Acute free perforation of gall bladder encountered at initial presentation in a 51 years old man: a case report

Introduction: Gallbladder perforation is a rare but life threatening event. We describe a case of gallbladder perforation encountered at initial presentation. Case Presentation: A 51 years old male, without any known medical co-morbidity, presented with a 1-day history of sudden-onset abdominal pain and abdominal distension. On examination, his abdomen was distended with generalized tenderness on palpation. Abdominal x-ray showed no signs of intestinal obstruction or pneumoperitoneum. Computed tomography scan of the abdomen showed appearance suggestive of gallbladder perforation. The Patient was taken to the operating room and a diagnostic laparoscopy was performed revealing yellowish green fluid in the peritoneum. Difficulty in visualization of the anatomy led to conversion of the procedure to an open laparotomy. Intra-operative findings included a perforation near the neck of the gall bladder in association with a 2 x 1 cm gall stone. Near-total cholecystectomy was performed and a single large gall stone was retrieved. The peritoneal cavity was washed with normal saline and a drain was placed. The rectus sheath was closed but the wound was kept open for healing by delayed primary closure. The Patient\u27s hospital course was uneventful and he was discharged from the hospital on the 3rd post-operative day. He returned to the clinic after one week whereby his drain was removed and his wound closed. Conclusion: Gallbladder perforation is an unusual initial presentation of gallbladder disease. Early diagnosis of gallbladder perforation and immediate surgical intervention are of prime importance in decreasing morbidity and mortality associated with this condition

2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.Peer reviewe

WSES guidelines for emergency repair of complicated abdominal wall hernias

Peer reviewe

2013 WSES guidelines for management of intra-abdominal infections

Peer reviewe

Akut renal kolik ağrisi olan Türk hastalarda kisa süreli metamizol sodyum ile diklofenak sodyum tedavilerinin karşilaştirilmasi; çift kör, gözlemsel bir çalişma

Objective: Renal colic pain is one of the most frequent reasons for emergency department visits. Metamizole sodium and diclofenac are the most common used non-narcotic drugs in available countries. The objective of this study was to compare the effectiveness and safety of metamizole sodium and diclofenac in treatment of acute renal colic pain in emergency room services in Ankara, Turkey. Methods: Eighty-eight patients with renal colic were treated intramuscularly (i.m.) with metamizole sodium (1 g) (n=48) or diclofenac sodium (75 mg) (n=40). Pain intensity was measured by using visual analogue scale (0-100 mm) and 5-point verbal score before (baseline) and after 30, 60, 90 and 120 minutes of i.m. drug administration. Results: Both of the treatment groups were homogeneous when analyzed by age, sex and baseline pain intensity. Both treatments were well tolerated and none of the observed side effects were serious. Five patients in the metamizole sodium and three patients in the diclofenac group needed extra treatment. The average pain intensity difference between groups for all time points measured was not significantly different. There was no significant difference in physician and patient evaluations for both drugs. Conclusion: Our results indicate that i.m. 1 g metamizole sodium is equally effective as i.m. 75 mg diclofenac sodium for two hours of observation period in acute renal colic treatment. © 2019, Refik Saydam National Public Health Agency (RSNPHA).Amaç: Renal kolik ağrisi, acil servis başvurularinin en sik nedenlerinden biridir. Metamizol sodyum ve diklofenak, ilaçlarin bulunduğu ülkelerde en yaygin kullanilan narkotik olmayan ilaçlardir. Bu çalişmanin amaci, Ankara'daki acil servislerde akut renal kolik ağrisinin tedavisinde metamizol sodyum ve diklofenak'in etkinliğini ve güvenliğini karşilaştirmaktir. Yöntem: Renal kolik ağrisi olan 88 hasta intramüsküler metamizol sodyum (1 g) (n=48) veya diklofenak sodyum (75 mg) (n=40) ile tedavi edildi. Ağri şiddeti, ilaç uygulanmadan önce (başlangiç düzeyi) ve uygulandiktan 30, 60, 90 ve 120 dakika sonra, Görsel Analog Skala (0-100 mm) ve 5-Nokta Sözel Derecelendirme ölçeği ile ölçüldü. Bulgular: Her iki tedavi grubu da yaş, cinsiyet ve başlangiçtaki ağri şiddeti yönlerinden analiz edildiğinde homojendi. Her iki tedavi de iyi tolere edildi ve gözlenen yan etkilerin hiçbiri ciddi değildi. Metamizol sodyum grubunda beş, diklofenak grubunda ise üç hasta ek tedaviye ihtiyaç duydu. ölçülen tüm zaman noktalari için gruplar arasindaki ortalama ağri şiddeti farki anlamli değildi. Her iki ilaç için de hekim ve hasta değerlendirmeleri arasinda anlamli fark yoktu. Sonuç: Sonuçlarimiz akut renal kolik tedavisinde i.m. 1 g metamizol sodyumun, iki saatlik gözlem dönemi için i.m. 75 mg diklofenak sodyum kadar etkili olduğunu göstermektedir. © 2019, Refik Saydam National Public Health Agency (RSNPHA)