How well does CT predict the need for laparotomy in hemodynamically stable patients with penetrating abdominal injury? A review and meta-analysis.

OBJECTIVE: The objective of our study was to determine how well CT predicts the need for laparotomy in hemodynamically stable patients with penetrating abdominal injury. MATERIALS AND METHODS: We reviewed MEDLINE articles published from January 1994 through June 2008. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy were calculated for each source and collectively using a meta-analysis. RESULTS: Of 180 relevant studies, five were included in the meta-analysis. Pooled weighted estimates of sensitivity, specificity, NPV, PPV, and accuracy were 94.90%, 95.38%, 98.62%, 84.51%, and 94.70%, respectively. CONCLUSION: CT in patients with penetrating abdominal trauma has high sensitivity, specificity, NPV, and accuracy, but has lower PPV in determining the need for laparotomy. It follows that CT is an indispensable tool in predicting the need for laparotomy in these patients but still has room for improvement.

Aggressive management of necrotizing fasciitis through a multidisciplinary approach using minimal surgical procedures: a case report.

Necrotizing fasciitis is an aggressive, destructive infection of the soft tissue and fascia and is a life-threatening surgical emergency. A case study is presented of necrotizing fasciitis in the right lower extremity of a 53-year-old male resident of a long-term skilled nursing facility. Limb salvage was achieved through a multidisciplinary approach with early surgical management and aggressive postoperative management. Through 3 surgical procedures, the combined efforts of podiatric surgery, orthopaedic surgery, general/trauma surgery, and infectious disease provided early wound closure and limb salvage. An aggressive multidisciplinary approach to the management of necrotizing fasciitis in the lower extremity is necessary for limb salvage. Use of this multidisciplinary approach will minimize the number of surgical procedures and decrease the potential morbidity and mortality seen in patients with this infection.

Isolated celiac artery aneurysm with splenic artery stenosis as a rare presentation of polyarteritis nodosum: a case report and review of the literature.

Polyarteritis nodosum (PAN) is a vasculitic disease that affects small to medium arteries. It often presents as a systemic and multiorgan disease that affects the skin, joints, gastrointestinal tract, kidneys, and nervous system. Nonspecific signs and symptoms are the hallmarks of PAN. It rarely affects single vessels, although there have been case reports of PAN involving single intra-abdominal vessels. The authors present a case of a 42-year-old white man who presented with mild epigastric pain but was otherwise asymptomatic. The workup ultimately revealed a rare case of an isolated celiac artery aneurysm with a concomitant stenosis of the splenic artery secondary to PAN. The patient was treated with high-dose steroid therapy, with resultant resolution of the vasculitis and a decreased size of the aneurysm.