No abstract available.
Gallbladder* ; Rupture*

An abdominal stab wound with evisceration is an indication of an emergency laparotomy. We encountered a case of a very severe ischemic change in the eviscerated small bowel as a result of stabbing. The patient was considered to have a high possibility of progressing to strangulation of the small bowel. Therefore, a stab wound extension was performed as a decompression in the emergency department before definite surgery in the operating room. Most of the small bowel could be saved except for the segment with the damage caused by the stab injury. The patient was discharged without complications.
Decompression ; Emergencies ; Emergency Service, Hospital ; Humans ; Laparotomy ; Operating Rooms ; Wounds, Stab*

PURPOSE: Patients in the intensive care unit (ICU) are more susceptible to nosocomial infections, including central line-associated bloodstream infection (CLABSI), surgical site infection, urinary tract infection or ventilator-associated pneumonia. This study is a comparative analysis of how central venous catheter (CVC) management staff affects CLABSI. METHODS: We performed a two-phase review of all patients transferred to the surgical ICU (SICU) from January 2013 to June 2014. CVC management staff was introduced in October 2013. Electronic medical records provided the data for a comparative analysis of incidence rates and risks of CLABSI, as well as the subjects' general characteristics. RESULTS: This study included 248 patients before the introduction of a CVC management staff member and 196 patients after the introduction. General patient characteristics before and after the CVC management staff was in place did not differ significantly. The CLABSI rate decreased by 4.61 cases/1,000 device days after the introduction (6.26 vs. 1.65; odds ratio, 4.47; 95% confidence interval, 1.39~14.37; p=0.009). However, the mortality rate and length of ICU stay did not change after CVC management staff was in place (12.9% vs. 10.7%, p=0.480; 16.00±24.89 vs. 15.87±18.80, p=0.954; respectively). CONCLUSION: In this study, the introduction of CVC management staff effectively reduced CLABSI rates in current ICU system.
Central Venous Catheters* ; Critical Care* ; Cross Infection ; Electronic Health Records ; Humans ; Incidence ; Intensive Care Units ; Mortality ; Odds Ratio ; Pneumonia, Ventilator-Associated ; Surgical Wound Infection ; Urinary Tract Infections

PURPOSE: A recent internal review of a community-based hospital system revealed a 19.19% rate of conversion from a laparoscopic appendectomy to an open procedure. This study examined the preoperative risk factors for failed laparoscopic appendectomy requiring a conversion to a laparotomy. METHODS: A total of 198 patients presented with perforated appendicitis. Perforation was defined as a computed tomography (CT) scan interpretation, pathology findings, or surgical findings. Of these patients, 161 underwent a laparoscopic appendectomy or laparoscopy converted to an open procedure. The preoperative risk factors in the two groups were compared through a retrospective chart review. RESULTS: Through multivariant analysis, age greater than 45 was the greatest risk factor for the need to convert to an open procedure with an odds ratio (OR) of 3.51. A CT scan read of perforation was associated with a significant 2.65 OR. The C-reactive protein was 19.82 mg/L in the failed laparoscopic cases and 9.96 mg/L in the laparoscopic cases. CONCLUSION: Patients older than 45 years old with a CT radiologist's read of a perforation in multivariant analysis have an increased risk of failed laparoscopic surgery requiring conversion to open surgery.
Appendectomy* ; Appendicitis* ; C-Reactive Protein ; Conversion to Open Surgery ; Humans ; Laparoscopy ; Laparotomy ; Odds Ratio ; Pathology ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed

The concept of acute care surgery (ACS) incorporates trauma, surgical critical care, and emergency general surgery. It was designed in the early 2000s by the United States as a solution to the looming crisis of trauma care and non-trauma emergency surgery. Reduced surgical opportunities for trauma surgeons resulted in a decreased interest in trauma surgery. Surgical sub-specialization further accelerated an indifference towards trauma and emergency general surgery. Started in 2008, the trauma center project in Korea is still in its infancy. Although the need for ACS was presented since the inception of the trauma center project, there was a lack of implementation at trauma centers due to government regulations. However, ACS has been initiated at several non-trauma center hospitals and is mainly operated by surgical intensivists. Studies demonstrate that adding emergency surgery to a trauma service does not compromise the care of the injured patients, despite an increase in trauma volume. Positive impacts of ACS are reported by numerous researches. We believe that the development and advancement of trauma centers will necessitate a discussion for the implementation of the ACS model at trauma centers in Korea.
Critical Care ; Emergencies ; Government Regulation ; Humans ; Korea* ; Surgeons ; Trauma Centers ; United States

The principal goal of an abdominal wall reconstruction is to repair abdominal defects by restoring the continuity of the myofascial layer, providing functional structural support, and minimizing the risk of recurrence. Ramirez and colleagues originally described the components separation technique in 1990. This technique accomplishes primary fascial closure over the midline through bilateral the external oblique aponeurotomis lateral to the linea semilunaris. Several techniques including the perforator-sparing technique, minimally invasive laparoscopic approaches, and posterior component separation have been developed to improve the outcomes. Managements, such as the use of synthetic and bioloprosthetic mesh, for reinforcement adjunctively have further decreased the rate of complications. Further refinements and prospective studies will be needed to achieve more durable repairs.
Abdominal Muscles ; Abdominal Wall* ; Hernia, Ventral ; Prospective Studies ; Reconstructive Surgical Procedures ; Recurrence

No abstract available.
Aneurysm, False* ; Portal Vein*

No abstract available.
Hemorrhage* ; Leg* ; Perineum* ; Wounds and Injuries*

No abstract available.
Aneurysm, False*

No abstract available.
Iliac Artery*