We evaluated the clinical usefulness of the preoperative risk assessment models in emergency gastrointestinal surgeries in elderly patients: the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), its Portsmouth (P-POSSUM) modification, the estimation of physiologic ability and surgical stress (E-PASS), the systemic inflammatory response syndrome (SIRS) and the quick sepsis-related organ failure assessment (qSOFA) score. Materials and Methods: A total of 107 elderly patients over 90 years of age, who underwent emergency gastrointestinal surgeries in our hospital between April 2013 and March 2018, were enrolled in this retrospective study. The morbidity and mortality risks were assessed using these models. Results: The reasons for emergency surgery in this study were strangulated intestinal obstruction (29.0%), strangulated hernia (17.8%), bowel perforation (16.8%) and acute appendicitis (12.0%). Postoperative complications were observed in 61 patients (57.0%) including 7 (6.5%) in-hospital deaths. Ninety patients (84.1%) returned to the same level of activity after discharge. There were statistically significant differences in the following three scores; the preoperative risk score (P=0.008) and comprehensive risk score (P=0.015) of the E-PASS score, and the SIRS score (P=0.045) between patients who died in the hospital and those who survived. Conclusions: The preoperative risk score and comprehensive risk score of the E-PASS score, and the SIRS score seemed to be useful for preoperative risk assessment of emergency gastrointestinal surgeries in patients over the age of 90.
Introduction and importance
Mediastinal cystic lesions, such as paratracheal air cyst (PTAC) and bronchogenic cyst (BC), are rare anomaly usually found incidentally in thoracic imaging. Special attention is needed in the case of thoracic surgery.
Case presentation
All three patients were male, 71, 73, and 76 years old. Preoperative CT showed each had a lobular cystic lesion at the right posterolateral side of trachea in the thoracic outlet 11, 14, and 19 mm in size, respectively, with air density and tracheal communication, leading to a diagnosis of PTACs. An oval cystic lesion, 7 mm in size, was found in one patient at the right lateral side of the upper esophagus with low density and without tracheal communication, leading to a diagnosis of paraesophageal BC. Intraoperative findings of the three PTACs demonstrated a soft bulge from the membranous portion of trachea that was left intact. The BC had an oval elastic structure, mimicking a metastatic lymph node, and was removed with the mediastinal lymph nodes. Histological examination showed ciliated columnar epithelium, confirming a diagnosis of BC.
Clinical discussion
PTACs are associated with increased intraluminal pressure due to chronic lung disease. BCs are congenital anomalies that originate from abnormal budding of the embryonic foregut.
Conclusion
PTACs and BCs need to be considered in preoperative image diagnosis in patients with esophageal cancer. PTACs should be left intact to avoid tracheal injury, while removal of isolated BCs is recommended as a diagnostic and therapeutic measure.
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