RESUMEN
Detection of small bowel injury after blunt abdominal trauma can be challenging. Occurrence is rare, but delay in the diagnosis and surgical repair increases patient morbidity and mortality. We present a case of crushing-type injury of the distal ileum in a farmer who has been attacked by a Highland bull. On arrival at the emergency department, physical examination and imaging modalities were reassuring. The maintenance of high clinical suspicion led us to perform an exploratory laparotomy that brought the ileal perforation to light.
Asunto(s)
Abdomen Agudo/etiología , Bovinos , Íleon/lesiones , Perforación Intestinal/etiología , Enfermedades Profesionales/etiología , Heridas no Penetrantes/etiología , Abdomen Agudo/cirugía , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/etiología , Traumatismos Abdominales/cirugía , Accidentes , Animales , Humanos , Íleon/cirugía , Perforación Intestinal/complicaciones , Perforación Intestinal/diagnóstico , Perforación Intestinal/cirugía , Laparotomía , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/cirugía , Heridas no Penetrantes/cirugíaRESUMEN
An accident and emergency (A&E) training has been suggested as an essential part of the basic surgical training. The A&E curriculum should be divided into three sections: a critical curriculum, a core curriculum and a comprehensive curriculum. For instance, the critical curriculum contains topics that provide the opportunity to translate the ABCDE principles of trauma management into practice. Furthermore, a post in the A&E department provides the surgical trainee with significant exposure to the management of the polytrauma patient and to the management of other acute general surgical, urological and orthopaedic conditions. By presenting better educational programs and by reducing the non-medical tasks a trainee has to deal with, the education of surgical trainees during A&E attachment can be improved.
Asunto(s)
Educación de Postgrado en Medicina/organización & administración , Medicina de Emergencia/educación , Cirugía General/educación , Traumatología/educación , Curriculum , HumanosRESUMEN
INTRODUCTION: Acute appendicitis is rarely seen after liver transplantation. CASE: We present a case of acute appendicitis 16 days after liver transplantation. CT-scan suggested this diagnosis, but there were also signs of biliary leakage. Surgical exploration only revealed an acute appendicitis and an appendectomy was performed. Histological examination confirmed the diagnosis. Postoperative course was uneventful. LITERATURE: Until now only 15 cases of acute appendicitis after liver transplantation have been reported. CT-scan is considered to be an accurate diagnostic tool. The duration of hospitalization after appendectomy seems to be longer in the immunosuppressed patient. CONCLUSION: Although acute appendicitis is not common after liver transplantation, quick diagnosis and treatment can prevent major complications.