Clinical features and outcomes of patients admitted to the intensive care unit due to acute abdomen are important to be investigated.
To evaluate the outcomes of critically ill subjects with acute abdomen according to etiology, comorbidity and severity.
Outcomes of 1,523 patients (878 women, mean age 66±18 years) consecutively admitted to a specialized gastrointestinal intensive care unit with different causes of acute abdomen from January 2012 to December 2019, were retrospectively evaluated according to etiology, comorbidity and severity.
The most common causes of acute abdomen were obstructive and inflammatory, particularly large bowel obstruction (27%), small bowel obstruction (18%) and acute pancreatitis (17%). Overall mortality was 13%. Surgery was required in 34% of patients. Median length of stay in the hospital was 9 [1-101] days. On univariate analysis mortality was significantly associated with age, APACHE II, Charlson comorbidity index, requirement for surgery and malignancy (p<0.0001), but only APACHE II, Charlson comorbidity index and surgical interventional remained significant on multivariate analysis.
Critically ill patients admitted to the intensive care unit with acute abdomen constitute a heterogeneous group of subjects with different prognosis. Mortality is more related to the severity of the disease, comorbidity and need for surgery than to the etiology of the acute abdomen.
The coronavirus disease 2019 (COVID-19) pandemic was identified in Brazil in February 2020. The first Brazilian case was reported on February 25, 20204, and since then, the number of cases increased dramatically, placing Brazil among the countries with the largest number of infected patients and the largest number of deaths from the new coronavirus (>600,000) (4)
A total of 3,000 patients with moderate or severe COVID-19 were admitted to the Hospital de Clinicas of the School of Medicine of the University of São Paulo for in-hospital treatment. Following the recommendations of its infection committee and the main medical societies, all nononcological elective surgeries were suspended.
From 2008 to 2018, the Cancer Institute performed over 8,500 surgeries for colorectal cancer. In this new scenario, although the number of surgeries was reduced to avoid including contaminated patients, some procedures cannot be canceled or postponed; this is especially the case for procedures performed at the Cancer Institute, given the need for continued oncological treatment in both elective and urgent cases. A contingency plan was, therefore, established to allow us to proceed with surgeries that cannot wait due to the risk of disease progression and worsening of the prognosis.
Three patients with colorectal cancer underwent elective (one patient) or urgent (two patients) surgical treatment in April 2020, and they were diagnosed with COVID-19 only during the postoperative period.
The nonoperative management of traumatic spleen injuries is the modality of choice in patients with blunt abdominal trauma and hemodynamic stability. However, there are still questions about the treatment indication in some groups of patients, as well as its follow-up.
Update knowledge about the spleen injury.
Was performed review of the literature on the nonoperative management of blunt injuries of the spleen in databases: Cochrane Library, Medline and SciELO. Were evaluated articles in English and Portuguese, between 1955 and 2014, using the headings "splenic injury, nonoperative management and blunt abdominal trauma".
Were selected 35 articles. Most of them were recommendation grade B and C.
The spleen traumatic injuries are frequent and its nonoperative management is a worldwide trend. The available literature does not explain all aspects on treatment. The authors developed a systematization of care based on the best available scientific evidence to better treat this condition.
The celiac trunk (CT) is one of the abdominal portion branches of the aortic artery and, together with the superior mesenteric and inferior mesenteric arteries, participates in the abdominal viscera vascularization through a series of anastomoses. Absence of CT or variation in the number of terminal branches implies in varied abdominal arteries origins, which may have implication in surgical approaches.
To analyze the anatomical variations of the celiac trunk and possible associated surgical clinical implications.
It is a systematic review of articles indexed in the PubMed, Lilacs, SciELO, Springerlink, Scienc Direct and Latindex databases from August to September 2017. Original articles involving the anatomical variations of the celiac trunk in humans were included. The presence/absence of the celiac trunk, the number of terminal branches and the place of origin of its branches in variant cases of the normal anatomical pattern, were considered for this study.
At the end of the research, 12 articles were selected, characterized by sample, anatomical structure evaluation method and main results. The normal anatomical pattern was the most prevalent in most studies (75.0%). CT was absent in 41.7% of the findings. The most prevalent anatomical variation was the presence of CT with bifurcation (66.7%). It was also observed the origin of the common and splenic hepatic arteries from the mesenteric arteries (25.0%). The presence of only one branch (16.7%) and quadrifurcation (8.33%) were other findings.
CT variations are not uncommon findings, with different anatomic variants being reported. Thus, the importance of knowing the possible variations of this structure is emphasized, which may have implications for surgical interventions and imaging studies related to the abdominal region.
Desenvolvido por Surya MKT