Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low-or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.

Intestinal malrotation, a congenital anomaly of the midgut, typically presents in pediatrics age group with the most feared complication of midgut volvulus and its catastrophic sequelae. Midgut volvulus secondary to intestinal malrotation is a rare presentation in adults more so in the elderly. Its rarity portends a diagnostic dilemma for both the surgeon and radiologist. We report a 65-year-old man admitted following a referral with a 12-hour history of acute abdomen with an initial diagnosis of acute pancreatitis but later had laparotomy with intraoperative findings of a midgut volvulus and gangrenous ileal segment secondary to intestinal malrotation. This case emphasizes the importance of early diagnosis to prevent the disastrous complication of this disease. The rarity of this condition portends a formidable diagnostic challenge in adults hence the awareness of its possibility and a high index of suspicion is crucial in diagnosis.

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions.

Penetrating thoracoabdominal injury is a common presentation in the trauma resuscitation room with the possibility of a myriad of injuries which may involve thoracic and abdominal viscera. Management is usually operative however non-operative management is a possibility especially following knife stab injuries when compared with gunshot injuries. Clinical presentation will depend on the injured organ, extent of injury and time from injury to presentation. Unusual presentation of delayed haematemesis is a possibility with injury to the stomach, however, due to its rarity, a high index of suspicion with emergency surgery will help to mitigate the fatal consequences that may follow. This type of presentation is not documented in the available on-line literature which portends the importance of this paper. This case highlights the possibility of this clinical presentation and importance of early management to improve patient outcome.