RESUMEN
BACKGROUND: Noncompressible hemorrhage is a leading cause of potentially survivable combat death, with the vast majority of such deaths occurring in the out-of-hospital environment. While large animal models of this process are important for device and therapeutic development, clinical practice has changed over time and past models must follow suit. Developed in conjunction with regulatory feedback, this study presents a modernized, out-of-hospital, noncompressible hemorrhage model, in conjunction with a randomized study of past, present, and future fluid options following a hypotensive resuscitation protocol consistent with current clinical practice. METHODS: We performed a randomized controlled experiment comparing three fluid resuscitation options in Yorkshire swine. Baseline data from animals of same size from previous experiments were analyzed (n = 70), and mean systolic blood pressure was determined, with a permissive hypotension resuscitation target defined as a 25% decrease from normal (67 mm Hg). After animal preparation, a grade IV to V liver laceration was induced. Animals bled freely for a 10-minute "time-to-responder" period, after which resuscitation occurred with randomized fluid in boluses to the goal target: 6% hetastarch in lactated electrolyte injection (HEX), normal saline (NS), or fresh whole blood (FWB). Animals were monitored for a total simulated "delay to definitive care" period of 2 hours postinjury. RESULTS: At the end of the 2-hour study period, 8.3% (1 of 12 swine) of the HEX group, 50% (6 of 12 swine) of the NS group, and 75% (9 of 12 swine) of the FWB had survived (p = 0.006), with Holm-Sidak pairwise comparisons showing a significant difference between HEX and FWB and (p = 0.005). Fresh whole blood had significantly higher systemic vascular resistance and hemoglobin levels compared with other groups (p = 0.003 and p = 0.001, respectively). CONCLUSION: Survival data support the movement away from HEX toward NS and, preferably, FWB in clinical practice and translational animal modeling. The presented model allows for future research including basic science, as well as translational studies of novel diagnostics, therapeutics, and devices.
Asunto(s)
Traumatismos Abdominales , Fluidoterapia , Hemoperitoneo , Resucitación , Choque Hemorrágico , Animales , Masculino , Traumatismos Abdominales/mortalidad , Traumatismos Abdominales/fisiopatología , Traumatismos Abdominales/terapia , Modelos Animales de Enfermedad , Fluidoterapia/métodos , Fluidoterapia/mortalidad , Hemoperitoneo/mortalidad , Hemoperitoneo/fisiopatología , Hemoperitoneo/terapia , Hígado/lesiones , Resucitación/métodos , Resucitación/mortalidad , Choque Hemorrágico/mortalidad , Choque Hemorrágico/fisiopatología , Choque Hemorrágico/terapia , PorcinosAsunto(s)
Transfusión Sanguínea/métodos , Enfermedad Hepática Inducida por Sustancias y Drogas , Hemoperitoneo , Hipotensión , Paracentesis , Pruebas en el Punto de Atención , Ultrasonografía/métodos , Anciano , Encefalopatías/diagnóstico , Encefalopatías/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/complicaciones , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/fisiopatología , Diagnóstico Diferencial , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Hemoperitoneo/diagnóstico , Hemoperitoneo/etiología , Hemoperitoneo/fisiopatología , Hemoperitoneo/terapia , Humanos , Hipotensión/diagnóstico , Hipotensión/etiología , Hígado/patología , Masculino , Paracentesis/instrumentación , Paracentesis/métodos , Respiración Artificial/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Colonoscopy is a frequently performed medical procedure; complications associated with this procedure often present to the emergency department (ED). Splenic laceration is a rare but life-threatening complication of colonoscopy. We report the unique case of a patient with a splenic laceration who presented after a recent colonoscopy and had no history of trauma. CASE REPORT: A 52-year-old man presented to our ED with abdominal pain and lightheadedness the day after a routine colonoscopy. Ultrasound demonstrated hemoperitoneum, and contrast-enhanced computed tomography of the abdomen revealed a large hemoperitoneum with active contrast extravasation from the laceration of the superior pole of the spleen. After resuscitation, the patient was managed with an emergency splenectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Colonoscopy complications are frequently identified and managed in the ED. Splenic laceration should be on the differential for patients that present with abdominal pain or hypotension after colonoscopy. Splenic injury carries a high mortality risk, and prompt, accurate diagnosis can be lifesaving.
Asunto(s)
Colonoscopía/normas , Rotura del Bazo/diagnóstico , Colonoscopía/métodos , Hemoperitoneo/diagnóstico , Hemoperitoneo/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Bazo/lesiones , Bazo/cirugía , Esplenectomía/métodos , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodosRESUMEN
CLINICAL INTRODUCTION: A woman in her 30s presented to the emergency department with sudden-onset abdominal pain with hypotension and tachycardia. She gave a history of congenital heart disease for which she had previously undergone multiple operations. On examination she demonstrated right upper quadrant tenderness. She underwent an urgent multiphase CT (figure 1A-C).heartjnl;105/4/275/F1F1F1Figure 1(A) Arterial phase coronal CT. (B) Arterial phase axial CT. (C) Portal venous phase axial CT. QUESTION: What is the underlying liver pathology?Hepatocellular adenomaCholangiocarcinomaHepatocellular carcinomaFocal nodular hyperplasiaHepatoblastoma.
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Dolor Abdominal/diagnóstico , Carcinoma Hepatocelular , Embolización Terapéutica/métodos , Procedimiento de Fontan/efectos adversos , Cardiopatías Congénitas/cirugía , Hemoperitoneo , Cirrosis Hepática , Neoplasias Hepáticas , Dolor Abdominal/etiología , Adulto , Angiografía de Substracción Digital/métodos , Carcinoma Hepatocelular/irrigación sanguínea , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/etiología , Carcinoma Hepatocelular/patología , Diagnóstico Diferencial , Femenino , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/etiología , Hemoperitoneo/fisiopatología , Hemoperitoneo/terapia , Arteria Hepática/diagnóstico por imagen , Humanos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/etiología , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/etiología , Neoplasias Hepáticas/patología , Rotura Espontánea , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Hemoperitoneo , Cirrosis Hepática Alcohólica/complicaciones , Paracentesis/métodos , Estómago/irrigación sanguínea , Várices , Vasoconstrictores/administración & dosificación , Cavidad Abdominal/patología , Cavidad Abdominal/cirugía , Resultado Fatal , Hemoperitoneo/diagnóstico , Hemoperitoneo/etiología , Hemoperitoneo/fisiopatología , Hemoperitoneo/terapia , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/etiología , Rotura Espontánea , Tomografía Computarizada por Rayos X/métodos , Várices/complicaciones , Várices/etiologíaRESUMEN
BACKGROUND: Bleeding after low-risk invasive procedures can be life-threatening or can lead to further complications in decompensated cirrhosis patients. In unstratified cohorts of hospitalized patients with cirrhosis, the rate of procedure-related bleeding is low despite abnormal coagulation parameters. Our objective was to identify patients with decompensated cirrhosis at a high risk of developing procedure-related bleeding in whom the value of pre-procedure transfusions could be assessed. METHODS: Hospitalized patients with cirrhosis who developed post-paracentesis hemoperitoneum confirmed by CT scan, from the period of January 2012 to August 2016, constituted the study group. They were compared to patients hospitalized in the same period in whom post-paracentesis hemoperitoneum was suspected but ruled out by CT scan. A retrospective chart review was conducted to determine specifics of the adverse event, patient characteristics and risk factors for bleeding. RESULTS: On multivariate analysis, acute kidney injury prior to paracentesis was the only independent predictor of post-paracentesis hemoperitoneum (OR 4.3, 95% CI 1.3-13.5, P = .01), independent of MELD score, large volume paracentesis, sepsis, platelets, INR and haemoglobin levels. CONCLUSIONS: Infection/sepsis is generally considered predictive of bleeding in cirrhosis. Our study suggests that acute kidney injury, and not sepsis, is the most important predictor of post-procedure bleeding in patients with decompensated cirrhosis. Although end-stage renal disease is a known cause of bleeding in non-cirrhotic patients, there are no studies establishing acute kidney injury as a risk factor for post-procedure bleeding in cirrhosis. Future studies investigating blood product transfusion needs in cirrhosis prior to procedures should carefully look at patients with acute kidney injury.
Asunto(s)
Lesión Renal Aguda/etiología , Hemoperitoneo/etiología , Cirrosis Hepática/complicaciones , Paracentesis/efectos adversos , Lesión Renal Aguda/fisiopatología , Adulto , Anciano , Coagulación Sanguínea , Femenino , Hemoperitoneo/fisiopatología , Humanos , Cirrosis Hepática/terapia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Sepsis/etiologíaRESUMEN
- Rupture of the corpus luteum is a frequent condition in women of reproductive age. Because of abdominal pain accompanied by hemoperitoneum, ruptured corpus luteum can easily be confused with ectopic pregnancy. The management of ruptured corpus luteum depends on the symptoms and laboratory findings, and can be just observation but laparoscopy or urgent laparotomy may also be needed. Although rare, hemoperitoneum following rupture of corpus luteum in early pregnancy should always be considered in the diagnostic process. We present a patient that was admitted to our department with amenorrhea, positive ßhCG and acute abdomen. Emergency laparoscopy was performed but no ectopic pregnancy was found, just blood, coagula and a ruptured corpus luteum. The day after the surgery, intrauterine pregnancy was found on ultrasound and the pregnancy ended with term delivery.
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Cuerpo Lúteo/diagnóstico por imagen , Hemoperitoneo , Laparoscopía/métodos , Abdomen Agudo , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Adulto , Diagnóstico Diferencial , Femenino , Hemoperitoneo/diagnóstico , Hemoperitoneo/etiología , Hemoperitoneo/fisiopatología , Hemoperitoneo/cirugía , Humanos , Embarazo , Resultado del Embarazo , Embarazo Ectópico/diagnóstico , Rotura Espontánea/cirugía , Ultrasonografía/métodosRESUMEN
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rescue maneuver for unstable patients with noncompressible hemorrhage below the diaphragm. The efficacy of REBOA in the setting a major abdominal venous injury is unknown. Our objective was to examine the use of REBOA in a large animal model of major abdominal venous injury and characterize any impact on the hemodynamics, rate and volume of hemorrhage, and survival. METHODS: Ten swine (35-55 kg) underwent a controlled and validated hemorrhage and ischemia/reperfusion injury protocol to produce shock physiology. Animals were randomly assigned to a control arm (N = 5) or a treatment (REBOA) arm (N = 5). An injury was then created in the common iliac vein. Bleeding was allowed for 60 seconds and the balloon was then inflated in the REBOA arm. Hemodynamics were recorded for 45 minutes or until death. Blood loss was verified post-mortem and bleeding rate calculated. RESULTS: All animals demonstrated shock physiology at the time of randomization. There were no differences between control versus REBOA animals in baseline mean arterial pressure (42 vs. 50), pH (7.29 vs. 7.26), lactate (6.19 vs. 6.26), or INR (1.2 vs. 1.3, all p = NS). REBOA animals demonstrated immediate improvements in mean arterial pressure (50.6 vs. 97.2, p = 0.04). The mean survival time was 4.1 minutes for controls (100% died) versus 40.1 minutes for REBOA (p < 0.01). There was no difference in total blood loss (mean 630 mL for both). The rate of bleeding was significantly lower in the REBOA animals (control 197 mL/min vs. REBOA 14 mL/min, p = 0.02). CONCLUSION: In the setting of an abdominal venous injury, REBOA improved hemodynamics and lengthened survival time. Blood loss was similar between groups but the rate of bleeding was markedly decreased with REBOA. REBOA appears effective for central venous injuries and provides a sustained period of stabilization and window for surgical intervention.
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Traumatismos Abdominales/terapia , Aorta Abdominal , Oclusión con Balón/métodos , Modelos Animales de Enfermedad , Hemoperitoneo/terapia , Vena Ilíaca/lesiones , Resucitación/métodos , Choque Hemorrágico/terapia , Traumatismos Abdominales/mortalidad , Traumatismos Abdominales/fisiopatología , Animales , Aorta Abdominal/fisiopatología , Paro Cardíaco/prevención & control , Hemodinámica/fisiología , Hemoperitoneo/mortalidad , Hemoperitoneo/fisiopatología , Choque Hemorrágico/mortalidad , Choque Hemorrágico/fisiopatología , Análisis de Supervivencia , PorcinosAsunto(s)
Hemoperitoneo/diagnóstico por imagen , Heparina/efectos adversos , Dolor de la Región Lumbar/etiología , Espacio Retroperitoneal/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Femenino , Estudios de Seguimiento , Hematoma/inducido químicamente , Hematoma/complicaciones , Hematoma/diagnóstico por imagen , Hemoperitoneo/inducido químicamente , Hemoperitoneo/fisiopatología , Heparina/uso terapéutico , Humanos , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/terapia , Vértebras Lumbares/fisiopatología , Persona de Mediana Edad , Espacio Retroperitoneal/fisiopatología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tromboembolia Venosa/tratamiento farmacológico , Tromboembolia Venosa/fisiopatologíaRESUMEN
Spontaneous intraperitoneal hemorrhage (SIPH), or abdominal apoplexy, is a rare complication of protracted vomiting. Although usually seen later in life, increased alcohol consumption may be contributory to the accelerated incidence of SIPH among younger populations. We describe a 22-year-old male who presented with abdominal pain after prolonged retching in the setting of binge drinking. A CT scan identified a highly attenuated intraperitoneal collection measuring 7.6 cm x 11.6 cm x 15.9 cm adjacent to the stomach. Due to hemodynamic instability, exploratory laparotomy was emergently performed and 1600 mL of blood was evacuated. A diagnosis of SIPH was made with bleeding visualized from a short gastric artery. Ultimately, vessel ligation failed to achieve hemostasis at the splenic hilum and a splenectomy was required. Given that a delay in identification may prove fatal, this case highlights the importance of recognizing SIPH as a differential diagnosis for unexplained abdominal pain and shock after persistent vomiting.
Asunto(s)
Abdomen Agudo , Consumo Excesivo de Bebidas Alcohólicas/complicaciones , Hemoperitoneo , Hemostasis Quirúrgica/métodos , Esplenectomía/métodos , Estómago/irrigación sanguínea , Vómitos/complicaciones , Abdomen Agudo/diagnóstico , Abdomen Agudo/etiología , Arterias/diagnóstico por imagen , Arterias/patología , Arterias/cirugía , Diagnóstico Diferencial , Hemoperitoneo/diagnóstico , Hemoperitoneo/etiología , Hemoperitoneo/fisiopatología , Hemoperitoneo/cirugía , Humanos , Laparotomía/métodos , Ligadura/métodos , Masculino , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Adulto JovenAsunto(s)
Hemoperitoneo/cirugía , Vena Cava Inferior/lesiones , Heridas por Arma de Fuego/cirugía , Enfermedad Crítica/terapia , Servicio de Urgencia en Hospital , Resultado Fatal , Escala de Coma de Glasgow , Hemoperitoneo/etiología , Hemoperitoneo/fisiopatología , Humanos , Puntaje de Gravedad del Traumatismo , Laparotomía/métodos , Ligadura/métodos , Masculino , Choque Hemorrágico/etiología , Choque Hemorrágico/fisiopatología , Choque Hemorrágico/terapia , Vena Cava Inferior/cirugía , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico , Adulto JovenRESUMEN
Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, non-operative management (NOM) is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma. Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2% (70/72). The success rates of NOM in the patients with grade I-III, IV and V liver trauma were 100%, 94.4% and 83.3%. The complication rates were 10.0% and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived. NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.
Asunto(s)
Fístula Biliar/etiología , Embolización Terapéutica , Hemoperitoneo/terapia , Hígado/lesiones , Heridas no Penetrantes/terapia , Heridas Penetrantes/terapia , Adolescente , Adulto , Anciano , Fístula Biliar/cirugía , Femenino , Hemodinámica , Hemoperitoneo/etiología , Hemoperitoneo/fisiopatología , Venas Hepáticas/lesiones , Humanos , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Vena Porta/lesiones , Radiografía , Estudios Retrospectivos , Tasa de Supervivencia , Índices de Gravedad del Trauma , Resultado del Tratamiento , Heridas no Penetrantes/clasificación , Heridas no Penetrantes/complicaciones , Heridas Penetrantes/clasificación , Heridas Penetrantes/complicaciones , Adulto JovenRESUMEN
AIM: Post-partum hemorrhage (PPH) is the leading cause of maternal mortality. Identification of the precise bleeding site is generally important to control hemorrhage, but such an approach has not been fully established in the context of PPH. We postulated that visualization of bleeding sites could aid treatment decisions in the management of PPH. METHODS: We conducted a prospective review of 26 patients who underwent dynamic computed tomography (CT) for PPH. RESULTS: A total of 17 cases presented with uterine bleeding, eight with vaginal hematomas, and one with hemoperitoneum. Overall, dynamic CT identified contrast media extravasation in the arterial phase in 12 of 26 (46.2%) cases: the upper (n = 4) and the lower uterine segment including the cervix (n = 2), subfascial space (n = 1) and vagina (n = 5). Identification of precise arterial bleeding sites using CT provided informative guidance about where to place balloons for intractable uterine bleeding, and how to manage hemoperitoneum and vaginal hematomas. In addition, dynamic CT revealed the existence of a subtype of uterine atony, which is characterized by focal active arterial bleeding in the upper uterine segment. Furthermore, negative contrast extravasation extracted cases of PPH that were well controlled without the need for surgical or radiological intervention. No patient required emergency hysterectomy to control PPH. CONCLUSION: Dynamic CT has potential clinical utility in treatment decision-making for PPH.
Asunto(s)
Hematoma/diagnóstico por imagen , Hemoperitoneo/diagnóstico por imagen , Hemorragia Posparto/etiología , Hemorragia Uterina/diagnóstico por imagen , Enfermedades Vaginales/diagnóstico por imagen , Oclusión con Balón , Medios de Contraste , Árboles de Decisión , Diagnóstico Diferencial , Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico por imagen , Femenino , Hematoma/fisiopatología , Hematoma/terapia , Hemoperitoneo/fisiopatología , Hemoperitoneo/terapia , Hospitales Universitarios , Humanos , Hemorragia Posparto/prevención & control , Embarazo , Estudios Prospectivos , Tomografía Computarizada por Rayos X , Embolización de la Arteria Uterina , Hemorragia Uterina/fisiopatología , Hemorragia Uterina/terapia , Enfermedades Vaginales/fisiopatología , Enfermedades Vaginales/terapiaRESUMEN
It was performed cohort prospective study of treatment results of 69 children with through-capsule spleen injuries for the period from 2002 to 2013. Patients were divided into 2 groups. The first group included 63 patients after non-surgical treatment. The second group included 6 children who underwent surgery. In the first group 95.3% of patients had stable hemodynamics at admission. In the second group only 2 patients had the signs of deferred bleeding. Continuing abdominal bleeding was the indication for surgery in 4 patients although stable hemodynamics. Hemoperitoneum in case of spleen injury is not significant prognostic factor defining the tactics of treatment. The physiological response on bleeding but not the amount of blood in abdominal cavity determines tactics of treatment. Hemodynamic status is single statistically significant criterion for choose of surgical treatment of children with spleen injuries. Unstable hemodynamics increases the risk of surgical treatment in 20 times (p<0.007).
Asunto(s)
Traumatismos Abdominales/cirugía , Hemostasis Quirúrgica/métodos , Bazo , Heridas no Penetrantes/cirugía , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/fisiopatología , Adolescente , Niño , Femenino , Hemodinámica , Hemoperitoneo/diagnóstico , Hemoperitoneo/etiología , Hemoperitoneo/fisiopatología , Hemoperitoneo/cirugía , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Selección de Paciente , Estudios Prospectivos , Ajuste de Riesgo , Federación de Rusia , Bazo/diagnóstico por imagen , Bazo/lesiones , Bazo/cirugía , Resultado del Tratamiento , Ultrasonografía , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/fisiopatologíaRESUMEN
In patients with liver cirrhosis and portal hypertension collateral circulation can develop to direct blood from portal to systemic veins allowing decompression of the portal system. A potential complication of portal hypertension is rupture of collateral vessels with subsequent fatal hemorrhage, occurring most commonly in the esophagus. The paraumbilical vein is a recognized collateral pathway in patients with portal hypertension however cases of rupture have been rarely documented. The authors report a case of hemoperitoneum caused by rupture of a paraumbilical vein into a paraumbilical hernia in a man with liver cirrhosis and portal hypertension. Post mortem CT imaging was valuable in localizing the source of hemorrhage in this case.
Asunto(s)
Medicina Legal/métodos , Hemoperitoneo/etiología , Hernia Umbilical/complicaciones , Hipertensión Portal/etiología , Cirrosis Hepática Alcohólica/complicaciones , Tomografía Computarizada por Rayos X , Venas Umbilicales/diagnóstico por imagen , Accidentes por Caídas , Autopsia , Causas de Muerte , Circulación Colateral , Resultado Fatal , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/patología , Hemoperitoneo/fisiopatología , Hernia Umbilical/diagnóstico por imagen , Hernia Umbilical/patología , Hernia Umbilical/fisiopatología , Humanos , Hipertensión Portal/diagnóstico por imagen , Hipertensión Portal/patología , Hipertensión Portal/fisiopatología , Cirrosis Hepática Alcohólica/diagnóstico por imagen , Cirrosis Hepática Alcohólica/patología , Cirrosis Hepática Alcohólica/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Venas Umbilicales/patología , Venas Umbilicales/fisiopatologíaRESUMEN
BACKGROUND: We aimed to test whether hemoperitoneum has adverse effects on colonic anastomosis healing by increasing fibrinolytic activity. METHODS: After colonic intersection and anastomosis, 20 Wistar Albino rats received intraabdominal injections of either 25 mg/kg blood (10, Group 1) or physiologic saline (10, Group 2). Anastomotic bursting pressures were measured after sacrifice on the fifth day. Following histopathological evaluation of the anastomotic line, hydroxyproline, tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), and tPA/PAI-1 complex levels were determined in the omentum, lung and anastomotic colon. RESULTS: Mean anastomotic bursting pressures of Groups 1 and 2 were 224.5 mmHg and 254.4 mmHg (p=0.121), and mean hydroxyproline levels were 45.89 and 65.959 mg/g protein, respectively (p=0.257). Histopathology was insignificant. There was a significant difference between groups in omental tPA levels (0.962 ng/ml and 0.27 ng/ml, p=0.041), but not in PAI-1 and tPA/PAI-1. Anastomotic line and lung levels of tPA, PAI-1 and tPA/PAI-1 complex were not significantly different between groups. The relation between anastomotic line tPA level and bursting pressure was highly significant in Group 2 (r=0.778; p=0.008). CONCLUSION: In this first study on the effect of hemoperitoneum on colonic anastomosis, we observed no significant effect on anastomotic healing or fibrinolytic activity, except in the omentum. Further studies with different blood volumes and assessment times are needed.
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Colon/cirugía , Fibrinólisis/fisiología , Hemoperitoneo/fisiopatología , Cicatrización de Heridas/fisiología , Anastomosis Quirúrgica , Animales , Femenino , Ratas , Ratas WistarRESUMEN
The linear dependence of the intraabdominal pressure and the volume of retroperitoneal bleeding was revealed in 34 patients with the aortic aneurism rupture. In patients with the blunt abdominal trauma, treated conservatively and laparotomized (each group consisted of 26 patients), the intraabdominal pressure is higher in the operated group during the first day after the operation. The main factors of the intraabdominal hypertension seem to be shock and massive infusion and transfusion therapy.
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Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Descompresión Quirúrgica , Hemoperitoneo , Hipertensión Intraabdominal , Insuficiencia Multiorgánica/prevención & control , Adulto , Anciano , Aorta Abdominal/lesiones , Aorta Abdominal/fisiopatología , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/fisiopatología , Rotura de la Aorta/complicaciones , Rotura de la Aorta/fisiopatología , Transfusión Sanguínea/métodos , Descompresión Quirúrgica/métodos , Descompresión Quirúrgica/estadística & datos numéricos , Resultado Fatal , Femenino , Hemoperitoneo/etiología , Hemoperitoneo/mortalidad , Hemoperitoneo/fisiopatología , Hemoperitoneo/terapia , Humanos , Hipertensión Intraabdominal/etiología , Hipertensión Intraabdominal/fisiopatología , Hipertensión Intraabdominal/terapia , Masculino , Insuficiencia Multiorgánica/etiología , Insuficiencia Multiorgánica/mortalidad , Insuficiencia Multiorgánica/fisiopatología , Espacio Retroperitoneal/fisiopatología , Espacio Retroperitoneal/cirugía , Análisis de SupervivenciaRESUMEN
BACKGROUND: Pelvic ring injuries can be associated with severe blood loss and hemodynamic instability. The increase in pelvic volume in disrupted pelvic ring injuries is thought to cause accumulation of large volumes of blood in the retroperitoneal cavity. Extra abdominal compression for reduction of the pelvic ring may affect intrapelvic pressure. We examined the effects of pelvic volume changes on retroperitoneal pressures (RPP) and intra-abdominal pressures (IAPs) in the intact and unstable pelvic ring. METHODS: In a cadaver study, unembalmed human torsos were used. Infusion lines were placed adjacent to the sacroiliac joint in the retroperitoneum and in the abdominal cavity. IAP and RPP measurements were performed with sequential infusion of crystalloid solution in 1,000 mL increments. Measurements were performed in the intact pelvic ring and after induction of unilateral and bilateral instability by disruption of the pubic symphysis, the sacroiliac joints, the sacrotuberous ligaments, and sacrospinous ligaments. RESULTS: After infusion of 4,000 mL of saline, we observed a pressure increase in the retroperitoneal cavity (RPP) of 19.64 mm Hg ± 6.43 mm Hg in the intact pelvis, 5.22 mm Hg ± 1.74 mm Hg in unilateral instability, and 2.78 mm Hg ± 0.57 mm Hg in bilateral instability. The RPP response in the case of instability decreased significantly (p = 0.019). The IAP showed a change of 4.63 mm Hg ± 2.64 mm Hg in the intact pelvis, 3.88 mm Hg ± 1.84 mm Hg in unilateral instability, and 2.30 mm Hg ± 0.36 mm Hg in bilateral instability. Further infusion revealed a close association between RAPs and IAPs. CONCLUSIONS: In the intact pelvis, RPP rises rapidly with increasing volume. The results seem to support the idea that disrupted pelvic ring fractures may lead to a significant volume uptake that is reversed during reduction.
Asunto(s)
Cavidad Abdominal/fisiopatología , Síndromes Compartimentales/etiología , Hemoperitoneo/complicaciones , Pelvis/patología , Presión , Espacio Retroperitoneal/fisiopatología , Anciano , Cadáver , Hemoperitoneo/patología , Hemoperitoneo/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los ÓrganosAsunto(s)
Hemoperitoneo/etiología , Hemoperitoneo/cirugía , Rotura del Bazo/cirugía , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/cirugía , Accidentes de Tránsito , Estudios de Seguimiento , Hemoperitoneo/fisiopatología , Humanos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Reoperación/métodos , Medición de Riesgo , Esplenectomía/efectos adversos , Esplenectomía/métodos , Rotura del Bazo/etiología , Resultado del TratamientoRESUMEN
The term "Damage-control" is borrowed from naval terminology. It means the initial control of a damaged ship. Because of the lethal triad in multiple injured patients the classical concept of definitive surgically therapy in the acute phase of the injury has a high rate of complications such as exsanguination, sepsis, heart failure and multiple organ failure. The core idea of the damage control concept was to minimize the additional trauma by surgical operations in these critical patients in the first phase. This means temporary control of a hemorrhage and measures for stopping abdominal contamination. After 24 - 48 hours in the intensive care unit and correction of physiological disturbances further interventions are performed for definitively treatment of the injuries. Summarized, the damage control strategy comprises an abbreviated operation, intensive care unit resuscitation, and a return to the operating room for the definitive operation after hemodynamic stabilisation of the patient.