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Mahmoud MA, Daboos MA, Bayoumi ASS, Helal AA, Almaawi A, Hassab MH, Aldaraan KZ. Role of Minimally Invasive Surgery in Management of Penetrating Abdominal Trauma in Children. Eur J Pediatr Surg 2021; 31:353-361. [PMID: 33757135 DOI: 10.1055/s-0041-1726411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Traditionally, exploratory laparotomy was used to treat penetrating abdominal trauma (PAT). At present, minimally invasive surgery (for diagnostic and therapeutic purposes) has developed and represents a rapidly evolving modality for dealing with PAT in stable children. In this article, we aim to present our experience, evaluate the effectiveness, and report the results of minimally invasive surgery (MIS) for PAT in stable pediatric patients. MATERIALS AND METHODS This prospective study involved 117 hemodynamically stable pediatric cases of PAT (caused by gunshots, stab, and accidental stab), admitted, and managed according to the severity of injury. The information recorded for analysis included demographic data, the anatomical location of injury, the initial vital data and scoring systems, the organs affected, the procedures done, operative time, need for conversion to laparoscopic-assisted approach, length of hospital stay, complications, missed injury, and mortality rate. RESULTS Among 117 pediatric patients with PAT, 15 cases were treated conservatively and 102 cases were managed by MIS. They were 70 males and 47 females with a mean age of 7.3 ± 0.6 years (range = 1-14 years). They included 48 cases of gunshot injury, 33 cases of abdominal stab, and 36 cases of accidental stab. Laparoscopy was diagnostic (DL) in 33.3% (n = 34) and therapeutic (TL) in 66.7% (n = 68) of cases. Of the 68 TL cases, we completely managed 59 cases (86.8%) by laparoscopy, while 9 cases (13.2%) were converted to limited laparotomy. The mean operative time was 17 ± 1 minutes (range = 12-25 minutes) for DL, 85 ± 9 minutes (range = 41-143 minutes) for complete TL cases, and 89 ± 3 minutes (range = 47-149 minutes) for laparoscopic-assisted procedures. For DL cases, the mean length of hospital stay was 2 ± 0.4 days, while for complete TL cases, it was 5.4 ± 0.83 days, and for laparoscopic-assisted cases, it was 5.8 ± 0.37 days. Postoperative complications occurred in eight cases (7.84%), with five cases (4.9%) required reintervention. No missed injury or mortality was recorded in the study. The patients were followed up for a median period of 52 months. CONCLUSION For management of PAT in children, MIS has 100% accuracy in defining the injured organs with zero percent missed injuries.
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Affiliation(s)
- Muhammad Abdelhafez Mahmoud
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.,Department of Pediatric Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Mohammad Alsayed Daboos
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt.,Department of Pediatric Surgery, Maternity and Children's Hospital, Bisha, Saudi Arabia
| | | | | | - Abdulrahman Almaawi
- Department of Pediatric Surgery, Maternity and Children's Hospital, Bisha, Saudi Arabia
| | - Mohamed Hany Hassab
- Department of Pediatric Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Khaled Zamel Aldaraan
- Department of Pediatric Surgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia
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Traumatic hollow viscus and mesenteric injury: role of CT and potential diagnostic-therapeutic algorithm. Updates Surg 2020; 73:703-710. [PMID: 33340338 PMCID: PMC8005390 DOI: 10.1007/s13304-020-00929-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022]
Abstract
Despite its rarity, traumatic hollow viscus and mesenteric injury (HVMI) have high mortality and complication rates. There is no consensus regarding its best management. Our aim is to evaluate contrast enhanced CT (ceCT) in the screening of HVMI and its capability to assess the need for surgery. All trauma patients admitted to an urban Level 1 trauma center between 2010 and 2018 were retrospectively evaluated. Patients with ceCT scan prior to laparotomy were included. Patients requiring surgical repair of HVMI and a ceCT scan consistent with HVMI were considered true positives. Six ceCT scan criteria for HVMI were used; at least one criterion was considered positive for HVMI. Sensitivity (Sn), specificity (Sp), predictive values (PV), likelihood ratios (LR) and accuracy (Ac) of ceCT of single ceCT criteria and of the association of ceCT criteria were calculated using intraoperative findings as gold standard. Therapeutic time (TT), death probability (DP), and observed mortality (OM) were described. 114 of 4369 patients were selected for ceCT accuracy analysis; 47 were considered true positives. Sn of ceCT for HVMI was 97.9%, Sp 63.6%, PPV 66.2%, NPV 97.6%, + LR 2.69, −LR 0.03, Ac 78%; no single criterion stood out. The association of four or more criteria improved ceCT Sp to 98.5%, PPV to 95.6%, + LR to 30.5. Median TT was 2 h (IQR: 1–3 h). OM was 7.8%—not significantly higher than overall OM. CeCT in trauma has become a reliable screening test for HVMI and a valid exam to select HVMI patients for surgical exploration.
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Shreffler J, Smiley A, Schultz M, Ross A, Baker J, Nash N, Harbrecht B, Huecker M. Patients with Abrasion or Ecchymosis Seat Belt Sign Have High Risk for Abdominal Injury, but Initial Computed Tomography is 100% Sensitive. J Emerg Med 2020; 59:491-498. [PMID: 32826121 DOI: 10.1016/j.jemermed.2020.06.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/25/2020] [Accepted: 06/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trauma providers seek to accurately assess the risk of patients with abdominal seat belt sign (ASBS). As hospital costs continue to rise, identification of strategies to safely discharge emergency department (ED) patients has become crucial. OBJECTIVES The purpose of this study is to 1) describe a large cohort of patients by type of ASBS and 2) determine the value of computed tomography (CT) of the abdomen and pelvis as a screening tool to rule out intra-abdominal injury (IAI) and support discharge of stable patients. METHODS We conducted a retrospective case series of all patients presenting to our urban, Level I trauma center from 2013-2015. We studied motor vehicle collision patients who presented with ASBS. We further classified individuals into ASBS groups: Abrasion, Ecchymosis, Abrasion + Ecchymosis, or Unknown ASBS to examine differences between groups. RESULTS In one of the largest described cohorts, the ASBS remained associated with IAI, most commonly, solid organ injury. Of 425 patients, 36.1% had some IAI on CT, but only 13.6% required laparotomy. Categorizing the type of skin injury in ASBS, we found that both abrasion and ecchymosis were associated with IAI. Initial CT performed with 100% sensitivity. CONCLUSIONS This study shows that ED trauma patients with significant seat belt abrasion or contusion can have IAI. With the very high sensitivity of modern abdominal CT scanners, clinicians could consider safe ED discharge of stable ASBS patients while providing strong return precautions. Our large cohort strengthens the evidence on decision-making in ASBS patients to ensure outcomes and use of health care resources.
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Affiliation(s)
- Jacob Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Abbey Smiley
- Department of Undergraduate Medical Education, University of Louisville, Louisville, Kentucky
| | - Melissa Schultz
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Adam Ross
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Jeffery Baker
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Nicholas Nash
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Brian Harbrecht
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
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Zurita Saavedra M, Pérez Alonso A, Pérez Cabrera B, Haro García AM, Ruiz García VM, Mirón Pozo B, Petrone P. Management of Splenic Injuries Utilizing a Multidisciplinary Protocol in 110 Consecutive Patients at a Level II Hospital. Cir Esp 2019; 98:143-148. [PMID: 31739975 DOI: 10.1016/j.ciresp.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/19/2019] [Accepted: 08/31/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Non-operative treatment (NOM) of splenic trauma is the management of choice in hemodynamically stable patients. The aim of the present study was to assess the failure rate of NOM after implementation of a multidisciplinary protocol for splenic injuries compared to literature results. METHODS A retrospective study was performed over a 16-year period. Patient data and management of splenic trauma was recorded according to our hospital protocol: demographic data, blood pressure, respiratory rate, Glasgow Coma Scale(GCS), Revised Trauma Score(RTS), Injury Severity Score(ISS), injury grade according to the American Association for the Surgery of Trauma(AAST), failure of NOM, morbidity and mortality. RESULTS One hundred ten patients were included: 90(81.8%) men, 20(18.2%) women; mean age 37 years; 106(96.5%) cases were blunt and four(3.5%) penetrating by knife. The diagnosis was established by US/CT. AAST classification: 14(13%) grade I; 24(22%) grade II; 34(31%) grade III; 37(34%) grade IV. Emergency laparotomy was performed in 54 patients: 37 due to grade IV injuries, 17 due to hemodynamic instability. NOM was utilized in 56 patients, spleen-preserving surgery in 16, and splenectomy in 38. Ten patients had postoperative complications: seven in the splenectomy group, two in the spleen-preserving surgery group, and one in the NOM group. One patient died. Average hospital stay: 22.8 days- NOM 17.6 days, conservative surgery 29 days, splenectomy 22.4 days. CONCLUSIONS Although we continue with a high hospital stay, the literature reports support our results. The implementation of the protocol by consensus contributed to the change towards NOM.
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Affiliation(s)
| | - Alejandro Pérez Alonso
- Unidad de Cirugía HBP, Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario de Jaén, Jaén, España; Departamento de Cirugía y sus Especialidades, Facultad de Medicina, Universidad de Granada, Granada, España
| | | | | | - Víctor Manuel Ruiz García
- Unidad de Cirugía HBP, Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario de Jaén, Jaén, España; Departamento de Cirugía y sus Especialidades, Facultad de Medicina, Universidad de Granada, Granada, España
| | - Benito Mirón Pozo
- Servicio de Cirugía General, Hospital Universitario San Cecilio, Granada, España
| | - Patrizio Petrone
- Department of Surgery, NYU Winthrop Hospital, NYU Long Island School of Medicine, Mineola (Nueva York), Estados Unidos.
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Bekker W, Smith M, Kong VY, Bruce JL, Laing G, Manchev V, Clarke DL. Isolated free fluid on computed tomography for blunt abdominal trauma. Ann R Coll Surg Engl 2019; 101:552-557. [PMID: 31219321 DOI: 10.1308/rcsann.2019.0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- W Bekker
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Mtd Smith
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - V Y Kong
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa.,Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - J L Bruce
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - G Laing
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - V Manchev
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - D L Clarke
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa.,Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Nixon R, Rossanese M, Mesquita L, Burrow R. CT evaluation of mesenteric avulsion after abdominal blunt trauma in a dog. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rachel Nixon
- Leahurst Small Animal Teaching HospitalUniversity of LiverpoolNestonUK
| | - Matteo Rossanese
- Leahurst Small Animal Teaching HospitalUniversity of LiverpoolNestonUK
| | - Luis Mesquita
- Radiology DepartmentWillows Veterinary Centre and Referrals ServiceSolihullUK
| | - Rachel Burrow
- School of Veterinary ScienceUniversity of LiverpoolNestonUK
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A Case of Small Bowel Obstruction and Enterocutaneous Fistulation Resulting from a Mesenteric Haematoma following Blunt Abdominal Trauma. Case Rep Surg 2017; 2017:7639265. [PMID: 29333314 PMCID: PMC5733230 DOI: 10.1155/2017/7639265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 12/03/2022] Open
Abstract
A 23-year-old male with a history of previous abdominal surgery was involved in a road traffic accident. He was discharged after initial assessment but represented several days with small bowel obstruction secondary to a mesenteric haematoma. He underwent resection and recovered well but represented later on the day of discharge with a leaking surgical wound consistent with an enterocutaneous fistula. This was managed conservatively and closed spontaneously after ten days. This case serves to highlight that adhesions from previous surgery can tether the small bowel causing mesenteric injury following blunt-force trauma. It also demonstrates that postoperative ileus can result in an enterocutaneous fistula that has the appearance of an anastomotic breakdown but which resolves more rapidly.
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Abstract
The management of blunt abdominal trauma has evolved over time. While laparotomy is the standard of care in hemodynamically unstable patients, stable patients are usually treated by non-operative management (NOM), incorporating adjuncts such as interventional radiology. However, although NOM has shown good results in solid organ injuries, other lesions, namely those involving the hollow viscus, diaphragm, and mesentery, do not qualify for this approach and need surgical exploration. Laparoscopy can substantially reduce additional surgical aggression. It has both diagnostic and therapeutic potential and, when negative, may reduce the number of unnecessary laparotomies. Although some studies have shown promising results on the use of laparoscopy in blunt abdominal trauma, randomized controlled studies are lacking. Laparoscopy requires adequate training and experience as well as sufficient staffing and equipment.
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Affiliation(s)
- Viktor Justin
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
| | - Selman Uranues
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
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Kong VY, Jeetoo D, Naidoo LC, Oosthuizen GV, Clarke DL. Isolated free intra-abdominal fluid on CT in blunt trauma: The continued diagnostic dilemma. Chin J Traumatol 2016; 18:357-9. [PMID: 26917028 DOI: 10.1016/j.cjtee.2015.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The clinical significance of isolated free fluid (FF) without solid organ injury on computed to- mography (CT) continues to pose significant dilemma in the management of patients with blunt abdominal trauma (BAT). METHODS We reviewed the incidence of FF and the clinical outcome amongst patients with blunt abdominal trauma in a metropolitan trauma service in South Africa. We performed a retrospective study of 121 consecutive CT scans over a period of 12 months to determine the incidence of isolated FF and the clinical outcome of patients managed in a large metropolitan trauma service. RESULTS Of the 121 CTs, FF was identified in 36 patients (30%). Seven patients (6%) had isolated FF. Of the 29 patients who had free fluid and associated organ injuries, 33 organ injuries were identified. 86% (25/ 29) of all 29 patients had a single organ injury and 14% had multiple organ injuries. There were 26 solid organ injuries and 7 hollow organ injuries. The 33 organs injured were: spleen, 12; liver, 8; kidney, 5; pancreas, 2; small bowel, 4; duodenum, 1. Six (21%) patients required operative management for small bowel perforations in 4 cases and pancreatic tail injury in 2 cases. All 7 patients with isolated FF were initially observed, and 3 (43%) were eventually subjected to operative intervention. They were found to have an intra-peritoneal bladder rupture in 1 case, a non-expanding zone 3 haematoma in 1 case, and a negative laparotomy in 1 case. Four (57%) patients were successfully managed without surgical interventions. CONCLUSIONS Isolated FF is uncommon and the clinical significance remains unclear. Provided that reli- able serial physical examination can be performed by experienced surgeons, an initial non-operative approach should be considered.
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Affiliation(s)
- Victor Y Kong
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa
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Bhatti KM, Taqi KM, Al-Harthy AZS, Hamid RS, Al-Balushi ZN, Sankhla DK, Al-Qadhi HA. Paediatric Blunt Torso Trauma: Injury mechanisms, patterns and outcomes among children requiring hospitalisation at the Sultan Qaboos University Hospital, Oman. Sultan Qaboos Univ Med J 2016; 16:e210-6. [PMID: 27226913 DOI: 10.18295/squmj.2016.16.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 02/17/2016] [Accepted: 03/03/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. METHODS This retrospective single-centre study involved all children ≤12 years old with blunt torso trauma admitted for paediatric surgical care at SQUH between January 2009 and December 2013. Medical records were analysed to collect demographic and clinical data. RESULTS A total of 70 children were admitted with blunt torso trauma during the study period, including 39 (55.7%) male patients. The mean age was 5.19 ± 2.66 years. Of the cohort, 35 children (50.0%) received their injuries after having been hit by cars as pedestrians, while 19 (27.1%) were injured by falls, 12 (17.1%) during car accidents as passengers and four (5.7%) by falling heavy objects. According to computed tomography scans, thoracic injuries were most common (65.7%), followed by abdominal injuries (42.9%). The most commonly involved solid organs were the liver (15.7%) and spleen (11.4%). The majority of the patients were managed conservatively (92.9%) with a good outcome (74.3%). The mortality rate was 7.1%. Most deaths were due to multisystem involvement. CONCLUSION Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach.
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Affiliation(s)
- Khalid M Bhatti
- Departments of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Kadhim M Taqi
- Departments of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Rana S Hamid
- Radiology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | | | - Hani A Al-Qadhi
- Departments of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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McGuigan A, Brown R. Early and delayed presentation of traumatic small bowel injury. BMJ Case Rep 2016; 2016:bcr-2016-214586. [PMID: 26961562 DOI: 10.1136/bcr-2016-214586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Traumatic small bowel injury (TSBI) is rare and presents in only 1% of patients following blunt trauma. Delay in diagnosis can result in significant morbidity so a high index of suspicion is required in patients with abdominal injuries and a significant mechanism of injury. We discuss three cases of TSBI with varying presentations, and discuss their investigation and treatment.
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Affiliation(s)
- Andrew McGuigan
- Department of General Surgery, Daisy Hill Hospital, Newry, UK
| | - Robin Brown
- Department of General Surgery, Daisy Hill Hospital, Newry, UK
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Colorectal cancer with intestinal perforation - a retrospective analysis of treatment outcomes. Contemp Oncol (Pozn) 2014; 18:414-8. [PMID: 25784840 PMCID: PMC4355655 DOI: 10.5114/wo.2014.46362] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/29/2014] [Accepted: 09/05/2014] [Indexed: 12/18/2022] Open
Abstract
Aim of the study Colorectal cancer (CRC) is one of the leading cause of death in European population. It progresses without any symptoms in the early stages or those clinical symptoms are very discrete. The aim of this study was a retrospective analysis of treatment outcomes in patients with colorectal cancer complicated with intestinal perforation. Material and methods A retrospective analysis of patients urgently operated upon in our Division of General Surgery, because of large intestine perforation, from February 1993 to February 2013 has been made. Results were compared with a group of patients undergoing the elective surgery for colorectal cancer in the same time and Division. Results Intestinal perforation occurred more often in males (6.52% vs. 6.03%), patients with mucous component in histopathological examination (9.09% vs. 6.01%) and with clinicaly advanced CRC. Patients treated because of perforation had a five-fold higher 30 day mortality rate (9.09% vs. 1.83%), however long-term survival did not differ significantly in both groups. After resectional surgery in 874 patients an intestinal anastomosis was made. Anastomotic leakage was present in 23 (2.6%) patients. This complication occurred six-fold more frequently in a group of patients operated upon because of intestinal perforation (12.20% vs. 2.16%). Conclusions In patients with CRC complicated with perforation of the colon in a 30-day observation significantly higher rate of complications and mortality was shown, whereas there was no difference in distant survival rates.
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Uranues S, Popa DE, Diaconescu B, Schrittwieser R. Laparoscopy in Penetrating Abdominal Trauma. World J Surg 2014; 39:1381-8. [DOI: 10.1007/s00268-014-2904-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Williams SR, Perera P, Gharahbaghian L. The FAST and E-FAST in 2013: trauma ultrasonography: overview, practical techniques, controversies, and new frontiers. Crit Care Clin 2014; 30:119-50, vi. [PMID: 24295843 DOI: 10.1016/j.ccc.2013.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article reviews important literature on the FAST and E-FAST examinations in adults. It also reviews key pitfalls, limitations, and controversies. A practical "how-to" guide is presented. Lastly, new frontiers are explored.
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Affiliation(s)
- Sarah R Williams
- Division of Emergency Medicine, Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive Alway Building, M121, Stanford, CA 93405, USA.
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Bouliaris K, Karangelis D, Spanos K, Germanos S, Alexiou E, Giaglaras A. Ileosigmoid fistula and delayed ileal obstruction secondary to blunt abdominal trauma: a case report. J Med Case Rep 2011; 5:507. [PMID: 21974825 PMCID: PMC3195765 DOI: 10.1186/1752-1947-5-507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 10/05/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Abdominal trauma is a source of significant mortality and morbidity. Bowel injury as a result of blunt abdominal trauma is usually evident within hours or days of the accident. CASE PRESENTATION A 38-year-old Caucasian Greek man presented with a subtle and delayed small bowel obstruction caused by a post-traumatic ileosigmoid fistula and ileal stricture four months after a road traffic accident. CONCLUSION Delayed occurrence of post-traumatic small bowel stricture and ileosigmoid fistula is an uncommon surgical emergency. General surgeons as well as emergency physicians should bear this manifestation in mind should a patient return to the hospital several weeks or even years after blunt abdominal trauma with symptoms or signs of bowel obstruction.
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