Abdomen agudo durante la pandemia COVID-19 / Acute Abdomen during the COVID-19 Pandemic

RESUMEN La pandemia actual COVID-19 ha afectado la población mundial con cifras alarmantes de contaminados y fallecidos, con un agotamiento de los recursos logísticos de los sistemas de salud. No serán pocos los pacientes sospechosos o confirmados de esta enfermedad que necesitarán tratamiento quirúrgico impostergable. El objetivo del estudio es exponer un conjunto de medidas para garantizar la mejor atención de estos pacientes, reducir la posibilidad de contagio entre pacientes, del personal sanitario y el desarrollo de complicaciones postoperatorias. Se realizó una revisión de la literatura actualizada sobre el tema en formato digital, en publicaciones en idioma inglés y español. La reorganización de los servicios quirúrgicos es necesaria para garantizar la mejor atención a los pacientes, salvaguardar al personal sanitario y utilizar adecuadamente los recursos del sistema de salud(AU)

ABSTRACT The current COVID-19 pandemic has affected the world population with alarming numbers of contaminated and fatalities, with a depletion of the logistical resources of health systems. There will be few suspected or confirmed patients of this disease who will need urgent surgical treatment. The objective of the study is to present a set of measures to guarantee the best care of these patients, reduce the possibility of contagion between patients, health personnel and the development of postoperative complications. A review of the updated literature on the subject was carried out in digital format, in publications in English and Spanish. The reorganization of surgical services is necessary to guarantee the best care for patients, safeguard health personnel, and use the resources of the health system properly(AU)

Retrospective study analyzing the data on non-traumatic abdominal emergency surgeries done tertiary care hospital, Chennai

Background: Abdominal pain is one among the common reason to visit the casualty. Appendicitis remains the commonest cause in it. An accurate diagnosis is needed for the essential treatment. Materials and methods: All patients admitted in emergency surgical ward as acute abdomen and underwent emergency surgeries during a period of November 2015 to January 2016 (3 months) in our Stanley Hospital were studied. Patients with history of trauma were excluded from the study. Patients managed conservatively were also excluded from the study. A total of 268 cases underwent emergency abdominal surgery were studied. The age, sex, type of surgery done, etc. details were collected from the emergency registers and other records available. The results were tabulated for age and sex incidence according to different surgeries done. Results: A total of 178 cases of acute appendicitis were operated. The majority of cases were in the age group of 10-30 years. 2 patients having appendicular mass were operated and 6 appendicular abscess patients were operated and drained. Most of the patients were operated by open appendectomy and few numbers of patients operated via laparoscopy technique. A total of 32 cases of intestinal perforation were studied. Out of 32 during the study 2 case of gastric perforation and 2 cases of ileal perforation were reported. Total number of cases operated was 20 with inguinal hernia accounting for 15 cases and umbilical hernia 2 and epigastric hernia 2 cases, 1 case of incisional hernia. 3 cases (10%) of large bowel obstruction observed and were due to gangrenous bowel, sigmoid.

Cirugía mayor ambulatoria en pacientes operados de urgencia / Outpatient major surgery in patients operated through an emergency

Se realizó una investigación descriptiva, prospectiva y longitudinal de los 1 067 pacientes con afecciones agudas intraabdominales, operados de urgencia por cirugía mayor ambulatoria en el Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba, desde enero de 2007 hasta mayo de 2010, con vistas a caracterizarles según algunas variables de interés. En la casuística predominaron el grupo etario de 31-45 años (47,7 %), el sexo masculino (50,8 %), la apendicitis aguda como diagnóstico preoperatorio (52,9 %), que además presentó complicaciones en 78,1 % del total, la operación por mínimo acceso (57,2 %), con solo 15,6 % de pacientes complicados, y la anestesia general orotraqueal (97,6 %). De acuerdo con la clasificación de la Sociedad Americana de Anestesiología, 83,8 % de los afectados perteneció al grupo I, mientras que al analizar las enfermedades asociadas, 42,8 % padecía hipertensión arterial. La modalidad quirúrgica empleada permitió incorporar nuevos diagnósticos preoperatorios, basados en adecuados criterios de selección del paciente; también se logró la satisfacción general de los operados, por lo que se recomendó extenderla a otros centros hospitalarios.

A descriptive, prospective and longitudinal investigation of the 1 067 patients with acute intraabdominal disorders, operated through an outpatient major emergent surgery in "Dr. Joaquín Castillo Duany" Teaching Clinical-Surgical Hospital in Santiago de Cuba was carried out from January, 2007 to May, 2010, with the aim of characterizing them according to some variables of interest. The age group 31-45 year old (47.7%), the male sex (50.8%), acute appendicitis as preoperative diagnosis (52.9%), which besides presented complications in 78.1% of the total, the minimal access surgery (57.2%), with only 15.6% of complicated patients, and the general orotracheal anesthesia (97.6%) prevailed in the case material. According to the classification of the American Society of Anesthesiology, 83.8% of the patients affected belonged to group I, while when analyzing the associated diseases, 42.8% suffered from hypertension. The used surgical modality allowed to incorporate new preoperative diagnoses, based on appropriate selection criteria of the patient; the general satisfaction of those patients operated was also achieved, so that it was recommended to extend it to other hospitals.

The Impact of Prenatal Diagnosis on the Outcome of Neonatal Surgical Emergencies Evaluated by Mortality Rate

As prenatal ultrasonography becomes popular, the number of prenatal diagnosis of congenital surgical diseases is also increasing. To evaluate the impact of antenatal ultrasonography on outcome the mortality rate in neonatal surgical emergencies was studied. The authors retrospectively reviewed 281 patients (congenital diaphragmatic hernia: 44, tracheoesophageal fistula: 78, intestinal atresia: 98, omphalocele: 28 and gastroschisis: 33 who had been managed at Seoul National University Childrens Hospital, from January 1991 to December 2000. The patients were divided into two groups; group A (1991 to 1995; 139 patients) and group B (1996 to 2000; 142 patients). These two groups were subdivided into prenatally diagnosed subgroup and postnatally diagnosed subgroup. We analyzed the changes of prenatal diagnosis rate, total mortality rate, and mortality rate of subgroups. Prenatal diagnosis rate was increased significantly in group B (Group A: 24.5 % and Group B: 45.1 %). Total mortality rate of group A was 21.6 %, and that of group B was 10.6 %, showing a significant decrease in group B. However, in both group A and B, when compared antenatally diagnosed subgroup with postnatally diagnosed subgroup, the mortality rate was lower in postnatally diagnosed subgroups but statistically not significant. The authors conclude that although prenatal diagnosis rate has been increased, prenatal diagnosis itself has not resulted in significant improvement in outcome.