Critical considerations for the management of acute abdomen in transplant patients

The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen.Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems.The perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients.The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes.Immunosuppression in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation agents.Many times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality.Multidetector computed tomo-graphy is of utmost importance for early diagnosis and management.Transplant recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and vigilance.It is necessary to follow evidence-based therapeutic protocols.Thus,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive surgery,including laparoscopic or even robotic surgery).

Evaluation of The Effectiveness of Abdominal and Vaginal B-Ultrasound in The Diagnosis of Acute Abdomen in Obstetrics and Gynecology

Objective: To explore the clinical effect of the combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen in obstetrics and gynecology. Methods: Eighty patients admitted to our hospital from March 2023 to March 2024 were selected, all of whom were acute abdomen patients admitted to the Department of Obstetrics and Gynecology. In this study, the patients were divided into two groups. One group of 40 patients was given a simple abdominal B-ultrasound diagnosis (control group). The other group of 40 patients was given both abdominal and vaginal B-ultrasound examinations (experimental group). The diagnostic accuracy between the two groups was compared. Results: Patients in the experimental group had higher consistency rates with pathological diagnosis results in ectopic pregnancy rupture, embryonic arrest, acute pelvic inflammation, corpus luteum rupture, and intrauterine adhesions as compared to the control group. At the same time, the inspection accuracy rate of the experimental group (92.50%) was higher than that of the control group (70.00%) (P < 0.05). Conclusion: The combined application of abdominal and vaginal B-ultrasound in the diagnosis of acute abdomen was of great significance in improving the accuracy of clinical diagnosis and guiding doctors to provide effective treatment.

Acute abdomen caused by spontaneous rupture of degenerative hysteromyoma during pregnancy:A case report

BACKGROUND Hysteromyoma is not a rare tumor among pregnant women.During pregnancy,the symptoms caused by hysteromyoma can be improved through conservative treatment in most cases.However,in order to ensure the safety of mothers and children,surgeries are necessary in some special cases.CASE SUMMARY We report a case of pregnancy complicated with hysteromyoma red degeneration.The patient had peritonitis after sudden abdominal pain during the 20th week of pregnancy.Laparoscopic exploration suggested rupture and bleeding of hysteromyoma,which were improved after drainage and an anti-inflammatory treatment.A cesarean section was performed after full term.This case shows the complications of rupture after red degeneration of hysteromyoma during pregnancy.CONCLUSION We should be alert to rupture of hysteromyoma during pregnancy,and active laparoscopic exploration is essential to improve the prognosis of such patients.

Spontaneous gastric hematoma as a rare cause of acute abdomen:A case report

BACKGROUND Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause.Coagulopathies are the most frequent cause of gastric he-matomas.However,other causes include amyloidosis,pancreatitis,visceral vas-cular aneurysms,endoscopy complications and others.The pathophysiology of spontaneous gastric hematoma is not completely understood.However,it is postulated that it is caused by disruption of submucosal vessels that leads to dissection of the muscularis layer and formation of false lumen.The rarity of this condition increases the challenge of diagnosis,and there is no standard treatment protocol.CASE SUMMARY We present the case of a spontaneous gastric hematoma in a 22-year-old male.He presented to our emergency department complaining of pain in the left flank area lasting for 2 wk.There was no history of trauma,antico-agulant medications or endoscopy procedures.His hemoglobin and hematocrit levels were slightly lower than normal.Multi-slice computed tomography,ultrasound and endoscopy confirmed a gastric intramural hematoma.We recommended conservative treatment because there was no hemodynamic instability nor significant bleeding.The patient responded well,and there were no unexpected events.At the 3-mo follow-up,the ultrasound exa-mination revealed complete regression of the hematoma.CONCLUSION After reviewing the literature and our experience,we recommend that more of these cases should be treated conservatively.The tendency to treat these cases with potentially burdensome procedures such as total or subtotal gastrectomy should be significantly reduced.

Etiologies, Clinical Presentation and Outcome of Adult Patients Presenting with Bowel Obstruction on a Virgin Abdomen

Context: Generally in Africa, BO remains the leading cause of acute abdomen. We therefore sought to study the current etiological factors of intestinal obstruction on a virgin abdomen or unhealed abdomen at the central hospital of Yaoundé in order to better understand the main causes and to better anticipate and improve the diagnosis, management and the evolution of intestinal obstruction on a virgin abdomen. Method: The patients were prospectively included from June 2021 to May 2022, these patients were recruited from the digestive and emergency surgery units of the Yaoundé Central Hospital during the study period and who met the inclusion criteria, with suspicion of partial or total intestinal obstruction or those with an intraoperative confirmed diagnosis were enrolled. Results: We recruited 73 patients including 43 (60.3%) men and 29 (39.7%) women whose mean age was 42.5 years with extremes ranging from 16 to 70 years. Most of them consulted after 72 hours, i.e. 65.2% of cases due to self-medication or even prior consultations in the lower level center at the Central Hospital of Yaoundé. The patients retained for this work presented in majority the symptoms according to the abdominal pains, the stop of the materials and gases;meteorism and vomiting. Abdominal wall hernias with incarcerated intestinal loops were the most common cause of intestinal obstruction in an unscarred abdomen in adults at 38.4% of cases, followed by digestive tumors 23.3% and adhesions 17.8%. Exceptionally, a cluster of roundworms was found as the cause of intestinal obstruction in two of our patients. Complications occurred in 25 patients or 31.5% of cases and were dominated respectively by nausea and hematoma (36%), local infections (24%) and malaria (24%). Death occurred in 5 of our patients, or 6.8% of cases, and was mostly caused by hypovolemic shock (40%) and pulmonary embolism (40%). Conclusion: Intestinal obstructions on the abdomen without scarring remain the prerogative of young adults and are caused by strangulated hernias with incarcerated intestinal loops, tumors and adhesions. The rate of complications remains high and they are dominated by infectious pathology. Their mortality is clearly improving.

Prevalence, Aetiology, and Clinical Profile of Acute Abdomen in Pregnancy in Southwest Cameroon: A 5-Year Retrospective Study

Background: Acute abdomen is one of the commonest reasons for presentation at the emergency department. The physiologic changes of pregnancy increase the chances of developing acute abdomen. The global incidence of acute abdomen in pregnancy range from 1 in 500 to 1 in 635 pregnant women. In 2018, a study in Azerbaijan reported a prevalence of 25%. However, to the best of our knowledge, very few studies have been carried out on this subject in Cameroon. Objectives: To determine the prevalence, assess the aetiologies, and review clinical profile of acute abdomen in pregnancy in the Southwest Cameroon. Methods: We conducted a 5-year retrospective study at the Obst/Gyn and Surgical units of Kumba, Buea, and Limbe Regional Hospitals. We included all files of pregnant women that were admitted for acute abdomen within the study period (1st Jan 2017 to 31st Dec 2021). Data was collected using a structured checklist adapted from previous studies. Descriptive statistics and statistical testing was done using SPSS version 25.0. Chi-square was used to compare categorical variables. p Results: Over 14,106 pregnant women were admitted to the aforementioned hospitals within the study period. 335 (2.4%) met our inclusion criteria. The patients’ age ranged from 17 to 43 years. The mean age was 27 years. Acute abdomen was more frequent (65%) in the first trimester. Ectopic pregnancy was the commonest obstetric aetiology while appendicitis was the commonest non obstetric surgical aetiology. Abdominal pain and tenderness were the most common presentation. Conclusion: The prevalence of acute abdomen in pregnancy in the Southwest Cameroon is 10 times higher than the global prevalence. Our study also confirmed the numerous aetiologies and varied clinical presentations of acute abdomen in pregnancy. Hence a wake-up call for primary care physicians.

Pancreatic Pseudocyst Rupture: Cause of Acute Abdomen

Case report of a 23-year-old male patient with a pancreatic pseudocyst, initially was treated by the Interventional Radiology service by placing percutaneous drainage with poor evolution, abruptly presented abdominal pain, Systemic Inflammatory Response Syndrome and peritoneal irritation, so an urgent exploratory laparotomy was performed with a finding of rupture of the pancreatic pseudocyst into the abdominal cavity. He presented septic shock and died in the immediate postoperative period. Computerized Axial Tomography represents the ideal diagnostic method. Spontaneous rupture is extremely rare and requires urgent surgical intervention.

A Qualitative Study of the Triage of Patients with Non-Traumatic Acute Abdomen

Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.

急腹症案例视频剧在护理本科生普外科见习中的实践

目的探讨急腹症案例视频剧结合病房见习,小组案例讨论的实践效果。方法采用便利抽样法选取河北某高校护理系2020级129名护生为研究对象,设计急腹症案例视频剧编写、拍摄、实施计划,护生分组拍摄5个病种,10个视频剧。采用视频剧临床见习调查问卷及书写见习日志的量性与质性研究方法,对学生进行评价。结果见习教学方式:改变了传统填鸭式教学(92.2%)、感受到了临床气氛(93.8%)、培养了护生的职业情感(93.0%)等;能力培养方面:开发了学生创造性思维能力(94.6%)、激发了学习兴趣(93.0%);案例分析过程方面:可以帮助掌握急腹症相关知识(96.1%)、案例反馈使努力得到肯定(96.1%)等。见习日志主题,共4个主题。分别是:掌握了急腹症护理要点;场景逼真,贴近临床;增强了团队合作意识;视频剧让学习生活变得有趣。结论急腹症视频剧结合小组讨论见习模式,改变了单向灌输知识的方法,培养了护生综合运用知识的能力,特别在病源不足或突发公共卫生事件发生时是线下见习的有益补充。

基于“肚腹三里留”理论应用子午流注针法促进腹腔镜胆囊切除术后胃肠功能恢复的疗效评价

目的:评价子午流注针法对腹腔镜胆囊切除术后患者胃肠功能恢复的疗效,同时论证“肚腹三里留”理论的指导作用。方法:本研究以“肚腹三里留”理论为指导,在腹腔镜胆囊切除术后患者以足三里为主穴应用子午流注针法进行择时针刺,通过比较分析两组患者术后首次排气、排便时间和肠鸣音恢复正常时间,血清炎性因子的变化,术后腹胀腹痛程度及恶心呕吐的发生情况,比较两组胃肠功能恢复情况,进一步论证“肚腹三里留”理论的指导作用及子午流注针法的临床疗效。结果:治疗组与对照组比较,患者首次排气时间、首次排便时间和肠鸣音恢复正常时间明显缩短,血清白介素-6、C反应蛋白水平明显降低,两组间比较差异均具有统计学意义(P<0.05)。结论:腹腔镜胆囊切除术后患者应用子午流注针法以足三里为主穴进行择时针刺能够促进患者胃肠功能恢复,进一步验证了“肚腹三里留”理论在腹腔镜胆囊切除术后仍具有指导意义。

化疗患者行个体化低流率腹部增强CT:双源CT低管电压高管电流的可行性分析

目的 探讨在癌症患者中使用双源CT结合低流速和低管电压方案的可行性。方法 共纳入90名进行上腹部增强CT扫描的患者,并随机分为A组、B组和C组(每组30人)。在A组中,患者使用120kVp和448mgl/kg对比剂量进行扫描。B组患者以100kVp和336 mgl/kg对比剂量进行扫描。C组患者以70kVp和224mgI/kg对比剂量进行扫描。对CT值、标准差、信噪比、对比噪声比、主观评分、对比剂剂量和流速进行测量。结果 在三组中,除了肾脏外,主观图像评分无统计学差异(均P>0.05)。与其他组相比,C组在大多数感兴趣区域(ROIs)中显示出显著更高的CT值、更低的噪声水平以及更高的SNR和CNR值(P<0.05)。与A组相比,C组所用对比剂剂量减少了47.3%(79.2±13.7 vs.41.7±8.9,P<0.01),对比剂注射速率降低了19.2%(2.6±0.5 vs.2.1±0.4,P<0.01)。结论 在化疗后血管受损的患者中使用70kVp管电压结合高管电流的方法,在保证图像质量和诊断信心的同时降低流速是可行的。

腹部DCE-MRI联合IVIM诊断子宫内膜病变的临床价值

目的探究腹部磁共振成像动态对比增强成像(DCE-MRI)联合体素内不相干运动扩散加权成像(IVIM)诊断子宫内膜病变的临床价值。方法选取2022年1月至2023年2月我院行MRI检查的子宫内膜病变患者82例,以病理结果为“金标准”,将患者分为良性组(49例)和恶性组(33例),比较两组DCEMRI、IVIM参数差异,绘制ROC曲线分析DCE-MRI联合IVIM检测子宫内膜病变的诊断价值。结果良性组体积转运常数(Ktrans)、速率转运常数(Kep)、体积分数(Ve)值低于恶性组(P<0.05)。良性组慢速表观扩散系数(ADC-slow)、灌注分数(f)、水分子扩散分布指数(DDC)、扩散异质性指数(α)值高于恶性组,快速表观扩散系数(ADC-fast)值低于恶性组(P<0.05)。ROC曲线分析显示:当Ktrans、Ke p、Ve、ADCslow、ADC-fast、f、DDC、αAUC分别为0.812、0.762、0.736、0.726、0.666、0.706、0.686、0.777时,约登指数最大,其截断值分别为0.45、0.86、0.51、0.47、12.69、0.37、1.02、0.66时,联合诊断AUC为0.894(95%CI:0.812~0.975)、灵敏度84.8%、特异度93.9%、阳性预测值93.4%、阴性预测值86.2%均高于各参数单项检测(P<0.05),诊断效能最佳。结论腹部DCE-MRI联合IVIM可提高子宫内膜病变的诊断准确性,具有较高临床价值。

经阴道超声检查联合经腹部超声检查诊断妇产科急腹症的效果评价

目的评估经阴道超声检查联合经腹部超声检查在妇产科急腹症中的诊断效果。方法选取2021年1月—2022年12月酒泉市人民医院妇产科100例急腹症患者为研究对象,患者均接受经阴道及经腹部联合超声检查。参照病理学检查结果,评估超声检查方法的诊断结果。结果100例妇产科急腹症患者,病理检查检出94例,检出率94.00%,准确率100%;100例妇产科急腹症患者,联合超声检出率明显高于经阴道超声、经腹部超声;联合超声准确率明显高于经阴道超声、经腹部超声。结论在妇产科急腹症诊断中,经阴道超声诊断准确率高于经腹部超声,且二者联合后的诊断准确性更高。

列车碰撞安全试验用假人的研究

针对列车碰撞场景与汽车碰撞场景中乘员损伤情况的不同,文章在传统的汽车正面碰撞试验假人(HybridⅢ-50th假人)基础上,参考人体乘员约束测试装置(THOR)假人结构,研制了可调角度的腰椎和立姿臀部模块;并重点研究了上腹部和下腹部生物力学响应特性,制作出可坐可站的列车碰撞安全试验用假人(H3-RS假人),使其既具备HybridⅢ-50th假人生物力学特性,又增加了上腹部和下腹部生物力学特性,更加符合列车碰撞安全试验需求;最后通过台车试验进行了初步验证,结果表明H3-RS假人在结构、功能和强度上基本满足试验需求。

基于从阴引阳从阳引阴浅谈腰痛治腹临床应用

目前临床上针对各种原因导致的腰背疼痛,主要采用单纯背腰部取穴治疗。临床发现,许多腰痛患者在腹部表现出阳性反应点,通过查阅古籍和阅读相关文献,还可采取以“从阴引阳,从阳引阴”理论为基础的腹部取穴法来治疗腰部疼痛疾病,从整体观念出发,平衡阴阳,有助于提高临床疗效。此文通过探讨《黄帝内经》中“从阴引阳”理论和腰痛治腹的指导思想,以期拓宽临床诊疗思路。

腹腔镜辅助下胃癌根治术与传统开腹术对比研究

目的对比腹腔镜辅助下胃癌根治术与传统开腹术临床疗效与患者应激反应程度。方法回顾性选取我院收治的94例胃癌患者,将其中采用开腹胃癌根治术(ORG)治疗的46例纳入ORG组,采用腹腔镜辅助下胃癌根治术(LAGR)治疗的48例纳入LARG组。对比两组手术情况、术后恢复进程、术后各项指标及术后并发症发生率;术后3个月对比两组血清肿瘤标志物变化情况;随访1年,统计两组生存率、复发率与转移率。结果LARG组均顺利完成手术,未发生中转开腹;术后LARG组患者炎症指标水平低于ORG组(P均<0.05);LARG组手术用时长于ORG组,LARG组术中出血量与切口总长度均小于ORG组(P均<0.05);LARG组患者术后肠功能恢复时间、总住院时间均短于ORG组(P均<0.05);LARG组患者术后疼痛评分和术后并发症总发生率低于ORG组(P均<0.05);术后1年,两组复发率、转移率与生存率均未见统计学差异(P均>0.05)。结论腹腔镜辅助下胃癌根治术与传统开腹术相比,能够达到持平的手术效果,虽手术时间较长但术中出血量减少,术后应激反应程度减轻,术后恢复时间缩短。

标准化病人“急腹症”案例构建及在中医临床教学中的应用

目的:探索标准化病人(SP)在中医临床专业外科学急腹症情景模式下的教学应用。方法:选取安徽中医药高等专科学校中医临床专业学生64人,随机分为对照组和实验组,每组32人;对照组采用传统的教学模式,实验组采用SP情景模拟教学法;从理论水平、技能操作、诊断及综合反馈四个维度比较两种方法的教学效果。结果:实验组学生理论考试成绩优于对照组(P=0.006);实验组学生技能操作方面、诊断能力方面、综合评价方面等级情况均优于对照组(P<0.01)。结论:在中医临床专业学生的见习阶段,SP急腹症情景模拟教学的教学效果较好,建议在外科学急腹症教学中应用。

深度学习重建算法改善腹部门静脉期CT图像质量的应用价值

目的:探究深度学习重建算法(Deep learning image reconstruction,DLIR)、传统滤波反投影(Filered back-projection,FBP)及自适应迭代重建算法(Adaptive statistical iterative reconstruction-veo,ASIR-V)对改善腹部门静脉期CT图像质量差异及临床获益。方法:前瞻性纳入45例行腹部增强CT扫描患者,其中包括18例肝硬化失代偿期患者,对门静脉期图像进行FBP、30%ASIR-V、80%ASIR-V及DLIR-H重建,并测量比较4组重建图像肝脏、脾脏、脾静脉、门静脉及左右支CT值、噪声、信噪比(Signal-to-noise ratio,SNR)及对比信噪比(Contrast-to-noise ratio,CNR);比较各重建算法图像主观评价,包括18例肝硬化失代偿期患者交通支血管。结果:4组重建算法图像CT值无统计学差异(P>0.05),噪声、SNR、CNR均有统计学差异,两两比较FBP与30%ASIR-V,80%ASIR-V与DLIR-H在CNR、SNR值中无统计学差异(校正P<0.008),80%ASIR-V与DLIR-H算法在SD值无统计学差异(校正P<0.008),余均有统计学差异。主观评价DLIR图像整体质量、对比度、失真伪影与其他各组有显著性差异(校正P<0.008),仅图像噪声与80%ASIR-V无显著性差异(校正P≥0.008)。DLIR交通支血管轮廓、清晰度与各组有显著性差异(校正P<0.008),噪声与80%ASIR-V无显著性差异(校正P≥0.008)。结论:DLIR算法降低腹部CT图像噪声,改善图像质量具有优势,尤其是肝硬化失代偿期微小血管结构,该重建算法可能为患者的精准诊断、风险评估提供更多信息。

基于人工智能触发技术优化腹部增强图像质量的可行性研究

目的 评估人工智能触发技术优化腹部增强CT图像质量的可行性。方法前瞻性纳入行腹部增强CT扫描100名患者,随机分为两组(A组、B组,每组n=50)A组采用传统固定延迟时间团注追踪技术,B组采用人工智能触发技术。其余扫描方案均一致。比较两组患者的定量参数(CT值、SD值、 SNR、CNR)及定性参数(总体图像质量和诊断可信度)。结果在动脉期,B组图像CT值均较高(P均<0.05),噪声无明显差异(P均>0.05)。B组的SNR值与CNR值也较高,仅在主动脉(pSNR=0.546;pCNR=0.114)及胰腺处(pSNR=0.052)无统计学差异。静脉期中,B组图像CT值均较高,但仅在门静脉处有差异(P=0.025)。SD值、SNR及CNFR两组均无统计学差异(P均>0.05)。两组图像的总体主观评分(P=1.000)及诊断信心(P=0.917)也无统计学差异。结论与常规团注追踪技术相比,人工智能触发技术可以在满足影像诊断的前提下,明显改善腹部增强CT的客观图像质量。

基于空间向量模长的青年女性腰腹臀部形态分类与判别

为实现女体三维曲面的分类与判别,提高裤装的合体性,提出一种基于空间向量模长表征腰腹臀部形态并进行体型分类的方法。获取323名18~25岁青年女性的三维点云数据,提取腰腹臀部10层横截面曲线,以臀围质心为原点重建点云坐标系,通过欧式距离计算130个特征点的空间向量模长,构建表征人体曲面形态的模长矩阵。引入拉普拉斯特征映射降维获取18个本征维度,采用K-means聚类,运用随机森林算法建立青年女性腰腹臀部形态的判别模型。结果表明,青年女性腰腹臀部可分为大众型、扁平型、腹凸型、臀凸型4类,分别占样本总数的58.82%、27.86%、8.36%和4.95%。分析获得4类体型对应的裤装样板差异,有效提高了裤装合体性,青年女性腰腹臀部形态判别准确率达96.92%。