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1.
Emerg Med Clin North Am ; 39(4): 769-780, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600636

RESUMO

Abdominal vascular emergencies are an uncommon entity in emergency medicine, but when they present, they are often catastrophic. These time-sensitive and life-threatening diagnoses are often hidden in nonspecific complaints such as nausea, vomiting, or flank pain, so the emergency physician must remain diligent and consider these in the differential diagnoses. The following is an overview of the more common of these abdominal vascular emergencies, in the hope that they help the Emergency Physician avoid the misdiagnosis and subsequent vascular catastrophe that would follow.


Assuntos
Abdome/irrigação sanguínea , Erros de Diagnóstico/prevenção & controle , Traumatismos Abdominais/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/cirurgia , Estenose da Valva Aórtica/diagnóstico , Arteriopatias Oclusivas/diagnóstico , Técnicas de Diagnóstico do Sistema Digestório , Medicina de Emergência , Humanos , Intestinos/irrigação sanguínea , Isquemia/diagnóstico , Isquemia/terapia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/terapia , Lesões do Sistema Vascular/diagnóstico
2.
Emerg Med Clin North Am ; 39(4): 795-806, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600638

RESUMO

Occult abdominal injuries are common and can be associated with increased risk of morbidity and mortality. Patients with a delayed presentation to care or who are multiply injured are at increased risk of this type of injury, and a high index of suspicion must be maintained. A careful combination of history, physical examination, laboratory, and imaging can be quite helpful in mitigating the risk of a missed occult abdominal injury.


Assuntos
Traumatismos Abdominais/diagnóstico , Ferimentos não Penetrantes/diagnóstico , Abdome/diagnóstico por imagem , Diagnóstico Tardio , Serviço Hospitalar de Emergência , Testes Hematológicos , Humanos , Testes de Função Hepática , Diagnóstico Ausente , Lavagem Peritoneal , Exame Físico , Doses de Radiação , Fatores de Risco
3.
Khirurgiia (Mosk) ; (10): 113-115, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34608790

RESUMO

The authors report surgical treatment of a patient with a penetrating abdominal trauma followed by damage to inferior vena cava, liver, duodenum and pancreas, massive bleeding and large retroperitoneal hematoma. Suturing of inferior vena cava defect, liver and pancreas, Billroth II gastric resection, drainage of retroperitoneal space and abdominal cavity were carried out. Postoperative period was complicated by pneumonia and seroma in lesser sac that required percutaneous puncture. Antibiotic therapy was used postoperatively. The patient was discharged in 25 days after surgery.


Assuntos
Traumatismos Abdominais , Ferimentos Penetrantes , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Humanos , Fígado/lesões , Espaço Retroperitoneal , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/lesões , Veia Cava Inferior/cirurgia
4.
BMC Surg ; 21(1): 382, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34715846

RESUMO

BACKGROUND: To the best of our knowledge, splenic rupture caused by hit by a pitch (HBP) has not been previously reported. We present a patient who underwent emergency laparotomy for splenic rupture after being HBP during a baseball game. CASE PRESENTATION: A 41-year-old male was HBP in the left abdomen during his first at-bat during a baseball game. During the operation, vascular injury of the splenic hilum and a deeply extending parenchymal injury were observed, and splenectomy was performed. Histologic findings were consistent with splenic rupture. CONCLUSIONS: The patient's postoperative course was uneventful. Although extremely rare, the possibility of intra-abdominal organ injury should be considered in batters who are hit in the abdomen by a pitched baseball, as illustrated by our patient.


Assuntos
Traumatismos Abdominais , Beisebol , Ruptura Esplênica , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/cirurgia , Adulto , Humanos , Masculino , Esplenectomia , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia
5.
J Trauma Acute Care Surg ; 91(5): 829-833, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34695059

RESUMO

BACKGROUND: Trauma care is associated with unplanned readmissions, which may occur at facilities other than the index treatment facility. This "fragmentation of care" may be associated with adverse outcomes. We evaluated a statewide database that includes readmissions to analyze the incidence and impact of FC. METHODS: The California Office of Statewide Health Planning and Development patient discharge data set was evaluated for calendar years 2016 to 2018. Patients 15 years or older diagnosed with blunt abdominal solid organ injury during the index admission were identified. Readmissions were evaluated postdischarge at 1, 3, and 6 months. Patients readmitted within 6 months to a facility other than the index admission facility (fragmented care [FC]) were compared with those readmitted to their index admission facility (non-FC). Logistic regression modeling was used to evaluate risk of FC. RESULTS: Of the total 1,580 patients, there were 752 FC (47.6%) and 828 (52.4%) non-FC. Readmissions representing FC at months 1, 3, and 6 were 40.3%, 49.3%, and 53.4%, respectively. At index admission, the groups were demographically and clinically similar, with similar rates of abdominal operations and complications. Non-FC patients had a higher rate of abdominal reoperation at readmission (5.8% non-FC vs. 2.9% FC, p = 0.006). In an adjusted model, multiple readmissions (odds ratio [OR] 1.11, p = 0.014), readmission >30 days after index facility discharge (OR, 1.98; p < 0.001), and discharge to a nonmedical facility (OR, 2.46; p < 0.0001) were associated with increased odds of FC. Operative intervention at index admission was associated with lower odds of FC (OR, 0.77; p = 0.039). However, FC was not independently associated with demographic or insurance characteristics. CONCLUSION: The rate of FC among patients with blunt abdominal injury is high. The risk of FC is mitigated when patients are managed operatively during the index admission. Trauma systems should implement measures to ensure that these patients are followed postdischarge. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III; Care management, level IV.


Assuntos
Traumatismos Abdominais/cirurgia , Assistência ao Convalescente/organização & administração , Readmissão do Paciente/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Ferimentos não Penetrantes/cirurgia , Adulto , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/normas , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos
6.
J Trauma Acute Care Surg ; 91(5): 834-840, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34695060

RESUMO

BACKGROUND: Blunt traumatic abdominal wall hernias (TAWH) occur in approximately 15,000 patients per year. Limited data are available to guide the timing of surgical intervention or the feasibility of nonoperative management. METHODS: A retrospective study of patients presenting with blunt TAWH from January 2012 through December 2018 was conducted. Patient demographic, surgical, and outcomes data were collected from 20 institutions through the Western Trauma Association Multicenter Trials Committee. RESULTS: Two hundred and eighty-one patients with TAWH were identified. One hundred and seventy-six (62.6%) patients underwent operative hernia repair, and 105 (37.4%) patients underwent nonoperative management. Of those undergoing surgical intervention, 157 (89.3%) were repaired during the index hospitalization, and 19 (10.7%) underwent delayed repair. Bowel injury was identified in 95 (33.8%) patients with the majority occurring with rectus and flank hernias (82.1%) as compared with lumbar hernias (15.8%). Overall hernia recurrence rate was 12.0% (n = 21). Nonoperative patients had a higher Injury Severity Score (24.4 vs. 19.4, p = 0.010), head Abbreviated Injury Scale score (1.1 vs. 0.6, p = 0.006), and mortality rate (11.4% vs. 4.0%, p = 0.031). Patients who underwent late repair had lower rates of primary fascial repair (46.4% vs. 77.1%, p = 0.012) and higher rates of mesh use (78.9% vs. 32.5%, p < 0.001). Recurrence rate was not statistically different between the late and early repair groups (15.8% vs. 11.5%, p = 0.869). CONCLUSION: This report is the largest series and first multicenter study to investigate TAWHs. Bowel injury was identified in over 30% of TAWH cases indicating a significant need for immediate laparotomy. In other cases, operative management may be deferred in specific patients with other life-threatening injuries, or in stable patients with concern for bowel injury. Hernia recurrence was not different between the late and early repair groups. LEVEL OF EVIDENCE: Therapeutic/care management, Level IV.


Assuntos
Traumatismos Abdominais/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/complicações , Parede Abdominal/cirurgia , Adulto , Feminino , Hérnia Ventral/etiologia , Herniorrafia/métodos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos não Penetrantes/complicações , Adulto Jovem
7.
S Afr J Surg ; 59(3): 90-93, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34515423

RESUMO

BACKGROUND: This study reviews the Pietermaritzburg Metropolitan Trauma Service (PMTS) experience with the management of blunt abdominal trauma (BAT). METHODS: A retrospective review of the hybrid electronic medical registry (HEMR) between December 2012 and September 2019 was conducted. All patients admitted following BAT were included. RESULTS: During the study period, 1 123 BAT patients were managed by the PMTS. The mean age was 29.19 years (SD 14.03). Of these admissions, 73.6% were male. The most common mechanism was road traffic crashes (RTCs) - 435 motor vehicle collisions (MVCs) and 250 pedestrian vehicle collisions (PVCs). There were 186 assaults, 118 falls, 62 community assaults, 22 accidents related to agriculture, construction or industry, 11 sporting injuries, nine animal injuries, seven patients injured by falling objects, five injured by trains, two hangings, one burn-related fall and two other causes. The mechanism of injury was unknown in 22 cases. There were 445 abdominal CT scans and 270 whole body CT scans. Surgical management was required for 395 patients. There were 259 index laparotomies and 176 repeat laparotomies. Four patients underwent selective arterial embolisation. Laparoscopy was undertaken in ten, and subsequently converted to laparotomy in five. There were 106 orthopaedic operations. Hospital stay ranged from 0-155 days (median stay three days). ICU admission was required in 24.9% of patients. The mortality rate was 7.5%. CONCLUSION: BAT is common in South Africa. Whilst the vast majority of patients require non-operative treatment, a welldefined subset require a laparotomy. Imaging is central to the management of patients with BAT.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/epidemiologia , Adulto , Animais , Humanos , Laparotomia , Masculino , Estudos Retrospectivos , África do Sul/epidemiologia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/etiologia
9.
J Laparoendosc Adv Surg Tech A ; 31(10): 1224-1226, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34520262

RESUMO

Although once thought to be a point of contention, the use of minimally invasive surgery for the hemodynamically stable pediatric trauma patients has grown dramatically since its conception in the 1970s and becoming a widely acceptable option for select patient populations. An accumulation of literature over the decades has continued to support laparoscopy for both diagnostic and therapeutic purposes in the pediatric trauma patients as laparoscopy is likely to decrease morbidity, hospital cost, and negative laparotomy rates. In this review, we describe what we believe to be the critical aspects of diagnostic laparoscopy in the setting of pediatric trauma.


Assuntos
Traumatismos Abdominais , Laparoscopia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Criança , Humanos , Lactente , Laparotomia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos
10.
J Trauma Nurs ; 28(5): 283-289, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34491943

RESUMO

BACKGROUND: Recent publications indicate that blunt solid organ injuries can be safely managed with reduced length of stay using pathways focused on hemodynamics. We hypothesized that pediatric patients with isolated blunt Grade I or II solid organ injuries may be safely discharged after brief observation with appropriate outpatient follow-up. OBJECTIVE: The purpose of this study is to evaluate the need for admission of pediatric trauma patients with isolated low-grade solid organ injury resulting from blunt trauma. METHODS: We performed a retrospective cohort study of trauma registry data from 2011 to 2018 to identify isolated blunt Grade I or II solid organ injuries among children younger than 19 years. "Complication or intervention" was defined as transfusions, transfer to the intensive care unit, repeat imaging, decrease in Hgb greater than 2 g/dl, fluid bolus after initial resuscitation, operation or interventional radiology procedure, or readmission within 1 week. RESULTS: A total of 51 patients were admitted to the trauma service with isolated Grade I or II blunt solid organ injuries during the 8-year study period. The average age was 11 years. Among isolated Grade I or II injuries, seven (14%) had "complication or intervention" including greater than 2 g/dl drop in Hgb in four patients (8%), follow-up ultrasonography for pain in one patient (2%), readmission for pain in one patient (2%), or a fluid bolus in two patients (4%). None required transfusion or surgery. The most common mechanism of injury was sports related (45%), and the average length of stay was 1 day. CONCLUSION: Among a cohort of 51 patients with isolated blunt Grade I or II solid organ injuries, none required a significant intervention justifying need for admission. All "complication or intervention" patients observed were of limited clinical significance. We recommend that hemodynamically stable patients with isolated low-grade solid organ injuries may be discharged from the emergency department after a brief observation along with appropriate instructions and pain management.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/terapia , Criança , Hospitalização , Humanos , Escala de Gravidade do Ferimento , Fígado/lesões , Alta do Paciente , Estudos Retrospectivos , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapia
11.
JNMA J Nepal Med Assoc ; 59(240): 802-804, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34508489

RESUMO

Open pelvic fractures are rare but represent a serious clinical problem with high mortality rates. Acute mortality is often associated with haemorrhage and delayed mortality is most often associated with sepsis and multiple organ failure. An aggressive multidisciplinary approach is of paramount importance to prevent catastrophe. It involves emergency resuscitation, stabilization of unstable fracture with an external fixator, and faecal diversion for rectal injury. Here, a case of open pelvic fracture with rectal laceration has been presented.


Assuntos
Traumatismos Abdominais , Fraturas Ósseas , Fraturas Expostas , Lacerações , Ossos Pélvicos , Sepse , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Fraturas Expostas/cirurgia , Humanos , Lacerações/complicações , Lacerações/cirurgia , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/lesões , Ossos Pélvicos/cirurgia
12.
J Med Case Rep ; 15(1): 474, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34526117

RESUMO

BACKGROUND: Pancreatic injury presented as isolated injury in the pediatric population is exceptionally rare, with a conveyed incidence of less than 2% of all abdominal trauma injuries cases and a very controversial management approach for grade III injuries. CASE PRESENTATION: A 16-year-old adolescent Sudanese boy was referred to our emergency department with a 5-day history of upper and left hypochondrial pain after blunt abdominal trauma to the epigastric region with a solid object. Grade III pancreatic body trauma with major duct involvement can be successfully treated operatively. The boy was discharged home on day 10 with regular oral intake and diet. A follow-up for 6 months continued by phone, and it was uneventful with no further complications. CONCLUSIONS: Roux-en-Y pancreatojejunostomy reconstruction can be a safe and valuable surgical option when the surgical approach is considered for grade III pancreatic injury.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Adolescente , Anastomose em-Y de Roux , Humanos , Masculino , Pâncreas/diagnóstico por imagem , Pâncreas/lesões , Pâncreas/cirurgia , Pancreaticojejunostomia , Estudos Retrospectivos , Ferimentos não Penetrantes/cirurgia
13.
Acta Chir Orthop Traumatol Cech ; 88(4): 307-312, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-34534061

RESUMO

INTRODUCTION The authors present an overview of polytrauma patients with urinary tract injuries managed in the Level I trauma centre. The purpose of this study was to evaluate the frequency of injuries to the urinary system, the mechanism of their injury and the method of treatment in the cohort of polytrauma patients treated in the trauma centre. MATERIAL AND METHODS Between 2012 and 2016, a total of 231 polytrauma patients were treated, of whom 47 (20.3%) also suffered a urotrauma. The renal trauma, ureteral trauma, bladder trauma and urethral trauma were classified according to the American Association for the Surgery of Trauma (AAST) scoring scale. RESULTS The non-operative treatment was opted for in 24 patients (86%) with Grade I and II kidney injury, whereas a surgical revision was indicated in line with the European Association of Urology (EAU) Guidelines in 9 patients (100%) with Grade III renal trauma or higher. The bladder trauma was treated non-operatively in two patients (22.2%) with Grade I and II bladder injury and operatively in 7 patients (77.7%) with Grade III injury or higher. After the operative management of urogenital injuries in 18 patients (38%), complications occurred in 7 patients (39%). A total of 7 patients (14.9%) died as a consequence of polytrauma with urinary tract injuries and in 5 of them the death occurred within 30 days of polytrauma, but no urinary tract injury led directly to death of the patient. DISCUSSION Kidneys are the most frequently injured uropoietic organ. A civilian kidney trauma is present in up to 5% of trauma patients and accounts for 24% of abdominal injuries. The computed tomography scanning with intravenous contrast (CT IVU) remains the Gold Standard. In recent decades there was a shift in treating the prevailing majority of patients with a kidney trauma, namely from surgical revision to non-operative treatment. This trend was also observed by the authors in their own cohort. CONCLUSIONS Based on the evaluation of their own cohort of patients, the authors state that the diagnostic algorithm including CT IVU and also UCG in indicated patients are adequate to timely diagnose the urinary tract injuries, including polytraumas. The study confirmed that the most frequent injury to the urinary tract in polytrauma patients is the kidney trauma and that the urinary tract injury is not usually the cause of death in polytraumatized patients. Key words: polytrauma, urotrauma, urogenital organ injury, kidney, urinary bladder, AAST.


Assuntos
Traumatismos Abdominais , Traumatismo Múltiplo , Traumatismos Torácicos , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/terapia , Humanos , Escala de Gravidade do Ferimento , Rim , Traumatismo Múltiplo/epidemiologia , Traumatismo Múltiplo/terapia , Estudos Retrospectivos , Centros de Traumatologia
14.
Wiad Lek ; 74(8): 1829-1833, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34537728

RESUMO

OBJECTIVE: The aim was to determine the role of obesity in the development of fatal complications and deaths in victims with abdominal trauma. PATIENTS AND METHODS: Materials and methods: The study was conducted on the basis of the Department of Polytrauma at the Municipal Health Care Institution of Kharkiv City Council "O.I. Meshchaninov City Clinical Hospital of Ambulance and Emergency Care". The authors have analyzed the case histories of 240 patients with abdominal trauma depending on the presence of obesity, which was determined by BMI (body mass index) and/or waist circumference (WC). RESULTS: Results: Complications were found in 93 (38.8%) victims, 34 (14.2%) victims died. It was found that the overall incidence of complications, respiratory and hemocoagulation complications, the incidence of multiple organ failure (MOF) and mortality signif i cantly increased in obese victims. Determination of obesity by the value of the BMI during hospitalization was possible in 41.7% of victims. The identif i cation of WC turned out to be no less informative, but more accessible. CONCLUSION: Conclusions: Obesity increases the incidence of complications and mortality in victims of abdominal trauma, and is a marker of a negative prognosis. Traditional assessment of BMI during hospitalization in most victims with abdominal trauma is not possible due to the severity of the condition and/or the presence of combined injuries. A good alternative to determining obesity in victims with abdominal trauma is a WC (more than 88 cm in women and more than 102 cm in men).


Assuntos
Traumatismos Abdominais , Obesidade Abdominal , Índice de Massa Corporal , Feminino , Hospitalização , Humanos , Masculino , Obesidade/epidemiologia , Fatores de Risco , Circunferência da Cintura
15.
Rozhl Chir ; 100(5): 246-251, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34465106

RESUMO

We present 3 case-reports with penetrating abdominal injury from our practice in this article. An urgent laparotomy was performed in all cases because of haemodynamic instability or the mechanism of injury. Penetrative abdominal traumas are associated with a high risk of life-threatening intra-abdominal injuries, require urgent revision and are often accompanied by postoperative infections of the peritoneal cavity. In recent years, there has been a growing tendency towards mini-invasive approaches or even non-operative treatment. This trend is particularly evident in the United States of America, where doctors experience a higher number of penetrating injuries compared to the prevalent blunt force trauma in Europe. The authors describe the need to follow all recommended procedures in the pre-hospital and hospital phases of treatment of these patients and compare them with recent literature. Key words: penetrating abdominal trauma.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Ferimentos Penetrantes , Traumatismos Abdominais/cirurgia , Europa (Continente) , Humanos , Laparotomia , Estudos Retrospectivos , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia
16.
BMC Surg ; 21(1): 339, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496803

RESUMO

BACKGROUND: Management of bowel traumatic injuries is a challenge. Although anastomotic or suture leak remains a feared complication, preserving bowel continuity is increasingly the preferred strategy. The aim of this study was to evaluate the outcomes of such a strategy. METHODS: All included patients underwent surgery for bowel traumatic injuries at a high volume trauma center between 2007 and 2017. Postoperative course was analyzed for abdominal complications, morbidity and mortality. RESULTS: Among 133 patients, 78% had small bowel injuries and 47% had colon injuries. 87% of small bowel injuries and 81% of colon injuries were treated with primary repair or anastomosis, with no difference in treatment according to injury site (p = 0.381). Mortality was 8%. Severe overall morbidity was 32%, and abdominal complications occurred in 32% of patients. Risk factors for severe overall morbidity were stoma creation (p = 0.036), heavy vascular expansion (p = 0.005) and a long delay before surgery (p = 0.023). Fistula rate was 2.2%; all leaks occurred after repairing small bowel wounds. CONCLUSION: Primary repair of bowel injuries should be the preferred option in trauma patient, regardless of the site-small bowel or colon-of the injury. Stoma creation is an important factor for postoperative morbidity, which should be weighed against the risk of an intestinal suture or anastomosis.


Assuntos
Traumatismos Abdominais , Intestinos , Anastomose Cirúrgica , Colo/cirurgia , Humanos , Intestinos/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
17.
Pediatr Surg Int ; 37(12): 1711-1718, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34477956

RESUMO

BACKGROUND: The optimal management method for pediatric pancreatic trauma is controversial. Moreover, the efficacy of stent placement via endoscopic retrograde pancreatography (ERP) remains poorly documented. METHODS: The present, retrospective review of pediatric patients with pancreatic trauma was conducted from 2010 to 2020 at a single institution. RESULTS: Ten, male children with the median age of 9.5 years (range 4-14 years) with a grade I (n = 2), II (n = 4) or III (n = 4) pancreatic injury were identified. Of six of these patients in whom ERP was performed, four had a pancreatic duct injury (PDI). Pancreatic stent placement was performed in all the patients with ERP at a site proximal to the injury in four patients and across the injury in two patients. A pseudocyst or pancreatic fluid collection was detected in five patients, of these, two with a grade II injury were managed successfully with conservative therapy while three with PDI required surgery. In the four patients with PDI, only one in whom the stent was placed across the PDI was able to avoid surgery. CONCLUSION: Therapeutic ERP might be effective even if a patient has a PDI, therefore, early ERP should be considered as a treatment option.


Assuntos
Traumatismos Abdominais , Pancreatopatias , Adolescente , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Masculino , Ductos Pancreáticos/cirurgia , Estudos Retrospectivos
18.
N Z Med J ; 134(1540): 16-24, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34482385

RESUMO

INTRODUCTION: Liver injuries sustained in blunt and penetrating abdominal trauma may cause serious patient morbidity and even mortality. AIM: To review the recent experience of liver trauma at Auckland City Hospital, describing the mechanism of injury, patient management, outcomes and complications. METHODS: A retrospective cohort study was performed, including all patients admitted to Auckland City Hospital with liver trauma identified from the trauma registry. Patient clinical records and radiology were systematically examined. RESULTS: Between 2006-2020, 450 patients were admitted with liver trauma, of whom 92 patients (20%) were transferred from other hospitals. Blunt injury mechanisms, most commonly motor-vehicle crashes, predominated (87%). Stabbings were the most common penetrating mechanism. Over half of liver injuries were low risk American Association for the Surgery of Trauma (AAST) grade I and II (56%), whereas 20% were severe grade IV and V. Non-operative management was undertaken in 72% of patients with blunt liver trauma and 92% of patients with penetrating liver trauma underwent surgery. Liver complications occurred in 11% of patients, most commonly bile leaks (7%), followed by delayed haemorrhage (2%). Thirty-two patients died (7%), with co-existing severe traumatic brain injury as the leading cause of death. There was a significant reduction in death from haemorrhage in patients with grade IV and V liver trauma between the first and second half of the study period (p=0.0091). CONCLUSION: Although the incidence and severity of liver trauma at Auckland City Hospital remained stable, there was a reduction in mortality, particularly death as a result of haemorrhage.


Assuntos
Traumatismos Abdominais/epidemiologia , Lesões por Esmagamento/epidemiologia , Fígado/lesões , Mortalidade/tendências , Ferimentos não Penetrantes/epidemiologia , Ferimentos Perfurantes/epidemiologia , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/terapia , Acidentes por Quedas , Acidentes de Trânsito , Falso Aneurisma/epidemiologia , Sistema Biliar/lesões , Lesões Encefálicas Traumáticas/mortalidade , Causas de Morte , Lesões por Esmagamento/mortalidade , Lesões por Esmagamento/terapia , Embolização Terapêutica , Hemobilia/epidemiologia , Hemorragia/mortalidade , Artéria Hepática , Humanos , Laparoscopia , Laparotomia , Motocicletas , Necrose , Nova Zelândia/epidemiologia , Pedestres , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/terapia , Ferimentos Perfurantes/mortalidade , Ferimentos Perfurantes/terapia
19.
J Trauma Acute Care Surg ; 91(4): 590-598, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34559162

RESUMO

BACKGROUND: Children with low-grade blunt solid organ injury (SOI) have historically been admitted to an inpatient setting for monitoring, but the evidence supporting the necessity of this practice is lacking. The purpose of this study was to quantify the frequency and timing of intervention for hemorrhage and to describe hospital-based resource utilization for low-grade SOI in the absence of other major injuries (OMIs). METHODS: A cohort of children (aged <16 years) with blunt American Association for the Surgery of Trauma grade 1 or 2 SOI from the American College of Surgeons Trauma Quality Improvement Program registry (2007-2017) was analyzed. Children were excluded if they had confounding factors associated with intervention for hemorrhage (comorbidities, OMIs, or extra-abdominal surgical procedures). Outcomes included frequency and timing of intervention (laparotomy, angiography, or transfusion) for hemorrhage, as well as hospital-based resource utilization. RESULTS: A total of 1,019 children were identified with low-grade blunt SOI and no OMIs. Nine hundred eighty-six (96.8%) of these children were admitted to an inpatient unit. Admitted children with low-grade SOI had a median length-of-stay of 2 days and a 23.9% intensive care unit admission rate. Only 1.7% (n = 17) of patients with low-grade SOI underwent an intervention, with the median time to intervention being the first hospital day. No child who underwent angiography was transfused or had an abnormal initial ED shock index. CONCLUSION: Children with low-grade SOI are routinely admitted to the hospital and often to the intensive care unit but rarely undergo hospital-based intervention. The most common intervention was angiography, with questionable indications in this cohort. These data question the need for inpatient admission for low-grade SOI and suggest that discharge from the emergency room may be safe. Prospective investigation into granular risk factors to identify the rare patient needing hospital-based intervention is needed, as is validation of the safety of ambulatory management. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.


Assuntos
Traumatismos Abdominais/diagnóstico , Admissão do Paciente/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Ferimentos não Penetrantes/diagnóstico , Traumatismos Abdominais/terapia , Adolescente , Angiografia/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Monitorização Fisiológica/métodos , Monitorização Fisiológica/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/terapia
20.
PLoS One ; 16(9): e0253690, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34559808

RESUMO

BACKGROUND: Road Traffic crash injury is one of the main public health problems resulting in premature death and disability particularly in low-income countries. However, there is limited evidence on the crash fractures in Ethiopia. OBJECTIVE: The study was conducted to assess the magnitude of road traffic crash fractures and visceral injuries. METHODS: A hospital-based cross-sectional study was conducted on 420 fracture patients. Participants were randomly selected from Addis Ababa City hospitals. The study was carried out between November 2019 and February 2020. Data were collected using a questionnaire and record of medical findings. Multilevel logistic regression analysis was carried out. Ethical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board. Confidentiality of participants' information was maintained. RESULTS: The study found out that the majority 265 (63. 1%) of fracture cases were younger in the age group of 18 to 34 years. Males were more affected-311(74.0%). The mortality rate was 59(14.1%), of those 50(85.0%) participants were males. The major road traffic victims were pedestrians-220(52.4%), mainly affected by simple fracture type -105(53.3%) and compound fracture type-92(46. 7%). Drivers mainly suffered from compound fracture type -23 (59.0%). One hundred eighty-two (43.3%) of fracture patients had a visceral injury. Homeless persons who sit or sleep on the roadside had a higher risk of thoracic visceral injury compared to traveler pedestrians (AOR = 4.600(95%CI: 1.215-17.417)); P = 0.025. CONCLUSION: Visceral injury, simple and compound fractures were the common orthopedic injury types reported among crash victims. Males, pedestrians, and young age groups were largely affected by orthopedic fracture cases. Homeless persons who sited or slept on the roadside were significant factors for visceral injury. Therefore, preventing a harmful crash and growing fracture care should be considered to reduce the burden of crash fracture.


Assuntos
Traumatismos Abdominais/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Fraturas Ósseas/epidemiologia , Pessoas em Situação de Rua/estatística & dados numéricos , Traumatismos Abdominais/mortalidade , Acidentes de Trânsito/mortalidade , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Fraturas Ósseas/mortalidade , Humanos , Masculino , Análise Multinível , Pobreza , Caracteres Sexuais , Adulto Jovem
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