Our experience of emergency colorectal injury as a result of abdominal trauma

Objective: In the present study, we aimed to examine the treatments and their outcomes in cases with colon injuries after blunt and penetrating abdominal traumas. Materials and Methods: Twenty-six patients who underwent a laparotomy and were found to have a colon injury due to blunt abdominal trauma, penetrating stab injury, gunshot injury, and traffic accident were included. All patients were admitted into the emergency outpatient clinic of Gazi Yasargil Training and Research Hospital General Surgery Clinic between 2016 and 2020. The records of the cases were analyzed retrospectively. Results: Colon injuries were detected in 26 cases. All 26 (100%) cases were males with an average age of 29.80 ± 11.4 (range: 17-60) years old. Colon injuries observed during emergency operations included 18 (69.23%) patients with a GSI (gunshot injuries), 3 (11.53%) with penetrating stab injuries, 4 (15.38%) who were a part of traffic accidents and 1 (3.85%) patient with a blunt abdominal trauma. A primary colon repair was performed in 10 patients. Five patients underwent a colon resection and there were end colostomies. Four patients underwent a loop ileostomy after a colon resection and anastomosis. Colon resections with anastomoses were performed in seven patients. The mean hospitalization period was 26 ± 29.28 days. Conclusion: Patients should be classified intraoperatively with findings, such as peritoneal contamination, degree of colon injury, duration of the injury, and any accompanying injuries. (AU)

Comparison of the diagnostic accuracy of CT scan with oral and intravenous contrast versus CT scan with intravenous contrast alone in the diagnosis of blunt abdominal trauma / 中华创伤杂志(英文版)

PURPOSE@#Abdominal CT scan using oral and intravenous (IV) contrast is helpful in the diagnosis of intra-abdominal injuries. However, the use of oral and IV contrast delays the process of diagnosis and increases the risk of aspiration. It has also been shown that CT scan with IV contrast alone is as helpful as CT scan with oral and IV contrast and rectal CT scan in detecting abdominal injuries. Therefore, the present study aims to prospectively compare the diagnostic value of CT scan with oral and IV contrast versus CT scan with IV contrast alone in the diagnosis of blunt abdominal trauma (BAT).@*METHODS@#Altogether 123 BAT patients, 60 (48.8%) women and 63 (51.2%) men with the mean age of (40.4 ± 18.7) years who referred to the emergency department of Imam Khomeini Educational and Medical Center in Sari, Iran (a tertiary trauma center in north of Iran) from November 2014 to March 2017 and underwent abdominal CT scans + laparotomy were investigated. Those with penetrating trauma or hemodynamically unstable patients were excluded. The participants were randomly allocated to two groups: abdominal CT scan with oral and IV contrast (n = 63) and CT scan with IV contrast alone (n = 60). No statistically significant difference was found between two groups regarding the hemodynamic parameters, age, gender, injury mechanisms (all p > 0.05). The results of CT scan were compared with that of laparotomy results. The collected data were recorded in SPSS version 22.0 for Windows. Quantitative data were presented as mean and SD.@*RESULTS@#The sensitivity and specificity of CT scan using oral and IV contrast in the diagnosis of BAT were estimated at 96.48 (95% CI: 90.73 - 99.92) and 92.67 (95% CI: 89.65 - 94.88), respectively; while CT scan with IV contrast alone achieved a comparable sensitivity and specificity of 96.6 (95% CI: 87.45 - 99,42 and 92.84 (95% CI: 89.88 - 95.00), respectively.@*CONCLUSION@#CT scan with IV contrast alone can be used to assess visceral injuries in BAT patients with normal hemodynamics to avoid diagnostic delay.

The "weekend effect" does not impact on outcome of trauma laparotomy - Experience from a level 1 trauma centre in New Zealand / 中华创伤杂志(英文版)

PURPOSE@#Trauma centres have been proven to provide better outcomes in developed countries for overall trauma, but there is limited literature on the systematic factors that describe any discrepancies in outcomes for trauma laparotomies in these centres. This study was conducted to examine and interrogate the effect of systematic factors on patients undergoing a trauma laparotomy in a developed country, intending to identify potential discrepancies in the outcome.@*METHODS@#This was a retrospective study of all laparotomies performed for trauma at a level 1 trauma centre in New Zealand. All adult patients who had undergone an index laparotomy for trauma between February 2012 and November 2020 were identified and laparotomies for both blunt and penetrating trauma were included. Repeat laparotomies and trauma laparotomies in children were excluded. The primary clinical outcomes reviewed included morbidity, length of hospital stay, and mortality. All statistical analysis was performed using R v.4.0.3.@*RESULTS@#During the 9-year study period, 204 trauma laparotomies were performed at Waikato hospital. The majority (83.3%) were performed during office hours (170/204), and the remaining 16.7% were performed after hours (34/204). And 61.3% were performed on a weekday (125/204), whilst 38.7% were performed on the weekend/public holiday (79/204). Most of the parameters in office hours and after hours groups had no statistically significant difference, except lactate (p = 0.026). Most of the variables in weekday and weekend groups had no statistically significant difference, except pH, lactate, length of stay, and gastrointestinal complications (p = 0.012, p < 0.001, p = 0.003, p = 0.020, respectively).@*CONCLUSION@#The current trauma system at Waikato hospital is capable of delivering care for trauma laparotomy patients with the same outcome regardless of working hours or after hours, weekday or weekend. This confirms the importance of a robust trauma system capable of responding to the sudden demands placed on it.

Blunt Mesenteric Injury: Two Case Reports

Two cases of blunt mesenteric injury were presented. In both cases, contrast-enhanced CT of the abdomen showed contrast extravasation in the intraperitoneal cavity (indicating injury of the superior mesenteric artery), bowel Wall thickening, hemoperitoneum and mesenteric hematoma. Under impression of mesenteric injury, emergency laparotomy was performed in both of the patients: two lacerations of the jejunal mesentery were identified in patient I and one laceration of the ileal mesentery was found in patient 2. Bowel resection was carried out in both of the patients. The course was uneventful during the 12 days and 11 days of hospitalization for patients 1 and 2 respectively

Surgical management of an abdominal impalement injury: a case report / Manejo quirúrgico de una lesion por empalamiento abdominal: reporte de caso

Impalement injuries are a complex and rare type of penetrating abdominal trauma that happens when an object such as a post or a pole penetrates a person injuring several organs, making it a life-threatening situation in which time and correct management play an important part in the survival of the patient. A 37-year-old man suffered abdominal impalement injury with a metal signal post, penetrating the left flank of the abdomen. On examination, there is a hypoventilated left hemithorax with intercostal retractions, increased heart rate, weak distal pulses, delayed capillary refill, and pale skin. A 1-meter-long metal post (approximately 7cm diameter) penetrates the left flank with the entry in the posterior lumbar region. Abdominal viscera, omentum, intestinal content, and ischemic loops of the small intestine are visible. An exploratory laparotomy was performed; left hemicolectomy, end colostomy and Hartmann procedure, resection of the affected jejunum, and end-to-end anastomosis were performed. On the ninth postoperative day, an abdominal tomography was performed due to the presence of fever peaks, which reported thrombosis of the left renal artery and emphysematous pyelonephritis, with the presence of a left pararenal collection. A simple left nephrectomy was performed. Postoperative surveillance was satisfactory during the following 5 days. The patient was discharged. An impaled injury is a complex lesion that needs special attention from the medical field for correct management. Although there is some literature about it, we encourage more research to be done about impalement injuries.

Las lesiones por empalamiento son un tipo de traumatismo abdominal penetrante complejo y raro de que se produce cuando un objeto, como un poste o una vara, penetra a una persona lesionando varios órganos, lo que la convierte en una situación potencialmente mortal en la que el tiempo y el manejo correcto juegan un papel importante en la supervivencia del paciente. Un hombre de 37 años sufrió una herida por empalamiento abdominal con un poste de señales de metal, penetrando el flanco izquierdo del abdomen. A la exploración física, hay un hemitórax izquierdo hipoventilado con retracciones intercostales, aumento de la frecuencia cardíaca, pulsos distales débiles, relleno capilar retrasado y piel pálida. Un poste metálico de 1 metro de largo (aproximadamente 7 cm de diámetro) penetra el flanco izquierdo con entrada en la región lumbar posterior. Son visibles las vísceras abdominales, el epiplón, el contenido intestinal y las asas isquémicas del intestino delgado. Se realizó una laparotomía exploradora; Se realizó hemicolectomía izquierda, colostomía terminal y procedimiento de Hartmann, resección del yeyuno afectado y anastomosis terminoterminal. Al noveno día postoperatorio se realiza tomografía abdominal por presencia de picos febriles, que reporta trombosis de arteria renal izquierda y pielonefritis enfisematosa, con presencia de colección pararrenal izquierda. Se realizó nefrectomía izquierda simple. La vigilancia postoperatoria fue satisfactoria durante los siguientes 5 días. El paciente fue dado de alta. Una lesión por empalamiento es una lesión compleja que necesita una atención especial desde el ámbito médico para su correcto manejo. Aunque existe cierta literatura al respecto, alentamos a que se realicen más investigaciones sobre estas lesiones.

OBSERVATIONAL STUDY OF ETIOLOGY AND OUTCOME IN HOLLOW VISCUS PERFORATION

Background: Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality. Missed diagnosis and late intervention are frequent causes of increased morbidity and mortality especially in patients who survive the initial phase of insult. Diagnosis and treatment of gastrointestinal perforation remains a formidable problem in our country. Aim & Objevtives: To compare certain common etiologies and their outcomes in the following diseases and sites respectively Acid Peptic Disease–Duodenal/Gastric Typhoid- Ileal Diverticulitis-Colon Trauma-Any Part Retrospec Methods: tive observational study of 50 Operated Patients done in Government Medical College Surat during period of September 2019 to December 2020 According to Inclusion and Exclusion Criteria. Data is analysed using descriptive statistics (Percentage, Proportions). Among 50 cases of hollow viscus Results & Conclusion: perforation, Peptic perforation was common (33 out of 50 cases). Next being Ileal perforation. Jejunum was common site of perforation in blunt abdominal trauma. Peptic Perforations are more commonly seen in 40-60yrs of age group with alcohol and smoking as their addiction, with worker as occupation. Typhoid Perforations are more commonly seen in 20-40yrs of age group. In this study except for wound dehiscence in 4 cases which needed secondary suturing, no major morbidity noted. 4% mortality noted in the present study.

Características clínico quirúrgicas de los pacientes con trauma cerrado de abdomen / Clinical-Surgical Characteristics of Patients with Blunt Abdominal Trauma

Introducción: El traumatismo abdominal cerrado puede provocar lesiones orgánicas graves con hemorragias que demandan un tratamiento quirúrgico emergente y es la principal causa de muertes evitables en todos los grupos de edad. Objetivo: Evaluar las características clínico quirúrgicas de los pacientes con trauma cerrado de abdomen. Métodos: Se realizó un estudio observacional descriptivo y retrospectivo para evaluar el comportamiento del trauma cerrado de abdomen en 81 pacientes atendidos en el Hospital General Provincial Docente "Roberto Rodríguez Fernández" de Morón desde enero del 2014 hasta diciembre de 2019. Resultados: El adulto joven fue el grupo de edad predominante (34,6 por ciento) del sexo masculino (19,8 por ciento), el accidente de tránsito (48,1 por ciento) fue la causa principal. El cuadro hemorrágico (39,5 por ciento) seguidos del cuadro doloroso abdominal (38,3 por ciento) representaron los síntomas clínicos más relevantes. La positividad de los exámenes auxiliares estuvo representada por la ecografía abdominal (74,1 por ciento) seguida de la punción abdominal (9,9 por ciento. Las lesiones hepáticas (27,0 por ciento) seguidas de las esplénicas (19,0 percent) fueron las vísceras macizas más afectadas. El 77,8 por ciento fue intervenido quirúrgicamente y las técnicas quirúrgicas hepáticas fueron las más empleadas para un total de 17 casos (26,9 por ciento). El choque hipovolémico (12,7 por ciento) fue la complicación posoperatoria más encontrada. Se reportó un 12,3 por ciento de fallecidos. Conclusiones: El paciente con trauma cerrado de abdomen debe ser considerado siempre politraumatizado cuyo tratamiento inicial se dirige a la estabilización rápida e identificación de lesiones que amenacen la vida(AU)

Introduction: Blunt abdominal trauma can cause severe organ injury with hemorrhage demanding emergent surgical treatment. It is the leading cause of preventable death among all age groups. Objective: To assess the clinical-surgical characteristics of patients with blunt abdominal trauma. Methods: A descriptive and retrospective observational study was carried out to assess the characteristics of blunt abdominal trauma in 81 patients treated at Roberto Rodríguez Fernández General Provincial Teaching Hospital of Morón from January 2014 to December 2019. Results: Young adults represented the predominant age group (34.6 percent), together with the male sex (19.8 percent). Traffic accident (48.1 percent) was the main cause. Hemorrhagic symptoms (39.5 percent) was the most relevant clinical symptoms, followed by abdominal pain (38.3 percent). Positive results in complementary tests were represented by abdominal ultrasound (74.1 percent), followed by abdominal puncture (9.9 percent). Hepatic lesions (27.0 percent) was the most affected solid viscera, followed by splenic lesions (19.0 percent). 77.8 percent of cases were operated on and hepatic surgical techniques were the most frequently used, accounting for 17 cases (26.9 percent). Hypovolemic shock (12.7 percent) was the most frequent postoperative complication. A death rate of 12.3 percent was reported. Conclusions: The patient with blunt abdominal trauma should always be considered polytraumatized, in which case the initial treatment is aimed at rapid stabilization and identification of life-threatening injuries(AU)

A STUDY OF PATIENTS PRESENTING WITH BLUNT ABDOMINAL INJURY WITH SPLENIC TRAUMA AND THEIR OUTCOME.

INTRODUCTION - Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology with a multidisciplinary team. Thus, the study to determine the presentation of a patient and further its investigation management and outcome is necessary. OBJECTIVE: To study all the cases (investigation and outcome) of blunt abdominal trauma with splenic laceration with its incidence , mode of presentation, grade, management and factors responsible for morbidity and mortality. MATERIALAND METHODS:Astudy was conducted in our tertiary care hospital on 22 patients presented with blunt abdominal trauma with splenic injury in emergency department during July 2019 to June 2021. RESULTS: In our retrospective study , all the patients underwent primary radiological and pathological investigation with 36% having associated limb injuries (fractures);4.5% with ckd , 9% with thoracic injury, 40% amongst 20-40 age group , 86% being male, 59.5% resulted from RTA, 31.5 % resulted from fall from height,0% with assault, 4.5% along with head injury, 9% with associated rib fracture,0% patient with free gas under diaphragm ; 9% with grade 1, 22% with grade 2, 31.5% grade 3 , 13.5% grade 4, 22%grade 5 splenic injuries. 91% patients underwent splenectomy and were given vaccination 15 days post operatively against capsulated organisms.9% patients were managed conservatively. Patients were followed up for 6 months postoperatively with 4.5% mortality rate. CONCLUSION: Splenic injury is most common solid organ injury in blunt abdominal trauma in 20- 40 years age group majority male and results maximally by RTA; associated with limb fractures commonly with liver as associated solid organ injured. Aggressive resuscitation and emergency laparotomy (splenectomy) yields excellent outcome

Trauma abdominal penetrante por heridas de arma blanca. Manejo laparoscópico vs convencional. Estudio prospectivo y comparativo / Penetrating abdominal trauma due to stab wounds. Laparoscopic vs conventional management. Prospective and comparative study

La evaluación y el manejo del trauma abdominal ha presentado cambios significativos en los últimos tiempos. La laparoscopia en el trauma abdominal penetrante ha sido de gran utilidad principalmente como método diagnóstico, sin embargo, se debería considerar como herramienta terapéutica.Objetivo: Determinar la eficacia del manejo laparoscópico vs el convencional en el tratamiento de pacientes con trauma abdominal penetrante por heridas de arma blanca.Métodos : Estudio experimental, prospectivo, comparativo. La población de estudio estuvo representada por pacientes con diagnóstico de traumatismo abdominal penetrante por herida de arma blanca que ingresaron a la emergencia de cirugía del Hospital Dr. Miguel Pérez Carreño durante el periodo enero 2019 a julio 2021.Resultados : Fueron incluidos 48 pacientes, 28 pacientes del grupo control y 20 pacientes del grupo experimental. Ambos grupos fueron comparables con respecto a edad y sexo. El índice de severidad del trauma (PATI) fue similar en ambos grupos. Las complicaciones y el tiempo quirúrgico no tuvieron diferencias estadísticamente significativas. Las cirugías negativas representaron el 15 % en el grupo laparoscópico vs 11 % en el abordaje convencional. El porcentaje de conversión fue de 15 %. La estancia hospitalaria fue menor en el grupo laparoscópico 3,25 vs 4,6 días (p = 0,04).Conclusión: La cirugía laparoscópica puede considerarse el abordaje de elección en pacientes hemodinámicamente estables con trauma abdominal penetrante por herida de arma blanca, siendo un método seguro y eficaz, brindando los beneficios propios de la cirugía mínimamente invasiva, con baja tasa de complicaciones y una recuperación más rápida(AU)

The evaluation and management of abdominal trauma have changed significantly in recent times. Laparoscopic approach in penetrating abdominal trauma has been useful as diagnostic method, however, its therapeutic value should be considered. Objective: To determine the efficacy of laparoscopy versus laparotomy approach as treatment in patients with penetrating abdominal trauma caused by stab wounds. Methods: We conducted an experimental, prospective and comparative study. Study population was represented by patients with diagnosis of penetrating abdominal trauma due to stab wounds who were admitted to the emergency room of Dr. Miguel Pérez Carreño Hospital between January 2019 and July 2021.Results : 48 patients were included, 28 in the control group and 20 patients in the experimental group. No differences were found between groups regarding age and sex. The penetrating abdominal trauma index (PATI) was similar in both groups. Differences in complications and surgical time were not statistically significant. Non-therapeutic surgeries represented 15 % in laparoscopic group and 11 % in laparotomy group. The conversion percentage was 15 %. Hospital stay were shorter in laparoscopic group, 3.25 vs 4.6 days (p = 0.04). Conclusion: Laparoscopic surgery can be considered the approach of choice in hemodynamically stable patients with penetrating abdominal trauma due to stab wounds. It is a safe and effective method, providing the benefits of minimally invasive surgery, with a low rate of complications and faster patient recovery(AU)

Application of mind mapping combined with scenario simulation teaching in probation teaching of abdominal trauma / 中华医学教育探索杂志

Objective:To explore the effect of mind mapping combined with scenario simulation teaching on probation teaching of abdominal trauma.Methods:The probation undergraduates from Batch 2017 five-year clinical medicine of Air Force Medical University were selected as research objects and randomly divided into experimental group ( n=98) and control group ( n=92). The experimental group was taught by mind mapping combined with scenario simulation teaching method, while the control group was taught by traditional teaching mode. After the end of the course, the effect of teaching was evaluated from two aspects: theoretical evaluation and teaching satisfaction evaluation. SPSS 19.0 was used for t test and chi-square test. Results:The results of theoretical test in the experimental group were significantly better than those of the control group [(84.03±8.99) vs. (78.53±8.97)], and the difference was statistically significant ( P<0.05). Compared with the control group, the experimental group had obvious advantages in learning interest, teamwork awareness and clear thinking, and achieved good teaching effect. Conclusion:Therefore, this teaching model helps to improve the teaching quality and provides some reference experience.

Guía práctica del traumatismo abdominal en la edad pediátrica

RESUMEN El traumatismo abdominal en la edad pediátrica se considera la segunda causa de muerte después del trauma craneoencefálico. Requiere para su diagnóstico un alto índice de sospecha y su riesgo vital está condicionado por la hemorragia y la peritonitis. Con el propósito de estandarizar en una guía la conducta en Cuba en el traumatismo abdominal pediátrico, se realiza una revisión bibliográfica sobre el tema y el estudio de diferentes casuísticas del hospital pediátrico "Juan Manuel Márquez", que es centro provincial de politrauma infantil de La Habana; la guía se aprueba por consenso en la Sociedad Cubana de Cirugía Pediátrica. Las causas más frecuentes de traumatismo abdominal son: en el niño mayor los accidentes de tránsito y en el niño menor las caídas de altura. En la anamnesis es importante la cinemática del trauma y la superficie de impacto. El examen físico debe ser evolutivo y en la evaluación inicial debe identificarse el riesgo vital. En el diagnóstico por imágenes se considera esencial la tomografía contrastada la que en nuestro centro se reserva para casos con dudas diagnósticas y de evolución no satisfactoria, la ecografía tiene gran utilidad. Se prioriza el tratamiento no quirúrgico en el trauma cerrado con ruptura de víscera maciza, siempre que exista estabilidad hemodinámica. Actualmente la cirugía de control de daños ha demostrado mejorar la sobrevida en pacientes con lesiones abdominales complejas y exanguinantes.

ABSTRACT Abdominal trauma in pediatric age is considered the second leading cause of death after traumatic brain injury. It requires for its diagnosis a high index of suspicion and its vital risk is conditioned by hemorrhage and peritonitis. With the purpose of standardizing in a guide the behavior in Cuba of pediatric abdominal trauma, a bibliographic review is carried out on the subject and the study of different casuistries of "Juan Manuel Márquez" Pediatric Hospital, which functions in turn as a provincial center of children's polytrauma of Havana; the guide is approved by consensus in the Cuban Society of Pediatric Surgery. The most frequent causes of abdominal trauma are: in the older children, traffic accidents and in the younger children falls from heights. In the anamnesis, the kinematics of the trauma and the impact surface are important. The physical examination should be evolutionary and the initial assessment should identify the life risk. In the diagnosis by images is considered essential the contrasted tomography which in our center is reserved for cases with diagnostic doubts and unsatisfactory evolution; ultrasound is very useful. Non-surgical treatment is prioritized in closed trauma with solid viscera rupture, provided that hemodynamic stability exists. Currently, damage control surgery has been shown to improve survival in patients with complex and exanguinating abdominal injuries.

Trauma esplénico: diagnostico, clasificación y tratamiento. Una revisión de la literatura actual

Resumen El bazo es el órgano que se lesiona con más frecuencia en el trauma abdominal cerrado, presentándose en 30 a 50% de los casos, principalmente por su fragilidad y localización, su tratamiento ha estado en constante cambio a lo largo del tiempo, siendo hoy en día más utilizado el manejo conservador por sobre el intervencionista, considerando sobre todo el mayor riesgo de mortalidad y las condiciones fisiológicas posteriores a la esplenectomía principalmente en niños y adolescentes. Objetivo. Realizar una revisión actual del diagnóstico, clasificación y tratamiento del trauma esplénico. Metodología . Se realizó una revisión bibliográfica incluyendo los descriptores relacionados con trauma esplénico y su tratamiento. Resultados. La identificación del trauma esplénico es de vital importancia para la supervivencia del paciente, el diagnostico se puede realizar mediante estudios de imagen eco-FAST o tomografía en dependencia del estado hemodinámico del paciente, la clasificación depende de las características anatómicas de las lesiones y orienta el tratamiento adecuado. Conclusiones. Actualmente el tratamiento conservador está recomendado para lesiones I-III; los estadios mayores (IV y V) o cualquier grado siempre y cuando exista compromiso hemodinámico implican tratamiento intervencionista o quirúrgico, no existe una diferencia significativa entre la utilización de técnica abierta vs laparoscópica.

Abstract The spleen is the organ that is most frequently injured in blunt abdominal trauma, occurring in 30 to 50% of cases, mainly due to its fragility and location, its treatment has been in constant change over time, today the conservative management is more widely used than interventionist, considering above all the greater risk of mortality and the physiological conditions after splenectomy, mainly in children and adolescents. Objective . To carry out a current review of the diagnosis, classification and treatment of splenic trauma. Methodology . A bibliographic review was carried out including the descriptors related to splenic trauma and its treatment. Results .The identification of splenic trauma is of vital importance for the survival of the patient, the diagnosis can be made by imaging studies, FAST ultrasound or tomography depending on the hemodynamic status of the patient, the classification depends on the anatomical characteristics of the lesions and guides the appropriate treatment. Conclusions . Conservative treatment is currently recommended for lesions I-III; the major stages (IV and V) or any grade whit hemodynamic compromise imply interventional or surgical treatment, there is no significant difference between the use of open versus laparoscopic technique.

Resumo O baço é o órgão mais frequentemente lesado no trauma abdominal fechado, ocorrendo em 30 a 50% dos casos, principalmente devido à sua fragilidade e localização, seu tratamento tem mudado constantemente ao longo do tempo, sendo hoje o manejo conservador mais utilizado que o intervencionista, considerando sobretudo o maior risco de mortalidade e as condições fisiológicas após a esplenectomia, principalmente em crianças e adolescentes. Objetivo . Fazer uma revisão atual do diagnóstico, classificação e tratamento do trauma esplênico. Metodologia . Foi realizada uma revisão bibliográfica incluindo os descritores relacionados ao trauma esplênico e seu tratamento. Resultados . A identificação do trauma esplênico é de vital importância para a sobrevida do paciente, o diagnóstico pode ser feito por exames de imagem echo-FAST ou tomografia dependendo do estado hemodinâmico do paciente, a classificação depende das características anatômicas das lesões e orienta o tratamento adequado. Conclusões . O tratamento conservador é atualmente recomendado para lesões I-III; os estágios principais (IV e V) ou em qualquer grau, desde que haja comprometimento hemodinâmico, implicam em tratamento intervencionista ou cirúrgico, não havendo diferença significativa entre o uso da técnica aberta e laparoscópica.

Ruptura diafragmática traumática: presentación de un caso / Traumatic diaphragmatic rupture: presentation of a case / Ruptura diafragmática traumática: apresentação de um caso

RESUMEN Introducción: el diafragma es un tabique que separa el tórax del abdomen y su función fisiológica es ayudar a la mecánica de la ventilación. La ruptura diafragmática traumática es una entidad de difícil diagnóstico inicial, por la baja sospecha clínica, lo que lleva a complicaciones como la estrangulación, que tiene una elevada morbimortalidad. Las lesiones traumáticas del diafragma son poco frecuentes, la incidencia global por mecanismo penetrante y cerrado es del 1 % al 6 %. Presentación de caso: paciente masculino de 20 años de edad con antecedentes de salud aparente, acude al servicio de urgencia a las 2 horas luego de haber sufrido accidente laboral al desprenderse un banco de arena sobre él, refiriendo dificultad para respirar y dolor torácico en hemitorax izquierdo, los estudios de imágenes practicados mostraron presencia de cámara gástrica y colon en hemitorax izquierdo, es intervenido quirúrgicamente con impresión diagnostica de ruptura diafragmática secundaria a traumatismo cerrado de abdomen. Durante el transoperatorio se comprobó la misma (laceración lineal que involucra todo hemidiafragma izquierdo) con herniación del estómago, bazo, colon transverso y parte de intestino delgado en cavidad torácica. Se realizó frenorrafia y pleurostomia baja izquierda. No otras alteraciones intraabdominales. Discusión: la rotura traumática del diafragma es una lesión infrecuente que ocurre como consecuencia de traumatismos cerrados y penetrantes del abdomen o del tórax. Su diagnóstico precoz continúa siendo un desafío y se asocia con una elevada morbimortalidad. El diagnóstico preoperatorio es difícil y sólo un alto nivel de sospecha, un examen minucioso de las técnicas de imagen y la intervención quirúrgica inmediata, son determinantes para el éxito en el tratamiento de estos pacientes. Conclusiones: nuestro paciente no presentó complicaciones mayores en el perioperatorio, a las 24 horas estaba con dieta y deambulando se retiró la sonda pleural a las 72 horas y ha tenido una evolución favorable libre de síntomas, siendo dado de alta a los 10 días.

ABSTRACT Introduction: the diaphragm is a septum that separates the thorax from the abdomen and its physiological function is to help the mechanics of ventilation. Traumatic diaphragmatic rupture is an entity of difficult initial diagnosis, due to low clinical suspicion, which leads to complications such as strangulation, which has high morbidity and mortality. Traumatic injuries to the diaphragm are rare, the overall incidence due to penetrating and closed mechanism is 1% to 6%. Case presentation: 20-year-old male patient with apparent health history, attended the emergency service 2 hours after having suffered an occupational accident when a sandbar fell off him, reporting difficulty breathing and chest pain in hemithorax On the left, the imaging studies performed showed the presence of a gastric chamber and colon in the left hemithorax, he was operated on with a diagnostic impression of a diaphragmatic rupture secondary to blunt abdominal trauma. During the intraoperative it was verified (linear laceration involving the entire left hemidiaphragm) with herniation of the stomach, spleen, transverse colon and part of the small intestine in the thoracic cavity. Left low pleurostomy and frenorrhaphy were performed. No other intra-abdominal alterations. Discussion: traumatic diaphragm rupture is an infrequent injury that occurs as a consequence of blunt and penetrating trauma to the abdomen or chest. Early diagnosis of it continues to be a challenge and is associated with high morbidity and mortality. Preoperative diagnosis is difficult and only a high level of suspicion, a thorough examination of imaging techniques, and immediate surgical intervention are decisive for the success of treating these patients. Conclusions: our patient did not present major complications in the perioperative period, at 24 hours he was on a diet and wandering, the pleural tube was removed at 72 hours and has had a favorable symptom-free evolution, being discharged at 10 days.

RESUMO Introdução: o diafragma é um septo que separa o tórax do abdome e sua função fisiológica é auxiliar na mecânica da ventilação. A ruptura diafragmática traumática é uma entidade de difícil diagnóstico inicial, devido à baixa suspeita clínica, o que leva a complicações como o estrangulamento, que apresenta elevada morbimortalidade. Lesões traumáticas do diafragma são raras, a incidência geral devido ao mecanismo penetrante e fechado é de 1% a 6%. Apresentação do caso: Paciente do sexo masculino, 20 anos, com história aparente de saúde, compareceu ao pronto-socorro 2 horas após ter sofrido acidente de trabalho com queda de banco de areia, relatando dificuldade respiratória e dor torácica em hemitórax À esquerda, exames de imagem realizados mostrou a presença de câmara gástrica e cólon em hemitórax esquerdo, foi operado com impressão diagnóstica de ruptura diafragmática secundária a trauma abdominal fechado. No intraoperatório, constatou-se (laceração linear envolvendo todo o hemidiafragma esquerdo) com herniação do estômago, baço, cólon transverso e parte do intestino delgado na cavidade torácica. Realizada pleurostomia baixa esquerda e frenorrafia. Sem outras alterações intra-abdominais. Discussão: a ruptura traumática do diafragma é uma lesão infrequente que ocorre como consequência de trauma contuso e penetrante no abdome ou no tórax. Seu diagnóstico precoce continua sendo um desafio e está associado a elevada morbimortalidade. O diagnóstico pré-operatório é difícil e apenas um alto nível de suspeita, um exame cuidadoso das técnicas de imagem e a intervenção cirúrgica imediata são decisivos para o sucesso do tratamento desses pacientes. Conclusões: nosso paciente não apresentou complicações maiores no período perioperatório, às 24 horas fazia dieta e vagueava, a tuba pleural foi retirada às 72 horas e teve evolução favorável sem sintomas, tendo alta hospitalar aos 10 dias.

Liver Injury in Abdominal Trauma: Management and Association with Other Solid Abdominal Organ Injury

Background and objective : Blunt abdominal injury remains one of the commonest injuries. The solid organs, namely the Liver, Spleen & Kidney are the most commonly injured intra-abdominal organs. Non operative line of management is now considered the line of treatment for patients with intra-abdominal organ injury who are hemodynamically stable. In the case of polytraumatized patients with open or blunt abdominal trauma, the liver is the most frequently injured abdominal organ. Earlier, surgical treatment was the standard procedure globally for all kinds of trauma-related liver injuries. However, development of new interventional radiological techniques has changed the paradigm towards a non-surgical patient management. Methodology: An observational study of 50 patients with solid organ injuries of the abdomen following abdominal trauma admitted over a period from July 2018 up to August 2020 was carried out. Patient management either operative or conservative was decided on basis of hemodynamic status and they were divided in groups OP (Operated) and NOM (Non Operative Management). Interpretation and conclusion : In our study, majority of liver injury were treated conservatively. Splenic injury patients were mostly managed by operative intervention and renal injury patients were managed according to grading of organ injury.

Retrospective study of polytrauma patients's medical records that presented abdominal trauma, comperad to abdominal trauma and extra-abdominal injuries

This study sought to retrospectively assess the relationship between intra and extra-abdominal injuries in polytrauma patients undergoing laparotomy at the Regional University Hospital of Maringá between 2017 and 2018.This study was based on 111 electronic medical records from the Brazilian public health system "SUS", admitted to the hospital due to trauma and undergoing laparotomy, comparing two groups: abdominal injury without extra-abdominal injury (WoEI) and abdominal injury with extra-abdominal injury (WiEI).A total of 111 medical records were analyzed, 57 from 2017 and 54 from 2018. Of these 111records, 43 (39%) were trauma victims with only abdominal injuries and 68 (61%) trauma victims with abdominal and extra-abdominalinjuries. Most patients were male (85%), with an average age of 33 years, ranging from 14 to 87 years. In statistical analysis, according to the T-test, there was significance (p > 0.05) between the WoEI and WiEI groups for data collected regarding death rates and hospitalization days. As for the morbidity rate and difference between genders (male and female), there was no statistical significance (p < 0.05).Polytraumapatients are exposed to greater kinetic energy, with more severe conditions and therefore required more in-hospital care.

Incidencia de infección del sitio quirúrgico en el Servicio de Cirugía I, hospital Dr. Miguel Pérez Carreño. 2019-2021. Estudio observacional / Surgical site infection incidence in surgery service I, Hospital Dr. Miguel Pérez Carreño. 2019-2021 Observational study

La infección del sitio quirúrgico es uno de los tipos más frecuentes de infección asociada al cuidado de la salud, tiene un impacto en el estado físico y mental de los pacientes, aumentando el riesgo de mortalidad. El objetivo de este estudio es determinar la incidencia de infección del sitio quirúrgico en cirugías electivas y de emergencia, y su distribución según la patología. Métodos: Estudio retrospectivo y observacional en el cual se incluyeron pacientes del servicio de Cirugía General I del Hospital Miguel Pérez Carreño, entre enero de 2019 y julio de 2021, a quienes se les realizó un procedimiento quirúrgico. Resultados: Se incluyeron 1341 pacientes. La incidencia global de infección de sitio quirúrgico fue de 9,77%, la mayoría de las infecciones fueron en cirugías de emergencia con una incidencia de 10,7% y de 4,17% en cirugías electivas. Las patologías con mayor porcentaje de infección fueron el trauma abdominal, seguido de la obstrucción intestinal. La incidencia de infección del sitio quirúrgico en patología apendicular fue de 10,4%. El microorganismo aislado con mayor frecuencia en los cultivos realizados fue E. coli. Conclusiones: La infección del sitio quirúrgico es una complicación frecuente en la cirugía de emergencia y requiere ser considerada y prevenida en el trauma abdominal, las obstrucciones intestinales y las peritonitis apendiculares. Conocer la incidencia de está complicación y comparar con estudios internacionales es fundamental para establecer protocolos propios para su control y prevención(AU)

Surgical site infection is one of the most frequently reported types of healthcare-associated infections, it has a negative impact on patients physical and mental health and increase the risk of mortality. The objective of this study is to determine the incidence of surgical site infection in elective and emergency surgeries, and its distribution according to the pathology. Methods: Retrospective and observational study, in which patients from the General Surgery Service I of the Hospital Miguel Pérez Carreño were included, between January 2019 and July 2021, who went under a surgical procedure. Results: In total 1341 patients were included. The overall incidence of surgical site infection was 9.77%, most of the infections were in emergency surgery with an incidence of 10.7% and 4.17% in elective surgeries. The pathologies with the highest percentage of infection were abdominal trauma followed by bowel obstruction. The incidence of surgical site infection in appendicular pathology was 10.4%. The most frequently isolated pathogens in the cultures performed was E. coli. Conclusions: Surgical site infection is a frequent complication in emergency surgery and needs to be considered and prevented in abdominal trauma, bowel obstructions, and complicated appendicitis. Knowledge of the incidence of this complication and comparing it with international studies is essential to establish own protocols for its control and prevention(AU)

Achados tomográficos nos traumas abdominais contusos e perfil dos pacientes / Tomographic findings in contune abdominal trauma and patient profile

O trauma é a 5ª. causa de morte no mundo e, na população com menos de 40 anos, é a maior causa de óbitos. O abdome é região frequentemente lesada e requer tratamento cirúrgico com frequência. Em se tratando de trauma contuso, exames de imagem oferecem diagnóstico mais acurado conduzindo tratamento mais adequado. O objetivo deste estudo foi avaliar a relação dos achados tomográficos, do exame físico e a prevalência das lesões. Foram selecionados 39 politraumatizados e vítimas de trauma abdominal contuso, através de um estudo prospectivo. Foram comparados exame físico e o achado tomográfico. Em conclusão, mostrou-se que a avaliação clínica isoladamente pode fazer com que lesões passem desapercebidas; a tomografia computadorizada teve boa sensibilidade e especificidade devendo ser realizada para diagnosticar e melhor guiar a terapêutica.

Trauma is the 5th cause of death in the world and, in the population under 40 years old, it is the biggest cause of death. The abdomen is a frequently injured region and often requires surgical treatment. In the case of blunt trauma, imaging tests offer a more accurate diagnosis leading to more appropriate treatment. The aim of this study was to evaluate the relationship between tomographic and physical examination findings and the prevalence of lesions. Thirty-nine polytraumatized and victims of blunt abdominal trauma were selected through a prospective study. Physical examination and tomographic findings were compared. In conclusion, it has been shown that clinical assessment alone can make lesions go unnoticed; computed tomography had good sensitivity and specificity and should be performed to diagnose and better guide therapy.

Trauma abdominal contuso por golpe con manubrio de bicicleta: evaluación y tratamiento / Blunt abdominal trauma due to handlebar injury

INTRODUCCIÓN: Los accidentes en bicicleta son una causa frecuente de trauma abdominal contuso en pediatría. En Chile no existen publicaciones científicas que traten sobre las lesiones abdominales por manubrio de bicicleta, su presentación y manejo. OBJETIVO: Describir tres casos clínicos de trauma abdominal contuso provocados por manubrio de bicicleta en niños, ilustrar las distintas lesiones observadas, sus formas de presentación y manejo. CASOS CLÍNICOS: 1) Paciente masculino, 11 años, consulta tras golpe con manubrio de bicicleta en epigastrio; en la Tomografía Computada (TC) de abdomen y pelvis se describió neumoretroperitoneo. Se realizó laparotomía exploradora, reparándose una perforación duodenal. 2) Paciente masculino, 14 años, consulta tras golpe en el hipocondrio izquierdo con el manubrio de la bicicleta; en la TC se evidenció fractura esplénica con múltiples laceraciones. Por la presencia de sangrado activo se trató con angioembolización, lográndose resolución de la lesión y viabilidad del órgano luego de 6 semanas de seguimiento. 3) Paciente masculino, 9 años, ingresó tras sufrir golpe con manubrio de bicicleta en el hipocondrio derecho. En TC se observó una laceración hepática, que fue manejada de forma expectante, con resolución de la lesión luego de 8 semanas de seguimiento. Todos los pacientes tuvieron una evolución favorable. CONCLUSIÓN: El trauma abdominal contuso por golpe con manubrio de bicicleta puede ser potencialmente grave en pacientes pediátricos, pudiendo afectar órganos sólidos y vísceras huecas. El manejo no quirúrgico cada vez es más utilizado, logrando altas tasas de éxito en pacientes estables. Los pacientes inestables o en los que se sospeche perforación de víscera hueca, requerirán cirugía como primera aproximación.

INTRODUCTION: Bicycle accidents are a frequent cause of blunt abdominal trauma in children. In Chile, there are no scientific articles about such accidents, their presentation and management. OBJECTIVE: The aim of this study is to describe three cases of blunt abdominal trauma due to handlebar injury in children, in order to illustrate the different kinds of lesions, their presentation, and management. CLINICAL CASES: 1) 11-year-old boy presented to Emergency Department (ED) after falling on a bi cycle handlebar, hitting his epigastric region. A CT scan showed signs of duodenal perforation. A la parotomy was performed and the duodenal perforation repaired. 2) 14-year-old boy seen at ED after a bicycle accident in which the handlebar hit him in the abdomen area. A CT scan showed a splenic injury with multiple lacerations and active bleeding that was treated with angioembolization. After 6 weeks of follow-up, he presented resolution of the lesion and viability of the spleen. 3) 9-year-old boy admitted due to a hit with the bicycle handlebar on the abdomen area. A CT scan showed a he patic injury that was managed with non-surgical procedures, achieving resolution of the lesion after 8 weeks of follow-up. CONCLUSION: Blunt abdominal trauma caused by handlebar can be potentially serious in pediatric patients, since it may affect solid and hollow abdominal viscera. Non-surgical ma nagement is becoming more used for stable patients, achieving high success rates. Unstable patients or those with suspicion of hollow viscera perforation will require surgery as first approach.

A retrospective study of blunt trauma abdomen in a tertiary center in central India: evaluation, management and outcome

Background: Blunt abdominal trauma is fairly common emergency and it is one of the important components of polytrauma. It requires high degree of suspicion, investigation and management. Inspite of improved imaging techniques leading to early recognition it is still associated with high morbidity and mortality. Trauma is the leading cause of blunt abdominal injury. This aim of the study was to find etiology, early diagnosis and management of patients with blunt abdominal trauma.Methods: This a retrospective study conducted in Gandhi medical college, Bhopal in which 90 cases of blunt abdominal trauma presented to emergency and outpatient department were included in the study duration of January 2019 to December 2019.Results: Motor vehicle accident was the most common mode of injury. Liver being the most common visceral organ injured while the most common surgery performed was the repair or resection and anastomosis of hollow viscous perforation. Rib fracture was the most common extra abdominal injury seen in 17.7% cases. Mortality rate was 5.5%. Most of the liver, spleen and renal injuries can be managed non-operatively whereas hollow viscous injury needs laparotomy.Conclusions: The result of present study is similar to other studies. Rapid diagnosis, early and timely referral, adequate and trained staff, close and careful monitoring, early wise and skilled decision to go for operative or non-operative management can help save many lives.

Massive retroperitoneal haematoma because of renal cyst rupture, report of a case / Hematoma retroperitoneal masivo por ruptura de quiste renal, reporte de caso

We report the case of an 86-year-old adult man who, as a pedestrian, is hit by a motorcycle, suffering polytrauma; in initial care, he refers to thoraco-abdominal pain and subsequently neurological deterioration. Assessed by a neurosurgeon and general surgeon, a right chest tube is placed and a laparoscopy is performed where there is little bleeding from the abdominal cavity. It shows deterioration of its general state and dies in respiratory failure. During the necropsy procedure there is subarachnoid hemorrhage and cerebral herniation, rib fractures and pneumonic consolidation, a massive retroperitoneal hematoma is observed due to rupture of simple renal cyst.

Reportamos el caso de un hombre de 86 años que, siendo peatón, es atropellado por una motocicleta, sufriendo politraumatismo. En la atención inicial refiere a dolor toracoabdominal y posteriormente deterioro neurológico. Evaluado por un neurocirujano y un cirujano general, se coloca un tubo torácico derecho y se realiza una laparoscopia y observándose poco sangrado de la cavidad abdominal. El paciente muestra deterioro de su estado general y muere por insuficiencia respiratoria. Durante el procedimiento de necropsia se determina hemorragia subaracnoidea y hernia cerebral, fracturas costales y consolidación neumónica, se observa un hematoma retroperitoneal masivo por rotura de quiste renal simple.