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1.
Khirurgiia (Mosk) ; (8): 96-100, 2024.
Artigo em Russo | MEDLINE | ID: mdl-39140950

RESUMO

We present gallbladder rupture following trauma. A 9-year-old boy admitted in 1.5 hours after injury. Considering clinical and ultrasound data, we diagnosed traumatic damage to the spleen and hemoperitoneum, biliary dyskinesia, cholestasis, sludge. Hemostatic therapy was carried out. After 3 days, signs of peritonitis appeared. Follow-up ultrasound revealed gallbladder enlargement with heterogeneous content, fluid in all parts of abdominal cavity. Intraoperatively, the gallbladder was enveloped in omentum soaked in bile. After mobilization of the gallbladder, we found longitudinal linear tear up to 3 cm clogged with omentum. Cholecystectomy was performed. Thus, we present a patient with combined injury and damage to the spleen. However, gallbladder wall thickening and heterogeneous content were interpreted as concomitant pathology. Delayed manifestation of peritonitis was due to gallbladder enveloped in omentum. The last one soaked in bile partially entered the gallbladder through perforation and prevented bile leakage into abdominal cavity. Timely diagnosis of gallbladder damage presents certain difficulties, especially in case of combined injury. Ultrasound signs of traumatic gallbladder rupture in this case were wall thickening, heterogeneous content and gradual gallbladder enlargement. It is necessary to analyze all organs at the damage site including computed tomography in patients with combined trauma.


Assuntos
Colecistectomia , Vesícula Biliar , Ultrassonografia , Humanos , Masculino , Criança , Vesícula Biliar/lesões , Vesícula Biliar/cirurgia , Colecistectomia/métodos , Ruptura , Ultrassonografia/métodos , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Resultado do Tratamento , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/cirurgia , Baço/lesões , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico , Peritonite/etiologia , Peritonite/diagnóstico , Peritonite/cirurgia
2.
Ned Tijdschr Geneeskd ; 1682024 Jul 18.
Artigo em Holandês | MEDLINE | ID: mdl-39132882

RESUMO

BACKGROUND: Isolated pancreatic injury after blunt abdominal trauma is rare but unreliably excludable based on clinical symptoms. A CT-abdomen is the golden standard in diagnosing. Undiagnosed pancreatic injury can result in severe complications as abscesses and fistulas. CASE DESCRIPTION: A sixteen-year old patient was brought to the Emergency Department (ED) with epigastric pain, two days after a low-energy scooter accident. No (abdominal) alarming symptoms were objectified during direct assessment by the general practitioner. However, a complete pancreatic transection was diagnosed after assessment at the ED, eventually resulting in a distal pancreatectomy with postoperative associated complications. CONCLUSION: In all traumas, the mechanism of injury should be judged critically for the possibility of abdominal injury (as pancreatic damage) and thus the need for imaging. An initially harmless clinical condition can mask extensive injury. This case illustrates the importance of thoughtful expectant policies with return instructions or demarcated follow-up when no CT-scan is performed.


Assuntos
Traumatismos Abdominais , Pâncreas , Pancreatectomia , Ferimentos não Penetrantes , Humanos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico , Traumatismos Abdominais/complicações , Pâncreas/lesões , Masculino , Adolescente , Acidentes de Trânsito , Tomografia Computadorizada por Raios X
3.
Ulus Travma Acil Cerrahi Derg ; 30(8): 546-533, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39092974

RESUMO

BACKGROUND: Adrenal gland injury (AGI) associated with trauma is an uncommon and often overlooked condition. This study aimed to evaluate the frequency of AGI in individuals with severe trauma injuries and investigate the outcomes of patients with AGI. METHODS: All patients admitted to a tertiary trauma referral center under the trauma protocol who had a computed tomography (CT) scan between January 2012 and January 2023 were analyzed retrospectively. Patients who were dead on arrival and patients with incomplete data were excluded. They were classified into two main groups, adult and pediatric, and further subcategorized by the presence or absence of radiologically evident AGI. Demographic data, mechanism of injury, injury severity scores (ISS), presence of concurrent abdominal injury, and 30-day mortality rates were compared. A separate analysis was performed for factors affecting mortality rates. RESULTS: A total of 1,253 patients were included: 950 adults and 303 pediatric patients. In the adult group, AGI was detected in 45 (4.7%) patients and was more commonly associated with the following mechanisms of injury: motor vehicle accidents (26.7% vs. 14.3%) and pedestrian accidents (37.8% vs. 15.5%). Injury to the right side was more common (55.6%). Patients with AGI had higher rates of concurrent liver (17.8% vs. 3.9%), spleen (11.1% vs. 3.6%), and kidney injuries (15.6% vs. 1.3%). In the pediatric population, AGI was detected in 30 patients (14.8%), a significantly higher rate compared to the adult group. Similar to the adult group, AGI was more commonly associated with concurrent abdominal injuries and had a right-sided dominance (60%), but the rate of concurrent abdominal injuries was higher in the pediatric group (80% vs. 46%). The 30-day mortality was significantly higher in both adult and pediatric AGI groups compared to patients without AGI (adult: 15.6% vs. 2.9%, pediatric: 10% vs. 1.8%). In patients with AGI, major head and neck injuries and chest injuries were associated with mortality. CONCLUSION: Adrenal gland injuries due to trauma are not uncommon. They are usually associated with blunt trauma and other concurrent abdominal organ injuries. The major contributors to mortality in patients with AGI were major head and neck injuries and chest injuries.


Assuntos
Glândulas Suprarrenais , Escala de Gravidade do Ferimento , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Glândulas Suprarrenais/lesões , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Estudos Retrospectivos , Adulto , Criança , Pessoa de Meia-Idade , Adolescente , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/complicações , Traumatismos Abdominais/epidemiologia , Pré-Escolar , Adulto Jovem , Idoso , Turquia/epidemiologia
4.
BMC Surg ; 24(1): 203, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38978029

RESUMO

INTRODUCTION: Abdominal trauma in children is a significant health concern that often leads to severe complications and even death. Children experience trauma more frequently than adults, with approximately one in four pediatric patients suffering from serious abdominal injuries. Falls are the leading cause of such trauma among children, which is intriguing considering that most hospital admissions for pediatric abdominal injuries result from blunt force impacts. METHOD: A retrospective cross-sectional analysis of medical records was conducted to examine all patients under the age of 16 who underwent exploratory laparotomy for abdominal trauma between January 1, 2020, and January 1, 2023. The clinical data were gathered using a data extraction sheet from each patient's medical charts. Information on socio-demographic characteristics, injury mechanisms, clinical conditions at the initial presentation, intraoperative findings and complications, and patient outcomes were collected. RESULTS: The study involved a total of 90 patients, consisting of 72 males (80%) and 18 females (20%). The average age of the patients was 10, with a standard deviation of 4.7, ranging from 2 to 16 years. Half of the patients were below the age of 10, accounting for 46 individuals (51%). The causes of the injuries varied among patients below and above the age of 10. However, overall, bullet injuries were the most common cause, accounting for 28 cases (31%), followed by falls in 21 cases (23.3%), horse or donkey kicks in 10 cases (11.1%), stab injuries in 10 cases (11.1%), horn injuries in 7 cases (7.8%), and road traffic accidents in 6 cases (6.7%). Physical assault, blasts, and other types of injuries, such as hen bites and metal rod injuries, were observed in 8 cases (8.9%) of the patients. Fall accidents, horse or donkey kicks, and horn injuries were particularly more common among children below the age of 10, while bullet injuries and stab injuries were most common among those above the age of 10. CONCLUSION: Following abdominal trauma in children, a range of complications may arise, including immediate issues such as infections and hemorrhaging, as well as long-term consequences like impaired organ functionality and psychological distress. In our region, young children are particularly vulnerable to accidents involving falls, kicks from horses or donkeys, and injuries caused by horns. Therefore, it is crucial to educate parents about these hazards. Additionally, providing appropriate guidance on firearm safety is essential for individuals who possess such weapons.


Assuntos
Traumatismos Abdominais , Adolescente , Criança , Pré-Escolar , Feminino , Traumatismos Abdominais/complicações , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/cirurgia , Estudos Transversais , Etiópia , Estudos Retrospectivos , Resultado do Tratamento , Humanos , Masculino
6.
Injury ; 55(9): 111651, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38849214

RESUMO

Introduction Computed Tomography (CT) to rule out pulmonary embolus (PE) is often ordered during post-trauma laparotomy clinical decompensation (CD) involving fever, tachycardia, tachypnea, and/or leukocytosis. We hypothesize this diagnostic modality is low-yield in the postoperative period when surgery-related sequelae are more probable. Methods This is a single-center retrospective cohort study of patients who underwent trauma laparotomy and had subsequent CT for CD from March 19, 2019 to June 30, 2022. Descriptive statistics and multiple logistic regression were performed. The primary outcome was saddle and lobar PE incidence. Results 1032 adult patients underwent trauma laparotomy with 434 undergoing CT for CD: 137 CT abdomen and pelvis only, 30 CTPE, 265 both. The majority (80.2 %) was male, age 33[interquartile range (IQR) 24-45], suffered penetrating mechanism (57 %), and had ISS 23[IQR16-30]. Injuries at laparotomy included 47 % solid organ, 62 % GI tract, 7 % biliary, 11 % vascular, and 42 % other. 176 (41 %) required damage control laparotomy. Median time to CT post-laparotomy was 174 h [111-235] with saddle and lobar PE in 3 (1 %), peripheral PE 18 (5 %), and abdominal abscess, leak, fluid, or pseudoaneurysm in 222 (51 %). Clinical management was altered (40 %) by antibiotics, therapeutic anticoagulation, drainage, aspiration, filter, thrombectomy, or surgical operation. Patients for whom CT findings changed management were more likely to have had GI tract surgery (69% vs 57 %, p = 0.021), higher white blood cell (WBC) (16.4 [13.1-20.5] vs 15.1 [9.9-19.5], p = 0.002), more hours between CT and laparotomy (184 [141-245] vs 162 [89-230], p = 0.002), and lower mortality (2% vs 8 %, p = 0.008). In-hospital mortality was 5 %; none were PE-related. Predictors of clinical intervention required based on CT imaging were GI tract injury (AOR: 1.65, p = 0.0182), and elevated WBC (AOR: 1.038, p = 0.010 Conclusion Saddle and lobar PE incidence post-trauma laparotomy is low. SIRS-type symptoms prompting postoperative CT commonly have no procedural or antibiotic requirement. Postoperative decompensation is more likely related post-operative complications, and less likely a PE.


Assuntos
Laparotomia , Embolia Pulmonar , Tomografia Computadorizada por Raios X , Humanos , Masculino , Embolia Pulmonar/etiologia , Embolia Pulmonar/diagnóstico por imagem , Feminino , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Incidência , Taquicardia/etiologia
7.
S Afr J Surg ; 62(2): 70, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38838127

RESUMO

SUMMARY: We present a previously healthy 13-year-old male, who sustained a handlebar injury after falling from his bicycle. The computerised tomography (CT) scan indicated a probable pancreatic neoplasm associated with a retroperitoneal haematoma which was, following resection, confirmed histologically to be a solid pseudopapillary neoplasm of the pancreas. These are rare tumours of the pancreas, especially in young males. The rarity of this neoplasm and the mechanism that led to its presentation make this an interesting and unique case.


Assuntos
Traumatismos Abdominais , Neoplasias Pancreáticas , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes , Humanos , Masculino , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgia , Adolescente , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/complicações , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Ciclismo/lesões
8.
Pediatr Emerg Care ; 40(8): e139-e142, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38849150

RESUMO

OBJECTIVE: Screening for blunt intra-abdominal injury in children often includes directed laboratory evaluation that guides need for computed tomography. We sought to evaluate the use of urinalysis in identifying patients with clinically important intraabdominal injury ( ci -IAI). METHODS: A retrospective chart review was performed for all patients less than 18 years who presented with blunt mechanisms at a level I trauma center between 2016 and 2019. Exclusion criteria included transfer from an outside facility, physical abuse, and death within thirty minutes of arrival. Demographics, physical exam findings, serum chemistries, urinalysis, and imaging were reviewed. Clinically important intraabdominal injury was defined as injury requiring ≥2 nights admission, blood transfusion, angiography with embolization, or therapeutic surgery. RESULTS: Two hundred forty patients were identified. One hundred sixty-five had a completed urinalysis. For all patients an abnormal chemistry panel and abnormal physical exam had a sensitivity of 88.9% and a negative predictive value of 99.3%. Nine patients had a ci -IAI. Patients with a ci -IAI were more likely to have abdominal pain, tenderness on exam, and elevated hepatic enzymes. When patients were stratified by the presence of an abnormal chemistry or physical exam with or without microscopic hematuria, urinalysis did not improve the ability to identify patients with a ci -IAI. In fact, presence of microscopic hematuria increased the rate of false positives by 12%. CONCLUSIONS: Microscopic hematuria was not a useful marker for ci -IAI and may lead to falsely assuming a more serious injury.


Assuntos
Traumatismos Abdominais , Hematúria , Urinálise , Ferimentos não Penetrantes , Humanos , Masculino , Criança , Hematúria/etiologia , Estudos Retrospectivos , Feminino , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico , Ferimentos não Penetrantes/complicações , Adolescente , Pré-Escolar , Centros de Traumatologia , Tomografia Computadorizada por Raios X , Sensibilidade e Especificidade , Lactente , Valor Preditivo dos Testes
9.
BMJ Case Rep ; 17(5)2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38782431

RESUMO

A female patient in her middle childhood presented to the paediatric emergency room (ER) after a bicycle accident with an abdominal impact on the bicycle handlebar. On physical examination, a painful ecchymosis on the upper left quadrant was the only abnormal finding. Abdominal ultrasound showed no intra-abdominal lesions, and the patient was discharged home after 24 hours under monitoring. Nine days after the accident, she returned to the ER due to the emergence of an abdominal mass around the area of impact. Abdominal examination detected a tender non-fluctuating mass on the epigastric and left hypochondrium, and abdominal ultrasound revealed a muscle and aponeurosis disruption of the rectus muscle, with fat herniation and cytosteatonecrosis. A conservative approach was chosen, with ambulatory follow-up. One month after the accident, the patient was asymptomatic, no abdominal mass was palpable, and an abdominal CT showed a reduction of the muscle disruption and hernial content.


Assuntos
Ciclismo , Hérnia Abdominal , Humanos , Ciclismo/lesões , Feminino , Hérnia Abdominal/etiologia , Hérnia Abdominal/diagnóstico por imagem , Criança , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Parede Abdominal/diagnóstico por imagem
10.
Air Med J ; 43(3): 253-255, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38821708

RESUMO

We present the case of a 10-year-old previously healthy male who suffered an out-of-hospital cardiac arrest because of abdominal trauma and survived with excellent neurologic outcomes and near complete return to baseline functional status at hospital discharge. The rapid response and efficient mobilization of resources led to an excellent patient outcome despite the severity of injuries, including intra-abdominal injuries with expected mortality, out-of-hospital traumatic arrest, coagulopathy, and an extended pediatric intensive care unit stay. This case underscores the significance of timely advanced trauma life support interventions, especially early blood product administration, efficient transport, and airway management, while sharing a remarkable case of out-of-hospital pediatric traumatic arrest with near full recovery.


Assuntos
Parada Cardíaca Extra-Hospitalar , Ferimentos não Penetrantes , Humanos , Masculino , Criança , Parada Cardíaca Extra-Hospitalar/terapia , Parada Cardíaca Extra-Hospitalar/etiologia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/terapia , Serviços Médicos de Emergência/métodos , Resgate Aéreo
11.
Injury ; 55(7): 111612, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38759489

RESUMO

BACKGROUND: The obesity paradox theorizes a survival benefit in trauma patients secondary to the cushioning effect of adiposity. We aim to evaluate the impact of body mass index (BMI) on abdominal injury severity, morbidity, and mortality in adults with isolated, blunt abdominal trauma in the United States. METHODS: We reviewed the National Trauma Data Bank (2013-2021) for adults sustaining isolated, blunt abdominal trauma stratified by BMI. We performed a doubly robust, augmented inverse-propensity weighted multivariable logistic regression to estimate the average treatment effect (ATE) of BMI on mortality and the presence of abdominal organ injury. RESULTS: 36,350 patients met the inclusion criteria. In our study, 41.4 % of patients were normal-weight (BMI 18.5-24.9), 20.6 % were obese (BMI 30-39.9), and 4.7 % were severely obese (BMI≥40). In these cohorts, the abdominal abbreviated injury scale (AIS) was 2 (2 -3). Obese and severely obese patients had significantly reduced presence of pancreas, spleen, liver, kidney, and small bowel injuries. The predicted probability of abdominal AIS severity decreased significantly with increasing BMI. Crude mortality was significantly higher in obese (1.3 %) and severely obese patients (1.3 %) compared to normal-weight patients (0.7 %). Obese and severely obese patients demonstrated non-statistically significant changes in the mortality of +26.4 % (ATE 0.264, 95 %CI -0.108-0.637, p = 0.164) and +55.5 % (ATE 0.555, 95 %CI -0.284-1.394, p = 0.195) respectively, compared to normal weight patients. CONCLUSION: BMI may protect against abdominal injury in adults with isolated, blunt abdominal trauma. Mortality did not decrease in association with increasing BMI, as this may be offset by the increase in co-morbidities in this population.


Assuntos
Traumatismos Abdominais , Índice de Massa Corporal , Obesidade , Ferimentos não Penetrantes , Humanos , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/complicações , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/complicações , Masculino , Feminino , Estados Unidos/epidemiologia , Adulto , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Retrospectivos , Escala de Gravidade do Ferimento , Idoso , Bases de Dados Factuais , Escala Resumida de Ferimentos
12.
Injury ; 55(9): 111613, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38763841

RESUMO

INTRODUCTION: Traumatic blunt adrenal injury (BAI) has been an area of debate, with conflicting data on its impact. BAI from blunt abdominal injury is challenging to diagnose early due to retroperitoneal gland location and minimal clinical signs. The incidence of BAI ranges from 0.03 % to 4.95 %, with an increasing trend attributed to advanced CT imaging. Conflicting data exists regarding BAI's implications on patient outcomes, necessitating a comprehensive evaluation. METHODS: A retrospective review of the National Trauma Data Bank (NTDB®) for 2017-2021 included a total of 352,654 patients with 337,628 polytrauma patients and 15,026 isolated abdominal trauma patients. Patients were categorized into those with and without adrenal injury. Demographic data and outcomes were compared using statistical tests, focusing on Injury Severity Scores (ISS), mortality, length of stay, and ventilation days. RESULTS: Polytrauma patients with BAI had increased mortality, longer ICU and hospital stays, and ventilation requirements when compared to polytrauma patients without BAI. However, when evaluating isolated abdominal trauma patients with BAI showed no significant differences when compared to isolated abdominal trauma without BAI in mortality or ICU LOS and a slight decrease in ICU admissions, hospital LOS, and ventilation requirement. DISCUSSION: The study indicates a significant association between BAI and increased trauma severity among polytrauma patients. Mortality, however, did not exhibit a consistent rise across all patients with adrenal injury, emphasizing that BAI may not independently influence outcomes. These findings align with the notion that adrenal injury is linked to the overall trauma burden rather than being a primary determinant of mortality.


Assuntos
Traumatismos Abdominais , Glândulas Suprarrenais , Bases de Dados Factuais , Escala de Gravidade do Ferimento , Tempo de Internação , Ferimentos não Penetrantes , Humanos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/mortalidade , Traumatismos Abdominais/complicações , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/epidemiologia , Masculino , Feminino , Estudos Retrospectivos , Adulto , Glândulas Suprarrenais/lesões , Glândulas Suprarrenais/diagnóstico por imagem , Pessoa de Meia-Idade , Tempo de Internação/estatística & dados numéricos , Traumatismo Múltiplo , Estados Unidos/epidemiologia
13.
Am Surg ; 90(9): 2217-2221, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38769499

RESUMO

BACKGROUND: Colon and pancreatic injuries have both long been independently associated with intraabdominal infectious complications in trauma patients. The goal of this study was to evaluate the impact of concomitant pancreatic injury on outcomes in patients with traumatic colon injuries. METHODS: Consecutive patients over a 3-year period who underwent operative management of colon injuries were identified. Patient characteristics, severity of injury and shock, presence and grade of pancreatic injury, and intraoperative packed red blood cell (PRBC) transfusions were recorded. Outcomes including intraabdominal abscess formation and suture line failure were collected and compared. Multivariable logistic regression analysis was then performed to determine the impact of concomitant pancreatic injury on intraabdominal abscess formation. RESULTS: 243 patients with traumatic colon injuries were identified. 17 of these also had pancreatic injuries. Patients with combined colon and pancreatic injuries were clinically similar to those with isolated colon injuries with respect to age, gender, penetrating mechanism of injury, admission lactate, ISS, suture line failure, and admission systolic blood pressure. Both intraabdominal abscess rates (88.2% vs 29.6%, P < .001) and intraoperative PRBC transfusions (8 vs 1 units, P = .004) were higher in the combined pancreatic and colon injury group. Multivariable logistic regression identified both intraoperative PRBC transfusions (odds ratio, 1.09; 95% confidence interval, 1.04-1.15; P < .001) and concomitant pancreatic injury (odds ratio, 14.8; 95% confidence interval, 3.92-96.87; P < .001) as independent predictors of intraabdominal abscess formation. DISCUSSION: Both intraoperative PRBC transfusions and presence of concomitant pancreatic injury are independent predictors of intraabdominal abscess formation in patients with traumatic colon injuries.


Assuntos
Colo , Pâncreas , Humanos , Masculino , Feminino , Adulto , Pâncreas/lesões , Colo/lesões , Estudos Retrospectivos , Pessoa de Meia-Idade , Abscesso Abdominal/etiologia , Abscesso Abdominal/epidemiologia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Modelos Logísticos , Resultado do Tratamento , Traumatismo Múltiplo/complicações , Transfusão de Eritrócitos , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/cirurgia , Adulto Jovem , Escala de Gravidade do Ferimento
14.
J Pak Med Assoc ; 74(3): 582-584, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38591304

RESUMO

Pancreaticoureteric Fistula (PUF) is a very rare complication secondary to penetrating abdominal trauma involving the ureter and pancreatic parenchyma. Pancreatic injuries carry h igh morbidity due to the involvem ent of surrounding structures and are d ifficult to diagnose due to thei r retroperitoneal location. A case of a patient is reported at Civil Hospital, Hyderabad who presented with a history of firearm injury and missed pancreatic duct involvement on initial exploration that eventually led to the development of Pan creaticoureteric Fistula. He was managed v ia p erc ut aneous nep hrostomy ( PCN ) for the right ureteric injury and pancreatic duct (PD) stenting was done for distal main pancreatic duct injury (MPD).


Assuntos
Traumatismos Abdominais , Armas de Fogo , Fístula , Pancreatopatias , Ferimentos por Arma de Fogo , Masculino , Humanos , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/cirurgia , Pancreatopatias/complicações , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia
15.
Khirurgiia (Mosk) ; (4): 64-68, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38634586

RESUMO

OBJECTIVE: To analyze treatment outcomes in children with traumatic injuries of the diaphragm. MATERIAL AND METHODS: We followed-up 14 children aged 3-18 years with traumatic injuries of the diaphragm. Diagnostic measures included anamnesis, physical examination, pleural and abdominal puncture, bladder catheterization, ultrasound and X-ray examination including CT. RESULTS: Traumatic brain injury and thoracoabdominal trauma prevailed in children with traumatic injuries of the diaphragm. In 8 children, diaphragm injury was the result of a traffic accident. Of these, 5 ones died at the scene due to traumatic brain injury. In 3 children, diaphragm injury was associated with penetration of an iron pin through the perineum, pelvic cavity, abdominal and chest cavities when falling from a height (n=1) and sledding (n=2). Two children were littered with a pile of bricks and building materials. One girl suffered a diaphragm injury as a result of a stab wound. CONCLUSION: Combined damage to the diaphragm, TBI, chest and abdominal organs are serious injuries. Signs of shock, internal bleeding, respiratory failure and bone fractures come to the fore. Assistance to these children should be carried out in specialized hospitals.


Assuntos
Traumatismos Abdominais , Lesões Encefálicas Traumáticas , Lesões dos Tecidos Moles , Traumatismos Torácicos , Feminino , Criança , Humanos , Diafragma/lesões , Tórax , Traumatismos Abdominais/complicações , Traumatismos Torácicos/complicações , Lesões Encefálicas Traumáticas/complicações
17.
Medicine (Baltimore) ; 103(17): e37978, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38669393

RESUMO

RATIONALE: Visceral artery aneurysm is a rare and potentially fatal vascular condition that typically affects the superior mesenteric or inferior mesenteric arteries, the splenic, hepatic, and celiac arteries, as well as their branches. Visceral artery aneurysms can usually be treated using endovascular intervention, open surgery, or percutaneous thrombin injection. PATIENT CONCERNS: A 9-year-old girl was admitted to our trauma center with abdominal and bilateral leg pain after a car accident involving a head-on collision. DIAGNOSIS: Abdominal computed tomography (CT) showed bowel herniation through a muscle defect in the left lateral abdominal wall. There was a small amount of fluid around the liver and spleen, mild thickening of the small bowel wall, and infiltration in the small bowel mesentery, indicating the possibility of small bowel injury. INTERVENTIONS: Emergent exploratory laparotomy was performed. After resection of the ischemic parts of the terminal ileum and sigmoid colon, intestinal continuity was reestablished. Primary repair was performed on a traumatic left lateral abdominal wall hernia. She recovered well postoperatively without any complications. A follow-up abdominal CT scan after 2 months showed a pseudoaneurysm of the ileal branch of the superior mesenteric artery. Despite the absence of any gastrointestinal symptoms, the pseudoaneurysm was treated by endovascular intervention using numerous coils because of the significant risk of delayed rupture or massive bleeding. OUTCOMES: Follow-up abdominal CT scan after 6 months showed complete occlusion and resorption of the pseudoaneurysm. LESSONS: Although it is technically challenging, endovascular coil embolization may be a feasible technique in children with traumatic visceral artery pseudoaneurysms without complications.


Assuntos
Falso Aneurisma , Procedimentos Endovasculares , Artéria Mesentérica Superior , Humanos , Feminino , Criança , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Falso Aneurisma/cirurgia , Artéria Mesentérica Superior/lesões , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Procedimentos Endovasculares/métodos , Íleo/irrigação sanguínea , Acidentes de Trânsito , Tomografia Computadorizada por Raios X , Traumatismos Abdominais/complicações , Embolização Terapêutica/métodos
18.
Perm J ; 28(2): 109-115, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38629878

RESUMO

The authors examined a 25-year-old man with a combined rupture of the diaphragm and urinary bladder following blunt trauma to the abdomen. The presence of hematuria, suprapubic tenderness, and elevated serum urea and creatinine levels in this patient raised suspicion of urinary bladder rupture. Documentation of bowel gas shadows on the chest x-ray suggested underlying diaphragm injury. A computed tomogram of the thorax and abdomen confirmed the tear in the left hemidiaphragm with intrathoracic herniation of abdominal contents; however, it failed to detect the intraperitoneal urinary bladder rupture. Both the defects were identified and repaired during laparotomy. The sudden increase in intraabdominal pressure in blunt trauma to the abdomen often resulted in full-thickness tears of the diaphragm and the urinary bladder. Although radiological investigations were pivotal for assessing the damage to the internal organs, a methodical and thorough exploratory laparotomy was invaluable for successfully managing patients with blunt abdominal trauma.


Assuntos
Traumatismos Abdominais , Diafragma , Bexiga Urinária , Ferimentos não Penetrantes , Humanos , Masculino , Ferimentos não Penetrantes/complicações , Bexiga Urinária/lesões , Adulto , Traumatismos Abdominais/complicações , Ruptura/cirurgia , Ruptura/etiologia , Diafragma/lesões , Tomografia Computadorizada por Raios X , Laparotomia
19.
Am Surg ; 90(8): 2120-2123, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38565208

RESUMO

Obesity in trauma patients is an established risk factor contributing to postoperative complications, but the relationship between body mass index (BMI) and trauma patient outcomes is not well-defined, especially when stratified by mechanism of injury. We surveyed the trauma laparotomy registry at an academic level 1 trauma center over a 3-year period to identify mortality, injury severity score, and hospital length of stay (hLOS) outcome measures across BMI classes, with further stratification by mechanism of injury: blunt vs penetrating trauma. A total of 442 patients were included with mean age 44.6 (SD = 18.7) and mean BMI 28.55 (SD = 7.37). These were subdivided into blunt trauma (n = 313) and penetrating trauma (n = 129). Within the blunt trauma subgroup, the hLOS among patients who survived hospitalization significantly increased 9% for each successive BMI class (P = .022, 95% CI = 1.29-17.5). We conclude that successive increase in BMI class is associated with longer hospital stay for blunt trauma patient survivors requiring laparotomy, though additional analysis is needed to establish this relationship to other outcome measures and among penetrating trauma patients.


Assuntos
Índice de Massa Corporal , Escala de Gravidade do Ferimento , Laparotomia , Tempo de Internação , Obesidade , Ferimentos não Penetrantes , Ferimentos Penetrantes , Humanos , Ferimentos não Penetrantes/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/mortalidade , Masculino , Adulto , Feminino , Ferimentos Penetrantes/cirurgia , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/complicações , Tempo de Internação/estatística & dados numéricos , Obesidade/complicações , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia , Sistema de Registros , Fatores de Risco , Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/complicações , Resultado do Tratamento , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
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