A 6-year-old boy presenting with traumatic evisceration following a bicycle handle bar injury: a case report

Abdominal Wall Evisceration Coupled With Iliac Vascular Injury After Blunt Trauma

Abdominal evisceration after blunt trauma is uncommon and rarely survivable when coupled with a concomitant iliac vascular injury. Blunt abdominal injury is rarely a cause of abdominal evisceration but may, on occasion, present in patients affected by a unique or high-energy traumatic injury. In these instances, major vascular injury is exceedingly rare but is associated with a high mortality rate. Damage to important vessels that may present more subtly, such as iliac arterial injury, can still be lethal and are important to evaluate in the trauma workup for blunt evisceration. We report the case of a 20-year-old woman who survived an abdominal wall and vascular injury in a motor vehicle accident. Management of this unusual association is discussed.

Deviant peer affiliation as a mediating variable in the relationship between family cohesion and adaptability and internet addiction among adolescents

The aim of this study was to investigate the mediating role of deviant peer affiliation in the relationship between family functioning, specifically family cohesion and family adaptability, and internet addiction among Saudi adolescents. A sample of 946 Saudi Arabian adolescents with a mean age of 18.5 years (SD = 3.06) was obtained using snowball sampling. Path analysis using structural equation modeling was conducted. The results indicated significant negative relationships between family cohesion and internet addiction and between deviant peer affiliation and family cohesion, and a significant positive relationship between family adaptability and internet addiction. In accordance with prior research, we found a significant positive relationship between deviant peer affiliation and internet addiction, but in terms of mediation, deviant peer affiliation mediated only the relationship between family cohesion and internet addiction. In conclusion, it is important for the effectiveness of interventions and preventive programs that aim to address deviant peer affiliation and internet addiction in adolescents to enhance the well-being of their family systems.

Managing severe traumatic abdominal-wall injuries, a monocentric experience

PURPOSE

Abdominal wall injuries (AWI) is a clinical and radiological diagnosis of fasciomuscular and at times cutaneous defects after abdominal trauma. Their severity encompasses a spectrum of parietal defects, with the most severe being a burst abdomen with eviscerated organs. With the wide use of CT scans in trauma settings, their incidence is being more recognized. Especially in severe AWI, where associated intrabdominal lesions are highly prevalent, many questions about parietal reconstruction arise concerning the timing and type of surgery, and their final hernia recurrence rate.

METHOD

A list of severe AWI injuries have been retrieved, all of which were treated in our center. Type of trauma, clinical presentation, surgical technique and follow-up have been included.

RESULTS

Eight cases were found with severe abdominal injuries, with an age range of 11-85 years. Road traffic accidents, crush injuries, fall from height, stab and gunshot wounds are included. Seven out of the 8 cases had associated intrabdominal traumatic lesions. Mesh augmentation due to tissue loss was used in three cases. Recurrence rate was estimated around 25%.

CONCLUSION

Prompt surgical exploration is required as associated intrabdominal traumatic lesions are highly associated with severe AWI. Even when intrabdominal lesions are ruled out, fasciomuscular defects should be managed during the same hospitalization, to prevent intestinal strangulation and occlusion. Mesh augmentation should only be used when parietal defects include extensive tissue loss preventing tension-free parietal reconstruction.

Degloving injury to groin, scrotum and penis due to low-velocity handlebar injury

Bicycles are a common cause of blunt abdominal trauma causing 5%-14% of injuries. However, impalement or shear injuries from low-velocity mechanism of injury are rare. We report a case of a 14-year-old boy presenting with an extensive left groin injury sustained while cycling one-handed along the pavement at walking pace. The laceration ran for 12-14 cm from the left groin across the pubis to the right and 10 cm inferiorly into the perineum. This inverted the left scrotum and partially degloved the penis. The corpus cavernosa and tunica vaginalis were exposed up to the level of the superficial inguinal ring. Literature on handlebar-impalement injuries is sparse and the majority of penile degloving injuries described in the literature result from alternative mechanisms. This unusual case demonstrates the potential forces involved, and potential damage resulting from handlebar injuries even at low velocity.

Laparoscopic-assisted management of traumatic abdominal wall hernias in children: case series and a review of the literature

BACKGROUND

Traumatic abdominal wall hernia (TAWH) is defined as herniation through a disrupted portion of musculature/fascia without skin penetration or history of prior hernia. In children, TAWH is a rare injury.

OBJECTIVE

The objectives of this study were to report our experience with different management strategies of TAWH in children and to determine the utility of laparoscopy.

DESIGN/METHOD

A retrospective chart review of all children treated by pediatric surgery at our institution for TAWH in a 5year interval was performed. Data were collected on mechanism of injury, initial patient presentation, surgical management, and outcomes.

RESULTS

We present 5 cases of traumatic abdominal wall hernia; 3 were managed using laparoscopic assistance. One patient was managed nonoperatively. All patients recovered without complications and were asymptomatic on follow up.

CONCLUSION

Traumatic abdominal wall hernias require a high index of suspicion in the cases of blunt abdominal trauma. Laparoscopy is useful mainly as a diagnostic modality, both to evaluate the hernia and associated injuries to intraabdominal structures. Its use may facilitate repair through a smaller incision. Conservative management of TAWH may be appropriate in select cases where there is a low risk of bowel strangulation.

Abdominal wall disruption with evisceration after blunt trauma

Abdominal evisceration after blunt trauma is rare. We report a case in a 65-year-old man who was crushed by a lorry. Management of this uncommon condition is reviewed.

[Evisceration of intestines following abdominal stab wounds: epidemiology and clinical aspects of emergency room management]

STUDY AIM

The aim of the study was an estimation of the incidence and clinical aspects of emergency room (ER) parameters of penetrating abdominal injury patients with bowel evisceration.

STUDY DESIGN AND METHODS

The study involved a retrospective cohort analysis of ER data from the Chris Hani Baragwanath Academic Hospitals, Soweto, Johannesburg, South Africa between September 2000 to May 2005.

RESULTS

Out of 9,010 ER patients, 4,390 suffered penetrating injuries with 8 out of 71 eviscerations due to a single gunshot wound, 60 out of 71 eviscerations due to single stab wounds and 3 further patients suffered multiple injuries. The ER mortality was 1 out of 71(1.6 %) with an average ER mortality of 4.2 %. The only death seen was a single abdominal gunshot wound with vascular injury. The causative mortality due to abdominal stab wounds with evisceration of the bowels was therefore zero. The heart rate in patients with abdominal stab wounds with and without bowel evisceration showed no significant difference, thus mesentery tearing or vagal overstimulation could not be seen, neither with bradycardia nor hypotension.

CONCLUSION

Evisceration itself is not a cause for increased mortality or cardiovascular instability seen in the ER. There is ample time for diagnostic procedures before laparotomy is performed.