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Introduction: The management of abdominal penetrating trauma remains complex. Between the risk of negative laparotomy and missed visceral injury, laparoscopy is a good alternative. We report 2 cases of abdominal penetrating trauma with colonic injury diagnosed and treated with laparoscopic approach. Observations: The first patient was 15 years old, with no medical history and received at 3 h of a penetrating trauma by stabbing. Hemodynamic status was normal. An exploratory laparoscopy was performed. It objectified a penetration of the peritoneum on the left flank with an injury of the anti-mesenteric edge of the descending colon that was sutured. The second patient was 20 years old, with no history, who had a penetrating trauma of the left iliac fossa by stabbing. Arterial pressure was normal. He was received 6 h after the trauma. An exploratory laparoscopy objectified an injury of 2 cm located at the sigmoid colon which was sutured with a good evolution. Conclusion: Laparoscopy in abdominal wounds is a good option in selected patients. It has a diagnostic and therapeutic importance in colonic injuries. The limits are represented by the possibility of unrecognized visceral lesions that can lead to additional morbidity.
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Background The quick sequential organ failure assessment (QSOFA) score and the systemic inflammatory response syndrome (SIRS) criteria were developed to predict the risk of sepsis and death in patients received in emergency. To improve sensitivity in predicting death, the association of the two scores was proposed under the term QSIRS (QSOFA + SIRS). Our aim was to determine the accuracy of QSOFA, SIRS, and QSIRS in prediction of mortality in surgical emergencies, and to compare these scores. Patients and Methods This is a prospective study over a period of 1 year. Patients older than 15 years who presented a digestive surgical emergency (bowel obstruction, peritonitis, appendicitis, strangulated hernia) were included. For each score, the specificity, the sensitivity, the positive predictive value, the negative predictive value, and areas under the receiver operating characteristic (ROC) curve (AUC) were compared. Results One hundred and eighteen patients were included and 11 deaths were recorded (9.3%). There was a statistically significant relationship between each score and death (QSOFA p = 0.01, SIRS p = 0.003, and QSIRS p = 0.004). The realization of the ROC curve found a higher AUC for QSIRS (0.845 [0.767-0.905]) compared with QSOFA (0.783 [0.698-0.854]) and SIRS (0.737 [0.648-0.813]). QSIRS (90.9%) had a higher sensitivity compared with the two other scores alone (SIRS = 81.9% and QSOFA = 36.3%). Conclusion Our study found that QSIRS improves the ability to predict death in digestive surgical emergencies.