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Diagnostics
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Abdominal Surgical Diseases: Diagnosis, Treatment and Management
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Abdominal Surgical Diseases: Diagnosis, Treatment and Management

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 73190

Special Issue Editor

Dr. Bogdan Socea

E-Mail Website
Guest Editor
Department of Surgery, Sf. Pantelimon Emergency Clinical Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, 021659 Bucharest, Romania
Interests: pancreatic cancer; acute pancreatitis; abdominal compartment syndrome; FAST, POCUS and pulmonary ultrasound; colorectal cancer; abdominal wall defects: hernias and incisional hernias
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Diagnostics (ISSN 2075-4418; CODEN: DIAGC9) is an international, peer-reviewed, open-access journal on medical diagnosis, published monthly online by MDPI.  Diagnostics has just received an updated Journal Impact Factor of 3.110 in the June 2020 release of the Journal Citation Reports, and ranks 39/165 (Q1) among all titles in the ‘’Medicine, General and Internal’’ category. I am honoured to be a Guest Editor for the Special Issue “Abdominal Surgical Diseases: Diagnosis, Treatment, and Management” of this valuable journal, which is planned for the spring of 2021, and I invite all of you to make a scientific contribution on the topic of abdominal surgery.

Abdominal surgical conditions often raise challenging diagnostic and management issues. The surgeon is often faced with difficult decision-making situations, especially in emergency conditions. Imaging methods are very useful in diagnostic guidance, but often the emergency condition does not provide the needed time to perform complex investigations. Sometimes, we revert to clinical exams, plain X-rays, FAST exams, and point-of-care ultrasound (POCUS). Interdisciplinarity can also be the key to a correct approach towards patients. Our defined scope of the topic for this Special Issue is to establish modern management protocols in the diagnosis, treatment, and management of digestive surgical diseases.   

 

Dr. Bogdan Socea
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Abdominal surgery
  • Imagistic diagnosis
  • Decision-making
  • Interdisciplinarity in digestive surgery
  • Laparoscopy
  • Pocus ultrasound.

Published Papers (16 papers)

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Research

Jump to: Review, Other

12 pages, 937 KiB  
Article
Serum and Urine Biomarker Leucine-Rich Alpha-2 Glycoprotein 1 Differentiates Pediatric Acute Complicated and Uncomplicated Appendicitis
by Mohit Kakar, Marisa Maija Berezovska, Renars Broks, Lasma Asare, Mathilde Delorme, Emile Crouzen, Astra Zviedre, Aigars Reinis, Arnis Engelis, Juta Kroica, Amulya Saxena and Aigars Petersons
Diagnostics 2021, 11(5), 860; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11050860 - 11 May 2021
Cited by 9 | Viewed by 2174
Abstract
Purpose: This prospective, single-center cohort study analyzes the potential of inflammatory protein mediator leucine-rich alpha-2 glycoprotein 1 (LRG1) for the early and accurate diagnosis of acute appendicitis (AA), and differentiation of acute complicated (AcA) from uncomplicated appendicitis (AuA). Methods: Participants were divided into [...] Read more.
Purpose: This prospective, single-center cohort study analyzes the potential of inflammatory protein mediator leucine-rich alpha-2 glycoprotein 1 (LRG1) for the early and accurate diagnosis of acute appendicitis (AA), and differentiation of acute complicated (AcA) from uncomplicated appendicitis (AuA). Methods: Participants were divided into the AcA, AuA, and control groups, and their serum (s-LRG1) and urine LRG1 (u-LRG1) levels were assayed preoperatively on the second and fifth postoperative days. Results: 153 patients participated, 97 had AA. Preoperative u-LRG1 with a cut-off value of 0.18 μg/mL generated an area under the receiver operated characteristic (AUC) curve of 0.70 (95% CI 0.62–0.79) for AA versus control (p < 0.001), while the results for AcA versus AuA were not significant (AUC 0.60, 95% CI 0.49–0.71, p = 0.089). The s-LRG1 levels of AA versus the control with a cut-off value of 51.69 μg/mL generated an AUC of 0.94 (95% CI 0.91–0.99, p < 0.001). The cut-off value of s-LRG1 was 84.06 μg/mL for diagnosis of AcA from AuA, and therefore, significant (AUC 0.69, 95% CI 0.59–0.80, p = 0.001). Conclusions: LRG1 exhibited excellent diagnostic performance as an inexpensive, non-invasive, rapid, and accurate biomarker able to reflect the pathogenesis of AA. LRG1 has the potential to replace advanced imaging to diagnose clinically ambiguous AA cases. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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13 pages, 1159 KiB  
Article
Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis
by Kojiro Omiya, Kazuhiro Hiramatsu, Yoshihisa Shibata, Masahide Fukaya, Masahiro Fujii, Taro Aoba, Atsuki Arimoto, Takayuki Yamaguchi and Takehito Kato
Diagnostics 2021, 11(3), 383; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11030383 - 24 Feb 2021
Cited by 4 | Viewed by 2917
Abstract
Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively [...] Read more.
Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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11 pages, 290 KiB  
Article
Evaluation of Pre-Therapeutic Assessment in Endometrial Cancer Staging
by Caroline Bouche, Manuel Gomes David, Julia Salleron, Philippe Rauch, Léa Leufflen, Julie Buhler and Frédéric Marchal
Diagnostics 2020, 10(12), 1045; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics10121045 - 04 Dec 2020
Cited by 9 | Viewed by 2181
Abstract
Objective: The aim of this retrospective cohort study is to evaluate the concordance between the preoperative MRI and histology data with the final histopathological examination. Method: This is a retrospective observational study of 183 patients operated for endometrioid cancer between January 2009 and [...] Read more.
Objective: The aim of this retrospective cohort study is to evaluate the concordance between the preoperative MRI and histology data with the final histopathological examination. Method: This is a retrospective observational study of 183 patients operated for endometrioid cancer between January 2009 and December 2019 in the surgical oncology department of the Lorraine Cancer Institute (ICL) in Vandœuvre-lès-Nancy. The patients included are all women operated on for endometrioid-type endometrial cancer over this period. The exclusion criteria are patients for whom the pre-therapy check-up does not include pelvic MRI and those who have not had first-line surgery. The final anatomopathological results were compared with preoperative imaging data and with endometrial biopsy data. Results: For the myometrial infiltration, the sensitivity of MRI was of 37% and the specificity of 54%. To detect nodal metastases, the sensitivity of MRI was of 21% and the specificity of 93%. We observed an under estimation of the FIGO classification (p = 0.001) with the MRI in 42.7% of cases (n = 76) and an overestimation in 24.2% of cases (n = 43). There was a concordance in 33.1% of cases (n = 59). We had a poor agreement between the MRI and final histopathological examination with an adjusted kappa (κ) of 0.12 [95% IC (0.02; 0.24)]. There was a moderate concordance on the grade between the pretherapeutic biopsy and the final histopathological examination on excised tissue with an adjusted kappa of 0.52 [95% IC 0.42–0.62)]. Endometrial biopsy underestimated the tumor grade in 28.9% of cases (n = 50) (p < 0.001), overestimated the tumor grade in 6.9% of cases (n = 12) and we observed a concordance in 64.2% of cases (n = 111). Conclusion: The pre-operative assessment of endometrial cancer is inconsistent with the results obtained on final histopathological examination. A study with a systematic review should be done to assess the performance of MRI, only in expert centers, in order to consider a a specific care management for endometrial cancer patients: patients who have had an MRI in an outpatient center should have their imaging systematically reviewed, with the possibility of a new examination in case of incomplete sequences, by expert radiologists, and discussed in multidisciplinary concertation meeting in expert centers, before any therapeutic decision. The sentinel node biopsy must be used for low and intermediate risk endometrial cancer. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
15 pages, 4804 KiB  
Article
Dynamic Enhancement Pattern on CT for Predicting Pancreatic Neuroendocrine Neoplasms with Low PAX6 Expression: A Retrospective Observational Study
by Koichiro Kimura, Junichi Tsuchiya, Yoshio Kitazume, Mitsuhiro Kishino, Keiichi Akahoshi, Atsushi Kudo, Shinji Tanaka, Minoru Tanabe and Ukihide Tateishi
Diagnostics 2020, 10(11), 919; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics10110919 - 09 Nov 2020
Cited by 2 | Viewed by 1699
Abstract
Paired box 6 (PAX6) is a transcription factor that plays a critical role in tumor suppression, implying that the downregulation of PAX6 promotes tumor growth and invasiveness. This study aimed to examine dynamic computed tomography (CT) features for predicting pancreatic neuroendocrine neoplasms (Pan-NENs) [...] Read more.
Paired box 6 (PAX6) is a transcription factor that plays a critical role in tumor suppression, implying that the downregulation of PAX6 promotes tumor growth and invasiveness. This study aimed to examine dynamic computed tomography (CT) features for predicting pancreatic neuroendocrine neoplasms (Pan-NENs) with low PAX6 expression. We retrospectively evaluated 51 patients with Pan-NENs without synchronous liver metastasis to assess the pathological expression of PAX6. Two radiologists analyzed preoperative dynamic CT images to determine morphological features and enhancement patterns. We compared the CT findings between low and high PAX6 expression groups. Pathological analysis identified 11 and 40 patients with low and high PAX6 expression, respectively. Iso- or hypoenhancement types in the arterial and portal phases were significantly associated with low PAX6 expression (p = 0.009; p = 0.001, respectively). Low PAX6 Pan-NENs showed a lower portal enhancement ratio than high PAX6 Pan-NENs (p = 0.044). The combination based on enhancement types (iso- or hypoenhancement during arterial and portal phases) and portal enhancement ratio (≤1.22) had 54.5% sensitivity, 92.5% specificity, and 84.3% accuracy in identifying low PAX6 Pan-NENs. Dynamic CT features, including iso- or hypoenhancement types in the arterial and portal phases and lower portal enhancement ratio may help predict Pan-NENs with low PAX6 expression. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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10 pages, 636 KiB  
Article
Neutrophil/Lymphocyte Ratio as Predictor of Anastomotic Leak after Gastric Cancer Surgery
by Dumitru Radulescu, Vlad Dumitru Baleanu, Vlad Padureanu, Patricia Mihaela Radulescu, Silviu Bordu, Stefan Patrascu, Bogdan Socea, Nicolae Bacalbasa, Marin Valeriu Surlin, Ion Georgescu and Eugen Florin Georgescu
Diagnostics 2020, 10(10), 799; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics10100799 - 09 Oct 2020
Cited by 27 | Viewed by 2650
Abstract
Introduction. Neutrophil/lymphocyte ratio (NLR) is known as a prognostic for the outcome of the patients with gastric cancer. As no definite risk marker for anastomotic leakage after gastric resection was identified, we investigated the possible role of NLR. Methods. Peripheral blood count for [...] Read more.
Introduction. Neutrophil/lymphocyte ratio (NLR) is known as a prognostic for the outcome of the patients with gastric cancer. As no definite risk marker for anastomotic leakage after gastric resection was identified, we investigated the possible role of NLR. Methods. Peripheral blood count for neutrophils and lymphocytes was done at the patient’s admission. We retrospectively evaluated 204 gastric cancer patients, who underwent gastric resection, comparing the values of NLR between the group of patients with anastomotic leakage and those without complications. Results. Using the ROC curve, we found the cutoff value of NLR, which permitted the comparison of the group with low NLR, presenting increased NLR. The cutoff value for NLR was 3.54. Between the two groups, we could observe statistically significant differences in developing fistula (p < 0.01) and complications leading to death (p < 0.025). The odds ratio for patients with NLR greater than 3.54 to develop anastomotic leak was 17.62, compared to those with lower NLR. Conclusion. Peripheral blood NLR proved to be a predictor for anastomotic leakage. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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19 pages, 3688 KiB  
Article
Spatial Configuration of Abdominal Aortic Aneurysm Analysis as a Useful Tool for the Estimation of Stent-Graft Migration
by Andrzej Polanczyk, Aleksandra Piechota-Polanczyk, Ludomir Stefańczyk and Michał Strzelecki
Diagnostics 2020, 10(10), 737; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics10100737 - 23 Sep 2020
Cited by 6 | Viewed by 2221
Abstract
The aim of this study was to prepare a self-made mathematical algorithm for the estimation of risk of stent-graft migration with the use of data on abdominal aortic aneurysm (AAA) size and geometry of blood flow through aneurysm sac before or after stent-graft [...] Read more.
The aim of this study was to prepare a self-made mathematical algorithm for the estimation of risk of stent-graft migration with the use of data on abdominal aortic aneurysm (AAA) size and geometry of blood flow through aneurysm sac before or after stent-graft implantation. AngioCT data from 20 patients aged 50–60 years, before and after stent-graft placement in the AAA was analyzed. In order to estimate the risk of stent-graft migration for each patient we prepared an opposite spatial configuration of virtually reconstructed stent-graft with long body or short body. Thus, three groups of 3D geometries were analyzed: 20 geometries representing 3D models of aneurysm, 20 geometries representing 3D models of long body stent-grafts, and 20 geometries representing 3D models of short body stent-graft. The proposed self-made algorithm demonstrated its efficiency and usefulness in estimating wall shear stress (WSS) values. Comparison of the long or short type of stent-graft with AAA geometries allowed to analyze the implants’ spatial configuration. Our study indicated that short stent-graft, after placement in the AAA sac, generated lower drug forces compare to the long stent-graft. Each time shape factor was higher for short stent-graft compare to long stent-graft. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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Review

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11 pages, 6343 KiB  
Review
Difficulties in Diagnosing Extraperitoneal Ureteroinguinal Hernias: A Review of the Literature and Clinical Experience of a Rare Encounter in Acute Surgical Care Settings
by Catalin Pirvu, Stelian Pantea, Alin Popescu, Mirela Loredana Grigoras, Felix Bratosin, Andrei Valceanu, Tudorel Mihoc, Vlad Dema and Mircea Selaru
Diagnostics 2022, 12(2), 353; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020353 - 29 Jan 2022
Cited by 1 | Viewed by 2213
Abstract
Although inguinal hernia repair is one of the most common surgical procedures, finding a retroperitoneal structure, such as the ureter, is a rather rare occurrence. Ureteroinguinal hernias may arise in the presence or absence of obstructive uropathy, the latter raising difficulties in diagnosis [...] Read more.
Although inguinal hernia repair is one of the most common surgical procedures, finding a retroperitoneal structure, such as the ureter, is a rather rare occurrence. Ureteroinguinal hernias may arise in the presence or absence of obstructive uropathy, the latter raising difficulties in diagnosis for the general surgeon performing a regular inguinal hernia surgery. This study aims to collect the relevant literature describing the diagnosis and management of ureteroinguinal hernias and update it with a case encountered in our clinic. The following study was reported following the SCARE guidelines. The relevant literature describes less than 150 cases of ureteroinguinal hernias overall, considering the 1.7% prevalence of inguinal hernias in the general population. With only 20% of these hernias being described as extraperitoneal, such an encounter becomes an extremely rare finding. Our clinical experience brings a case of a 75-year-old male with frequent urinary tract infections and a large irreducible inguinoscrotal hernia of about 20/12 cm located at the right scrotum. The patient underwent an open inguinal hernia repair technique under general anesthesia, incidentally finding an extraperitoneal ureteral herniation. Segmental ureterectomy was performed with uneventful recovery. Intraoperatively, finding an incidental ureteroinguinal hernia raises concerns about probable urinary tract complications during regular hernia repair surgery and whether the diagnosis is likely to happen prior to surgical intervention. Although imaging is rarely indicated in inguinal hernias, the case reports show that a pelvic CT scan with urography in symptomatic patients with urinary symptoms will provide accurate confirmation of the diagnosis. The relevant literature is limited due to the rarity of respective cases, thus making standardized management of such cases unlikely. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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15 pages, 369 KiB  
Review
Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery
by Eugenia Claudia Zarnescu, Narcis Octavian Zarnescu and Radu Costea
Diagnostics 2021, 11(12), 2382; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11122382 - 17 Dec 2021
Cited by 32 | Viewed by 7514
Abstract
Anastomotic leakage is a potentially severe complication occurring after colorectal surgery and can lead to increased morbidity and mortality, permanent stoma formation, and cancer recurrence. Multiple risk factors for anastomotic leak have been identified, and these can allow for better prevention and an [...] Read more.
Anastomotic leakage is a potentially severe complication occurring after colorectal surgery and can lead to increased morbidity and mortality, permanent stoma formation, and cancer recurrence. Multiple risk factors for anastomotic leak have been identified, and these can allow for better prevention and an earlier diagnosis of this significant complication. There are nonmodifiable factors such as male gender, comorbidities and distance of tumor from anal verge, and modifiable risk factors, including smoking and alcohol consumption, obesity, preoperative radiotherapy and preoperative use of steroids or non-steroidal anti-inflammatory drugs. Perioperative blood transfusion was shown to be an important risk factor for anastomotic failure. Recent studies on the laparoscopic approach in colorectal surgery found no statistical difference in anastomotic leakage rate compared with open surgery. A diverting stoma at the time of primary surgery does not appear to reduce the leak rate but may reduce its clinical consequences and the need for additional surgery if anastomotic leakage does occur. It is still debatable if preoperative bowel preparation should be used, especially for left colon and rectal resections, but studies have shown similar incidence of postoperative leak rate. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
17 pages, 2078 KiB  
Review
Differential Diagnosis of Abdominal Tuberculosis in the Adult—Literature Review
by Sinziana Ionescu, Alin Codrut Nicolescu, Octavia Luciana Madge, Marian Marincas, Madalina Radu and Laurentiu Simion
Diagnostics 2021, 11(12), 2362; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11122362 - 15 Dec 2021
Cited by 5 | Viewed by 4366
Abstract
Tuberculosis (TB) is a public health issue that affects mostly, but not exclusively, developing countries. Abdominal TB is difficult to detect at first, with the incidence ranging from 10% to 30% of individuals with lung TB. Symptoms are non-specific, examinations can be misleading, [...] Read more.
Tuberculosis (TB) is a public health issue that affects mostly, but not exclusively, developing countries. Abdominal TB is difficult to detect at first, with the incidence ranging from 10% to 30% of individuals with lung TB. Symptoms are non-specific, examinations can be misleading, and biomarkers commonly linked with other diseases can also make appropriate diagnosis difficult. As a background for this literature review, the method used was to look into the main characteristics and features of abdominal tuberculosis that could help with differentiation on the PubMed, Science Direct, and Academic Oxford Journals databases. The results were grouped into three categories: A. general features (the five forms of abdominal tuberculosis: wet and dry peritonitis, lymphadenopathy, lesions at the level of the cavitary organs, lesions at the level of the solid organs), B. different intra-abdominal organs and patterns of involvement (oesophageal, gastro-duodenal, jejunal, ileal, colorectal, hepatosplenic, and pancreatic TB with calcified lymphadenopathy, also with description of extraperitoneal forms), and C. special challenges of the differential diagnosis in abdominal TB (such as diagnostic overlap, the disease in transplant candidates and transplant recipients, and zoonotic TB). The study concluded that, particularly in endemic countries, any disease manifesting with peritonitis, lymphadenopathy, or lesions at the level of the intestines or solid organs should have workups and protocols applied that can confirm/dismiss the suspicion of abdominal tuberculosis. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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10 pages, 282 KiB  
Review
Abdominal Compartment Syndrome—When Is Surgical Decompression Needed?
by Dan Nicolae Păduraru, Octavian Andronic, Florentina Mușat, Alexandra Bolocan, Mihai Cristian Dumitrașcu and Daniel Ion
Diagnostics 2021, 11(12), 2294; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11122294 - 07 Dec 2021
Cited by 3 | Viewed by 3357
Abstract
Compartment syndrome occurs when increased pressure inside a closed anatomical space compromises tissue perfusion. The sudden increase in pressure inside these spaces requires rapid decompression by means of surgical intervention. In the case of abdominal compartment syndrome (ACS), surgical decompression consists of a [...] Read more.
Compartment syndrome occurs when increased pressure inside a closed anatomical space compromises tissue perfusion. The sudden increase in pressure inside these spaces requires rapid decompression by means of surgical intervention. In the case of abdominal compartment syndrome (ACS), surgical decompression consists of a laparostomy. The aim of this review is to identify the landmarks and indications for the appropriate moment to perform decompression laparotomy in patients with ACS based on available published data. A targeted literature review was conducted on indications for decompression laparotomy in ACS. The search was focused on three conditions characterized by a high ACS prevalence, namely acute pancreatitis, ruptured abdominal aortic aneurysm and severe burns. There is still a debate around the clinical characteristics which require surgical intervention in ACS. According to the limited data published from observational studies, laparotomy is usually performed when intra-abdominal pressure reaches values ranging from 25 to 36 mmHg on average in the case of acute pancreatitis. In cases of a ruptured abdominal aortic aneurysm, there is a higher urgency to perform decompression laparotomy for ACS due to the possibility of continuous hemorrhage. The most conflicting recommendations on whether surgical treatment should be delayed in favor of other non-surgical interventions come from studies involving patients with severe burns. The results of the review must be interpreted in the context of the limited available robust data from observational studies and clinical trials. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
17 pages, 4283 KiB  
Review
Idiopathic Megacolon—Short Review
by Adrian Constantin, Florin Achim, Dan Spinu, Bogdan Socea and Dragos Predescu
Diagnostics 2021, 11(11), 2112; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11112112 - 15 Nov 2021
Cited by 5 | Viewed by 4949
Abstract
Introduction: Idiopathic megacolon (IM) is a rare condition with a more or less known etiology, which involves management challenges, especially therapeutic, and both gastroenterology and surgery services. With insufficiently drawn out protocols, but with occasionally formidable complications, the condition management can be difficult [...] Read more.
Introduction: Idiopathic megacolon (IM) is a rare condition with a more or less known etiology, which involves management challenges, especially therapeutic, and both gastroenterology and surgery services. With insufficiently drawn out protocols, but with occasionally formidable complications, the condition management can be difficult for any general surgery team, either as a failure of drug therapy (in the context of a known case, initially managed by a gastroenterologist) or as a surgical emergency (in which the diagnostic surprise leads additional difficulties to the tactical decision), when the speed imposed by the severity of the case can lead to inadequate strategies, with possibly critical consequences. Method: With such a motivation, and having available experience limited by the small number of cases (described by all medical teams concerned with this pathology), the revision of the literature with the update of management landmarks from the surgical perspective of the pathology appears as justified by this article. Results: If the diagnosis of megacolon is made relatively easily by imaging the colorectal dilation (which is associated with initial and/or consecutive clinical aspects), the establishing of the diagnosis of idiopathic megacolon is based in practice almost exclusively on a principle of exclusion, and after evaluating the absence of some known causes that can lead to the occurrence of these anatomic and clinical changes, mimetically, clinically, and paraclinically, with IM (intramural aganglionosis, distal obstructions, intoxications, etc.). If the etiopathogenic theories, based on an increase in the performance of the arsenal of investigations of the disease, have registered a continuous improvement and an increase of objectivity, unfortunately, the curative surgical treatment options still revolve around the same resection techniques. Moreover, the possibility of developing a form of etiopathogenic treatment seems as remote as ever. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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10 pages, 833 KiB  
Review
The Current Diagnostic Accuracy on Free Peritoneal Fluid in Computed Tomography to Determinate the Necessity of Surgery in Blunt Bowel and Mesenteric Trauma—Systemic Review and Meta-Analysis
by Szu-An Chen, Chen-Yu Wang, Chih-Po Hsu, Jia-Yen Lin, Chi-Tung Cheng, Chun-Hsiang Ouyang, Jen-Fu Huang and Chien-Hung Liao
Diagnostics 2021, 11(11), 2028; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11112028 - 02 Nov 2021
Viewed by 1238
Abstract
Traumatic bowel mesenteric injury (TBMI) is a challenge in trauma care. The presence of free peritoneal fluid (FF) in computed tomography (CT) was considered the indication for surgical intervention. However, conservative treatment should be applied for minor injuries. We conduct a systematic review [...] Read more.
Traumatic bowel mesenteric injury (TBMI) is a challenge in trauma care. The presence of free peritoneal fluid (FF) in computed tomography (CT) was considered the indication for surgical intervention. However, conservative treatment should be applied for minor injuries. We conduct a systematic review to analyze how reliable the FF is to assess the TBMI. Publications were retrieved by structured searching among databases, review articles and major textbooks. For statistical analysis, summary receiver operating characteristic curves (SROCs) were computed using hierarchical models. Fourteen studies enrolling 4336 patients were eligible for final qualitative analysis. The SROC line was created by a hierarchical summary receiver operating characteristic model. The summary sensitivity of FF to predict surgical TBMI was 0.793 (95% CI: 0.635–0.894), and the summary specificity of FF to predict surgical TBMI was 0.733 (95% CI: 0.468–0.896). The diagnostic odds ratio was 10.531 (95% CI: 5.556–19.961). This study represents the most robust evidence (level 3a) to date that FF is not the absolute but an acceptable indicator for surgically important TBMI. However, there is still a need for randomized controlled trials to confirm. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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13 pages, 4869 KiB  
Review
Ultrasound of Small Bowel Obstruction: A Pictorial Review
by Nicola Rosano, Luigi Gallo, Giuseppe Mercogliano, Pasquale Quassone, Ornella Picascia, Marco Catalano, Antonella Pesce, Valeria Fiorini, Ida Pelella, Giuliana Vespere, Marina Romano, Pasquale Tammaro, Ester Marra, Gabriella Oliva, Marina Lugarà, Mario Scuderi, Stefania Tamburrini and Ines Marano
Diagnostics 2021, 11(4), 617; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11040617 - 30 Mar 2021
Cited by 10 | Viewed by 19228
Abstract
Small bowel obstruction (SBO) is a common condition requiring urgent attention that may involve surgical treatment. Imaging is essential for the diagnosis and characterization of SBO because the clinical presentation and results of laboratory tests may be nonspecific. Ultrasound is an excellent initial [...] Read more.
Small bowel obstruction (SBO) is a common condition requiring urgent attention that may involve surgical treatment. Imaging is essential for the diagnosis and characterization of SBO because the clinical presentation and results of laboratory tests may be nonspecific. Ultrasound is an excellent initial imaging modality for assisting physicians in the rapid and accurate diagnosis of a variety of pathologies to expedite management. In the case of SBO diagnosis, ultrasound has an overall sensitivity of 92% (95% CI: 89–95%) and specificity of 93% (95% CI: 85–97%); the aim of this review is to examine the criteria for the diagnosis of SBO by ultrasound, which can be divided into diagnostic and staging criteria. The diagnostic criteria include the presence of dilated loops and abnormal peristalsis, while the staging criteria are represented by parietal and valvulae conniventes alterations and by the presence of free extraluminal fluid. Ultrasound has reasonably high accuracy compared to computed tomography (CT) scanning and may substantially decrease the time to diagnosis; moreover, ultrasound is also widely used in the monitoring and follow-up of patients undergoing conservative treatment, allowing the assessment of loop distension and the resumption of peristalsis. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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20 pages, 503 KiB  
Review
Indocyanine Green-Enhanced Colorectal Surgery—between Being Superfluous and Being a Game-Changer
by Catalin Alius, Corneliu Tudor, Cristinel Dumitru Badiu, Ana Maria Dascalu, Catalin Gabriel Smarandache, Alexandru Dan Sabau, Ciprian Tanasescu, Simona Andreea Balasescu and Dragos Serban
Diagnostics 2020, 10(10), 742; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics10100742 - 24 Sep 2020
Cited by 24 | Viewed by 3864
Abstract
Nowadays, surgical innovations incorporate new technological conquests and must be validated by evidence-based medicine. The use of augmented reality-assisted indocyanine green (ICG) fluorescence has generated a myriad of intraoperative applications such as demonstration of key anatomical landmarks, sentinel lymph nodes, and real-time assessment [...] Read more.
Nowadays, surgical innovations incorporate new technological conquests and must be validated by evidence-based medicine. The use of augmented reality-assisted indocyanine green (ICG) fluorescence has generated a myriad of intraoperative applications such as demonstration of key anatomical landmarks, sentinel lymph nodes, and real-time assessment of local blood flow. This paper presents a systematic review of the clinical evidence regarding the applications of ICG near-infrared (NIR) fluorescence in colorectal surgery. After we removed duplicate publications and screened for eligibility, a total of 36 articles were evaluated: 23 on perfusion assessment, 10 on lymph node mapping, and 3 on intraoperative identification of ureters. Lack of homogenous studies, low statistical power, and confounding evidence were found to be common amongst publications supporting the use of ICG in colorectal surgery, raising concerns over this seductive technique′s cost efficiency and redundancy. The compiled data showed that ICG NIR fluorescence may be a game-changer in particular situations, as proven for low colorectal anastomosis or lateral pelvic lymph node dissection, but it remains controversial for routine use and sentinel lymph node assessment. Further randomized studies are needed to confirm these conclusions. Future research directions include tumor-targeted fluorescence imaging and digital software for quantitative evaluation of fluorescence. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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16 pages, 722 KiB  
Review
Laparoscopic Surgery in COVID-19 Era—Safety and Ethical Issues
by Dragos Serban, Catalin Gabriel Smarandache, Corneliu Tudor, Lucian Nicolae Duta, Ana Maria Dascalu and Cătălin Aliuș
Diagnostics 2020, 10(9), 673; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics10090673 - 04 Sep 2020
Cited by 28 | Viewed by 4611
Abstract
(1) Background: The paper aims to review the available evidence regarding the health risk of the aerosolization induced by laparoscopy induced and impact of the COVID-19 pandemic upon minimally invasive surgery. (2) Materials and methods: A systematic review of the literature was performed [...] Read more.
(1) Background: The paper aims to review the available evidence regarding the health risk of the aerosolization induced by laparoscopy induced and impact of the COVID-19 pandemic upon minimally invasive surgery. (2) Materials and methods: A systematic review of the literature was performed on PubMed, Medline and Scopus until 10 July. (3) Results: Chemicals, carcinogens and biologically active materials, such as bacteria and viruses, have been isolated in surgical smoke. However, the only evidence of viral transmission through surgical smoke to medical staff is post-laser ablation of HPV-positive genital warts. The reports of SARS-CoV-2 infected patients who underwent laparoscopic surgery revealed the presence of the virus, when tested, in digestive wall and stools in 50% of cases but not in bile or peritoneal fluid. All surgeries did not result in contamination of the personnel, when protective measures were applied, including personal protective equipment (PPE) and filtration of the pneumoperitoneum. There are no comparative studies between classical and laparoscopic surgery. (4) Conclusions: Previously published data showed there is a possible infectious and toxic risk related to surgical smoke but not particularly proven for SARS-CoV-2. Implementing standardized filtration systems for smoke evacuation during laparoscopy, although increases costs, is necessary to increase the safety and it will probably remain a routine also in the future. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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19 pages, 6117 KiB  
Case Report
How Many Times Can One Go Back to the Drawing Board before the Accurate Diagnosis and Surgical Treatment of Glucagonoma?
by Carmen Sorina Martin, Ovidiu Dumitru Parfeni, Liliana Gabriela Popa, Mara Madalina Mihai, Dana Terzea, Vlad Herlea, Mirela Gherghe, Razvan Adam, Osama Alnuaimi, Valentin Calu, Adrian Miron, Silvius Negoita, Cornelia Nitipir and Simona Fica
Diagnostics 2022, 12(1), 216; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12010216 - 16 Jan 2022
Cited by 6 | Viewed by 4102
Abstract
Glucagonomas are neuroendocrine tumors (NETs) that arise from the alpha cells of the pancreatic islets. They are typically slow-growing tumors associated with abnormal glucagon secretion, resulting in one or more non-specific clinical features, such as necrolytic migratory erythema (NME), diabetes, diarrhea, deep vein [...] Read more.
Glucagonomas are neuroendocrine tumors (NETs) that arise from the alpha cells of the pancreatic islets. They are typically slow-growing tumors associated with abnormal glucagon secretion, resulting in one or more non-specific clinical features, such as necrolytic migratory erythema (NME), diabetes, diarrhea, deep vein thrombosis, weight loss, and depression. Here, we report the case of a 44-year-old male with a history of diabetes mellitus, presenting with a pruritic and painful disseminated cutaneous eruption of erythematous plaques, with scales and peripheral pustules, misdiagnosed as disseminated pustular psoriasis and treated for 2 years with oral retinoid and glucocorticoids. During this period, the patient complained of weight loss of 32 kg and diarrhea and developed deep vein thrombosis. These symptoms, together with an inadequate response to therapy of the skin lesions, led to the reassessment of the initial diagnosis. Laboratory tests confirmed elevated plasma glucagon levels (>1000 pg/mL) and computed tomography (CT) scans revealed a 35/44 mm tumor in the pancreatic tail. Due to considerable disease complications and the COVID-19 pandemic, the surgical removal of the tumor was delayed for nearly 2 years. During this time, somatostatin analogue therapy efficiently controlled the glucagonoma syndrome and likely prevented tumor progression. As in other functional pancreatic NETs, the early clinical recognition of hormonal hypersecretion syndrome and the multidisciplinary approach are the keys for best patient management. Full article
(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management)
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