BACKGROUND: Acute mechanical bowel obstruction (AMBO) is still a major surgical problem for emergency departments. The aim of this study was to evaluate AMBO in terms of etiology, management, and survival.METHODS: Data of the age, sex, etiology, management, and survival of patients who were hospitalized for bowel obstruction between January 2014 and December 2018 were evaluated retrospectively. Adhesions, tumors, hernias and peritoneal carcinomatosis were evaluated in detail. RESULTS:A total of 735 patients were included in the study. The obstruction was located in the small bowel (AMSBO) in 60% and in the large bowel (AMLBO) in 40%. The mean patient age was 59.9±16.02 years and 52.9% of the patients were male. Adhesion, tumor, and hernia were the most common etiologies of the overall AMBO group (43.3%, 26.2%, and 6%, respectively). The most common etiology for AMSBO was an adhesion (69.3%), while it was a tumor for AMLBO cases (61.6%). The most common management of AMBO patients was a conservative approach (53.2%; adhesions: 76.7%). Surgical palliation was performed in 24.9% (peritoneal carcinomatosis: 65.7%), and resection was performed in 21.9% (volvulus: 61.9%). The mortality rate in the group was 8.6%. The most common etiology was colorectal surgery (51.4%) for adhesions, colorectal cancer (93.8%) for tumors, and incisional hernia (47.7%) in cases of hernia-related AMBO. CONCLUSION:Adhesions, tumors, and hernias are the most common etiologies of AMBO. The incidence of femoral/inguinal hernia have decreased while that of incisional hernia has increased, and it was further observed that peritoneal carcinomatosis has now become as common as hernia as a cause. .). AMBO is described as small (AMSBO) or large (AMLBO) according to the level of the bowel obstruction, and complete or incomplete obstruction according to the discharge of gas. [2] AMBO is observed in the small bowel in 75% to 80% of cases and in the large bowel in 20% to 25%. [3] The etiology of AMBO varies according to considerations such as age, development of the country of occurrence, and the level of the obstruc- ORIGINAL ARTICLEAcute mechanical bowel obstruction (AMBO) is still one of the major surgical problems encountered in emergency departments. AMBO constitutes 3% of all emergency admissions and 15% of acute abdominal pain cases. AMBO is an important cause of mortality as well as costs, as it may involve a long hospital stay, readmissions, and reoperations. [1] AMBO is described as local blockage of intestinal content transit for reasons that may be intramural (e.g., invagination, bezoar,
BACKGROUND: The Alvarado score (AS) and the Appendicitis Inflammatory Response score (AIRS) were developed to diagnose acute appendicitis (AA). The aim of this study was to evaluate the severity of AA using the AS and the AIRS tools. METHODS: Patients who presented between January 2016 and December 2017 and underwent surgery for AA and who had a preoperative AS and AIRS value were evaluated retrospectively. The details of age, sex, pathological severity, the presence of local peritonitis or fecaloid, drainage, appendix diameter, and operation type were evaluated according to the AS and the AIRS. RESULTS: A total of 578 patients were included in the study. Appendicitis was the most common pathological severity classification (44.4%). The most common appendix diameter group was 7-10 mm (59.2%). The difference observed in the AS and AIRS results for all of the pathological severity categories was statistically significant (p<0.05). The AIRS revealed a statistically significant difference (p<0.05) in the detection of uncomplicated and complicated appendicitis. The AIRS difference was statistically significant for appendix diameter (p<0.05). The AS and the AIRS results were both statistically significant for drainage (p<0.05). The AS was correlated with pathological severity, local peritonitis, and drainage, while the AIRS was correlated with pathological severity, uncomplicated/complicated determination, appendix diameter, and drainage (p<0.05). CONCLUSION: Both the AS and the AIRS can evaluate pathological severity, but only the AIRS can evaluate complicated or uncomplicated appendicitis and the diameter of the appendix. These tools can be used to reduce the number of unnecessary radiological or surgical interventions.
BACKGROUND: Acute pancreatitis has an incidence of approximately 1 in 1000 to 5000 pregnancies, and is most often seen in the third trimester or the postpartum period. The most common cause of pregnancy-related acute pancreatitis is cholelithiasis, which accounts for more than 65% of cases. The aim of this study was to present a detailed analysis of 4 years of experience with cases of acute biliary pancreatitis related to pregnancy from a single center. METHODS:The medical records of 55 consecutive patients who were hospitalized in the emergency surgery clinic for acute biliary pancreatitis related to pregnancy between January 1, 2014 and January 1, 2018 were examined in this single-center, retrospective study. RESULTS:Fifty-five patients with acute biliary pancreatitis related to pregnancy were included in the study. Of the 55 women, 13 (24%) were in the pregnant group, 28 (51%) in the postpartum (6 weeks) group, and 14 (25%) were in the 1-year (6 weeks-1 year) group. There was no statistically significant difference between the 3 groups. The most appropriate treatment for each patient was targeted. Six (10%) patients had recurrent acute pancreatitis. There was no maternal or fetal mortality or morbidity. CONCLUSION:Acute biliary pancreatitis related to pregnancy is not limited to pregnant women, and the incidence of these cases was greater than expected. Acute biliary pancreatitis related to pregnancy can be successfully managed with conservative treatment because it usually has a mild to moderate clinical course. However, the surgeon should keep an early cholecystectomy in mind for patients other than those in the first trimester.
Fournier's gangrene (FG) is necrotizing fasciitis of the perianal and genital regions, caused by interdependent polymicrobial infections. Identifying the symptoms early is critical as delay in diagnosis and treatment can be fatal. The clinical presentation of this disease is highly variable, ranging from early, localised skin hardening, redness, and swelling to more obvious dermal indications during the later stages including up to sepsis, which is a systemic finding. FG usually begins with perianal or perineal pain. 1 Scrotal swelling, deep local erythema, hyperemia, pruritus, fever, and nonspecific abdominal pain are other common symptoms. Minimal skin lesions in the early phase of FG may lead to the disease being overlooked because a definitive diagnosis is difficult. The rapid and aggressive nature, symptoms, and outcomes of this disease can sometimes manifest themselves in apparent findings such as deep tanning, cyanosis, foul-smelling flow, and even necrosis. [1][2][3] The repulsive faecaloid odour is another characteristic of the disease. Black dermal necrosis prevails with the development of gangrene. Reduction or even loss of pain with gangrene formation is typical. 4 The disease was described by Jean Alfred Fournier, dermatologist and venereologist in Paris, in 1883. [2][3][4] Present, FG affects every age group but its incidence increases after 50 years of age. 4 Interestingly, FG is closely related to low socioeconomic status and it is more prevalent in low-income societies. 2 The infection is most frequently of colorectal origin (30-50%) in terms of etiology, followed by the urological (20-40%) and dermal (20%). 3 It is frequently associated with accompanying systemic disorders, independent of the primary effect. For example, diabetes mellitus (DM) has been detected in 20-70% of FG cases. 1,3 Chronic alcoholism is the second most common cause (25-50%). 1,3 The underlying element shared by all of these associated risk factors is the impaired of immune resistance due to reduced cellular immunity. 2 The main bases of treatment are contained hemodynamic stabilisation, parenteral appropriate antibiotics,
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