Racial equity in trauma injury: An unresolved enigma.

BACKGROUND: Racial disparities in healthcare have been attributed to socioeconomic inequalities while the relative risk (RR) of traumatic injury in people of color has yet to be described. METHODS: Demographics of our patient population were compared to the population of our service area. The racial and ethnic identities of gunshot wound (GSW) and motor vehicle collision (MVC) patients were used to establish RR of traumatic injury adjusting for socioeconomic status defined by payor mix and geography. RESULTS: GSW assaults were more common in Blacks (59.1%) while self-inflicted GSWs were more common in Whites (46.2%). RR of having a GSW was 4.65 times greater (95% CI 4.03-5.37; p < 0.01) among Blacks than other populations. MVC patients were 36.8% Black, 26.6% White, and 32.6% Hispanic. Blacks had an increased risk of MVC compared to other races (RR 2.13; 95% CI 1.96-2.32; p < 0.01). The racial and ethnic identity of the patient was not a predictor of GSW or MVC mortality. CONCLUSIONS: Increased risk of GSW and MVC was not correlated with local population demographics or socioeconomic status.

Robotic Diagnosis and Management of Acute Cholecystocolonic Fistula.

Cholecystocolonic fistula (CCF) is a rare complication of biliary tract disease. Increased use of imaging has aided in diagnosing these fistulae preoperatively and has established laparoscopy as a safe alternative to laparotomy. Here, we present a 79-year-old male who presented to the emergency room with abdominal pain and was diagnosed with choledocholithiasis. CT scan revealed a CCF, and he underwent endoscopic retrograde cholangiopancreatography (ERCP). He was followed closely to allow maturation of the fistula, and then, da Vinci® Xi robotic cholecystectomy and ligation were performed. Although current comparisons to laparoscopy have yet to demonstrate a clinical advantage, robotic assistance enhances dexterity, visualization, and ergonomics. Our case is one of the first documented successful operative management of CCF using the da Vinci® Xi robot.

Splenic Cysts and the Case of Mistaken Identity.

Endometriosis is a well-described pathology, with anatomic location of endometrial cell implantation extending both intraperitoneal and rarely extraperitoneal. Interestingly, previous reports indicated that the spleen enjoys immunity to endometriosis. Here, we present a patient with unremitting abdominal pain who, upon further workup, revealed multicystic disease of the spleen. The patient underwent an open splenectomy with pathology revealing intraparenchymal endometriosis likely due to seeding from traumatic splenorrhaphy. Two-week follow-up demonstrated resolution of symptoms and a well-healing incision with no postoperative complications.