ABSTRACT
The authors studied 196 consecutive emergency admissions to their unit with a diagnosis of non-traumatic acute abdomen. The data were analysed in order to evaluate the demographic data, the diagnostic procedures performed and treatments administered, and the reliability of the admission diagnosis in comparison with the final diagnosis. During the study period acute abdomen emergencies amounted to 7% of the total admissions to the unit. Laboratory tests and abdominal ultrasonography were the most frequently used diagnostic tools, followed by plain film of the abdomen and CT scans, the latter being used in a distinctly lower number of cases. Seventy patients out of 196 (35.7%) underwent an emergency surgical procedure. The most frequently reported disease was acute appendicitis. Sixty-one of the subjects (31.1%) with acute abdomen were successfully treated conservatively while 65 (33.2%) were diagnosed as being affected by non-splanchnic-diseases, and thus categorised as cases of false acute abdomen The Authors conclude that the diagnostic work-up for acute abdomen always needs a precise clinical history and a complete physical examination, but in some instances the support of widely available facilities, such as plain x-rays, ultrasonography, or CT scans can help to avoid useless surgical procedures or, conversely, potentially dangerous delays in administering treatment.
Subject(s)
Abdomen, Acute , Abdomen, Acute/diagnosis , Abdomen, Acute/surgery , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND AND OBJECTIVES: Geriatric population life expectancy is rapidly increasing and the impact of major surgical procedures is not well defined. The purpose of this study was to compare short term surgical results assessing mortality and morbidity and long-term survival and disease-free interval in elective rectal surgery patients older than 65 years of age. The main independent risk factors of mortality, morbidity, and overall and disease-free survival were also identified. METHODS: Out of 177 rectal cancer accepted consecutively from 1991 to 2002, we studied the main clinical and pathological parameters comparing patients older and younger than 65 years. Data have been collected in a database and variables considered were studied by univariate analysis; independent predictive factors of 30-day mortality and morbidity were identified by multiple logistic regression analysis. Overall, cancer specific and disease-free survival curves were obtained with the Kaplan-Meier method and results compared with the log-rank test. Independent risk factors of overall and disease-free survival have been identified by multivariate logistic regression analysis. RESULTS: In patients younger and older than 65 years postoperative mortality (3.2% vs. 9.6%) and morbidity (30% vs. 29%) were not significantly different. Variables independently associated with 30-day mortality were the duration of surgical procedures and postoperative complications. The Kaplan-Meier survival curves showed a significantly worst overall survival (P = 0.003), cancer specific survival (P = 0.02), and disease-free survival (P = 0.03) in patients aged 65 years or more. Multivariate analysis showed that pT, grading, preoperative CEA level, gender, and site of the tumor along the rectum, the number of blood transfusion and the age group of more than 65 years are independent risk factors for both overall survival and disease-free interval. The presence of residual disease was an adjunctive factor of overall survival, whereas the Astler and Coller staging was a risk factor for the disease-free survival. CONCLUSION: The short-term prognosis for elective rectal cancer procedure in patients over 65 years of age was comparable to that of younger patients, whereas long term cancer-related survival was statistically worst in older patients.
