Damien Massalou

Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

The CIAO Study (“C omplicated Intra-A bdominal infection O bservational” Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012).Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.2,152 patients with a mean age of 53.8 years (range: 4–98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified.The overall mortality rate was 7.5% (163/2.152).According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission.Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.

Complicated Intra-Abdominal Infections in a Worldwide Context: An Observational Prospective Study (CIAOW Study)

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18–98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients.The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.

A proposal for a CT driven classification of left colon acute diverticulitis

Computed tomography (CT) imaging is the most appropriate diagnostic tool to confirm suspected left colonic diverticulitis. However, the utility of CT imaging goes beyond accurate diagnosis of diverticulitis; the grade of severity on CT imaging may drive treatment planning of patients presenting with acute diverticulitis.The appropriate management of left colon acute diverticulitis remains still debated because of the vast spectrum of clinical presentations and different approaches to treatment proposed. The authors present a new simple classification system based on both CT scan results driving decisions making management of acute diverticulitis that may be universally accepted for day to day practice.

Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study

The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4–98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.

Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion

Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports.In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature.

Influence of loading speed on the mechanical properties of the colon

Trauma is a leading cause of death for young people in developed countries, becoming a public health issue. After the spleen and liver, the digestive tract is the third most frequently affected organ during blunt abdominal trauma. Gastrointestinal injuries are responsible for significant morbidity and mortality due to the difficulty in diagnosing such intestinal lesions and the resulting delay in treatment. In-depth studies are required to understand the pathophysiological mechanisms that are responsible for these intestinal lesions. Virtual trauma studies using numerical models of the intra-abdominal organs are among the most promising means that are used to study and predict the occurrence of intestinal injuries during abdominal trauma. Mechanical behaviour of the colon has only been studied under quasi-static loads. This study involves the experimental characterization of the mechanical behaviour of the colon using tensile tests to determine the mechanical response under different loads.

Perforation recto-sigmoïdienne au cours d’un effort de défécation : définition, prise en charge et propositions physiopathologiques de cette nouvelle entité

Introduction Les perforations recto-sigmoidiennes au cours d’un effort de defecation representent un probleme diagnostique et therapeutique, avec un morbi-mortalite potentiellement elevee en raison de la peritonite stercorale qui en resulte. Materiel et methodes Nous avons pris en charge dans notre institution entre mai 2008 et janvier 2014, cinq patients pour apparition soudaine d’une douleur abdominale intense lors de la defecation. Ces 5 patients presentaient un syndrome peritoneal generalise a l’admission aux urgences avec un scanner evocateur d’une perforation d’organe creux. Resultats Une intervention a ete realisee pour chaque patient et a revele une perforation recto-sigmoidienne sur le bord anti-mesenterique du recto-sigmoide ; la perforation n’etait pas exteriorisable. Pour ces 5 patients, le colon etait macroscopiquement sain et ne presentait pas de diverticulose. Une coelioscopie premiere a ete realisee chez 3 patients. La localisation et la taille de la perforation ne permettaient pas techniquement une suture coelioscopique pour 4 patients. Discussion Differentes hypotheses semblent pouvoir expliquer la fragilite de la jonction recto-sigmoidienne : vascularisation precaire du bord anti-mesenterique, angulation de la charniere rectosigmoidienne realisant un « pseudo-sphincter », presence d’un ralentissement du transit iatrogene ou iodiopathique, etc. Toutefois, la physiopathologie exacte de cette maladie n’est pas encore etablie.