• Gastroenterology
• Gastrointestinal
• Mesenteric ischemia
• Vascular

• antibiotic treatment
• intra-abdominal infection
• peritonitis
• surgery
• therapeutic failure

In this study, a review of available data and literature on the epidemiology and anamnesis of inguinal hernias in nonhuman primates, as well as on their clinical evaluation and surgical management, was conducted. Inguinal hernias are assumed to be relatively common in male nonhuman primates. Clinical signs are usually limited to a visible or palpable mass in the groin region without pain or systemic illness. Most hernias contain omentum. Careful monitoring is an acceptable treatment option for those animals. Size, the danger of incarceration, and the presence of strangulation are important factors when considering surgical repair. A strangulated inguinal hernia is an emergency, requiring prompt surgery to avoid tissue necrosis and death. Imaging techniques, as well as computed tomography (CT), ultrasonography, and magnetic resonance imaging (MRI), provide information about the anatomical characteristics of the suspected region, allowing for a diagnosis and treatment. An inguinal hernia repair can be performed with either open surgery or laparoscopic surgery. The hernia repair can be achieved by mesh or suture. Decisions regarding which repair technique to use depend on the surgeon′s skill level and preference. Complication and recurrence rates are generally low. The most common postsurgical complication is a recurrence of the hernia. Contraceptive measures are not indicated in breeders, as there is no known hereditary component, and the presence of hernia does not appear to affect fertility, nor does it predispose to occurrence, recurrence, or incarceration.

Acute appendicitis with mesenteric vein thrombosis (MVT) is an uncommon condition and usually lacks specific clinical manifestations, which leads to a high rate of misdiagnosis or delayed diagnosis, especially when it is accompanied by other abdominal diseases. Prompt and accurate recognition is vital for treatment and prognosis.

A 37-year-old woman had a history of acute metastatic right lower abdominal pain, nausea, and fever. A contrast-enhanced computed tomography (CT) scan showed a filling defect in the mesenteric vessels. The patient was diagnosed with acute appendicitis complicated by MVT and was treated with anticoagulation and intravenous antibiotics. The follow-up CT scan showed full resolution of the thrombosis and inflammation.

Clinical awareness is essential for recognizing MVT, especially when it is accompanied by other common acute abdominal diseases, such as acute appendicitis. Contrast-enhanced CT is helpful for the diagnosis of MVT and is recommended for patients with acute abdominal diseases.

• Mesenteric vein thrombosis
• Ischemic bowel disease
• Acute abdominal diseases
• Contrast-enhanced computed tomography
• Acute appendicitis
• Case report

Thromboangiitis obliterans or Buerger’s disease is a form of peripheral vascular disease in young male smokers. The involvement of the intestine occurs in only about 2% of the cases, when they may present as acute abdomen due to mesenteric ischemia. The uncommonness of the condition makes it a less suspected differential diagnosis, leading to a delay in appropriate management, thereby increasing chances of morbidity or mortality. Cessation of smoking is known to stall the disease progression including visceral involvement, but may not always be the case as happened in the case being presented.

Our Indian Hindu male patient, a known smoker, presented with diffuse abdominal pain along with bouts of vomiting and loose motions. He had a prior history of amputation of the right foot, 4 years before. At presentation he had abdominal distension with diffuse tenderness and guarding. An omental band attached to the tip of the appendix was discovered at the initial exploration along with dilated proximal bowel loops, for which a release of the omental band along with appendectomy was done. He developed an enterocutaneous fistula on the 6th postoperative day for which he had to be reexplored, and multiple jejunal perforations were found. Segmental jejunal resection and a Roux-en-Y gastrojejunostomy with distal ileostomy were done along with a feeding jejunostomy. The patient however again had feculent discharge from the wound for which a third exploration was done. The gastrojejunostomy and feeding jejunostomy sites were leaky, both of which were repaired primarily. The patient developed septicemia which progressed to refractory septic shock, and he ultimately succumbed to his illness on the 23rd postoperative day of the index surgery.

Acute abdomen in a young man who is a chronic smoker and having an antecedent history of amputation of some part of an extremity for a nontraumatic cause should raise the suspicion of Buerger’s disease of the intestine. Although it is a progressive disease and the situation has already progressed by the time intestinal symptoms manifest, early detection may give some scope of salvage and decrease the morbidity and mortality.

• Acute mesenteric ischemia
• Buerger’s disease
• Case report
• Smoking
• Thromboangiitis obliterans

• Acrolein/analogs & derivatives
• Acrolein/pharmacology
• Acrolein/therapeutic use
• Animals
• Apoptosis/drug effects
• Cytoprotection/drug effects
• Disease Models, Animal
• Inflammation/etiology
• Inflammation/pathology
• Inflammation/prevention & control
• Kidney/blood supply
• Kidney/drug effects
• Kidney/pathology
• Liver Diseases/etiology
• Liver Diseases/pathology
• Liver Diseases/prevention & control
• Lung/blood supply
• Lung/drug effects
• Lung/pathology
• Lung Injury/etiology
• Lung Injury/pathology
• Lung Injury/prevention & control
• Male
• Mesenteric Ischemia/complications
• Mesenteric Ischemia/drug therapy
• Mesenteric Ischemia/pathology
• Rats
• Rats, Sprague-Dawley
• Reperfusion Injury/etiology
• Reperfusion Injury/pathology
• Reperfusion Injury/prevention & control

To compare patients hospitalised in the intensive care unit (ICU) after surgery for community-acquired intra-abdominal infection (CA-IAI) and hospital-acquired intra-abdominal infection (HA-IAI) in terms of mortality, severity and complications.

Retrospective study including all patients admitted to 2 ICUs within 48 h of undergoing surgery for peritonitis.

Two hundred twenty-six patients were enrolled during the study period. Patients with CA-IAI had an increased 28-day mortality rate compared to those with HA-IAI (30% vs 15%, respectively (p = 0.009)). At 90 days, the mortality rates were 36.7 and 37.5% in the CA-IAI group and HA-IAI group, respectively, with a similar APACHE II score on admission (median: 21 [15–25] vs. 21 [15–24] respectively, p = 0.63). The patients with HA-IAI had prolonged ICU and hospital stays (median: 17 [7–36] vs. 6[3–12] days, p < 0.001 and 41 [24–66] vs. 17 [7–32] days, p = 0.001), and experienced more complications (reoperation and reintubation) than those with CA-IAI.

CA-IAI group had higher 28-day mortality rate than HA-IAI group. Mortality was similar at 90 days but those with HA-IAI had a prolonged ICU and hospital stay. In addition, they developed more complications.

• Intensive care unit
• Intra-abdominal infection
• Microbiology
• Outcome
• Peritonitis

Perforated diverticulitis is an emergent clinical condition and its management is challenging and still debated. The aim of this position paper was to critically review the available evidence on the management of perforated diverticulitis and generalized peritonitis in order to provide evidence-based suggestions for a management strategy. Four Italian scientific societies (SICCR, SICUT, SIRM, AIGO), selected experts who identified 5 clinically relevant topics in the management of perforated diverticulitis with generalized peritonitis that would benefit from a multidisciplinary review. The following 5 issues were tackled: 1) Criteria to decide between conservative and surgical treatment in case of perforated diverticulitis with peritonitis; 2) Criteria or scoring system to choose the most appropriate surgical option when diffuse peritonitis is confirmed 3); The appropriate surgical procedure in hemodynamically stable or stabilized patients with diffuse peritonitis; 4) The appropriate surgical procedure for patients with generalized peritonitis and septic shock and 5) Optimal medical therapy in patients with generalized peritonitis from diverticular perforation before and after surgery. In perforated diverticulitis surgery is indicated in case of diffuse peritonitis or failure of conservative management and the decision to operate is not based on the presence of extraluminal air. If diffuse peritonitis is confirmed the choice of surgical technique is based on intraoperative findings and the presence or risk of severe septic shock. Further prognostic factors to consider are physiological derangement, age, comorbidities, and immune status. In hemodynamically stable patients, emergency laparoscopy has benefits over open surgery. Options include resection and anastomosis, Hartmann’s procedure or laparoscopic lavage. In generalized peritonitis with septic shock, an open surgical approach is preferred. Non-restorative resection and/or damage control surgery appear to be the only viable options, depending on the severity of hemodynamic instability. Multidisciplinary medical management should be applied with the main aims of controlling infection, relieving postoperative pain and preventing and/or treating postoperative ileus. In conclusion, the complexity and diversity of patients with diverticular perforation and diffuse peritonitis requires a personalized strategy, involving a thorough classification of physiological derangement, staging of intra-abdominal infection and choice of the most appropriate surgical procedure.

• Acute diverticulitis
• Diffuse peritonitis
• Diverticular disease
• Septic shock

• Anastomosis, Surgical
• Colostomy
• Diverticulitis/surgery
• Diverticulitis, Colonic/surgery
• Humans
• Intestinal Perforation/etiology
• Intestinal Perforation/surgery
• Italy
• Laparoscopy
• Peritonitis/complications
• Peritonitis/surgery

• Università degli Studi di Brescia

Despite improvements in diagnosis, intensive-care medicine and surgical technique, the mortality of patients with secondary peritonitis is still high. Early and aggressive empiric antibiotic treatment has strong impact on the outcome. This retrospective study investigates bacterial and fungal pathogens and their antibiotic sensitivity in patients with secondary peritonitis. All patients that underwent emergency laparotomy due to secondary peritonitis at the Department of Surgery, University Medical Center Hamburg-Eppendorf between 2005 and 2015 were reviewed and overall 414 patients were included. We correlated the intra-abdominal localization of the organ perforation with intraoperative microbiological findings and corresponding sensitivities to relevant antibiotics. Overall, the most common findings were Escherichia coli (39%) and other Enterobacterica (24%). Depending on the location of the perforation, Cefuroxime/Metronidazole and Cefutaxime/Metronidazole were effective (based on in vitro susceptibility testing) in only 55–73% of the patients, while Meropenem/Vancomycin was able to control the peritonitis in more than 98% of the patients; independent of the location. Besides early source control, appropriate empiric treatment plays a pivotal role in treatment of secondary peritonitis. We are able to show that the frequently used combinations of second or third generation Cephalosporins with Metronidazole are not always sufficient, which is due to the biological resistance of the bacteria. Further clinical studies are needed to determine whether calculated use of broad-spectrum antibiotics with a sensitivity rate > 99%, such as Carbapenem plus Vancomycin, can improve overall survival rates in critically ill patients with secondary peritonitis.

• Acute mesenteric ischemic
• Chronic mesenteric ischemia
• Non-occlusive mesenteric ischemia
• Superior mesenteric artery embolism
• Superior mesenteric artery thrombosis

• laparoscopic lavage
• perforated diverticulitis
• peritonitis
• resection

Our objective was to assess the clinical effectiveness of shorter versus longer duration antibiotics for treatment of bacterial infections in adults and children in secondary care settings, using the evidence from published systematic reviews. We conducted electronic searches in MEDLINE, Embase, Cochrane, and Cinahl. Our primary outcome was clinical resolution. The quality of included reviews was assessed using the AMSTAR criteria, and the quality of the evidence was rated using the GRADE criteria. We included 6 systematic reviews (n = 3,162). Four reviews were rated high quality, and two of moderate quality. In adults, there was no difference between shorter versus longer duration in clinical resolution rates for peritonitis (RR 1.03, 95% CI 0.98 to 1.09, I² = 0%), ventilator-associated pneumonia (RR 0.93; 95% CI 0.81 to 1.08, I² = 24%), or acute pyelonephritis and septic UTI (clinical failure: RR 1.00, 95% CI 0.46 to 2.18). The quality of the evidence was very low to moderate. In children, there was no difference in clinical resolution rates for pneumonia (RR 0.98, 95% CI 0.91 to 1.04, I² = 48%), pyelonephritis (RR 0.95, 95% CI 0.88 to 1.04) and confirmed bacterial meningitis (RR 1.02, 95% CI 0.93 to 1.11, I² = 0%). The quality of the evidence was low to moderate. In conclusion, there is currently a limited body of evidence to clearly assess the clinical benefits of shorter versus longer duration antibiotics in secondary care. High quality trials assessing strategies to shorten antibiotic treatment duration for bacterial infections in secondary care settings should now be a priority.

• Anti-Bacterial Agents/therapeutic use
• Bacterial Infections/drug therapy
• Drug Resistance, Bacterial
• Humans
• Review Literature as Topic
• Secondary Care
• Time Factors

• RP-PG-0514-20015 Department of Health

The purpose of this study was to determine the shifting trends in bacteriology and antimicrobial resistance of infectious specimens isolated from gastrointestinal (GI) fistula patients over eight years in China.

We retrospectively reviewed the microbial records of intra-abdominal specimens at a teaching hospital from 2008 to 2015. Study period was divided into the first half (2008–2011) and the second half (2012–2015). All isolates underwent antibiotic susceptibility testing by the micro dilution method.

A total of 874 intra-abdominal isolates were consecutively collected from 502 GI fistula patients (mean age, 46.5 years, 71.1% male) during the study period. Patients in the second study period (2012–2015) were older (>65 years) and more likely to have experienced cancer. Over the entire study period, most infections were caused by E. coli (24.2%) and K. pneumonia (14.1%). There was a significant decrease in the proportion E. coli isolates that were extended- spectrum beta-lactamase (ESBL)-positive (P = 0.026). The proportion of E. coli resistant to imipenem increased from 14.3% in 2008–2011 to 25.9% in 2012–2015 (P = 0.037). Imipenem resistance prevalence was higher in ESBL-negative bacteria than ESBL-positive bacteria for both E. coli and K. pneumonia (P < 0.001). In Enterococcus, significant increase in resistance to ampicillin (P = 0.01) and moxifloxacin (P = 0.02) over time were observed. In Staphylococcus and fungi, rates of antibiotic resistance did not significantly change over the study period.

Gram-negative bacteria predominated as causative agents of intra-abdominal infections in GI fistula patients, and there was an increase in levels of resistance to certain antibiotics, particularly carbapenems. Infection control and source control are important tools available to surgeons to prevent the emergence of antibiotic-resistant pathogens.

The online version of this article (10.1186/s12879-017-2744-7) contains supplementary material, which is available to authorized users.

• Antibiotic resistance
• Bacteriology
• Intra-abdominal infections

Acute appendicitis (AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy (LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Non-operative management of AA may be tolerated only in children. Postoperative complications increase according to the patient’s factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon’s skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner (i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

• Laparoscopic appendectomy
• Acute appendicitis
• Interval appendectomy
• Surgery
• Delayed appendectomy

• Adult
• Age Factors
• Anesthesia, General/adverse effects
• Anti-Bacterial Agents/therapeutic use
• Appendectomy/adverse effects
• Appendectomy/economics
• Appendectomy/methods
• Appendicitis/blood
• Appendicitis/diagnosis
• Appendicitis/economics
• Appendicitis/therapy
• Biomarkers/blood
• Child
• Clinical Competence
• Colonoscopy
• Humans
• Japan
• Laparoscopy/adverse effects
• Laparoscopy/economics
• Laparoscopy/methods
• Leukocyte Count
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Surgeons/education
• Time Factors
• Tomography, X-Ray Computed
• Universal Health Insurance

• Abdominal sepsis
• On-demand relaparotomy
• Peritonitis
• Planned relaparotomy
• Treatment strategy

• Anti-Bacterial Agents/therapeutic use
• Combined Modality Therapy
• Interdisciplinary Communication
• Intersectoral Collaboration
• Monitoring, Physiologic
• Peritonitis/diagnostic imaging
• Peritonitis/etiology
• Peritonitis/mortality
• Peritonitis/surgery
• Point-of-Care Testing
• Randomized Controlled Trials as Topic
• Reoperation
• Resuscitation
• Survival Rate
• Tomography, X-Ray Computed

• Acute mesenteric ischaemia
• Clinical management
• Diagnosis
• Guidelines

• Anti-Bacterial Agents/therapeutic use
• Anticoagulants/therapeutic use
• Early Diagnosis
• Early Medical Intervention/methods
• Fluid Therapy/methods
• Humans
• Mesenteric Ischemia/diagnosis
• Mesenteric Ischemia/diagnostic imaging
• Mesenteric Ischemia/etiology
• Mesenteric Ischemia/physiopathology
• Mesenteric Ischemia/surgery
• Multidetector Computed Tomography/methods
• Oxygen Inhalation Therapy/methods
• Practice Guidelines as Topic
• Risk Assessment/methods
• Symptom Assessment/methods
• Vascular Surgical Procedures/methods

• Abdominal sepsis
• On-demand relaparotomy
• Peritonitis
• Planned relaparotomy
• Treatment strategy

Perforation peritonitis is a common surgical emergency. Anesthesia in patients with perforation peritonitis can be challenging. Delayed presentations, old age, hemodynamic instability, presence of sepsis and organ dysfunction are some of the predictors of poor outcome in such patients. Pre-operative optimization can reduce intraoperative and post-operative morbidity and mortality, but surgery should not be unnecessarily delayed. Intensive care in critical care settings may be essential.

• Abdominal sepsis
• perforation peritonitis
• post-operative period
• pre-operative care

• Antibiotics
• Community-acquired intra-abdominal infections
• Cost of care
• Direct costs
• Hospitalization

• Feces
• Female
• Humans
• Male
• Peritonitis/mortality

Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification. Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations. We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation. The diagnosis was supported by computed tomography (CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient. Medical treatment was elected to manage the patient’s condition instead of surgical intervention. The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication. Factors affecting clinical treatment decisions include the nature of micro-perforation, the patient’s good overall health condition, and the early diagnosis before sepsis signs develop. Micro-perforation means the puncture of intestine wall without CT evidence of free air, purulent peritoneum or abscess. We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.

• Fish bone ingestion
• Micro-perforation
• Decision-making
• Medical treatment
• Small intestine

This study aims to determine whether abdominal microbial profiles in early severe secondary peritonitis are associated with ongoing infection or death. The study is performed within a randomized study comparing two surgical treatment strategies in patients with severe secondary peritonitis (n = 229). The microbial profiles of cultures retrieved from initial emergency laparotomy were tested with logistic regression analysis for association with ‘ongoing infection needing relaparotomy’ and in-hospital death. No microbial profile or the presence of yeast or Pseudomonas spp. was related to the risk of ongoing infection needing relaparotomy. Resistance to empiric therapy for gram positive cocci and coliforms was moderately associated with ongoing abdominal infection (OR 3.43 95%CI 0.95–12.38 and OR 7.61, 95%CI 0.75–76.94). Presence of only gram positive cocci, predominantly Enterococcus spp, was borderline independently associated with in-hospital death (OR 3.69, 95%CI 0.99–13.80). In secondary peritonitis microbial profiles do not predict ongoing abdominal infection after initial emergency laparotomy. However, the moderate association of ongoing infection with resistance to the empiric therapy compels to more attention for resistance when selecting empiric antibiotic coverage.

• Anti-Infective Agents/therapeutic use
• Europe
• Evidence-Based Medicine
• Humans
• Peritonitis/drug therapy
• Peritonitis/microbiology
• Practice Guidelines as Topic

• Aged
• Ascitic Fluid/microbiology
• Diagnosis, Differential
• Female
• Humans
• Incidence
• Liver Cirrhosis/complications
• Male
• Middle Aged
• Peritoneal Cavity/diagnostic imaging
• Peritoneal Cavity/microbiology
• Peritonitis/diagnosis
• Peritonitis/mortality
• Peritonitis/therapy
• Prognosis
• Retrospective Studies
• Sensitivity and Specificity
• Severity of Illness Index
• Survival Rate
• Tomography, X-Ray Computed

• Evidence-Based Medicine
• Humans
• Practice Guidelines as Topic
• Wounds and Injuries/therapy

• Ampicillin/adverse effects
• Ampicillin/pharmacokinetics
• Ampicillin/pharmacology
• Ampicillin/therapeutic use
• Anti-Bacterial Agents/adverse effects
• Anti-Bacterial Agents/pharmacokinetics
• Anti-Bacterial Agents/pharmacology
• Anti-Bacterial Agents/therapeutic use
• Bacterial Infections/drug therapy
• Bacterial Infections/prevention & control
• Humans
• Sulbactam/adverse effects
• Sulbactam/pharmacokinetics
• Sulbactam/pharmacology
• Sulbactam/therapeutic use

• Anti-Bacterial Agents/administration & dosage
• Anti-Bacterial Agents/adverse effects
• Anti-Bacterial Agents/pharmacokinetics
• Anti-Bacterial Agents/therapeutic use
• Bacteremia/drug therapy
• Bacteremia/etiology
• Bacteremia/microbiology
• Catheterization/adverse effects
• Central Nervous System Infections/drug therapy
• Central Nervous System Infections/microbiology
• Community-Acquired Infections/drug therapy
• Community-Acquired Infections/microbiology
• Critical Care/standards
• Cross Infection/drug therapy
• Cross Infection/microbiology
• Drug Resistance, Multiple, Bacterial
• Endocarditis, Bacterial/drug therapy
• Endocarditis, Bacterial/microbiology
• Evidence-Based Medicine
• Gram-Positive Bacterial Infections/drug therapy
• Gram-Positive Cocci/drug effects
• Humans
• Pneumonia, Bacterial/drug therapy
• Pneumonia, Bacterial/microbiology
• Soft Tissue Infections/drug therapy
• Soft Tissue Infections/microbiology

• Anti-Bacterial Agents/pharmacology
• Anti-Bacterial Agents/therapeutic use
• Bacteremia/drug therapy
• Bacteremia/etiology
• Catheterization/adverse effects
• Central Nervous System Bacterial Infections/drug therapy
• Community-Acquired Infections/drug therapy
• Critical Illness
• Cross Infection/drug therapy
• Endocarditis, Bacterial/drug therapy
• Gram-Positive Bacterial Infections/drug therapy
• Humans
• Pneumonia, Bacterial/drug therapy
• Soft Tissue Infections/drug therapy