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Management of surgical site infection after emergency laparotomy

Thomas Peponis, Jordan D Bohnen, Sandra Muse, Eva Fuentes, Gwendolyn M van der Wilden, Ali Mejaddam, Hasan Alam, Haytham M A Kaafarani, Peter J Fagenholz, David R King, D Dante Yeh, George C Velmahos, Marc A de Moya
BACKGROUND: The optimal method of fascial closure, interrupted versus continuous (IFC and CFC respectively) has never been studied exclusively in the setting of emergency surgery. We hypothesized that IFC decreases postoperative incisional hernia development following emergent laparotomies. METHODS: Between August 2008 and September 2015, patients undergoing emergent laparotomies were consented and randomly assigned to either IFC or CFC. Patients were followed postoperatively for at least three months and assessed for incisional hernia, dehiscence, or wound infection...
May 4, 2018: Journal of Trauma and Acute Care Surgery
Antonella Frattari, Giustino Parruti, Rocco Erasmo, Luigi Guerra, Ennio Polilli, Rosamaria Zocaro, Giuliano Iervese, Paolo Fazii, Tullio Spina
BACKGROUND: In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control. CASE PRESENTATION: A 42-year-old white man presented with traumatic hemorrhagic shock. Unstable pelvic fractures led to emergency stabilization surgery. Fever ensued with diarrhea, followed by septic shock...
February 22, 2017: Journal of Medical Case Reports
Brandon R Bruns, Sarwat A Ahmad, Lindsay O╩╝Meara, Ronald Tesoriero, Margaret Lauerman, Elena Klyushnenkova, Rosemary Kozar, Thomas M Scalea, Jose J Diaz
BACKGROUND: Damage-control surgery with open abdomen (OA) is described for trauma, but little exists regarding use in the emergency general surgery. This study aimed to better define the following: demographics, indications for surgery and OA, fascial and surgical site complications, and in-hospital/long-term mortality. We hypothesize that older patients will have increased mortality, patients will have protracted stays, they will require specialized postdischarge care, and the indications for OA will be varied...
April 2016: Journal of Trauma and Acute Care Surgery
S Irtan, M Lamerain, F Lesage, V Verkarre, M-E Bougnoux, F Lanternier, J R Zahar, N Salvi, C Talbotec, O Lortholary, F Lacaille, C Chardot
Mucormycosis, an emerging fungal infection in solid organ transplant patients, is mostly located in rhino-orbito-cerebral, pulmonary, and cutaneous areas, or disseminated with poor prognosis. A 4-year-old girl with chronic intestinal pseudo-obstruction syndrome underwent a modified multivisceral transplantation, including half of the stomach, the duodeno-pancreas, the small bowel, and the right colon. On postoperative day 5, a digestive perforation was suspected. Surgical exploration found a small necrotic area on the native stomach, which was externally drained...
December 2013: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Brian P Smith, Nicole Fox, Abdulla Fakhro, Mary LaChant, Abhijit S Pathak, Steven E Ross, Mark J Seamon
OBJECTIVE: The Surgical Care Improvement Project (SCIP) established surgical antibiotic prophylaxis guidelines as part of a national patient safety initiative aimed at reducing surgical complications such as surgical site infection (SSI). Although these antibiotic prophylaxis guidelines have become well established in surgical patients, they remain largely unstudied in patients with injury from trauma undergoing operative procedures. We sought to determine the role of these antibiotic prophylaxis guidelines in preventing SSI in patients undergoing trauma laparotomy...
August 2012: Journal of Trauma and Acute Care Surgery
Peep Talving, Shahin Mohseni, Kenji Inaba, David Plurad, Bernardino Castelo Branco, Lydia Lam, Linda S Chan, Demetrios Demetriades
BACKGROUND: The objective of this study was to investigate associations between closed suction intra-abdominal drain placement in isolated hollow viscus injury (HVI) and intra-abdominal deep surgical site infections (DSSI). PATIENTS: Patients undergoing emergent trauma laparotomy at a Level I trauma center after isolated HVI from January 2006 to December 2008 were identified. Study variables extracted from institutional trauma registry and patient electronic medical records included demographics, clinical characteristics, abdominal injuries, drain placement, DSSI, septic events, intensive care unit and hospital length of stay, and mortality...
June 2011: Journal of Trauma
Tao Peng, Min-Hao Peng, Le-Qun Li, Yao-Liang Deng, Ding-Hua Yang, Bang-Yu Lu, Xi-Gang Chen, Ya Guo, Kai-Yin Xiao, Bin Chen, Qin Zhong, Min-Yi Wei
AIM: To highlight the intestinal perforation (IP), an uncommon and catastrophic complication after combined liver-kidney transplantation. METHODS: Combined liver-kidney transplantation (LKTx) with left kidney excision and a cyst fenestration procedure on the right kidney were performed on a case of 46-year-old female with congenital polycystic disease (CPCD). RESULTS: Two sites of IP were noted 40-50 cm proximal to ileocecal area during emergent laparotomy 10 d postoperatively...
September 15, 2004: World Journal of Gastroenterology: WJG
Sigmar Stelzner, Gunter Hellmich, Klaus Ludwig
PURPOSE: The disappointing outcome of local fascial repair and stoma relocation in parastomal hernias has stimulated a variety of new techniques that use a prosthetic mesh for herniorrhaphy. Many of these procedures either carry the risk of mesh contamination or allow only a local repair. We established a method that allows both an aseptic operation and the management of concurrent incisional hernias. METHODS: In a retrospective study we evaluated all patients who had undergone operation for a paracolostomy hernia with an expanded polytetrafluoroethylene (PTFE) mesh in the intraperitoneal onlay position in our Department of General Surgery from 1994 until 2002...
February 2004: Diseases of the Colon and Rectum
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