Background and Objectives: Acute acalculous cholecystitis (AAC) is rare, mostly in older males, with cardiovascular diseases, diabetes, critical illness, or systemic infection. Antibiotherapy before or after cholecystectomy is important for preventing septic shock and postoperative infections. Increasing antibiotic resistance was recently noted and can complicate antibiotherapy. Materials and Methods: A retrospective study of all patients who underwent cholecystectomy between 2018 and 2024 in the Clinical Emergency Hospital of Craiova was performed. The etiology of AAC, complications, hospitalization duration, mortality, positive bile cultures, and in vitro antibiotic resistance were analyzed. Results: A total of 802 calculous and 54 AAC were recorded. Patients with AAC were predominantly males (OR = 1.767, p = 0.043) with diabetes (OR = 2.049, p = 0.014) and were older (66.6 ± 13.2 vs. 61.4 ± 15.6, p = 0.014). Mortality was significantly higher in AAC (18.5 vs. 3.6%, OR = 6.058, p < 0.001), with longer hospitalization (mean 9.7 vs. 8.4 days) and more perforation. Positive bile cultures were recorded in 60.5–66.2% of cases, with a similar etiology in both forms of acute cholecystitis (mostly Gram-negative species, Enterococcus, and Staphylococcus); 10 ESBL Escherichia coli and Klebsiella strains, 11 Staphylococcus aureus MRSA, and 1 Enterococcus VRE strain were recorded. Antibiotic susceptibility in vitro was similar in both AAC and calculous cholecystitis. Significant resistance to cephalosporins and quinolones was recorded; the lowest resistance was noted for amikacin, carbapenems, chloramphenicol, colistin (Gram-negative bacteria), and vancomycin. Conclusions: AAC was encountered in older males with diabetes, with a higher rate of complications and in-hospital mortality. Bile cultures were positive in 60.5–66.2%, predominantly with Gram-negative, Enterococcus, and Staphylococcus species. Significant in vitro resistance to cephalosporins and quinolones was found.

Small-bowel tumors are a heterogeneous and relatively uncommon group of neoplasms whose definitive diagnosis frequently cannot be established before surgery. Their common jejunal or ileal location limits conventional endoscopic access, and stenosing, predominantly extraluminal, or complicated presentations may render preoperative biopsy impossible. In such situations, the surgeon may have to decide the extent of resection and the need for lymphadenectomy without a histological diagnosis, even though the optimal strategy differs substantially among adenocarcinoma, gastrointestinal stromal tumor (GIST), small-bowel neuroendocrine tumor (SBNET), lymphoma, and desmoid-type fibromatosis. This narrative review integrates clinical presentation, preoperative computed tomography (CT) features, and intraoperative macroscopic findings to support a presumptive diagnosis and guide surgical decision-making when histology is unavailable. The evidence was synthesized along the decision pathway preoperative imaging → diagnostic suspicion → intraoperative appearance → surgical decision → definitive histopathology. Histology-specific CT associations are relatively well documented, whereas the independent ability of intraoperative macroscopic impression to predict histology remains limited. We propose a pragmatic, histology-oriented decision framework that prioritizes clinical urgency, disease extent and resectability, the feasibility of preoperative tissue sampling, and the potential impact of histology on the surgical procedure. The framework is conceptual and requires prospective validation; its aim is not to replace histopathological examination but to reduce the risk of both oncologically inadequate and unnecessarily extensive resections.

Background and Objectives: Necrotizing fasciitis (NF) is characterized by rapid and aggressive infection of the subcutaneous tissue and fascia, and a high risk of death in case of delay in diagnosis and treatment. Materials and Methods: This 7-year retrospective study (May 2017–May 2024) evaluated 38 patients with upper- and lower-limb NF admitted to the surgery clinic at the County Emergency Hospital in Craiova, Romania. Results: 21.8% of the confirmed NF cases were monomicrobial; Gram-positive strains were predominant, but Gram-negative strains were also involved. The mortality rate was 28.9%; acute kidney injury appears as the only independent risk factor associated with mortality, although in univariate analysis, septic shock and high NLR and INR values were also factors associated with mortality. An increased resistance rate to antibiotics was recorded, with a 32.7% MDR rate; moderate to high resistance to piperacillin + tazobactam, most cephalosporins, most carbapenems (for Gram-negative strains), and quinolones was noted. Conclusions: Multidisciplinary management, comprising intensive medical support, prompt targeted antibiotic therapy, and immediate surgical intervention, was critical for achieving favorable patient outcomes. Increasing antibiotic resistance may alter the prognosis in patients with NF.