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.
