Outcomes of penetrating carotid artery injuries: A South African multicentre study.

BACKGROUND: This multicenter study examines the contemporary management of penetrating carotid artery injury (PCAI) to identify trends in management, outcomes, and to determine prognostic factors for stroke and death. METHODS: Data from three large urban trauma centers in South Africa were retrospectively reviewed for patients who presented with PCAI from 2012 to 2020. RESULTS: Of 149 identified patients, 137 actively managed patients were included. Twenty-four patients (17.9%) presented in coma and 12 (9.0%) with localizing signs (LS). CT angiography was performed on admission for 120 (87.6%) patients. Thirty patients (21.9%) underwent nonoperative management, 87 (63.5%) open surgery, and 20 (14.6%) endovascular stenting. Eighteen patients (13.1%) died, and 15 (12.6%) surviving patients had strokes. Ligation was significantly related to death and reperfusion to survival. A mechanism of gunshot wound, occlusive injuries, a threatened airway, a systolic blood pressure <90 mmHg, hard signs of vascular injury, a low GCS, coma, a CT brain demonstrating infarct, a high injury severity score and shock index, a low pH or HCO3, and an elevated lactate were significant independent prognostic factors for death. Ligation was unsurvivable in all patients with severe neurological deficits, whereas reperfusion procedures resulted in survival in 63% (12/19) patients with coma and 78% (7/9) with LS although with high stroke rates (coma: 25.0%, LS: 85.7%). CONCLUSIONS: Outcomes in PCAI, including patients with severe neurological deficit and stroke, are better when reperfused. Reperfusion holds the best promise of survival and ligation should be reserved for technically inaccessible bleeding injuries.

A case report of colonic Ameboma mimicking colon cancer in an immunocompromised patient.

INTRODUCTION AND IMPORTANCE: Entamoeba histolytica is an anaerobic protozoan. It infects humans causing Amoebiasis. Most infections are asymptomatic; however, clinical manifestations include intestinal or extraintestinal. In rare instances, patients can present with Ameboma: a mass of granulation tissue consisting of a core of inflammation with peripheral fibrosis related to chronic amoebic infection usually found in the cecum/ascending colon. PRESENTATION OF CASE: A 50-year-old patient presented with signs and symptoms of bowel obstruction. He had raised inflammatory markers and was HIV positive on treatment and virally suppressed. At laparotomy a hepatic flexure stricture with desmoid reaction, and wall thickening with induration at the mesenteric border of mid-transverse colon was found, with disseminated nodular disease. Histology confirmed entamoeba histolytica infection. DISCUSSION: The parasite exists in two forms: a cyst stage and a trophozoite stage: the form causing invasive disease. The presentation of intestinal amoebiasis ranges from an asymptomatic carrier state, colitis, to abscess formation and bowel perforation The management principles: to eliminate the invading trophozoites and eradicate the organism's intestinal carriage and manage complications such as obstruction, fulminant colitis, or toxic megacolon with surgery. CONCLUSION: This case identifies a rare cause of bowel obstruction in a patient without a travel history. Even with the lack of significant risk factors other than HIV, clinicians should be aware of the infective causes of colonic mass/stricture outside of malignant causes. Entamoeba histolytica is an infection of impoverished communities in developing countries, it should remain high on our differential for tumour-like granulation tissue in the colon.

A case report on chylothorax post penetrating chest trauma.

INTRODUCTION AND IMPORTANCE: Chylothorax is a rare condition secondary to a chyle leak from the thoracic duct. The most common cause is after thoracic and cardiac surgery. Other causes include malignancy, non-iatrogenic trauma, and miscellaneous disorder - tuberculosis, filariasis and idiopathic conditions. The incidence of chylothorax post non-iatrogenic trauma is low; however, it does occur. Therefore, clinicians managing trauma patients should be aware of chylothorax as a differential and understand how it can be managed. PRESENTATION OF CASE: Our patient presented in respiratory distress 5 days after sustaining a stab to the chest. His chest X-ray showed a massive left pleural effusion with mediastinal shift. An Intercostal drain (ICD) was inserted and, drained 2 l of a white milky fluid - confirmed to be chyle on biochemistry. Other potential differentials like empyema and a pseudochylothorax, were excluded. He was kept nil-per os, received total parenteral nutrition and the ICD output was monitored. Subsequently the drainage decreased and eventually cleared, and the ICD was removed on day 8 of admission. Chest X-rays showed resolution of the effusion, and the patient was discharged. DISCUSSION: Patients with trauma can present with chylothorax after penetrating or blunt trauma. The diagnosis can be made by checking the fluid triglyceride level or the presence of chylomicrons. Once the diagnosis is confirmed, the clinician should decide on either conservative or surgical. Due to the condition's rarity, there are no randomized control trials comparing different treatment modalities. CONCLUSION: Despite the patient's delayed presentation, he was successfully managed conservatively.

A case report on a rare cause of bowel ischaemia in penetrating trauma.

INTRODUCTION AND IMPORTANCE: Gastric mucormycosis is a rare condition that usually manifests in immunocompromised patients. It's a lethal disease with a poor prognosis requiring prompt diagnosis and aggressive management. Although found more commonly in immunocompromised patients, it can also affect the immunocompetent patient, highlighting the importance of clinical suspicion when dealing with a critically ill patient. CASE PRESENTATION: This is a case report on a patient who presented with penetrating trauma to the abdomen requiring surgical intervention. Damage control surgery was performed in the form of a right hemicolectomy ('clip and drop') for extensive colonic injuries (AAST Grade V) with contamination of the abdominal cavity [1]. In the days subsequent to the injury, he developed sepsis and progressive bowel ischaemia and necrosis, requiring surgical debridement. Histological findings revealed mucormycosis of the gastrointestinal tract. CLINICAL DISCUSSION: The diagnosis of mucormycosis depends on high clinical suspicion as well as histopathological evidence. The management comprises of surgical debridement and appropriate antifungal therapy. Timeous diagnosis and adequate treatment may improve the prognosis. CONCLUSION: This was a challenging case for the clinicians involved, highlighting that the clinician should consider this infection as a rare cause of bowel ischaemia in the back of their minds when dealing with such patients.