Splenic injury grades & management

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“Management of blunt spleen injuries has evolved from mandatory splenectomy to non-operative management (NOM) allowing for splenic salvage. The Eastern Association for the Surgery of Trauma (EAST) practice management guideline for the management of blunt solid organ injury recommends NOM in splenic injury regardless of age, grade, or associated injuries.”

“Splenectomy continues to be the treatment of choice in patients with unstable hemodynamics and a known splenic injury. In the hemodynamically normal patient, current practice is to observe the patient and treat with NOM to save the patients the complications associated with surgery.”

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Parkinson’s Gut Motility

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“Growing evidence suggests an increasing significance for the extent of gastrointestinal tract (GIT) dysfunction in Parkinson’s disease (PD). Most patients suffer from GIT symptoms, including dysphagia, sialorrhea, bloating, nausea, vomiting, gastroparesis, and constipation during the disease course. The underlying pathomechanisms of this α-synucleinopathy play an important role in disease development and progression, i.e., early accumulation of Lewy pathology in the enteric and central nervous systems is implicated in pharyngeal discoordination, esophageal and gastric motility/peristalsis impairment, chronic pain, altered intestinal permeability and autonomic dysfunction of the colon, with subsequent constipation.”

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Retained wound VAC material as complication of abdominoplasty

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With large cavitating wounds, there is a risk of sponge retention that may be all too easily
overlooked, particularly with the surgeons’ habit of cutting the sponge to the desired shape and the use of multiple fragments. We therefore recommend that a count is made of the number of sponges used – as is standard practise for swabs, needles and instruments.

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Percutaneous transhepatic biliary drainage (PTBD) in patients with biliopancreatic and biliary leak post-Whipple

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“Complementary to percutaneous intra-abdominal drainage, percutaneous transhepatic
biliary drainage (PTBD) might ameliorate healing of pancreatic fistula and biliary leakage after pancreatoduodenectomy by diversion of bile from the site of leakage. Pancreatoduodenectomy is a complex surgical procedure associated with a high risk of complications (50%), even at specialized high-volume centers. A common complication is leakage of the pancreatic anastomosis: i.e. postoperative pancreatic fistula (POPF). The incidence of clinically relevant POPF (grade B/C) is approximately 12%. A less common complication is bile leakage, with an incidence varying between 1 and 4%.”

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Association between positive intra-operative bile cultures during Whipple procedures and subsequent organ space infections

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“The association between intraoperative bile cultures and infectious complications after
pancreatoduodenectomy remains unclear. Pancreatoduodenectomy remains a complex and technically demanding procedure with high rates of morbidity (25–52%) and mortality (1–3%). Infectious complications, such as surgical site infections (SSIs) and organ space infections (OSIs), are reported as the most common complications following pancreatoduodenectomy besides pancreatic fistula and delayed gastric emptying.”

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Post-ERCP pancreatitis

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“Acute pancreatitis is the most common post-procedural complication following endoscopic retrogrande cholangiopancreatography (ERCP). Its incidence is reported between 2.1% and 24.4%, with such variability being attributable to heterogeneous patient populations, differing levels of endoscopic expertise, procedural differences, disparate definitions of post-ERCP pancreatitis (PEP) and its severity”

“The pathophysiology of PEP is not entirely clear with a multi-factorial concept being held. This involves a combination of chemical, thermal, mechanic, hydrostatic, enzymatic, allergic, and microbiological insults that result from papillary instrumentation and/or hydrostatic injury
from the overfilling of the pancreatic duct with contrast material. The influence of these factors leads to a cascade of events resulting in premature intracellular activation
of pancreatic proteolytic enzymes, autodigestion, and the release of inflammatory cytokines that produce both local and systemic effects.”

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Vascular injury during laparoscopic cholecystectomy

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“Several risk factors may contribute to vascular injuries during laparoscopic cholecystectomy: Anatomical factors, including vascular anomalies, patient-related factors, the gallbladder pathology and surgeon’s experience. Concerning the anatomical factors, the different variants of vascular anatomy may represent a possible cause of bile duct injuries, particularly anomalies of the cystic artery and right hepatic artery (RHA). If surgeons are not aware of possible variations of the RHA, such as in the case of acute and chronic cholecystitis with unclear anatomy of Calot’s triangle, the RHA may be accidentally injured or mistaken for the cystic artery and actively cut off”

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