Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2019

Open Access 01-12-2019 | Magnetic Resonance Imaging | Research article

Pregnancy and appendicitis: a systematic review and meta-analysis on the clinical use of MRI in diagnosis of appendicitis in pregnant women

Authors: Mania Kave, Fateme Parooie, Morteza Salarzaei

Published in: World Journal of Emergency Surgery | Issue 1/2019

Login to get access

Abstract

Background

The aim of this systematic review and meta-analysis was to evaluate the clinical use of MRI for the evaluation of acute appendicitis during pregnancy.

Methods

The searches were conducted by two independent researchers (MK, MS) to find the relevant studies published from 1/1/2009 until end of 30/12/2018. We searched for published literature in the English language in MEDLINE via PubMed, EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS. The keywords used in the search strategy are Pregnancy [MeSH], Pregnant [MeSH] OR—Magnetic resonance imaging [MeSH] OR—Appendicitis [MeSH] OR—Ultrasound, [MeSH] OR, imaging, MRI [MeSH] OR"،" and Right lower quadrant pain [MeSH]. The risk of bias of every article was evaluated by using QUADAS-2. On the basis of the results from the 2 × 2 tables, pooled measures for sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curves (AUC) along with their 95% confidence intervals (CIs) were calculated using the DerSimonian Lair methodology.

Results

As many as 1164 studies were selected. After analyzing the correspondence of the studies with the required criteria, 19 studies were selected for the final review. For appendicitis in pregnancy, the MRI sensitivity was 91.8% at the 95% confidence interval of (95% CI 87.7–94.9%). At the confidence interval of 95%, the specificity was 97.9% (95% CI 0.97.2–100%). The risk of bias in the studies conducted was measured using the QUADAS-2 tool.

Conclusion

MRI has high sensitivity and specificity (91.8%, 97.9% respectively) for the diagnosis of acute appendicitis in pregnant patients with clinically suspected appendicitis. It is an excellent imaging technique in many instances, which does not expose a fetus, or the mother, to ionizing radiation, making it an excellent option for pregnant patients with suspected acute appendicitis.
Literature
1.
Ueberrueck T, Koch A, Meyer L, et al. Ninety-four appendectomies for suspected acute appendicitis during pregnancy. World J Surg. 2004;28(5):508–11.PubMedCrossRef
2.
Andersson RE, Lambe M. Incidence of appendicitis during pregnancy. Int J Epidemiol. 2001;30(6):1281–5.PubMedCrossRef
3.
Şimşek D, Turan ÖD, Ergenoğlu AM, Demir HB, Sezer TÖ, Şahin Ç. Pregnancy outcomes and surgical management of pregnancy complicated by appendicitis: obstetrician view. Meandros Med Dental J. 2015;16(2):43–9.CrossRef
4.
Apandisit AP. Acute perforated appendicitis as a cause of fetal tachycardia at term pregnancy. Cukurova Med J. 2015;40(2):336–9.CrossRef
5.
Aydın S, Fatihoğlu E. Perfore Apandisit: Ultrasonografik Bir Tanısal Zorluk. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 51(2):110–5.
6.
Gök AF, Soytaş Y, Bayraktar A, Emirikçi S, İlhan M, Koltka AK, Günay MK. Laparoscopic versus open appendectomy in pregnancy: a single center experience. Ulusal Travma Acil Cerrahi Derg. 2018;24(6):552–6.
7.
Hatipoglu S, Hatipoglu F, Akbulut S, Abdullayev R. Management of acute appendicitis in pregnancy: Early diagno.
8.
Ucuncu MZ, Ucuncu MM. Left sided acute appendicitis in pregnant woman: a case report/Sol Yerlesimli Gebe Akut Apandisit: Olgu Sunumu. Turk J Color Dis. 2016;26(4):136–9.
9.
Demir MK, Savas Y, Furuncuoglu Y, Cevher T, Demiral S, Tabandeh B, Aslan M. Imaging findings of the unusual presentations, associations and clinical mimics of acute appendicitis. Eurasian J Med. 2017;49(3):198.PubMedPubMedCentralCrossRef
10.
Çınar H, Aygün A, Derebey M, Tarım İA, Akalın Ç, Büyükakıncak S, Erzurumlu K. Significance of hemogram on diagnosis of acute appendicitis during pregnancy. Ulus Travma Acil Cerrahi Derg. 2018;24(5):423–8.PubMed
11.
Mir SA, Wani M, Tak SA, Shiekh SH, Moheen HA. Feasibility of early surgical intervention for acute appendicitis in gravid patients. Saudi Surg J. 2017;5(3):111.CrossRef
12.
13.
14.
Beyazal M, Özkaçmaz S, Ünal Ö, Yavuz A, Bora A. Necrotizing Brucella epididymoorchitis: magnetic resonance imaging findings. Prevalence. 2014;19:24.
15.
Oto A, Ernst RD, Ghulmiyyah LM, Nishino TK, Hughes D, Chaljub G, Saade G. MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdominal imaging. 2009;34(2):243–50.CrossRef
16.
De Wilde JP, Rivers AW, Price DL. A review of the current use of magnetic resonance imaging in pregnancy and safety implications for the fetus. Prog Biophys Mol Biol. 2005;87(2–3):335–53.
17.
Mourad J, Elliott JP, Erickson L, Lisboa L. Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs. Am J Obstet Gynecol. 2000;182(5):1027–1029. [PubMed: 10819817]..PubMedCrossRef
18.
Dewhurst C, Beddy P, Pedrosa I. MRI evaluation of acute appendicitis in pregnancy. J Magn Reson Imaging. 2013;37(3):566–75.PubMedCrossRef
19.
Tamir IL, Bongard FS, Klein SR. Acute appendicitis in the pregnant patient. Am J Surg. 1990;160(6):571–6.PubMedCrossRef
20.
Chen MM, Coakley FV, Kaimal A, Laros RK. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol. 2008;112(2):333–40.CrossRef
21.
Vu L, Ambrose D, Vos P, Tiwari P, Rosengarten M, Wiseman S. Evaluation of MRI for the diagnosis of appendicitis during pregnancy when ultrasound is inconclusive. J Surg Res. 2009;156(1):145–9.PubMedCrossRef
22.
Colletti PM, Sylvestre PB. Magnetic resonance imaging in pregnancy. Magnetic resonance imaging clinics of North America. 1994;2(2):291–307.
23.
Tremblay E, Thérasse E, Thomassin-Naggara I, Trop I. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics. 2012;32(3):897–911.PubMedCrossRef
24.
Rooholamini SA, Au AH, Hansen GC, Kioumehr F, Dadsetan MR, Chow PP, Kurzel RB, Mikhail G. Imaging of pregnancy-related complications. Radiographics. 1993;13(4):753–70.PubMedCrossRef
25.
Rosen MP, Ding A, Blake MA, Baker ME, Cash BD, Fidler JL, Grant TH, Greene FL, Jones B, Katz DS, Lalani T. ACR Appropriateness Criteria® right lower quadrant pain—suspected appendicitis. J Am College Radiol. 2011;8(11):749–55.CrossRef
26.
Nunnelee JD, Musselman R, Spaner SD. Appendectomy in pregnancy and postpartum: analysis of data from a large private hospital. Clin Excell Nurse Pract. 1999;3(5):298–301. [PubMed: 10763629]..
27.
Ito K, Ito H, Whang EE, Tavakkolizadeh A. Appendectomy in pregnancy: evaluation of the risks of a negative appendectomy. Am J Surg. 2012;203(2):145–50.PubMedCrossRef
28.
Wallace CA, Petrov MS, Soybel DI, Ferzoco SJ, Ashley SW, Tavakkolizadeh A. Influence of imaging on the negative appendectomy rate in pregnancy. J Gastrointest Surg. 2008;12(1):46–50.PubMedCrossRef
29.
Baysinger CL. Imaging during pregnancy. Anesthesia & Analgesia. 2010;110(3):863–7.
30.
Jung SE, Byun JY, Lee JM, Rha SE, Kim H, Choi BG, Hahn ST. MR imaging of maternal diseases in pregnancy. Am J Roentgenol. 2001;177(6):1293–300.PubMedCrossRef
31.
32.
33.
Ramalingam V, LeBedis C, Kelly JR, Uyeda J, Soto JA, Anderson SW. Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female. Emerg Radiol. 2015;22(2):125–32.PubMedCrossRef
34.
Aggenbach L, Zeeman GG, Cantineau AE, Gordijn SJ, Hofker HS. Impact of appendicitis during pregnancy: no delay in accurate diagnosis and treatment. Int J Surg. 2015;15:84–9.PubMedCrossRef
35.
36.
Baron KT, Arleo EK, Robinson C, Sanelli PC. Comparing the diagnostic performance of MRI versus CT in the evaluation of acute nontraumatic abdominal pain during pregnancy. Emerg Radiol. 2012;19(6):519–25.PubMedCrossRef
37.
SCOAP Collaborative, Cuschieri J, Florence M, et al. Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg. 2008;248(4):557–63.
38.
Babaknia A, Parsa H, Woodruff JD. Appendicitis during pregnancy. Obstet Gynecol. 1977;50(1):40–1.
39.
Leeuwenburgh MM, Jensch S, Gratama JW, Spilt A, Wiarda BM, Van Es HW, Cobben LP, Bossuyt PM, Boermeester MA, Stoker J, OPTIMAP Study Group. MRI features associated with acute appendicitis. Eur Radiol. 2014;24(1):214–22.PubMedCrossRef
40.
Repplinger MD, Levy JF, Peethumnongsin E, Gussick ME, Svenson JE, Golden SK, Ehlenbach WJ, Westergaard RP, Reeder SB, Vanness DJ. Systematic review and meta-analysis of the accuracy of MRI to diagnose appendicitis in the general population. J Magn Reson Imaging. 2016;43(6):1346–54.PubMedCrossRef
41.
Hiersch L, Yogev Y, Ashwal E, From A, Ben-Haroush A, Peled Y. The impact of pregnancy on the accuracy and delay in diagnosis of acute appendicitis. J Matern Fetal Neonatal Med. 2014;27(13):1357–60.PubMedCrossRef
42.
van Randen A, Bipat S, Zwinderman AH, Ubbink DT, Stoker J, Boermeester MA. Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology. 2008;249(1):97–106.PubMedCrossRef
43.
Leeuwenburgh MM, Wiarda BM, Jensch S, van Es HW, Stockmann HB, Gratama JW, Cobben LP, Bossuyt PM, Boermeester MA, Stoker J. OPTIMAP Study group. Accuracy and interobserver agreement between MR-non-expert radiologists and MR-experts in reading MRI for suspected appendicitis. Eur J Radiol. 2014;83(1):103–10.PubMedCrossRef
44.
Debnath J, Sharma P, Maurya V. Diagnosing appendicitis during pregnancy: which study when? Am J Obstet Gynecol. 2016;214(1):135–6.PubMedCrossRef
45.
Kapan S, Bozkurt MA, Turhan AN, Gönenç M, Alış H. Management of acute appendicitis in pregnancy. Ulus Travma Acil Cerrahi Derg. 2013;19(1):20–4.PubMedCrossRef
46.
Affleck DG, Handrahan DL, Egger MJ, Price RR. The laparoscopic management of appendicitis and cholelithiasis during pregnancy. Am J Surg. 1999;178(6):523–8.PubMedCrossRef
47.
Theilen LH, Mellnick VM, Shanks AL, Tuuli MG, Odibo AO, Macones GA, Cahill AG. Acute appendicitis in pregnancy: predictive clinical factors and pregnancy outcomes. Am J Perinatol. 2017;34(06):523–8.PubMed
48.
Kinner S, Repplinger MD, Pickhardt PJ, Reeder SB. Contrast-enhanced abdominal MRI for suspected appendicitis: how we do it. Am J Roentgenol. 2016;207(1):49–57.CrossRef
49.
Kereshi B, Lee KS, Siewert B, Mortele KJ. Clinical utility of magnetic resonance imaging in the evaluation of pregnant females with suspected acute appendicitis. Abdomin Radiol. 2018;43(6):1446–55.CrossRef
50.
Coursey CA, Nelson RC, Patel MB, et al. Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology. 2010;254:460–8.PubMedCrossRef
51.
Morse BC, Roettger RH, Kalbaugh CA, Blackhurst DW, Hines WB. Abdominal CT scanning in reproductive-age women with right lower quadrant abdominal pain: does its use reduce negative appendectomy rates and healthcare costs? Am Surg. 2007;73:580–4.PubMed
52.
Raja AS, Wright C, Sodickson AD, et al. Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology. 2010;256:460–5.PubMedCrossRef
53.
Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM. MR imaging evaluation of acute appendicitis in pregnancy. Radiology. 2006;238(3):891–9.PubMedCrossRef
54.
Long SS, Long C, Lai H, Macura KJ. Imaging strategies for right lowerquadrant pain in pregnancy. AJR Am J Roentgenol. 2011;196(1):4–12.PubMedCrossRef
55.
Hurwitz LM, Yoshizumi T, Reiman RE, Goodman PC, Paulson EK, Frush DP, et al. Radiation dose to the fetus from body MDCT during early gestation. AJR Am J Roentgenol. 2006;186(3):871–6.PubMedCrossRef
56.
57.
Moses LE, Shapiro D, Littenberg B. Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med. 1993;12:1293–316.PubMedCrossRef
58.
59.
60.
Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol. 2003;56:1129–35.PubMedCrossRef
61.
Arends LR, Hamza TH, van Houwelingen JC, Heijenbrok-Kal MH, Hunink MG, Stijnen T. Bivariate random effects meta-analysis of ROC curves. Med Decis Making. 2008;28:621–38.PubMedCrossRef
62.
Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol. 2005;58:982–90.PubMedCrossRef
63.
Rutter CM, Gatsonis CA. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Statist Med. 2001;20:2865–84.CrossRef
64.
Theilen LH, Mellnick VM, Longman RE, Tuuli MG, Odibo AO, Macones GA, Cahill AG. Utility of magnetic resonance imaging for suspected appendicitis in pregnant women. Am J Obstet Gynecol. 2015;212(3):345–e1.PubMedCrossRef
65.
Ramalingam V, LeBedis C, Kelly JR, Uyeda J, Soto JA, Anderson SW. Evaluation of sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female. Emerg Radiol. 2015;22:125–32.PubMedCrossRef
66.
Birchard KR, Brown MA, Hyslop WB, Firat Z, Semelka RC. MRI of acute abdominal and pelvic pain in pregnant patients. AJR. 2005;184:452–8.PubMedCrossRef
67.
Fonseca AL, Schuster KM, Kaplan LJ, Maung AA, Lui FY, Davis KA. The use of magnetic resonance imaging in the diagnosis of suspected appendicitis in pregnancy: shortened length of stay without increase in hospital charges. JAMA Surg. 2014;149:687–93.PubMedCrossRef
68.
Israel GM, Malguria N, McCarthy S, Copel J, Weinreb J. MRI vs. ultrasound for suspected appendicitis during pregnancy. J Magn Reson Imaging. 2008;28:428–33.PubMedCrossRef
69.
Rapp EJ, Naim F, Kadivar K, Davarpanah A, Cornfeld D. Integrating MR imaging into the clinical workup of pregnant patients suspected of having appendicitis is associated with a lower negative laparotomy rate: single-institution study. Radiology. 2013;267:137–44.PubMedCrossRef
70.
Jang KM, Kim SH, Choi D, Lee SJ, Rhim H, Park MJ. The value of 3D T1-weighted gradient-echo MR imaging for evaluation of the appendix during pregnancy: preliminary results. Acta Radiol. 2011;52:825–8.PubMedCrossRef
71.
Masselli G, Brunelli R, Casciani E, et al. Acute abdominal and pelvic pain in pregnancy: MR imaging as a valuable adjunct to ultrasound? Abdom Imaging. 2011;36:596–603.PubMedCrossRef
72.
Vu L, Ambrose D, Vos P, Tiwari P, Rosengarten M, Wiseman S. Evaluation of MRI for the diagnosis of appendicitis during pregnancy when ultrasound is inconclusive. J Surg Res. 2009;156:145–9.PubMedCrossRef
73.
Pedrosa I, Lafornara M, Pandharipande PV, Goldsmith JD, Rofsky NM. Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology. 2009;250:749–57.PubMedCrossRef
74.
Oto A, Ernst RD, Ghulmiyyah LM, et al. MR im- aging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdom Imaging. 2009;34:243–50.PubMedCrossRef
75.
Cobben LP, Groot I, Haans L, Blickman JG, Puylaert J. MRI for clinically suspected appendicitis during pregnancy. AJR. 2004;183:671–5.PubMedCrossRef
76.
Aguilera F, Gilchrist BF, Farkas DT. Accuracy of MRI in Diagnosing Appendicitis during Pregnancy. Am Surg. 2018;84(8):1326–8.PubMed
77.
Konrad J, Grand D, Lourenco A. MRI: first-line imaging modality for pregnant patients with suspected appendicitis. Abdom Imaging. 2015;40(8):3359–64.PubMedCrossRef
78.
Wi SA, Kim DJ, Cho ES, Kim KA. Diagnostic performance of MRI for pregnant patients with clinically suspected appendicitis. Abdom Radiol. 2018;43(12):3456–61.CrossRef
79.
Kereshi B, Lee KS, Siewert B, Mortele KJ. Clinical utility of magnetic resonance imaging in the evaluation of pregnant females with suspected acute appendicitis. Radiology. 2017:1-0.
80.
Burke LM, Bashir MR, Miller FH, Siegelman ES, Brown M, Alobaidy M, Jaffe TA, Hussain SM, Palmer SL, Garon BL, Oto A. Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study. Am J Obstet Gynecol. 2015;213(5):693–e1.PubMedCrossRef
81.
Tsai R, Raptis C, Fowler KJ, Owen JW, Mellnick VM. MRI of suspected appendicitis during pregnancy: interradiologist agreement, indeterminate interpretation and the meaning of non-visualization of the appendix. Br J Radiol. 2017;90(1079):20170383.PubMedPubMedCentralCrossRef
82.
Patel D, Fingard J, Winters S, Low G. Clinical use of MRI for the evaluation of acute appendicitis during pregnancy. Abdom Radiol. 2017;42(7):1857–63.CrossRef
83.
Duke E, Kalb B, Arif-Tiwari H, Daye ZJ, Gilbertson-Dahdal D, Keim SM, Martin DR. A systematic review and meta-analysis of diagnostic performance of MRI for evaluation of acute appendicitis. Am J Roentgenol. 2016;206(3):508–17.CrossRef
84.
Blumenfeld YJ, Wong AE, Jafari A, Barth RA, El-Sayed YY. MR imaging in cases of antenatal suspected appendicitis–a meta-analysis. J Matern Fetal Neonatal Med. 2011;24(3):485–8.PubMedCrossRef
85.
Shetty MK, Garrett NM, Carpenter WS, Shah YP, Roberts C. Abdominal computed tomography during pregnancy for suspected appendicitis: a 5-year experience at a maternity hospital. In Seminars in Ultrasound, CT and MRI. Philadelphia: WB Saunders; 2010;31(1):8–13.PubMedCrossRef
86.
Eng KA, Abadeh A, Ligocki C, Lee YK, Moineddin R, Adams-Webber T, Schuh S, Doria AS. Acute appendicitis: a meta-analysis of the diagnostic accuracy of US, CT, and MRI as second-line imaging tests after an initial US. Radiology. 2018;288(3):717–27.PubMedCrossRef
87.
Smith MP, Katz DS, Lalani T, et al. ACR appropriateness Criteria® right lower quadrant pain--suspected appendicitis. Ultrasound Q. 2015;31(2):85–91.PubMedCrossRef
88.
Groen RS, Bae JY, Lim KJ. Fear of the unknown: ionizing radiation exposure during pregnancy. Am J Obstet Gynecol. 2012;206:456–62.PubMedCrossRef
89.
Masselli G, Derchi L, McHugo J, Rockall A, Vock P, Weston M, Spencer J, Subcommittee EFPI. Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol. 2013;23:3485–500.PubMedCrossRef
90.
Katz DS, Khalid M, Coronel EE, Mazzie JP. Computed tomography imaging of the acute pelvis in females. Can Assoc Radiol J. 2013;64:108–18.PubMedCrossRef
91.
Masselli G, Derme M, Laghi F, Framarino-dei-Malatesta M, Gualdi G. Evaluating the acute abdomen in the pregnant patient. Radiol Clin North Am. 2015;53:1309–25.PubMedCrossRef
92.
Karamat MI. Strategies and scientific basis of dose reduction on state-of-the-art multirow detector X-Ray CT systems. Crit Rev Biomed Eng. 2015;43:33–59.PubMedCrossRef
93.
Masselli G, Brunelli R, Monti R, Guida M, Laghi F, Casciani E, Polettini E, Gualdi G. Imaging for acute pelvic pain in pregnancy. Insights Imaging. 2014;5:165–81.PubMedCrossRefPubMedCentral
94.
Furey EA, Bailey AA, Pedrosa I. Magnetic resonance imaging of acute abdominal and pelvic pain in pregnancy. Top Magn Reson Imaging. 2014;23:225–4.PubMedCrossRef
95.
Karul M, Berliner C, Keller S, Tsui TY, Yamamura J. Imaging of appendicitis in adults. Rofo. 2014;186:551–8.PubMedCrossRef
96.
Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc. 2017;31(10):3767–82.PubMedCrossRef
Metadata
Title
Pregnancy and appendicitis: a systematic review and meta-analysis on the clinical use of MRI in diagnosis of appendicitis in pregnant women
Authors
Mania Kave
Fateme Parooie
Morteza Salarzaei
Publication date
01-12-2019
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2019
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-019-0254-1

Other articles of this Issue 1/2019

World Journal of Emergency Surgery 1/2019 Go to the issue

Research article

Medications and patient safety in the trauma setting: a systematic review

Research article

IL-33 and its increased serum levels as an alarmin for imminent pulmonary complications in polytraumatized patients

Review

Highlighting the gaps in quantifying the economic burden of surgical site infections associated with antimicrobial-resistant bacteria

Research article

The impact of polytrauma on sRAGE levels: evidence and statistical analysis of temporal variations

Review

Primary resection anastomosis versus Hartmann’s procedure in Hinchey III and IV diverticulitis

Research article

Frailty and functional decline after emergency abdominal surgery in the elderly: a prospective cohort study