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Objective:To explore the early coagulation function changes of penetrating intestinal firearm injury of pig in high-altitude environments.Methods:Twenty healthy long white piglets were selected and divided into the plain group and the high-altitude group using the random number table method, with 10 pigs in each group. Pigs in the plain group were placed in a plain environment at an altitude of 800 meters, while pigs in the high-altitude group were placed in an experimental chamber simulating an altitude of 6 000 meters for 48 hours. Both groups received pistol gunshot to have firearm penetrating wounds to the abdominal intestinal tract and then returned to the plain observation room. At 0, 2, 4, 8, 12 and 24 hours after injury, coagulation in the peripheral blood and fibrinolytic indexes [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fbg), D-dimer (D-D), and fibrinogen degradation product (FDP)], thromboelastogram (TEG) [reaction time (R), clotting time (K), clot formation rate (α), maximum amplitude (MA) and coagulation composite index (CI) ], platelet parameters [platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR)] in the two groups were detected separately.Results:The PT values at 0 and 2 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours than those in the plain group ( P<0.01); there was no significant difference at 4 hours between the two groups ( P>0.05). The APTT values at 0, 2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The TT values at 0, 2 and 4 hours after the injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 12 and 24 hours after injury than those in the plain group ( P<0.01); there was no significant difference at 8 hours after injury between the two groups ( P>0.05). The Fbg, D-D and FDP values at 0, 2, 4, 8, 12 and 24 hours after injury were higher in the high-altitude group than those in the plain group ( P<0.01). The R values at 0, 2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The K values at 0, 2, 4 and 8 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 12 and 24 hours after injury than those in the plain group ( P<0.05 or 0.01). The α angles at 0, 2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The MA values at 0, 2 and 4 hours after the injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The CI values at 0, 2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The PLT values at 0, 2, 4 and 8 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 12 and 24 hours after injury than those in the plain group ( P<0.05 or 0.01). The MPV values at 0, 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group ( P<0.01). The PDW values at 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group ( P<0.05 or 0.01), while there was no significant difference in PDW at 0 hour after injury between the two groups ( P>0.05). The P-LCR values at 0, 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were all significantly higher than those in the plain group ( P<0.01). Conclusion:Compared with the plain environments, pig intestinal firearm penetrating injury in the high-altitude environments is more prone to early hypercoagulable state accompanied by mild hyperfibrinolysis, and faster to reach a hypocoagulable state accompanied by obvious hyperfibrinolysis.
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The incidence rate of abdominal trauma is increasing year by year in pediatric trauma, and traumatic pancreatic injury should be taken seriously by clinicians. The pancreas is located behind the peritoneum, and it is difficult to make an early diagnosis of pancreatic injury, especially in children with grade Ⅰ/Ⅱ injury. Through a literature review, this article analyzes the application value of endocrine indices and abdominal ultrasound in the early diagnosis of pediatric pancreatic injury, so as to improve the rate of early diagnosis and avoid the onset of related complications. Changes of the endocrine indices such as serum insulin and C Peptide have certain advantages in diagnosing and evaluating the degree of pediatric pancreatic injury and can thus be used as early warning indices for pediatric pancreatic injury. Ultrasound elastography provides a new method for the diagnosis and differentiation of pancreatic injury; contrast-enhanced ultrasound, which has no radioactive damage, has relatively high specificity and sensitivity in identifying pediatric pancreatic injury, and therefore, it is expected to become an alternative to CT examination.
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ABSTRACT Introduction: Trauma primarily affects the economically active population, causing social and economic impact. The non-operative management of solid organ injuries aims to preserve organ function, reducing the morbidity and mortality associated with surgical interventions. The aim of study was to demonstrate the epidemiological profile of patients undergoing non-operative management in a trauma hospital and to evaluate factors associated with mortality in these patients. Methods: This is a historical cohort of patients undergoing non-operative management for solid organ injuries at a Brazilian trauma reference hospital between 2018 and 2022. Included were patients with blunt and penetrating trauma, analyzing epidemiological characteristics, blood transfusion, and association with the need for surgical intervention. Results: A total of 365 patients were included in the study. Three hundred and forty-three patients were discharged (93.97%), and the success rate of non-operative treatment was 84.6%. There was an association between mortality and the following associated injuries: hemothorax, sternal fracture, aortic dissection, and traumatic brain injury. There was an association between the need for transfusion and surgical intervention. Thirty-eight patients required some form of surgical intervention. Conclusion: The profile of patients undergoing non-operative treatment consists of young men who are victims of blunt trauma. Non-operative treatment is safe and has a high success rate.
RESUMO Introdução: O trauma atinge principalmente a população economicamente ativa, causando impacto social e econômico. O tratamento não operatório das lesões de órgãos sólidos tem como objetivo preservar a função do órgão, diminuindo a morbimortalidade envolvida nos tratamentos cirúrgicos. O objetivo do estudo foi demonstrar o perfil epidemiológico dos pacientes submetidos ao tratamento não operatório em um hospital de trauma, bem como avaliar o fatores associados ao óbito nesses pacientes. Métodos: Trata-se de uma coorte histórica de pacientes submetidos à tratamento não operatório de lesão de órgãos sólidos, em um hospital referência de trauma brasileiro, entre 2018 e 2022. Foram incluídos pacientes vítimas de trauma contuso e penetrante, analisando as características epidemiológicas, hemotransfusão e associação ou não com necessidade de abordagem cirúrgica. Resultados: Foram incluídos 365 pacientes no estudo. Trezentos e quarenta e três pacientes receberam alta (93,97%) e a taxa de sucesso no tratamento não operatório foi de de 84,6%. Houve associação entre o desfecho óbito e as seguintes lesões associadas: hemopneumotorax, fratura de esterno, dissecção de aorta e traumatismo crânio encefálico. Houve associação entre necessidade de transfusão e abordagem cirúrgica. Trinta e oito pacientes necessitaram de alguma abordagem cirúrgica. Conclusão: O perfil dos pacientes submetidos a TNO são homens jovens, vítimas de trauma contuso. O tratamento não operatório é seguro e apresenta alta taxa de sucesso.
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Introducción: La colocación de sondas pleurales es un procedimiento quirúrgico frecuente que puede tener graves complicaciones, las cuales dependen en la mayoría de los casos de la experiencia del operador, el tamaño del tubo y el uso de imágenes para guiar la inserción. Objetivo: Describir las principales lesiones esplácnicas provocadas durante la inserción de sondas pleurales y presentar algoritmos para el diagnóstico precoz y el tratamiento oportuno de estas iatrogenias. Métodos: Se realizó una revisión descriptiva narrativa durante el primer trimestre del año 2023. Se utilizaron las bases de datos electrónicas PubMed, LILACS, EBSCO y Cochrane. Se revisaron artículos publicados desde 1984 hasta el 2022. Se procuró que la mayoría de la información se enmarcara en un período no mayor de 10 años de antigüedad. Desarrollo: De las lesiones esplácnicas de la cavidad torácica, la de pulmón es la más frecuente y puede conducir a sangrado o fuga aérea persistente. Las lesiones vasculares son graves y pueden provocar la muerte si no se toman las medidas pertinentes. Se han descrito lesiones de órganos huecos de la cavidad abdominal que suelen ser parte de una hernia diafragmática. Dentro de las lesiones esplácnicas en el abdomen más frecuentes están la hepática y la esplénica. Conclusiones: Estas lesiones son prevenibles y se debe tener en cuenta su mecanismo de producción para evitarlas. Para este fin recomendamos una selección cuidadosa del sitio de inserción, realizar una confirmación adecuada de la posición de la sonda, manipularla cuidadosamente y monitorear constantemente al paciente(AU)
Introduction: Chest tube insertion is a frequent surgical procedure that can have serious complications, which depend mostly on the practitioner's experience, the tube's size and the use of imaging to guide the insertion. Objective: To describe the main splanchnic injuries caused during chest tube insertion, as well as to present algorithms for early diagnosis and timely treatment of these types of iatrogeny. Methods: A descriptive narrative review was performed during the first quarter of the year 2023. The electronic databases PubMed, LILACS, EBSCO and Cochrane were used. Articles published from 1984 to 2022 were reviewed. Most of the information was secured to be framed within a period of no more than 10 years. Development: Among the splanchnic injuries within the thoracic cavity, lung injury is the most frequent and may lead to bleeding or persistent air leak. Vascular injuries are severe and can lead to death if appropriate measures are not taken. Injuries to hollow organs of the abdominal cavity have been described to be usually part of a diaphragmatic hernia. Among the most frequent splanchnic lesions within the abdomen are the hepatic and splenic injuries. Conclusions: These lesions are preventable and their mechanism of production should be taken into account in order to avoid them. To achieve this, we recommend that the insertion site be carefully selected and that the tube's position be adequately confirmed, as well as the careful handling of the tube and the constant monitoring of the patient(AU)
الموضوعات
Humans , Chest Tubes/adverse effects , Thoracic Cavity/injuries , Review Literature as Topic , Databases, Bibliographicالملخص
ABSTRACT Objective: Establish the frequency of incidences, management, and description of the relationship between thoracic and abdominal trauma and spinal injury. Methods: Observational, retrospective study of quantitative analysis carried out through the analysis of medical records of patients who presented spinal fractures and associated thoracoabdominal injuries. The participants were treated at a reference hospital in trauma care in Curitiba-PR from 2019 to 2021. The data were from patients with spine fractures referring to gender, age, trauma mechanism, fracture classification, associated injuries, Frankel neurological scale, and proposed treatment. Results: There was a predominance of male patients (84.5%) and young, with a mean age of 37.3 years, victims of car accidents. The main vertebrae affected were the lumbar spine (36.8%) and thoracic spine (36.2%). The most prevalent associated injuries were extra vertebral and cervical spine fractures. The most observed thoracic injuries were hemothorax, chest contusion, and fracture of multiple costal arches, while the most observed abdominal injuries were kidney injury, hemoperitoneum/abdominal hematoma, and liver injury. Of the total patients analyzed, 68% had fractures with associated thoracoabdominal injuries. Conclusion: Abdominal and thoracic injuries are frequently associated with spine fractures, with an association of 14.6% and 53.4%, respectively. The production of knowledge on the subject contributes to creating action plans to optimize the management and reduce the morbidity and mortality of these cases. Levels of evidence III; Systematic Review.
Resumo: Objetivos: Estabelecer a frequência de incidências, manejo e descrição da relação entre traumas torácicos e abdominais com a lesão da coluna vertebral. Métodos: Estudo observacional, retrospectivo de análise quantitativa realizado através da análise de prontuários de pacientes que apresentaram fraturas da coluna vertebral e lesões toracoabdominais associadas. Os participantes incluídos foram atendidos em um hospital referência no atendimento ao trauma em Curitiba-PR no período de 2019 a 2021. Os dados foram de pacientes com fratura de coluna referente a sexo, idade, mecanismo de trauma, classificação da fratura, lesões associadas, escala neurológica de Frankel e tratamento proposto. Resultados: Houve predomínio de pacientes masculinos (84,5%) e jovens, sendo a média de idade de 37,3 anos, vítimas de acidentes automobilísticos. As principais vértebras acometidas foram de coluna lombar (36,8%) e torácica (36,2%). As lesões associadas mais prevalentes foram as fraturas extravertebrais e de coluna cervical. As lesões torácicas mais observadas foram o hemotórax, contusão torácica e fratura de múltiplos arcos costais, enquanto as lesões abdominais mais observadas foram lesão renal, hemoperitônio/ hematoma abdominal e lesão hepática. Sendo do total de pacientes analisados 68% apresentavam fraturas com lesões toracoabdominais associadas. Conclusão: Lesões abdominais e torácicas frequentemente estão associadas a fraturas de coluna, com associação de 14,6% e de 53,4% respectivamente. A produção de conhecimento sobre o assunto, contribui para criação de planos de ação para a otimização do manejo e redução da morbimortalidade desses casos. Nível de evidência III; Revisão sistemática.
Resumen: Objetivos: Establecer la frecuencia de incidencias, manejo y descripción de la relación entre trauma torácico y abdominal y lesión medular. Métodos: Estudio observacional, retrospectivo de análisis cuantitativo realizado a través del análisis de historias clínicas de pacientes que presentaron fracturas de columna y lesiones toracoabdominales asociadas. Los participantes incluidos fueron atendidos en un hospital de referencia en atención de trauma en Curitiba-PR de 2019 a 2021. Los datos fueron de pacientes con fracturas de columna con referencia a sexo, edad, mecanismo de trauma, clasificación de fractura, lesiones asociadas, escala neurológica de Frankel y tratamiento propuesto. Resultados: Predominaron los pacientes del sexo masculino (84,5%) y jóvenes, con una edad media de 37,3 años, víctimas de accidentes automovilísticos. Las principales vértebras afectadas fueron la columna lumbar (36,8%) y la columna torácica (36,2%). Las lesiones asociadas más prevalentes fueron las fracturas extra vertebrales y de columna cervical. Las lesiones torácicas más observadas fueron hemotórax, contusión torácica y fractura de múltiples arcos costales, mientras que las lesiones abdominales más observadas fueron lesión renal, hemoperitoneo/ hematoma abdominal y lesión hepática. Del total de pacientes analizados, el 68% presentaba fracturas con lesiones toracoabdominales asociadas. Conclusión: Las lesiones abdominales y torácicas se asocian con frecuencia a las fracturas de columna, con una asociación del 14,6% y 53,4% respectivamente. La producción de conocimiento sobre el tema contribuye a la creación de planes de acción para optimizar el manejo y disminuir la morbimortalidad de estos casos. Nivel de evidencia; Revisión sistemática.
الموضوعات
Humans , Male , Adultالملخص
ABSTRACT Introduction: in Brazil, trauma is responsible for 40% of deaths in the age group between 5 and 9 years old, and 18% between 1 and 4 years, and bleeding is the leading cause of preventable death in the traumatized child. Conservative management of blunt abdominal trauma with solid organs injury - started in the 60s - is the current world trend, with studies showing survival rates above 90%. The objective was to assess the efficacy and safety of conservative treatment in children with blunt abdominal trauma treated at the Clinical Hospital of the University of Campinas, in the last five years. Methods: retrospective analysis of medical records of patients classified by levels of injury severity, in 27 children. Results: only one child underwent surgery for initial failure of conservative treatment (persistent hemodynamic instability), resulting in a 96% overall success rate of the conservative treatment. Five other children (22%) developed late complications that required elective surgery: a bladder injury, two cases of infected perirenal collections (secondary to injury of renal collecting system), a pancreatic pseudocyst and a splenic cyst. Resolution of the complications was attained in all children, with anatomical and functional preservation of the affected organ. There were no deaths in this series. Conclusion: the conservative initial approach in the treatment of blunt abdominal trauma was effective and safe with high resolution and low rate of complications leading to a high preservation rate of the affected organs. Level of evidence III - prognostic and therapeutic study.
RESUMO Introdução: no Brasil, o trauma é responsável por 40% dos óbitos na faixa etária entre 5 e 9 anos, e 18% entre 1 e 4 anos, e o sangramento é a principal causa de prevenção morte na criança traumatizada. O manejo conservador de trauma abdominal contuso com lesão de órgãos sólidos - iniciado na década de 60 - é a tendência mundial atual, com estudos mostrando taxas de sobrevivência acima de 90%. O objetivo do presente trabalho foi avaliar a eficácia e segurança do tratamento conservador em crianças com trauma abdominal contuso tratado no Hospital das Clínicas da Universidade de Campinas, nos últimos cinco anos. Métodos: análise retrospectiva de prontuários de pacientes classificados por níveis de gravidade da lesão, em 27 crianças. Resultados: apenas uma criança foi submetida a cirurgia por falha inicial do tratamento conservador (instabilidade hemodinâmica persistente), resultando em uma taxa de sucesso global de 96% do tratamento conservador inicial. Outras cinco crianças (22%) desenvolveram complicações tardias que exigiram cirurgias eletivas: lesão na bexiga, dois casos de coleção perirenal infectada (secundária à lesão de sistema de coleta renal), um pseudocisto pancreático e um cisto esplênico. Resolução da complicação foi atingida em todas as crianças, com preservação anatômica e funcional do órgão afetado. Não houve mortes nesta série. Conclusão: a abordagem inicial conservadora no tratamento de trauma abdominal contundente foi eficaz e segura com alta resolução e baixa taxa de complicações levando a uma alta taxa de preservação dos órgãos afetados. Nível de evidência III - estudo prognóstico e terapêutico.
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Abstract Small bowel injury in a sports setting is a rare occurrence with a paucity of reported cases. A 30-year old male patient consulted for generalized abdominal pain subsequent to secondary blunt abdominal trauma during kick-boxing practice. A computed tomography scan of the abdomen and pelvis revealed a moderate amount of free fluid in both the parietocolic space and the rectovesical pouch, with perihepatic pneumoperitoneum. Emergency laparoscopy was indicated and a closure of small bowel defect was performed. Diagnosis of small bowel injuries is difficult, resulting in delayed treatment and increased mortality and morbidity.
Resumen La lesión intestinal en un entorno deportivo es infrecuente con pocos casos comunicados. Un varón de 30 años consultó por dolor abdominal generalizado posterior a un traumatismo abdominal cerrado secundario a la práctica de kick-boxing. Una tomografía computarizada de abdomen y pelvis reveló líquido libre tanto en el espacio parietocólico como en la bolsa rectovesical, con neumoperitoneo perihepático. Se indicó laparoscopia exploradora con cirugía de rafia intestinal. El diagnóstico de las lesiones del intestino delgado es difícil, lo que provoca un retraso en el tratamiento y un aumento de la mortalidad y la morbilidad.
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RESUMEN Antecedentes: el manejo no operatorio del traumatismo hepático cerrado es exitoso en el 95% de los pacientes hemodinámicamente normales. Las lesiones de alto grado presentan una tasa de complicaciones de hasta un 14%, y una mortalidad del 27% cuando requieren cirugía abierta. Material y métodos: estudio descriptivo de informe de casos. Resultados: 3 casos con traumatismo hepático de alto grado. "A": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, drenaje percutáneo de absceso hepático, recambio de catéter y CPRE, por fístula biliar persistente. "B": cirugía de control de daño inicial sin hepatectomía, drenaje percutáneo de absceso hepático y posterior recambio. "C": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, posterior drenaje percutáneo de absceso hepático y recambio de drenajes. No presentaron mortalidad. Conclusión: estos casos resumen la utilización de las diferentes modalidades del manejo del traumatismo hepático cerrado y la posibilidad del manejo mininvasivo de las complicaciones.
ABSTRACT Background: Nonoperative management of blunt hepatic trauma is successful in 95% of hemodynamically stable patients. The complication rate of high-grade injuries is 14% and mortality reaches 27% when they require open surgery. Material and methods: We conducted a descriptive study of case reports. Results: Three cases of high-grade hepatic trauma are reported. "A": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess, catheter replacement and ERCP due to persistent biliary fistula. "B": initial damage control surgery without liver resections, percutaneous drainage of liver abscess and catheter replacement. "C": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess and catheter replacement. None of the patients died. Conclusion: These cases summarize the use of different management modalities of blunt hepatic trauma and the possibility of minimally invasive management of the complications.
الموضوعات
Humans , Adult , Young Adult , Acinetobacter Infections , Minimally Invasive Surgical Procedures , Liver/injuries , Epidemiology, Descriptive , Laparoscopy , Lacerations/complications , Lacerations/diagnostic imaging , Hematoma/diagnostic imaging , Abdominal Injuries/complications , Liver Abscess/diagnostic imagingالملخص
Objective:To explore the clinical characteristic, pathogenesis, diagnosis and treatment strategies of gastroinstinal injury caused by magnets ingestion in children.Methods:A retrospective analysis of 46 patients with gastrointestinal tract magnets ingestion in Anhui Provincial Children′s Hospital from October 2017 to September 2021 was performed. Patients were divided into different groups according to gastroinstinal perforation. Some basic information was collected, including gender, age, duration of swallow foreign bodies, quantity of foreign bodies, symptoms, white blood cell, neutrophil, C-reactive protein, therapeutic method, gastroinstinal injury and follow up. Logistic regression. Univariate analysis and multivariate Logistic regression were used to analysis the risk factors of gastroinstinal perforation. Continuous parametric data were summarized using median and interquartile range, differences were evaluated using Wilcoxon Mann-Whitney test.Noncontinuous data were analyzed using chi-square test or corrected chi-square test.Results:Among the 46 patients, there were 33 males and 13 females. The median age was 3 years, with a range of 8 months to 11years. 34 cases had a history of ingesting magnets. The common number of ingested magnets was 2-10 (25 cases). Vomiting (18 cases) and abdominal pain (13 cases)were the commonest complaint. 6 cases tend to pass through the gastrointestinal tract uneventfully, and the remaining cases were successfully extracted by endoscopy (5 cases) and surgery(35 cases). Gastroinstinal perforation was found in 28 cases, and the majority of perforation was located in the ileum (18 cases). Univariate analysis showed that symptom, white blood cell, neutrophil, and CRP were associated with gastroinstinal perforation ( P<0.05). Multivariate Logistic regression analysis showed that symptom( OR=4.715, 95% CI: 1.074-20.696, P=0.040) and CRP( OR=11.605, 95% CI: 1.132-118.981, P=0.039) were independent factors for gastroinstinal perforation. There was no significant correlation between the number of magnets and gastroinstinal perforation ( r=0.276, P>0.05). Conclusions:The ingestion of magnetic foreign bodies in children often requires urgent management.When magnets are located within the prepyloric part of the GI tract, retrieval by endoscopy is recommended.The surgical intervention is required as soon as possible due to the failure of endoscopic treatment.
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Objective:To compare the efficacy of transcatheter arterial embolization (TAE) with laparotomy in the treatment of severe liver injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 48 patients with severe liver injury admitted to 909th Hospital of Joint Logistics Support Force (Affiliated Dongnan Hospital of Xianmen University Medical College) from December 2013 to June 2020, including 28 males and 20 females; aged 16-75 years [(45.7±6.2)years]. There were 25 patients with grade III, 15 grade IV and 8 grade V according to the American Association for the Surgery of Trauma (AAST) classification. After general treatments such as infusion and hemostasis, TAE was performed in 26 patients (TAE group) and laparotomy in 22 patients (laparotomy group). The operation time and length of hospital stay were compared between the two groups. Erythrocyte, hemoglobin and serum creatinine were compared before operation and at postoperative 1 day. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were analyzed before operation and at postoperative 1, 3, 7 days. Complications were observed.Results:All patients were followed up for 12-60 months [(17.1±9.1)months]. The operation time and length of hospital stay were (65.7±9.2)minutes and (21.6±6.6)days in TAE group, significantly shorter than (162.5±28.1)minutes and (31.5±7.4)days in laparotomy group ( P<0.05 or 0.01). There was no significant difference between the two groups referring to erythrocyte, hemoglobin and serum creatinine before operation and at postoperative 1 day (all P>0.05). There was no significant difference in ALT and AST between the two groups before operation (all P>0.05). TAE group showed ALT level of 1 154(884, 1 698)U/L, (975.3±400.9)U/L and (403.4±232.9)U/L at postoperative 1, 3, 7 days, significantly lower than 2 053(1 965, 2 132)U/L, (1 604.1±188.2)U/L and (915.3±160.5)U/L in laparotomy group (all P<0.05). TAE group showed AST level of (1 313.2±542.0)U/L, 525(302, 971)U/L and 174(84, 324)U/L at postoperative 1, 3, 7 days, significantly lower than (1 962.9±245.4)U/L, 1 478(1 089, 1 677)U/L and 837(674, 1 006)U/L in laparotomy group ( P<0.05 or 0.01). The complication rate was 26.9% (7/26) in TAE group, significantly lower than 59.1% (13/22) in laparotomy group ( P<0.05). Conclusion:For severe liver injury, TAE can significantly shorten operation time and length of hospital stay, accelerate the recovery of liver function and reduce the complication rate in comparison with laparotomy.
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Objective:To investigate the thyroid function changes and clinical significance after acute traumatic and infectious abdominal surgery.Methods:The clinical data of patients admitted to the intensive care unit (ICU) for acute traumatic and infectious abdominal surgery during the period from January 1, 2012 to December 31, 2021 in the First Medical Center of People′s Liberation Army General Hospital were retrospectively analyzed using retrospective case-control study. Eligible cases were obtained according to the inclusion and exclusion criteria, and an observation group was set ( n=65). According to the factors such as gender, age, body mass index, and surgical site (organ), a 1∶1 propensity score matching method was used to match the same number of non-traumatic non-infectious abdominal surgery patients admitted in the same time interval, and they were set as the control group ( n=65). The preoperative white blood cells, neutrophils, interleukin -6, c-reactive protein, and procalcitonin were collected, and the thyroid function index for the first time after operation was calculated. The incidence of postoperative thyroid dysfunction was calculated. The thyroid function changes of patients with thyroid dysfunction after exogenous thyroid hormone replacement therapy and the effects on complications and mortality within 30 days were observed. Measurement data of normal distribution were expressed as mean standard deviation( ± s), and t-test was used for comparison between groups. Enumeration data were compared between groups using chi-square test. Results:In the observation group, there were 50 patients with thyroid dysfunction (76.9%). After a 1∶1 match, the baseline of the observation group and the control group was level and comparable. The preoperative inflammatory indexes such as leukocyte, neutrophil ratio, interleukin -6, C-reactive protein and procalcitonin in the observation group were (23.7±5.7)×10 12/L, 0.86±0.13, (66.7±16.3) ng/L, (365.8±77.9) mg/L and (17.9±3.5) μg/L, respectively. Those in the control group were (12.3±2.7)×10 12/L, 0.71±0.04, (8.5±4.7) ng/L, (14.3±6.5) mg/L and (1.3±0.6) μg/L, respectively. The elevations in the observation group were different from those in the control group( P<0.05). In the first postoperative thyroid function test, T3 and FT3 in the observation group were (1.07±0.54) nmol/L and (2.23±1.02) pmol/L, respectively, and those in the control group were (1.61±0.34) nmol/L and (4.36±1.25) pmol/L, respectively. These values in the observation group were significantly lower than those in the control group( P<0.05). On the 10th day after surgery, T3 and FT3 levels in the exogenous thyroid supplementation group rapidly increased and gradually returned to the normal level. In addition, the total hospitalization time of patients in the observation group was significantly shortened, and the incidence and mortality of postoperative complications were reduced. The results in the observation group were (13.47±4.66) d, 17.6% and 11.8%, respectively. The corresponding results in the control group were (16.33±5.18) d, 36.4% and 21.2%, respectively. The difference between the two groups was statistically significant( P<0.05). Conclusion:The incidence of thyroid dysfunction after acute traumatic and infectious abdominal surgery is high, and exogenous thyroxine supplementation can improve the outcome of patients.
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ABSTRACT Objective: to assess the need of computed tomography (CT) for the definition of management in pediatric abdominal trauma. Methods: observational retrospective study with patients under 18 years old victims of blunt or penetrating abdominal trauma that underwent CT of the abdomen and pelvis at admission. We evaluated CT scan findings, indications and management. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of clinical variables and energy of trauma for findings on CT. Results: among the 236 patients included in our study, 72% (n=170) did not present abnormal findings on CT. It was performed surgical treatment in 15% (n=10), conservative treatment in 54,5% (n=36) and 27% (n=18) did not receive treatment for abdominal injuries. In the assessment of CT indications, 28,8% (n=68) presented no justifications. In this group, 91% (n=62) did not show any abnormal findings. Among the six patients with positive findings, half were selected for conservative treatment, while the rest did not need any treatment for abdominal injuries. The presence of abdominal pain, hemodynamic alterations and high energy blunt trauma had low positive predictive values when isolated, whereas the negative predictive values were higher. Conclusion: although CT is necessary in some instances, there is a possible high number of exams that did not make any difference in the management of the pediatric population.
RESUMO Introdução: avaliar a necessidade da tomografia computadorizada (TC) para definição de condutas em trauma abdominal pediátrico. Métodos: estudo observacional retrospectivo com pacientes menores de 18 anos vítimas de trauma abdominal contuso ou penetrante e que realizaram TC de abdome e pelve na admissão. Avaliou-se achados das tomografias, condutas e justificativas para indicação da TC. Foram calculados sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de fatores clínicos e energia do trauma para alterações na TC. Resultados: dentre os 236 pacientes incluídos, 72% (n=170) não apresentaram alterações na TC. Foi realizado tratamento cirúrgico em 15% (n=10), tratamento conservador em 54,5% (n=36) e 27% (n=18) não receberam tratamento por lesões abdominais. Na avaliação das indicações de TC, 28,8% (n=68) não apresentavam nenhuma justificativa, sendo que nesse grupo 91% (n=62) resultaram em ausência de achados. Dentre os seis pacientes com achados positivos, metade recebeu tratamento conservador, enquanto o restante não necessitou de tratamento por lesões abdominais. A presença de dor abdominal, alteração hemodinâmica e trauma contuso de alta energia apresentaram baixos valores preditivos positivos de forma isolada, enquanto os valores preditivos negativos foram mais altos. Conclusão: apesar de a TC ser necessária e justificável em alguns casos, há um possível excesso de tomografias dispensáveis para definição de condutas em população pediátrica.
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Abstract Rectal trauma is uncommon, but it is usually associated with injuries in adjacent pelvic or abdominal organs. Recent studies have changed the paradigm behind military rectal trauma management, showing better morbidity and mortality. However, damage control techniques in rectal trauma remain controversial. This article aims to present an algorithm for the treatment of rectal trauma in a patient with hemodynamic instability, according to damage control surgery principles. We propose to manage intraperitoneal rectal injuries in the same way as colon injuries. The treatment of extraperitoneal rectum injuries will depend on the percentage of the circumference involved. For injuries involving more than 25% of the circumference, a colostomy is indicated. While injuries involving less than 25% of the circumference can be managed through a conservative approach or primary repair. In rectal trauma, knowing when to do or not to do it makes the difference.
Resumen El trauma de recto es poco frecuente, pero generalmente se asocia a lesiones de órganos adyacentes en la región pélvica y abdominal. Estudios recientes han cambiado los paradigmas del manejo tradicional derivados del trauma militar, mostrando mejores resultados en la morbilidad y mortalidad. Sin embargo, las técnicas de control de daños en el trauma rectal aún son controvertidas. El objetivo de este articulo es proponer el algoritmo de manejo del paciente con trauma rectal e inestabilidad hemodinámica, según los principios de la cirugía de control de daños. Se propone que las lesiones del recto en su porción intraperitoneal sean manejadas de la misma manera que las lesiones del colon. Mientras que el manejo de las lesiones extraperitoneales del recto dependerá del compromiso de la circunferencia rectal. Si es mayor del 25% se recomienda realizar una colostomía. Si es menor, se propone optar por el manejo conservador o el reparo primario. Saber que hacer o que no hacer en el trauma de recto marca la diferencia.
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RESUMEN Fundamento: el trauma vascular abdominal constituye un reto para el cirujano. El control vascular es una condición sine qua non en los pacientes que reciben intervención quirúrgica frente a esta letal enfermedad, donde las maniobras de movilización visceral constituyen una herramienta clave en el tratamiento. Objetivo: explicar las maniobras de movilización visceral que pueden auxiliar al cirujano frente a un trauma vascular abdominal. Métodos: se realizó una búsqueda en las bases de datos Scopus, Medline, Cochrane, Hinari y Redalyc se utilizaron los descriptores: trauma vascular, abdomen, maniobras, movilización visceral. Resultados: se abordaron las maniobras de movilización visceral a tener en cuenta en el trauma vascular abdominal con una explicación de los principales pasos técnicos en cada una de ellas. Conclusiones: el conocimiento y aplicación de las maniobras de movilización visceral constituyen una herramienta útil en el tratamiento de pacientes con trauma vascular abdominal.
ABSTRACT Background: abdominal vascular trauma is a challenge for the surgeon. Vascular control is a sine qua non condition in patients who receive surgical intervention against this lethal pathology, where visceral mobilization maneuvers are a key tool in treatment. Objective: to explain the visceral mobilization maneuvers that can help the surgeon against abdominal vascular trauma. Methods: a search of the Scopus, Medline, Cochrane, Hinari and Redalyc databases was performed using the descriptors: vascular trauma, abdomen, maneuvers, visceral mobilization. Results: visceral mobilization maneuvers to be taken into account in abdominal vascular trauma were addressed with an explanation of the main technical steps in each of them. Conclusions: the knowledge and application of visceral mobilization maneuvers constitute a useful tool in the treatment of patients with abdominal vascular trauma.
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Objective:To investigate the effect of early enteral nutrition in patients with severe traumatic brain injury requiring exploratory abdominal surgery.Methods:The clinical data of 104 patients with severe traumatic brain injury requiring exploratory abdominal surgery treated in the PLA Army 72th Group Military Hospital from January 2016 to December 2020 were retrospectively analyzed. Among them, 47 patients were given early enteral nutrition (24-48 hr) as the observation group, and 57 patients were given delayed enteral nutrition (>48 hr), as the control group. The levels of hemoglobin, albumin, prealbumin, total bilirubin, alanine transaminase, C-reactive protein, white blood cells, postoperative infectious complications and clinical outcomes were compared between the two groups on the 1st, 7th and 14th days after surgery.Results:On the 14th day after operation, the prealbumin level of the observation group was higher than that of the control group, and the leukocyte level of the observation group was lower than that of the control group, with statistical significance ( P=0.020, P=0.013). The hospital stay and hospitalization costs of the observation group were lower than those of the control group ( P=0.017, P=0.032). The incidence of pulmonary infection in the observation group was 10.6%, which was lower than 29.8% in the control group ( P=0.017). Conclusions:Early postoperative enteral nutrition in patients with severe traumatic brain injury requiring exploratory abdominal surgery can significantly improve the nutritional status of patients, reduce the incidence of pulmonary infection, the hospital stay and the hospitalization cost.
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Objective:To evaluate the hemostatic efficacy of N-carboxyethylchitosan fiber gauze (numbered NWL-K) in a leporine bleeding wounds of intraperitoneal parenchymal visceral.Methods:Sixty New Zealand rabbits were divided into two groups according to the randomized digital number method, with 30 rabbits per group. The leporine bleeding models of hepatic or splenic wound were made respectively. The two groups were subdivided into three groups: common gauze group, SURGICEL group and NWL-K group, with 10 rabbits per group. By analyzing the weight of excised liver tissue and amount of bleeding, the model stability was measured. The time to hemostasis and bleeding score in each group were analyzed every (20±5)seconds after compression for 30 seconds in the hepatic bleeding models or every (30±5)seconds after compression for 3 minutes in the splenic bleeding models. The adhesion between wound and gauze was evaluated at the same time.Results:There was no significant difference in the weight of excised liver tissue and amount of bleeding when the hepatic or splenic bleeding models were made ( P>0.05). It showed that the model was made stably and the hemostasis experiment would not be affected. In the splenic wound model experiment, the time to hemostasis was 255(233, 300)seconds in SURGICEL group and 210(180, 248)seconds in NWL-K group, both of which were significantly shorter than 465(383, 660)seconds in common guaze group ( P<0.05). NWL-K achieved shorter time to hemostasis than SURGICEL ( P<0.05). In the hepatic wound model experiment, the time to hemostasis was 90(85, 110)seconds in SURGICEL group and 70(70, 95)seconds in NWL-K group, both of which were significantly shorter than 250(225 290)seconds in common gauze group ( P<0.05). In the splenic wound model experiment, the bleeding score in NWL-K group and SURGICEL group decreased faster than that in common gauze group ( P<0.05). The difference of bleeding score was significant between NWL-K group and SURGICEL group at 180 seconds ( P<0.05). In the hepatic wound model experiment, the bleeding score in NWL-K group and SURGICEL group decreased faster than that in common gauze group at 50 seconds, 70 seconds and 90 seconds ( P<0.05). The bleeding score in common gauze group and NWL-K group showed significant difference at 30 seconds, 110 seconds and 130 seconds ( P<0.05). For the adhesion evaluation, both the water-absorbency and adhesion to tissue of NWL-K were better than common gauze and SURGICEL. Conclusions:For hepatic and splenic bleeding wounds, compared with other types of gauze, the application of NWL-K can effectively shorten the time to hemostasis and reduce the blood loss. The NWL-K shows high water-absorbency and firm adhesion to bleeding wound.
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PURPOSE@#There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries, specifically for intra-abdominal injury (IAI). The impact of concomitant spinal cord injury (SCI) with the risk of associated IAI has not been well clarified. The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.@*METHODS@#A retrospective cohort study using the Israeli National Trauma Registry was conducted. Patients with thoracic, lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1, 1997 to December 31, 2018 were examined, comparing the incidence, severity and mortality of IAIs in patients with or without SCI. The collected variables included age, gender, mechanism of injury, incidence and severity of the concomitant IAIs and pelvic fractures, abbreviated injury scale, injury severity score, and mortality. Statistical analysis was performed using GraphPad InStat ® Version 3.10, with Chi-square test for independence and two sided Fisher's exact probability test.@*RESULTS@#Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures. Combined thoracic and lumbar fractures were observed in 1272 patients (7.5%), isolated thoracic fractures in 4967 patients (29.4%) and isolated lumbar fractures in 10,639 patients (63.0%). The incidence of concomitant SCI was found in 4.95% (63/1272), 7.65% (380/4967) and 2.50% (266/10639) of these patients, respectively. The overall mortality was 2.5%, proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts (11.3% vs. 4.6%, p < 0.001). Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts (8.2% vs. 3.1%, p < 0.001). There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures; although isolated lumbar fractures patients with SCI were more likely to have renal (3.4% vs. 1.6%, p = 0.02) or bowel injuries (2.3% vs. 1.0%, p = 0.04) than the non-SCI counterparts.@*CONCLUSION@#SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI. However, in a subset of isolated lumbar fractures, SCI patient is associated with increased risks for renal and bowel injury.
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ABSTRACT The spleen is one of the most frequently affected organs in blunt abdominal trauma. Since Upadhyaya, the treatment of splenic trauma has undergone important changes. Currently, the consensus is that every splenic trauma presenting with hemodynamic stability should be initially treated nonoperatively, provided that the hospital has adequate structure and the patient does not present other conditions that indicate abdominal exploration. However, several topics regarding the nonoperative management (NOM) of splenic trauma are still controversial. Splenic angioembolization is a very useful tool for NOM, but there is no consensus on its precise indications. There is no definition in the literature as to how NOM should be conducted, neither about the periodicity of hematimetric control, the transfusion threshold that defines NOM failure, when to start venous thromboembolism prophylaxis, the need for control imaging, the duration of bed rest, and when it is safe to discharge the patient. The aim of this review is to make a critical analysis of the most recent literature on this topic, exposing the state of the art in the NOM of splenic trauma.
RESUMO O baço é um dos órgãos mais frequentemente afetados no trauma abdominal contuso. Desde os trabalhos de Upadhyaya, o tratamento do trauma esplênico vem sofrendo importantes modificações. Atualmente, é consenso que todo trauma esplênico que se apresenta com estabilidade hemodinâmica pode ser tratado inicialmente de forma não operatória, desde que o serviço possua estrutura adequada e o paciente não apresente outras condições que indiquem exploração da cavidade abdominal. Entretanto, vários tópicos permanecem controversos no que diz respeito ao tratamento não operatório (TNO) do trauma esplênico. A angioembolização esplênica é uma ferramenta de grande auxílio no TNO, porém não há consenso sobre suas indicações precisas. Não há uma definição na literatura a respeito da forma como o TNO deve ser conduzido, tampouco a respeito da periodicidade do controle hematimétrico, do limiar de transfusão que define falha do TNO, de quando iniciar a profilaxia contra tromboembolismo venoso, da necessidade de exames de imagem de controle, do período de repouso no leito, e de quando é seguro indicar alta hospitalar. O objetivo desta revisão é analisar de forma crítica a literatura a respeito desse tema, expondo o estado da arte no TNO do trauma esplênico.
الموضوعات
Humans , Wounds, Nonpenetrating/therapy , Abdominal Injuries , Spleen/injuries , Blood Transfusion , Injury Severity Score , Retrospective Studies , Treatment Outcome , Hemodynamicsالملخص
ABSTRACT Objective: the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma. Methods: retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program. Results: most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%. Conclusions: the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.
RESUMO Objetivo: identificar fatores associados ao aumento do tempo de hospitalização de pacientes submetidos a tratamento cirúrgico por trauma hepático e descrever preditores de mortalidade, assim como a epidemiologia desse trauma. Métodos: estudo retrospectivo de 191 pacientes admitidos no Hospital Universitário Cajuru, referência no atendimento de politraumatizados, no período entre 2010 e 2017, com variáveis epidemiológicas, clinicopatológicas, terapêuticas analisadas por meio do programa STATA versão 15.0. Resultados: maioria dos pacientes incluídos eram homens com média de idade de 29 anos. Ferimento por arma de fogo representou o mecanismo de trauma mais comum. O lobo hepático direito foi lesado em 51,2% dos casos e hepatorrafia foi a correção cirúrgica mais empregada. O tempo de internamento hospitalar foi em média de 11(0-78) dias e o tempo de internação em unidade de terapia intensiva de 5 (0-52) dias. Preditores de maior tempo de hospitalização foram mecanismo de trauma, instabilidade hemodinâmica à admissão, número de lesões associadas, grau da lesão hepática e lobo acometido, técnica cirúrgica empregada, presença de complicações, necessidade de reoperação e outros procedimentos cirúrgicos. Taxa de mortalidade foi de 22,7%. Conclusões: o estudo corroborou a epidemiologia descrita na literatura. Maior gravidade do trauma hepático e das lesões associadas caracterizam os pacientes submetidos ao tratamento cirúrgico, que apresentam aumento de tempo de hospitalização devido a trauma penetrante, instabilidade hemodinâmica, tamponamento hepático, complicações e reoperações.
الموضوعات
Humans , Male , Adult , Wounds, Gunshot , Firearms , Trauma Centers , Injury Severity Score , Retrospective Studies , Hospitalization , Length of Stay , Liver/surgery , Liver/injuriesالملخص
ABSTRACT Introduction: Traumatic pancreatitis (TP) comprises less than 10% of all abdominal traumas but can reach mortality and morbidity rates of up to 34% and 64%, respectively. The treatment of TP has a conservative approach, followed by minimally invasive procedures and surgery if the evolution is torpid. Case report: A 54-year-old male patient with blunt trauma in right hypochondrium due to a bovine kick developed moderate-severe TP and grade IV pancreatic injury (PI). He underwent laparoscopic surgery twice with adequate clinical evolution. He required antibiotic therapy for 19 days and hospitalization for 29 days, of which 9 were in the ICU. Conclusion: The diagnosis of TP is difficult to achieve due to the retroperitoneal location of the pancreas. The treatment of this condition is usually conservative, preferring clinical management with percutaneous or endoscopic drainage over surgical drainage due to its low morbidity and mortality. The recommended surgical approach to these patients is laparotomy; however, the laparoscopic approach is a therapeutic option to be considered for comprehensive management.
RESUMEN Introducción. La pancreatitis postraumática ocurre en menos del 10% de los traumas abdominales, pero su mortalidad y morbilidad llegan a ser de 34% y 64%, respectivamente. El abordaje de esta condición es conservador en primera instancia, seguido de técnicas mínimamente invasivas y finalmente cirugía si hay evolución pobre. Presentación del caso. Paciente masculino de 54 años de edad con trauma cerrado en hipocondrio derecho por patada de bovino, quien presentó pancreatitis postraumática moderadamente severa y trauma pancreático grado IV. El sujeto, intervenido mediante laparoscopia en dos ocasiones con adecuada evolución clínica, requirió terapia con antibióticos por 19 días y hospitalización por 29 días. Conclusión. El diagnóstico de la pancreatitis postraumática es difícil dada la localización retroperitoneal del páncreas. La tendencia en el manejo de esta condición es conservadora, prefiriendo el manejo clínico acompañado de drenajes percutáneos o endoscópicos sobre el manejo quirúrgico. El abordaje quirúrgico recomendado en pacientes con pancreatitis postraumática es la laparotomía; sin embargo, el abordaje laparoscópico es una opción terapéutica a tener en cuenta dentro de las opciones del manejo integral.