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1.  Abdominal wall defect with large duodenal disruption treated by a free tissue flap with a help of temporary expandable metallic stent 
Abdominal wall defect with large duodenal disruption after penetrating abdominal injury is a rare emergency situation that can result in life-threatening complications. We report on a 64-year-old man who had abdominal wall defect with large duodenal disruption after penetrating abdominal injury. The patient presented with intra-abdominal exsanguinating bleeding, duodenal disruption, and multiple small bowel perforation. The rarity of this complex injury and its initial presentation as a posttraumatic large duodenal disruption with abdominal wall defect warrant its description. The present case indicates that combining a free tissue flap with a covered expandable metallic stent can effectively and successfully repair an abdominal wall defect that is associated with a large duodenal disruption.
doi:10.4174/jkss.2013.85.5.240
PMCID: PMC3834024  PMID: 24266016
Stents; Abdominal wall; Duodenum; Abdominal injury; Free tissue flaps
2.  Enteral nutrition associated non-occlusive bowel ischemia 
We describe two patients, with no previous history of vascular problems but poor lung function, who experienced septic shock due to bowel ischemia. Both were fed an enteral formula rich in fiber using a feeding tube and experienced septic shock with regular enteral feeding. Surgical finding showed hemorrhagic ischemia in the bowel. The pathologic finding suggests these changes may have been due to inspissations of bowel contents, which may put direct pressure on the mucosa of the bowel wall, leading to local impairment of mucosal and submucosal blood flow with subsequent bowel necrosis. Bowel ischemia may have been precipitated by an increased mesenteric blood flow requirement in combination with a metabolically stressed bowel. Patients in the intensive care unit fed a fiber-rich enteral formula may have inspissated bowel contents, leading to bowel ischemia, suggesting that the use of fiber-rich formula should be limited in patients at high-risk of bowel ischemia.
doi:10.4174/jkss.2012.83.3.171
PMCID: PMC3433554  PMID: 22977764
Enteral nutrition; Acute mesenteric ischemia; Intensive care units; Sepsis
3.  Non-invasive ventilation for surgical patients with acute respiratory failure 
Purpose
Acute respiratory failure is a relatively common complication in surgical patients, especially after abdominal surgery. Non-invasive ventilation (NIV) is increasingly used in the treatment of acute respiratory failure. We have assessed the usefulness of NIV in surgical patients with acute respiratory failure.
Methods
We retrospectively reviewed the medical charts of patients who were admitted to a surgical intensive care unit between March 2007 and February 2008 with acute respiratory failure. The patients who have got respiratory care for secondary reason such as sepsis and encephalopathy were excluded from this study.
Results
Of the 74 patients who were treated with mechanical ventilation, 15 underwent NIV and 59 underwent invasive ventilation. The causes of acute respiratory failure in the NIV group were atelectasis in 5 patients, pneumonia in 5, acute lung injury in 4, and pulmonary edema in 1, this group included 3 patients with acute respiratory failure after extubation. Overall success rate of NIV was 66.7%.
Conclusion
NIV may be an alternative to conventional ventilation in surgical patients with acute respiratory failure. Use of NIV may avoid re-intubation in patients who develop respiratory failure after intubation.
doi:10.4174/jkss.2011.80.6.390
PMCID: PMC3204685  PMID: 22066065
Non-invasive ventilation; Acute respiratory failure; Pulmonary atelectasis; Pneumonia; Post-operative complications
4.  World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections 
Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.
doi:10.1186/1749-7922-9-57
PMCID: PMC4242587  PMID: 25422671
5.  Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study 
Sartelli, Massimo | Catena, Fausto | Ansaloni, Luca | Coccolini, Federico | Corbella, Davide | Moore, Ernest E | Malangoni, Mark | Velmahos, George | Coimbra, Raul | Koike, Kaoru | Leppaniemi, Ari | Biffl, Walter | Balogh, Zsolt | Bendinelli, Cino | Gupta, Sanjay | Kluger, Yoram | Agresta, Ferdinando | Saverio, Salomone Di | Tugnoli, Gregorio | Jovine, Elio | Ordonez, Carlos A | Whelan, James F | Fraga, Gustavo P | Gomes, Carlos Augusto | Pereira, Gerson Alves | Yuan, Kuo-Ching | Bala, Miklosh | Peev, Miroslav P | Ben-Ishay, Offir | Cui, Yunfeng | Marwah, Sanjay | Zachariah, Sanoop | Wani, Imtiaz | Rangarajan, Muthukumaran | Sakakushev, Boris | Kong, Victor | Ahmed, Adamu | Abbas, Ashraf | Gonsaga, Ricardo Alessandro Teixeira | Guercioni, Gianluca | Vettoretto, Nereo | Poiasina, Elia | Díaz-Nieto, Rafael | Massalou, Damien | Skrovina, Matej | Gerych, Ihor | Augustin, Goran | Kenig, Jakub | Khokha, Vladimir | Tranà, Cristian | Kok, Kenneth Yuh Yen | Mefire, Alain Chichom | Lee, Jae Gil | Hong, Suk-Kyung | Lohse, Helmut Alfredo Segovia | Ghnnam, Wagih | Verni, Alfredo | Lohsiriwat, Varut | Siribumrungwong, Boonying | El Zalabany, Tamer | Tavares, Alberto | Baiocchi, Gianluca | Das, Koray | Jarry, Julien | Zida, Maurice | Sato, Norio | Murata, Kiyoshi | Shoko, Tomohisa | Irahara, Takayuki | Hamedelneel, Ahmed O | Naidoo, Noel | Adesunkanmi, Abdul Rashid Kayode | Kobe, Yoshiro | Ishii, Wataru | Oka, Kazuyuki | Izawa, Yoshimitsu | Hamid, Hytham | Khan, Iqbal | Attri, AK | Sharma, Rajeev | Sanjuan, Juan | Badiel, Marisol | Barnabé, Rita
The CIAOW study (Complicated intra-abdominal infections worldwide observational study) is a multicenter observational study underwent in 68 medical institutions worldwide during a six-month study period (October 2012-March 2013). The study included patients older than 18 years undergoing surgery or interventional drainage to address complicated intra-abdominal infections (IAIs).
1898 patients with a mean age of 51.6 years (range 18-99) were enrolled in the study. 777 patients (41%) were women and 1,121 (59%) were men. Among these patients, 1,645 (86.7%) were affected by community-acquired IAIs while the remaining 253 (13.3%) suffered from healthcare-associated infections. Intraperitoneal specimens were collected from 1,190 (62.7%) of the enrolled patients.
827 patients (43.6%) were affected by generalized peritonitis while 1071 (56.4%) suffered from localized peritonitis or abscesses.
The overall mortality rate was 10.5% (199/1898).
According to stepwise multivariate analysis (PR = 0.005 and PE = 0.001), several criteria were found to be independent variables predictive of mortality, including patient age (OR = 1.1; 95%CI = 1.0-1.1; p < 0.0001), the presence of small bowel perforation (OR = 2.8; 95%CI = 1.5-5.3; p < 0.0001), a delayed initial intervention (a delay exceeding 24 hours) (OR = 1.8; 95%CI = 1.5-3.7; p < 0.0001), ICU admission (OR = 5.9; 95%CI = 3.6-9.5; p < 0.0001) and patient immunosuppression (OR = 3.8; 95%CI = 2.1-6.7; p < 0.0001).
doi:10.1186/1749-7922-9-37
PMCID: PMC4039043  PMID: 24883079
6.  2013 WSES guidelines for management of intra-abdominal infections 
Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high.
The 2013 update of the World Society of Emergency Surgery (WSES) guidelines for the management of intra-abdominal infections contains evidence-based recommendations for management of patients with intra-abdominal infections.
doi:10.1186/1749-7922-8-3
PMCID: PMC3545734  PMID: 23294512
7.  Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study) 
Sartelli, Massimo | Catena, Fausto | Ansaloni, Luca | Moore, Ernest | Malangoni, Mark | Velmahos, George | Coimbra, Raul | Koike, Kaoru | Leppaniemi, Ari | Biffl, Walter | Balogh, Zsolt | Bendinelli, Cino | Gupta, Sanjay | Kluger, Yoram | Agresta, Ferdinando | Di Saverio, Salomone | Tugnoli, Gregorio | Jovine, Elio | Ordonez, Carlos | Gomes, Carlos Augusto | Junior, Gerson Alves Pereira | Yuan, Kuo-Ching | Bala, Miklosh | Peev, Miroslav P | Cui, Yunfeng | Marwah, Sanjay | Zachariah, Sanoop | Sakakushev, Boris | Kong, Victor | Ahmed, Adamu | Abbas, Ashraf | Gonsaga, Ricardo Alessandro Teixeira | Guercioni, Gianluca | Vettoretto, Nereo | Poiasina, Elia | Ben-Ishay, Offir | Díaz-Nieto, Rafael | Massalou, Damien | Skrovina, Matej | Gerych, Ihor | Augustin, Goran | Kenig, Jakub | Khokha, Vladimir | Tranà, Cristian | Kok, Kenneth Yuh Yen | Mefire, Alain Chichom | Lee, Jae Gil | Hong, Suk-Kyung | Lohse, Helmut Alfredo Segovia | Ghnnam, Wagih | Verni, Alfredo | Lohsiriwat, Varut | Siribumrungwong, Boonying | Tavares, Alberto | Baiocchi, Gianluca | Das, Koray | Jarry, Julien | Zida, Maurice | Sato, Norio | Murata, Kiyoshi | Shoko, Tomohisa | Irahara, Takayuki | Hamedelneel, Ahmed O | Naidoo, Noel | Adesunkanmi, Abdul Rashid Kayode | Kobe, Yoshiro | Attri, AK | Sharma, Rajeev | Coccolini, Federico | El Zalabany, Tamer | Khalifa, Khalid Al | Sanjuan, Juan | Barnabé, Rita | Ishii, Wataru
Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18–98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients.
The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.
doi:10.1186/1749-7922-8-1
PMCID: PMC3538624  PMID: 23286785
8.  Fatal Peripheral Candidal Suppurative Thrombophlebitis in a Postoperative Patient 
Journal of Korean Medical Science  2008;23(6):1094-1096.
We report a case of fatal fungal peripheral suppurative thrombophlebitis, caused by Candida albicans, which was disseminated to the blood, lungs, eyes, and spine. Clinical suspicion and aggressive management are important in managing fungal peripheral suppurative thrombophlebitis. Early clinical suspicion is important in managing fungal peripheral suppurative thrombophlebitis, and radical excision of the affected veins, recognition of metastatic foci, and use of systemic antifungal agents are essential to avoid septic shock and death.
doi:10.3346/jkms.2008.23.6.1094
PMCID: PMC2610646  PMID: 19119456
Candidemia; Shock, Septic; Thrombophlebitis

Results 1-8 (8)