was to evaluate the clinical spectrum of emergency surgery for acute abdominal disorders and their outcome. Material and methods. The study group comprised 1426 patients, aged between 10 and 92 years subject to emergency surgery, due to an acute abdomen during the period 2001-2004. Analysis comprised age, sex, concomitant diseases, ASA scale classification, postoperative diagnosis, type of surgery, complications, mortality and duration of hospitalization. Patients were divided into two age groups: <60 and ≥60 years. Results. Appendicitis was the most common diagnosis (52.9%) in patients under 60 years, while cholecystitis (32.5%) and ileus (30.9%) in patients over 60 years. Complications were observed in 14.8% patients, the most common being related with wound healing (5.6%). The mortality rate amounted to 5.7%. Mortality was most often associated with bowel obstruction (29.2%), surgery for acute bowel ischemia (25.5%), and bowel perforation (20.7%). The mean duration of hospitalization was 7.9 days. Conclusions. 1. In comparison to elective surgery, emergency abdominal operations, particularly in elderly patients are related with a higher mortality rate. 2. In elderly patients, the high mortality rate and substantial number of complications is associated with the advanced primary disease and severe coexisting comorbidities, which significantly reduce the overall health condition.
Background: Acute appendicitis is the most common cause of acute abdomen. Delay in diagnosis increases the mortality and morbidity. Aim: In this study, we aimed to investigate whether the body mass index is useful in diagnosis and whether the neutrophil /lymphocyte and platelet/lymphocyte ratios can help in determining the inflammation level of acute appendicitis. Meterial and Methods: Cases of appendectomy performed between June 2012 and December 2018 in our clinic were analyzed retrospectively. Based on the pathology results of the cases included in the study, 4 groups were formed, i.e.: Group 1 (initial stage), Group 2 (catarrhal stage), Group 3 (phlegmonous-gangrenous stage) and Group 4 (perforation). The study compared age, body mass index, leukocyte values, red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), platelet /lymphocyte ratio (PLR), and mean platelet volume (MPV) between groups. Results: 828 cases were included in the study. When compared between groups, the values of Group 3 and Group 4 were higher than those of Group 1 and Group 2 for PLR and NLR. There was no difference in RDW and MPV values in the blood. When Body Mass Index (BMI) was compared between groups, it was found to be significantly higher with increasing histopathological stage. Conclusion: In acute appendicitis, the blood leukocyte value, elevated PLR and NLR are helpful in diagnosis. We aimed to emphasize that the diagnosis of acute appendicitis is delayed in patients with a BMI above 30 and/or at age of over 40 years, with the perforation rate being determined more frequently.
The authors reported a case of small bowel obstruction secondary to internal herniation through a defect of the broad ligament. This is a rare cause of small bowel obstruction. A 42 year-old woman without previous abdominal surgery presented with episodes of abdominal pain, nausea and vomiting. Due to rather unspecific and changing symptoms and the fact that objective findings were normal the patient was discharged and admitted a couple of times before a computed tomography-scan showed small bowel obstruction. Acute diagnostic laparoscopy showed internal herniation of a loop of small bowel trapped in a 2 cm defect in the right side of the broad ligament. The defect was gently expanded bluntly and it was then possible to retract the strangulated part of the small bowel which afterwards was vital. The defect was sutured laparoscopically. The postoperative recovery was uneventful. This case demonstrates that a preoperative diagnosis is difficult and a high index of suspicion is necessary to prevent diagnostic delay. Internal herniation through a defect in the broad ligament should be considered as a differential diagnosis in female patients presenting with symptoms of small bowel obstruction without a history of prior abdominal surgery, especially in parous women.
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