Factors affecting morbidity and mortality in hollow visceral injuries following blunt abdominal trauma

BACKGROUND AND AIM

Hollow visceral injuries following blunt abdominal trauma are uncommon. The potential risk factors affecting morbidity and mortality are not well known. The purpose of our study was to evaluate the outcomes of hollow viscus perforation after blunt abdominal trauma.

MATERIALS AND METHODS

Patient files of 56 adult patients who were treated with diagnosis hollow viscus injuries due to blunt abdominal trauma between the years 2000 and 2011 at the Dicle University Medical School General Surgery Clinic were retrospectively evaluated by analyzing the relationship between morbidity-mortality and potential risk factors.

RESULTS

Fifty-six patients formed the study group, with median age of 37.5 ± 17,0 (range, 16-78) years and a significant male (80.3%) predominance. The median Injury Severity Score was 4 (1-25). The median length of hospital stay 7.5 (1-21) days. The mean age in the group with morbidity (47.1 ± 17.4) was significantly higher than the group without morbidity (34.3 ± 15.8) (p<0.05). Also, re-operation (p=0.0013), treatment modality (p=0.037), cause of injuries (0.0046) were other factors that affect morbidity.

CONCLUSIONS

These findings suggest that factors affecting morbidity were cause of injuries, re-operation and treatment in patients with hollow viscus injury caused by blunt abdominal trauma. And factors affecting mortality were the injured organ, the presence of shock and median injury severity score.

Rectovaginal fistulas: five year's experience

BACKGROUND

Rectovaginal fistula is an epithelial connection between the anterior wall of the rectum and posterior wall of the vagina. The etiology of the rectovaginal fistula can be trauma orginated from violent acts or foreign bodies as well as trauma during obstetric, gynecologic, or colorectal surgeries. The purpose of this study was to share our clinic experience and surgical management for rectovaginal fistulas.

PATIENTS AND METHODS

This study was conducted at the Department of General Surgery, University of Dicle. All patients who were treated for rectovaginal fistulas between January 2005 and December 2011 were included to this study.

RESULTS

There were fifteen patients in a mean age of 32 ± 9.6. The most common complains of patients were arrival of gas and stool from the vagina. The etilogy of rectovaginal fistula was most commonly obstetric trauma in our patients and three of them had anal incontinance. The mean time of hospital stay was 5 days ± 1.7. Postoperative wound infection was seen in two patients and reccurence disease occurred in two patients during the postoperative period.

CONCLUSIONS

Rectovaginal fistula treatment is a challenging condition for the surgeon since anatomical relationships and different surgical conditions changes according to the paitents. Various surgical techniques are available for the management of rectovaginal fistulas according to their etiology, size, location. For the treatment of low fistulas, best results were achieved using conservative fistulectomy, layer closure, and both-sided covering of the tissue defect with advancement vaginal and rectal flaps.

Effect of Intraperitoneal Thymoquinone on Postoperative Peritoneal Adhesions

BACKGROUND

To determine the effect of thymoquinone on adhesion formation in a rat caecotomy/suture model.

MATERIAL AND METHODS

Thirty wistar rats were randomized into three groups: The control group received saline and the thymoquinone group received 10 mg/kg thymoquinone after cecal caecotomy/suture model. In the sham group the abdominal wall was closed without any abrasion to the cecum. On day 15, adhesions were classified, and histopathological samples were taken.

RESULTS

There were no incisional hernias or wound dehiscences. In comparing adhesion scores, a significant difference was found between the thymoquinone and the control groups (p < 0.05). The grade of inflammation for the thymoquinone and the sham groups were significantly lower than that of the control group (p < 0.01 and p < 0.001, respectively). Hydroxyproline levels were significantly lower in the sham and thymoquinone groups compared to the control group (p < 0.05).

CONCLUSIONS

Based on the results of this study in a rat peritoneal adhesion model, intraperitoneal administered thymoquinone has a strong anti-adhesive effect.

Blunt trauma - related isolated pancreatic injury

BACKGROUND

Pancreatic injuries arising from blunt trauma are rarely seen. Diagnosis and treatment are difficult because of retroperitoneal localization of the organ. We present four pancreatic cases with isolated pancreatic injury due to blunt abdominal trauma.

METHODS

This retrospective study included four pancreatic patients who were operated on due to isolated injury caused by blunt abdominal trauma at our department between January 2004 and October 2010.

RESULTS

The patients consisted of three males and one female. One of them was in stage IV and the rest were in stage III. All underwent pancreaticojejunostomy, distal pancreatectomy, distal pancreatectomy + splenectomy and drainage, respectively. Fistula developed in two of them, and abscess developed in one, while the other one died.

CONCLUSION

Diagnosis may be delayed since the clinical condition is initially stable. Tomography remains one of the most important diagnostic tools. Common risk factors for morbidity and mortality are the presence of ductal injury and delayed laparotomy (Tab. 1, Fig. 4, Ref. 22).

The effect of different suture materials on the safety of colon anastomosis in an experimental peritonitis model

BACKGROUND

The aim of this experimental study was to compare the safety of different suture materials in a left colonic anastomosis in the presence of peritonitis.

MATERIALS AND METHODS

Twenty-one male Wistar albino rats were randomly divided into three groups. First, left colonic injuries were created in all groups for the peritonitis model. After 24 hours, coated polyglactin 910 and silk suture were used in Group I rats, polydioxanone and silk suture were used in Group II rats, and coated polyglactin 910 plus antibacterial suture and silk suture were used in Group III rats during colonic anastomosis. Tissue hydroxyproline, anastomotic bursting pressure, and histopathologic findings on the anastomosis line were evaluated on the 10th postoperative day by performing a relaparatomy.

RESULTS

The mean bursting pressure values were 198 ± 11.37, 220 ± 17.7, and 244 ± 9.52 in Groups I, II, and III, respectively (Group I vs. II, p < 0.035; I vs III, p < 0.002; and II vs III, p < 0.021). The mean hydroxyproline levels were 1.21 ± 0.58, 1.47 ± 0.44, and 2.11 ± 0.32 in Groups I, II, and III, respectively (Group I vs II, p < 0.338; I vs III, p < 0.011; and II vs III, p < 0.025). When histopathologic findings of the groups were compared, the healing score of the intestinal tissue was higher in Group III than in Group I (p < 0.015), whereas there were no statistically significant differences among Groups I vs II and II vs III (p < 0.081 and p < 0.095, respectively).

CONCLUSION

Antibacterial suture usage increased anastomosis safety in the presence of peritonitis in resection and primary anastomosis.

Sigmoid colon torsion: mortality and relevant risk factors

INTRODUCTION

Sigmoid volvulus is an important acute intestinal obstruction, leading to high mortality and requiring urgent operation. The purpose of this study is to analyze risk factors for mortality in patients that were operated on due to sigmoid volvulus at our Department.

MATERIALS AND METHODS

The retrospective study included 158 patients, who were operated on due to sigmoid volvulus between January 1994-December 2010, in terms of age, gender, complaints at admission, physical signs, period of symptoms before admission, associated diseases, laboratory and radiological parameters, hospital stay, morbidity, and mortality.

RESULTS

The study consisted of 135 men (85.4%) and 23 women (14.6%), with a mean age of 62.54 years. Cardiovascular disease and respiratory disease were present in 34 (21.5%) and 42 (26.6%) patients, respectively. Urgent operation was undertaken in 125, while 33 received elective surgery. Abdominal distension and pain was evident in all the patients. Generalized tenderness was detected in 58.2%, while 70.9% had hyperactive bowel sound with tympanism. Plain radiograph revealed an impression of "omega ans" in all patients, while free air was detected in 11.4% of them. Risk factors for mortality included age (p = 0.008), delayed admission (p = 0.001), cardiovascular and respiratory diseases (p = 0.001), fluid-electrolyte imbalance (p =0.001), presence of necrosis (p = 0.001), and major contamination (p = 0.001). Wound infection and intraabdominal abscess were more common in patients that developed mortality (p = 0.001 and p = 0.002).

CONCLUSIONS

Complications like wound infection and intraabdominal abscess are more frequent in the patients with the risk of mortality. Delayed admission results in higher risk of mortality. Mortality rates can be reduced by early admission, preoperative intensive resuscitation, suitable antibiotics, and emergent and viable surgery.  

The comparison of the effects of hot milk and hot water scald burns and factors effective for morbidity and mortality in preschool children

PURPOSE

Scald burns are the leading cause of burns in children, especially in those younger than 5 years of age, however, they are easily preventable. Our aim in this study was to emphasise the importance and impact of scald burns caused by hot milk.

METHODS

A total of 334 patients below seven years of age were included in this study. Of these, 252 were admitted with acquired hot water scald burns (Group 1) and 82 with hot milk scald burns (Group 2) between August 2009 and September 2010. Demographic data of the patients were retrospectively investigated.

RESULTS

The depth of the burns was determined to be higher in Group 2 (p < 0.001). The total burnt body surface area in Group 1 and Group 2 were 17.1 ± 12.3 and 16.3 ± 10.9 (p = 0.99), respectively. Skin grafting was performed in 23 patients in Group 1 and 16 patients in Group 2 (p = 0.01) and complications developed in three patients in Group 1 and in five patients in Group 2 (p = 0.01). The mean length of hospital stay was 9.1 ± 7.4 days in Group 1 and 14.9 ± 9.8 days in Group 2 (p < 0.001) and the mortality rates were similar between the two groups.

CONCLUSIONS

More emphasis should be placed on the effects of hot milk scalding due to its ominous clinical course and the high healthcare costs associated with this type of scalding. We believe that taking simple precautions would help reduce the physical, psychological effects and financial consequences of hot milk scalds.

Laparoscopic salvage for malfunctioning of peritoneal dialysis catheters

AIM

The aim of this study was to emphasize the efficacy of the laparoscopic surgical method performed for elimination of catheter-induced mechanical complications developing in CAPD patients.

METHODS

Medical records of 31 patients who had undergone CAPD catheter implantation at the Dicle University Medical Faculty Hemodialysis Unit between January 2001 and June 2012 were examined retrospectively. Double-felted spiral Tenckhoff catheters were used in all patients for peritoneal access.

RESULTS

We performed a retrospective review of 31 patients who, over an 11-year period, underwent revision of a peritoneal dialysis catheter using laparoscopy. Chronic renal failure requiring dialysis occurred in 31 patients (12 males and 19 female). Ages ranged from 13 to 77 years (mean age 35.8 years).

CONCLUSION

As a conclusion, CAPD is currently a choice to be frequently used in patients with ESRD. In the treatment of CAPD-associated mechanical catheter complications laparoscopic method may be preferred because of patient comfort, short hospital stay, and lesser postoperative complications.