Acute abdominal pain: a challenging diagnosis.

We hereby describe a case of an acutely ill 41-year-old male without any medical history who presented with an acute abdomen in the emergency department. An abdominal CT showed a dissection of the coeliac trunk and infarction of the spleen. Because of a presumed diagnosis of vasculitis he was started on high dose IV steroids. However, after additional testing the diagnosis of segmental arteriolar Mediolysis (SAM) was made. In this case report we describe the presentation, diagnosis, treatment and follow-up of this patient and provide the readers with background about common differential diagnosis and criteria for diagnosing SAM.

Degloving injuries. A retrospective study at the University Hospital Rotterdam.

Degloving injuries are severe and frequently underestimated lesions. In a retrospective study, 65 patients treated between 1985 and 1991 were reviewed. Therapy consisted of surgical exploration as soon after injury as possible, with defatting of the avulsed skin and its replacement on the most functionally important sites. The remaining raw areas were covered with split skin grafts (SSG). This technique reduced morbidity, hospital stay and work incapacity, as compared with patients treated by other methods.

Colostomy closure: still a hazardous procedure.

Seventy nine patients with closure of a loop (51 patients) or a terminal (28 patients) colostomy were reviewed retrospectively. Operative mortality was 2.5%. Wound infection in 19% and anastomotic breakdown in 7.7% were the most important postoperative complications. Restoring continuity after a Hartmann intervention, closure of left sided colostomies and early closure (before 12 weeks) all accounted for a statistically significant higher complication rate, while age and sex, the underlying disease, bowel preparation and the method of closure had no influence on the operative outcome.