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2.
Wilderness Environ Med ; 30(4): 454-460, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31672510

RESUMO

Pig bite injuries are an infrequently described consequence of human-animal conflict. The domestic pig is thought to be a placid animal not given to unprovoked aggression. We report 2 separate cases of children managed at our institution who sustained abdominal injuries after attack by domestic pigs in rural Zimbabwe. Both incidents occurred at home in remote rural areas with long prehospital transport times. Initial resuscitative interventions were performed in both cases in the prehospital setting and at poorly resourced peripheral hospitals before referral. Prophylactic antibiotics were also given in both cases. Laparotomy was performed for both patients. Reduction of eviscerated bowel, exploratory laparotomy, and peritoneal lavage were performed with closure of the abdominal wounds. No surgical site infections were encountered, and patients were subsequently discharged after an uneventful convalescence. Prehospital care is the crucial phase of management of these injuries, which frequently take place in remote, rural settings and usually have a long time to definitive intervention. Expeditious laparotomy and exploration are indicated, as well as meticulous attention to techniques to avert infectious complications. Despite the generally placid temperament of the domestic pig, their bite can result in grave injuries, including abdominal evisceration necessitating prompt referral and emergency laparotomy.


Assuntos
Traumatismos Abdominais/etiologia , Traumatismos Abdominais/patologia , Mordeduras e Picadas/patologia , Suínos , Traumatismos Abdominais/cirurgia , Adolescente , Agressão , Animais , Criança , Humanos , Masculino
3.
Am J Case Rep ; 20: 1492-1496, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597909

RESUMO

BACKGROUND First described in 1863 by French surgeon Victor-Auguste-François Morel-Lavallee, the Morel-Lavallee lesion (MLL) is a closed traumatic soft-tissue degloving injury. These lesions most commonly occur following motor vehicle collisions (MVCs). The pathophysiology stems from a shearing force that causes separation of the soft tissue from the fascia underneath, which disrupts the vasculature and lymphatic vessels that perforate between the tissue layers. Timely diagnosis and treatment are imperative, as a delayed diagnosis can lead to complications. However, at present there is no universally accepted treatment algorithm. CASE REPORT A 60-year-old morbidly obese woman presented after being involved in an MVC. She complained of abdominal tenderness in the right lower quadrant, with no evidence of peritonitis. Cross-sectional imaging revealed hemoperitoneum and a traumatic posterior abdominal wall/lumbar hernia on the right, with multiple contusions in the subcutaneous abdomen. The patient was taken to the operating room and underwent an exploratory laparotomy that revealed a large abdominal Morel-Lavallee lesion (MLL) along with a traumatic abdominal wall hernia (TAWH). There was also a mesenteric avulsion injury with an associated ileocecal injury. The patient underwent resection of the involved bowel, with primary anastomosis, debridement of the abdominal wall degloving injury, and expectant management for the hernia defect. She recovered from the injuries and was doing well when followed up in the clinic, with follow-up to repair the hernia in the near future. CONCLUSIONS More research is needed to provide surgeons with evidence-based standardized therapies for dealing with these rare pathologies to ensure optimal patient outcomes.


Assuntos
Traumatismos Abdominais/etiologia , Acidentes de Trânsito , Desenluvamentos Cutâneos/etiologia , Hérnia Ventral/etiologia , Traumatismos Abdominais/diagnóstico por imagem , Desenluvamentos Cutâneos/diagnóstico por imagem , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hérnia Ventral/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Tomografia Computadorizada por Raios X
4.
Clin Sports Med ; 38(4): 513-535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472763

RESUMO

The athletic training room is filled with a multitude of conditions encompassing many different specialties of medicine. When it comes to traumatic injuries in the training room, many of them are not musculoskeletal in nature. Ultrasound in the training room can help identify serious and subtle solid-organ injury and small pneumothoraces. The discussion of these conditions follows a simple outline that helps identify injury/conditions through a proper history and physical. Evidence-based treatment/management/return to play guidelines are discussed.


Assuntos
Traumatismos Abdominais/diagnóstico , Traumatismos em Atletas/diagnóstico , Traumatismos Faciais/diagnóstico , Traumatismos Torácicos/diagnóstico , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/terapia , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/terapia , Traumatismos Faciais/etiologia , Traumatismos Faciais/terapia , Humanos , Boca/lesões , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/etiologia , Lesões do Pescoço/terapia , Nariz/lesões , Exame Físico , Volta ao Esporte , Traumatismos Torácicos/etiologia , Traumatismos Torácicos/terapia
5.
Cir Cir ; 87(S1): 53-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501625

RESUMO

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


Assuntos
Traumatismos Abdominais/cirurgia , Duodeno/lesões , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Acidentes de Trânsito , Adulto , Colectomia , Duodeno/irrigação sanguínea , Duodeno/cirurgia , Gastrostomia , Hematoma/classificação , Hemoperitônio/etiologia , Humanos , Íleo/irrigação sanguínea , Isquemia/etiologia , Isquemia/cirurgia , Jejunostomia , Lacerações/classificação , Fígado/lesões , Masculino , Mesentério/lesões , Nutrição Parenteral , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Ferimentos não Penetrantes/etiologia
6.
Khirurgiia (Mosk) ; (8): 63-68, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464277

RESUMO

Thoracic and abdominal injuries caused air weapons are rarer compared with gunshot wounds. Nevertheless, pneumatic weapons are able to inflict potentially fatal lesions despite small mass and dimension of projectile. Three clinical cases of patients with various internal injuries are presented in the article. Differentiated diagnostic and surgical approach is suggested.


Assuntos
Traumatismos Abdominais/etiologia , Armas de Fogo , Traumatismos Torácicos/etiologia , Ferimentos por Arma de Fogo/etiologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/terapia , Armas de Fogo/classificação , Humanos , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/terapia , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/terapia
7.
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
8.
J Surg Res ; 241: 317-322, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31055157

RESUMO

BACKGROUND: Children are more likely to have urinary system injury after blunt abdominal trauma (BAT) because of anatomical vulnerabilities. Urinalysis (UA) is often performed during initial evaluation to screen for injury. The purpose of this study was to determine how often finding microscopic hematuria after BAT leads to further testing and whether this indicates a significant injury. METHODS: A retrospective review of children evaluated for BAT at Children's Health from 2013 to 2017 was performed. Patients included had microscopic hematuria on initial UA. Data collected included demographics, injury data, laboratory and imaging data, and outcomes. Analysis was performed using descriptive statistics, Fisher's exact, and independent t-test. RESULTS: Of 1059 patients treated for BAT during the study period, 203 (19%) exhibited microscopic hematuria on UA during the initial workup. Most UAs resulted after imaging was completed and did not impact management (158, 78%); twenty-two (14%) of these patients had urinary injury, which were diagnosed by imaging regardless of UA results. Forty-five (22%) patients were found to have microscopic hematuria that independently led to workup for urinary injury. Of these, nine patients had a urinary system injury: 6 low-grade renal and three bladder wall injuries, none of which required surgery. Those with and without urinary injury in this group underwent similar numbers of radiographic studies. CONCLUSIONS: Microscopic hematuria on screening UA after BAT may lead to extensive workup, regardless of the presence of symptoms. In patients who receive cross-sectional abdominal imaging, preceding UA adds little to the clinical workup of children with BAT.


Assuntos
Traumatismos Abdominais/diagnóstico , Hematúria/diagnóstico , Sistema Urinário/lesões , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/urina , Adolescente , Criança , Pré-Escolar , Feminino , Hematúria/etiologia , Hematúria/urina , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Sistema Urinário/diagnóstico por imagem , Ferimentos não Penetrantes/urina
9.
Spine (Phila Pa 1976) ; 44(20): E1227-E1230, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31095120

RESUMO

STUDY DESIGN: Case series and review of literature. OBJECTIVE: To report three cases of vascular injury during posterior lumbar disc surgery, two of these occurred during open discectomy, and one during an endoscopic surgery. Aim is to highlight importance of early diagnosis and prompt steps taken to prevent morbidity and mortality. SUMMARY OF BACKGROUND DATA: Vascular injury during lumbar discectomy is rare injury. Also no case has been reported so far occurring during an endoscopic discectomy. METHODS: Three patients were treated for lumbar intervertebral disc prolapse, two had undergone open posterior discectomy while the third patient underwent endoscopic discectomy and all of them were diagnosed to have suffered an abdominal vascular injury. RESULTS: In two cases pseudo-aneurysm was found while third case was diagnosed as an arterio-venous fistula. All the three cases were managed with endovascular stenting and followed for a minimum period of 2 years. No further complications were detected. CONCLUSION: Vascular injury during a disc surgery is difficult to diagnose due to the rarity of occurrence and subtle signs which need to be recognized to start early management. LEVEL OF EVIDENCE: 5.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Discotomia/efeitos adversos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Complicações Intraoperatórias/diagnóstico por imagem , Vértebras Lombares/cirurgia , Traumatismos Abdominais/etiologia , Adulto , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
10.
J Surg Res ; 242: 151-156, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31078899

RESUMO

BACKGROUND: The aim of our study was to determine if the combination of physical examination (PE), serum transaminases along with Focused Assessment with Sonography in Trauma (FAST) would effectively rule out major hepatic injuries (HIs) after blunt abdominal trauma (BAT) in hemodynamically stable pediatric patients. METHODS: We conducted a 9-year retrospective study of pediatric patients (<18 y) with BAT. We collected data on liver enzymes (aspartate transaminase [AST] and alanine transaminase [ALT]), FAST, and PE findings. Definitive diagnosis and staging of HI were based on abdominal CT scanning. The sensitivity and specificity of ALT/AST, FAST, and PE were then calculated individually and in combination. RESULTS: We identified a total of 423 pediatric patients with BAT. Mean age was 11 y, median abdominal Abbreviated Injury Scale was 3 [2-4], and mean ED-SBP was 132 mm Hg. One hundred ninety-eight patients had HI of which 107 were major HI, defined by the American Association for the Surgery of Trauma as ≥grade III. Using ROC curve analysis, optimum ALT and AST thresholds were determined to be 90 U/L and 120 U/L, respectively. The sensitivity of FAST was 50% while that of PE was 40%. Combining PE with AST/ALT and FAST had an overall sensitivity of 97%, a specificity of 95%, a positive predictive value of 87%, and a negative predictive value of 98%. CONCLUSIONS: In hemodynamically stable pediatric blunt abdominal trauma patients, CT scanning can be avoided using a combination of readily available tests thus avoiding unnecessary radiation exposure. However, pediatric patients with positive PE, FAST, and elevated AST/ALT may eventually require CT scan to further evaluate liver injuries.


Assuntos
Traumatismos Abdominais/diagnóstico , Fígado/lesões , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/sangue , Traumatismos Abdominais/etiologia , Adolescente , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Fígado/diagnóstico por imagem , Fígado/metabolismo , Testes de Função Hepática , Masculino , Exame Físico , Curva ROC , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/efeitos adversos , Centros de Traumatologia , Índices de Gravidade do Trauma , Ultrassonografia , Ferimentos não Penetrantes/diagnóstico
11.
Pol Przegl Chir ; 91(1): 14-21, 2019 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-30919815

RESUMO

Introduction Bile duct injuries (BDIs) still occur during laparoscopic cholecystectomy. Although management of such complications is challenging, collaboration of a multidisciplinary team and development of treatment methods and materials often lead to the successful treatment. Materials and methods Medical records of 67 patients who have experienced bile duct injures after laparoscopic cholecystectomy were retrospectively reviewed. All injures were classified according to the European Association for Endoscopic Surgery ATOM classification and investigated by manifestation of the injury, surgical repair technique, early and late complications. Results In 28 (41.8 %) patients with partial divisions, the surgical treatment of BDI was completed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting while in 14 (20.1%) cases, the defect of bile duct was closed by suture. End-to-end ductal anastomosis was performed for 6 (13.4%) patients with complete division while 19 (28.3%) patients underwent hepaticojejunostomy. We followed up 58 (92.1%) of 63 patients. The mean follow-up duration was 25.7 (3 - 123) months. Twenty-three (39.7%) patients were found with strictures. Discussion Intraoperative detection and management of BDIs is crucial to achieve good results. The routine intraoperative cholangiography and possibilities of repair by initial surgeons in peripheral hospitals remain controversial. Stenting with a covered self-expanding metal stent is promising for the patients with partial divisions of bile ducts. Initial hepaticojejunostomy is often a preferred treatment for transected bile ducts because of lower rate of anastomosis strictures. However, as end-to-end anastomosis is more physiological, and endoscopy allows successful management of the strictures, we suggest choosing this treatment when possible Recommendation for paperwork content: Classifying bile duct injuries according to the new ATOM classification may be useful in the decision of the most appropriate treatment in each case.


Assuntos
Traumatismos Abdominais/etiologia , Traumatismos Abdominais/cirurgia , Ductos Biliares/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Doenças da Vesícula Biliar/cirurgia , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
West Afr J Med ; 36(1): 75-79, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30924120

RESUMO

BACKGROUND: This paper is a case report of a 54 year old woman that presented in our casualty with just "seat belt sign" following a road traffic injury. At laparotomy, she was found to have sustained disastrous internal/visceral injuries with torrential intraperitoneal haemorrhage from the surface of the liver caused by the seat belt. Frantic attempts at haemostasis were proving difficult and time wasting. The lacerated liver surface was then generously packed with absorbent abdominal mops which were left in-situ for 48hrs. A second-look operation 48 hrs later revealed satisfactory haemostasis of the bleeding surface of the left lobe of the liver OBJECTIVE: This paper is to highlight the wisdom in using "Damage Control" techniques to save a patient's life in an unsuspecting torrential bleed during laparotomy - especially in seatbelt injuries. DESCRIPTION: "Damage Control" implies doing the minimum, in the quickest time possible, to keep patient alive and coming back when patient is stable to deal with the pathology. RESULT: After 48hrs, a re-laparotomy was performed on the patient and it was found that complete haemostasis had been achieved. The packs were removed and abdomen closed in a single layer. The patient remained well till discharge after two weeks of hospitalisation and has remained well on follow up. CONCLUSION: Seatbelts, although protective, can lead to complex injury patterns. Early detection and prompt management of the injuries is key to survival.


Assuntos
Traumatismos Abdominais/etiologia , Acidentes de Trânsito , Fígado/lesões , Fígado/cirurgia , Cintos de Segurança/efeitos adversos , Feminino , Hospitais de Ensino , Humanos , Laparotomia , Pessoa de Meia-Idade , Síndrome , Resultado do Tratamento
13.
Int Emerg Nurs ; 44: 1-7, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30902618

RESUMO

This report describes an extremely rare case of combined penetrating trauma that includes the head, neck, chest, abdomen and scrotum. A 46-year-old male construction worker fell from a 5-metre-high platform, and a rebar that was fixed vertically on the ground penetrated the scrotum into the pelvic and abdominal cavities, passing through the chest, neck, mouth, and nose to the outside of the body through the left side of the head. The rebar penetrated the oral cavity and was palpable on the anterior side of the neck and abdomen. The head, neck, chest and abdominal CT scan and reconstruction showed brain contusion, fractures of the skull and skull base, subarachnoid haemorrhage, palate injury, tongue injury, injury to the right lobe of the thyroid, pleural effusion, pulmonary contusion, cardiac contusion, injury to the left lobe of the lung, neck and mediastinal emphysema, and pneumothorax. Emergency green channels provide a rescue process for urgent and severe cases and smooth and timely diagnostic and treatment process to save patients' lives. The medical staff worked together as a team for the initial evaluation and rescue. Emergency nurses played an important role in communicating, cooperating, managing insulation and pain, and providing psychological counselling, which greatly enhanced the efficiency and quality of the nursing. After the patient underwent surgery, anti-infection treatment, sedatives, analgesics, nutritional therapy, psychological support, and other intensive treatment measures, he recovered well two months after the injury. Follow-up at 5 and 11 months after discharge showed good recovery.


Assuntos
Acidentes por Quedas , Ferimentos e Lesões/complicações , Ferimentos Penetrantes/complicações , Traumatismos Abdominais/etiologia , Antibacterianos/uso terapêutico , China , Traumatismos Craniocerebrais/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/etiologia , Escroto/lesões , Traumatismos Torácicos/etiologia , Tomografia Computadorizada por Raios X/métodos , Ferimentos e Lesões/tratamento farmacológico , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/tratamento farmacológico
14.
Cir Cir ; 87(2): 183-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768058

RESUMO

Introduction: Trauma is a leading cause of morbimortality in the world. Intraabdominal compartment is the third most affected anatomical region and bleeding from this origin is difficult to identify, therefore the importance to predict possible lesions to the abdominal cavity. Objective: To describe and analyze the sociodemographic profile and injuries found in patients with abdominal trauma in a western hospital in Mexico. Method: Consecutive patients included in the local registry GDL-SHOT were analyzed. Results: From 4961 patients, 91.4% were men, with a mean age of 28.7 years. Regarding the mechanism of trauma, 39.7% were stab wounds, 33% blunt abdominal trauma and 27.3% gunshots. The most affected organs were: small bowel (20.9%), liver (18.2%), and colon (14.2%). The mean hospital stay was 6.95 days with a mortality of 6.74%. Conclusion: In Mexico, abdominal trauma represents an important cause of morbidity and mortality, especially in young patients. We found an important amount of penetrating trauma.


Assuntos
Traumatismos Abdominais/epidemiologia , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos Perfurantes/epidemiologia , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/mortalidade , Adulto , Colo/lesões , Feminino , Mortalidade Hospitalar , Humanos , Intestino Delgado/lesões , Tempo de Internação/estatística & dados numéricos , Fígado/lesões , Masculino , México/epidemiologia , Distribuição por Sexo , Fatores Socioeconômicos , Baço/lesões , Ferimentos por Arma de Fogo/etiologia , Ferimentos por Arma de Fogo/mortalidade , Ferimentos não Penetrantes/etiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos Perfurantes/etiologia , Ferimentos Perfurantes/mortalidade
15.
Ann Vasc Surg ; 58: 378.e11-378.e15, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30802581

RESUMO

Portopulmonary hypertension (PoPH) is a well-recognized complication of portal hypertension. This study reports a case of PoPH that was secondarily caused by post-traumatic mesenteric arteriovenous fistula. A 38-year-old man with a history of knife stabbing wounds in the abdomen in 2003 was admitted to the hospital with exertional shortness of breath and a mechanic murmur over the umbilical region. Computed tomography indicated signs of PoPH and mesenteric arteriovenous fistula. Percutaneous catheter-directed embolization was first performed but failed. Subsequently, the patient was successfully treated with fistula resection and partial enterectomy. The patient had been postoperatively followed regularly, and chief symptoms had been alleviated significantly and pulmonary pressure had successfully decreased to normal range. We believe that this is the first case of PoPH caused by mesenteric arteriovenous fistula.


Assuntos
Traumatismos Abdominais/etiologia , Fístula Arteriovenosa/etiologia , Hipertensão Portal/etiologia , Hipertensão Pulmonar/etiologia , Artérias Mesentéricas/lesões , Veias Mesentéricas/lesões , Traumatismo Múltiplo/etiologia , Ferimentos Perfurantes/etiologia , Traumatismos Abdominais/diagnóstico , Adulto , Angiografia Digital , Pressão Arterial , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/fisiopatologia , Hipertensão Portal/cirurgia , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/cirurgia , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Artérias Mesentéricas/fisiopatologia , Artérias Mesentéricas/cirurgia , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/fisiopatologia , Veias Mesentéricas/cirurgia , Traumatismo Múltiplo/diagnóstico , Flebografia/métodos , Pressão na Veia Porta , Artéria Pulmonar/fisiopatologia , Ferimentos Perfurantes/diagnóstico
16.
J Obstet Gynaecol ; 39(3): 384-388, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30634877

RESUMO

The objective of this study was to investigate the incidence of gastrointestinal injuries during gynaecologic operations, the management of such injuries and associated risk factors. This case-control study (1:4) examined patients who received gynaecologic operations from 2007 to 2016 in Ramathibodi Hospital. The study cases comprised patients who had gastrointestinal injuries, while the control cases comprised patients who had gynaecologic surgeries in the same period with matching the types of procedures. The 10-year incidence was 0.38% (104 cases of gastrointestinal injuries among a total of 27,520 cases). The most common injury site was the small bowel (43.3%). There were 102 cases (98%) of gastrointestinal injuries which were diagnosed intraoperatively and which were immediately repaired with successful outcomes. Logistic regression indicated that a pelvic adhesion, previous pelvic surgery and previous abdominal surgery were predictive risk factors associated with the injuries (odds ratios: 9.45, 3.20 and 11.84, respectively). An immediate consultation with a surgeon and surgical repair of the injury resulted in excellent outcomes. Impact statement What is already known about this subject? Gastrointestinal injury is a rare, but fatal complication of gynaecologic operations. The previous small study identified some risk factors such as surgical approach and pelvic surgery associated with the injury. What do the results of this study contribute? Our study identified the associated risk factors for gastrointestinal injury, including previous abdominal injury, pelvic adhesion and previous pelvic surgery. A previous abdominal surgery was the most associated risk factor. Patients with the history of abdominal surgery had an almost 4-fold higher odds ratio than the ones with previous pelvic surgery. Other factors, including endometriosis, ovarian cancer and subsequent oncological procedures, and surgical staging were less related to the gastrointestinal injury. What are the implications of these findings for clinical practice and/or further research? The knowledge is useful for pre-operative evaluation and preparation. Bowel preparation and consultation with surgeon are necessary for patients with these risk factors prior to their surgeries. Moreover, an immediate intra-operative surgical correction of the injury results in excellent outcomes.


Assuntos
Traumatismos Abdominais/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Laparoscopia/efeitos adversos , Traumatismos Abdominais/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Doença Iatrogênica/epidemiologia , Incidência , Intestino Grosso/lesões , Intestino Delgado/lesões , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estômago/lesões , Tailândia/epidemiologia
17.
World J Surg ; 43(5): 1216-1225, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30610269

RESUMO

BACKGROUND: There have been recommendations for increased non-operative management (NOM) of abdominal trauma in adults. To assess the impact of this trend and changes in the epidemiology of trauma, we examined the management of serious abdominal injuries and mortality, in Victorian major trauma patients 16 years or older, between 2007 and 2016. METHODS: Using data from the population-based Victorian Trauma Registry, characteristics of patients who underwent laparotomy, embolisation, laparotomy and embolisation, or NOM, were compared with the Chi-square test. Poisson regression was used to determine whether the incidence of serious abdominal injury changed over time. Temporal trends in the management of abdominal injury and in-hospital mortality were analysed using, respectively, the Chi-square test for trend, and multivariable logistic regression. RESULTS: Of 2385 patients with serious abdominal injuries, 69% (n = 1649) had an intervention; predominantly a laparotomy (n = 1166). The proportion undergoing laparotomy decreased from 60% in 2007 to 44% in 2016 (p < 0.001), whilst embolisation increased from 6 to 20% (p < 0.001). Population-adjusted incidence of abdominal injury increased 1.6% per year (IRR 1.016, 95% CI 1.002-1.031; p < 0.024), predominantly in people aged 65 years and over (4.6% per year). Adjusted odds of in-hospital mortality declined 6.0% per year (adjusted odds ratio 0.94; 95% CI 0.89, 1.00; p = 0.04). CONCLUSIONS: Whilst the incidence of major abdominal trauma increased during the study period, there was a reduction in the proportion of patients managed with laparotomy and reduction in the adjusted odds of in-hospital mortality. Older patients, for whom management is influenced by the complex interplay of frailty and co-morbidities, had lower laparotomy rates.


Assuntos
Traumatismos Abdominais/terapia , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/etiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Comorbidade , Embolização Terapêutica/estatística & dados numéricos , Embolização Terapêutica/tendências , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Incidência , Escala de Gravidade do Ferimento , Laparotomia/estatística & dados numéricos , Laparotomia/tendências , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Vitória/epidemiologia , Adulto Jovem
18.
J Laparoendosc Adv Surg Tech A ; 29(2): 206-212, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30256167

RESUMO

PURPOSE: Bile duct injuries (BDIs) are more frequent during laparoscopic cholecystectomy (LC). Several BDI classifications are reported, but none encompasses anatomy of damage and vascular injury (A), timing of detection (To), and mechanism of damage (M). Aim was to apply the ATOM classification to a series of patients referred for BDI management after LC. METHODS: From 2008 to 2016, 26 patients (16 males and 10 females, median age 63 years, range 34-82 years) with BDIs were observed. Fifteen patients were managed by percutaneous transhepatic cholangiography (PTC)+endoscopic retrograde cholangiopancreatography (ERCP); five and six underwent PTC and ERCP alone, respectively. Median overall follow-up duration was 34 months. Three patients died from sepsis. RESULTS: Out of 26 patients, 20 presented with main bile duct and six with nonmain bile duct injuries. Using the ATOM classification, every aspect of the BDI in every case was included, unlike with other classifications (Neuhaus, Lau, Strasberg, Bergman, and Hanover). CONCLUSIONS: The all-inclusive European Association for Endoscopic Surgery (EAES) classification contains objective data and emphasizes the underlying mechanisms of damage, which is relevant for prevention. It also integrates vascular injury, necessary for ultimate management, and timing of discovery, which has diagnostic implications. The management complexity of these patients requires specialized referral centers.


Assuntos
Traumatismos Abdominais/classificação , Traumatismos Abdominais/etiologia , Vasos Sanguíneos/lesões , Colecistectomia Laparoscópica/efeitos adversos , Ducto Colédoco/lesões , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
19.
Surg Laparosc Endosc Percutan Tech ; 29(1): e7-e8, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30300255

RESUMO

INTRODUCTION: Isolated complete transection of the small bowel is extremely rare in blunt abdominal trauma. If it occurs, it is often associated with high-energy impact, as seen in motor vehicle accidents and falls from heights. In this case, a trivial trauma due to a handlebar injury caused a complete transection of the middle jejunum. CASE PRESENTATION: A 47-year-old man walked into the emergency department with moderate abdominal pain ∼10 hours after a fall on to a bicycle's handlebar from a standing position. A bedside ultrasound showed minimal amount of free fluid and a following performed computed tomographic scan indicated an edematous loop of small bowel with diminutive amount of extraluminal air, suggesting small bowel perforation. Because of the absence of abdominal peritonism in a hemodynamically stable patient, a conservative treatment and surveillance was established. In the follow-up, the patient suddenly developed severe abdominal pain with now clear signs of peritonism. An emergency laparoscopy showed a complete transection of the middle jejunum. A primary anastomosis was performed. The patient had an uneventful recovery and was discharged after 7 days. CONCLUSIONS: Even seemingly trivial blunt abdominal traumas can cause complete transection of the small bowel, as shown in this case. Patients with blunt abdominal trauma need to be reviewed frequently by an experienced clinician. Diagnostic laparoscopy attaches a great importance to early detection and treatment of small bowel injuries. The mechanical pattern of the injury seems to be more important than the energy of the impact itself.


Assuntos
Traumatismos Abdominais/etiologia , Perfuração Intestinal/etiologia , Doenças do Jejuno/etiologia , Jejuno/lesões , Ferimentos não Penetrantes/etiologia , Dor Abdominal/etiologia , Acidentes por Quedas , Anastomose Cirúrgica , Ciclismo/lesões , Humanos , Perfuração Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Jejuno/cirurgia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade
20.
Am J Surg ; 218(5): 847-850, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30563694

RESUMO

BACKGROUND: This study aimed to determine the incidence of intra-abdominal injuries in elderly patients after a ground-level fall. METHODS: A 6-year retrospective review was conducted on patients 65 years of age or older involved in a fall from standing and evaluated at a level 1 trauma center. Each patient presented with a pelvic, thoracolumbar, and/or lower rib fracture. Data collection included demographics, injury characteristics, FAST exam results, CT imaging results, and hospitalization outcomes. RESULTS: A total of 324 patients met study inclusion criteria. The majority of patients were white (95.1%) females (65.4%) with an average age of 82.0 ±â€¯7.3 years. Only 22 patients (6.8%) reported abdominal pain, although an abdominal CT was performed in 91 patients (28.1%). Only 1 patient (0.3%) was found to have an intra-abdominal injury when no abdominal pain was reported and the FAST exam was negative. This injury was not clinically significant enough to warrant surgical intervention. CONCLUSION: Elderly patients who suffer a ground-level fall do not benefit from PAN-SCAN, even when presenting with rib, thoracolumbar, and/or pelvic fractures.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Acidentes por Quedas , Fraturas Ósseas/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/etiologia , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/lesões , Sistema de Registros , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/etiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X , Ultrassonografia , Ferimentos não Penetrantes/etiologia
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