Blunt gastric injury. A multicentre experience.

A multicentre retrospective analysis of blunt gastric injuries from four trauma centres in Brazil was performed. From January 1982 to May 1996, 33 patients were found to have blunt gastric injury: 26 were male and the mean age was 26.2 years. The most frequent mechanism of injury was automobile versus pedestrian (17) followed by motor vehicle accidents (seven). Abdominal pain was the most common finding (29) and peritoneal signs were present in 14. There were 21 grade I, seven grade II, four grade III and one grade IV blunt gastric injuries. Simple suture was the treatment of choice in 24 patients, eight required no treatment, and only one patient underwent gastric resection. The liver and spleen were the most commonly associated injured organs. Two patients had isolated gastric injury. There were two gastric fistulae and both patients died. Overall morbidity and mortality was 12 (36%) and nine (27%), respectively. The ISS was higher in the non-survivor group (P=0.03) and the gastric organ injury score did not reach statistical significance when comparing survivors and non-survivors. We conclude that blunt gastric injury is uncommon and is associated with other injuries of greater magnitude, which generally influence mortality.

Preservación del bazo en la pancreatectomía distal por trauma en el niño / Preservation of the spleen in distal pancreatomy in children

La preservación total o parcial del bazo traumatizado es un procedimiento seguro y frecuente en los servicios de emergencia.Constituye la medida profiláctica más efectiva contra la infección fulminante post-esplenectomía(IFPE).En la pancreatectomía distal,aunque es una cirugía infrecuente,también puede hacerse la preservación del bazo.Se presentan cinco niños con traumatismo de cuerpo y de la cola de páncreas que fueron sometidos a una pancreactomía distal con preservación del bazo.La edad varió entre 6 y 9 años,con un promedio de 7,5.La lesión fue ocasionada por contusión en 4(80 por ciento)y por arma de fuego en uno Solo un paciente tuvo asociadas en el estómago,el bazo y el riñon.El Injury Severity Score(ISS)varió entre 9 y 27,con promedio de 15,2.La sutura de superficie pancreátics se hizo con puntos separados y material no absorbible.En todos los casos,los vasos esplénicos fueron conservados.En un caso se resecó el polo inferior del bazo.Un paciente tuvo como complicación un absceso abdominal,que fue evacuado por punción.El promedio de permanencia hospitalaria fue de 9,7 días y no falleció ningún paciente.La conservación del bazo en la pancreatectomía distal es un procedimiento seguro en el paciente estable

Preservación del bazo en la pancreatectomía distal por trauma en el niño / Preservation of the spleen in distal pancreatomy in children

La preservación total o parcial del bazo traumatizado es un procedimiento seguro y frecuente en los servicios de emergencia.Constituye la medida profiláctica más efectiva contra la infección fulminante post-esplenectomía(IFPE).En la pancreatectomía distal,aunque es una cirugía infrecuente,también puede hacerse la preservación del bazo.Se presentan cinco niños con traumatismo de cuerpo y de la cola de páncreas que fueron sometidos a una pancreactomía distal con preservación del bazo.La edad varió entre 6 y 9 años,con un promedio de 7,5.La lesión fue ocasionada por contusión en 4(80 por ciento)y por arma de fuego en uno Solo un paciente tuvo asociadas en el estómago,el bazo y el riñon.El Injury Severity Score(ISS)varió entre 9 y 27,con promedio de 15,2.La sutura de superficie pancreátics se hizo con puntos separados y material no absorbible.En todos los casos,los vasos esplénicos fueron conservados.En un caso se resecó el polo inferior del bazo.Un paciente tuvo como complicación un absceso abdominal,que fue evacuado por punción.El promedio de permanencia hospitalaria fue de 9,7 días y no falleció ningún paciente.La conservación del bazo en la pancreatectomía distal es un procedimiento seguro en el paciente estable

Sonographic features of portal hypertension in schistosomiasis mansoni.

The diagnostic value of real-time sonography in the study of portal hypertension was assessed in 66 patients with hepatosplenic schistosomiasis mansoni, all with Symmers's fibrosis and esophageal varices. Seventy-one individuals without schistosomiasis were selected as controls. The inner diameters of the portal vessels were measured by sonography in all patients and controls: splenoportography was also performed in the schistosomal group. Intra-splenic pressure was over 30 cm of water in 44 of 60 patients with schistosomiasis. The upper limit of normality for portal vessel diameters was set through receiver operating characteristic curve at 12 mm for portal vein, 9 mm for splenic vein at splenic hilus, and 9 mm for superior mesenteric vein. The best discriminative vein for the diagnosis of portal hypertension was the splenic vein followed by the portal vein. A direct correlation was observed between the diameter of the splenic vein, measured by sonography, and the intra-splenic pressure. Except for the paraumbilical and mesenteric veins, more frequently identified by sonography, there was no statistical difference in the frequency of visualization of splanchnic vessels by sonography or splenoportography.

Cirurgia conservadora do trauma esplênico na criança / Conservative surgery of splenic trauma in children

O baço é um importante componente do sistema imunológico, sobretudo nas crianças. Nesta faixa etária, a esplenectomia pode resultar em significativo déficit imunológico, devendo ser evitada no tratamento dos traumatismos abdominais. OBJETIVO. Demonstrar a exeqüibilidade e segurança da preservaçäo cirúrgica do baço na criança traumatizada feita por equipes de diferente nível técnico. MÉTODOS. Foram estudadas 139 crianças com idade de 5 meses a 12 anos, atendidas na Unidade de Emergência do Hospital Joäo XXIII, no período de dez anos. Foram analisadas as causas, o tipo da lesäo esplênica e o tratamento efetuado. Choque hipovolêmico ocorreu em 30 por cento dos pacientes. Trauma contuso foi o responsável pela lesäo em 97,2 por cento, com 58,7 por cento causados por atropelamento. Houve 41, 6 por cento de lesöes grau I e II, 30,6 por cento grau III e 26,5 por cento grus IV e V (Injury Scalling Comitee). RESULTADOS. Tratamento näo cirúrgico em dois pacientes e cirurgia em 137, com preservaçäo do órgäo em 98 (71,5 por cento). Esplenorrafia 81 (82,6 por cento), ressecçäo parcial em dez (10,2 por cento) e observaçäo clínica após a laparotomia em sete (7,1 por cento). Hemostasia da superfície cruenta foi feita com pontos separados e retalho de epíploon. Hemorragia pós-operatória ocorreu em apenas um caso (1,02 por cento). Esplenectomia foi realizada em 39 crianças (28,5 por cento, com 75 a 100 por cento de indicaçäo nas lesöes de graus IV e V, respectivamente. Lesöes associadas abdominais e extra-abdominais ocorreram em 87 casos (62,5 por cento). A mortalidade global foi de 10,5 por cento (15 casos), com 13 óbitos devidos a trauma craniano. CONCLUSAO. A cirurgia conservadora do baço é possível em cerca de 70 por cento dos traumatismos esplênicos. O tratamento näo-cirúrgico é seguro, mas exige vigilância constante, preferencialmente em UTI, com controle por ultrasom e/ou tomografia computadorizada. Havendo suspeita de lesöes associadas intra-abdominais, a laparotomia é mandatória

[Conservative surgery of splenic trauma in children]. / Cirurgia conservadora do trauma esplênico na criança.

The spleen is an important component of the immunologic system, especially in children. Splenectomy may result in immunologic deficiency, and splenic salvage is recommended as management in splenic surgery. PURPOSE--Splenic injury management, considering splenic salvage as a safe therapeutic option in these children. METHODS--One hundred and thirty nine (139) children, aged 5 months to 12 years were at João XXIII Hospital, Belo Horizonte, Brazil, for the period of 1981 to 1990. The causes of the trauma, the extent and the management of splenic injuries were evaluated. Hemodynamic instability with shock occurred in 30% of the children. The contusions were responsible for injury in 135 patients (97.2%) with 58.7% caused by pedestrian/motor vehicle accidents 41.6% of splenic injury were grade I and II, 30.6% were grade III, and 26.5 grade IV e V (Injury Scalling Committee). RESULTS--Non operative management was done in 2 patients and 137 were operated on. Conservative surgery was performed in 98 patients (71.5%), which included: splenorraphy in 81 (82.6); partial splenectomy in 10 (10.2%), and laparotomy followed by observation in 7 (7.1%). Post-surgical hemorrhage occurred in one case after conservative surgery. Splenectomy was performed in 39 (28.5%) of the patients with 75-100% of the splenic injury classified in grades IV and V. Multiple associated lesions occurred in 87 children (62.5%). The mortality rate was 10.5%. Cranioencephalic trauma was the cause of death in 13 children. CONCLUSION--The splenic salvage is a possible option in the management of splenic injury in 70% of the cases. Nonoperative treatment of splenic injury depends on the physiologic status of the patient, CT scan demonstration of splenic injury and intensive care management. If there was an associated abdominal injury, there would be an indication for surgery.