Purpose
Although several studies of preperitoneal pelvic packing (PPP) have reported a hemostatic effect in patients with pelvic fractures, the presence of packed surgical tapes may provoke inflammation or infection. In Korean institutions, the delta neutrophil index (DNI) is currently used as a clinical biomarker for identifying sepsis and predicting prognosis. Therefore, this study aimed to evaluate the usefulness of DNI in pelvic fracture patients who underwent PPP.
Methods
We retrospectively reviewed 36 hemodynamically unstable patients who underwent PPP between May 2014 and December 2018 at Wonju Severance Christian Hospital. To evaluate differences in postoperative DNI patterns between survivors and nonsurvivors, repeated-measures analysis of variance was performed.
Results
Eight patients died, and 16 patients developed PPP-related complications. Packed surgical tapes were maintained for a mean of 46.3 hours. Compared with survivors, nonsurvivors had significantly higher DNI values on postoperative day (POD) 2 (5.3% [range, 0%–40.2%] vs. 36.0% [range, 5.4%–70.2%], P<0.001) and POD 3 (2.6% [range, 0%–16.3%] vs. 29.9% [range, 1.2%–64.2%], P<0.001). The overall pattern of DNI change over time differed significantly between survivors and nonsurvivors (P=0.001). In addition, patients with PPP-related complications exhibited a significantly smaller decrease in DNI between POD 1 and POD 2 compared with those without complications (–1.6% [range, −7.8% to 58.9%] vs. –4.5% [−46.8% to 31.6%], P=0.048).
Conclusion
Postoperative DNI may serve as a clinical indicator for predicting mortality and complications in pelvic fracture patients who have undergone PPP.

Adhesive small bowel obstruction (ASBO) is a common postoperative complication and remains a leading cause of emergency surgical admissions. This review synthesizes current evidence regarding the diagnosis, conservative management, and surgical treatment of ASBO, focusing on the role of standardized protocols in optimizing patient outcomes. ASBO most often develops following abdominal or pelvic surgery, especially after open procedures. Conservative management, including nasogastric decompression, water-soluble contrast studies (e.g., Gastrografin), and nutritional support, is effective in 65% to 80% of cases without ischemia or strangulation. However, fever, leukocytosis, persistent pain, or computed tomographic findings (e.g., the whirl sign or bowel wall thickening) necessitate early surgical intervention. Evidence indicates that extending conservative management beyond 3 to 5 days in nonresponders increases both morbidity and mortality. Recent studies do not support routine antibiotic or antispasmodic use in uncomplicated ASBO. Although analgesics and ambulation may provide symptom relief, their impact on surgical timing remains unclear. Laparoscopic adhesiolysis has demonstrated reduced morbidity and shorter hospital stays versus open surgery in appropriately selected patients. Accurate differentiation between ASBO and postoperative ileus is essential for effective treatment. Conservative management remains the first-line approach in cases of partial ASBO, but clinicians must be vigilant for signs of clinical deterioration. Surgical management, including laparoscopic intervention, should be promptly pursued if conservative therapy fails or patients exhibit clinical decline. Implementing evidence-based guidelines and individualized decision-making improves patient safety, reduces complications, and enhances overall outcomes. Ongoing research is needed to refine conservative strategies and identify predictive markers for early surgical intervention.

Purpose
Pelvis fractures are associated with bladder and urethral injury (BUI). The purpose of this study was to identify risk factors associated with BUI in patients with pelvic fracture.
Methods
Patients (> 18 years) with pelvic injury (N = 314) at our hospital between January 2015 and June 2020 were retrospectively analyzed for age, sex, cause of injury, initial vital signs, urine red blood cell (RBC) count, Glasgow Coma Scale and Abbreviated Injury Scale score, Injury Severity Score, preperitoneal pelvic packing, and femur, lumbar spine, and pelvic fractures.
Results
Compared with the BUI-absent group, the BUI-present group had a greater percentage of patients who were male (79.2% vs. 55.9%; p = 0.026), had a urine RBC count/high power field (HPF) ≥ 30 (94.4% vs. 38.8%; p < 0.001), underwent preperitoneal pelvic packing (37.5% vs. 18.6%; p = 0.035), had symphysis pubis diastasis (33.3% vs. 11.7%; p = 0.008), and had sacroiliac joint dislocation (54.2% vs. 23.4%; p = 0.001). Independent risk factors associated with BUI were symphysis pubis diastasis [odds ratio (OR) was 3.958 (95% confidence interval: 1.191–13.154); p = 0.025] and a urine RBC count/HPF ≥ 30 [OR = 25.415 (95% confidence interval: 3.252–198.637); p = 0.006]. Of those with BUI, 15 patients were diagnosed at the trauma bay, and 9 had a delayed diagnosis.
Conclusion
Patients with pelvic injury who display symphysis pubis diastasis or have a urine RBC count/ HPF ≥ 30 are at higher risk of BUI, therefore, further BUI investigations should be considered.

Citations

• Hematuria as a Screening Tool for Bladder and Urethral Injuries in Pelvic Trauma: A Sensitivity and Specificity Analysis
  Md Habibur Rahman, Muktadir Tamim, Goutom Mukharzi
  TAJ: Journal of Teachers Association.2024; 37(2): 802.     CrossRef

Intra-abdominal infection is a common, serious complication in patients undergoing emergency abdominal surgery following blunt abdominal trauma. Infectious conditions increase the incidence of autoimmune hemolytic anemia (AIHA), but reports of AIHA occurring after abdominal trauma surgery are rare. Therefore, we report a case of sepsis due to fasciitis and AIHA after abdominal trauma surgery which was successfully managed following the appropriate treatment of both conditions.

Citations

• A case of autoimmune hemolytic anemia with cold agglutinin disease post-operation for recurrent ovarian cancer
  Aisa Sugimoto, Hiroaki Yamada, Kazuto Tasaki, Takahiro Katsuda, Shin Nishio, Naotake Tsuda
  International Cancer Conference Journal.2025; 14(3): 235.     CrossRef
• Autoimmune Hemolytic Anemia Following Uncomplicated Spinal Surgery: A Report and Brief Review
  Westin M Yu, Hiren N Patel
  Cureus.2023;[Epub]     CrossRef

Purpose
To describe the experience of patients over a 7-year period who have had open abdomen (OA) surgery, at a tertiary university hospital.
Methods
The medical records of 59 patients, who were managed with OA after a laparotomy between March 2009 and December 2015, were reviewed retrospectively. The data collected included demographics, indication for OA, abdominal closure methods, abdominal closure rate, the intensive care unit stay duration, mechanical ventilation duration, hospital stay duration, and complications.
Results
Forty-seven patients (37 males, 78.7%) with a mean age of 52.2 ± 16.7 years were reviewed in the study. The indications for OA were traumatic intra-abdominal bleeding in 23 patients (48.9%), nontraumatic bowel perforation in 10 (21.3%), non-traumatic bleeding in 7 (14.9%), and bowel infarction in 6 (12.8%). The abdominal wall was closed in 38 patients (80.9%). Primary closures and fascial closure using an artificial mesh were performed on 21 (44.7%) and 12 patients (25.5%), respectively. The median number of dressing changes was 0 (interquartile range 0 - 1). The median duration of the intensive care unit and hospital stays were 12.0 and 32.0 days, respectively. The median interval to abdominal closure was 4 days (interquartile range 2 - 10.3 days). Twenty-seven patients developed complications, including uncontrolled sepsis (21.3%), entero-atmospheric fistula (19.1%), ventral hernia (8.5%), bleeding (4.3%), and lateralization (4.3%). The mortality rate was 44.7% with sepsis being the main cause of death (61.9%).
Conclusion
Traumatic intra-abdominal bleeding was a common indication for OA. Primary closure was performed in most patients, and frequent complications resulted in poor patient outcomes.

Citations

• The mortality rate of patients with open abdomen and contributing factors – a three-year audit in a major academic trauma unit
  E van der Merwe, MS Moeng, M Joubert, M Nel
  South African Journal of Surgery.2023; 61(3): 21.     CrossRef