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Patients with palpable appendicular lump, appendicular abscess, previous history of urolithiasis and pelvic inflammatory disease were excluded from the study. The myriads of scoring system have been devised based on clinical history, physical examination and laboratory finding which help in early diagnosis and prompt management of acute appendicitis (e.g, Alvarado, Fenyo, Techer, Ramirez , Christian scores).The two promising scoring systems with increasing sensitivity and specificity in diagnosing acute appendicitis and to reduce the negative appendectomy rates are modified Alvarado and RIPASA score. The negative appendectomy rate decreased significantly from 16.3% to 6.9%, which was 9.4% reduction [3].Since not many studies have been conducted on RIPASA scoring system in the diagnosis of acute appendicitis, we have prospectively studied RIPASA score by applying them to the patients attending our tertiary care hospital with right iliac fossa pain. In our study, the sensitivity of RIPASA Scoring system was 92.47%, specificity 86.92%, positive predictive value 86% and negative predictive value of 93%.

Introduction: Acute appendicitis is the most common general surgical emergency worldwide; however, its diagnosis remains challenging, particularly in rural or remote areas such as Tibet. This study aimed to investigate the clinical characteristics and applicability of the routine risk prediction models of acute appendicitis for rural Tibetan populations. Methods: Data of patients who underwent appendectomy at the Chaya People's Hospital between 1 April 2018 and 30 September 2021 were retrospectively collected. Multivariate logistic regression analysis was performed to identify risk factors associated with complicated appendicitis. The appendicitis risk prediction model scores for each patient were calculated by the binary logistic regression model based on the data. The index of union method was applied to identify the optimal cut-off value for the critical values of risk prediction models. Results: We included 127 patients with suspected acute appendicitis in the study, consisting of 96 surgically and 31 non- surgically treated. The diagnoses of 93 patients who underwentappendectomy included 55 (59.1%) cases of uncomplicated appendicitis. Patients with complicated appendicitis had a significantly longer postoperative hospital stay (11.0 (interquartile range 8.8-13.3) days v 8.0 (interquartile range 6.0-11.0) days; p<0.001) and higher hospital costs (US2147.2 (interquartile range US1625.1-2516.6) v US1487.9 (interquartile range US1202.6-1809.2); p<0.001) than those with uncomplicated appendicitis. Duration of illness onset >24 hours, age >30 years, and male sex were independent risk factors associated with complicated appendicitis. The appendicitis inflammatory response score showed the best performance among the prediction models. Incorporating imaging features in the prediction models May provide better diagnostic value for appendicitis. Conclusion: Acute appendicitis in the rural Tibetan population has unique clinical features. To reduce the incidence of complicated appendicitis, local health workers must balance religious beliefs and professional services for residents.

Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a “planned second-look” laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.

Metodos Se obtuvieron datos sobre muertes y anos de vida ajustados por discapacidad (AVAD) perdidos de la base de datos Global Burden of Disease para 193 paises que abarcan de 2011 a 2019. Se definieron como afecciones de emergencia las enfermedades que, si no se diagnostican y tratan en las horas o dias siguientes a su aparicion, suelen causar discapacidad fisica o mental grave o la muerte. Se definieron las afecciones de tipo quirurgico como aquellas que pueden requerir la experiencia de un profesional con formacion quirurgica, y estas afecciones se identificaron mediante un proceso de consenso Delphi modificado. AVAD. Las afecciones clasificadas como de emergencia y de tipo quirurgico representaron 6 966 425 muertes y 303 344 808 AVAD. En el caso de las afecciones de emergencia, la carga per capita de muertes y AVAD fue mayor en los paises de ingresos bajos. Entre 2011 y 2019, las muertes y los AVAD debidos a afecciones de emergencia disminuyeron, mientras que las muertes debidas a afecciones de tipo quirurgico aumentaron ligeramente. Estas tendencias pueden deberse al refuerzo de los mecanismos de prevencion y deteccion precoz, a la mejora de la atencion de urgencia o a cambios epidemiologicos. Sin embargo, dado que las afecciones de emergencia y de tipo quirurgico se definieron de forma diferente, es posible que no sea valido comparar las tendencias de manera directa. [phrase omitted]

Delay of surgery for hip fracture is associated with increased risk of morbidity and mortality, but the effects of surgical delays on mortality and resource use in the context of other emergency surgeries is poorly described. Our objective was to measure the independent association between delay of emergency surgery and in-hospital mortality, length of stay and costs. We identified all adult patients who underwent emergency noncardiac surgery between January 2012 and October 2014 at a single tertiary care centre. Delay of surgery was defined as the time from surgical booking to operating room entry exceeding institutionally defined acceptable wait times, based on a standardized 5-level priority system that accounted for surgery type and indication. Patients with delayed surgery were matched to those without delay using propensity scores derived from variables that accounted for details of admission and the hospital stay, patient characteristics, physiologic instability, and surgical urgency and risk. Of 15 160 patients, 2820 (18.6%) experienced a delay. The mortality rates were 4.9% (138/2820) for those with delay and 3.2% (391/12 340) for those without delay (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.30–1.93). Within the propensity-matched cohort, delay was significantly associated with mortality (OR 1.56, 95% CI 1.18–2.06), increased length of stay (incident rate ratio 1.07, 95% CI 1.01–1.11) and higher total costs (incident rate ratio 1.06, 95% CI 1.01–1.11). Delayed operating room access for emergency surgery was associated with increased risk of inhospital mortality, longer length of stay and higher costs. System issues appeared to underlie most delays and must be addressed to improve the outcomes of emergency surgery.

Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques may provide new options. Thus, we believe that a current position paper from World Society of Emergency Surgery (WSES) is warranted, in order to put forth the most recent and practical recommendations for diagnosis and treatment of AMI. This review will address the concepts of AMI with the aim of focusing on specific areas where early diagnosis and management hold the strongest potential for improving outcomes in this disease process. Some of the key points include the prompt use of CT angiography to establish the diagnosis, evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel, resection of necrotic intestine, and use of damage control techniques when appropriate to allow for re-assessment of bowel viability prior to definitive anastomosis and abdominal closure.

Background: Equitable access to surgical care remains a challenge in low-resource settings. In Uganda, regional referral hospitals (RRHs) and district hospitals are the primary providers of Bellwether surgical procedures, while Health Centre IVs (HCIVs) mostly provide only cesarean sections. Expanding HCIV capacity to perform all 3 Bellwether procedures (i.e., emergency cesarean section, laparotomy, and open fracture fixation) could substantially improve timely access. The golden hour for trauma care and the 2-hour standard for Bellwether procedures are key benchmarks for surgical access. We sought to model 1-hour and 2-hour access to Bellwether procedures in Uganda and to evaluate the impact of upgrading HCIVs to perform all Bellwether procedures, using geospatial analysis to inform equitable health policy. Methods: Using AccessMod 5.0, we modelled travel times to surgical facilities under 2 scenarios: one including only RRHs and district hospitals, and another including RRHs, district hospitals and upgraded HCIVs. Inputs included population, road networks, land cover, hydrography, and elevation. Travel speeds were stratified by land cover and road class. We compared unimodal (walking only) and bimodal (walking plus motorized) travel scenarios, estimating population coverage within 1-hour and 2-hour intervals stratified by region. Results: Under the unimodal model (walking only), 37.9% of Ugandas population could reach a main hospital within 2 hours. Introducing motorized transport in the bimodal model increased baseline 1-hour access from 74.9% (main hospitals only) to 91.6% when HCIVs were included, an improvement of 16.7%. The northern region experienced the largest 1-hour gains, with a 20.6% increase. In the bimodal model, 2-hour access rose from 96.7% with main hospitals only to 98.7% after adding HCIVs. Conclusion: Geospatial modelling showed that motorized transport substantially improved timely access to surgical care, and equipping HCIVs to perform all Bellwether procedures markedly increased 1-hour access, particularly in underserved districts. Strategic investment in emergency prehospital systems and upgrading HCIVs to Bellwether-capable facilities can enhance equity, close regional gaps, and align Uganda with global surgical benchmarks, addressing critical needs in trauma and emergency surgery.

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.