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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
2.
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
3.
Ulus Travma Acil Cerrahi Derg ; 25(5): 489-496, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31475332

RESUMO

BACKGROUND: In most respects, the vast majority of pelvic injuries is not of a life-threatening status, but co-presence of other injuries needs to be diagnosed. This study aims to evaluate associated pelvic and extra-pelvic visceral organ injuries of the patients with closed pelvic fractures. METHODS: This retrospective study was conducted with 471 adult patients who had been admitted to our Emergency Service with the diagnosis of pelvic fractures. Type of fractures, accompanying visceral organ injuries, the demographic data, type of operation, mortality rates were recorded and analysed statistically. RESULTS: The rate of operations carried out by the general surgery clinic or other surgical clinics in each type of fracture according to AO classification did not differ (p=0.118). In patients with A2, A3 and B1 types of fractures, the operation rate of general surgery clinic did not show a significant difference. However, most of the patients who had extrapelvic surgery were in the mild severity pelvic trauma, such as AO A2 and A3. A total of 31 patients were ex-patients, 17 of whom had AO-A2 type of fractures. The findings showed that there was a significant difference between abdominal ultrasonography outcome that was normal and non-orthopedic surgery types (p<0.001). There was no significant difference between the types of surgery performed and Abdominal CT outcome, which was normal (p=0.215). CONCLUSION: In the management of patients with pelvic fractures irrespective of its type or grade, the findings suggests that greater attention should be paid to not to overlook the associated injuries. Early blood and imaging tests are encouraged after the patient's hemodynamic status is stabilized.


Assuntos
Traumatismos Abdominais , Fraturas Ósseas , Ossos Pélvicos/lesões , Traumatismos Abdominais/complicações , Traumatismos Abdominais/epidemiologia , Fraturas Ósseas/complicações , Fraturas Ósseas/epidemiologia , Humanos , Estudos Retrospectivos
4.
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
5.
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
6.
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
7.
J Surg Res ; 243: 440-446, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31279984

RESUMO

BACKGROUND: The association between psychiatric illness and outcomes in trauma patients in general has only recently been investigated. The aim of this study was to describe the unique characteristics, risk factors, and outcomes of patients with comorbid psychiatric illness and penetrating abdominal and pelvic injuries. MATERIALS AND METHODS: This was a retrospective review of trauma patients with open injuries to the abdomen and pelvis identified in the 2010-2015 the American College of Surgeons Trauma Quality Improvement Program database. Baseline variables extracted included demographics, comorbidities, including a discrete "psychiatric illness" variable that preexisted in the database, and injury information. Outcome variables collected included in-hospital mortality, length of stay and intensive care unit stay, and complications. Categorical variables were analyzed using chi-square and Fisher's exact test. Logistic regression was used to assess independent predictors for mortality with odds ratios (ORs) and 95% confidence intervals (CIs) constructed about group differences. RESULTS: There were 22,053 patients identified, 6.1% of whom were diagnosed with a psychiatric comorbidity. Patients with psychiatric illnesses were more likely to be aged ≥65 y (5.4% versus 3.2%, P < 0.0001), female (25.4% versus 12.4%, P < 0.0001), and have other comorbidities. Their injuries were more likely to be self-inflicted (34.9% versus 4.9%) and of a cut or piercing mechanism (33.7% versus 24.1%). Psychiatric comorbidity was an independent predictor of intensive care unit admission (OR 1.32, 95% CI 1.14-1.53) and was independently associated with decreased odds of mortality (OR 0.42, 95% CI 0.32-0.55) despite increased complication rates. CONCLUSIONS: The presence of a psychiatric comorbidity may be independently associated with trauma patients' complications and outcomes. Patients with psychiatric comorbidities have a unique set of risk factors and health needs that must be recognized and addressed by multidisciplinary care teams.


Assuntos
Traumatismos Abdominais/complicações , Transtornos Mentais/complicações , Pelve/lesões , Ferimentos Penetrantes/complicações , Traumatismos Abdominais/mortalidade , Idoso , Comorbidade , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Ferimentos Penetrantes/epidemiologia
9.
J Med Case Rep ; 13(1): 172, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31164170

RESUMO

BACKGROUND: Aspergillus terreus, a saprophytic fungus, is recognized as an emerging pathogen in various infections in humans. However, bone and joint involvement is uncommon. To the best of our knowledge, only seven cases of spondylodiscitis caused by Aspergillus terreus have been reported previously in humans. We report a case of a patient with Aspergillus terreus spondylodiscitis following an abdominal stab wound. CASE PRESENTATION: A 74-year-old Japanese man with no particular medical history fell from a ladder and sustained a left abdominal stab wound from an L-shaped metal peg. Computed tomography showed the trace of the L-shaped metal peg from the left abdomen to the left rib and left kidney. The scan also showed an anterolateral bone avulsion of the left side of the T12 vertebral body, as well as fractures of the L1 left transverse process and the left 10th-12th ribs. He was hospitalized and treated with conservative therapy for 6 weeks. He was readmitted to the hospital with complaints of sudden back pain, numbness of both legs, and inability to walk 13 weeks after the fall. Magnetic resonance imaging findings were typical of spondylodiscitis. Gadolinium-enhanced T1-weighted magnetic resonance imaging indicated increased signal intensity at T11-T12 vertebral bodies and severe cord compression and epidural abscess at T11-T12 associated with infiltration of soft paravertebral tissues. On the seventh day after admission, he underwent partial laminectomy at T11 and posterior fusion at T9 to L2. The result of his blood culture was negative, but Aspergillus terreus was isolated from the material of T11-T12 intervertebral disc and vertebral bodies. His Aspergillus antigen was positive in a blood examination. Histological examination showed chronic suppurative osteomyelitis. On the 35th day after admission, he underwent anterior fusion at T11 and T12 with a rib bone graft. For 5 months, voriconazole was administered, and he wore a rigid corset. Posterior partial laminectomy at T11 and anterior fusion at T11 and T12 resulted in a good clinical course. The patient's neurological dysfunction was completely recovered, and his back pain disappeared. Two years after the operation, computed tomography was performed and showed bone fusion at T11 and T12. Magnetic resonance imaging revealed no evidence of increased signal intensity at T11-T12 vertebral bodies and severe cord compression and epidural abscess at T11-T12. CONCLUSIONS: To our knowledge, this is the first report of spondylodiscitis caused by Aspergillus terreus after an abdominal penetrating injury. The histological finding of chronic suppurative osteomyelitis and the radiological findings strongly suggested direct inoculation of Aspergillus terreus.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Aspergilose/diagnóstico por imagem , Discite/diagnóstico por imagem , Abscesso Epidural/diagnóstico por imagem , Osteomielite/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Traumatismos Abdominais/complicações , Acidentes por Quedas , Idoso , Antifúngicos/uso terapêutico , Aspergilose/etiologia , Aspergilose/terapia , Discite/etiologia , Discite/terapia , Abscesso Epidural/etiologia , Abscesso Epidural/terapia , Fratura Avulsão/complicações , Fratura Avulsão/diagnóstico por imagem , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Masculino , Osteomielite/etiologia , Osteomielite/terapia , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Voriconazol/uso terapêutico , Ferimentos Perfurantes/complicações
10.
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
11.
Medicine (Baltimore) ; 98(23): e15889, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169697

RESUMO

RATIONALE: Intestinal perforations due to blunt abdominal handlebar trauma are difficult to diagnose. This report presents a retrospective analysis of 3 patients with intestinal perforations due to abdominal bicycle handlebar trauma who were diagnosed via upright abdominal radiography. PATIENTS CONCERNS: All the patients lost their balance while riding a bicycle for leisure and had fallen on the handlebar tip. The patients were initially misdiagnosed at different-level health centers despite various radiologic investigations performed. DIAGNOSIS: The patients' intestinal perforations were diagnosed via plain upright abdominal X-ray radiography (UAXR) in our institution. INTERVENTIONS AND OUTCOMES: The children underwent exploratory laparotomy due to intestinal perforations. All the perforations were repaired either with primary closure or bowel resection and anastomosis with successful outcomes. LESSONS: Pneumoperitoneum due to intestinal perforation can be diagnosed via UAXR with appropriate patient positioning and timing. This case series shows that to accurately diagnose intestinal perforations, upright plain X-ray should be routinely performed, carefully evaluated, and repeated in patients with enduring abdominal complaints.


Assuntos
Traumatismos Abdominais/complicações , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Pneumoperitônio/diagnóstico , Ferimentos não Penetrantes/complicações , Adolescente , Ciclismo , Criança , Humanos , Perfuração Intestinal/diagnóstico por imagem , Masculino , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Radiografia Abdominal , Estudos Retrospectivos
12.
Khirurgiia (Mosk) ; (5): 82-87, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169825

RESUMO

The last decades are characterized by advanced incidence of injuries with the share of abdominal injuries 1.5-18%. Blunt abdominal trauma is characterized by high incidence of complications and mortality due to severity of injury of internal organs and difficult diagnosis. The article presents 3 case reports of isolated and combined abdominal trauma followed by intestinal injury. Patients were treated at the department of emergency surgical gastroenterology of Sklifosovsky Research Institute for Emergency Care in for the period from August 2017 to February 2018.


Assuntos
Traumatismos Abdominais/complicações , Intestinos/lesões , Intestinos/cirurgia , Ferimentos não Penetrantes/complicações , Emergências , Humanos
13.
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
14.
Expert Rev Gastroenterol Hepatol ; 13(9): 867-876, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31204541

RESUMO

Introduction: Hemoperitoneum can be a life-threating condition in cirrhotic patients who have a limited compensatory reserve during hemorrhagic shock. We aim to review the literature on the different etiologies associated with non-traumatic hemoperitoneum (NTH), summarizing the most relevant conditions associated with spontaneous and iatrogenic peritoneal and retroperitoneal bleeding that may occur in cirrhotic patients and to illustrate the most relevant diagnostic strategies and optimal management. Area covered: This review encompasses the current literature in hemoperitoneum in cirrhotic patients in the absence of abdominal trauma. Established diagnostic procedures, therapeutic interventions and potential novel targets are reported and discussed. Expert opinion: To ensure the optimal management regardless of the underlying etiology of NTH, the first goal for the clinician is to obtain immediate hemodynamic stabilization with supportive measures and to control the source of bleeding. The latter can be achieved with angiographic embolization, which is usually the first choice, or with open surgery. Other therapeutic options according to specific etiologies include transjugular intrahepatic portosystemic shunt (TIPS), balloon-occluded retrograde transvenous obliteration (BRTO), balloon-occluded anterograde transvenous obliteration (BATO) or intra operative radio frequency (RF).


Assuntos
Hemoperitônio/etiologia , Cirrose Hepática/complicações , Traumatismos Abdominais/complicações , Humanos
15.
Pan Afr Med J ; 32: 77, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223368

RESUMO

Pancreatic pseudocyst is a rare benign condition, in particular among children. It is an intra or extra pancreatic juice collection lacking of an epithelial lining. We conducted a retrospective study of 7 children whose medical record data were collected in the Department of Paediatric Surgery at the University Hospital Hassan II in Fez, over a period of 11 years, from 1 January 2005 to 31 December 2016. All children were male, their average age was 6.6 years (15 months - 12 years). An history of abdominal trauma was found in 4 cases, abdominal bloating, pain, vomiting and transit disorders were the primary reason for consultation. Clinical examination showed epigastric tenderness and an alteration of the general state in all cases. Abdominal ultrasound as well as abdominal CT scan helped to diagnose pancreatic pseudocyst before surgery. Six patients, out of a total of seven, underwent surgery; we opted for internal bypass (gastro-cystic anastomosis) in 4 cases, external bypass in 2 cases and therapeutic abstention in one case. Pancreatic pseudocysts are rare. Nevertheless, they are the most frequent (80% of pancreatic cystic lesions are pseudocysts and due to acute and/or chronic pancreatitis, pancreatic trauma or pancreatic ductal obstruction).


Assuntos
Traumatismos Abdominais/epidemiologia , Dor Abdominal/etiologia , Pseudocisto Pancreático/diagnóstico por imagem , Traumatismos Abdominais/complicações , Dor Abdominal/epidemiologia , Criança , Pré-Escolar , Hospitais Universitários , Humanos , Lactente , Masculino , Pseudocisto Pancreático/fisiopatologia , Pseudocisto Pancreático/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Vômito/epidemiologia , Vômito/etiologia
16.
Diagn Interv Radiol ; 25(4): 310-319, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31199287

RESUMO

PURPOSE: Active bleeding due to abdominal trauma is an important cause of mortality in childhood. The aim of this study is to demonstrate the advantages of early percutaneous transcatheter arterial embolization (PTAE) procedures in children with intra-abdominal hemorrhage due to blunt trauma. METHODS: Children with blunt abdominal trauma were retrospectively included. Two groups were identified for inclusion: patients with early embolization (EE group, n=10) and patients with late embolization (LE group, n=11). Both groups were investigated retrospectively and statistically analyzed with regard to lengths of stay in the intensive care unit and in the hospital, first enteral feeding after trauma, blood transfusion requirements, and cost. RESULTS: The duration of stay in the intensive care unit was greater in the LE group than in the EE group (4 days vs. 2 days, respectively). The duration of hospital stay was greater in the LE group than in the EE group (14 days vs. 6 days, respectively). Blood transfusion requirements (15 cc/kg of RBC packs) were greater in the LE group than in the EE group (3 vs. 1, respectively). The total hospital cost was higher in the LE group than in the EE group (4502 USD vs. 1371.5 USD, respectively). The time before starting enteral feeding after first admission was higher in the LE group than in the EE group (4 days vs. 1 day, respectively). CONCLUSION: Early embolization with PTAE results in shorter intensive care and hospitalization stays, earlier enteral feeding, and lower hospital costs for pediatric patients with intra-abdominal hemorrhage due to blunt trauma.


Assuntos
Traumatismos Abdominais/complicações , Embolização Terapêutica/métodos , Prevenção Secundária/normas , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/economia , Adolescente , Transfusão de Sangue/estatística & dados numéricos , Transfusão de Sangue/tendências , Criança , Pré-Escolar , Nutrição Enteral/estatística & dados numéricos , Nutrição Enteral/tendências , Feminino , Hemorragia/etiologia , Hemorragia/mortalidade , Humanos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Estudos Retrospectivos , Prevenção Secundária/estatística & dados numéricos , Tomografia Computadorizada por Raios X
17.
BMC Gastroenterol ; 19(1): 54, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991953

RESUMO

BACKGROUND: Conventionally, disconnected pancreatic duct syndrome is treated surgically. Endoscopic management is associated with lesser morbidity and mortality than that observed with surgery and shows similar success rates. However, limited data are available in this context. We evaluated the efficacy of endotherapeutic management for this syndrome. METHODS: We prospectively obtained data of patients with disconnected pancreatic duct syndrome between September 2008 and January 2016. Demographic and clinical data were assessed, and factors affecting clinical outcomes were statistically analyzed. RESULTS: Thirty-one patients underwent 40 endoscopic transpapillary procedures, and 1 patient developed an infection after prosthesis insertion. Etiological contributors to disconnected pancreatic duct syndrome were abdominal trauma (52%) and acute necrotizing pancreatitis (48%). The median interval between the appearance of pancreatic leaks and disconnected pancreatic duct syndrome was 6.6 months (range 0.5-84 months). The median follow-up after the last treatment procedure was 38 months (range 17-99 months). Patients with complete main pancreatic duct disruption in the body/tail showed a low risk of pancreatic atrophy (P = 0.009). This study highlighted the significant correlation between endoscopic transpapillary drainage and clinical success (P = 0.014). CONCLUSIONS: Disconnected pancreatic duct syndrome is not an uncommon sequel of pancreatic injury, and much of the delayed diagnosis is attributable to a lack of knowledge regarding this disease. Endoscopic transpapillary intervention with ductal stenting is an effective and safe treatment for this condition.


Assuntos
Traumatismos Abdominais/complicações , Drenagem/métodos , Endoscopia , Pancreatopatias/etiologia , Pancreatopatias/cirurgia , Pancreatite Necrosante Aguda/complicações , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Drenagem/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/diagnóstico por imagem , Ductos Pancreáticos/diagnóstico por imagem , Fístula Pancreática/diagnóstico por imagem , Fístula Pancreática/etiologia , Fístula Pancreática/cirurgia , Estudos Retrospectivos , Stents , Síndrome , Resultado do Tratamento , Adulto Jovem
18.
Eur J Orthop Surg Traumatol ; 29(6): 1337-1345, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30993522

RESUMO

Methods of controlling hemorrhage in penetrating abdominal injuries are varied, ranging from electrocautery, ligation, laparotomy sponge packing, angiography, hemostatic agents, and direct manual pressure. Unfortunately, traditional methods are sometimes unsuccessful due to the location or nature of the hemorrhage, and manual pressure cannot be held indefinitely. We describe a novel damage control technique for hemorrhage control in these situations, followed by three cases where an external fixator vascular compressor (EFVC) was used to hold continual pressure. Three patients are presented to a Level 1 trauma center following multiple ballistic injuries, all requiring emergent exploratory laparotomy. The first had a two-pin iliac crest EFVC placed during repeat exploratory laparotomy to control bleeding. The second patient had a supra-acetabular EFVC placed during initial exploratory laparotomy after emergent embolization failed to control bleeding from the L3 vertebral body. The third patient had a two-pin iliac crest EFVC placed at initial exploratory laparotomy due to uncontrollable bleeding from the sacral venous plexus and internal iliac veins. Of the three patients, two stabilized and survived, while one passed away due to multi-organ failure. We describe a novel damage control technique that may be a useful means of temporarily stemming intraabdominal bleeding that is otherwise recalcitrant to traditional hemostatic methods. Additionally, we provided a limited case series of patients who have undergone this technique to illustrate its utility and versatility. This technique is simple, fast, effective, and adaptable to a variety of circumstances that may be encountered in patients with intraabdominal bleeding recalcitrant to conventional hemorrhage control.


Assuntos
Traumatismos Abdominais , Fixadores Externos , Hemorragia , Hemostasia Cirúrgica , Ferimentos Penetrantes/complicações , Traumatismos Abdominais/complicações , Traumatismos Abdominais/cirurgia , Adolescente , Adulto , Desenho de Equipamento , Hemorragia/etiologia , Hemorragia/terapia , Hemostasia Cirúrgica/instrumentação , Hemostasia Cirúrgica/métodos , Humanos , Escala de Gravidade do Ferimento , Laparotomia/métodos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/cirurgia , Resultado do Tratamento
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