RESUMO
BACKGROUND: The Joint Trauma System database estimates that about 1,200 individuals have sustained a combat-related amputation during the Global War on Terror. Previous retrospective studies have demonstrated that combat-related amputees develop obesity and cardiovascular disease, but the incidence of obesity and associated comorbidities in this population is unknown. The objectives of this study are to determine the prevalence of obesity in the military amputee population and to compare this with the general population. METHODS: This is a retrospective review of 978 patients who sustained a combat-related amputation from 2003 to 2014. Prevalence of obesity and comorbid conditions were determined. A multivariate logistic regression model was performed to identify risk factors for postamputation obesity. Kaplan-Meier curves were constructed using obesity as the event of interest. RESULTS: A total of 1,233 charts were reviewed with 978 patients included for analysis. The median age of injury was 24 years. Median follow-up time was 8.7 years, ranging from 0.5 years to 16.9 years. The average Injury Severity Score was 23.3. The average body mass index preinjury was 25.6 kg/m2, and the average most recent corrected body mass index was found to be 31.4 kg/m2. Prevalence of comorbidities was higher in the amputee population. Fifty percent of patients who progressed to obesity did so within 1.3 years. CONCLUSION: There is a notable prevalence of obesity that develops in the amputee population that is much higher than the general population. We determined that the amputee population is at risk, and these patients should be closely monitored for 1 to 2.5 years following injury. This study provides a targeted period for which monitoring and intervention can be implemented. LEVEL OF EVIDENCE: Retrospective, basic science, outcomes analysis, level III/IV.
Assuntos
Amputação Cirúrgica , Saúde Militar/estatística & dados numéricos , Obesidade , Complicações Pós-Operatórias , Ferimentos e Lesões , Adulto , Amputação Cirúrgica/efeitos adversos , Amputação Cirúrgica/métodos , Amputação Cirúrgica/estatística & dados numéricos , Conflitos Armados , Índice de Massa Corporal , Comorbidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Militares , Avaliação das Necessidades , Obesidade/diagnóstico , Obesidade/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prevalência , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Estados Unidos/epidemiologia , Guerra , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/cirurgiaRESUMO
Primary small bowel neoplasms at the ligament of Treitz are extremely rare and require advanced surgical technique for extirpation. The insidious onset of disease allows for a delayed presentation, often accompanied by moderate-size growth of the neoplasm, causing intestinal bleeding and bowel obstruction. The partial retroperitoneal location of these tumors pose a unique challenge for surgical resection. We present an unusual case of a primary small bowel adenocarcinoma at the Ligament of Treitz, requiring segmental resection of the fourth portion of the duodenum plus the proximal jejunum.
