Background: The aim of this multicentre prospective observational study was to identify the incidence, patient characteristics, diagnostic pathway, management and outcome of acute mesenteric ischaemia (AMI). Methods: All adult patients with clinical suspicion of AMI admitted or transferred to 32 participating hospitals from 06.06.2022 to 05.04.2023 were included. Participants who were subsequently shown not to have AMI or had localized intestinal gangrene due to strangulating bowel obstruction had only baseline and outcome data collected. Results: AMI occurred in 0.038% of adult admissions in participating acute care hospitals worldwide. From a total of 705 included patients, 418 patients had confirmed AMI. In 69% AMI was the primary reason for admission, while in 31% AMI occurred after having been admitted with another diagnosis. Median time from onset of symptoms to hospital admission in patients admitted due to AMI was 24 h (interquartile range 9-48h) and time from admission to diagnosis was 6h (1–12 h). Occlusive arterial AMI was diagnosed in 231 (55.3%), venous in 73 (17.5%), non-occlusive (NOMI) in 55 (13.2%), other type in 11 (2.6%) and the subtype could not be classified in 48 (11.5%) patients. Surgery was the initial management in 242 (58%) patients, of which 59 (24.4%) underwent revascularization. Endovascular revascularization alone was carried out in 54 (13%), conservative treatment in 76 (18%) and palliative care in 46 (11%) patients. From patients with occlusive arterial AMI, revascularization was undertaken in 104 (45%), with 40 (38%) of them in one site admitting selected patients. Overall in-hospital and 90-day mortality of AMI was 49% and 53.3%, respectively, and among subtypes was lowest for venous AMI (13.7% and 16.4%) and highest for NOMI (72.7% and 74.5%). There was a high variability between participating sites for most variables studied. Conclusions: The overall incidence of AMI and AMI subtypes varies worldwide, and case ascertainment is challenging. Pre-hospital delay in presentation was greater than delays after arriving at hospital. Surgery without revascularization was the most common management approach. Nearly half of the patients with AMI died during their index hospitalization. Together, these findings suggest a need for greater awareness of AMI, and better guidance in diagnosis and management. Trial registration: NCT05218863 (registered 19.01.2022).

Severe or major burns induce a pathophysiological, immune, and inflammatory response that can persist for a long time and affect morbidity and mortality. Severe burns are followed by a “hypermetabolic response”, an inflammatory process that can be extensive and become uncontrolled, leading to a generalized catabolic state and delayed healing. Catabolism causes the upregulation of inflammatory cells and innate immune markers in various organs, which may lead to multiorgan failure and death. Burns activate immune cells and cytokine production regulated by damage-associated molecular patterns (DAMPs). Trauma has similar injury-related immune responses, whereby DAMPs are massively released in musculoskeletal injuries and elicit widespread systemic inflammation. Hemorrhagic shock is the main cause of death in trauma. It is hypovolemic, and the consequence of volume loss and the speed of blood loss manifest immediately after injury. In burns, the shock becomes evident within the first 24 h and is hypovolemic-distributive due to the severely compromised regulation of tissue perfusion and oxygen delivery caused by capillary leakage, whereby fluids shift from the intravascular to the interstitial space. In this review, we compare the pathophysiological responses to burns and trauma including their associated clinical patterns.

Peritonitis from perforation of abdominal viscera is associated with high mortality. In western countries individuals older than 65 years constitute a significant proportion of the population and intra abdominal infections are more challenging to manage in these aged patients. This prospective cohort study included 143 consecutive patients operated on for primary perforative peritonitis. The aim of the study was to assess the prognostic efficacy of Mannheim Peritonitis Index (MPI) in a population with a significant proportion of older patients and to substantiate advanced age as an independent prognostic factor. Patients' informations were collected both on hospitalization and after surgical exploration; severity of peritonitis was evaluated using the MPI. The prognostic value of MPI was compared to older age and other clinical variables. The intra-hospital mortality was 25.2%. According to the MPI score, the ROC curve identified 21 as cut-off value with a sensitivity of 86% and a specificity of 59% in predicting the risk of death. MPI score and age over 80 years old resulted independent predictors of mortality at multivariate analysis. In the subgroup of patients with MPI score≥21, the mortality rate was 46.4% for patients older than 80 years old and 38.3% for younger patients (p=0.07); in patients with MPI score<21, the mortality of those aged more than 80 years reached 33.3% compared to 3.4% for younger patients (p=0.001). Age older than 80 years is strongly related to major increase in mortality rates and should be taken into account together with the MPI score in planning the surgical approach and the post-operative care.

Ulcerative colitis (UC) is a benign disease characterized by a chronic relapsing and remitting inflammation of the colon-rectum. Medical treatment, including corticosteroids, antibiotics, immunomodulators, 5-aminosalicylate and biological agents, is the first line approach. Because of steroid-dependence, therapy refractory disease, unacceptable medical side-effects, suspect of malignant degeneration and non-compliant behavior, up to 35% of patients need surgical treatment [ 1 x [1] Filippi, J., Allen, P.B., Hebuterne, X., and Peyrin-Biroulet, L. Does anti-TNF therapy reduce the requirement for surgery in ulcerative colitis? a systematic review. Curr. Drug Targets. 2011; 12: 1440–1447 Crossref | PubMed | Scopus (44) | Google Scholar See all References , 2 x [2] Targownik, L.E., Singh, H., Nugent, Z., and Bernstein, C.N. The epidemiology of colectomy in ulcerative colitis: results from a population-based cohort. Am. J. Gastroenterol. 2012; 107: 1228–1235 Crossref | PubMed | Scopus (103) | Google Scholar See all References ]. A total (procto)colectomy is often required and this procedure is defined as standard in the last European Crohn's and Colitis Organization (ECCO) and American Society of Colon and Rectal Surgeons (ASCRS) guidelines [ 3 x [3] Travis, S.P., Stange, E.F., Lémann, M., Oresland, T., Bemelman, W.A., Chowers, Y., Colombel, J.F., D'Haens, G., Ghosh, S., Marteau, P., Kruis, W., Mortensen, N.J., Penninckx, F., and Gassull, M. European Crohn's and Colitis Organisation (ECCO), European evidence-based consensus on the management of ulcerative colitis: current management. J. 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This allows a close to the bowel dissection and it can be performed as a one-, two- or three-stage procedure. In the first case after colectomy, ileal-pouch anal anastomosis (IPAA) is performed. In the second approach, the IPAA is protected by a temporary diverting ileostomy. In the latter, colectomy with terminal ileostomy is performed, then the IPAA is carried out with diverting ileostomy and, finally, the intestinal transit is restored [ 5 x [5] McAllister, I., Sagar, P.M., Brayshaw, I., Gonsalves, S., and Williams, G.L. Laparoscopic restorative proctocolectomy with and without previous subtotal colectomy. Colorectal Dis. 2009; 11: 296–301 Crossref | PubMed | Scopus (21) | Google Scholar See all References , 6 x [6] Heuschen, U.A., Hinz, U., Allemeyer, E.H., Lucas, M., Heuschen, G., and Herfarth, C. One- or two-stage procedure for restorative proctocolectomy: rationale for a surgical strategy in ulcerative colitis. Ann. 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Robotic colorectal surgery: hype or new hope? a systematic review of robotics in colorectal surgery. Colorectal Dis. 2010; 12: 1084–1093 Crossref | PubMed | Google Scholar See all References ] [8] . In effect, robotics has the potential to provide an enhanced and clear view even within a narrow pelvis, with improved visualization of the nerves and their branches and a better manipulation in a field difficult to access in laparoscopy [ 9 x [9] Aly, E.H. Robotic colorectal surgery: summary of the current evidence. Int. J. Colorectal Dis. 2014; 29: 1–8 Crossref | PubMed | Scopus (36) | Google Scholar See all References ] [9] . Moreover the learning curve of the robotic technique seems to be faster than laparoscopic surgery, probably because robotic assistance improves performance with complex tasks, while decreasing operator workload [ 10 x [10] Melich, G., Hong, Y.K., Kim, J., Hur, H., Baik, S.H., Kim, N.K., Sender Liberman, A., and Min, B.S. Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves. Surg. Endosc. 2015; 29: 558–568 Crossref | PubMed | Scopus (21) | Google Scholar See all References ] [10] . Finally, several reports have demonstrated the non inferiority of robotics compared to laparoscopy, in terms of short and long-term outcomes [ 11 x [11] Buchs, N.C. Robotic...

Background: There are no clinical or laboratory markers that can diagnose acute mesenteric ischemia (AMI) accurately. This study aimed to find differences in clinical and laboratory markers between arterial occlusive AMI and other acute abdominal diseases where AMI was initially suspected. Methods: This was a post hoc study of an international prospective multicenter study where data on patients with suspected AMI were collected. Independent factors associated with arterial occlusive AMI were evaluated in a multivariable logistic regression analysis. Results: The number of patients with arterial occlusive AMI was 231, consisting of thrombotic (n = 104), embolic (n = 61), and indeterminate (n = 66) occlusions. The non-AMI group included 287 patients, of whom 128 had strangulated bowel obstruction. Current smoking (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.31–5.03), hypertension (OR 2.08, 95% CI 1.09–3.97), bowel emptying (OR 3.25, 95% CI 1.59–6.63), and leukocytosis (OR 1.54, 95% CI 1.14–2.08) at admission were independently associated with arterial occlusive AMI compared to the non-AMI group. Conclusions: This study found clinical and laboratory data to be associated with arterial occlusive AMI in patients with suspicion of AMI, which can possibly be of value in screening for arterial occlusive AMI at the emergency department. Further studies are needed to find more accurate diagnostic markers.