Peritonitis

This research aims to improve how appendicitis, a common emergency surgery condition, is managed worldwide by studying different emergency care systems. Appendicitis requires quick diagnosis and treatment to avoid complications. Using appendicitis as a marker, the study looks at access, quality, and efficiency across hospitals in various countries, including low- and middle-income regions, to find ways to enhance emergency surgical care. The study collects data from about 500 hospitals globally between February and May 2025, focusing on patients undergoing appendicectomy using any surgical method, including open, laparoscopic, or robotic approaches. Hospitals will record information for consecutive patients over 14-day periods. The study includes two sub-studies: one on sustainability and waste management in operating rooms and another on the financial impact of surgery on patients, especially in resource-limited settings. Participants will have their care observed through routine health records without extra follow-up visits. Researchers will measure key factors such as time from symptoms to surgical assessment, rates of minimally invasive surgery, complications within 30 days, and hospital stay length. This data will help identify gaps and guide improvements in emergency surgical care worldwide, aiming to make treatment safer, faster, and more affordable.

Trauma is a leading cause of death in children in the US, with abdominal trauma accounting for 30% of pediatric traumatic deaths, second only to brain injury. This research evaluates the use of the Focused Assessment with Sonography for Trauma (FAST) examination, a bedside abdominal ultrasound, to determine if it can safely reduce abdominal CT scans in hemodynamically stable children with blunt abdominal trauma. The study aims to improve care quality and reduce morbidity and mortality by identifying appropriate evaluation strategies for injured children. The trial is a multicenter, randomized, controlled study involving 3,194 children under 18 years presenting within 24 hours of blunt abdominal trauma. Participants are assigned to either the FAST examination arm, where a bedside ultrasound is performed to detect blood in the abdomen, or to the standard care arm without FAST. The FAST exam is quick, radiation-free, and performed by emergency or trauma physicians. The study compares CT scan rates and tracks delayed or missed diagnoses of intra-abdominal injuries over up to 30 days. Throughout the emergency department stay and initial hospitalization (up to 24 hours), participants undergo assessments including FAST or standard evaluation, CT scan monitoring, and tracking of injuries for up to 30 days if hospitalized. Outcomes measured include CT scan frequency, missed injuries, emergency department length of stay, hospitalization rates, physician suspicion of injury, and surgery rates. The study also examines factors influencing CT use in low-risk patients after a negative FAST exam, aiming to optimize diagnostic care in pediatric trauma.

Researchers are evaluating the impact of regular use of a consumer-grade FODMAP-targeting digestive enzyme blend called FODZYME® on gastrointestinal symptoms in adults who experience self-reported bloating. The study focuses on how this enzyme blend affects symptoms such as bloating and abdominal pain, which are often triggered by fermentable carbohydrates known as FODMAPs. This is a randomized, double-blind, placebo-controlled crossover trial that aims to provide a more flexible alternative to the restrictive Low FODMAP Diet by breaking down FODMAPs before they ferment in the colon. Participants will take the enzyme blend or a placebo with each meal, snack, or substantial beverage, applying it directly to their food. The trial is divided into two main periods: half the participants will start with the enzyme blend for four weeks followed by a two-week washout and then switch to placebo for another four weeks; the other half start with placebo and then switch to the enzyme blend after the washout. The study product is designed to target specific FODMAPs like fructan, GOS, and lactose and is intended for adults with or without IBS symptoms. During the study, participants will complete daily questionnaires and assessments over about 19 weeks, including patient-reported outcome measures for bloating, gastrointestinal symptoms, abdominal pain, food-related quality of life, and anxiety. The study is conducted remotely, allowing participants to complete assessments at home using a smartphone app. Safety is monitored by excluding those with known allergies to corn or previous reactions to digestive enzyme supplements, and researchers will review changes in bloating symptoms as the primary outcome.

Researchers are evaluating the safety and effectiveness of Zavicefta in patients with difficult infections in the abdomen, urinary tract, and pneumonia, including infections possibly acquired during hospital stays. This observational study follows regulations by the Ministry of Food and Drug Safety (MFDS) in Korea and focuses on real-world use after Zavicefta is released in the Korean market. The study aims to collect data on adverse events and treatment responses during routine clinical practice. The study involves patients who have been given at least one dose of Zavicefta for approved infections such as complicated intra-abdominal infection, complicated urinary tract infection including pyelonephritis, hospital-acquired pneumonia including ventilator-associated pneumonia, and other infections caused by aerobic Gram-negative bacteria with limited treatment options. Patients receiving Zavicefta for the first time are included. The study period covers monitoring from the first dose and continues for at least 28 days post-treatment, with follow-up up to one year for clinical response assessment. Participants will be observed during their usual medical care while data is collected on any adverse events or drug reactions, including both expected and unexpected effects. Researchers will track the number of patients reporting adverse events and evaluate treatment outcomes such as clinical cure rates. This post-marketing surveillance study continues for six years after Zavicefta's approval to ensure ongoing safety and effectiveness monitoring in real-world settings.

This research aims to study how alcohol use, psychoactive drugs, or prior pain medication affect the clinical evaluation and surgical decisions for patients with penetrating abdominal trauma. It is conducted as a prospective observational study in two high-volume trauma centers in Cali, Colombia, including a public and a private university hospital. The study addresses concerns about whether intoxication or altered mental status might reduce the reliability of serial physical examinations, which are commonly used to decide if surgery is needed in these patients. Patients aged 15 years and older who have penetrating abdominal trauma and are hemodynamically stable will be evaluated using standard care protocols at these centers. This includes serial physical examinations and selective use of imaging tests like focused abdominal sonography or CT scans when necessary. The study does not add any extra procedures and classifies patients based on whether they consumed alcohol, used psychoactive substances, or received analgesics before evaluation. The main focus is the time from hospital admission to the decision for surgery, with other outcomes like trauma severity, surgery need, hospital stay length, complications, and mortality also being studied. Participants will be followed during their hospital stay, with data collected through electronic forms and verified for accuracy. Researchers will analyze the timing of surgical decisions and compare outcomes between patients with and without substance exposure. This study aims to provide evidence on the safety and reliability of serial physical examination in these trauma patients and may help improve trauma care protocols. The total observation period includes up to 28 days for surgical decision and related outcomes.

Peritoneal carcinomatosis often occurs in colorectal and digestive tract cancers. Researchers are auditing perioperative changes in patients undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), focusing on the challenges and physiological changes during this complex treatment. This observational study aims to better understand the effects and management of these procedures in patients treated for cancers such as colorectal, gastric, ovarian, or peritoneal mesothelioma. The treatment involves CRS to remove visible metastatic disease in the abdomen and pelvis, along with HIPEC where heated chemotherapy is applied inside the abdomen for 90 minutes at 42ºC. This extensive procedure can lead to significant blood and fluid loss, as well as cardiovascular and metabolic changes before, during, and after surgery. The study collects perioperative data from patients receiving this combined treatment to monitor these effects. Participants will be monitored from the start of surgery up to 48 hours afterward to track changes in blood pressure, body temperature, cardiac output, and arterial blood gases. Secondary measures include length of stay in intensive care and mortality up to 30 days post-surgery. The study aims to document perioperative physiological alterations and related outcomes to improve coordinated care by the surgical and anesthetic teams.

This trial investigates treatment approaches for people with intra-abdominal abscesses, which are collections of pus inside the abdominal cavity. The study evaluates the clinical effects of irrigating the abscess drain with a higher local concentration of antibiotics compared to the standard practice of using normal saline. This research is conducted as a Phase 2 randomized trial to better understand how local antibiotic irrigation might impact recovery. Participants will be randomly assigned to one of two groups. One group will have their surgical drains irrigated twice daily with an antibiotic solution containing Gentamicin and/or Clindamycin for up to 7 days or until the drain is removed. The other group will receive drain irrigation twice daily with normal saline as a placebo. The antibiotic dosages are specified as 5 mg Gentamicin in 10 ml volume twice daily and 12 mg Clindamycin in 10 ml once daily. Throughout the study and up to one month after starting systemic antibiotic treatment, researchers will monitor several outcomes including the duration of systemic antibiotic use, white blood cell count, body temperature changes, abscess size, drain output, and how long the drain remains in place. Participants will receive standard systemic antibiotics and will be followed during hospitalization and after discharge to assess these measurements.

The trial investigates the clinical and cost-effectiveness of using povidone-iodine (PVI) irrigation during surgery for patients with perforated appendicitis. It aims to understand barriers and facilitators for implementing PVI irrigation and to collect cost and patient-reported outcomes for those with non-perforated appendicitis. This is a phase 4 randomized study sponsored by The University of Texas Health Science Center, Houston. Participants undergoing appendectomy for perforated appendicitis will be randomly assigned to receive either PVI irrigation or usual care. In the PVI group, after appendix removal and controlling bleeding, 10 mL/kg of 1% PVI (up to 1,000 mL) is used to irrigate the pelvis and abdominal quadrants, left to dwell for 1 minute, then suctioned out. The usual care group may receive local or large volume saline irrigation as per the surgeon's practice but will not receive PVI irrigation. Participants will be followed to assess cost-effectiveness at 30 days, including hospital costs, length of stay, complications, and patient-reported costs and quality of life up to 12 months. Additional outcomes include days of work missed and postoperative complications. The study includes single-blind monitoring and tracks health-related quality of life with the EQ-5D-5L questionnaire.

Sepsis is a leading cause of admission to intensive care units and a major cause of respiratory failure and death in these settings. Researchers are evaluating the effectiveness of two different sepsis treatment bundles—the Hour-1 bundle versus the 3-Hour bundle—in patients admitted to emergency departments with sepsis. This study uses a pragmatic, cluster-randomized design to compare the impact of these bundles on mortality and respiratory failure outcomes, while also exploring distinct sepsis patient types to enable more personalized treatment in the future. Patients enrolled in the trial will receive the same sepsis treatment bundle, which includes measuring lactate levels, obtaining blood cultures before antibiotics, administering broad-spectrum antibiotics, providing rapid fluid resuscitation, and applying vasopressors if needed. The difference between groups lies in the timing: one group will have all interventions started within 1 hour, and the other within 3 hours of identification. The study employs a detailed electronic alert and navigation system to guide providers through the treatment steps and ensure timely completion. Participants will be closely monitored for outcomes such as mortality within 28 days, hospital length of stay, ventilator-free days, and respiratory failure incidence. The study collects routine clinical data to identify sepsis phenotypes and tracks adherence to treatment bundles. The total duration and follow-up depend on hospital stay and clinical progress, with continuous evaluation of patient data through automated screening tools and electronic health record methods.

Minimally invasive ultrasound-guided procedures are widely used in medicine but can be challenging due to the need for practitioners to coordinate between viewing the patient, advancing the needle, and watching a separate ultrasound screen. This research aims to develop and evaluate an advanced augmented reality (AR) platform that could simplify this hand-eye coordination by displaying live ultrasound images as holograms through wearable AR glasses. The study is conducted to assess if this technology can make ultrasound-guided procedures more intuitive, easier, and safer. Participants will use the HoloUS app with HoloLens see-through AR glasses to visualize live ultrasound images during a vascular access procedure performed on a phantom model. This is a single-arm study where each participant evaluates the HoloUS app and effectively serves as their own control. The technology aims to integrate the ultrasound image directly into the practitioner's field of view to enhance precision and efficiency. During the study, researchers will measure the total time taken from needle puncture to successful fluid aspiration, as well as the number of needle attempts and head adjustments needed. Participants are employees trained in point-of-care ultrasound procedures who provide oral consent. The study includes assessments of task completion time and user interactions with the AR visualization, with a goal to reduce procedure time by 20%. Participants may be monitored throughout their involvement, which includes the use of the AR device and the simulated procedure on the phantom.