22nd European Congress of Trauma & Emergency Surgery

Chairs

Pneumotosis intestinalis: Ischemic or not? that is the question

Abstract text (incl. references and figure legends) pneumatosis intestinalis has a wide presentation and its meaning depends on the nature and severity of the underlying condition. Due to conditions and outcomes ranging from benign diseases to abdominal sepsis and death, clinical presentation and laboratory tests are extremely important to associate with the image and offer a global assessment and correct management. A 12-year-old boy presented to the emergency department with abdominal pain, vomiting, absence of flatulence, and constipation that have worsened in the last 7 days. On examination, he showed abdominal distension, no bowel sounds and diffuse pain. In computed tomography was identified extensive bowel and mesentery pneumatosis, diffuse bowel distension (marked in jejune), pneumoperitoneum and pneumoretroperitoneum with no gas in the portal system. Due to the difficulty to clear the diagnosis by the association of positive and negative signs of ischemia, exploratory laparotomy was indicated. There were extensive bowel distension with widespread subserous bubbles, wall thickening but without signs of ischemia during the intraoperative time. No resection was necessary and the abdomen was closed. The patient had a slow diet progression and recovering. It is very difficult to differentiate between benign and ischemic causes when symptoms, signs, patient and image are not completely clear.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No.

Education

Emergency surgery

Poster

Intussusception. An Emergency case of large bowel obstruction

Abstract text (incl. references and figure legends) A 66-year-old woman with a medical history of HTA, DM and surgical cholecystectomy and hysterectomy.He goes to the emergency room for rectorrhagia, abdominal pain and obstructive clinic. On physical examination, abdominal distension is observed and on rectal examination an indurated and ulcerated mass about 5-6 cm from the external anal margin. As complementary tests, blood test is performed where anemia is observed without further alterations and a CT scan with contrast where a colorectal intussusception secondary to neoplasia probably in recto-sigma is objective. Supportive treatment is initiated, SNG is placed and NPT is requested and it is decided to complete the study by performing a Ct body and a colonosopia CT. In both, persistence ofintussusception of the sigma in the rectum secondary to a sigmoid mamelonate lesion without distant involvement was observed. It is decided before the intervention findings performing open sigmoidectomy (it is tried to perform by laparoscopy without success due to the distension of the loops). A laparotomy is performed, with a sigma-dependent tumor, with intussusception of the left colon and upper rectum, and monthly retractionwithout associated peritoneal carcinomatosis.Discussión:Bowel obstruction occurs when the normal flow of intraluminal contents is blocked. Large bowel obstruction constitutes approximately 25 percent of all intestinal obstructions. The obstruction is the initial presenting symptom of up to 30 percent of colon cancers. The most common location of obstructing colorectal cancer is at the sigmoid colon.Large bowel intussusception is a rare condition associated with clinical obstrucción y high mortality if left untreated. Surgery of intussuspecition is made with laparosocopic or open approach We report a patient who underwent open approach with a good postoperative course.Buechter KJ, Boustany C, Caillouette R. Surgical management of the acutely obstructed colon. A review of 127 cases. Am J Surg 1988. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Massive intestinal infarction due to volvulus in congenital malrotation: A case study

Abstract text (incl. references and figure legends) Case history We present the case of a young girl with a total small bowel volvulus in congenital malrotation. Clinical Findings The patient had multiple admissions to the emergency room in the previous 8 years for the same symptoms, discharged every time with diagnosis of abdominal cramping. Investigation/results FBC and ABG showed leucocytosis (WBC 20.9), anaemia (HGB 5.6), ARF (sCr 1.9 mf/dL), severe metabolic acidosis (pH 7.08) and high lactates level (20 mmol/L). Patient showed abdominal distension, diffuse pain and early sign of peritonism. A contrast enhanced CT scan highlighted ascending and transverse colon swelling and SMA-SMV blockage 3cm from its origin. Diagnosis A diagnosis of intestinal volvulus was made with necessity of emergency surgical intervention. Therapy and progression We performed an exploratory laparotomy with finding of vast necrosis of the whole small intestine from 80cm for the Treitz ligament, to the distal third of the transverse colon. Therefore, we resected the whole necrotic tract &quot;en bloc&quot; and performed a right lower quadrant ileostomy. The patient recovered bowel function through ileostomy on the 10th day and the NG tube was removed on the 13th day. She was followed-up by the clinical nutrition specialists that diagnosed IFALD due to the TPN and SBS. Patient was discharged on the 30th day and after 2 months underwent successful re-channelling operation. Comments This case highlights the need to think about congenital malrotation in the differential diagnosis of a patient presenting recurrent abdominal pain with multiple admission to the ER and negative or unclear examinations. As a matter of fact, it could allow physicians to early identify this condition in order to perform a Ladd&quot;s procedure before the onset of necrosis in the case of a total small bowel volvulus. References A.T. Fung,et al Malrotation with midgut volvulus in an adult:a case report and review of the literature IJSCR 2017;5, 1–3 Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

Prof.

Introducing a new severity classification of complicated intra-abdominal infections

Abstract text (incl. references and figure legends) Introduction To date no severity classification of complicated intra-abdominal infections (cIAIs) is accepted or used in everyday practice. We aimed to present such classification in order to improve prognostic evaluation and unfavorable outcome of patients with cIAIs. Material and methods The retrospective analysis involved 116 patients admitted to the Department of Surgical Diseases (DSD) at a University Hospital "Prof. Dr. Stoyan Kirkovich" Stara Zagora and operated on for cIAIs between January 2017 and August 2021. We created three groups of severity according to calculated Sequential Organ Failure Assessment (SOFA) score and World Society of Emergency Surgery Sepsis Severity Score (WSES SSS) of each patient – mild cIAIs (SOFA &lt; 2 points and WSES SSS &lt; 8), severe cIAIs (SOFA ≥ 2 and WSES SSS &lt; 8) and severe complicated intra-abdominal sepsis (SCIAS) – WSES SSS ≥ 8. Different laboratory markers, clinical parameters and scoring systems were compared and analyzed between the severity groups. Results The established overall in-hospital mortality was 25%. Among patients with mild cIAIs death rate was 5.6%, in severe cIAIs group – 24.5% and in SCIAS group we observed the highest mortality rate – 48.4%. Variables that differed significantly according to severity were age, systolic blood pressure, heart rate, respiratory rate, altered mental status, C-reactive protein levels, quick-SOFA score, SOFA score, Mannheim Peritonitis Index and WSES SSS. Conclusion The proposed severity classification of cIAIs was shown as useful and reliable for predictive assessment of each patient. We believe this new severity classification could assist surgeons and intensivists in treatment and evaluation of cIAIs if acceptedDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Intraoperative colonoscopy and surgical treatment in patients with ILE-colic intussuspection secondary to polyp

Abstract text (incl. references and figure legends) A 66-year-old woman, with a history of hypertension, Forrest III prepyloric ulcer, not previous abdominal surgeries, was admitted to the emergency department wit abdominal pain and diarrhea with blood remains, associating loss of 3 kg. In the analysis, mild anemia, slight leukocytosis and elevation of acute phase reactants stand out. Five days earlier she went to another center for abdominal pain and diarrhea, being diagnosed with enterocolitis and discharged.CT body was performed with findings "compatible with ileocolic intussusception with head of intusspection in the transverse colon, with distension probably of the cecum but without dilation of loops of small intestine and with a small amount of intraperitoneal free fluid, not being able to rule out, given the findings, underlying lesion in the head of intussusception.Given these findings, preparation for urgent colonoscopy and surgery begins. In the operating room, colonoscopy is performed with a finding of "suspected transverse colon neoplasia", so a laparotomy, enlarged right hemicolectomy and reconstruction with manual ileo-colic anastomosis are carried out.After the intervention, the patient is discharged after 6 days of admission, with tolerance to oral diet and transit for gas and feces, without complications. The anatomical-pathological diagnosis was a "tubulovillous adenoma with high-grade dysplasia, 18 lymph nodes with no evidence of malignancy.Discussion: Intestinal intussuspection is a rare cause of intestinal obstruction in adults. Unlike the child, most cases in adults are secondary (mainly, benign and malignant tumors). Abdominal CT is the diagnostic test to confirm;The management in general is surgical: a resection will be carried out without reduction of intussuspection(suspicion of malignant;no viability of the intestine,while in the rest of cases a manual reduction prior to resection. Hong KD, Kim J, Ji W, WSD.Adult intussusception:asystematicreviewandmetaanalysisTech Coloproctol.2019;23(4).Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Penetrating lower limb trauma: An unexpected source of hemoperitoneum

Abstract text (incl. references and figure legends) A 17-year-old male presented after stumbling over a fence and getting pierced by one of the metal spikes. He complained abdominal and right lower limb pain. The patient was agitated and his Glasgow Coma Scale scored 14. The primary survey conducted following ATLS principles1 was altered at "C" due to hemodynamic instability. A 3cm hole at the root of the right thigh showed no external bleeding. FAST proved evidence of left and right upper quadrants and pelvic free fluid. A transitory response to fluid challenge allowed the execution of a full CT scan with contrast that confirmed hemoperitoneum and showed left pelvic hematoma (Fig1-2) without arterial blush. The patient was transferred to the operating room for emergency laparotomy. Abdominal packing was performed starting from the left lower quadrant. Once the patient was stable, investigating the origin of the bleeding, liver, spleen and intestinal mesentery were found intact. A retroperitoneal hematoma was evident in the left hypogastric vein region, connected to the peritoneal cavity through a tearing of the serosa. The left colon was medialized to perform a focused pelvic packing. Total blood loss was 1500cc (1/3 reinfused through blood salvage). Open abdomen treatment allowed revision of the abdominal cavity after 48h in presence of a vascular surgeon. Hemostasis was granted and the area compartmentalized with a peritoneal oversewing. Air-leak tests of rectum and bladder were negative, and the thigh wound was explored and dressed. The abdomen was then closed. The post-operative course was uneventful. Hypogastric vein injury without pelvic fracture or direct penetration is a rare and dangerous entity2; immediate recognition and packing can be lifesaving. ATLS 10th ed, American College of Surgeons Iliac vascular injury in the absence of a pelvic fracture, N. Helton et al. J Trauma Nurs 2017 Fig1: Left and right upper quadrants free fluid (blue); hematoma (red); air/spike route (green arrows) Fig2: Spike routeDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Polytrauma

Abdominal stab wound in a woman with a long-term depression: A case report

Abstract text (incl. references and figure legends) 1. Case history: A 46 year old woman with a history of depression and several suicide attempts, taken to the emergency room after stabbing herself in the abdomen with a knife. 2. Clinical findings: BP: 110/65 mmHg, HR: 78 bpm. Knife of 25-30cm stuck in mesogastrium with no active bleeding. 3. Research/Results: - Eco-FAST: free liquid in Morrison's space. - Blood test: No significant alterations except from high ethanol levels. - CT Scan with IV contrast: sharp object with a blade of about 21.5 cm penetrating below the umbilicus, with a descending right oblique trajectory and the end in the right hemipelvis, in close contact with the sigmoid and transverse colon. Pneumoperitoneum bubbles with some perihepatic and perisplenic free fluid. 4. Diagnosis: Penetrating abdominal trauma. 5. Therapy and Progressions: Urgent exploratory laparotomy. - Findings: Punctiform perforation in middle ileum. - Surgical technique: Simple suture of the perforation. - Uneventful recovery, discharged on the 8th postoperative day. 6. Comments: Penetrating trauma constitutes the third cause of mortality in patients under 44 years old. Most cases reported of abdominal stab wounds occur in the left upper cuadrant1. Most common injured organs are: small bowel (50%), large bowel (40%), liver (30%), and intra-abdominal vessels (25%)2. Our case was exceptional given the minimal injuries sustained by the patient despite the dimensions of the weapon. 7. References: 1. Cowell, Christopher, and Maria E Moreira. "Initial Evaluation and Management of Abdominal Stab Wounds in Adults." UpToDate, Inc, Sept. 2022. 2. Lotfollahzadeh, Saran, and Bracken Burns. "Penetrating Abdominal Trauma." StatPearls Publishing, June 2022. Figures: 1. Knife penetrating the abdominal cavity. 2. Punctiform perforation in middle ileum.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Laparoscopic lavage and drainage for Hinchey III diverticulitis: Is it as bad as it sounds?

Abstract text (incl. references and figure legends) Case history:A 42-year-old obese man went to the emergency department for non-persistent and aggravating abdominal pain with 3 days of evolution, located in the hypogastrium and LIF, accompanied by nausea and fever. He denied other symptoms.Clinical findings:At physical exam, he had pain at deep palpation, at decompression, and tenderness over the hypogastrium and LIF. No renal murphy sign was present.Results and Diagnosis:An elevation of inflammatory parameters was present;renal function was normal.A CT scan showing inflamed sigmoid diverticular sacs, with liquid on the Douglas fossa and an abscess next to spleen, confirmed the diagnosis of acute diverticulitis Hinchey II.Therapy and Progression:Antibiotic and proper analgesia was initiated, with improvement of the patient. 2 days later, he got hypotensive, tachycardic, with uncontrolled pain; a proper optimization was started. A CT scan was asked, revealing free air and liquid next to inflamed sigmoid colon (Hinchey III). It was proposed a laparoscopic drainage and lavage of the abdomen with the possibility of ending in a Hartman procedure. Generalized purulent content was found in laparoscopy, with no perforation spot or faecaloid peritonitis; collections were drained, and an extensive lavage of the abdomen was made; abdominal drains were left. The patient got better and was discharged, with the usual recommendations. A total colonoscopy after the surgery showed sigmoid diverticular sacs. After discussing options, it was decided to perform a watch and wait approach with the patient remaining asymptomatic.Comments:Laparoscopic lavage and drainage is suggested in selected patients with generalized purulent peritonitis, allowing preservation of sigmoid colon and avoidance of a stoma, especially in young patients.References: Sartelli, M., Weber, D.G., Kluger, Y. et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg 15, 32 (2020).Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No.

Predictive factors for conservative treatment failure of acute complicated diverticulitis. A single center retrospective analysis on 164 patients

Abstract text (incl. references and figure legends) INTRODUCTION: Conservative treatment is the first-line therapy for acute complicated diverticulitis (ACD) but failure may represent a challenge in terms of hospitalization, medical costs, morbidities and mortality. The aim of this study was to evaluate failure rates following nonoperative management of acute complicated diverticulitis and to examine possible predictive factors for conservative treatment failure. MATERIALS &amp; METHODS: We retrospectively analysed 164 patients with diagnosis of diverticulitis admitted in Humanitas Research Hospital DEA from 1 January 2017 to 31 December 2021. Patient demographics, blood inflammatory markers, radiological findings, management and outcomes were evaluated. RESULTS: A total of 164 patients were admitted, 34 had uncomplicated diverticulitis and 130 had ACD. Of those with ACD, 18 patients underwent urgent surgery and 112 (WSES 1a n=54, 1b n=19, 2a n=31, 2b n=8) underwent conservative treatment, composed of intravenous antibiotics with or without percutaneous drainage. Twenty-three patients (20.5%) failed conservative treatment. Univariate analysis revealed that male patients, obesity (BMI&gt;30), ASA&gt;2 and pericolic abscess greater than 4 cm on CT scan, were significantly associated with conservative treatment failure. Multivariate analysis proved that obesity [OR 2,92; 95%CI 1,104 - 7,702; p-value 0,046] and pericolic abscess &gt; 4 cm [OR 3,66; 95%CI 1,386 - 9,672; p-value 0,014], were possible predictive factors of conservative treatment failure. CONCLUSIONS: Nonoperative treatment of ACD is safe and effective. Radiological findings in association with patient clinical characteristics could help estimate the probability of conservative treatment failure. REFERENCES: Sartelli M et al. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting. World J Emerg Surg. 2020 FIGURE LEGENDS: 1 Analysis flowchart 2 Univariate analysis of patients and radiological characteristicsDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) NO

Evaluating clinical outcomes of the new femoral neck system (DePuy Synthes)

Abstract text (incl. references and figure legends) Introduction The recently introduced Femoral Neck System (FNS)(DePuy Synthes, Zuchwil, Switzerland) is developed for dynamic fixation with rotational stability of a fracture of the femoral neck. Question is what clinical outcomes of FNS placement in a large patient cohort after 6months of follow-up are. Methods For this cohort study data was extracted from a prospective hip fracture database. Patients receiving an FNS in a level II trauma teaching hospital between 1 January 2018 and 13 May 2021 were included. Follow-up duration was at least 6months. Results A total of n=81 patients were included, with a median age of 67years with a female gender in n=45(56%) and had most frequently an ASA-score of 1 or 2 (n=52(61%)). The FNFs were non-displaced fractures in n=61 patients (75%) and in n=9 patient (11%) Pauwels type I, in n=42(52%) type II and in n=30(37%) type III. Time to surgery was 17hours(IQR 10–21) and surgery time was 34minutes(IQR 28–41). In n=6(7%) patients avascular necrosis of the femoral head was diagnosed after six months of follow-up. No significant baseline differences were found between patients who developed AVN and patients without this complication. Conclusion Early results appear to show that the FNS can be a safe alternative for dynamic osteosynthesis with rotational stability of a FNF.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Skeletal trauma and sports medicine

A rare and life-threatening complication following liposuction

Abstract text (incl. references and figure legends) Being one of the most popular esthetic procedures, liposuction may have rare yet potentially life-threatening complications. We present a severe case of multiple bowel perforations which resulted in a 5-month long hospitalization, and numerous surgeries – 4 laparotomies, and 13 free skin grafts. A 43-year-old female patient presented to the ER with severe skin necrosis, covering her entire abdomen and most of her anterior thighs, 5 days after a liposuction procedure which took place as an out-patient procedure in a small private clinic. A CT scan revealed free air in the abdomen, and air and fat stranding in the soft tissue of the abdominal wall and thighs. She was taken to an emergent laparotomy. During surgery multiple enterotomies (perforations) were identified. Also, extensive skin and abdominal wall necrosis, with pockets of pus and enteric content throughout. The entire necrotic fascia and skin were resected, leaving no abdominal wall. In addition, 2 large segments of the small intestines were resected as well. Primary anastomosis were made. Second look surgery took place after 48 hours, with temporary closure of the abdomen with 2 layers of vicryl mesh. During her long stay at the ICU she underwent 2 more laparotomies, and 13 STSG procedures in attempt to restore the resected skin. During the postoperative period the patient developed two enteroatmospheric fistulas. The patient was discharged home after 5 month hospitalization – 3 month of which in the ICU. A systemic literature review published by Skorochod et al, found 49 cases of abdominal visceral perforation. Seven patients died from this dreadful complication, 20 discharged without any sequelae, and 22 developed complications after discharge.This case of severe skin and fascia necrosis, with multiple small bowel perforations, following liposuction, is extremely rare, in both its severity and the positive intermediate outcome. Liposuction should be performed in a large hospital with ample experience, close follow up and treating physicians should have a high index of suspicion for complicationsDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) NO

Visceral trauma

Blunt thoracic aortic injury after high energy trauma: A case report

Abstract text (incl. references and figure legends) Blunt thoracic aortic injury (BTAI) has mortality rates up to 46% among patients who are alive upon hospital admission1. However, due to its rarity, strong evidence for its management lacks. A 61-year-old man was brought to the emergency department after a high-energy motorcycle accident. He presented with chest and abdominal pain, and left chest deformation, but no signs of respiratory distress or external hemorrhage. He displayed severe hypotension and tachycardia, signs of malperfusion and hyperlactacidemia. D-Dimer count was of 122176ng/mL. Chest X-ray showed multiple rib fractures and left costophrenic angle obliteration, without significant hemothorax. Pelvic binder was in place, and X-ray confirmed a type III Anterior Posterior Compression Pelvic Fracture (Young-Burgess). Focused Assessment with Sonography in Trauma was unremarkable. The patient responded partially to massive transfusion, but no major source of bleeding was established initially. Body Computed Tomography (CT) showed an acute aortic dissection of the descending thoracic aorta with active bleeding to the left hemithorax. Upon multidisciplinary discussion, the patient was taken to the Operating Room and submitted to thoracic endovascular aortic repair (TEVAR) and osteotaxis of the pelvis through external fixation. He was afterwards admitted to the Intensive Care Unit (ICU) for hemodynamic stabilization. Left side hemothorax was drained with a chest tube. Reevaluation CT showed a well-positioned endoaortic prosthesis with no contrast leak. He was released from the ICU after 11 days and submitted to definite pelvic osteosynthesis 8 weeks after the injury. 3 months after the accident, the patient resumed normal activities. BTAI requires immediate intervention. European databases are needed to establish evidence-based consensus guidelines. 1- Mouawad, N.J., Paulisin, J., Hofmeister, S. et al. Blunt thoracic aortic injury – concepts and management. J Cardiothorac Surg 15, 62 (2020).Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

"Train as you fight" – Who has the most experience performing life-saving surgical procedures? A retrospective analysis from the German armed forces hospital Ulm

Abstract text (incl. references and figure legends) Background When deployed in a &quot;Role 2&quot; treatment facility on mission, the military surgeon, as a generalist, must handle polytrauma patients on his own. Does the daily surgical routine in Germany sufficiently prepare for these situations? It is unclear who (among abdominal, vascular and orthopdedic surgeons) has the most experience performing life-saving surgical procedures in the trauma patient. Methods We retrospectively identified all patients admitted to the trauma unit who underwent immediate surgery with life-threating injuries. These injuries were assigned to a surgical specialty (abdominal, vascular, orthopedic). The frequency of involvement of different surgical specialties in such procedures was evaluated. Results A total of 474 patients requiring immediate life-saving surgery were identified from 2015 - 2022. Among these, life-threatening injuries were most commonly abdominal, followed by vascular and orthopedic trauma. Most of these procedures were performed by a specialist. Conclusion Abdominal surgeons have the most experience performing surgical procedures for life-threatening injuries. Orthopedic surgeons were least likely to perform such interventions. This must be taken into account when planning personnel for military deploymentsDisclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Traumatic abdominal wall hernia, what else?

Abstract text (incl. references and figure legends) Male, 70 years old. Came to the emergency department due to increasing abdominal pain, after having fallen from a bicycle 4 days before.No relevant past medical history, no usual medication.Hemodynamically stable, no fever. GCS 15. Soft and depressing abdomen, with pain on palpation at the epigastrium. He had a hematoma of the abominal wall near the midline, without tension.The abdominal ultrasound showed an epigastric hernia corresponding to a palpable swelling with 8cm of major axis with fat and digestive loops.Diagnosed with painful traumatic abdominal hernia with indication of surgical treatment. It was operated on the same day: Midline hernioplasty with a polypropylene mesh on pre-periotneal space. Surgery and hospitalization without complications.Hospital discharge on the 3rd postoperative day. Follow-up at 6 months without recurrence and without complications.Comments: Traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after low- or high-velocity impact of the abdominal wall against a blunt object. It is defined as bowel or abdominal organ herniation through a disruption of musculature and fascia following severe blunt trauma. The prevalence of TAWHs in blunt trauma patients seen at a designated trauma center in published series is approximately 1 %. Owing to the rare incidence and complex nature of this condition, it is not possible to plan randomized control trials for optimal surgical management. The timing of surgery in any TAWH case should be considered depending on the severity of the trauma, the size of the wall defect, clinical and radiological findings, associated injuries, and the clinical status of the patient. In this particular case the pation had pain wich was the main reason for urgent treatment. Ref: Indian Journal of Surgery; Traumatic Abdominal Wall Hernia: Early or Delayed Repair?, Published online 2014 May 7. doi: 10.1007/s12262-014-1083-9. ATLS, American College of Surgeons, 9th edition.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

Ileocolic intussusception in adults – An unusual entity

Abstract text (incl. references and figure legends) Introduction Intussusception is defined as the invagination of a segment of the intestine over the lumen of the immediately adjacent segment, more common in children. In adults, almost all cases are malignant neoplasms involving the ileocecal valve. Diagnosis is challenging given nonspecific symptomatology. Abdomino-pelvic X-ray and computed tomography (CT) are useful. Almost 70-90% of cases in adults require surgery as definitive treatment. Material and Methods Case report and presentation of casuistry of the last 10 years in our emergency department. Results A 38-year-old woman was admitted to the emergency department with severe diffuse abdominal pain associated with blood stool that started 2 hours before. She reports the onset of abdominal pain for 7 months. The abdomen was diffusely painful. Ultrasonography and CT report aspects were suggestive of ileocolic invagination. We confirmed intraoperatively invagination of small intestine and a Meckel&quot;s diverticulum into the cecum extending to the proximal transverse colon. A right hemicolectomy with primary anastomosis was performed. The postoperative had no complications. Histology was negative for neoplasia. Conclusion Intestinal intussusception in adults is rare and has nonspecific symptomatology. It is a surgical emergency associated with high mortality rates in case of late treatment. In our department in the past 10 years, only a few cases were diagnosed, as reported. References Moniakis A.A. et al: Ileocolic intussusception: A case report and literature review, Am J Case Rep, 2021; 22:e933341 Muniba M. et al: A rare case of idiopathic ileocolic intussusception in an adult; Medicine and pharmacy reports, Vol. 94/No. 4 /2021: 516-520 Lief K et al: Diagnostic challenge of the non-specific presentation of adult intussusception BMJ Case, Rep 2019;12:e229931 Amol N. Wagh, et al: A rare case report of large B cell lymphoma in adult presentation as intussusception, Clinics and Practice 2020;volume 10:1292l. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) NO

Poster Session 4
Emergency surgery 2

Appointment

Chairs

Programme

Poster Session 4Emergency surgery 2

Appointment

Chairs

Programme

Poster Session 4
Emergency surgery 2