- BACKGROUND: One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors. AIM: This study aimed to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures. METHODS: This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection. RESULTS: There were 7 (1.59%) cases of wound infection. No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection. CONCLUSIONS: The non-use of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.

BACKGROUND: One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors. AIMS: This study aims to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures. METHODS: This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection. RESULTS: There were seven cases of wound infection (1.59%). No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection. CONCLUSIONS: The nonuse of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.

Objective: to perform an external validation of two clinical decision instruments (DIs) - Chest CT-All and Chest CT-Major - in a cohort of patients with blunt chest trauma undergoing chest CT scanning at a trauma referral center, and determine if these DIs are safe options for selective ordering of chest CT scans in patients with blunt chest trauma admitted to emergency units. Methods: cross-sectional study of patients with blunt chest trauma undergoing chest CT scanning over a period of 11 months. Chest CT reports were cross-checked with the patients’ electronic medical record data. The sensitivity and specificity of both instruments were calculated. Results: the study included 764 patients. The Chest CT-All DI showed 100% sensitivity for all injuries and specificity values of 33.6% for injuries of major clinical significance and 40.4% for any lesion. The Chest CT-Major DI had sensitivity of 100% for injuries of major clinical significance, which decreased to 98.6% for any lesions, and specificity values of 37.4% for injuries of major clinical significance and 44.6% for all lesions. Conclusion: both clinical DIs validated in this study showed adequate sensitivity to detect chest injuries on CT and can be safely used to forego chest CT evaluation in patients without any of the criteria that define each DI. Had the Chest CT-All and Chest CT-Major DIs been applied in this cohort, the number of CT scans performed would have decreased by 23.1% and 24.6%, respectively, resulting in cost reduction and avoiding unnecessary radiation exposure.

Introdução: Um quarto dos pacientes com diverticulite aguda precisarão de um procedimento cirúrgico, 15% por uma perfuração colônica. A perfuração para o retroperitônio, um evento raro, geralmente se apresenta sem sinais de peritonite, sendo relatado na literatura algumas manifestações incomuns como abscesso em quadril, dor na coxa e enfisema em subcutâneo. Relato do caso: Apresentamos o caso de um paciente de 61 anos, do sexo masculino, que chega ao pronto-socorro com rebaixamento do nível de consciência, com informante relatando quadro com inicio há uma semana de edema de membro inferior esquerdo progressivo associado a confusão mental e sonolência há 2 dias. Notava-se importante edema em coxa e pelve esquerdas, com exame abdominal inocente. Os exames laboratoriais mostraram acidose metabólica, além de Proteína C-reativa e Lactato elevados. A tomografia computadorizada realizada na sequência demonstrava múltiplos divertículos colônicos, pneumoperitônio e perfuração do cólon descendente comunicando com retrocavidade, além de extenso enfisema de subcutâneo em parede abdominal que se estendia até a coxa esquerda e região escrotal e inguinal bilateral. O paciente foi prontamente encaminhado ao centro cirúrgico para laparotomia, na qual evidenciou-se grande quantidade de líquido purulento e fezes em cavidade. Durante liberação do cólon descendente, foi identificada perfuração para retroperitônio com grande contaminação para retrocavidade. Optou-se então pela realização de retossigmoidectomia com fechamento de coto distal e colostomia terminal em flanco direito. Após o procedimento cirúrgico, o paciente foi admitido na unidade de tratamento intensivo (UTI) com quadro de choque séptico refratário, evoluindo com parada cardiorrespiratória não responsiva a medidas de ressuscitação. Conclusão: Este trabalho mostra que, frente a um quadro infeccioso sistêmico inespecífico, manifestações em membro inferior e enfisema de parede abdominal, a diverticulite complicada deve entrar no rol de possibilidades diagnósticas.