Isolated free intraperitoneal fluid in young male after blunt abdominal sport trauma: two case reports from the World Cup 2022

The presence of isolated intraperitoneal free fluid (IFIPF) indicates the presence of mesenteric, organ, or bowel injury, which necessitates surgical exploration. The advances in computerized tomographic scanning (CT scan) allow even smaller amounts of IFIPF being detected. However, the clinical significance of IFIPF following blunt abdominal trauma remains not well-studied. Moreover, IFIPF is an unexpected condition in healthy male in the absence of mesenteric or organ injury on abdominal imaging. Herein, we presented two cases with IFIPF detected by CT scan in two healthy football male players during the World Cup 2022. The two players were managed conservatively and rejoined safely their football team during the same competition.

All-terrain vehicle (ATV)-related injuries among different age groups: insights from a 9-year observational study

PURPOSE

To describe the epidemiology, patterns, seasonality and outcome of all-terrain vehicle-related injuries (ATVRIs) among different age groups in Qatar.

METHODS

A retrospective analysis of all patients hospitalized with ATVRI from 2010 to 2018 was conducted. Data were analyzed by age, gender, seasonality, and Injury severity Score  (ISS). Chi-square, Student t and ANOVA tests were used for analysis. Multivariate regression analysis was performed to find out predictors of head injury and severe injury among ATV users.

RESULTS

Out of 15,000 trauma admissions, 521 had ATVRI (4%) with a mean age of 23.3 ± 12.3. The male-to-female ratio was 4:1 and the pediatric population represented 40%. The compliance with helmet use was 3.6%. The most injured regions were chest (29.8%), upper extremities (28.8%) and the head (25.9%). The mean ISS was 10.6 ± 7.7. Fracture fixation was the most operative intervention. Among hospitalized patients, 7.7% were transferred to rehabilitation . ATVRIs occurred more frequently between October and April and a large proportion (57.8%) occurred during weekends. The overall ATV-related hospital mortality rate was 2.1%. Young and older ATV users were more likely to suffer spine injuries than the pediatric population (p = 0.001). The mean ISS was greater in the older groups (p = 0.03). There were no statistically significant differences regarding the use of protective devices, mortality, or length of hospital stay between the different age groups. On multivariate analysis, young age and ISS were predictors of head injury among ATV users after adjusting for gender and helmet use.

CONCLUSION

This is a nationwide study looking at all age groups who sustained ATVRI in Qatar. ATVRIs were observed in all age groups following leisure and recreational use. It follows a seasonal pattern with poor protective measures compliance. There is a need to reinforce helmet use and raise public awareness.

Traumatic tension pneumocephalus: Two case reports

INTRODUCTION

Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly.

CASE PRESENTATION

We presented two cases of post-traumatic tension pneumocephalus. A 30- year old male pedestrian hit by a car presented with right frontal bone fracture extending to right frontal sinuses. He developed pneumocephalus involving all ventricles and subdural space and extending down to foramen magnum with tight basal cistern. The patient was managed conservatively. During the hospital course, he developed cerebrospinal fluid leak from the facial fractures and meningitis. After complete recovery, the patient was discharged home in a good health condition. The second case was a 43- year old lady driver who involved in a motor vehicle crash and presented with comminuted fracture of the right frontal bone, right parietal extra-axial hemorrhage. She developed pnemocephalus involving the bilateral frontal lobes, mainly on the left side with extension to the left lateral ventricle. Pneumocephalus was also noted in the pre-pontine cistern. The patient had rhinorrhea during the hospital course. The patient underwent wound debridement, intracranial pressure monitoring, and repair of her globe and advancement flap for right facial injury.

CONCLUSIONS

These are two rare cases with posttraumatic tension pneumocephalus treated conservatively with a favorable outcome. Early diagnosis of tension pneumocephalus is a crucial step to facilitate early recovery; however, the associated injuries need attention as they could influence the hospital course.