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Abstract

Introduction: Anatomical changes in the spleen's position in the abdomen, a rare and unique condition known as wandering spleen (WS), are a vital differential diagnosis in patients presenting with an acute abdomen.

Case presentation: We present a case of WS in a 22-year-old female who presented with abdominal pain due to splenic torsion, a potentially life-threatening complication of WS. Our report provides a detailed account of this case's diagnosis, management, and outcomes, serving as a valuable reference for future cases and contributing to a better understanding of this rare condition.

The patient underwent splenectomy and was discharged without further complications. She was followed up for 6 months post-surgery, with a favorable evolution.

The presentation of WS varies from an asymptomatic mass to an acute abdomen due to splenic torsion and infarction, making recognition challenging. The diagnosis depends on imaging studies, and treatment options include splenectomy or splenopexy. The choice of procedure depends on the patient's clinical signs.

Conclusions: Given the high incidence of splenic torsion and infarction in patients with WS, the urgency and significance of early recognition and immediate intervention cannot be overstated. Surgery is the gold standard treatment, with both splenopexy and splenectomy being effective and safe options.

Keywords: wandering spleen, splenectomy, splenic torsion. 

Infectious Disease Specialists, trauma, and surgery

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Abstract

Background: Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances, and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches, and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF.

Methods: This position paper was developed in accordance with the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail to develop a consensus on the position statements.

Results: A total of 287 studies (systematic reviews, randomized clinical trials, prospective and retrospective comparative studies, case series, and original articles) were selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concomitant thoracic injuries, surgical approach, stabilization methods, and material selection

Conclusion: This consensus document addresses the key focus questions on the surgical treatment of rib fractures. The expert recommendations clarify current evidence on SSRF indications, timing, operative planning, approaches, and techniques, with the aim of guiding clinicians in optimizing the management of rib fractures, to improve patient outcomes, and direct future research.

Keywords: Rib fractures, Surgical stabilization of rib fractures (SSRF), Flail chest, Multiple rib fractures, Thoracic/chest trauma injury, Rib fixation, Operative reduction and internal fixation (ORIF), Minimally invasive plating osteosynthesis (MIPO), Video-assisted thoracoscopy surgery (VATS), Consensus, Guidelines

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Abstract

Background: Fournier’s Gangrene (FG) is a rare and potentially fatal form of necrotizing fasciitis that affects the perineal, perianal, or genital regions. The condition often originates from an infection in the anorectal or genitourinary area and is exacerbated by comorbidities, such as diabetes mellitus, chronic alcoholism, and immunosuppression. The rapid progression and high mortality associated with FG necessitate immediate diagnosis and prompt surgical intervention.

Case Presentation: We present a case of a 52-year-old male with poorly controlled diabetes mellitus who developed FG following the drainage of a perianal abscess. Despite early surgical intervention, the infection progressed, leading to extensive necrosis of the perineum, scrotum, and lower abdominal wall. The patient required multiple debridements, broad-spectrum antibiotics, and intensive care management. Over a prolonged hospital stay, the patient recovered with significant wound care, including skin grafting, in large defect. This case illustrates the complexity of managing FG, particularly due to a perianal abscess. The presence of diabetes mellitus complicates the clinical course and increases the risk of severe outcomes. A comprehensive multidisciplinary approach involving surgical, medical, and supportive care teams is essential for successful management. A review of the current literature highlights the critical importance of early and aggressive treatment to improve patient outcomes in FG cases.

Conclusion: FG following a perianal abscess presents significant management challenges, especially in patients with underlying comorbidities. This case emphasizes the necessity of early diagnosis, prompt surgical intervention, and a multidisciplinary approach to care. Despite the severity of the condition, timely and comprehensive management can lead to favorable outcomes.

 

Keywords: Fournier’s Gangrene, Perianal Abscess, Necrotizing Fasciitis, Surgical Management, Diabetes Mellitus, Multidisciplinary Approach, Case Report

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Abstract

Background:  Advanced Trauma Life Support (ATLS) has become the most widely adopted educational framework for the initial assessment and management of trauma patients across diverse global healthcare settings. Developed to standardize early trauma care, ATLS aims to improve patient safety, reduce preventable mortality, and enhance team performance, particularly in high-acuity emergency environments.

Objective: This review examines ATLS as a benchmark for quality and safety in trauma care, analyzing its core principles, clinical impact, educational value, and limitations, with emphasis on contemporary trauma systems.

Materials and Methods: A narrative educational review was conducted using peer-reviewed literature from 2020 to 2023, including guideline documents, systematic reviews, registry analyses, and outcome studies on ATLS implementation and trauma system performance.

Evidence demonstrates improved process metrics, earlier definitive interventions, and reduced preventable deaths in healthcare systems adopting ATLS principles. However, outcome heterogeneity persists, particularly in settings with varying resources, highlighting the need for tailored adaptations to ensure equitable trauma care worldwide.

Conclusions: ATLS remains a cornerstone of modern trauma education and a global reference for quality and safety. Continuous updates, integration with simulation-based training, and adaptation to evolving trauma systems are essential to maintain its relevance and effectiveness.

 

Keywords: Advanced Trauma Life Support; trauma systems; patient safety; trauma education