score the only independent predictor (OR 1.9, 95% CI 1.25-2.92, p = 0.003). Fifty-two patients survived to achieve early closure and 12 late closure, respectively. Overall PFC rate was 92.2% (59 patients), 75% within late closure (p = 0.001). Compared to short OA, in long OA nine patients (56.3%, p < 0.001) experienced intraabdominal complications including enteroatmospheric fistula (EAF-3, 18.8%) and frozen abdomen (7, 43.8%); in 10 patients (87.5%, p < 0.001) NPWT regimen was modified to isolate and divert effluent or clean a contaminated field.CONCLUSIONSLate closure of the OA for IAI may significantly associate with EAF and frozen abdomen. In these challenging scenarios NPWT specific properties may be leveraged to address complex anatomical situations, extensive contamination, or the need for targeted wound-healing responses.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"106 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680610","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}
BACKGROUNDIndividualized management of early fluid therapy in acute pancreatitis (AP) remains challenging. Traditional studies primarily focus on static fluid balance, overlooking the heterogeneity of dynamic trajectories.METHODSBased on a single-center retrospective cohort, 3,142 AP patients admitted within 72 h of onset were included. Daily fluid therapy-to-body weight ratio (FWR) and CumFWR (trapezoidal AUC) were calculated. Latent Class Growth Modeling (LCGM) identified dynamic FWR trajectories within 72 h. Multivariate Cox regression analyzed the relationship between FWR and in-hospital mortality risk. Three-dimensional fitted surface plot analysis evaluated interactions between CumFWR and hematocrit.RESULTSLCGM successfully identified five distinct dynamic fluid therapy trajectories within 72 h, showing significant clinical differences: Low Stable Group (LSG1, n = 229, 7.3%), Low-Moderate Sustained Group (LMSG2, n = 340, 10.8%), Moderate Stable Group (MSG3, n = 2073, 66.0%), Moderate-High Fluctuating Group (MHFG4, n = 231, 7.4%), and High Sustained Group (HSG5, n = 269, 8.6%). Multivariate Cox regression revealed significantly increased in-hospital mortality risk compared to MSG3 for both MHFG4 (adjusted HR = 2.08, 95%CI 1.15-3.78) and HSG5 (adjusted HR = 2.91, 95%CI 1.77-4.79). Furthermore, each 1 standard deviation increase in CumFWR was associated with a 47% increased mortality risk (HR = 1.47, 95%CI 1.26-1.72). Three-dimensional fitted surface plot demonstrated high mortality risk between high CumFWR and abnormal hematocrit (low/high HCT), particularly prominent in the HSG5 group (p < 0.001).CONCLUSIONThis study reveals five distinct dynamic trajectory patterns of early fluid therapy in AP. High-load sustained or fluctuating therapy significantly increases mortality risk. Dynamic monitoring of HCT (within a 35-44% safety window) and therapy trajectories offers a potential strategy to optimize fluid management.
背景：急性胰腺炎（AP）早期液体治疗的个体化管理仍然具有挑战性。传统的研究主要集中在静态流体平衡上，忽视了动态轨迹的异质性。方法基于单中心回顾性队列，纳入发病72小时内入院的3142例AP患者。计算每日液体治疗体重比（FWR）和梯形AUC （CumFWR）。潜在类别增长模型（LCGM）确定了72小时内的动态FWR轨迹。多变量Cox回归分析了FWR与院内死亡风险之间的关系。三维拟合曲面分析评估了CumFWR与红细胞压积之间的相互作用。结果slcgm在72 h内成功识别出5种不同的动态流体治疗轨迹，临床差异具有显著性：低稳定组（LSG1, n = 229, 7.3%）、中低持续组（LMSG2, n = 340, 10.8%）、中稳定组（MSG3, n = 2073, 66.0%）、中高波动组（MHFG4, n = 231, 7.4%）和高持续组（HSG5, n = 269, 8.6%）。多因素Cox回归显示，与MSG3相比，MHFG4（校正HR = 2.08, 95%CI 1.15-3.78）和HSG5（校正HR = 2.91, 95%CI 1.77-4.79）的住院死亡风险均显著增加。此外，CumFWR每增加1个标准差，死亡风险增加47% （HR = 1.47, 95%CI 1.26-1.72）。三维拟合曲面图显示，高CumFWR和异常红细胞压积（低/高HCT）之间存在较高的死亡风险，特别是在HSG5组（p < 0.001）。结论本研究揭示了AP早期液体治疗的五种不同的动态轨迹模式。高负荷持续或波动治疗显著增加死亡风险。动态监测HCT（在35-44%的安全窗口内）和治疗轨迹为优化流体管理提供了潜在的策略。
{"title":"Early fluid therapy trajectories in acute pancreatitis: a retrospective cohort study.","authors":"Jianhua Wan,Shixuan Xiong,Yaoyu Zou,Maobin Kuang,Huajing Ke,Wenhua He,Yin Zhu,Nonghua Lu,Liang Xia","doi":"10.1186/s13017-025-00664-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00664-w","url":null,"abstract":"BACKGROUNDIndividualized management of early fluid therapy in acute pancreatitis (AP) remains challenging. Traditional studies primarily focus on static fluid balance, overlooking the heterogeneity of dynamic trajectories.METHODSBased on a single-center retrospective cohort, 3,142 AP patients admitted within 72 h of onset were included. Daily fluid therapy-to-body weight ratio (FWR) and CumFWR (trapezoidal AUC) were calculated. Latent Class Growth Modeling (LCGM) identified dynamic FWR trajectories within 72 h. Multivariate Cox regression analyzed the relationship between FWR and in-hospital mortality risk. Three-dimensional fitted surface plot analysis evaluated interactions between CumFWR and hematocrit.RESULTSLCGM successfully identified five distinct dynamic fluid therapy trajectories within 72 h, showing significant clinical differences: Low Stable Group (LSG1, n = 229, 7.3%), Low-Moderate Sustained Group (LMSG2, n = 340, 10.8%), Moderate Stable Group (MSG3, n = 2073, 66.0%), Moderate-High Fluctuating Group (MHFG4, n = 231, 7.4%), and High Sustained Group (HSG5, n = 269, 8.6%). Multivariate Cox regression revealed significantly increased in-hospital mortality risk compared to MSG3 for both MHFG4 (adjusted HR = 2.08, 95%CI 1.15-3.78) and HSG5 (adjusted HR = 2.91, 95%CI 1.77-4.79). Furthermore, each 1 standard deviation increase in CumFWR was associated with a 47% increased mortality risk (HR = 1.47, 95%CI 1.26-1.72). Three-dimensional fitted surface plot demonstrated high mortality risk between high CumFWR and abnormal hematocrit (low/high HCT), particularly prominent in the HSG5 group (p < 0.001).CONCLUSIONThis study reveals five distinct dynamic trajectory patterns of early fluid therapy in AP. High-load sustained or fluctuating therapy significantly increases mortality risk. Dynamic monitoring of HCT (within a 35-44% safety window) and therapy trajectories offers a potential strategy to optimize fluid management.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"27 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145674418","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}
Pub Date : 2025-12-05DOI: 10.1186/s13017-025-00665-9
Fikri M Abu-Zidan,David O Alao,Arif Alper Cevik
AIMTo review the literature on the role of Point-of-care ultrasound (POCUS) in diagnosing rib fractures compared with other diagnostic modalities and to give recommendations on its role.METHODSBroad text PubMed database search was performed using general terms (rib, fracture, ultrasound, diagnosis) in English language without time restriction. Selected articles were critically read by three acute care physicians who have more than 20 years' experience in POCUS.RESULTSUltrasound, as shown by a recent meta-analysis, had a pooled sensitivity of 89.3%, a pooled specificity of 98.4%, and a pooled positive likelihood ratio of 55.7 without difference between emergency and radiology departments. The uncertainty of evidence was high due to (1) selection bias, (2) geographical bias, and (3) heterogeneity of the operator's experience. POCUS has certain advantages including: (1) it is dynamic so it can evaluate the rib displacement during respiration, (2) It is portable so that it can be used in prehospital setting and disaster situations, (3) it has no risk of radiation so that it can be used in pregnant women, children, and in repeated follow-up, and (4) it has good resolution to evaluate the soft tissues around fractures. In contrast, its limitations include: (1) it is operator dependant, (2) it takes a longer time, (3) it cannot diagnose ribs covered by bones like those under the scapula, and (4) it needs a conscious patient to guide the examination. Ultrasound-guided blocks, including intercostal nerve block, serratus anterior plane block, and erector spinae plane block were successful in controlling the pain of multiple rib fractures.CONCLUSIONSThis review supports the use of POCUS in diagnosing rib fractures, which can be extended into ultrasound-guided blocks for pain control. Nevertheless, it highlights the need for research with higher quality in this area. Ultrasound and CT scan should be complementary and not competitive.
{"title":"Point-of-care ultrasound (POCUS) diagnosis of rib fractures.","authors":"Fikri M Abu-Zidan,David O Alao,Arif Alper Cevik","doi":"10.1186/s13017-025-00665-9","DOIUrl":"https://doi.org/10.1186/s13017-025-00665-9","url":null,"abstract":"AIMTo review the literature on the role of Point-of-care ultrasound (POCUS) in diagnosing rib fractures compared with other diagnostic modalities and to give recommendations on its role.METHODSBroad text PubMed database search was performed using general terms (rib, fracture, ultrasound, diagnosis) in English language without time restriction. Selected articles were critically read by three acute care physicians who have more than 20 years' experience in POCUS.RESULTSUltrasound, as shown by a recent meta-analysis, had a pooled sensitivity of 89.3%, a pooled specificity of 98.4%, and a pooled positive likelihood ratio of 55.7 without difference between emergency and radiology departments. The uncertainty of evidence was high due to (1) selection bias, (2) geographical bias, and (3) heterogeneity of the operator's experience. POCUS has certain advantages including: (1) it is dynamic so it can evaluate the rib displacement during respiration, (2) It is portable so that it can be used in prehospital setting and disaster situations, (3) it has no risk of radiation so that it can be used in pregnant women, children, and in repeated follow-up, and (4) it has good resolution to evaluate the soft tissues around fractures. In contrast, its limitations include: (1) it is operator dependant, (2) it takes a longer time, (3) it cannot diagnose ribs covered by bones like those under the scapula, and (4) it needs a conscious patient to guide the examination. Ultrasound-guided blocks, including intercostal nerve block, serratus anterior plane block, and erector spinae plane block were successful in controlling the pain of multiple rib fractures.CONCLUSIONSThis review supports the use of POCUS in diagnosing rib fractures, which can be extended into ultrasound-guided blocks for pain control. Nevertheless, it highlights the need for research with higher quality in this area. Ultrasound and CT scan should be complementary and not competitive.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680612","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}
Pub Date : 2025-11-26DOI: 10.1186/s13017-025-00663-x
Dong Jin Park, Seung Min Baik, Kyung Sook Hong, Heejung Yi, Jae Gil Lee, Jae-Myeong Lee
{"title":"Correction: Development and external validation of an artificial intelligence model for predicting mortality and prolonged ICU stay in postoperative critically ill patients: a retrospective study.","authors":"Dong Jin Park, Seung Min Baik, Kyung Sook Hong, Heejung Yi, Jae Gil Lee, Jae-Myeong Lee","doi":"10.1186/s13017-025-00663-x","DOIUrl":"https://doi.org/10.1186/s13017-025-00663-x","url":null,"abstract":"","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"20 1","pages":"88"},"PeriodicalIF":5.8,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12648853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145641719","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}
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