Acute Abdomen

The goal of this clinical trial is to learn whether initial assessment by a physician specializing in emergency medicine can improve the care of adults who come to the emergency department with acute abdominal pain or another undifferentiated acute abdominal condition and are referred for surgical assessment. The main questions it aims to answer are: Does initial assessment by an emergency medicine physician reduce the time patients spend in the emergency department? Is this model of care as safe as standard surgical assessment, including the risk of readmission and death within 30 days? Researchers will compare patients who receive their initial assessment from an experienced emergency medicine physician with patients who receive standard care, where the initial assessment is usually performed by a junior surgical physician. Participants will: Be randomly assigned to one of the two models of initial assessment Receive diagnostic tests and treatment according to usual clinical practice Be followed for outcomes such as use of diagnostic imaging, treatment, hospital stay, readmission, and mortality Be asked to complete a short questionnaire about their experience in the emergency department The study does not involve experimental drugs, devices, or procedures. The intervention changes which type of physician is responsible for the initial assessment and management in the emergency department.

Rectus sheath catheters (RSC) are used for postoperative analgesia following midline laparotomies. Local anesthetics are applied to the posterior rectus sheath via the RSC. The target structures are the anterior cutaneous branches of the spinal nerves Th7-Th12. RSC can be used in particular if thoracic epidurals are contraindicated (compromised coagulation), technically unfeasible or refused by the patient. The study investigates placebo-controlled weather RSC have a significant additional analgesic effect in a multimodal analgesic concept. Primary outcome parameters are the maximum pain score, the Quality-of-Recovery-15-Score (QoR-15GE) and the opioid consumption (morphine equivalents) in the first 72h postoperatively.

The primary aim of this project is to increase the knowledge about how perforations in the esophagus, stomach and small intestine are treated on a national level. Furthermore, secondary aims include assessment of how different treatment options and type of treating facilities relate to patient survival. This will be done by studying information about all adult patients with an upper GI perforation treated in Sweden during 2005-2023.

Computer tomography (CT) is the primary imaging option for acute abdominal pain in adults. Intravenous (IV) contrast media is used to improve the CT quality. In patients with impaired renal function, post-contrast acute kidney injury (PC-AKI) has remained a significant concern. Modern retrospective studies have shown no association between worsened baseline renal function and IV-contrast CT. However, no randomised controlled trial has been done to conclude this. The INCARO (INtravenous Contrast computed tomography versus native computed tomography in patients with acute Abdomen and impaired Renal functiOn) trial is a multicentre, open-label, parallel group, superiority, individually randomised controlled trial comparing IV-contrast enhanced CT to native CT in patients with impaired renal function. Patients requiring emergency abdominal or body CT with eGFR 15-45 ml/min/1.73 m2 are included in the study. The primary outcome is a composite outcome of all-cause mortality or renal replacement therapy within 90 days from CT.