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1.
Crit Care ; 24(1): 49, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050985

RESUMO

BACKGROUND: Severe blunt chest injury sometimes induces acute respiratory failure (ARF), requiring ventilator use. We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence. METHODS: This observational study prospectively enrolled patients with multiple bicortical rib fractures with hemothorax caused by severe blunt chest trauma. All patients received positive pressure mechanical ventilation within 24 h after trauma because of ARF. Some patients who received rib fixation with VATS were enrolled as group 1, and the others who received only VATS were designated as group 2. The length of ventilator use was the primary clinical outcome. Rates of pneumonia and length of hospital stay constituted secondary outcomes. RESULTS: A total of 61 patients were included in this study. The basic demographic characteristics between the two groups exhibited no statistical differences. All patients received operations within 6 days after trauma. The length of ventilator use was shorter in group 1 (3.19 ± 3.37 days vs. 8.05 ± 8.23, P = 0.002). The rate of pneumonia was higher in group 2 (38.1% vs. 75.0%, P = 0.005). The length of hospital stay was much shorter in group 1 (17.76 ± 8.38 days vs. 24.13 ± 9.80, P = 0.011). CONCLUSION: Rib fixation combined with VATS could shorten the length of ventilator use and reduce the pneumonia rate in patients with severe chest blunt injury with ARF. Therefore, this operation could shorten the overall length of hospital stay.


Assuntos
Respiração Artificial , Traumatismos Torácicos , Cirurgia Torácica Vídeoassistida , Desmame do Respirador , Ferimentos não Penetrantes , Adulto , Idoso , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Adulto , Costelas/cirurgia , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/cirurgia
2.
Khirurgiia (Mosk) ; (1): 74-79, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994503

RESUMO

A 8-year-old child with multiple skeletal injuries after car accident is presented in the article. Extensive right-sided urohematoma with impaired kidney function was diagnosed after 15 days. External drainage of urohematoma, ureteroscopy and examination of the right kidney were consecutively performed within 1.5 months. A complete rupture of the right ureter at the level of pyeloureterostomy was diagnosed. Right kidney autotransplantation with ureteral resection and pyeloureteral anastomosis were performed in 2 months after injury. Duration of surgery was 7.5 hours, cold ischemia - 55 min. Postoperative examination confirmed satisfactory function of the right kidney. This observation is relatively rare and the first in Russia.


Assuntos
Traumatismos Abdominais/cirurgia , Transplante de Rim , Reimplante , Ureter/lesões , Ureter/cirurgia , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/complicações , Acidentes de Trânsito , Criança , Humanos , Rim/lesões , Rim/cirurgia , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/cirurgia , Transplante Autólogo , Ferimentos não Penetrantes/complicações
3.
Br J Radiol ; 93(1106): 20190017, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31899661

RESUMO

Paediatric aortic trauma is a rare injury which can be fatal if not identified and managed appropriately. Surgical repair remains the gold-standard in moderate to severe aortic injuries. In the last decade however, endovascular treatment has gained popularity in children who have suitable vascular anatomy for intervention and are either not fit for surgery or in whom, endovascular intervention is the only alternative that will make a difference in the clinical outcome. Children pose a unique set of challenges to endovascular therapy. In this article, we aim to illustrate the different endovascular options that are available for the treatment of acute traumatic aortic injury and visceral thromboembolisation through pictorial representation. We will also demonstrate the feasibility and the limitation of this technique.


Assuntos
Aorta Abdominal/lesões , Aorta Torácica/lesões , Procedimentos Endovasculares , Ferimentos não Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia , Acidentes de Trânsito , Adolescente , Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética , Masculino , Ferimentos não Penetrantes/diagnóstico , Ferimentos Perfurantes/diagnóstico
5.
Ann R Coll Surg Engl ; 102(1): e4-e6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31509003

RESUMO

Thoracoabdominal hernia following blunt trauma is extremely rare. Abdominal viscera are more likely to herniate into the thorax if there is traumatic diaphragmatic rupture. We report the case of a patient presenting with a traumatic thoracoabdominal hernia containing part of the right lobe of the liver and the hepatic flexure of the colon. The hernia migrated cranially, to protrude through a seventh intercostal defect despite the diaphragm remaining fully intact. The need for early multispecialty (thoracic and hepatobiliary) surgical repair is highlighted, with improvements in surgical outcome for a complex trauma case by using a novel chest-wall reconstruction technique.


Assuntos
Hérnia Diafragmática Traumática/cirurgia , Herniorrafia/métodos , Ferimentos não Penetrantes/cirurgia , Acidentes por Quedas , Hérnia Diafragmática Traumática/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas das Costelas/etiologia , Fraturas das Costelas/cirurgia , Telas Cirúrgicas , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos não Penetrantes/etiologia
6.
Br J Sports Med ; 54(1): 23-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30988018

RESUMO

OBJECTIVES: To describe ocular injuries caused by badminton and to explore the implications for future prevention strategies. METHODS: We enrolled 85 patients with ocular trauma caused by badminton. Information collected from patients included type of game, instigator, instrument of injury and lessons in badminton from a professional, and ocular trauma information such as type of injury, treatment and final outcomes. RESULTS: The 85 patients (52 men, 33 women) were aged 15-65 years with an average age of 42.9 (±10.7) years. In 60 cases the player was hit by a shuttlecock and in 25 the player was hit by a racquet. 73 cases occurred in doubles matches and 10 in singles matches. In 31 cases the trauma was caused by an opponent and in 52 cases by a partner; 2 cases involved bystanders, not players. About 70% (43/61) of the injured and 82% (40/49) of the instigators had not received badminton lessons from a professional. 80 injuries were non-penetrating and 5 were penetrating. There were 58 cases with hyphaema, 36 with secondary glaucoma, 23 with lens subluxation and 2 with retinal detachment. Surgery comprised phacoemulsification or lensectomy and vitrectomy in 16 cases, silicone oil tamponade in 2 cases, trabeculectomy in 3 cases and direct cyclopexy in 5 cases. CONCLUSION: The vast majority of the badminton related eye injuries occurred among doubles players and were instigated by the injured person's partner. Non-penetrating injury was more frequent; penetrating injury was usually more serious. We recommend that badminton players use protective eyewear and receive safety education and professional coaching/instruction on techniques to protect against serious eye injuries.


Assuntos
Traumatismos Oculares/etiologia , Traumatismos Oculares/prevenção & controle , Esportes com Raquete/lesões , Adolescente , Adulto , Traumatismos Oculares/complicações , Traumatismos Oculares/cirurgia , Ferimentos Oculares Penetrantes/complicações , Ferimentos Oculares Penetrantes/etiologia , Ferimentos Oculares Penetrantes/prevenção & controle , Ferimentos Oculares Penetrantes/cirurgia , Dispositivos de Proteção dos Olhos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/prevenção & controle , Ferimentos não Penetrantes/cirurgia , Adulto Jovem
7.
J Surg Res ; 245: 593-599, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31499365

RESUMO

BACKGROUND: After traumatic arrest, resuscitative thoracotomy is lifesaving in appropriately selected patients, yet data are limited regarding hospital course after intensive care unit (ICU) admission. The objective of this study was to describe the natural history of resuscitative thoracotomy survivors admitted to the ICU. MATERIALS AND METHODS: We conducted a retrospective review (January 1, 2012-June 30, 2017) of all adult trauma patients who underwent resuscitative thoracotomy after traumatic arrest at two adult level 1 trauma centers. Data evaluated include demographics, injury characteristics, hospital course, and outcome. RESULTS: Over 66 mo, there were 52,624 trauma activations. Two hundred ninety-eight patients underwent resuscitative thoracotomy and 96 (32%) survived to ICU admission. At ICU admission, mean age was 35.8 ± 14.5 y, 79 (82%) were male, 36 (38%) sustained blunt trauma, and the mean injury severity score was 32.3 ± 13.7. Eight blunt and 20 penetrating patients (22% and 34% of ICU admissions, respectively) survived to discharge. 67% of deaths in the ICU occurred within the first 24 h, whereas 90% of those alive at day 21 survived to discharge. For the 28 survivors, mean ICU length of stay was 24.1 ± 17.9 d and mean hospital length of stay was 43.9 ± 32.1 d. Survivors averaged 1.9 ± 1.5 complications. Twenty-four patients (86% of hospital survivors) went home or to a rehabilitation center. CONCLUSIONS: After resuscitative thoracotomy and subsequent ICU admission, 29% of patients survived to hospital discharge. Complications and a long hospital stay should be expected, but the functional outcome for survivors is not as bleak as previously reported.


Assuntos
Parada Cardíaca/cirurgia , Complicações Pós-Operatórias/epidemiologia , Ressuscitação/efeitos adversos , Toracotomia/efeitos adversos , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Adulto , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Centros de Reabilitação/estatística & dados numéricos , Ressuscitação/métodos , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Adulto Jovem
8.
Pan Afr Med J ; 33: 256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692849

RESUMO

A rare case series of traumatic right diaphragmatic rupture with hepatothorax in Ghana is reported. The first case involved a middle-aged man who sustained a penetrating chest injury following an unprovoked attack by a wild bull. The second case was a young woman who sustained a blunt chest injury after being knocked down by a moving vehicle whiles crossing the road. Both presented with ruptured right diaphgramatic rupture and had to undergo repair through thoracotomy after stabilization and the two had been well one year after surgery without any complications or sequelae.


Assuntos
Diafragma/lesões , Fígado/patologia , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Adulto , Diafragma/cirurgia , Feminino , Gana , Hérnia Diafragmática Traumática/etiologia , Hérnia Diafragmática Traumática/cirurgia , Humanos , Masculino , Ruptura , Traumatismos Torácicos/complicações , Traumatismos Torácicos/cirurgia , Toracotomia/métodos , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia
10.
Ulus Travma Acil Cerrahi Derg ; 25(6): 631-634, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701505

RESUMO

Globe rupture is a major postoperative complication after penetrating keratoplasty (PK). Because the corneal wound is never comparable with that of healthy corneal tissue, globe rupture following blunt trauma occurs at the corneal graft-host junction. In this study, we report a case of scleral rupture that arose from blunt trauma occurring after PK. A 60-year-old female presented with loss of vision, redness and pain in the left eye, which was the consequence of blunt trauma, was our case in this study. Slit-lamp examination revealed ecchymosis on the eyelids, diffuse subconjunctival hemorrhage and total hyphema. The donor cornea was intact. The right eye showed PK, the cornea was transparent, and the sclera was blue. A 2 mm rupture behind the limbus extending from 3 o'clock to 9 o'clock in the upper half of the sclera was observed during exploratory surgery. She did not report any coexisting medical conditions except for systemic hypertension. The differential diagnosis of the bluish discoloration of her sclera was investigated. In detailed anamnesis, the patient reported that she had been treated for severe allergic eye disease during childhood. Vernal keratoconjunctivitis complication was diagnosed. It should be kept in mind that closed scleral perforation may occur in the patient with PK and blue sclera due to blunt trauma.


Assuntos
Traumatismos Oculares , Ceratoplastia Penetrante , Ruptura , Esclera , Ferimentos não Penetrantes , Acidentes , Traumatismos Oculares/patologia , Traumatismos Oculares/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Ruptura/patologia , Ruptura/cirurgia , Esclera/lesões , Esclera/patologia , Esclera/cirurgia , Acuidade Visual , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/cirurgia
11.
Am Surg ; 85(10): 1134-1138, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657309

RESUMO

Traumatic esophageal injury is a highly lethal but rare injury with minimal data in the trauma population. We sought to provide a descriptive analysis of esophageal trauma (ET) to identify the incidence, associated injuries, interventions, and outcomes. We hypothesized that blunt trauma is associated with higher risk of death than penetrating trauma. The Trauma Quality Improvement Program (2010-2016) was queried for patients with ET. Patients with blunt and penetrating trauma were compared using chi-square and Mann-Whitney U tests. A multivariable logistic regression model was used to determine risk of mortality. Of 1,403,466 adult patients, 651 (<0.01%) presented with ET. The most common associated thoracic injuries were rib fractures (38.7%) and pneumothorax (26.7%). More patients with a penetrating mechanism underwent open repair of the esophagus than those with blunt mechanism (46.2% vs 11.7%, P < 0.001). After controlling for covariates, there was no difference in risk of mortality between blunt and penetrating trauma (P = 0.65). The mortality rate for patients with esophageal injury surviving greater than 24 hours was 7.5 per cent. In this large national database analysis, ET was rare and most commonly associated with rib fractures and pneumothorax. Contrary to our hypothesis, the risk of mortality was equivalent between blunt and penetrating ET.


Assuntos
Esôfago/lesões , Ferimentos não Penetrantes/mortalidade , Ferimentos Penetrantes/mortalidade , Adulto , Distribuição de Qui-Quadrado , Esôfago/cirurgia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Modelos Logísticos , Masculino , Morbidade , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumotórax/complicações , Pneumotórax/epidemiologia , Melhoria de Qualidade , Estudos Retrospectivos , Fraturas das Costelas/complicações , Fraturas das Costelas/epidemiologia , Fatores de Risco , Estatísticas não Paramétricas , Stents/estatística & dados numéricos , Taxa de Sobrevida , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/cirurgia
12.
Am Surg ; 85(10): 1142-1145, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657311

RESUMO

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC+USC (January 2008-July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23-53]. The median Injury Severity Score was 4 [1-10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/etiologia , Ferimentos Penetrantes/etiologia , Escala Resumida de Ferimentos , Adulto , California/epidemiologia , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Triagem , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/cirurgia , Adulto Jovem
13.
Cir Cir ; 87(S1): 53-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501625

RESUMO

There are few reported cases of small bowel injury due to blunt abdominal trauma. We describe the clinical presentation and surgical management of these lesions. This is the clinical case of a polytraumatized male with a duodenal injury IIID3 according to AAST, who underwent resection of the intestinal segment with duodeno-duodenum anastomosis with favorable results. The infrequent presentation of injuries to the small intestine due to blunt trauma may lead the clinician to overlook the need for intentional interrogation about the kinematics of the trauma, while at the same time neglecting the taking of complementary diagnostic imaging studies, this because of a lack of clinical suspicion. It is important to analyze the patient's context, which will allow us to assess the need to delve into diagnostic studies in order to optimize their treatment.


Assuntos
Traumatismos Abdominais/cirurgia , Duodeno/lesões , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Acidentes de Trânsito , Adulto , Colectomia , Duodeno/irrigação sanguínea , Duodeno/cirurgia , Gastrostomia , Hematoma/classificação , Hemoperitônio/etiologia , Humanos , Íleo/irrigação sanguínea , Isquemia/etiologia , Isquemia/cirurgia , Jejunostomia , Lacerações/classificação , Fígado/lesões , Masculino , Mesentério/lesões , Nutrição Parenteral , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Ferimentos não Penetrantes/etiologia
14.
J Craniofac Surg ; 30(7): e683-e687, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503126

RESUMO

Injury to the orbital region represents a significant proportion of emergency department attendances and it is a common injury in patients with multisystem trauma. To date, trauma remains a leading cause of monocular blindness.Traumatic optic neuropathy may be caused by direct trauma to the optic nerve and from compression caused by foreign bodies and bone fragments. Indirect trauma can lead to visual loss from transmitted force to the optic canal by blunt facial trauma without associated fractures. Occasionally traumatic optic neuropathy is due to reversible changes, such as edema or contusion.High-dose intravenous steroids and surgical decompression of the optic canal have been advocated for the management of acute traumatic optic neuropathy, but the efficacy and safety of these treatments have been questioned.The authors present 3 patients with traumatic optic nerve injury, 1 due to a gunshot wound to the face and 2 caused by blunt facial trauma, where fragments of bone intrude into the orbit leading to compression of its content. These injuries where successfully treated with both preoperative intravenous steroids followed by acute surgical decompression of the orbit with return of visual function.


Assuntos
Traumatismos Faciais/cirurgia , Traumatismos do Nervo Óptico/cirurgia , Transtornos da Visão/cirurgia , Adulto , Descompressão Cirúrgica , Traumatismos Faciais/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Traumatismos do Nervo Óptico/complicações , Crânio/cirurgia , Transtornos da Visão/etiologia , Acuidade Visual , Ferimentos por Arma de Fogo/cirurgia , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/cirurgia , Adulto Jovem
18.
Bone Joint J ; 101-B(8): 1002-1008, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31362546

RESUMO

AIMS: Type IIIB open tibial fractures are devastating high-energy injuries. At initial debridement, the surgeon will often be faced with large bone fragments with tenuous, if any, soft-tissue attachments. Conventionally these are discarded to avoid infection. We aimed to determine if orthoplastic reconstruction using mechanically relevant devitalized bone (ORDB) was associated with an increased infection rate in type IIIB open tibial shaft fractures. PATIENT AND METHODS: This was a consecutive cohort study of 113 patients, who had sustained type IIIB fractures of the tibia following blunt trauma, over a four-year period in a level 1 trauma centre. The median age was 44.3 years (interquartile range (IQR) 28.1 to 65.9) with a median follow-up of 1.7 years (IQR 1.2 to 2.1). There were 73 male patients and 40 female patients. The primary outcome measures were deep infection rate and number of operations. The secondary outcomes were nonunion and flap failure. RESULTS: In all, 44 patients had ORDB as part of their reconstruction, with the remaining 69 not requiring it. Eight out of 113 patients (7.1%) developed a deep infection (ORDB 1/44, non-ORDB 7/69). The median number of operations was two. A total of 16/242 complication-related reoperations were undertaken (6.6%), with 2/16 (12.5%) occurring in the ORDB group. CONCLUSION: In the setting of an effective orthoplastic approach to type IIIB open diaphyseal tibial fractures, using mechanically relevant debrided devitalized bone fragments in the definitive reconstruction appears to be safe. Cite this article: Bone Joint J 2019;101-B:1002-1008.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Expostas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Infecção da Ferida Cirúrgica/etiologia , Fraturas da Tíbia/cirurgia , Ferimentos não Penetrantes/cirurgia , Adulto , Idoso , Desbridamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
19.
Ethiop J Health Sci ; 29(4): 503-512, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31447524

RESUMO

Background: Abdominal injury is among the major causes of trauma admissions. The aim was to determine etiology, commonly injured organs, indication and outcome of patients with abdominal injuries requiring laparotomy. Methods: A retrospective study of all adult patients who underwent laparotomy for abdominal injury at St. Paul's Hospital Millennium Medical College was conducted from January 2014 to December 2016. The factors associated with outcome were identified with bivariate and multivariate logistic regressions. Results: Laparotomy for abdominal injury was performed for 145 patients. Of these, 129 (89%) case records were retrieved. The male to female ratio was 6.2:1. The mean age was 29 years, and most of them were unemployed. Penetrating trauma was the commonest injury, stab (46, 35.7%) and Road Traffic Accidents (RTA) (27, 20.9%) being the leading causes. Extra-abdominal injuries were seen in 33.3% (46) of the cases. Hollow organs were commonly injured than solid organs. Small intestine (35, 43.8%) and Spleen (17, 34.7%) were the leading injured organs in penetrating and blunt respectively. The main procedure performed was repair of hollow and solid organ laceration/perforation (70,54.3%). The negative laparotomy rate was 4.6% (6). Complications were seen in 23(17.8%) patients, the commonest being irreversible shock (7,30.4%). The mortality rate was 8.5 % (11), and it was significantly associated with blunt abdominal injury (AOR=7.25; 95% CI 1.09-48.37; p=0.041) and systolic blood pressure<90mmHg (AOR=8.66; 95% CI 1.1-68.41; p=0.041). Conclusion: Stab and RTA were the commonest indications of laparotomy. The mortality was significantly associated with blunt abdominal injury and hypotension (SBP<90mmHg).


Assuntos
Traumatismos Abdominais/cirurgia , Hospitais de Ensino/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/patologia , Adulto , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/patologia , Ferimentos Penetrantes/cirurgia , Adulto Jovem
20.
Rozhl Chir ; 98(8): 315-320, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31462053

RESUMO

INTRODUCTION: Patients with abdominal trauma appear frequently. The most vulnerable organs in these patients are the liver and the spleen. Injuries of the small and large intestines are relatively less frequent. The diagnostic process of these injuries is complex and requires an analysis of all results. Therefore it is highly probable that the final diagnosis can be delayed and so can be delayed an indication of surgical exploration of the abdominal cavity, which can have serious consequences on the morbidity and mortality of these patients with intestinal trauma. METHODS: We collected our data using the WinMedicalc 2000 software. We searched for patients hospitalised in years 20082017 in the Department of Surgery, Faculty of Medicine in Pilsen subjected to surgical revision of the abdominal cavity for intestinal trauma. RESULTS: Our set comprised 41 patients, including 30 men and 11 women. The mean age of the patients was 41 years, 4 of the patients were children. Twenty-three of the patients suffered from polytrauma, while 9 of the patients had a relatively isolated injury of either the small intestine or the colon. Six of the patients died. The small intestine was injured in 17 patients, the colon was injured in 14 patients and both were injured in 10 patients. The intestinal injury was diagnosed in 17 cases based on CT imaging (performed 31 times in total); 23 cases were diagnosed in the peroperative period. CONCLUSIONS: We assessed a set of patients with an intestinal injury in terms of specific diagnosis, severity of trauma, diagnostic process and treatment. The results are similar to the results of studies in large sets of patients. Even though imaging methods can help to reach the right diagnosis, they are insufficient as a sole diagnostic method, and physical examination plays a major role.


Assuntos
Traumatismos Abdominais , Intestino Grosso , Traumatismo Múltiplo , Ferimentos não Penetrantes , Adulto , Criança , Feminino , Humanos , Intestino Grosso/lesões , Intestino Grosso/cirurgia , Masculino , Estudos Retrospectivos , Ferimentos não Penetrantes/cirurgia
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