Background/Objectives: Small bowel obstruction (SBO) is a common surgical emergency associated with significant morbidity and mortality. This retrospective analysis aimed to identify key predictors for the need for surgery in SBO management and to develop a simple clinical risk score to support decision-making. Methods: This retrospective study included 285 patients treated for SBO at the University Hospital Erlangen from 2018 to 2022. Pretherapeutic clinical, laboratory, and imaging data, as well as treatment details and outcome parameters were assessed and analyzed using univariate and multivariate logistic regression to identify significant predictors for the need of surgery. A weighted point-based risk score was then derived from the final model, and its discriminative performance was evaluated using receiver operating characteristic (ROC) analysis. Results: Of the 285 patients, 234 (82.1%) underwent surgery and 51 (17.9%) were successfully managed conservatively. Multivariate analysis identified the following independent predictors for surgery: 0–1 previous abdominal operation (OR 4.7, p = 0.009), serum albumin ≤ 34 g/L (OR 4.5, p = 0.011), free intraperitoneal fluid on imaging (OR 3.6, p = 0.015), air–fluid levels on plain abdominal X-ray (OR 3.5, p = 0.024) and a transition point on CT (OR 11.4, p = 0.002). A weighted score (range 0–6 points) was constructed, assigning 1 point to each of the first four predictors and 2 points to the transition point. The score showed good discrimination for predicting the need for surgery (AUC 0.874). Using a cut-off of ≥3 points, sensitivity was 96.2% and specificity 64.7%. The observed proportion of patients requiring surgery increased from 21.4% in the low-risk group (0–2 points) to 88.6% in the intermediate-risk group (3–4 points) and 97.3% in the high-risk group (5–6 points). Conclusions: The proposed predictors and the weighted risk score may support bedside decision-making in SBO by distinguishing patients who require surgery from those eligible for conservative management, but they require prospective multicenter validation before routine clinical implementation.

Spontaneous liver rupture is rare and highly dangerous, life-threatening condition occurring in 1–2% of pregnant women with preeclampsia and eclampsia. There are more than 100 similar case reports in the literature. It is believed that liver rupture is caused by HELLP syndrome as one of the signs of preeclampsia. The results of surgical treatment is still unsatisfactory. Appropriate treatment strategy is absent because of rareness of this condition. It is presented case report of a woman with spontaneous liver rupture associated with HELLP syndrome. Patient underwent perihepatic tamponade, endovascular embolization of right hepatic artery followed by right-sided hemihepatectomy.

Introduction: Despite its clinical significance and the fact that mechanical adhesive small bowel obstruction (SBO) is a common surgical emergency, data on the prevalence, types and risk factors of morbidity remain limited. This study aims to assess the frequency and kind of complications and identify patient- and surgery-related risk factors, with particular attention to the impact of surgical timing. Methods: We conducted a retrospective analysis of patients who underwent surgery for mechanical adhesive SBO at the University Hospital Erlangen over a five-year period (2018–2022). Postoperative complications and their outcomes were assessed. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors associated with postoperative morbidity. Results: Postoperative in-hospital morbidity occurred in 22.2% of patients, the majority of which were surgery-related (71.2%). The most frequent complications were postoperative paralytic ileus (6.0%), wound healing disorders (5.1%) and cardiopulmonary complications (5.1%). The in-hospital mortality rate was 2.1%. Postoperative morbidity was managed conservatively in 75.0% of cases and required reoperation in 25.0%. In 89.4% of affected patients, morbidity was associated with prolonged hospitalization. Multivariate analysis identified BMI > 25 kg/m² (OR 2.9; 95% CI, 1.4–6.0; p = 0.007), ASA class III–IV (OR 3.0; 95% CI, 1.4–6.5; p = 0.007) and surgery duration > 110 minutes (OR 4.0; 95% CI, 1.9–8.7; p < 0.001) as independent predictors of morbidity. In contrast, surgical timing – specifically nighttime procedures (p = 0.200) and weekend surgery (p = 0.572) - was not significantly associated with increased risk. Conclusion: In surgically treated patients with adhesive small bowel obstruction, postoperative morbidity was independently associated with elevated BMI, ASA class III–IV, and prolonged operative duration. In contrast, nighttime and weekend surgery were not significantly associated with postoperative morbidity in this cohort. These findings underscore the importance of risk-adapted perioperative optimization and close interdisciplinary management, particularly in high-risk patients.

We describe a rare case of cure for poorly differentiated stage T4N1M0 cholangiocarcinoma with an atypical genetic mutation in the BRAF V600E gene. The 38-year-old patient underwent surgery at the National Surgical Institute for cholangiocellular carcinoma of the left lobe of the liver with invasion of the anterior abdominal wall, diaphragm, and pericardium. A left lobe liver resection with lymph node dissection and pericardial resection was performed. Adjuvant chemotherapy (GEMOX) was ineffective. Treatment with pembrolizumab also failed to improve the patient's condition. Molecular profiling of the tumor using next-generation sequencing revealed a mutation in the BRAF V600E gene. Targeted therapy with dabrafenib and trametinib, BRAF gene inhibitors, was initiated, resulting in a complete response. The patient has been free of tumor activity and signs of recurrence for two years. To our knowledge, this clinical case is the most detailed reported worldwide for stage IV cholangiocellular carcinoma treated with dabrafenib and trametinib.

This study presents a clinical case analyzing risk factors for the development of antibiotic resistance in abdominal surgery, with particular emphasis on the effectiveness of preventive and therapeutic strategies despite a complex risk profile. The patient underwent laparoscopic cholecystectomy complicated by bile contamination and subsequent conversion to open surgery. The postoperative course was further challenged by multiple preoperative comorbidities, including obesity and type 2 diabetes mellitus, as well as prior antibiotic exposure, all contributing to a high risk of multidrug-resistant infection. The uniqueness of this case lies not only in the combination of significant risk factors, but in the favorable clinical outcome achieved through timely diagnosis, targeted antimicrobial therapy, strict antibiotic stewardship, and optimized perioperative management. This case highlights the importance of comprehensive risk assessment, individualized treatment strategies, and reinforced infection control measures in mitigating antibiotic resistance in abdominal surgery.