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1.
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.
Am Surg ; 85(10): 1139-1141, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657310

RESUMO

Decisions regarding whether to close the skin in trauma patients with hollow viscus injuries (HVIs) are based on surgeon discretion and the perceived risk for an SSI. We hypothesized that leaving the skin open would result in fewer wound complications in patients with HVIs. We performed a retrospective analysis of all adult patients who underwent operative repair of an HVI. The main outcome measure was superficial or deep SSIs. Of 141 patients, 38 (27%) had HVIs. Twenty-six patients developed SSIs, of which 13 (50%) were superficial or deep SSIs. On adjusted analysis, only female gender (P = 0.03) and base deficit were associated (P = 0.001) with wound infections Open wound management was not associated with a decreased incidence of SSIs (P = 0.19) in patients with HVIs. Further research is required to determine optimal strategies for reducing wound complications in patients sustaining HVIs.


Assuntos
Traumatismos Abdominais/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Ferida Cirúrgica/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais/estatística & dados numéricos , Adulto , Antibioticoprofilaxia/estatística & dados numéricos , Procedimentos Cirúrgicos Dermatológicos/métodos , Duodeno/lesões , Feminino , Humanos , Intestino Delgado/lesões , Jejuno/lesões , Masculino , Estudos Retrospectivos , Pele , Estatísticas não Paramétricas , Estômago/lesões , Infecção da Ferida Cirúrgica/classificação , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle
6.
Ulus Travma Acil Cerrahi Derg ; 25(5): 531-534, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31475326

RESUMO

Heterotopic mesenteric and/or omental ossification is an uncommon bone-like lesion located inside the abdominal cavity. Its etiology is unclear, but most of the patients with this rare disease had a history of a blunt or penetrating abdominal trauma or multiple surgical operations owing to surgical complications. Heterotopic mesenteric and/or omental ossification may be asymptomatic or may present with symptoms of bowel obstruction or cause a severe complication, such as bowel perforation. Due to its rarity, intra-abdominal ossification may sometimes be overlooked or misdiagnosed. However, the surgeon should be aware of this unusual condition, particularly in patients with a previous surgical history. In this study, we present a case of heterotopic mesenteric and omental ossification incidentally found in a 41-year-old man with multiple abdominal surgical operations because of a gunshot injury.


Assuntos
Traumatismos Abdominais , Ossificação Heterotópica , Doenças Peritoneais , Ferimentos por Arma de Fogo , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Adulto , Humanos , Masculino , Mesentério/cirurgia , Omento/cirurgia , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/etiologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia
7.
J Laparoendosc Adv Surg Tech A ; 29(10): 1281-1284, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31397620

RESUMO

Background: Recently, several series have reported the use of laparoscopy in pediatric trauma, most commonly for bowel and pancreatic injury within the first 12 or 24 hours. During a multicenter trial at 10 Level 1 pediatric trauma centers, selective use of laparoscopy in children with blunt liver or spleen injury (BLSI) was noted. A secondary analysis was performed to describe the frequency and application of these procedures to pediatric BLSI. Patients and Methods: Prospective data were collected on all children age ≤18 years with BLSI presenting to 1 of 10 pediatric trauma centers. An unplanned secondary analysis of children who underwent laparoscopy was done. Results: Of 1008 children with BLSI, 59 initially underwent a laparotomy, but 11 underwent a laparoscopic procedure during their index admission; 1 of these was 22 hours postlaparotomy and 2 others were laparoscopy-assisted and converted to laparotomy. Median age of patients undergoing a laparoscopic procedure was 11.5 years (interquartile range [IQR]: 5.8-16.4). Laparoscopy was performed at 7 of the 10 centers. Median time to surgery was 42 hours (IQR: 8-96). Most patients had a liver (n = 6) injury; 4 had spleen and 1 had both. One of the laparoscopies was for pancreatic surgery, and 2 were for bowel injury (but converted to open). Conclusions: Laparoscopy was utilized in 16% of children requiring abdominal surgery after BLSI, with a median time of 42 hours postinjury. Uses included diagnostic laparoscopy, drain placement, laparoscopic pancreatectomy, and washout of hematoma.


Assuntos
Traumatismos Abdominais/cirurgia , Hemorragia/terapia , Laparoscopia/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Baço/lesões , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Hemorragia/etiologia , Humanos , Lactente , Recém-Nascido , Fígado/lesões , Fígado/cirurgia , Masculino , Estudos Retrospectivos , Baço/cirurgia , Centros de Traumatologia , Estados Unidos , Ferimentos não Penetrantes/complicações
8.
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
9.
J Surg Res ; 243: 496-502, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31377489

RESUMO

BACKGROUND: Surgical site infections (SSIs) have a substantial impact on economic and health indices for patients and health-care institutions. The aim of this study was to identify risk factors for superficial SSIs (sSSIs) in operative abdominal trauma patients using a national cohort. METHODS: A retrospective analysis of adult trauma patients treated within the Trauma Quality Improvement Database who underwent an exploratory laparotomy from 2010 to 2015 was performed. Risk factors for infection were evaluated using χ2, Wilcoxon rank-sum, and multivariate logistic regression. RESULTS: In total, 41,034 patients underwent an exploratory laparotomy for trauma. There were 18,538 (45.6%) penetrating injuries. Additionally, 10,938 (26.7%) patients suffered a hollow viscus injury with one (8484; 20.7%), two (2188; 5.3%), or three or more (266; 0.7%) hollow viscus organs injured, respectively. The sSSI rate was 4.3%. On multivariate analysis, colonic injuries conferred the greatest single organ independent risk for sSSIs (odds ratio [OR] 2.88 [2.41-3.44]), followed by duodenal injuries (OR 1.99 [1.24-3.17]), small bowel injuries (OR 1.54 [1.28-1.84]), gastric injuries (OR 1.41 [1.06-1.89]), body mass index >30 (1.32 [1.14-1.54]), severe Injury Severity Score (16-25) (OR 1.43 [1.19-1.74]), profound Injury Severity Score (>25) (OR 1.76 [1.44-2.15]), and increasing number of hollow viscus injuries with one (OR 2.75 [2.33-3.26]), two (OR 3.82 [2.98-4.89]), or three (OR 6.85 [4.20-11.17]) organs injured, respectively. CONCLUSIONS: The incidence of sSSI in operative abdominal trauma patients increases with increased body mass index, increased age, location of injury, blood transfusion need, and increasing number hollow viscus injuries. Consideration should be given to avoiding primary skin closure in patients with these risk factors as a way to mitigate SSIs in this patient population.


Assuntos
Traumatismos Abdominais/cirurgia , Laparotomia/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Estados Unidos/epidemiologia , Adulto Jovem
10.
S Afr J Surg ; 57(3): 30-37, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392862

RESUMO

BACKGROUND: Major pancreatic injuries are complex to treat, especially when combined with vascular and other critical organ injuries. This case-matched analysis assessed the influence of associated visceral vascular injuries on outcome in pancreatic injuries. METHOD: A registered prospective database of 461 consecutive patients with pancreatic injuries was used to identify 68 patients with a Pancreatic Injury combined with a major visceral Vascular Injury (PIVI group) and were matched one-to-one by an independent blinded reviewer using a validated individual matching method to 68 similar Pancreatic Injury patients without a vascular injury (PI group). The two groups were compared using univariate and multivariate logistic regression analysis and outcome including complication rates, length of hospital stay and 90-day mortality rate was measured. RESULTS: The two groups were well matched according to surgical intervention. Mortality in the PIVI group was 41% (n = 28) compared to 13% (n = 9) in the PI alone group (p = 0.000, OR 4.5, CI 1.00-10.5). On univariate analysis the PIVI group was significantly more likely to (i) be shocked on admission, (ii) have a RTS < 7.8, (iii) require damage control laparotomy, (iv) require a blood transfusion, both in frequency and volume, (v) develop a major postoperative complication and (vi) die. On multivariate analysis, the need for damage control laparotomy was a significant variable (p = 0.015, OR 7.95, CI 1.50-42.0) for mortality. Mortality of AAST grade 1 and 2 pancreatic injuries combined with a vascular injury was 18.5% (5/27) compared to an increased mortality of 56.1% (23/41) of AAST grade 3, 4 and 5 pancreatic injuries with vascular injuries (p = 0.0026). CONCLUSION: This study confirms that pancreatic injuries associated with major visceral vascular injuries have a significantly higher complication and mortality rate than pancreatic injuries without vascular injuries and that the addition of a vascular injury with an increasing AAST grade of pancreatic injury exponentially compounds the mortality rate.


Assuntos
Pâncreas/lesões , Pâncreas/cirurgia , Sistema Porta/lesões , Lesões do Sistema Vascular/complicações , Lesões do Sistema Vascular/mortalidade , Traumatismos Abdominais/complicações , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Idoso , Aorta/lesões , Transfusão de Sangue , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação , Masculino , Artéria Mesentérica Superior/lesões , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Artéria Renal/lesões , Veias Renais/lesões , Choque/etiologia , Artéria Esplênica/lesões , Taxa de Sobrevida , Índices de Gravidade do Trauma , Lesões do Sistema Vascular/cirurgia , Veia Cava Inferior/lesões , Adulto Jovem
11.
S Afr J Surg ; 57(3): 38-43, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392863

RESUMO

BACKGROUND: The influence of HIV-infection on surgical site infection (SSI) after surgery for penetrating abdominal trauma is not investigated and therefore not as yet elucidated. This prospective study was performed with the aim to compare the SSI rate in human immunodeficiency virus (HIV)-seropositive and HIV-negative patients and to identify other risk factors for this abdominal wound complication. METHOD: 98 patients who underwent small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma were included in the study. Injury related factors as well as demographical and physiological parameters, including HIV-status were analysed and superficial and deep SSI incidence rates were evaluated. RESULTS: Of the 98 patients, 23 patients (23%) were HIV-seropositive. The overall superficial SSI rate was 45% and the deep SSI rate was 15%. No significant difference in SSI (superficial or deep) in the HIV-seropositive and -negative group was demonstrated (superficial SSI HIV-pos vs HIV-neg: 61% vs 40%; p=0.172, deep SSI 22% vs 13%, p=0.276). Multivariate analysis identified five independent risk factors for SSI: postoperative CD4 count < 250 cells/µl, postoperative albumin < 30 g/L, relook operation, anastomotic leak and colonic anastomosis. CONCLUSION: HIV-infection is not an independent risk factor for developing SSI after penetrating abdominal trauma. Low postoperative CD4 count, irrespective of HIV status, low postoperative albumin, relook operation, anastomotic leak and colonic anastomosis are predictors for SSI irrespective of the HIV-serostatus. These factors should be considered in unison during the decision-making process of abdominal wound closure; planned secondary wound treatment or immediate application of negative pressure dressings in patients with a high-risk profile may decrease the hospital stay and the financial burden on the health care system.


Assuntos
Colo/cirurgia , Soronegatividade para HIV , Soropositividade para HIV/complicações , Infecção da Ferida Cirúrgica/etiologia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/cirurgia , Adulto , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Contagem de Linfócito CD4 , Colo/lesões , Feminino , Humanos , Intestino Delgado/lesões , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Cirurgia de Second-Look , Albumina Sérica/metabolismo , Adulto Jovem
12.
Khirurgiia (Mosk) ; (6): 65-72, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317943

RESUMO

AIM: To develop the algorithm of optimal combination of conventional and minimally invasive procedures for surgical diagnosis and treatment of thoracoabdominal wounds (TAW). MATERIAL AND METHODS: The most common borders of TAW were analyzed in 81 bodies of victims. Typical borders of costodiaphragmatic pleural sinus were assessed in 90 male cadavers. There were 81 victims with TAW who were divided into two groups. The first group included 40 patients who underwent newly developed methods of treatment. Group II consisted of 41 patients who were treated earlier. RESULTS: The algorithm of invasive diagnosis of diaphragm wounds and the method of sequential determination of indications for conventional or endoscopic procedures were developed and applied in the first group. Minimally invasive operations alone or in combination with open surgery were applied in 80% of patients in group I and in 53.66% of patients in group II. Thirty-eight (97.5%) and 35 (85.37%) patients convalesced in groups I and II, respectively. CONCLUSION: Thoracotomy was required in 34.29% of cases for TAW correction, laparotomy - in 71.43% of cases. Minimally invasive operations were sufficient in other cases.


Assuntos
Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Diafragma/lesões , Diafragma/cirurgia , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Traumatismos Abdominais/complicações , Algoritmos , Cadáver , Humanos , Laparoscopia , Laparotomia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Traumatismos Torácicos/complicações , Toracoscopia , Toracotomia
13.
J Trauma Acute Care Surg ; 87(1): 27-34, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31260424

RESUMO

BACKGROUND: Rates of damage control laparotomy (DCL) vary widely and consensus on appropriate indications does not exist. The purposes of this multicenter quality improvement (QI) project were to decrease the use of DCL and to identify indications where consensus exists. METHODS: In 2016, six US Level I trauma centers performed a yearlong, QI project utilizing a single QI tool: audit and feedback. Each emergent trauma laparotomy was prospectively reviewed. Damage control laparotomy cases were adjudicated based on the majority vote of faculty members as being appropriate or potentially, in retrospect, safe for definitive laparotomy. The rate of DCL for 2 years prior (2014 and 2015) was retrospectively collected and used as a control. To account for secular trends of DCL, interrupted time series was used to effectiveness of the QI interventions. RESULTS: Eight hundred seventy-two emergent laparotomies were performed: 73% definitive laparotomies, 24% DCLs, and 3% intraoperative deaths. Of the 209 DCLs, 162 (78%) were voted appropriate, and 47 (22%) were voted to have been potentially safe for definitive laparotomy. Rates of DCL ranged from 16% to 34%. Common indications for DCL for which consensus existed were packing (103/115 [90%] appropriate) and hemodynamic instability (33/40 [83%] appropriate). The only common indication for which primary closure at the initial laparotomy could have been safely performed was avoiding a planned second look (16/32 [50%] appropriate). CONCLUSION: A single faceted QI intervention failed to decrease the rate of DCL at six US Level I trauma centers. However, opportunities for improvement in safely decreasing the rate of DCL were present. Second look laparotomy appears to lack consensus as an indication for DCL and may represent a target to decrease the rate of DCL after injury. LEVEL OF EVIDENCE: Epidemiological study with one negative criterion, level III.


Assuntos
Traumatismos Abdominais/cirurgia , Laparotomia/métodos , Melhoria de Qualidade , Centros de Traumatologia/estatística & dados numéricos , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/terapia , Adulto , Feminino , Humanos , Laparotomia/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Cirurgia de Second-Look/métodos , Cirurgia de Second-Look/estatística & dados numéricos
14.
Chirurgia (Bucur) ; 114(3): 359-368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264574

RESUMO

Laparoscopy is accepted in penetrating abdominal trauma (PAT), but its role in blunt trauma (BAT) remains a controversial one. Our study assessed the utility of diagnostic laparoscopy (DL) and therapeutic laparoscopy (TL) in abdominal trauma between December 2006 and January 2016. We analysed the indication for laparoscopy, type of lesions, TL, conversion rate, complications and length of hospital stay. 49 patients had a DL: 42 males and 7 females, with a mean age of 36.1+-13.3. We had 20 PAT and 30BAT. The indications for laparoscopy were: diagnosis of penetration in PAT, suspicion of hollow organ injury or diaphragm injury, active bleeding in organ injuries in BAT. 11/48 of preoperative ultrasounds and 4/48 of CT's were false negative. In 3 of 20 PAT, DL was negative and in 4 nontherapeutic. There were 4 TL's and 7 conversions. The main injuries in BAT were: 9 hollow organ perforations, 6 mesenteric lacerations, 2 diaphragmatic and 2 splenic injuries. There were 10 TL's, 9 conversions and 14 TL. The operative time and length of hospital stay was higher in the conversion group. There were 6 complications and 3 mortalities. There were no missed injuries. An unnecessary laparotomy was avoided in 18/49 cases (36.73%). In selected cases of PAT and BAT with equivocal clinical and imaging diagnosis, laparoscopy is a useful tool with therapeutic role, that reduces unnecessary laparotomies, complication rate and hospital stay.


Assuntos
Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Laparoscopia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
BMJ Case Rep ; 12(6)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31164381

RESUMO

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been implemented in numerous countries. However, its use has not been widespread in (South) Africa, and when used, not well reported on. Further, REBOA has been performed with devices designed for other purposes. In this case report, we describe the use of a purpose designed device for image-free use in emergent haemorrhage control and resuscitation in a patient with multicavity penetrating trauma. Implications for the use of REBOA in these challenging cases is discussed, and a novel method of insertion of a REBOA catheter is presented.


Assuntos
Traumatismos Abdominais/cirurgia , Oclusão com Balão/instrumentação , Traumatismos Torácicos/cirurgia , Ferimentos Perfurantes/cirurgia , Traumatismos Abdominais/complicações , Aorta/lesões , Procedimentos Endovasculares , Desenho de Equipamento , Evolução Fatal , Humanos , Escala de Gravidade do Ferimento , Masculino , África do Sul , Traumatismos Torácicos/complicações , Tronco/lesões , Centros de Traumatologia , Adulto Jovem
16.
Transplant Proc ; 51(6): 1902-1906, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31155306

RESUMO

Managing traumatic liver injury (TLI) is always challenging and demands precise clinical judgment. Currently, treatment of TLI in most circumstances is non-operative; however, surgical therapy might be required for severe TLI, particularly those that result in extensive blood loss. In the current institutional study carried out from June 1995 to April 2017, we describe our experience with 5 patients who received an orthotopic liver transplant for severe TLI. One patient passed away postoperatively from cerebral edema; 1 patient died of renal failure 4 years after the liver transplantation, and 3 patients are still alive. Based on our experience, we conclude that in patients with TLI, especially those with uncontrollable bleeding or those who develop liver failure, liver transplantation should be taken into consideration.


Assuntos
Traumatismos Abdominais/cirurgia , Transplante de Fígado/mortalidade , Fígado/lesões , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/mortalidade , Adulto , Idoso , Evolução Fatal , Feminino , Humanos , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade
17.
J Laparoendosc Adv Surg Tech A ; 29(8): 1052-1059, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237470

RESUMO

Purpose: To characterize injury patterns and institutional trends associated with the utilization of laparoscopy in the management of pediatric abdominal trauma. Methods: The National Trauma Data Bank (2010-2014) was queried for encounters involving patients ≤14 years who underwent an open or laparoscopic abdominal operation within 48 hours of emergency department arrival. Patient, injury, and hospital characteristics associated with each approach were identified. Multivariate logistic regression was used to evaluate the influence of patient and hospital characteristics on operative approach. Results: Laparoscopy comprised 7.8% (n = 355) of all abdominal trauma operations. Patients undergoing laparoscopy had lower injury severity scores and higher Glasgow Coma Scale scores on arrival compared with laparotomy subjects (P < .001). Laparoscopic patients also had a shorter length of hospital stay (5.0 versus 8.6 days, P < .001), but longer time to the operating room (9.2 versus 6.3 hours, P < .001) compared with their open counterparts. The proportion of cases managed laparoscopically increased from 6.2% in 2010 to 10.1% in 2014 (P = .013), with increase in utilization primarily driven by university hospitals (P = .026) and level I pediatric trauma centers (P = .043). Conversion to laparotomy was uncommon (18.6%), and mortality in the laparoscopic cohort was low (0.4%). Conclusions: Use of laparoscopy has increased in the pediatric abdominal trauma population, typically in a less injured cohort of patients. As familiarity with and availability of minimally invasive techniques increase, this trend will likely continue.


Assuntos
Traumatismos Abdominais/cirurgia , Laparoscopia/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Ferimentos e Lesões/cirurgia , Traumatismos Abdominais/epidemiologia , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Ferimentos e Lesões/epidemiologia
18.
BMC Surg ; 19(1): 69, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242883

RESUMO

BACKGROUND: The abdomen is one of the most commonly injured regions in trauma patients. Abdominal injury surgeries are common in Tanzania and in many parts of the world. This study aimed to determine the relationships among the causes, characteristics, patterns and outcomes of abdominal injury patients undergoing operations at Kilimanjaro Christian Medical Centre. METHODS: A prospective observational study was performed over a period of 1 year from August 2016 to August 2017. A case was defined as a trauma patient with abdominal injuries admitted to the general surgery department and undergoing an operation. We assessed injury types, patterns, aetiologies and outcomes within 30 days. The outcomes were post-operative complications and mortality. Multivariate logistic regression was used to explore the association between factors associated with morbidity and mortality. RESULTS: Out of 136 patients, 115 (84.6%) were male, with a male-to-female ratio of 5.5:1. The most affected patients were in the age range of 21-40 years old, which accounted for 67 patients (49.3%), with a median age (IQR) of 31.5 (21.3-44.8) years. A majority (99 patients; 72.8%) had blunt abdominal injury, with a blunt-to-penetrating ratio of 2.7:1. The most common cause of injury was road traffic accidents (RTAs; 73 patients; 53.7%). Commonly injured organs in blunt and penetrating injuries were, respectively, the spleen (33 patients; 91.7%) and small bowel (12 patients; 46.1%). Most patients (89; 65.4%) had associated extra-abdominal injuries. Post-operative complications were observed in 57 patients (41.9%), and the mortality rate was 18 patients (13.2%). In the univariate analysis, the following were significantly associated with mortality: associated extra-abdominal injury (odds ratio (OR): 4.9; P-value< 0.039); head injury (OR: 4.4; P-value < 0.005); pelvic injury (OR: 3.9; P-value< 0.043); length of hospital stay (LOS) ≥ 7 days (OR: 4.2; P-value < 0.022); severe injury on the New Injury Severity Score (NISS) (OR: 21.7; P-value < 0.003); time > 6 h from injury to admission (OR: 4.4; P-value < 0.025); systolic BP < 90 (OR: 3.5; P-value < 0.015); and anaemia (OR: 4.7; P-value< 0.006). After adjustment, the following significantly predicted mortality: severe injury on the NISS (17 patients; 25.8%; adjusted odds ratio (aOR): 15.5, 95% CI: 1.5-160, P-value < 0.02) and time > 6 h from injury to admission (15 patients; 19.2%; aOR: 4.3, 95% CI: 1.0-18.9, P-value < 0.05). CONCLUSION: Blunt abdominal injury was common and mostly associated with RTAs. Associated extra-abdominal injury, injury to the head or pelvis, LOS ≥ 7 days, systolic BP < 90 and anaemia were associated with mortality. Severe injury on the NISS and time > 6 h from injury to admission significantly predicted mortality.


Assuntos
Traumatismos Abdominais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/mortalidade , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Tanzânia , Ferimentos não Penetrantes/mortalidade , Ferimentos Penetrantes/mortalidade , Adulto Jovem
19.
Ann R Coll Surg Engl ; 101(8): 552-557, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31219321

RESUMO

INTRODUCTION: The clinical significance of isolated free fluid on abdominal computed tomography (CT) in patients with blunt abdominal trauma is unclear. This audit reviews our unit's experience with isolated free fluid and attempts to refine our clinical algorithms for the assessment of patients with blunt abdominal trauma. MATERIALS AND METHODS: All patients who sustained blunt abdominal trauma between December 2012 and December 2017 who were subjected to multidetector CT of the abdomen as part of their initial investigation were included in this study. RESULTS: During the five-year period under review, a total of 1066 patients underwent abdominal CT following blunt poly trauma. A total of 84 (7.9%) patients died. There were 148 (14%) patients with CT finding of isolated free fluid. Of these, 128 (67%) were selected for non-operative management, which included a period of serial abdominal examinations. In this non-operative group, five patients failed their abdominal observations and underwent laparotomy. Findings in these five cases were negative (1), non-therapeutic (1), splenic injury (1), Pancreatic and splenic injury (1) and bladder injury (1). Thirteen patients (10%) died, none of whom had surgery. The causes of death were exsanguination from a major traumatic lower limb injury (1), multiple organ failure (1), traumatic brain injury (10) and spinal cord injury (1). The remaining 20 patients underwent laparotomy. The indications were failed non-operative management (5), abdominal distension (1) and suspicion of a missed hollow viscus injury (14). In this group there were 11 therapeutic and 6 non-therapeutic surgeries and three negative laparotomies. For the 15 patients selected for operative management, the findings were as follows: hollow viscus injury (3), mesenteric bleeds (2), splenic and pancreatic injury (1), liver and bladder injury (1), splenic and bladder injury (1), non-therapeutic (4), negative (3). The finding of isolated free fluid on CT is 98% sensitive and 96% specific for true isolated free fluid (chi square 331.598; P = 0.000). This finding predicts successful non-operative management with a positive predictive value of 93% and a negative predictive value of 96%. DISCUSSION: In patients with blunt abdominal trauma, the finding of isolated free fluid on abdominal CT alone is no longer an indication for laparotomy. Other clinical factors must be taken into account when deciding on the need for laparotomy, such as haemodynamic status, clinical abdominal findings and the ability to reliably assess the abdomen. In the absence of a clinical indication for urgent laparotomy, patients with isolated free fluid may be observed.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Líquidos Corporais/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Adulto , Algoritmos , Ascite/diagnóstico por imagem , Ascite/etiologia , Tomada de Decisão Clínica , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Masculino , Auditoria Médica/métodos , Tomografia Computadorizada Multidetectores/métodos , Valor Preditivo dos Testes , Radiografia Abdominal/métodos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgia , Adulto Jovem
20.
Radiol Clin North Am ; 57(4): 671-687, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076025

RESUMO

Damage control surgery is a staged surgical procedure in a patient who has suffered penetrating or blunt abdominal traumatic injury with severe metabolic derangements. Multidetector computed tomography scanning is a vital tool for patient management in the damage control patient, providing many uses, including assessing the extent of traumatic injury, evaluating areas that were not surgically explored, evaluating for injuries that were missed during the initial surgery, and assessing the stability of surgical repair. Understanding the postsurgical multidetector computed tomography appearance of these patients can aid the radiologist in protocol optimization and provide immediate accurate diagnoses.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Tomografia Computadorizada Multidetectores/métodos , Pelve/lesões , Pelve/cirurgia , Ferimentos não Penetrantes/cirurgia , Abdome/diagnóstico por imagem , Abdome/cirurgia , Humanos , Pelve/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem
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