Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered. Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7%) while in the later, 4 (80%) died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.
*Abdomen ; *Compartment Syndromes/diagnosis ; *Compartment Syndromes/etiology ; *Compartment Syndromes/surgery ; Decompression, Surgical ; *Multiple Organ Failure/diagnosis ; *Multiple Organ Failure/etiology ; *Multiple Organ Failure/surgery ; *Pancreatitis, Acute Necrotizing/complications ; *Pancreatitis, Acute Necrotizing/diagnosis ; *Pancreatitis, Acute Necrotizing/surgery

This article analyzed the medical records of two patients with Vibrio vulnificus primary sepsis who were admitted to the First Affiliated Hospital of Naval Medical University and reviewed the latest literature. On November 6, 2019, a 54-year-old male patient was admitted to the hospital. The patient's lower limbs were red, swollen, and painful with ecchymosis and hemorrhagic bullae after he ate freshwater products. The emergency fasciotomy was performed 3 h after admission, and the multiple organ failure occurred after operation. The patient was given up treatment 24 h after admission. On August 12, 2020, a 73-year-old male patient was admitted to the hospital. He was in shock state on admission and had hemorrhagic bullae on his right lower limb after he ate seafood. At 3 h post admission, he underwent emergency surgical exploration and amputation of right thigh. Six days later, he received negative pressure wound treatment on the stump. On the 13^th day post admission, his families forgo the active treatment and he died 15 d after admission. The two cases were both failed to be diagnosed at the first time, and the disease progressed rapidly. Necrotizing fasciitis and multiple organ failure occurred. After the diagnosis was confirmed, timely fasciotomy and high amputation were performed respectively. The microbiological examinations both reported Vibrio vulnificus. Although the 2 cases were not cured successfully, the course of disease and some indexes of patient with early amputation were better than those of patients with fasciotomy. Vibrio vulnificus is widely distributed and frequently detected in fresh water products. The pathogenic pathway is fuzzy and complex, and it is easy to be misdiagnosed. It is necessary to establish the treatment process of Vibrio vulnificus sepsis. Early and aggressive surgical intervention should be carried out as soon as possible, fasciotomy and debridement should be thorough, and the patients with hemorrhagic bullae should be amputated early. Postoperative comprehensive measures are also important for improving the survival rate of patients.
Aged ; Fasciitis, Necrotizing/surgery* ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Sepsis/diagnosis* ; Vibrio Infections/pathology* ; Vibrio vulnificus

Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered. Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7%) while in the later, 4 (80%) died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.
Abdomen ; Adult ; Aged ; Compartment Syndromes ; diagnosis ; etiology ; surgery ; Decompression, Surgical ; Female ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; diagnosis ; etiology ; surgery ; Pancreatitis, Acute Necrotizing ; complications ; diagnosis ; surgery

PURPOSE: As techniques and instruments for video-assisted thoracic surgery (VATS) have been evolving, attempts to perform VATS for chest trauma have been increasing. Several studies have demonstrated the feasibility and safety of VATS for thoracic trauma. We reviewed our experience to evaluate the clinical feasibility and safety of VATS for thoracic trauma. METHODS: Fifty-two patients underwent thoracic surgery for chest trauma in Asan Medical Center from January 1990 to December 2009. VATS was performed in 21 patients who showed stable vital signs. We reviewed retrospectively the medical records of those patients to investigate the results of VATS for thoracic trauma. RESULTS: Thoracic exploration for chest trauma was performed in 52 patients. There were 46 males (88.5%) and 6 females (11.5%). The median age was 46.0 years (range: 11~81 years). There were 39 blunt and 13 penetrating traumas. A standard posterolateral thoracotomy was performed in 31 patients, and VATS was tried in 21 patients. We performed successful VATS in 13 patients; 11 males (84.5%) and 2 females (15.5%) with a median age of 46.0 years (range: 24~75 years). The indication of VATS was persistent intrathoracic hemorrhage in 10 patients and clotted hemothorax in 3 patients. There were no complications, but there were two mortalities due to multiple organ failure after massive transfusion. In 8 patients, VATS was converted to a standard posterolateral thoracotomy for several reasons. The reason was inadequate visualization for bleeding control or evacuation of the hematoma in 5 patients. In 3 patients, VATS was performed to evaluate diaphragmatic injury. After the diaphragmatic injury had been confirmed, a standard posterolateral thoracotomy was performed to repair the diaphragm. CONCLUSION: VATS should be safe and efficient method for diagnostic evaluation and surgical management of stable patients with thoracic trauma.
Female ; Hematoma ; Hemorrhage ; Hemothorax ; Humans ; Male ; Medical Records ; Multiple Organ Failure ; Retrospective Studies ; Thoracic Surgery ; Thoracic Surgery, Video-Assisted ; Thoracotomy ; Thorax ; Vital Signs

PURPOSEEarly intramedullary nailing (IMN) within the first 24 h for multiply injured patients with femoral fracture and concomitant thoracic trauma is controversial. Previously published studies have been limited in size and their outcomes have been inconclusive. A meta-analysis was conducted to evaluate the available data in order to guide care and help improve the outcomes for these patients.

METHODSWe searched the literature up to December 2011 in the main medical search engines and identified 6 retrospective cohort studies that explored the safety of early IMN in patients with both femoral fracture and chest injury. Our primary outcome was the rates of pulmonary complication (pneumonia, adult respiratory distress syndrome, fat embolism syndrome), multiple organ failure (MOF) and mortality.

RESULTSWe found no statistically significant difference in the rate of pulmonary complications, MOF or mortality in the patients treated with early IMN.

CONCLUSIONEarly IMN for femoral fractures does not increase the mortality and morbidity in chest- injured patients in the studies analyzed.

Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; adverse effects ; methods ; mortality ; Humans ; Multiple Organ Failure ; epidemiology ; Pneumonia ; epidemiology ; Respiratory Distress Syndrome, Adult ; epidemiology ; Thoracic Injuries ; surgery

Transfusion associated graft-versus-host disease is a rare but fatal disease reported after open heart surgeries mainly in Asian people.It can be prevented by pretransfusion gamma irradiation of the fresh whole blood. In this presentation,we report a case of transfusion associated graft-versus-host disease following coronary artery bypass surgery in a 61 year-old male patient.Postoperatively the patient was transfused urgently with 2 units of fresh whole blood from his two sons. He was discharged on postoperative 10 day with only symptom of mild diarrhea.Two days after discharge,he was readmitted because of persistent diarrhea,systemic erythema and high fever.On laboratory examinations,he showed findings of failure in liver,kidney, gastrointestinal tract,and bone marrow.Hemodynamically he deteriorated acutely and died of multiple organ failure on 17th postoperative day. This has been our first experience since we started open heart program at our hospital and we changed our policy for the transfusion of the fresh whole blood after this event.
Asian Continental Ancestry Group ; Blood Transfusion ; Coronary Artery Bypass ; Erythema ; Graft vs Host Disease* ; Heart* ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Thoracic Surgery*

BACKGROUND: In the last year there has been an increasing interest for using frailty scales for risk stratification of elderly patients undergoing major surgery. We planned to compare two frailty scales with risk scales already used in cardiac surgery, to study which of these scores have better prognostic value predicting postoperative outcome in open heart surgery. METHODS: We conducted a prospective clinical trial, including 57 patients over 65 years. We calculated Cardiac Anesthesia Risk Evaluation score, EuroScore II, Clinical Frailty Scale, Edmonton Frail Scale for each patient and followed the postoperative complications, length of mechanical ventilation, length of stay in the intensive care unit and hospital, and in-hospital death related to these risk and frailty scores. RESULTS: Postoperative complications occurred in 25 patients (43.9%), while four patients (7%) died with multiple organ failure. All scales had low predictability for postoperative complications, but for length of mechanical ventilation we obtained positive correlations with EuroScore II, Edmonton Frail Scale and Clinical Frailty Scale. EuroScore II can also predict the length of stay in the intensive care unit. For postoperative deaths, the highest sensitivity had EuroScore II, followed by Clinical Frailty Scale and Edmonton Frail Scale. CONCLUSIONS: EuroScore II and the frailty scales have an increased prognostic value regarding the postoperative outcome of patients (length of mechanical ventilation and in-hospital mortality), the EuroScore II can predict the length of stay in the intensive care unit as well.
Aged ; Anesthesia* ; Humans ; Intensive Care Units ; Length of Stay ; Multiple Organ Failure ; Postoperative Complications ; Prospective Studies ; Respiration, Artificial ; Risk Assessment ; Thoracic Surgery* ; Weights and Measures*

OBJECTIVETo study the effect of laparoscopy combined with endoscopic and digital subtraction angiography in the treatment of severe acute pancreatitis (SAP).

METHODSNine-seven SAP patients were randomly divided into group A (n=32) with conventional treatment and group B (n=35) with combined treatment with laparoscopy, endoscopic and digital subtraction angiography in addition to the conventional treatment. The clinical indices and therapeutic effects in the 2 groups were compared.

RESULTSAfter treatment, the patients in group B had significantly lower APACHE score than those in group A (P<0.05), with also better hepatic, renal and lung functions (P<0.05). The serum TNF-alpha and IL-1beta levels was significantly lower, but IL-10 significantly higher in group B (P<0.05). The CT SPN was significantly lowered in group B as compared with that in group A (P<0.05). The patients in group B had significantly lower rate of organ failure (P<0.01) and higher successful rate in organ failure management (P<0.05), with also lowered inhospital mortality than those in group A (P<0.05).

CONCLUSIONLaparoscopy combined with endoscopic pancreaticobiliary duct drainage and digital subtraction angiography in addition to conventional treatment significantly improves the outcome and decreases the mortality of SAP patients.

Angiography, Digital Subtraction ; Endoscopy, Digestive System ; Female ; Humans ; Interleukin-1beta ; blood ; Kidney ; physiopathology ; Laparoscopy ; Liver ; physiopathology ; Male ; Middle Aged ; Multiple Organ Failure ; Pancreatitis ; blood ; diagnostic imaging ; pathology ; surgery ; Treatment Outcome ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo explore the role of massive escharectomy at early postburn stage in the prevention of internal organ dysfunction.

METHODS(1) Ten cases of severely burned patients were randomly divided into early (A) and non-early escharectomy (B) groups in equal number. Venous blood samples were harvested from the patients of the two groups in 1, 3 and 7 postburn days (PBDs), And the samples from 6 healthy volunteers were taken as the control. The serum was separated from the above blood samples and was employed to stimulate cultured HUVECs in vitro. The cell viability and permeability was observed after the stimulation. (2) Seventy Wistar rats inflicted with 30% TBSA III degree scalding were used as an animal model, and were randomized into early (C, n = 30) and non-early escharectomy (D, n = 30) groups, with 5 normal rats as control in each group. Intra-peritoneal fluid infusion was carried out at 1, 3, 6, 12, 24 and 48 postburn hours (PBHs) in rats in both groups. The rats were killed by blood letting at 1 hour after fluid supplementation. The changes in peritoneal macrophage (M Phi) activation state and plasma contents of LPS, IL-8, PLA(2) and MDA were determined at 48 hours after escharectomy in the rats.

RESULTSThe cell viability and permeability of the HUVECs co-cultured with the serum from burn patients in E group was much better preserved than that in B group. On the other hand, the peritoneal M Phi activation and the plasma contents of LPS, IL-8, PLA(2) and MDA in C group were obviously decreased compared with those in D group.

CONCLUSIONEarly postburn escharectomy to remove denatured burned tissue were proved to be helpful in ameliorating endothelial injury and in inhibiting activation of inflammatory cells. Therefore, early escharectomy was assumed to be beneficial in the prevention of postburn SIRS and MODS.

Adult ; Animals ; Burns ; blood ; complications ; surgery ; Cell Division ; Cell Line ; Cell Membrane Permeability ; Culture Media, Conditioned ; chemistry ; Dinoprostone ; metabolism ; Endothelium, Vascular ; cytology ; Female ; Humans ; Interleukin-8 ; blood ; Lipopolysaccharides ; blood ; Macrophages, Peritoneal ; metabolism ; Male ; Malondialdehyde ; blood ; Multiple Organ Failure ; etiology ; prevention & control ; Nitric Oxide ; metabolism ; Phospholipases A ; blood ; metabolism ; Random Allocation ; Rats ; Rats, Wistar ; Time Factors ; Tumor Necrosis Factor-alpha ; metabolism

OBJECTIVETo compared the clinical efficacy of laparoscopic repair (LR) versus open repair (OR) for perforated peptic ulcers.

METHODSFrom January 2010 to June 2014, in Shanghai Tongji Hospital, 119 patients who were diagnosed as perforated peptic ulcers and planned to receive operation were prospectively enrolled. Patients were randomly divided into LR (58 patients) and OR(61 patients) group by computer. Intra-operative and postoperative parameters were compared between two groups. This study was registered as a randomized controlled trial by the China Clinical Trials Registry (registration No.ChiCTR-TRC-11001607).

RESULTSThere was no significant difference in baseline data between two groups (all P>0.05). No significant differences of operation time, morbidity of postoperative complication, mortality, reoperation probability, decompression time, fluid diet recovery time and hospitalization cost were found between two groups (all P>0.05). As compared to OR group, LR group required less postoperative fentanyl [(0.74±0.33) mg vs. (1.04±0.39) mg, t=-4.519, P=0.000] and had shorter hospital stay [median 7(5 to 9) days vs. 8(7 to 10) days, U=-2.090, P=0.001]. In LR group, 3 patients(5.2%) had leakage in perforation site after surgery. One case received laparotomy on the second day after surgery for diffuse peritonitis. The other two received conservative treatment (total parenteral nutrition and enteral nutrition). There was no recurrence of perforation in OR group. One patient of each group died of multiple organ dysfunction syndrome (MODS) 22 days after surgery.

CONCLUSIONLR may be preferable for treating perforated peptic ulcers than OR, however preventive measures during LR should be taken to avoid postopertive leak in perforation site.

China ; Comparative Effectiveness Research ; Digestive System Surgical Procedures ; adverse effects ; methods ; Enteral Nutrition ; Female ; Fentanyl ; Humans ; Laparoscopy ; adverse effects ; rehabilitation ; Laparotomy ; Length of Stay ; statistics & numerical data ; Male ; Multiple Organ Failure ; epidemiology ; Operative Time ; Pain, Postoperative ; drug therapy ; epidemiology ; Parenteral Nutrition, Total ; Peptic Ulcer Perforation ; rehabilitation ; surgery ; Peritonitis ; therapy ; Postoperative Complications ; epidemiology ; therapy ; Postoperative Period ; Prospective Studies ; Recurrence ; Reoperation ; Treatment Outcome