Search Results (376)

Background and Clinical Significance: Spontaneous renal forniceal rupture is an uncommon complication of obstructive uropathy and is classically associated with ureteric calculi rather than distal urinary retention. Bilateral retention-related rupture appears to be exceptionally rare and may be diagnostically challenging when renal function begins to improve after bladder decompression; Case Presentation: An 82-year-old man with a history of prostate cancer treated five years earlier with external beam radiotherapy and androgen deprivation therapy presented with acute abdominal pain radiating to both flanks and inability to void. Bedside ultrasonography showed urinary retention and bilateral hydronephrosis, and a 16-Fr Foley catheter drained 900 mL of urine. Admission evaluation showed severe acute kidney injury, microscopic hematuria, minimal leukocyturia, and elevated inflammatory markers. Post-obstructive diuresis developed after bladder decompression. CT urography with excretory-phase imaging on hospital day 3 demonstrated severe bilateral hydroureteronephrosis with bilateral renal forniceal rupture and associated urinomas, including a larger left-sided collection extending toward the psoas compartment. Bilateral percutaneous nephrostomies were placed on hospital day 4 for upper-tract diversion. Immediate nephrostography showed no active contrast extravasation. At one-month follow-up, combined CT and nephrostographic assessment confirmed complete resolution of the bilateral urinomas without persistent leak, and the nephrostomy tubes were removed; Conclusions: This case suggests that urinary retention in an older man with prior prostate radiotherapy may reflect radiation-associated outlet pathology and/or impaired detrusor function rather than simple prostate enlargement. Delayed-phase CT urography was essential for diagnosis, and active bilateral diversion was justified by bilateral rupture, acute kidney injury, and the extent of urinary extravasation. The report expands the limited PubMed-indexed literature on retention-related upper urinary tract rupture and supports cautious follow-up aimed at defining the underlying mechanism of retention. Full article

Background: Acute intermittent porphyria (AIP) is the most common and severe form of acute hepatic porphyria, caused by heterozygous mutations in the HMBS gene. Due to its non-specific clinical manifestations and low clinical awareness among clinicians, AIP is frequently misdiagnosed, leading to significant diagnostic delays and potentially fatal complications. Case presentation: We report a 20-year-old female patient who presented with a 9-month history of recurrent abdominal pain, paralytic ileus, unexplained liver injury, and hyponatremia, followed by progressive limb weakness. She was initially misdiagnosed with Guillain–Barré syndrome (GBS) and received intravenous immunoglobulin and systemic glucocorticoids. However, her condition deteriorated, and she developed life-threatening respiratory muscle paralysis requiring invasive mechanical ventilation. The diagnosis of AIP was confirmed by positive urinary porphobilinogen (PBG) testing and identification of the heterozygous HMBS c.517C>T pathogenic variant. The patient was treated with high-dose carbohydrate loading therapy and comprehensive supportive care, resulting in gradual clinical improvement. Discussion and Conclusions: This case exemplifies the substantial diagnostic challenges associated with AIP, especially when it manifests with peripheral neuropathy that closely mimics GBS. The triad of absent albuminocytologic dissociation in cerebrospinal fluid, preceding visceral symptoms, and inadequate response to standard first-line GBS therapy should immediately raise clinical suspicion for AIP. Enhanced clinical awareness of this rare disorder and timely implementation of urinary PBG screening are of paramount importance to prevent irreversible neurological complications and optimize long-term patient outcomes. Full article

Background and Clinical Significance: Acute appendicitis following blunt abdominal trauma is a rare and historically debated clinical entity. We present a century-spanning descriptive review of 106 cases of post-traumatic appendicitis, embedded with an illustrative pediatric case initially managed conservatively. Methods: A comprehensive literature review was conducted following PRISMA guidelines across PubMed/MEDLINE, Web of Science, and Google Scholar, encompassing a 100-year period (1925–2025). Clinical variables, trauma mechanisms, and outcomes were extracted and statistically analyzed by age cohort (Pediatric ≤ 18 vs. Adult > 18) and historical medical era. Results: A total of 106 cases were analyzed. High-energy trauma predominated in adults compared to the pediatric cohort (48.8% vs. 18.5%, p = 0.001). The overall complication rate was exceptionally high (66.0%), with no significant difference between pediatric and adult cohorts (61.5% vs. 73.2%, p = 0.293). An epoch-based analysis revealed a significant drop in perforation rates from the historical era (1925–1980) to the modern era (2001–2025) (51.7% to 27.0%, p = 0.033) due to improved diagnostic timelines. Crucially, purely mechanical injuries such as complete appendiceal auto-amputation remained a constant signature of blunt trauma across the century (11.5% overall rate). Conclusions: Our synthesis of historical cases suggests that post-traumatic appendicitis might be a relevant clinical entity where trauma mechanics appear to play a significant role in injury severity, irrespective of patient age. While conservative management could be feasible and safe in the acute setting of uncomplicated cases, we hypothesize that the initial kinetic impact might cause subtle structural changes or alter local appendiceal dynamics, potentially predisposing the organ to recurrent inflammation, warranting close follow-up or elective surgery. Full article

Background/Objectives: Traumatic duodenal diverticulum perforation is a rare, potentially fatal consequence of blunt trauma. Nonspecific symptoms and diagnostic challenges often delay recognition. This systematic review characterizes its clinical features, management, and outcomes. Methods: A systematic literature search covering 1960 to December 2025 identified eligible cases. Inclusion criteria were blunt trauma-related duodenal diverticulum perforations confirmed by imaging or surgery. Data were analyzed according to PRISMA 2020 guidelines. Results: Twenty-one cases were identified (mean age 62.9 years; sex ratio (M:F) 8:13). Primary injury mechanisms were traffic accidents (10 of 21) and falls from height (8 of 21). Most injuries involved the descending duodenum (D2; 17 of 21). Common presenting signs included abdominal pain (19 of 21) and epigastric tenderness (16 of 21). Computed tomography confirmed findings consistent with perforation in all scanned patients (17 of 17). Surgical management was employed in 20 of 21 patients, predominantly via manual (11 of 20) or stapled (9 of 20) diverticulectomy, with drainage applied in 18 of 20 operated cases. Complications occurred in 13 of 21 patients. Overall mortality was 4 of 21. Conclusions: Traumatic duodenal diverticulum perforation remains a life-threatening event requiring high clinical vigilance. The data collected suggest that early CT scanning and prompt surgical intervention may be associated with better treatment outcomes, although these conclusions should be treated with caution due to the small sample size. The protocol was registered in PROSPERO (CRD420261285658). Full article

Necrotizing enterocolitis (NEC) remains one of the most serious gastrointestinal emergencies in preterm infants, and imaging plays a central role in diagnosis and clinical management. Historically, evaluation has relied primarily on abdominal radiography, which remains widely available and embedded in established diagnostic frameworks. However, the hallmark radiographic signs of NEC (i.e., pneumatosis intestinalis, portal venous gas, and free air) reflect relatively advanced manifestations of intestinal injury that indicate established mucosal disruption or transmural necrosis. Bowel ultrasound has increasingly complemented radiography by enabling real-time assessment of bowel wall integrity, perfusion, motility, and intra-abdominal fluid, providing physiologic information that may refine clinical interpretation and monitoring of disease progression. Expanding use of neonatologist-performed bowel ultrasound may further improve access to bedside intestinal imaging and facilitate more timely evaluation in neonatal intensive care settings. In parallel, emerging imaging technologies seek to extend the capabilities of conventional imaging by interrogating biologic processes that underlie intestinal injury. Modalities such as contrast-enhanced ultrasound, ultra-high-frequency ultrasound, and photoacoustic imaging offer the potential to characterize bowel microvascular perfusion, tissue oxygenation, and microstructural changes that may precede overt radiographic abnormalities. Complementary physiologic monitoring approaches are also being explored to identify infants at risk before clinical disease develops. Techniques including superior mesenteric artery Doppler, near-infrared spectroscopy, bowel acoustic monitoring, and electrogastrography aim to detect early alterations in intestinal perfusion, oxygenation, and motility. In addition, artificial intelligence applied to imaging and physiologic data may enhance pattern recognition, risk stratification, and clinical decision support. Together, these advances suggest that NEC evaluation is evolving from a paradigm focused on detecting late structural injury toward integrated approaches capable of identifying intestinal vulnerability earlier and monitoring disease more precisely. Full article

Background and Objectives: Pediatric liver injury is a frequent solid organ injury after blunt abdominal trauma, and its management has progressively shifted toward nonoperative care in hemodynamically stable children. This narrative review aims to synthesize current evidence regarding diagnosis, eligibility for nonoperative management, inpatient monitoring, outcomes, complications, escalation criteria, and post-discharge care in pediatric liver trauma. Materials and Methods: A structured literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science, with supplementary screening through Google Scholar and reference lists. Publications from January 2000 to December 2025 were considered. The literature was analyzed descriptively and thematically, without formal risk-of-bias assessment, evidence grading, or quantitative meta-analysis. Results: The available evidence supports nonoperative management for most children with blunt liver injury who are hemodynamically stable or show a sustained response to initial resuscitation. Eligibility depends primarily on physiological status, clinical evolution, associated injuries, and institutional capability rather than imaging grade alone. Nonoperative management requires structured clinical, hemodynamic, and laboratory reassessment, with follow-up imaging reserved for selected cases based on clinical evolution or suspected complications. Delayed hemorrhage, bile leak, biloma, pseudoaneurysm, hemobilia, infection, and failure of nonoperative management remain clinically relevant and may require repeat imaging, interventional radiology, or surgery. Conclusions: Nonoperative management should be understood as an active organ-preserving strategy based on careful selection, serial reassessment, and immediate access to escalation when needed. Further pediatric liver-specific studies are required to standardize monitoring, repeat imaging, intervention thresholds, activity restriction, and post-discharge follow-up. Full article

Background/Objectives: Baseball pitching injuries associated with fatigue-induced mechanisms may be attributed to change in lower-body power. In this study, a stretch-resistant belt (theorized to increase intra-abdominal pressure) was studied to determine if it influenced countermovement jump (CMJ) power pre- and post-pitching. Methods: Thirteen college athletes participated in three separate, randomized pitching sessions of forty pitches to evaluate the CMJ performance impacts owed to wearing a team-issued baseball belt versus a belt that was configured with the intent to raise intra-abdominal pressure (IAP). The three belt conditions were; (1) the team-issued belt, standard belt (SB), (2) the IAP-configured belt worn at regular length (RIAP), and the IAP-configured belt fastened two inches with the tightest cinch (2IN). Maximum jump heights were measured on a Jumpmat and captured with hands on hips. Data was integrated to compute jump power and the eccentric utilization ratio, being the ratio of a full stretch CMJ to a static CMJ biased to concentric power. Static CMJ testing had pitchers hold the bottom position for 5 s before takeoff. Repeated measures ANOVA with a post hoc Bonferroni correction determined significant differences; subject-specific interactions were identified. Results: Most athletes maintained or improved performance post-pitching with the RIAP with less variability in coordinating stretch-shortening responses. On a group level, RIAP had greater post-pitching CMJ height and power versus 2IN (p < 0.03) and had less CMJ power loss compared to SB and 2IN belt conditions (p < 0.02). IAP was not directly measured, yet this exploratory study provides preliminary evidence that a 5 mm, theoretical IAP design, via a stretch-resistant belt can influence pre- and post-pitching lower-body neuromuscular performance in collegiate pitchers. Conclusions: The RIAP condition showed less performance decline inferring fatigue resistance, preserved max CMJ height, and lessened post-pitch CMJ power loss. Maximal cinching tended to compromise post-pitch lower-body power and inferred the need to individualize the stretch-resistant belt, designed to increase intra-abdominal pressure, for performance and injury protection benefits. Full article

Sepsis-induced liver failure remains a serious and often under-recognized complication of abdominal sepsis. Clinical reports suggest that liver dysfunction develops in a substantial proportion of these patients, and once failure ensues, mortality rises sharply. Despite progress in antimicrobial therapy and critical care support, there is still no therapy that directly halts or reliably reverses septic liver injury. Systemic drug administration frequently underperforms in this setting. Hepatic drug accumulation becomes unpredictable, pharmacokinetics shift, and immune dysregulation further complicates therapeutic control. Nanotechnology-based delivery systems have attempted to address these shortcomings by improving drug stability and circulation time. Yet their behavior under septic conditions remains inconsistent. This inconsistency may reflect a deeper issue: most carriers are engineered under relatively stable physiological assumptions that do not hold during systemic inflammation. Biomimetic platforms, particularly those derived from erythrocyte membranes, offer a different conceptual entry point. Rather than merely evading immune recognition, erythrocyte-based systems interact naturally with hepatic clearance pathways. During sepsis, erythrocyte turnover appears to accelerate, and macrophage-mediated clearance in the liver intensifies. This shift, while pathologic, may present a therapeutic opportunity. In this review, we examine current liver-targeted delivery strategies for sepsis-induced liver failure and critically assess the underexplored role of erythrocyte ghost-based systems. We discuss how sepsis-specific pathophysiological changes reshape carrier biodistribution, identify translational constraints, and propose design considerations for inflammation-adaptive biomimetic platforms. By reconsidering hepatic clearance not solely as a pharmacokinetic barrier but as a potential delivery route, we outline a disease-aligned approach to nanomedicine design in septic organ failure. Full article

A 65-year-old man with type 2 diabetes presented with abdominal pain. Although he had no typical reflux symptoms such as heartburn or acid regurgitation, esophagogastroduodenoscopy (EGD) showed findings suggestive of reflux esophagitis, and proton pump inhibitor therapy was initiated. Two months later, he was admitted with intractable vomiting. EGD demonstrated diffuse circumferential mucosal injury without black discoloration, predominantly in the distal esophagus. These findings were interpreted as severe reflux esophagitis (Los Angeles grade D; RE-D). Symptoms improved with supportive care, glycemic control, and continued PPI therapy; follow-up EGD showed marked improvement. Six months later, he re-presented with identical symptoms and endoscopic findings. Laboratory testing confirmed diabetic ketoacidosis (DKA), with ketonuria, elevated total ketone bodies (2469 µmol/L), and high-anion gap metabolic acidosis (anion gap 17.2 mEq/L). The diagnosis was revised to DKA-associated acute esophageal mucosal lesion (AEML). He improved with fluid resuscitation and insulin therapy, and medication adherence was reinforced. Follow-up EGD showed complete healing without recurrence. AEML has been proposed as a spectrum that includes acute esophageal necrosis (AEN; “black esophagus”) and esophagitis without black-appearing mucosa. This case highlights a diagnostic pitfall in which DKA-associated AEML without black discoloration may be misattributed to severe reflux esophagitis. When the clinical presentation or endoscopic appearance is severe or atypical, clinicians should consider AEML and evaluate for underlying systemic precipitants. Full article

Background/Objectives: Blunt suprahepatic inferior vena cava (SHIVC) injury is a rare and highly lethal condition associated with severe thoracoabdominal trauma. This study describes the clinical characteristics and outcomes of SHIVC injuries treated at a single institution. Methods: We retrospectively reviewed patients with blunt SHIVC injury treated between January 2014 and September 2023. Demographics, injury characteristics, management strategies, and outcomes were analyzed descriptively. The primary outcome was in-hospital mortality. Given the small sample size, statistical analyses were exploratory. Results: Ten patients were identified (mean age: 47 ± 17 years; mortality: 40%; ISS: 43 ± 19). On admission, 50% presented with systolic blood pressure < 90 mmHg and a mean Glasgow Coma Scale score of 7 ± 5. Non-survivors had lower systolic blood pressure (70 ± 12 vs. 115 ± 34 mmHg, p = 0.05), lower GCS scores (3 ± 0 vs. 9 ± 5, p = 0.02), and worse base excess (−20.1 ± 5.8 vs. −7.8 ± 7.1) than survivors. Surgical intervention was performed in 9 patients, while 1 was managed nonoperatively. Common associated injuries included right atrial injury (70%), liver injury (50%), and diaphragm injury (30%). Four patients received intraoperative circulatory support; two treated with cardiopulmonary bypass survived, whereas those treated with extracorporeal membrane oxygenation died. No definitive conclusions can be drawn regarding treatment effectiveness due to the limited sample size. Conclusions: Outcomes appear strongly influenced by initial physiological status and injury severity. This study is descriptive and hypothesis-generating; further multicenter studies remain warranted to define optimal management strategies. Full article

Introduction: Intraoperative hypotension (IOH) is a frequent manifestation of haemodynamic instability during general anaesthesia. Advances in arterial waveform analysis have led to two distinct monitoring strategies: flow-derived platforms and predictive algorithms designed to anticipate hypotension. However, prospective comparisons and their associations with IOH and postoperative outcomes remain limited. The objective was to compare predictive haemodynamic monitoring using the Hypotension Prediction Index (HPI) with flow-derived monitoring using the Vigileo/FloTrac system and to evaluate their associations with IOH and postoperative outcomes. Methods: In this single-center prospective observational study, 101 adults undergoing elective major abdominal surgery under general anaesthesia were monitored using either the HPI system (n = 49) or the Vigileo/FloTrac system (n = 52). Primary outcomes were cumulative duration and frequency of IOH (mean arterial pressure < 65 mmHg). Secondary outcomes included postoperative complications, organ injury biomarkers (troponin, creatinine, eGFR), and hospital length of stay. Multivariable regression models adjusted for predefined confounders were used to estimate associations. Results: Vigileo/FloTrac monitoring, compared with HPI, was independently associated with a greater cumulative duration of IOH (adjusted β = 1.66; 95% CI, 0.63–2.72) and a higher number of hypotensive episodes (adjusted β = 0.53; 95% CI, 0.10–0.95). Monitoring strategy was not associated with surgical site, respiratory, or neurological complications. However, Vigileo/FloTrac monitoring was associated with higher odds of vascular complications (adjusted OR = 4.36; 95% CI, 1.13–20.41). No significant associations were observed between monitoring strategy and postoperative organ injury biomarkers or length of hospital stay. Conclusions: Predictive haemodynamic monitoring using the HPI system was associated with lower IOH burden compared with the Vigileo/FloTrac system. However, these differences were not consistently accompanied by improvements in postoperative outcomes. Haemodynamic optimisation should be considered as one component within a broader, integrated perioperative management strategy. Further large-scale, multicenter prospective studies are warranted to clarify its impact on patient-centered outcomes. Full article

Background: Minimal access surgeries are growing more common in neonatal care, but the risk of accidental injury to abdominal wall blood vessels remains a concern. This risk is increased by limited precise anatomical data specific to neonates. Therefore, this study aimed to quantitatively map the superficial and deep blood vessels of the neonatal anterior abdominal wall concerning important surgical landmarks to develop evidence-based recommendations for safer laparoscopic port placement. Methods: Thirty formalin-fixed low-birth-weight neonatal body donations (≤4 weeks old) were dissected. An anatomical grid based on palpable landmarks—including the umbilicus, xiphoid process, and anterior superior iliac spines—was utilised to measure distances to the nearest vessels via digital image analysis. In situ topography of the liver, stomach, and umbilical vessels was also documented. Results: A midline corridor of reduced vascular density was identified; minimum circumferential distances to deep vessels above the umbilicus averaged 6.84–6.88 mm. Conversely, lateral regions were highly vascular, particularly at or below the transumbilical plane, with distances to deep vessels as short as 1.08 ± 0.83 mm. The liver and stomach extended significantly below the costal margin (averaging 20.61 ± 8.29 mm and 34.18 ± 14.44 mm, respectively). Conclusions: The results establish an anatomical foundation for using the reduced vascular midline for port placement and highlight the importance of inserting secondary lateral ports under direct visualisation. Full article

This study aimed to investigate the protective effects of fenofibrate against sepsis-induced acute lung injury using a feces-induced peritonitis (FIP) rat model, with particular emphasis on the modulation of HSP70 and Nrf2 as key cellular defense mechanisms. The FIP model was employed to mimic colon-origin abdominal sepsis, frequently encountered in general surgery, including conditions such as colonic perforation and anastomotic leakage. Thirty male Wistar albino rats were randomly assigned to control, FIP, and FIP + fenofibrate groups. Sepsis was induced by intraperitoneal injection of a fecal-saline suspension. Fenofibrate (100 mg/kg) was administered intraperitoneally after the FIP procedure. After 24 h, lung tissues and blood samples were collected. Assessments included histopathology (H&E staining), thoracic CT imaging, arterial blood gas analysis, ELISA-based quantification of plasma cytokines (IL-6, IL-1β, TNF-α), MDA for oxidative stress, and lung tissue levels of HSP70 and Nrf2. Feces-induced peritonitis caused severe acute lung injury, evidenced by increased histopathological damage (p < 0.001), impaired gas exchange (PaO₂ and PaCO₂, p < 0.01), elevated inflammatory cytokines (IL-6, IL-1β, TNF-α; p < 0.001), increased oxidative stress (MDA, p < 0.001), and suppressed lung Nrf2 and HSP70 expression (p < 0.001). Fenofibrate significantly attenuated lung injury, improved gas exchange (p < 0.05), reduced inflammation (p < 0.01–p < 0.001), decreased MDA (p < 0.001), and increased Nrf2 (p < 0.001) and HSP70 (p < 0.01). Fenofibrate attenuates sepsis-induced acute lung injury by reducing inflammation and oxidative stress while preserving HSP-70 and Nrf2-mediated cytoprotective pathways. These findings are clinically relevant to general surgery, as septic lung injury commonly arises from colon-origin abdominal sepsis, including colonic perforation and anastomotic leakage. Full article

Background: Isolated gallbladder injuries are rare, especially when initial imaging is normal. Advanced imaging is required to detect delayed complications. Moreover, it is necessary to make an appropriate diagnosis while selecting the most suitable treatment option. Case Presentation: A 49-year-old man fell while cycling and developed worsening abdominal pain. Initial contrast-enhanced computed tomography (CT) scans showed no abnormalities. However, the patient later developed cholangitis and cholecystitis caused by biliary obstruction from a delayed gallbladder hematoma. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) were used to diagnose this condition. The patient was initially managed conservatively with antibiotics, which led to temporary symptomatic improvement. Notably, the patient developed a delayed recurrence of suspected acute cholangitis (Grade I) on Day 12 due to hematoma migration. After recurrence, endoscopic nasobiliary drainage was performed as a step-up approach, in accordance with the Tokyo Guidelines 2018 management bundle, to achieve biliary decompression, followed by elective laparoscopic cholecystectomy. Pathological examination revealed chronic cholecystitis with hematoma. Conclusions: Isolated gallbladder injuries should be considered in patients with blunt abdominal trauma. Delayed hematoma formation can lead to biliary obstruction, even without initial CT findings. In such cases, early implementation of MRI and MRCP, along with close clinical monitoring for delayed recurrence, is essential. A strategic “step-up approach” incorporating endoscopic drainage is a safe and effective management option prior to definitive surgery. Full article

Background: Antimicrobial resistance coupled with the lack of new antibiotics calls for the responsible use of antibiotics, including old antimicrobials. Aminoglycosides are effective against bacteria in acute appendicitis, a common intra-abdominal infection. Their use has been discouraged recently, but their place in therapy is based on studies performed in the era of lower resistance rates, and with multiple dosing regimens. Methods: In a prospective randomized open-label study, we compared the efficacy and safety of gentamicin in one daily dose and metronidazole (GTM+MZ) to ertapenem (ETP) and to cefuroxime with metronidazole (CXM+MZ) in adult patients surgically treated for acute appendicitis. Efficacy was assessed via the duration of antibiotic treatment and hospital stay, c-reactive protein (CRP) dynamics, and post-operative complications. Nephrotoxicity was assessed with urine biomarkers. Statistical analysis comprised mixed-model analysis of variance (ANOVA) with the missing-data-imputation method and linear mixed model (LMM). Results: One hundred-and-sixty-six patients were included in this study. There were no significant differences among the three groups in the durations of treatment and lengths of stay (p = 0.093, p = 0.222). CRP level was the lowest (p = 0.003) in the ETP group. There were five complications during hospitalization, with two of them classified as infectious. Both occurred in the GTM+MZ group; however, the difference was not statistically significant (p = 0.330). No difference was found in complications in the month following the operation (p = 0.763). Biomarkers indicating kidney injury showed the same trend in all three groups. Conclusions: Our results suggest the use of once-daily dose of gentamicin following an appendectomy for acute appendicitis. Gentamicin may be used to decrease selective pressure of other antimicrobials. Full article