Background: Acute appendicitis is one of the most common causes of acute abdomen presentation to the emergency department. Appendicectomy is one of the most common emergency operations performed. Appendicitis is attributed to lymphoid hyperplasia or faecolith causing obstruction of the appendiceal lumen. Other causes include helminth infection, primary appendiceal tumours, malignancy, and calculi. Metastatic malignancy causing acute appendicitis is very uncommon. In this article, we review the literature that exists reporting acute appendicitis attributed to metastatic diseases of the appendix, the malignancies that were identified
Enhanced recovery after surgery, or rapid recovery after surgery, is a concept that was first described in the context of colorectal surgeries in the late 1990s, which adopted a multifaceted approach to the implementation of fast-track recovery protocols. These protocols accelerate recovery and reduce time in hospital in the hospital creating a smoother and more efficient process for the patient and hospital. [1] These protocols were recognized by orthopaedic surgeons as useful in total joint arthroplasty and have been widely and quickly assimilated. The main goals are to enhance recovery and reduce morbidity, and secondarily to reduce length of stay, convalescence, and costs. [2] Today, numerous institutions have implemented rapid recovery protocols for common elective orthopedic procedures such as hip and knee arthroplasty. A successful rapid recovery program encompasses many aspects. Firstly, a thorough standardized pre-operative assessment of risk factors and fitness for rapid recovery should be conducted well in advance for surgical optimization. Preoperative education should be provided, and the expectation of rapid recovery should be enforced with the patient as well as the healthcare team. Additionally, as per the American Society of Anesthesiologists, healthy patients undergoing elective procedures may continue oral hydration with clear fluids to 2 hours prior to the procedure [3]. Intraoperatively, considerations for rapid recovery should also be enforced, notably with regards to anesthetic techniques and nausea management. While admitted, postoperatively, proper fluid and pain management protocols should be maintained, as well as coordinated efforts of the nursing and physiotherapy teams [4]. Upon discharge, patients should have adequate pain control and a plan in place to manage pain satisfactory.
Chinese orthopedic surgeons have accumulated rich experience in clinical practice for thousands of years and formed a unique theoretical system and treatment methods, which have been passed down from generation to generation. With the introduction of western plastic surgery technology into China in the mid-19th century, orthopedics of traditional Chinese medicine had a great development. At this stage, traditional Chinese orthopedic surgeons accepted modern western surgical techniques and summed up eight new techniques for bone-setting (traditional Chinese medicine manual Reduction). The history of the development of CO (Chinese osteosynthesis) is briefly reviewed in this article. Instead of pursuing open reduction and internal fixation, CO insists on closed reduction to treat long bone fractures of the extremities. CO pursues functional alignment of fractures, relative fixation, and recovery of the function of the affected limb as the primary purpose. This treatment concept has been widely recognized by orthopedic surgeons in China. This article introduces eight kinds of reduction manipulations for treating long bone fractures under the guidance of the concept of CO, including Touching with Hands; Traction; Rotation, Flexion, and Extension; Lift-pressing and Squeezing; Swing and Percussing; Separating the bones; Folding and Rotation; Massage. It is important that manual Reduction should not be used for open fractures. Attention should be paid to avoid injury of blood vessels and nerves during reduction.
Introduction:The aim was to determine the indications and evaluate the results of the Hartmann procedure in the general surgery department of the CHU Ignace Deen.Material and Methods: Five-year retrospective descriptive study (January 2018 to December 2022) carried out in the general surgery department of the Ignace Deen National Hospital.All complete records of patients undergoing Hartmann surgery were included in the study.The variables were sociodemographic, clinical, therapeutic and prognostic.Univariate and bivariate analysis was used to determine prognostic factors.Results: We collated 32 cases involving a Hartmann procedure out of 3164 hospitalisations, representing (1%) of the department's total activity.The mean age was 48 years, with extremes of 18 and 80 years.Symptoms were dominated by abdominal pain (81%), abdominal distension (75%), abdominal guarding (68%) and fever (21%).Pelvic colonic volvulus was the main indication (50%), followed by colorectal tumours (19%).The average length of hospitalisation was 16.5 days.The outcome was favourable in 90% of cases.We recorded 3 deaths.Prior abdominal surgery and the existence of bridges were morbidity and mortality factors in our study.Conclusion: Pelvic colon volvulus with necrosis was the main indication for this procedure.The Hartmann procedure represents an alternative operation in an emergency situation, with satisfactory results.
Introduction: The announcement of cancer is a primordial stage in the management of patients, consequently, it impacts in the majority of cases the daily lifestyle, in particular the eating habits and diet of certain patients, who find themselves confronted with the culture of non-medicalized communication of its environment being able to have a contradictory effect to the nutritional and therapeutic project proposed by the medical body. Material and Methods: Survey of Moroccan patients during the first 2 years of a cancer diagnosis. Socio-demographic characteristics, nutritional advice received, and weekly frequency of intake of each of the foods before and after the cancer diagnosis were received through a dedicated questionnaire Results: 85 patients were included in the study, 64.7% of whom were men with an average age of 55 years. 92.9% of the patients were in curative status, and 58.8% were being followed for colorectal cancer. However, only 25.9% of the patients received nutritional advice from health personnel, while 54% of the patients changed their diet after the announcement. Analyzing the obtained results shows that 62.35% of patients reduced their consumption of red meat with a p-value < 0.001, and 52.94% of patients reduced their poultry consumption with a p-value < 0.001. Furthermore, there has been an increase in fruit consumption in 57.65% of patients, an increase in vegetable consumption in 52.94% of patients, and fish consumption in 47.06% with a p-value < 0.001. Conclusion: Cancer patients report a significant and unsupervised change in dietary habits in the first few years after a cancer diagnosis, which opens up the prospect of implementing a personalized oncology nutrition protocol in tertiary health centers. Citation: Bahaoui NE, Lahnaoui O, Boubkri N, Benkabbou A, Majbar A, et al. (2023) Do Cancer Diagnosis Announcements Impact Eating Habits in Cancer Patients: Pilot Study Describing the Moroccan Experience. J Surg 8: 1788 DOI: 10.29011/2575-9760.001788 2 Volume 08; Issue 08 J Surg, an open access journal ISSN: 2575-9760
Background: Preperitoneum cryptorchidism is infrequent in adults, and has an extremely high risk of malignant transformation.The diagnosis requires a comprehensive consideration of symptoms, findings upon physical examination, and laboratory and imaging tests.Case information: We report a case of a 38-year-old man with a massive abdominal mass corresponding to a seminoma arising from cryptorchidism.Contrast-enhanced computer tomography demonstrated a large mass with clear realm and uneven density.The testicular artery was found to originate from the left iliac fossa, and could be traced back to the abdominal aorta.The left spermatic cord was not present within the inguinal canal.Result: Laparotomy was performed with midline incision, and we did not enter the abdominal cavity, wherein a large solid mass was identified in the preperitoneum, with the vascular pedicle originating in the left iliac fossa.The mass was resected en bloc.The pathological evaluation of the resected specimen was compatible with seminoma.The patient was referred to the department of oncology after discharge.The patient completed four cycles of etoposide/cisplatin adjuvant chemotherapy.The five-year follow-up showed no evidence of local or distant disease recurrence.Conclusions: Malignant transformation of cryptorchidism can present as an abdominal mass, and clinicians must be aware of this possibility, in order to provide opportune diagnosis.
Orbital tumors are a difficult pathology for surgical removal and are additionally complicated by the issue of selecting a proper surgical approach.Currently, the choice of approach remains debatable for the surgical treatment of orbital tumors.This paper presents a retrospective analysis of 26 patients with isolated orbital tumors who were operated on in our neurosurgical center from 2012 till 2020.The series included 15 female and 11 male patients, whose age varied from 3 to 75 years.The most common symptoms of lesions were exophthalmia (20 pts), retrobulbar pain (15 pts) and visual disorders (6 pts).In all the considered cases, the tumors were removed via osteoplastic orbitotomy.12 patients (46%) had a tumor in either central or lateral location, 5 (20%) -in superior location, 5 (20%) -in inferior location.24 tumors (92%) were removed totally and 2 tumors (8%) -were removed subtotally.More than 70% of the treated tumors comprised hemangiomas, pseudotumors and tear-gland tumors.18 patients preserved their acuity at the preoperative level; 6 patients improved their visual function; visual function degraded in 2 patients.Orbitotomy has proven to be an effective technique in the removal of the most of isolated intraorbital tumors excluding those of medial location.
Background: Major liver resections, performed for malignant and symptomatic benign tumours, carries a risk of post Hepatectomy Liver Failure (PHLF).Computed tomography and biochemical tests provide information on volumes and global function, however mebrofenin Hepatobiliary Scintigraphy (HBS) has the added benefit of assessing regional function.A remnant function 2.7%/min/m 2 has been suggested to prevent PHLF, and those with insufficient remnant function are able to undergo augmentation to facilitate surgery.We aim to review the outcomes on our selective use of HBS within a single tertiary referral centre.Methods: All patients referred for major hemihepatectomy between February 2016 to December 2021 were reviewed at the multidisciplinary meeting.High risk patients were required to undergo HBS, and treatment tailored accordingly.Demographics and outcomes were reviewed from electronic medical records.Results: 99 patients were included in the study, where 63 were considered high-risk due to larger resection volumes or preoperative chemotherapy.Patients with sufficient function were able to undergo surgery.Conversely, patients identified to have insufficient remnant function despite sufficient volume had their treatments modified by performing a smaller resection with no complications, or augmentation performed where sufficient hypertrophy was achieved.5 high-risk cohort patients developed PHLF, as compared to 8 patients from the low-risk cohort. Conclusion:HBS is a useful pre-operative tool for risk assessment, allowing us to tailor treatments and improve patient outcomes.Patients who require larger resections, or have chronic liver disease should undergo HBS.
Rationale: Cystic transformation of the bile ducts is rare. There are no publications on the complication of this pathology in the form of invagination of hepatic duct cysts. The search for optimal methods of surgical treatment of transformed cysts continues. Objective: To analyze the surgical treatment of patients with bile duct cysts, their complications and the choice of optimal methods of surgical correction depending on the localization of cysts. Material and methods: The 40–year experience of treating 15 women and 1 man with cystic transformation of the bile ducts is presented. There were 2 rare observations – the invagination of fragments of partially excised walls of confluence cysts of lobar ducts through their iatrogenic defect into the common hepatic duct. The main diagnostic methods were ultrasound, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography. Results: For intrahepatic cysts, left-sided hemihepatectomy (1), resection of 2 and 3 segments of the liver with simultaneous excision of all walls of the hepaticocholedoch cyst, hepaticoejunoanastomosis with isolated jejunum according to Roux (1) was performed. Invagination of fragments of partially excised walls of cysts confluence of lobar ducts through their iatrogenic defect into the common hepatic duct was eliminated using disinvagination through hepaticotomy (1) and resection of hepatic ducts with invaginate with the creation of a bigepaticoejunoanastomosis into the intestinal ring of the isolated jejunum (1). The walls of the cysts of the ducts of the subhepatic localization were completely excised (11) using bigepaticoejunoanastomosis into the intestinal ring of the isolated jejunum (2), hepaticoejunostomy according to Roux (9). Cystoenteroanastomosis according to Brown was performed in 2 patients. Regarding the membranous intra-current septa, their excision (1) and resection of the stenosed left hepaticoejunoanastmosis (1) were required. There were no fatal outcomes. Unresectable tumors of the subhepatic space were found in 2 patients 13 and 15 years after complex excision of cysts with hepaticoejunostomy. Conclusion: We use active surgical tactics: complete excision of the cyst walls, the creation of a hepaticoejunoanastomosis using an isolated intestinal loop according to Roux and a resection technique for single-lobar liver lesion with cysts. Diagnosis of invagination of cystic fragments into the ducts requires highly informative equipment, treatment requires specialized surgical care.
Introduction: Malignant soft tissue tumours (MSCTs) are mainly represented by sarcomas, and their incidence varies.The aim of this study was to describe the surgical treatment of MPMT in the surgical oncology unit of the Donka National Hospital.Materials and Methods: This was a retrospective study carried out over a period of 14 years (2007 to 2021), covering patients with histologically confirmed malignant soft tissue tumours who had received specific treatment.Results: We compiled 83 records of patients with histologically confirmed soft tissue tumours, 12 (14.4%) of whom were treated surgically and 15 (18.1%) medically with chemotherapy.The mean age was 39.4 years.The 40-49 age group accounted for 6 (22.2%) cases.Women predominated in 14 (51.8%)cases.The average consultation time was 26.2 months.The thigh and the knee were the sites represented in 7 (26.0%)and 6 (22.2%) cases respectively.Fibrosarcoma was the most common histological type in 12 (44.4%)cases, followed by rhabdomyosarcoma in 9 (33.3%)cases.Clinical stages III and VI accounted for 13 (48.1%)and 8 (29.6%) cases respectively.Seven (58.3%) cases underwent wide excision and 5 (41.7%) cases underwent amputation.Node dissection was inguinal in 5 (100.0%)cases.Resection was R0 in 8 (66.6%) cases.Post-operative follow-up was good in 11 (91.6%)cases.One case of lymphoedema of the limb and chronic pain was recorded.Conclusion: The management of malignant soft tissue tumours is fraught with difficulties in our context, as the diagnosis is usually made at a late stage.Early, planned and correctly performed initial surgical treatment has a major impact on prognosis.
Background:The purpose of this article is to present a case of septate gallbladder with acalculous cholecystitis to increase the awareness of anatomical variables and anomalies related to the gallbladder especially if recognized preoperatively.By share this experience of surgical approach and reviewing the literature, surgeons as well as all clinicians could widen their differential diagnosis list.Case Report: A 42-year-old male who has presented to the clinic due to frequent episodes of right upper quadrant abdominal pain.Since that time, he denies any episode of fever, nausea, vomiting, or any change in stool or urine color as well as no episodes of yellowish discoloration of sclera or mucus membranes.The Abdominal Ultrasound study was requested which showed thickened gall bladder wall of 8 mm and average gallbladder capacity.It also showed a septum of gallbladder at the distal body which divides the gallbladder into two parts.The patient has agreed with the plan of management of laparoscopic cholecystectomy.The procedure was uneventful laparoscopic cholecystectomy in which the initial laparoscopic assessment showed no signs of inflammation with clear anatomy of cystic duct and cystic artery.Pathology report showed that gall bladder is measuring 8.7 x 3.8 x 2.3 cm.Cut section shows Septate gall bladder with velvety mucosa. Conclusion:Inflammation of gallbladder without evidence of gall stones (acalculous cholecystitis) could be explained, at least in this reported case, by the presence of septate gallbladder especially if shown on radiological investigations.The surgical approach to calculous cholecystitis in a septate gallbladder remains the same approach to any calculous cholecystitis while it should be justified for acalculous cholecystitis especially in critically ill patients.However, these cases are likely to be better in the hands of an experienced surgeons.
Introduction: In most African public hospitals, emergencies remain a frequent mode of admission. The aim of this study was to describe the epidemiological profile and management of surgical emergencies at ANAIM hospital in Kamsar (Guinea). Patients and methods: this was a prospective descriptive study lasting six months (October 2021 to April 2022) in the general surgery department at ANAIM hospital in Kamsar, covering all patients admitted for emergency surgery in the surgery department during the study period. Results: During the six-month study period, surgical emergencies accounted for 16.92% (n=203) of all admissions (N=1200). The mean age of patients was 29.87%, with extremes of 1 and 85 years. The sex ratio was 2.38, with males predominating (70%). Housewives were the most affected (27.10%). Acute appendicitis (24.1%), limb fractures (16.3%), acute bowel obstruction (13.3%) and acute peritonitis (11.8%) were the more frequent emergencies. The morbidity consisted mainly of surgical site infection (14.3%) and incisional hernia (3.4%). The overall mortality was 8.9%. Conclusion: Surgical emergencies, dominated by infectious diseases and fractures, are a major concern at ANAIM hospital in Kamsar. Our data showed that show clearly that late management because of lack of emergency kits and experienced surgeons increases the risk of postoperative complications and death. Thus, supplying the hospital with emergency kits and resuscitation means could considerably improve the quality of care for these patients.
Introduction: the objective of this study was to describe the epidemiological, clinical, therapeutic and evolutionary aspects of priapism in children with sickle cell disease.Methodology: this was a descriptive retrospective study, lasting 6 years from January 1,2017 to December 31, 2022, carried out at the pediatric surgery unit of the Ignace Deen national hospital and at the SOS center drepa of morykanteyah.Itcovered 28 records of sickle cell patients aged 0 to 15 years.Results: we recorded 28 cases of priapism out of 1050 sickle cell patients, a frequency of 2.66%.The average age of patients was 9.79 years with the extremes of 5 and 14 years, 54% of cases were homogygous, pain and rigidity of the penis were the most frequent clinical signs, i e 100%.The duration of symptom evolution was greater than 36 hours in 53.57%.It was an acute priapism in 54% with a nocturnal occurrence in 57%.39.29% had suffered 1 to 2 episodes of priapism in their history.The medical treatment involved analgesics, rehydration and oral etilefrine in 85.71%, 32.14% and 21.43% respectively.Intracavernous injection of etilefrine was the most used method with 35.71% success rate, while bilateral incision of the corpora cavernosa (distal Al-Ghorab shunt) was the ultimate remedy with 100% success rate.hit.Detumescence was obtained the same day in 60.71%.Fibrosis of the corpora cavernosa and relapse were the complications found.Conclusion: priapism in children with sickle cell disease is a relatively frequent urological emergency, early consultation and adequate care could reduce complications.
Background; One of the most prevalent acute abdominal illnesses, intestinal obstruction (IO), frequently necessitates immediate surgical treatment in a hospital setting. Surgical care, however, can occasionally result in unfavorable results marked by both fatal and nonfatal postoperative sequelae. Objective; to assess the proportion and associated factors of the results of the management of intestinal obstruction at TGSH Bahir Dar Ethiopia 2021 Methods; an institution-based cross-sectional study was conducted among patients who were surgically treated for IO during the last 1 year at the TGSH. Patient participants were selected using a systematic random sampling technique. A structured research tool was used to collect all the necessary data from the patients' medical records. Data was analyzed by using SPSS version 21 Frequencies with percentages was used to describe the surgical management outcome of IO. Binary logistic regression model was used to explore the determinant factors associated with the surgical management outcome of IO. Factors at P value< 0.05 were declared statically significant. Result: There were 2023 total surgical admissions in the TGSH surgical ward over the course of the 12-month study period. The adjusted odds ratio (AOR) for intestinal obstruction is 3.24 with a 95% confidence interval (CI) for men (p=0.003). AOR=12.53 and 95% CI showed a significant association between living in a rural area and intestinal blockage. Duration of illness before operation (in days) had also significantly associated with intestinal blockage. Conclusion: The second most typical cause of acute abdomen in TGSH was intestinal obstruction. Hence, this study found that small intestinal obstruction was more common than large bowel obstruction. The most common causes of minor and large bowel blockage were, respectively, adhesion/band and sigmoid volvulus. IO was more prevalent in rural areas and among men. Most patients were relatively old, in the 5th and6th decades of life.
Background:The COVID-19 pandemic led to widespread disruption of colorectal cancer services in 2020.Cancer care pathways have changed in response to reduced diagnostic availability.The purpose of this paper is to evaluate the impact of COVID-19 on late diagnosis in patients with colorectal cancer and the impact in surgical treatment.This was a single-center retrospective study performed at a secondary referral center. Methods:We selected patients diagnosed with Colorectal Carcinoma (CRC) between January 2023 and April 2023 and analyzed patients in terms of cancer pathological staging (TNM), prevalence of different colorectal cancer locations, type of surgery, postoperative complications, rehospitalization within 30 days of discharge, ostomy rate, and 30-day mortality.We asked if in the previous 5 years they had ever performed a control colonoscopy and if the colonoscopy had not been performed the reason for not performing it.Results: In all, 25 patients were diagnosed with colorectal adenocarcinoma.8 patients presented as emergencies with large bowel obstruction or bleeding colorectal cancer.The most common was the T3 stage.T4a stage was represented by 4 patients and T4b stage was represented by 4 patients.Four patients had metastatic disease at the time of diagnosis.A high rate of stoma creation has been reported.The readmission to hospital and complications was 12%.the 30-day mortality was 4%.Twenty-four (96%) patients had never had a colonoscopy in the previous 5 years. Conclusion :Despite the end of the pandemic, we have observed a series of consecutive cases of CRC in the more advanced stages.one of the causes could be the lack of screening during the covid 19 pandemic.We will observe secondary effects like a "tsunami" in the coming years especially in oncological diseases with diagnostic delay such as CRC.
Cystadenomas come from the superficial coelomic epithelium, being the most frequent benign tumors in the ovary, 25% of them with a low malignancy index of around 7% approximately. Its diagnosis is more frequent in women of reproductive age around 20-50 years of age. In the case of the mucinous in particular, it has a representation of 15%. In the review of the literature, a giant ovarian tumor is considered to be one that measures more than 10 cm. In our case, we present the case of a 59-year-old woman (not reproductive age) who presented an ovarian cystadenoma of > 30 cm.
Background: Systemic vasculitis resulting in inflammation of vessel walls may progress to ischemic damage of major dependent organs, including the gastrointestinal system.Polyarteritis nodosa (PAN) is a vasculitis that is known to present with necrotizing vasculitis in small-medium arteries, leading to life-threatening injury and surgical emergencies.We report the case of a young patient who presented with an acute abdomen and perforation of the small intestine confirmed to be caused by a small-medium vessel vasculitis with PAN as the leading diagnosis.Case Presentation: A 27-year-old African American male with a past medical history of Stage 4 CKD and uncontrolled hypertension presented to the ED complaining of generalized abdominal and bilateral flank pain.He was found to have pneumoperitoneum on abdominal imaging requiring an emergent exploratory laparotomy found to have multiple microperforations of the small bowel requiring 110 cm of small bowel resection with primary anastomosis. Conclusion:This case reports an unusual presentation of advanced vasculitis, possibly polyarteritis nodosa that resulted in acute abdomen requiring emergency bowel resection.Patients with multisystem involvement of vasculitis necessitate comprehensive work up for early diagnosis and management of the underlying etiology to improve outcomes and avoid significant morbidity/mortality.
Thread lifting is popular for addressing the loss of facial skin elasticity and reducing wrinkles.However, the incidence of complications varies with the practitioner's competence, the characteristics of materials used, and variations in procedural techniques.Therefore, this study aimed to compare the outcomes of thread lifting procedures based on the insertion layer and suture length to propose different techniques tailored to the objective of thread lifting.We assessed the major complications observed in individuals who underwent thread lifting to evaluate the overall efficacy and safety of the procedure.From March 2022 to January 2023, we performed thread lifting using Vxil threads with uni-and multi-layer insertion on 24 patients, and evaluated the outcomes and complications.The mean age of the patients was 37.5 (range 24-63) years, and the mean followup period was 199 (range 188-207) days.An average of 4.4 long lines (2-8 lines) and 12.6 middle lines (8-16 lines) were used.The degree of pulling after insertion varied with the technique and length of threads.For uni-layer insertions, a greater amount of tissue displacement was observed.Displacement was also greater using long lines than using middle lines.The global aesthetic improvement scale score increased, indicating increased satisfaction, at the 3-month and 6-month follow-ups.Reported complications included edema, pain, foreign body sensation, bruising, asymmetry, and temporary sinking.Clinicians need to choose the appropriate thread and procedure technique based on their research and efforts to minimize complications and boost patient satisfaction.
