Retroperitoneal Haematoma - Still a Medical Challenge for Abdominal Trauma.

Introduction: The study is presenting a personal experience of a Trauma Centre Level I and is try to conclude on optimal medical attitude for patients with retroperitoneal hematoma, still a controversial topic for traumatologists. Material and Method: A retrospective analysis of 22 cases of post-traumatic retroperitoneal hematoma admitted on Bucharest Emergency Hospital between September 2018 August 2021 (including time of Covid-19 pandemic), is presented Results: The patients (males predominance, mean age 43, mean ISS of 23), benefited of nonoperative management on admission for 10 cases (45%) with a failure rate of 4/10 due to recurrent bleeding from spleen injuries and continuous bleeding from mesenteric vessels lesions. CT scan (73% - 16 cases) within 1 hour from the admission and emergency surgery were necessary for 12 cases (55%). 2 patients benefited of angioembolization on admission. Conservative attitude for retroperitoneal hematoma was adopted for 72% cases. Over-all mortality: 18% (4 patients, mean ISS of 36), among 82% polytrauma cases. Conclusions: Algorithm of treatment is adapted to every case of retroperitoneal hematoma but the following sequences are mandatory: rapid transportation to Trauma Centre Level I with medical help, correct resuscitation, immediate relevant imagistic (CT scan), emergency surgery prior to angioembolization (for hemodynamic instable patients) or after it, ICU stabilization of the patient and then definitive repair of the injuries. Despite all, mortality remains high.

Probability of Survival Scores in Different Trauma Registries: A Systematic Review.

INTRODUCTION: A mixed score to predict the probability of survival has a key role in the modern trauma systems. The aim of the current studies is to summarize the current knowledge about estimation of survival in major trauma patients, in different trauma registries. METHOD: Systematic review of the literature using electronic search in the PubMed/Medline, Web of Science Core Collection and EBSCO databases. We have used as a MeSH or truncated words a combination of trauma "probability of survival" and "mixed scores". The search strategy in PubMed was: "((((trauma(MeSH Major Topic)) OR injury(Title/Abstract)) AND score (Title/Abstract)) AND survival) AND registry (Title/Abstract))))". We used as a language selection only English language literature. RESULTS: There is no consensus between the major trauma registries, regarding probability of survival estimation in major trauma patients. The German (RISC II), United Kingdom (PS Model 14) trauma registries scores are based of the largest population, with demographics updated to the nowadays European injury pattern. The revised TRISS, resulting from the USA National Trauma Database, seems to be inaccurate for trauma systems managing predominantly blunt injuries. CONCLUSIONS: The probability of survival should be evaluated in all major trauma patients, with a score derived from a population which reproduce the current demographics.Only a careful audit of the unpredicted deaths may continuously improve our care for severely injured patients.

Most small bowel cancers are revealed by a complication.

OBJECTIVE: To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. METHODS: A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. RESULTS: There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of the small bowel, and the prevalence of duodenal stromal tumors was 1.818 time greater than that of the small bowel. Obstruction was the complication in adenocarcinoma in 57.9% of cases, and perforation was the major local complication (47.8%) in stromal tumors. CONCLUSION: Primary small bowel cancers are usually diagnosed at advanced stages, and revealed by a local complication of the tumor. Their surgical management in emergency setting is associated to significant morbidity and mortality rates.

Most small bowel cancers are revealed by a complication / A maioria dos cânceres de intestino delgado são revelados por uma complicação

ABSTRACT Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. Methods A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. Results There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of the small bowel, and the prevalence of duodenal stromal tumors was 1.818 time greater than that of the small bowel. Obstruction was the complication in adenocarcinoma in 57.9% of cases, and perforation was the major local complication (47.8%) in stromal tumors. Conclusion Primary small bowel cancers are usually diagnosed at advanced stages, and revealed by a local complication of the tumor. Their surgical management in emergency setting is associated to significant morbidity and mortality rates.

RESUMO Objetivo Caracterizar o padrão de neoplasias malignas primárias do intestino delgado em um hospital terciário de Leste Europeu. Métodos Estudo retrospectivo de pacientes com câncer de intestino delgado, internados em um hospital terciário e de emergência, ao longo dos últimos 15 anos. Resultados Foram avaliados 57 pacientes com neoplasias malignas gastrintestinais, o que representou 0,039% das admissões e 0,059% das laparotomias realizadas. Total de 37 (64,9%) pacientes masculinos, média de idade de 58 anos, e de 72 anos para mulheres. Dentre os 57 pacientes, 48 (84,2%) foram internados em situação de emergência: obstrução intestinal em 21 (38,9%), perfuração em 17 (31,5%), hemorragia digestiva alta em 8 (14,8%), e hemorragia digestiva baixa em 2 (3,7%). Houve 10 (17,5%) tumores duodenais, 21 (36,8%) jejunais e 26 (45,6%) ileais. As neoplasias mais frequentes foram tumor estromal gastrintestinal, em 24 (42,1%) pacientes, adenocarcinoma em 19 (33,3%), linfoma em 8 (14%) e carcinoides em 2 (3,5%). A prevalência de adenocarcinoma duodenal foi 14,55 vezes maior do que a do intestino delgado, e a prevalência de tumores estromais duodenais foi 1,818 vez maior do que a do intestino delgado. A obstrução intestinal foi complicação do adenocarcinoma em 57,9% dos casos, e a perfuração foi a principal complicação local (47,8%) dos tumores estromais. Conclusão As neoplasias malignas primárias do intestino delgado foram geralmente diagnosticadas em estado avançado e reveladas por uma complicação local do tumor. O tratamento cirúrgico em situação de emergência está associado à significativa morbimortalidade.