Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

Background: Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Method: A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Conclusions: The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting

Splenic trauma : WSES classification and guidelines for adult and pediatric patients

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.Peer reviewe

Growth and stress evaluation in juvenile diploid and triploid Atlantic salmon (Salmo salar) during smoltification.

Growth and stress evaluation in juvenile diploid and triploid Atlantic salmon (Salmo salar) during smoltification

Benign multicystic mesothelioma of peritoneum complicating acute appendicitis in a man: a case report.

Background: Benign multicystic mesothelioma is a rare pathology. Few cases are reported in the medical literature and acute presentation is extremely uncommon. Case presentation: We describe an acute clinical presentation of the neoplasm that revealed itself with signs and symptoms attributable to acute appendicitis in a 41-year-old white man. Abdominal echography and computed tomography scans demonstrated the presence of a mass in direct contiguity with cecal fundus, but diagnosis remained unclear. Our patient underwent surgery and complete removal of the neoplasm. Only a definitive histological examination defined the nature of the lesion. No signs of relapse were demonstrated 1 year after the operation. Conclusions: We showed that an acute presentation of a benign neoplasm represents a diagnostic and therapeutic challenge for the surgeon, because of the difficult differential diagnosis that acute presentation can sometimes pose and the trouble that an emergence treatment can imply. Keywords: Acute appendicitis, Multicystic mesothelioma, Peritoneal neoplas

A fissured aortic aneurysm accidentally detected thanks to a symptomatic retroperitoneal leiomyosarcoma: Case report

We present the case of a concomitant retroperitoneal leiomyosarcoma and a fissured abdominal aortic aneurysm. Coexistence of these two pathologies is itself rare, but in our case we observed a singular presentation, that avoided the surgical emergence which represents the inspected rupture of an aortic aneurysm for an unaware patient. In fact, our subject presented to emergency with a symptomatology related to a complication of the neoplasm, but imaging exams let us discover an unknown fissured aortic aneurysm in a pre-rupture phase. The abdominal pain to the left flank referred by our patient was due, in fact, to an intraparenchimal hemmorage. The CT scan demonstrated an aortic aneurysmatic dilation with signs of recent bleeding, compatible with a tamponed fissured aneurysm. In these cases, the treatment strategy must consider if a combined surgery can be performed, or if the most urgent pathology must be addressed first. In our case, the patient was submitted to a combined operation of abdominal and vascular surgery few days after the accidental diagnosis of his life-Threatening condition, with macroscopical complete excision of the neoplasm and aneurysm repair with aorto-Aortic graft. No short or middle-Time complications occurred, but six-months follow-up revealed a neoplasm relapse, confirming the local aggressiveness of leiomyosarcomas

Dietary effects on biomarkers of growth, stress, and welfare of diploid and triploid Atlantic salmon (Salmo salar) during parr-smolt transformation

Triploidy is induced in Atlantic salmon (Salmo salar) to produce sterile fish for genetic containment and to hinder early sexual maturation in farmed fish, but it can have unwanted negative effects on growth, health, and welfare. However, the growth and welfare of triploid fish may be improved by adjusting the rearing environment, feeding conditions and diets. This study evaluated physiological changes and used a suite of biomarkers to assess the potential impact of diet on growth and welfare of diploid and triploid salmon during the parr-smolt transformation. Diploids and triploids, held at low temperature, were fed a standard salmon feed or one with hydrolyzed fish proteins thought to be suitable for triploid Atlantic salmon. Fish muscle was collected monthly from October to December (2454–3044 degree-days post-start feeding, ddPSF) for analysis of biomarkers, and the progress of the parr-smolt transformation was monitored using a seawater challenge test. Real-Time PCR and radioimmunoassay were used to assess growth and stress response biomarkers (expression of genes of the GH-IGF axis and HSP70; cortisol concentrations), and oxidative stress biomarkers of lipids (MDA) and proteins (AOPP) were assayed. Changes in the biomarkers were related to sampling time rather than being associated with diet or ploidy, and the changes were compatible with the progression of the parr-smolt transformation. Growth and expressions of the biomarkers in triploid Atlantic salmon were similar to those of their diploid counterparts, and there was no evidence that the rearing conditions employed in the study resulted in stress responses being elicited. Overall, the physiological indicators and biomarkers employed in this study did not point to there being any dietary effects on performance and welfare of diploid and triploid salmon that were undergoing parr-smolt transformation

The need for red blood cell transfusions in the emergency department as a risk factor for failure of non-operative management of splenic trauma: a multicenter prospective study

The majority of patients with splenic trauma undergo non-operative management (NOM); around 15% of these cases fail NOM and require surgery. The aim of the current study is to assess whether the hemodynamic status of the patient represents a risk factor for failure of NOM (fNOM) and if this may be considered a relevant factor in the decision-making process, especially in Centers where AE (angioembolization), intensive monitoring and 24-h-operating room are not available. Furthermore, the presence of additional risk factors for fNOM was investigated

An approach to complicated diverticular disease. A retrospective study in an Acute Care Surgery service recently established

Acute diverticulitis is a frequent disease in the Western Countries. The increase number of patients admitted in the Surgery Departments led the necessity of new Scores and Classifications in order to clarify, in absence of clear guidelines, the best treatments to offer in the different situations