RESUMO
Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.
Assuntos
Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Causas de Morte , Laparotomia/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Traumatismos Abdominais/diagnóstico , Síndromes Compartimentais/prevenção & controle , Feminino , Humanos , Escala de Gravidade do Ferimento , Laparotomia/métodos , Modelos Logísticos , Masculino , Análise Multivariada , Complicações Pós-Operatórias/diagnóstico , Probabilidade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Centros de TraumatologiaRESUMO
Presentamos el caso de un niño de 11 años de edad con hidrocefalia a quien se instaló sistema derivativo ventrículo-auricular V-A) y presentó como complicación ruptura de porción del catéter distal, con alojamiento en cavidades cardiacas derechas. Desarolló endocarditis bacteriana que se resolvió con tratamiento médico; para una cura definitiva se debió extraer el catéter no radio-opaco quirúrgicamente. La localización del catéter intracardiaco se realizó con ecocardiografía bidimensional