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Campbell BR, Rooney AS, Krzyzaniak A, Lee JJ, Carroll AN, Calvo RY, Peck KA, Martin MJ, Bansal V, Sise MJ, Krzyzaniak MJ. To the point: Utility of laparoscopy for operative management of stabbing abdominal trauma. Am J Surg 2024; 231:125-131. [PMID: 38309996 DOI: 10.1016/j.amjsurg.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/20/2023] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Algorithms for managing penetrating abdominal trauma are conflicting or vague regarding the role of laparoscopy. We hypothesized that laparoscopy is underutilized among hemodynamically stable patients with abdominal stab wounds. METHODS Trauma Quality Improvement Program data (2016-2019) were used to identify stable (SBP ≥110 and GCS ≥13) patients ≥16yrs with stab wounds and an abdominal procedure within 24hr of admission. Patients with a non-abdominal AIS ≥3 or missing outcome information were excluded. Patients were analyzed based on index procedure approach: open, therapeutic laparoscopy (LAP), or LAP-conversion to open (LCO). Center, clinical characteristics and outcomes were compared according to surgical approach and abdominal AIS using non-parametric analysis. RESULTS 5984 patients met inclusion criteria with 7 % and 8 % receiving therapeutic LAP and LCO, respectively. The conversion rate for patients initially treated with LAP was 54 %. Compared to conversion or open, therapeutic LAP patients had better outcomes including shorter ICU and hospital stays and less infection complications, but were younger and less injured. Assessing by abdominal AIS eliminated ISS differences, meanwhile LAP patients still had shorter hospital stays. At time of admission, 45 % of open patients met criteria for initial LAP opportunity as indicated by comparable clinical presentation as therapeutic laparoscopy patients. CONCLUSIONS In hemodynamically stable patients, laparoscopy remains infrequently utilized despite its increasing inclusion in current guidelines. Additional opportunity exists for therapeutic laparoscopy in trauma, which appears to be a viable alternative to open surgery for select injuries from abdominal stab wounds. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Bryan R Campbell
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
| | - Alexandra S Rooney
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
| | - Andrea Krzyzaniak
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
| | - Joseph J Lee
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
| | - Alyssa N Carroll
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
| | - Richard Y Calvo
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
| | - Kimberly A Peck
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
| | - Matthew J Martin
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
| | - Vishal Bansal
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
| | - Michael J Sise
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
| | - Michael J Krzyzaniak
- Division of Trauma and Acute Care Surgery, Department of Surgery, Scripps Mercy Hospital, San Diego, CA, USA.
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Gupta A, Channappa C, Elsheikh MARI, Annappa M. Vaginal pessary: a culprit for intraperitoneal bladder perforation. BMJ Case Rep 2024; 17:e257233. [PMID: 38569734 PMCID: PMC10989178 DOI: 10.1136/bcr-2023-257233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/05/2024] Open
Abstract
Vaginal pessaries are widely considered to be a safe and effective non-surgical management option for women with pelvic organ prolapse. Complications may occur, and are more frequent with improper care and certain device designs and materials. It is imperative to provide information to patients about potential complications. We present the case of a woman in her 70s who presented to the Emergency Department with increasing groin and abdominal pain following a vaginal pessary insertion 2 days prior for grade 3 vaginal vault prolapse. On presentation, her abdomen was markedly distended with guarding. Laboratory investigations showed a significant acute kidney injury with a metabolic acidosis. An initial non-contrast CT showed fluid and inflammatory changes surrounding the bladder, and bladder perforation was suspected. A subsequent CT cystogram showed extravasation of contrast from the bladder into the peritoneal cavity, in keeping with an intraperitoneal bladder rupture. The patient underwent an emergency bladder repair in theatre.
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Affiliation(s)
- Ankit Gupta
- School of Medicine, University of Leeds School of Medicine, Leeds, UK
| | | | | | - Manjula Annappa
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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Emara MH, Mazid U, Elshaer YA, Elkerdawy MA, Malik DF, Mahros AM. Trauma to the solid abdominal organs: The missed dark box of colonoscopy. World J Gastroenterol 2024; 30:624-630. [PMID: 38515946 PMCID: PMC10950622 DOI: 10.3748/wjg.v30.i7.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure. Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used, the sedatives used, but to the procedure related as well including bleeding and perforation. Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon, however, serious complications related to the procedure have been reported infrequently in the literature. Life threatening injuries to the spleen, liver, pancreas, mesentery, and urinary bladder have been reported as early as in mid-1970s. These injuries should not be overlooked by clinicians and endoscopists. Steadily increasing abdominal pain, abdominal distension, and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury. Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening. Although conservative management may help, yet they usually need interventional radiology or surgical intervention. Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively. The mechanism of abdominal organ injuries during colonoscopy is not fully understood, however many risk factors have been identified, which can be classified as- organ related, procedure related, and local abdominal factors. Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries. Left lateral position, avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
- Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
| | - Usama Mazid
- Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
| | - Yasmine A Elshaer
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mahmoud A Elkerdawy
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | | | - Aya M Mahros
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
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Pourmand A, Terrebonne E, Shapovalov V, Kartiko S, AlRemeithi R, Tran QK. Prevalence of intra-abdominal injury among patients with seatbelt signs, a systematic review and meta-analysis. Am J Emerg Med 2024; 76:199-206. [PMID: 38086186 DOI: 10.1016/j.ajem.2023.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION The advancement of seat belts have been essential to reducing morbidity and mortality related to motor vehicle collisions (MVCs). The "seat belt sign" (SBS) is an important physical exam finding that has guided management for decades. This study, comprising a systematic review and random-effects meta-analysis, asses the current literature for the likelihood of the SBS relating to intra-abdominal injury and surgical intervention. METHODS PubMed and Scopus databases were searched from their beginnings through August 4, 2023 for eligible studies. Outcomes included the prevalence of intra-abdominal injury and need for surgical intervention. Cochrane's Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I2 values were used to assess for heterogeneity. RESULTS The search yielded nine observational studies involving 3050 patients, 1937 (63.5%) of which had a positive SBS. The pooled prevalence of any intra-abdominal injury was 0.42, (95% CI 0.28-0.58, I2 = 96%) The presence of a SBS was significantly associated with increased odds of intra-abdominal injury (OR 3.62, 95% CI 1.12-11.6, P = 0.03; I2 = 89%), and an increased likelihood of surgical intervention (OR 7.34, 95% CI 2.03-26.54, P < 0.001; I2 = 29%). The measurement for any intra-abdominal injury was associated with high heterogeneity, I2 = 89%. CONCLUSION This meta-analysis suggests that the presence of a SBS was associated with a statistically significant higher likelihood of intra-abdominal injury and need for surgical intervention. The study had high heterogeneity, likely due to the technological advancements over the course of this study, including seat belt design and diagnostic imaging sensitivity. Further studies with more recent data are needed to confirm these results.
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Affiliation(s)
- Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Emily Terrebonne
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Vadym Shapovalov
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Susan Kartiko
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, United States
| | - Rashed AlRemeithi
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
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Santos J, Delaplain PT, Tay-Lasso E, Biffl WL, Schaffer KB, Sundel M, Ghneim M, Costantini TW, Santorelli JE, Switzer E, Schellenberg M, Keeley JA, Kim DY, Wang A, Dhillon NK, Patel D, Campion EM, Robinson CK, Kartiko S, Quintana MT, Estroff JM, Kirby KA, Grigorian A, Nahmias J. Development and Validation of a Novel Hollow Viscus Injury Prediction Score for Abdominal Seatbelt Sign: A Pacific Coast Surgical Association Multicenter Study. J Am Coll Surg 2023; 237:826-833. [PMID: 37703489 DOI: 10.1097/xcs.0000000000000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND High-quality CT can exclude hollow viscus injury (HVI) in patients with abdominal seatbelt sign (SBS) but performs poorly at identifying HVI. Delay in diagnosis of HVI has significant consequences necessitating timely identification. STUDY DESIGN This multicenter, prospective observational study conducted at 9 trauma centers between August 2020 and October 2021 included adult trauma patients with abdominal SBS who underwent abdominal CT before surgery. HVI was determined intraoperatively and physiologic, examination, laboratory, and imaging findings were collected. Least absolute shrinkage and selection operator- and probit regression-selected predictor variables and coefficients were used to assign integer points for the HVI score. Validation was performed by comparing the area under receiver operating curves (AUROC). RESULTS Analysis included 473 in the development set and 203 in the validation set. The HVI score includes initial systolic blood pressure <110 mmHg, abdominal tenderness, guarding, and select abdominal CT findings. The derivation set has an AUROC of 0.96, and the validation set has an AUROC of 0.91. The HVI score ranges from 0 to 17 with score 0 to 5 having an HVI risk of 0.03% to 5.36%, 6 to 9 having a risk of 10.65% to 44.1%, and 10 to 17 having a risk of 58.59% to 99.72%. CONCLUSIONS This multicenter study developed and validated a novel HVI score incorporating readily available physiologic, examination, and CT findings to risk stratify patients with an abdominal SBS. The HVI score can be used to guide decisions regarding management of a patient with an abdominal SBS and suspected HVI.
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Affiliation(s)
- Jeffrey Santos
- From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias)
| | - Patrick T Delaplain
- From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias)
- Department of Surgery, Boston Children's Hospital/Harvard Medical System, Boston, MA (Delaplain)
| | - Erika Tay-Lasso
- From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias)
| | - Walter L Biffl
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA (Biffl, Schaffer)
| | - Kathryn B Schaffer
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA (Biffl, Schaffer)
| | - Margaret Sundel
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD (Sundel, Ghneim)
| | - Mira Ghneim
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD (Sundel, Ghneim)
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA (Costantini, Santorelli)
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA (Costantini, Santorelli)
| | - Emily Switzer
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA (Switzer, Schellenberg)
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA (Switzer, Schellenberg)
| | - Jessica A Keeley
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA (Keeley, Kim)
| | - Dennis Y Kim
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA (Keeley, Kim)
| | - Andrew Wang
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Want, Dhillon, Patel)
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Want, Dhillon, Patel)
| | - Deven Patel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Want, Dhillon, Patel)
| | - Eric M Campion
- Department of Surgery, Denver Health Medical Center, Denver, CO (Campion, Robinson)
| | - Caitlin K Robinson
- Department of Surgery, Denver Health Medical Center, Denver, CO (Campion, Robinson)
| | - Susan Kartiko
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC (Kartiko, Quintana, Estroff)
| | - Megan T Quintana
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC (Kartiko, Quintana, Estroff)
| | - Jordan M Estroff
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC (Kartiko, Quintana, Estroff)
| | - Katharine A Kirby
- Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, CA (Kirby)
| | - Areg Grigorian
- From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias)
| | - Jeffry Nahmias
- From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias)
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Park C, Patel K. Invited Commentary: A Pragmatic Approach to Calculating Risk of Hollow Viscus Injury in Trauma Patients with a Seat-Belt Sign. J Am Coll Surg 2023; 237:833-834. [PMID: 37732624 DOI: 10.1097/xcs.0000000000000876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
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Schunn MC, Schäfer J, Neunhoeffer F, Lieber J, Fuchs J. [Blunt abdominal trauma in children and adolescents: treatment concepts in the acute phase]. Chirurgie (Heidelb) 2023; 94:651-663. [PMID: 37338573 DOI: 10.1007/s00104-022-01798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 06/21/2023]
Abstract
Fatal accidents due to blunt force trauma are the leading cause of death in children and adolescents [1]. Abdominal trauma is the third most common cause of death after traumatic brain injury and thoracic injuries [2]. Abdominal injury is seen in approximately 2-5% of children involved in accidents [3]. Blunt abdominal injuries are common sequelae of traffic accidents (for example as seat belt injury), falls, and sports accidents. Penetrating abdominal injuries are rare in central Europe. Spleen, liver, and kidney lacerations are the most common injuries after blunt abdominal trauma [4]. In most situations, nonoperative management (NOM) has become the gold standard with the surgeon leading the multidisciplinary treatment [5].
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Affiliation(s)
- M C Schunn
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
| | - J Schäfer
- Diagnostische und Interventionelle Radiologie, Abteilung für Kinderradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - F Neunhoeffer
- Klinik für Kinderheilkunde, Abteilung für Kinderkardiologie, Intensivmedizin und Pulmonologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - J Lieber
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - J Fuchs
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
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Gajin P, Nešković M. Chronic Blunt Abdominal Aortic Trauma. Eur J Vasc Endovasc Surg 2023; 65:492. [PMID: 36657705 DOI: 10.1016/j.ejvs.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/12/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Predrag Gajin
- "Dedinje" Cardiovascular Institute, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Navarro AS, Gomez CM, Angeles MA, Fuzier R, Ruiz J, Picard M, Martinez A, Ferron G. Open abdominal vacuum pack technique for the management of severe abdominal complications after cytoreductive surgery in ovarian cancer. Gynecol Oncol 2023; 170:108-113. [PMID: 36681011 DOI: 10.1016/j.ygyno.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/27/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the indications and management of grade III-IV postoperative complications in patients requiring vacuum-assisted open abdomen after debulking surgery for ovarian carcinomatosis. METHODS Retrospective study of prospectively collected data from patients who underwent a cytoreductive surgery by laparotomy for an epithelial ovarian cancer that required postoperative management of an open abdomen. An abdominal vacuum-assisted wound closure (VAWC) was applied in cases of abdominal compartmental syndrome (ACS) or intra-abdominal hypertension, to prevent ACS. The fascia was closed with a suture or a biologic mesh. The primary aim was to achieve primary fascial closure. Secondary outcomes considered included complications of cytoreductive surgery (CRS) and open abdominal wounds (hernia, fistula). RESULTS Two percent of patients who underwent CRS required VAWC during the study's patient inclusion period. VAWC indications included: (i) seven cases of gastro-intestinal perforation, (ii) three necrotic enterocolitis, (iii) two intestinal ischemia, (iv) three anastomotic leakages and (v) four intra-abdominal hemorrhages. VAWC was used to treat indications (i) to (iv) (which represented 73.7% of cases), to prevent compartmental syndrome. Primary fascia closure was achieved in 100% of cases, in four cases (21.0%) a biologic mesh was used. Median hospital stay was 65 days (range: 18-153). Four patients died during hospitalization, three of these within 30 days of VAWC completion. CONCLUSION VAWC for managing open abdominal wounds is a reliable technique to treat surgical post-CRS complications in advanced ovarian cancer and reduces the early post-operative mortality in cases presenting with severe complications.
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Affiliation(s)
- Anne-Sophie Navarro
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT) - Oncopole, Toulouse, France.
| | | | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT) - Oncopole, Toulouse, France
| | - Régis Fuzier
- Department of Anesthesia Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT) - Oncopole, Toulouse, France
| | - Jean Ruiz
- Intensive care unit, Institut Universitaire du Cancer de Toulouse (IUCT) - Oncopole, CHU Toulouse, Toulouse, France
| | - Muriel Picard
- Intensive care unit, Institut Universitaire du Cancer de Toulouse (IUCT) - Oncopole, CHU Toulouse, Toulouse, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT) - Oncopole, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT) - Oncopole, Toulouse, France
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10
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Pinchuk PV, Leonov SV, Levandrovskaia IA. [Algorithm of spleen and sterno-vertebrocostal segment models creation to simulate blunt abdominal trauma as a part of situational forensic medical examinations production]. Sud Med Ekspert 2023; 66:53-55. [PMID: 37796462 DOI: 10.17116/sudmed20236605153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
The algorithm of spleen and sterno-vertebrocostal segment models creation, the use of which allows to simulate various variants of conditions of spleen damage occurrence, is proposed. These data can be used for simulation of blunt abdominal trauma as a part of situational forensic medical examinations production. The results of performed experimental works on this issue showed the efficacy and adequacy of created models, which makes implementation of spleen injuries modelling into routine forensic medical expert practice promising.
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Affiliation(s)
- P V Pinchuk
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia
- Main State Centre of Forensic Medicine and Forensic Examinations, Moscow, Russia
| | - S V Leonov
- Main State Centre of Forensic Medicine and Forensic Examinations, Moscow, Russia
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - I A Levandrovskaia
- Main State Centre of Forensic Medicine and Forensic Examinations, Moscow, Russia
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Bélemlilga Gueswendé LH, Yabré N, Ouédraogo S, Keita N, Tiendrébéogo L, Zaré C, Zida M. [Abdomen Trauma From A Fall From A Height In Two University Teaching Hospital In Burkina Faso]. Mali Med 2023; 38:18-21. [PMID: 38514939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE The purpose of this study was to describe the nature and reasons for the fall, the injuries caused and their prognosis. PATIENTS AND METHODS This was a descriptive cross-sectional study over a period of 9 years. Patients admitted for abdominal trauma from a fall from a height during the study period were included. Ultrasound and CT scan allowed diagnosis of the lesion. Patients in shock who do not respond to resuscitation are considered to have unstable hemodynamics. RESULTS fifty-three cases of abdominal trauma by falling from a height, including 11 adults and 42 children, were collected. They were 46 men and 7 women. The average age was 11.6 years. In 86.8% (n=46) of the cases it was a fall from the top of a tree. There were 83% (n=44) abdominal contusion and 17% (n=9) open trauma. Other lesions were associated in 28.3% (n=15) of cases. There were 26 splenic lesions (49%), 14 liver (22.6%) and 6 hollow organs (11.3%). Non-operative treatment was applied in 79.2% (n=42) of cases. Morbidity was 9.4% (n=5) and mortality 5.7% (n=3). CONCLUSION Abdominal trauma from a fall from a height was dominated by falls from the top of fruit trees, and occurred in young male subjects.
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Affiliation(s)
| | - Nassirou Yabré
- Centre Hospitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | | | - Namori Keita
- Centre Hospitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | - Lazare Tiendrébéogo
- Centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Cyprien Zaré
- Centre Hospitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | - Maurice Zida
- Centre hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Wang J, Hu Y, Wang H. Acute abdominal aortic injury during posterior lumbar fusion surgery: A case report. Medicine (Baltimore) 2022; 101:e30216. [PMID: 36107582 PMCID: PMC9439786 DOI: 10.1097/md.0000000000030295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Vascular injury is a serious complication during lumbar fusion surgery, leading to massive blood loss and life-threatening circulatory failure. In this study, we report on a patient with abdominal aorta injury at L2-L3 level during lumbar fusion surgery via posterior approach. Fortunately, our patient was successfully managed with prompt intervention. PATIENT CONCERNS A 73-year-old female was admitted to our department of low back and bilateral leg pain with claudication for over 6 months. DIAGNOSIS L2-S1 spinal canal stenosis, with abdominal aorta injury at the L2-L3 level during lumbar fusion surgery via a posterior approach. INTERVENTIONS L2-S1 decompression and fusion via a posterior approach was employed for spinal canal stenosis. Transluminal angioplasty with stent placement was successfully performed to stop the bleeding. OUTCOMES During the procedure, it was decided that staunching the active bleeding was necessary and attention should be paid to the vital signs and blood pressure. Vascular surgical intervention was immediately scheduled when the blood pressure dropped. After stent placement, hemodynamic parameters stabilized. CONCLUSION In this case report we review the prevalent sites, predisposing risk factors, diagnosis, and treatment of acute abdominal aortic injury during posterior lumbar fusion surgery, in view of our case findings. Although the incidence of vascular injury during lumbar fusion surgery is low, it is often easily overlooked. Consequently, during surgery, physicians should always be alert to the risk of vascular injury and master its clinical characteristics. Once injury is suspected, active and effective measures should promptly be taken for diagnosis and treatment to avoid serious adverse consequences.
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Affiliation(s)
- Jianhe Wang
- Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, China
- The First Affiliated Hospital Of Dalian Medical University, Dalian City, China
| | - Yunxiang Hu
- Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, China
| | - Hong Wang
- Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, China
- *Correspondence: Hong Wang, Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, No. 826, Southwestern Road, Shahekou District, Dalian City, Liaoning Province 116021, China (e-mail: )
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Mahoney EJ, Bugaev N, Appelbaum R, Goldenberg-Sandau A, Baltazar GA, Posluszny J, Dultz L, Kartiko S, Kasotakis G, Como J, Klein E. Management of the open abdomen: A systematic review with meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2022; 93:e110-e118. [PMID: 35546420 DOI: 10.1097/ta.0000000000003683] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multiple techniques describe the management of the open abdomen (OA) and restoration of abdominal wall integrity after damage-control laparotomy (DCL). It is unclear which operative technique provides the best method of achieving primary myofascial closure at the index hospitalization. METHODS A writing group from the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of the current literature regarding OA management strategies in the adult population after DCL. The group sought to understand if fascial traction techniques or techniques to reduce visceral edema improved the outcomes in these patients. The Grading of Recommendations Assessment, Development and Evaluation methodology was utilized, meta-analyses were performed, and an evidence profile was generated. RESULTS Nineteen studies met inclusion criteria. Overall, the use of fascial traction techniques was associated with improved primary myofascial closure during the index admission (relative risk, 0.32) and fewer hernias (relative risk, 0.11.) The use of fascial traction techniques did not increase the risk of enterocutaneous fistula formation nor mortality. Techniques to reduce visceral edema may improve the rate of closure; however, these studies were very limited and suffered significant heterogeneity. CONCLUSION We conditionally recommend the use of a fascial traction system over routine care when treating a patient with an OA after DCL. This recommendation is based on the benefit of improved primary myofascial closure without worsening mortality or enterocutaneous fistula formation. We are unable to make any recommendations regarding techniques to reduce visceral edema. LEVEL OF EVIDENCE Systematic Review and Meta-Analysis; Level IV.
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Affiliation(s)
- Eric J Mahoney
- From the Tufts Medical Center (E.J.M, N.B.), Division of Trauma and Acute Care Surgery, Department of Surgery, Boston, Massachusetts; Atrium Health Wake Forest Baptist (R.A.) Division of Acute Care Surgery, Department of Surgery, Winston-Salem, North Carolina; Cooper University Hospital (A.G.-S.), Division of Trauma and Acute Care Surgery, Department of Surgery, Camden, New Jersey; NYU Langone Hospital-Long Island (G.A.B.), Division of Trauma and Acute Care Surgery, Department of Surgery, Mineola, New York; Northwestern Memorial Hospital (J.P.), Division of Trauma and Critical Care, Department of Surgery, Chicago, Illinois; University of Texas Southwestern (L.D.), Division of Burn, Trauma, Acute and Critical Care Surgery, Department of Surgery, Dallas, Texas; The George Washington School of Medicine and Health Sciences (S.K.), Center of Trauma and Critical Care, Department of Surgery, Washington, District of Columbia; Duke University Medical Center (G.K.), Division of Trauma and Critical Care Surgery, Department of Surgery, Durham, North Carolina; MetroHealth Medical Center (J.C.), Cleveland, Ohio; and Northwell Health-North Shore University Hospital (E.K.) Division of Acute Care Surgery, Department of Surgery, Great Neck, New York
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Schieffer S, Costa C, Gawdi R, Devane K, Ronning IN, Hartka T, Martin RS, Kiani B, Miller AN, Hsu FC, Stitzel JD, Weaver AA. Body mass index influence on lap belt position and abdominal injury in frontal motor vehicle crashes. Traffic Inj Prev 2022; 23:494-499. [PMID: 36037019 DOI: 10.1080/15389588.2022.2113782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE As obesity rates climb, it is important to study its effects on motor vehicle safety due to differences in restraint interaction and biomechanics. Previous studies have shown that an abdominal seatbelt sign (referred hereafter as seatbelt sign) sustained from motor vehicle crashes (MVCs) is associated with abdominal trauma when located above the anterior superior iliac spine (ASIS). This study investigates whether placement of the lap belt causing a seatbelt sign is associated with abdominal organ injury in occupants with increased body mass index (BMI). We hypothesized that higher BMI would be associated with a higher incidence of superior placement of the lap belt to the ASIS level, and a higher incidence of abdominal organ injury. METHODS A retrospective data analysis was performed using 230 cases that met inclusion criteria (belted occupant in a frontal collision that sustained at least one abdominal injury) from the Crash Injury Research and Engineering Network (CIREN) database. Computed tomography (CT) scans were rendered to visualize fat stranding to determine the presence of a seatbelt sign. 146 positive seatbelt signs were visualized. ASIS level was measured by adjusting the transverse slice of the CT to the visualized ASIS level, which was used to determine seatbelt sign location as superior, on, or inferior to the ASIS. RESULTS Obese occupants had a significantly higher incidence of superior belt placement (52%) vs on-ASIS placement (24%) compared to their normal (27% vs 67%) BMI counterparts (p < 0.001). Notable trends included obese occupants with superior placement having less abdominal organ injury incidence than those with on-ASIS belt placement (42% superior placement vs 55% on-ASIS). In non-obese occupants, there was a higher incidence of abdominal organ injury with superior lap belt placement compared to on-ASIS placement counterparts (Normal BMI: 62% vs 41%, Overweight: 57% vs 43%). CONCLUSIONS In CIREN occupants with abdominal injury, those with obesity are more prone to positioning the lap belt superior to the ASIS, though the impact on abdominal injury incidence remains a key point for continued exploration into how occupant BMI affects crash safety and belt design.
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Affiliation(s)
- Sydney Schieffer
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Casey Costa
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rohin Gawdi
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Karan Devane
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Isaac N Ronning
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thomas Hartka
- Department of Emergency Medicine, University of Virginia, Charlottesville, Virginia
| | - R Shayn Martin
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bahram Kiani
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna N Miller
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ashley A Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Sahariah Khound G, Bora D, Khaund Borkotoky R, Paul SP. Pancreatic Transection in a 6-year Child Following Bicycle Handlebar Injury. J Coll Physicians Surg Pak 2022; 32:541-543. [PMID: 35330535 DOI: 10.29271/jcpsp.2022.04.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/22/2021] [Indexed: 06/14/2023]
Abstract
Bicycle handlebar injuries are the commonest cause of pancreatic trauma in children and adolescents, especially in males. Recognition of such injuries and initiation of correct treatment may be delayed when there is no abdominal wall bruising. We present a case of a 6-year boy with severe pancreatic trauma, who was referred from a local hospital following bicycle handlebar injury five days earlier. Contrast-enhanced computed tomography showed grade III pancreatic injury, which was repaired the following day; and he subsequently made a good recovery. The case highlights challenges faced by non-specialist clinicians working in resource-limited settings in diagnosing these injuries. Key Words: Bicycle handlebar injury, Blunt trauma, Pancreatic injury.
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Affiliation(s)
| | - Dibyajyoti Bora
- Department of Gastrointestinal Surgery, Apollo Hospitals, (Unit: International Hospital), Guwahati, India
| | - Rekha Khaund Borkotoky
- Department of Paediatrics, Apollo Hospitals, (Unit: International Hospital), Guwahati, India
| | - Siba Prosad Paul
- Department of Paediatrics, Yeovil District Hospital, Yeovil, United Kingdom
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Halloway D, Hauschild H, Pintar F, Yoganandan N. Belt-induced abdominal injuries in recent frontal impact CIREN cases. Traffic Inj Prev 2021; 22:S142-S146. [PMID: 34714184 DOI: 10.1080/15389588.2021.1982595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The objective is to report sex-related variation in 3-point belt-related abdominal injuries in Crash Injury Research Engineering Network (CIREN) cases. METHODS A query of CIREN cases was made for those with the highest ranked Collision Deformation Classification (CDC) to the front plane, a principal direction of force (PDOF) ±20° from 0°, and Abbreviated Injury Scale (AIS) 2+ abdomen injuries attributed to the seat belt. Patterns of injury were categorized as above the crest of the ilium, injuries below the crest of the ilium, and injuries above and below the ilium. This was done in the context of autonomous vehicle occupant kinematics testing results. Twelve 5th and 95th percentile 3-point belt-restrained postmortem human subjects were subjects; test speeds and recline angles varied. Abdomen injuries were anticipated; none were observed. RESULTS Thirty-five occupants with belt-related abdominal injuries were identified. Seventeen case occupants sustained an injury only within the pelvic contents: 5 women and 12 men. Nine of the 17 were at or above the 81st percentile for height, 13 were between the 62nd and 80th percentile for height, and 4 were less than the 50th percentile for height. CONCLUSIONS The stature component of the body mass index (BMI) appears to be a plausible candidate for an independent variable that is a contributing factor explaining the incidence of pelvic contents injuries when a 3-point belt-restrained occupant is involved in a frontal impact.
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Affiliation(s)
| | | | - Frank Pintar
- Medical College of Wisconsin, Milwaukee, Wisconsin
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17
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Abstract
OBJECTIVES Injuries associated with bicycles can generally be categorized into 2 types: injuries from falling from/off bicycles and injuries from striking the bicycle. In the second mechanism category, most occur as a result of children striking their body against the bicycle handlebar. The purpose of this study was to evaluate the presentation, body location, injury severity, and need for intervention for pediatric handlebar injuries at a single level one pediatric trauma center and contrast these against other bicycle-related injuries in children. METHODS This work is a retrospective review of the trauma registry over an 8-year period. Individual charts were then reviewed for patients' demographic factors, injury details, and other clinical/radiographic findings. Each patient was then categorized as either having a handlebar versus nonhandlebar injury. Additionally, each patient's injuries were classified according to affected body "zone(s)" and the need for intervention in relation to these injuries. During the course of chart review, several unique radiographic and history/physical findings were noted and are also reported. RESULTS During the study period, 385 patients were identified that met study criteria. Bicycle handlebars were involved in 27.8% (107/385) of injuries and 72.2% (278/385) were nonhandlebar injuries. There were differences in injury severity score, Head Abbreviated Injury Scale, length of stay between patients with handlebar versus nonhandlebar injuries, respectively. There were also differences in incidence of injuries across most body zones between patients with handlebar versus nonhandlebar injuries. There was statistically significant difference in need for intervention for abdominal solid organ injuries among handlebar versus nonhandlebar injuries mechanisms (21.6% vs 0%; P = 0.026), respectively. Sixteen patients with a handlebar injury underwent abdominal computed tomography (CT), which found only pericolic/pelvic free fluid or were negative for any disease and had normal/mildly elevated liver function test results at the time of arrival with otherwise normal laboratory workup results. Two patients required laparotomy for bowel injury and presented with peritonitis less than 12 hours after injury. The remaining patients did not have peritonitis on examination and were discharged without operative intervention 12 to 24 hours after injury without further event. CONCLUSIONS The bicycle handlebar is a unique mechanism of injury. The location, need for intervention, and the nature of the injury can vary significantly compared to other bicycle injuries. Handlebar injuries are more likely to cause abdominal and soft tissue injuries, whereas nonhandlebar injuries are more likely to cause extremity and skull/neck/central nervous system injuries. Because more than 20% of the reported handlebar injuries did not involve the abdomen or thoracoabdominal/extremity soft tissue as well as the variable presentation of handlebar injuries, it is imperative for the physician to consider this mechanism in all bicycle injuries. In addition, even within the same area of the body, handlebar injuries can be very different compared to nonhandlebar (i.e., orthopedic vs vascular injuries in the extremities). Physical examination and observation remain paramount when laboratory and radiographic workups are equivocal.
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Affiliation(s)
- Robert J Vandewalle
- From the Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine
| | | | - Jodi L Raymond
- Riley Hospital for Children at Indiana University Health
| | - Brandon P Brown
- Division of Pediatric Radiology, Department of Radiology, Indiana University School of Medicine
| | - Thomas M Rouse
- From the Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine
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Conti L, Grassi C, Delfanti R, Cattaneo GM, Banchini F, Capelli P. Left diaphragmatic rupture in vehicle trauma: Report of surgical treatment and complications of two consecutive cases. Acta Biomed 2021; 92:e2021121. [PMID: 33944817 PMCID: PMC8142760 DOI: 10.23750/abm.v92is1.10931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Diaphragmatic ruptures are associated with blunt abdominal or thoracic trauma and often occur in car and motorbike accident with a high energy impact. CASE PRESENTATION We report two cases of patients victims of car and motorbike accidents that were referred to the Emergency Department of our Hospital in August and September 2017 for a politrauma. The patients were both diagnosed with a left diaphragmatic rupture with herniation of the stomach in the chest, and decomposed fractures of the ribs. One of the two patients reported a large abdominal wound with loss of substance in the site of the impact. Both patients underwent to open emergency surgery with primary repair of the phrenic rupture. The post-operative course was characterized by the occurrence of complications such as respiratory distress and emothorax for one of the patients. CONCLUSION Traumatic rupture of the diaphragm can be associated to blunt or penetrating abdominal trauma in car and motorbike accident with a prevalence of the left-sided lesions. In patients with politrauma an associate rupture of the diaphragm should be always suspected especially in motor accident where high energy impact can generate a traumatic laceration of the respiratory muscle. The treatment of associate thoracic wall fractures to prevent weaning and respiratory distress in intubated patient should be discussed.
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Affiliation(s)
- Luigi Conti
- Department of Surgery, G. Da Saliceto Hospital, Piacenza.
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Abstract
ABSTRACT We describe 13 children who presented to the Penn State Health Milton S. Hershey Medical Center (HMC) with pediatric soccer-related abdominal organ injuries. A review of the Pennsylvania Trauma System Foundation's Trauma Registry was performed between 2001 and 2015 for children with soccer injuries hospitalized at trauma centers across Pennsylvania. Out of 52 children at Hershey Medical Center, 13 suffered abdominal organ injuries. Injuries included the spleen [5], kidney [4], liver [2], and combined organ involvement [2]. All patients presented with abdominal and/or flank pain. All patients with kidney injuries presented with hematuria. All patients presented after a player-to-player (P2P) contact. Nearly all patients (12/13) were treated nonsurgically. Our findings showed that abdominal organ injuries constitute a substantial portion of pediatric soccer injuries requiring hospitalization, with spleen being the organ injured most frequently. Soccer-related abdominal organ injuries should be suspected in players who suffer abdominal and/or flank pain, and/or hematuria after a P2P contact.
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Affiliation(s)
| | | | - Joseph Hess
- Pediatric Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey
| | - William Hennrikus
- Orthopaedic Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
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20
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Tokumaru T, Eifuku R, Sai K, Kurata H, Hata M, Tomioka J. Pediatric blunt abdominal trauma with horizontal duodenal injury in school baseball: A case report. Medicine (Baltimore) 2021; 100:e24089. [PMID: 33466171 PMCID: PMC10545394 DOI: 10.1097/md.0000000000024089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/13/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Pediatric sports injuries, including those from baseball, most often are musculoskeletal injuries and rarely include blunt abdominal injuries. Duodenal injury is rare and often associated with other organ injuries. Because it has a relatively high mortality, early recognition and timely treatment are needed. Here, we report a case of successful treatment of a pediatric patient with duodenal injury incurred in the context of school baseball. PATIENT CONCERNS A 13-year-old boy suffered blunt abdominal trauma and a right-hand injury caused by beating his abdomen strongly with his own right knuckle after he performed a diving catch during a baseball game. On the following day, the abdominal pain had worsened. DIAGNOSES Computed tomography led to a suspicion of injury to the horizontal part of the duodenum. INTERVENTIONS The duodenal injuries were repaired by simple closure. On the 10th post-operative day, an abscess formed in the retroperitoneal cavity because of an occult pancreatic injury. Ultrasound-guided percutaneous drainage of the cavity was performed. OUTCOMES The post-operative course of the abscess drainage was uneventful. The patient was discharged from our hospital on day 72 after admission and was in good health at the 9-month follow-up. LESSONS Regardless of the type of injury, we must assess the life-threatening conditions that can be expected based on the mechanism of the injury. In duodenal injuries, it is critical to perform surgical procedures and post-operative management based on the assumption of injuries to other organs.
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Atıcı A, Özkan M, Çelikkaya ME, Akçora B. Successful Treatment of Major Abdominal Trauma in a 9-year-old Male due to Bomb Explosion. Chirurgia (Bucur) 2020; 115:690-694. [PMID: 33138908 DOI: 10.21614/chirurgia.115.5.690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
Abstract
The present case report describes a pediatric patient that sustained and survived major abdominal trauma due to an open-air explosion during the Syrian civil war. A 9-year-old male patient was brought to our hospital's paediatric emergency department after a bomb explosion that occurred 8 hours prior to presentation. The patient had a severe flap-like skin defect that extended from the below the umbilicus to the right femur. The defect was embedded with multiple stones, plastic, and soil fragments of varying size. Debridement of the anterior abdominal wall was performed, followed by exploratory laparotomy. Multiple sites of perforation of the small bowel were resected, and anastomosis was performed. Vacuum-assisted closure (VAC) was applied to the large wound area. The VAC dressing was changed every 3 days. Granulation tissue developed post-operatively after 26 days and the defect was repaired using skin grafts harvested from the patient's left leg. The patient was considered fully recovered and was discharged 34 days post-surgery. The presented case shows that despite the severity of the patient's major abdominal injuries, rapid wound debridement, exploratory laparotomy, VAC therapy and a multidisciplinary approach are crucial in preventing death and achieving a full recovery.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Erdman MK, Munger AM, Brown M, Schellenberg M, Tucker D, Inaba K, Fleming ME, Marecek GS. Injury and treatment patterns of ballistic pelvic fractures by anatomic location. Eur J Orthop Surg Traumatol 2020; 31:111-119. [PMID: 32720105 DOI: 10.1007/s00590-020-02744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/14/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pelvic ballistic injuries threaten critical gastrointestinal, vascular, and urinary structures. We report the treatment patterns and injury profiles of ballistic pelvic fractures and the association between location of ballistic fractures of the pelvis and visceral injuries. METHODS A prospectively collected database at an academic level I trauma center was reviewed for clinical and radiographic data on patients who sustained one or more ballistic fractures of the pelvis. Main outcomes compared included: procedures with orthopedic surgery, emergent surgery, concomitant intrapelvic injuries, and mortality. RESULTS Eighty-six patients were included. Eight patients (9.3%) underwent surgical debridement with orthopedic surgery, no ballistic pelvic fractures required surgical stabilization. The anatomical locations of ballistic pelvic fractures included: 10 (14.7%) anterior ring, 13 (19.1%) posterior ring, 27 (39.7%) anterior column, and 18 (20.9%) posterior column. There was a statistically significant association between anterior ring and rectal injury. The association between anterior ring injury and bladder injury approached significance. CONCLUSIONS This case series included 86 patients with a ballistic fracture of the pelvis, none requiring pelvic ring surgical stabilization. The unpatterned behavior of these injuries demands a high suspicion for visceral injury, with special attention to the rectum and bladder in the setting of anterior ring involvement. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Mary Kate Erdman
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Alana M Munger
- Yale Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Meghan Brown
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Douglass Tucker
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Yale Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Mark E Fleming
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Geoffrey S Marecek
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Cohan CM, Beattie G, Tang A, Mazzolini K, Farzaneh N, Senekjian L, Victorino GP. Does Abdominal Seat Belt Sign Warrant Admission After a Negative CT Scan? A Cost-Utility Analysis. J Surg Res 2020; 255:619-626. [PMID: 32653694 DOI: 10.1016/j.jss.2020.05.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/05/2020] [Accepted: 05/24/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Rapid deceleration against a seat belt during a motor vehicle collision (MVC) may result in an abdominal seat belt sign (ASBS), which is associated with a higher risk of hollow viscus injury (HVI). After a negative abdominal CT scan, management of patients with ASBS is variable, but recent evidence suggests emergency department (ED) discharge may be safe. Therefore, we hypothesized that discharge from the ED is cost-effective compared with 23-h observation or hospital admission for patients with ASBS and a negative CT. METHODS A cost-utility model was developed for an evaluable patient with ASBS and negative CT scan using TreeAge software. ED discharge was compared with 23-h observation and admission. Analysis was from a health care-based third-party payer perspective. Quality-adjusted life years (QALYs) were based on 3-y expected outcomes. Probability and costs were estimated from published literature and the Healthcare Cost and Utilization Project. RESULTS In our base case, ED discharge was the most cost-effective strategy, yielding a cost of $706 with 2.86 QALYs. The average costs of 23-h observation and hospital admission were $2600 and $8,827, respectively, with 2.87 QALYs gained each. The strategy of ED observation becomes cost-effective when the rate of HVI after ED discharge exceeds 2.3%. In a Monte Carlo simulation, ED discharge was the optimal strategy in 91% of 1000 trials of the model. CONCLUSIONS ED discharge is a cost-effective strategy for evaluable patients with ASBS and a negative abdominal CT and remains so when the risk of HVI after ED discharge is higher than currently assumed.
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Affiliation(s)
- Caitlin M Cohan
- Department of Surgery, University of California San Francisco, East Bay, Oakland, California.
| | - Genna Beattie
- Department of Surgery, University of California San Francisco, East Bay, Oakland, California
| | - Annie Tang
- Department of Surgery, University of California San Francisco, East Bay, Oakland, California
| | - Kirea Mazzolini
- Department of Surgery, University of California San Francisco, East Bay, Oakland, California
| | | | - Lara Senekjian
- Department of Surgery, University of California San Francisco, East Bay, Oakland, California
| | - Gregory P Victorino
- Department of Surgery, University of California San Francisco, East Bay, Oakland, California
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Patel S, Sheahan CM, Fontenot DD, Sheahan MG. Aortic Transection after Blunt Abdominal Trauma in a Child. Ann Vasc Surg 2020; 66:671.e11-671.e14. [PMID: 32035264 DOI: 10.1016/j.avsg.2020.01.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/16/2022]
Abstract
Abdominal aortic injury secondary to blunt abdominal aortic trauma (BAAI) is rare in children but frequently occurs in association with other injuries, including bowel injury and vertebral fracture. We present a case of a 14-year-old boy who sustained a partial transection of the infrarenal aorta with a lumbar chance fracture and small bowel injury after a motor vehicle accident. Repair was performed with bowel resection followed by Dacron graft interposition. We reviewed the literature on BAAI in children with a focus on the method of repair of these injuries.
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Affiliation(s)
- Shivik Patel
- Louisiana State University Health Sciences Center, New Orleans, LA
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Donahue C, Sarkar B, Narsule C, Taha A, Rosenblatt M. Management of an Anterior Abdominal Stab Wound in a Hostile Abdomen. Am Surg 2020; 86:e79-e80. [PMID: 32167052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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[A focal abdominal swelling after an accident with a 'space scooter']. Ned Tijdschr Geneeskd 2020; 163:D3986. [PMID: 32186818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 7-year-old boy presents at the Emergency Department with an abdominal swelling after an accident with a space scooter. He was diagnosed with a traumatic anterior abdominal wall hernia, for which he underwent surgical correction.
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Delaplain PT, Barrios C, Spencer D, Lekawa M, Schubl S, Dosch A, Grigorian A, Smith M, Pejcinovska M, Nahmias J. The use of computed tomography imaging for abdominal seatbelt sign: A single-center, prospective evaluation. Injury 2020; 51:26-31. [PMID: 31706587 DOI: 10.1016/j.injury.2019.10.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/11/2019] [Accepted: 10/30/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Guidelines surrounding abdominal seat belt sign (SBS) were made prior to the use of modern computed tomography (CT) imaging. We sought to prospectively determine whether a negative CT scan is associated with the absence of hollow viscus injury (HVI), and we hypothesized that trauma patients with an abdominal SBS without CT imaging findings would not have a hollow viscus injury (HVI). METHODS A prospective cohort of patients with SBS was compiled over one year. Subjects were divided into those with and without HVI. Covariate distributions were summarized by group. Bivariate tests and logistic regression were used to investigate associations between covariates and HVI. RESULTS Of 220 patients with SBS, the incidence of HVI was 7% (n = 15). Radiographic findings were strongly associated with HVI and no patients with a negative CT scan had HVI. Free fluid was seen in 80% (12) of patients with HVI, whereas it was found in only 11% (23) without injury. A composite variable for negative CT scan was found to be associated with the absence of HVI: (Fisher's exact 1-tailed p, doubled = 0.014). CONCLUSION In this study, the incidence of HVI with SBS is lower than previously reported, and no patients with negative CT imaging required an operation for HVI-suggesting there is a population of patients with SBS who could be discharged from the emergency room. A prospective multicenter study is needed to confirm these findings.
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Affiliation(s)
- Patrick T Delaplain
- Department of Surgery, University of California, Irvine Medical Center, United States.
| | - Cristobal Barrios
- Division of Trauma, Burns and Critical Care, University of California, Irvine Medical Center, United States
| | - Dean Spencer
- Department of Surgery, University of California, Irvine Medical Center, United States
| | - Michael Lekawa
- Division of Trauma, Burns and Critical Care, University of California, Irvine Medical Center, United States
| | - Sebastian Schubl
- Division of Trauma, Burns and Critical Care, University of California, Irvine Medical Center, United States
| | - Austin Dosch
- Department of Surgery, University of California, Irvine Medical Center, United States
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine Medical Center, United States
| | - Megan Smith
- Center for Statistical Consulting, University of California, Irvine, United States
| | - Marija Pejcinovska
- Center for Statistical Consulting, University of California, Irvine, United States
| | - Jeffry Nahmias
- Division of Trauma, Burns and Critical Care, University of California, Irvine Medical Center, United States
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Zeeshan M, Hamidi M, O'Keeffe T, Hanna K, Kulvatunyou N, Tang A, Joseph B. Pediatric Liver Injury: Physical Examination, Fast and Serum Transaminases Can Serve as a Guide. J Surg Res 2019; 242:151-156. [PMID: 31078899 DOI: 10.1016/j.jss.2019.04.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/21/2019] [Accepted: 04/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of our study was to determine if the combination of physical examination (PE), serum transaminases along with Focused Assessment with Sonography in Trauma (FAST) would effectively rule out major hepatic injuries (HIs) after blunt abdominal trauma (BAT) in hemodynamically stable pediatric patients. METHODS We conducted a 9-year retrospective study of pediatric patients (<18 y) with BAT. We collected data on liver enzymes (aspartate transaminase [AST] and alanine transaminase [ALT]), FAST, and PE findings. Definitive diagnosis and staging of HI were based on abdominal CT scanning. The sensitivity and specificity of ALT/AST, FAST, and PE were then calculated individually and in combination. RESULTS We identified a total of 423 pediatric patients with BAT. Mean age was 11 y, median abdominal Abbreviated Injury Scale was 3 [2-4], and mean ED-SBP was 132 mm Hg. One hundred ninety-eight patients had HI of which 107 were major HI, defined by the American Association for the Surgery of Trauma as ≥grade III. Using ROC curve analysis, optimum ALT and AST thresholds were determined to be 90 U/L and 120 U/L, respectively. The sensitivity of FAST was 50% while that of PE was 40%. Combining PE with AST/ALT and FAST had an overall sensitivity of 97%, a specificity of 95%, a positive predictive value of 87%, and a negative predictive value of 98%. CONCLUSIONS In hemodynamically stable pediatric blunt abdominal trauma patients, CT scanning can be avoided using a combination of readily available tests thus avoiding unnecessary radiation exposure. However, pediatric patients with positive PE, FAST, and elevated AST/ALT may eventually require CT scan to further evaluate liver injuries.
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Affiliation(s)
- Muhammad Zeeshan
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Mohammad Hamidi
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Terence O'Keeffe
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Kamil Hanna
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Narong Kulvatunyou
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Andrew Tang
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
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Schmiegelow AF, Stockholm JH, Burgdorf SK. [Traumatic pancreatic lesions]. Ugeskr Laeger 2019; 181:V06180442. [PMID: 31036150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this review, the recommendations for treating pancreatic traumas are summarised. A pancreatic trauma is rare but serious. Initially, the symptoms can be subtle and may easily be overlooked by concurrent injuries such as internal bleeding. Delayed detection of pancreatic lesions is associated with increased mortality and morbidity. There is a tendency towards a more conservative approach in the treatment of pancreatic lesions, including injuries involving the pancreatic duct. In the haemodynamically instable patient damage control surgery is preferred, with closed suction drainage of the pancreas and later definitive surgery. We propose contact to a hepato-pancreato-biliary facility in case of any suspicion of a pancreatic injury.
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Olsen AA, Penninga L, Achiam MP. [Severe intra-abdominal injuries following the LUCAS chest compression system being applied for cardiopulmonary resuscitation]. Ugeskr Laeger 2019; 181:V11180828. [PMID: 30950373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this case report two patients, having severe intra-abdominal injuries after cardiopulmonary resuscitation (CPR) with the LUCAS system, are presented. They both underwent surgical intervention. Severe intra-abdominal injuries following manual CPR are rare, but little is known about the incidence of these injuries associated with mechanical CPR. We have reviewed the literature on clinical outcome and adverse events after out-of-hospital cardiac arrest with LUCAS CPR and manual CPR, and our conclusion is, that more research is needed to establish the safety of mechanical chest compression systems.
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Skalický T, Skalický A. [Liver Injury after a Collapse Caused by Acute Myocardial Infarction, Resuscitation and Acute Myocardial Revascularisation]. Acta Chir Orthop Traumatol Cech 2019; 86:444-446. [PMID: 31941573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The presented case report describes primarily an unrecognized liver injury after the resuscitation with cardiac massage due to myocardial infarction. After myocardial revascularization, the hemodynamic instability and anaemia in the patient persisted. The performed CT scan confirmed a liver injury, namely the rupture of liver parenchyma with hemoperitoneum, which had to be treated surgically. It represents a complication of cardiac massage that occurs, though less frequently. Key words: resuscitation, liver trauma.
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Affiliation(s)
- T Skalický
- Chirurgická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice, Plzeň
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Onuoha CE, Onuoha KM, Odufola O. Seat-Belt Syndrome as managed in Babcock University Teaching Hospital. A Case Report and Literature Review. West Afr J Med 2019; 36:75-79. [PMID: 30924120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND This paper is a case report of a 54 year old woman that presented in our casualty with just "seat belt sign" following a road traffic injury. At laparotomy, she was found to have sustained disastrous internal/visceral injuries with torrential intraperitoneal haemorrhage from the surface of the liver caused by the seat belt. Frantic attempts at haemostasis were proving difficult and time wasting. The lacerated liver surface was then generously packed with absorbent abdominal mops which were left in-situ for 48hrs. A second-look operation 48 hrs later revealed satisfactory haemostasis of the bleeding surface of the left lobe of the liver OBJECTIVE: This paper is to highlight the wisdom in using "Damage Control" techniques to save a patient's life in an unsuspecting torrential bleed during laparotomy - especially in seatbelt injuries. DESCRIPTION "Damage Control" implies doing the minimum, in the quickest time possible, to keep patient alive and coming back when patient is stable to deal with the pathology. RESULT After 48hrs, a re-laparotomy was performed on the patient and it was found that complete haemostasis had been achieved. The packs were removed and abdomen closed in a single layer. The patient remained well till discharge after two weeks of hospitalisation and has remained well on follow up. CONCLUSION Seatbelts, although protective, can lead to complex injury patterns. Early detection and prompt management of the injuries is key to survival.
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Affiliation(s)
- C E Onuoha
- Department of Surgery, Babcock University Teaching Hospital - Ilisan Remo, Ogun State - Nigeria
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Abstract
PURPOSE This study examines non-accidental trauma (NAT) fatalities as a percentage of all injury fatalities and identifies injury patterns in NAT admissions to two level 1 pediatric trauma centers. METHODS We reviewed all children (<5years old) treated for NAT from 2011 to 2015. Patient demographics, injury sites, and survival were obtained from both institutional trauma registries. RESULTS Of 4623 trauma admissions, 557 (12%) were due to NAT. However, 43 (46%) of 93 overall trauma fatalities were due to NAT. Head injuries were the most common injuries sustained (60%) and led to the greatest increased risk of death (RR 5.1, 95% CI 2.0-12.7). Less common injuries that increased the risk of death were facial injuries (14%, RR 2.9, 95% CI 1.6-5.3), abdominal injuries (8%, RR 2.8, 95% CI 1.4-5.6), and spinal injuries (3%, RR 3.9, 95% CI 1.8-8.8). Although 76% of head injuries occurred in infants <1year, children ages 1-4years old with head injuries had a significantly higher case fatality rate (27% vs. 6%, p<0.001). CONCLUSION Child abuse accounts for a large proportion of trauma fatalities in children under 5years of age. Intracranial injuries are common in child abuse and increase the risk of death substantially. Preventing NAT in infants and young children should be a public health priority. TYPE OF STUDY Retrospective Review. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Yangyang R Yu
- Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Annalyn S DeMello
- Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Christopher S Greeley
- Department of Pediatrics, Section of Public Health Pediatrics, Texas Children's Hospital, Houston, TX, United States
| | - Charles S Cox
- Department of Pediatric Surgery, Children's Memorial Hermann Hospital, Houston, TX, United States
| | - Bindi J Naik-Mathuria
- Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States
| | - David E Wesson
- Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Houston, TX, United States.
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Schmidt MS, Rosenberg J, Tolver MA. Traumatic bicycle handlebar hernia in children: a systematic review. Dan Med J 2018; 65:A5433. [PMID: 29301610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This is a systematic review of existing literature on the diagnostic modalities and treatment of traumatic abdominal wall hernia caused by bicycle handlebar injury in children.
METHODS: A systematic literature search was conducted covering incidents involving children below 17 years of age. Data were extracted regarding gender, age, diagnostic modality, timing of surgery, location of hernia, associated injuries, management and recurrence of hernia.
RESULTS: A total of 62 cases of handlebar hernia were included in the systematic review. CT scan was the most frequently used final diagnostic modality (52%) followed by
ultrasonography (13%), explorative laparotomy (5%) and diagnostic laparoscopy (5%). Coexisting intraabdominal injuries were present in 57% of all hernias located in the upper abdomen. Open surgical repair was the preferred treatment of choice (85%). Laparoscopic suturing was performed in one study. Six cases of handlebar hernia were treated conservatively. No cases of recurrence of hernia were reported in any of the cases.
CONCLUSIONS: Traumatic abdominal wall hernia can be visualized by ultrasonography, but CT scan is often used as the final diagnostic modality because of the risk of associated intra-abdominal injuries. Open surgical repair in layers or laparoscopic suturing during diagnostic laparoscopy may be appropriate in managing traumatic abdominal wall hernias in children. Non-surgical management has been described, but available data do not support a general recommendation for a non-surgical approach.
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Vlček M, Jaganjac E, Niedoba M, Landor I, Neumann J. Current treatment procedures for civilian gunshot wounds. Rozhl Chir 2018; 97:558-562. [PMID: 30646735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION This work provides an overview of the incidence of gunshot wounds during peace conditions in a civilian population and aims to assess the principles of their treatment. METHOD We evaluated a total of 104 patients with gunshot wounds with an average age of 38.7 years (range 1871). 84 men (80.8%) and 20 women (19.2%) were involved. The head was affected 7 times (6.7%). Out of those, penetrating injury occurred only once (1.0%). The throat was hit three times (2.9%). The chest was injured 15 times (14.4%), penetrating injury at this site was observed in 10 cases (9.6%). In five cases the lungs were affected and the heart once. Gastric injury occurred 13 times, penetration into the peritoneal cavity occurred seven times (6.7%). The intestine was injured five times, the liver three times and the gall-bladder once. Limb injury was present in 66 (63.5%) cases and in 19 of those, the injury was associated with a fracture. In 50 cases (48.1%), the patient was attacked by another person. 45 patients (43.3%) injured themselves unintentionally, five patients (4.8%) were injured in a suicidal attempt and four (3.8%) were accidentally shot by someone else. The weapons used were: pistol in 57 (54.8%) cases, air rifle in 20 cases (19.2%), a rifle in 10 cases (9.6%), two patients (1.9%) were injured with a detonator and one (1.0%) with an assault rifle. In 14 cases (13.5%), the type of firearm used was not established. RESULTS Surgical treatment was indicated in all cases. The first step was always a thorough wound irrigation. Single surgical treatment was performed in 48 cases (46.2%) while the other 56 patients (53.8%) required multiple surgeries. Specialized surgical procedures were performed in a total of 30 cases: seven laparotomies, five thoracotomies, five fracture stabilizations using external fixator, four amputations of limbs, two intramedullary osteosyntheses, two stabilizations with the use of Kirchner wires, two vascular surgeries, one craniotomy and one suture of a peripheral nerve. Complications of healing were not frequent: wound infection was observed in two cases (1.9%), wound dehiscence in one case (1.0%), osteomyelitis in two cases (1.9%), nonunion of the fracture (1.0 %) occurred once and in one case (1.0%), pulmonary embolism was diagnosed which was not fatal. CONCLUSION Consistent debridement, fasciotomy, and complete drainage of the wound are only indicated in deep gunshot wounds. A surgical revision of the abdominal cavity is indicated for all penetrating abdominal gunshot injuries. The watch-and-wait approach with surgical wound management and hospitalization is only allowed for unambiguously non-penetrating abdominal injuries. Complications of gunshot wound healing in civilian settings are not common and are most often infectious. Key words: gunshot wound - civilian settings surgical treatment.
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Huang JJ, Ren JA, Wang GF, Li ZA, Wu XW, Ren HJ, Liu S. 3D-printed “fistula stent” designed for management of enterocutaneous fistula: An advanced strategy. World J Gastroenterol 2017; 23:7489-7494. [PMID: 29151703 PMCID: PMC5685855 DOI: 10.3748/wjg.v23.i41.7489] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
Enterocutaneous fistulas (ECFs) are great challenges during the open abdomen. The loss of digestive juice, water-electrolyte imbalance and malnutrition are intractable issues during management of ECF. Techniques such as “fistula patch” and vacuum-assisted closure therapy have been applied to prevent contamination of open abdominal wounds by intestinal fistula drainage. However, failures are encountered due to high-output fistula and anatomical complexity. Here, we report 3D-printed patient-personalized fistula stent for ECF treatment based on 3D reconstruction of the fistula image. Subsequent follow-up demonstrated that this stent was well-implanted and effective to reduce the volume of enteric fistula effluent.
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Affiliation(s)
- Jin-Jian Huang
- Department of Surgery, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Jian-An Ren
- Department of Surgery, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
| | - Ge-Fei Wang
- Department of Surgery, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
| | - Zong-An Li
- NARI School of Electrical and Automation Engineering, Nanjing Normal University, Nanjing 210042, Jiangsu Province, China
| | - Xiu-Wen Wu
- Department of Surgery, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
| | - Hua-Jian Ren
- Department of Surgery, Jinling Hospital, Nanjing 210002, Jiangsu Province, China
| | - Song Liu
- Department of General Surgery, Nanjing Drum Tower Hospital, Nanjing 210008, Jiangsu Province, China
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Feliciano DV. Abdominal Trauma Revisited. Am Surg 2017; 83:1193-1202. [PMID: 29183519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although abdominal trauma has been described since antiquity, formal laparotomies for trauma were not performed until the 1800s. Even with the introduction of general anesthesia in the United States during the years 1842 to 1846, laparotomies for abdominal trauma were not performed during the Civil War. The first laparotomy for an abdominal gunshot wound in the United States was finally performed in New York City in 1884. An aggressive operative approach to all forms of abdominal trauma till the establishment of formal trauma centers (where data were analyzed) resulted in extraordinarily high rates of nontherapeutic laparotomies from the 1880s to the 1960s. More selective operative approaches to patients with abdominal stab wounds (1960s), blunt trauma (1970s), and gunshot wounds (1990s) were then developed. Current adjuncts to the diagnosis of abdominal trauma when serial physical examinations are unreliable include the following: 1) diagnostic peritoneal tap/lavage, 2) surgeon-performed ultrasound examination; 3) contrast-enhanced CT of the abdomen and pelvis; and 4) diagnostic laparoscopy. Operative techniques for injuries to the liver, spleen, duodenum, and pancreas have been refined considerably since World War II. These need to be emphasized repeatedly in an era when fewer patients undergo laparotomy for abdominal trauma. Finally, abdominal trauma damage control is a valuable operative approach in patients with physiologic exhaustion and multiple injuries.
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Brown MA, Schermerhorn B, White C, Bates W. Trauma-Associated Abdominal Cocoon: Demonstration of Radiographic Evolution. Am Surg 2017; 83:e297-e299. [PMID: 28822366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Gratzon A, Bhullar IS, Lube MW. Innovative Surgical Technique Using Omentum to Isolate and Control an Enteroatmospheric Fistula. Am Surg 2017; 83:e245-e246. [PMID: 28738926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Nauser C, Williams R, Morse B. Early Onset Massive Pulmonary Embolism after Penetrating Trauma in the Absence of Deep Vein Thrombosis. Am Surg 2017; 83:e240-e242. [PMID: 28738924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Zhang PH, Liu Z, Ren LC, Zeng JZ, Huang GW, Xiao MZ, Zhou J, Liang PF, Zhang MH, Huang XY. Early laparotomy and timely reconstruction for patients with abdominal electrical injury: Five Case Reports and Literature Review. Medicine (Baltimore) 2017; 96:e7437. [PMID: 28723751 PMCID: PMC5521891 DOI: 10.1097/md.0000000000007437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION High-tension electricity can cause devastating injuries that may result in abdominal wall loss, visceral damage, and sometimes major threat to life. The visceral organ may be exposed after debridement and require flap cover, but the tensile strength of abdominal wall may be lack even if flap transplanted. METHODS From April 2007 through May 2015, 5 patients with severe abdominal electrical injury were treated at our hospital. Exploratory laparotomy was performed based on their clinical manifestations and debridement findings of abdominal wall at early stage, and decision regarding technique for reconstruction of abdominal wall was based on an assessment of the location and extent of the defect. Medical records were reviewed for these data. RESULTS Clinical evaluation and debridement findings of the abdomen revealed 4 patients with suspicious visceral damage. Laparotomy was performed in 4 cases, and revealed obvious lesion in 3 cases, including segmental necrosis of small intestine, partial necrosis of diaphragm, left liver and gastric wall, and greater omentum. Five patients underwent abdominal wall reconstruction using island retrograde latissimus dorsi myocutaneous flap or free/island composite anterolateral thigh myocutaneous flap. All flaps survived, abdominal bulging occurred in 3 cases after follow-up of 12 to 36 months. CONCLUSIONS The clinical manifestations and wound features of abdomen collectively suggest a possible requirement of laparotomy for severe abdominal electrical burns. Retrograde latissimus dorsi myocutaneous flap or composite anterolateral thigh myocutaneous flap is an effective option for reconstruction of abdominal wall loss, the long-term complication of abdominal bulging, however, remains a significant clinical challenge.
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Affiliation(s)
| | - Zan Liu
- Department of Burns and Reconstructive Surgery
| | | | | | | | | | - Jie Zhou
- Department of Burns and Reconstructive Surgery
| | | | | | - Xiao-Yuan Huang
- Institute of Burn Research, Xiangya Hospital, Central South University, Changsha, Hunan Province, P.R. China
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Holmes JF, Kelley KM, Wootton-Gorges SL, Utter GH, Abramson LP, Rose JS, Tancredi DJ, Kuppermann N. Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial. JAMA 2017; 317:2290-2296. [PMID: 28609532 PMCID: PMC5815005 DOI: 10.1001/jama.2017.6322] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The utility of the focused assessment with sonography for trauma (FAST) examination in children is unknown. OBJECTIVE To determine if the FAST examination during initial evaluation of injured children improves clinical care. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial (April 2012-May 2015) that involved 975 hemodynamically stable children and adolescents younger than 18 years treated for blunt torso trauma at the University of California, Davis Medical Center, a level I trauma center. INTERVENTIONS Patients were randomly assigned to a standard trauma evaluation with the FAST examination by the treating ED physician or a standard trauma evaluation alone. MAIN OUTCOMES AND MEASURES Coprimary outcomes were rate of abdominal computed tomographic (CT) scans in the ED, missed intra-abdominal injuries, ED length of stay, and hospital charges. RESULTS Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62%]), all completed the study. A total of 50 patients (5.4%, 95% CI, 4.0% to 7.1%) were diagnosed with intra-abdominal injuries, including 40 (80%; 95% CI, 66% to 90%) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97%; 95% CI, 0.44% to 1.8%) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4%) in the FAST group and 254 of 465 (54.6%) in the standard care-only group (difference, -2.2%; 95% CI, -8.7% to 4.2%). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2%; 95% CI, -0.6% to 1.2%). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care-only group (difference, -0.04 hours; 95% CI, -0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care-only group (difference, -$1180; 95% CI, -$6651 to $4291). CONCLUSIONS AND RELEVANCE Among hemodynamically stable children treated in an ED following blunt torso trauma, the use of FAST compared with standard care only did not improve clinical care, including use of resources; ED length of stay; missed intra-abdominal injuries; or hospital charges. These findings do not support the routine use of FAST in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01540318.
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Affiliation(s)
- James F. Holmes
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
| | - Kenneth M. Kelley
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
| | | | - Garth H. Utter
- Department of Surgery, University of California, Davis School of Medicine, Sacramento
| | - Lisa P. Abramson
- Department of Surgery, University of California, Davis School of Medicine, Sacramento
| | - John S. Rose
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
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Borhan F, Borhan N, O'Riordan B. An unusual case of multiple self-inflicted punctures to the precordium. Ir Med J 2017; 110:588. [PMID: 28952678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sewing needles, albeit a rare case of penetrating cardiac injury, are potentially life-threatening. We report a case of successful intra-cardiac needle removal from a 32 year old who inserted multiple needles into the chest and abdomen.
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Affiliation(s)
- F Borhan
- Department of Emergency Medicine, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - N Borhan
- Department of Emergency Medicine, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - B O'Riordan
- Department of Emergency Medicine, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
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45
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Nunn A, Jahn N, Hewes J, Wong C. Gastric perforation in a 16 year old girl. BMJ 2017; 357:j1859. [PMID: 28468771 DOI: 10.1136/bmj.j1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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46
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Viner Y, Braslavsky A, Zarka S. Multidisciplinary Care of a 13 Year Old Syrian Child. Isr Med Assoc J 2017; 19:212-213. [PMID: 28480671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - Salman Zarka
- Director General, Ziv Medical Center, Safed, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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47
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Greiffenstein P, Hastings PR. The Hidden Story of Innovation: Charity Hospital, Angola Prison, and the Challenging of Surgical Dogma. Am Surg 2017; 83:113-118. [PMID: 28228196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The late 1960s was a period of significant upheaval of social, cultural, and scientific norms. The generally accepted notion of mandatory laparotomy for all penetrating abdominal injuries was among those norms being called into question across the country and many advocated expectant management of selected patients presenting with this type of injury. Leaders of the surgical community published opinions on either side of the argument. The house staff at Charity Hospital during this period was among the busiest in the nation in treating these injuries, many of them inmates of the Louisiana State Penitentiary who used self-inflicted stab wounds to the abdomen as a means of temporary respite from the inhumane conditions in the prison. Inspired, in part, by the overabundance of negative laparotomies among this group, F. Carter Nance went on to systematically challenge the standard of care. This effort constitutes one of the major forces for change of the surgical dogma of mandatory laparotomy for all abdominal stab wounds. It is the first major study to show conclusively that delayed laparotomy for perforated viscous was not significantly detrimental and posed less of a risk than unnecessary laparotomy. The circumstances surrounding this initiative constitute a powerful and heretofore unknown chapter in the history of surgical innovation.
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Philipoff AC, Ramsay D, Weber DG. Acute traumatic renal arteriocalyceal fistula: selective angioembolisation for haemodynamic instability. BMJ Case Rep 2017; 2017:bcr-2016-216795. [PMID: 28052944 DOI: 10.1136/bcr-2016-216795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abdominal angiography with selective arteriography and subsequent embolisation is an accepted management modality in the treatment of selected solid organ injuries following blunt abdominal trauma. This management practice is well established in the haemodynamically stable patient; however, this remains more controversial in haemodynamically compromised patients, though warrants consideration in both cases due to the associated benefits of non-operative management. This case report describes the successful non-operative management of a severe renal injury in a young polytraumatised patient following a high-speed motor vehicle crash. In addition, the rare CT diagnosis and management of an acute traumatic arteriocalcyeal fistula is discussed with a focus on the importance of renal parenchymal preservation.
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Affiliation(s)
- Adam Carl Philipoff
- Department of Trauma & General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Duncan Ramsay
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Dieter G Weber
- Department of Trauma & General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
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Occhionorelli S, Andreotti D, Tartarini D, Cappellari L, Stano R, Morganti L, Vasquez G. Delayed diagnosis of blunt carotid trauma in a seat belt syndrome with associated abdominal wall injury A case report. Ann Ital Chir 2016; 5:S2239253X16025391. [PMID: 27904004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The aim of this case report is to be aware of occult carotid lesions in thoracic- abdominal trauma because, carotid artery injury consequent to blunt trauma is rare, affecting less than 1% of patients as reported in literature. A 45-years-old female, involved in a traffic accident, arrived to Emergency Room hemodynamically stable, with a Glasgow Coma Scale of 15, complaining abdominal pain, without any neurological signs. She underwent Computed Tomography (CT) scan that showed a complete disruption of left abdominal wall muscles, associated with massive bowel loops herniation. No free air nor other visceral injuries were found. The radiological brain evaluation was negative for neurological injuries. Considering the nature of the trauma, an explorative laparotomy was performed. During the fifth postoperative day, the patient presented neurological side signs with right facial-brachial-crural hemiparesis and expressive aphasia. Head and neck CT scan revealed a lesion of the left common carotid artery with distal embolization of the internal carotid. A left-carotid-axis revascularization procedure and a surgical endarterectomy were immediately performed. Patient was discharged after 20 days without neurological consequences. Physicians should be aware of neck vascular injuries when evaluating patients with multiple trauma, even in neurological asymptomatic patients without seatbelt abrasions of the neck skin. KEY WORDS Abdominal Hernia, Carotid artery, Seat belt, Surgery.
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MESH Headings
- Abdominal Injuries/diagnostic imaging
- Abdominal Injuries/etiology
- Abdominal Wall/diagnostic imaging
- Accidents, Traffic
- Aphasia/etiology
- Carotid Artery Injuries/diagnosis
- Carotid Artery Injuries/diagnostic imaging
- Carotid Artery Injuries/etiology
- Carotid Artery Injuries/surgery
- Carotid Artery Thrombosis/etiology
- Carotid Artery, Common/diagnostic imaging
- Carotid Artery, Internal
- Delayed Diagnosis
- Endarterectomy, Carotid
- Female
- Hernia, Abdominal/diagnostic imaging
- Hernia, Abdominal/etiology
- Humans
- Middle Aged
- Multiple Trauma/diagnostic imaging
- Multiple Trauma/etiology
- Paresis/etiology
- Seat Belts/adverse effects
- Tomography, X-Ray Computed
- Wounds, Nonpenetrating/diagnosis
- Wounds, Nonpenetrating/diagnostic imaging
- Wounds, Nonpenetrating/etiology
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Helfenstein-Didier C, Rongiéras F, Gennisson JL, Tanter M, Beillas P. A new method to assess the deformations of internal organs of the abdomen during impact. Traffic Inj Prev 2016; 17:821-826. [PMID: 27027332 DOI: 10.1080/15389588.2016.1165346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 03/07/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Due to limitations of classic imaging approaches, the internal response of abdominal organs is difficult to observe during an impact. Within the context of impact biomechanics for the protection of the occupant of transports, this could be an issue for human model validation and injury prediction. METHODS In the current study, a previously developed technique (ultrafast ultrasound imaging) was used as the basis to develop a protocol to observe the internal response of abdominal organs in situ at high imaging rates. The protocol was applied to 3 postmortem human surrogates to observe the liver and the colon during impacts delivered to the abdomen. RESULTS The results show the sensitivity of the liver motion to the impact location. Compression of the colon was also quantified and compared to the abdominal compression. CONCLUSIONS These results illustrate the feasibility of the approach. Further tests and comparisons with simulations are under preparation.
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Affiliation(s)
- Clémentine Helfenstein-Didier
- a Université de Lyon , Lyon , France
- b Université Claude Bernard Lyon 1 , Villeurbanne
- c IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et Mécanique des Chocs , Bron , France
| | - Frédéric Rongiéras
- a Université de Lyon , Lyon , France
- b Université Claude Bernard Lyon 1 , Villeurbanne
- c IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et Mécanique des Chocs , Bron , France
- d Service Chirurgie Orthopédique et Traumatologique-Hôpital Desgenettes , Lyon , France
| | | | - Mickaël Tanter
- e Institut Langevin-Ondes et Images, ESPCI ParisTech , Paris , France
| | - Philippe Beillas
- a Université de Lyon , Lyon , France
- b Université Claude Bernard Lyon 1 , Villeurbanne
- c IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et Mécanique des Chocs , Bron , France
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