1
|
Yang X, Tang N, Li L, Xu G, Dai J, Tao K, He C, Huangfu C. Management of a patient with cardiac arrest, intestinal ischemia necrosis, multiple fractures, hemorrhagic shock, renal failure, disseminated intravascular coagulation, and thrombosis after severe abdominal crush injury: A case report. Exp Ther Med 2022; 23:386. [PMID: 35495585 PMCID: PMC9019741 DOI: 10.3892/etm.2022.11313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/28/2022] [Indexed: 11/06/2022] Open
Abstract
Abdominal crush injury has been widely reported. However, abdominal crush injury cases involving most of the organ systems have seldom been reported. In the present case report, a 58-year-old man was hit in the abdomen by a 4-ton machine tool. The case described a rare combination of cardiac arrest, intestinal ischemia necrosis, multiple fractures, hemorrhagic shock, renal failure, disseminated intravascular coagulation and thrombosis after severe abdominal crush injury. During the treatment, crush syndrome, anemia, electrolyte disorder, pleural effusion, pulmonary emphysema, compartment syndrome, respiratory failure, pulmonary hemorrhage, injury of the right common peroneal nerve and tibial nerve, septum abscess and malnutrition were also observed. Systemic and symptomatic treatments were performed for >3 months, after which the patient was discharged from hospital without any further risk of fatality. The related treatments were also described in detail in the present case report. This case represented one of the most complicated cases among abdominal crush injuries that have been reported, and the treatment experiences reported here will hopefully provide suitable reference points for similar cases.
Collapse
Affiliation(s)
- Xiaokun Yang
- Department of Emergency Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Nan Tang
- School of Nursing, Lanzhou University, Lanzhou, Gansu 730010, P.R. China
| | - Le Li
- Department of Emergency Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Guisen Xu
- Department of Emergency Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Juan Dai
- Department of Emergency Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Kai Tao
- Department of Emergency Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Chunyang He
- Department of Hyperbaric Oxygenation Medicine, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Chaoji Huangfu
- Center for Disease Control and Prevention, Western Theater Command, Lanzhou, Gansu 730020, P.R. China
| |
Collapse
|
2
|
Bhosale M, Sangle A, Bhat G, Dambal P. Transanal Small Bowel Evisceration in a 3-Year-Old Victim of Motor Vehicle Accident. J Indian Assoc Pediatr Surg 2021; 26:253-255. [PMID: 34385770 PMCID: PMC8323572 DOI: 10.4103/jiaps.jiaps_124_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/01/2020] [Accepted: 08/23/2020] [Indexed: 11/11/2022] Open
Abstract
Although motor vehicle accidents (MVAs) in children are common, pediatric rectal perforations secondary to MVAs leading to transanal evisceration of the small bowel are very rare. Herniation of bowel through breach in the rectal wall seen eviscerating through the anus is a surgical emergency requiring laparotomy and necessary surgical procedure. We report case of a 3-year-old boy, victim of run-over MVA accident, presenting with bilateral fracture shaft femur, fracture of the left humerus, and transanal small bowel evisceration. About 30–40 cm long, gangrenous, small bowel loop was hanging outside the anal canal. Two consecutive surgeries were performed to manage this unusual and complex case with an excellent outcome. This report is presented for an extremely rare presentation of MVA injury in a child.
Collapse
Affiliation(s)
- Minakshi Bhosale
- Department of Pediatric Surgery, B J Government Medical College, Pune, Maharashtra, India
| | - Ameya Sangle
- Department of Pediatric Surgery, B J Government Medical College, Pune, Maharashtra, India
| | - Ganesh Bhat
- Department of Pediatric Surgery, B J Government Medical College, Pune, Maharashtra, India
| | - Praveen Dambal
- Department of Pediatric Surgery, B J Government Medical College, Pune, Maharashtra, India
| |
Collapse
|
3
|
Das S, Ravi K. Traumatic herniation of intestine through ruptured skin at the ankle. Forensic Sci Med Pathol 2021; 17:734-737. [PMID: 34241757 DOI: 10.1007/s12024-021-00399-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 10/20/2022]
Abstract
Vehicular runover of pedestrians is a commonly reported occurrence in literature. The usual presentations at autopsy are avulsion of the intra-abdominal viscera, solid organ crushing, hemorrhage, fracture of pelvic bone and vertebra, and herniation of the abdominal contents. There are reports of many cases where the abdominal and thoracic viscera have herniated out of their respective compartment following rupture of the diaphragm. Herniation of the intestine through natural orifices or other anatomical openings of the body has also been reported. This herniation occurs following a reduction in the anteroposterior diameter and acute increase in intra-abdominal pressure, displacing the abdominal contents out of their normal position through some natural anatomical openings inside the body following the path of least resistance. We report an interesting case of vehicular runover where the intestinal coils have come out of the body at the ankle. The authors describe the plausible mechanism and the route through which the intestine could have traversed.
Collapse
Affiliation(s)
- Siddhartha Das
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry 605006, India.
| | - Kirthika Ravi
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry 605006, India
| |
Collapse
|
4
|
Wellé IB, Mbaye PA, Séck NF, Ndoye NA, Guéye D, Lo FB, Ndiaye M, Sylla MA, Sagna A, Ngom G. [Transanal evisceration of small bowel caused by impalement in children: about a case]. Pan Afr Med J 2020; 37:320. [PMID: 33654538 PMCID: PMC7896525 DOI: 10.11604/pamj.2020.37.320.18332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/21/2019] [Indexed: 11/23/2022] Open
Abstract
L'éviscération transanale de l'intestin grêle par empalement est exceptionnelle chez l'enfant. Nous rapportons l'observation d'un adolescent de 11 ans reçu à 2 heures d'une issue des anses grêles à travers l'anus suite à une chute avec réception sur un morceau de bois pointu. L'examen clinique avait objectivé un bon état général, une issue, par l'anus, d'environ 25 cm d'intestin grêle viable et un abdomen sensible dans son ensemble. Le bilan biologique préopératoire était normal et aucune imagerie n'était réalisée. Après une réanimation, l'exploration chirurgicale avait mis en évidence un liquide séro-hématique (300 ml) et une issue d'environ 60 cm d'anse grêle inflammatoire à travers une brèche d'environ 5 cm de la paroi antérieure du rectum. Une réduction des anses grêles éviscérées par traction douce, une réparation de la paroi rectale par des points séparés, une toilette et un drainage ont été réalisés. Le patient était sous antibiotique à large spectre. Les suites opératoires étaient simples avec une reprise du transit à J2 post-opératoire. La sortie a été autorisée à J7 post opératoire. Après un recul d'un mois, la patiente a été revue en consultation et l'examen clinique était normal.
Collapse
Affiliation(s)
| | | | - Ndéye Fatou Séck
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| | - Ndéye Aby Ndoye
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| | - Doudou Guéye
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| | - Faty Balla Lo
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| | - Modou Ndiaye
- Service de Chirurgie Générale, Hôpital de Ourossogui, Sénégal
| | | | - Aloise Sagna
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| | - Gabriel Ngom
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| |
Collapse
|