Laparoscopia con preservación de órgano en lesión esplénica en dos tiempos por traumatismo cerrado de abdomen / Laparoscopy with spleen preservation for delayed splenic rupture due to blunt abdominal trauma

RESUMEN El tratamiento no operatorio (TNO) de lesiones abdominales en traumatismo cerrado de abdomen (TCA) se basa en pilares clínicos y radiológicos. Presentamos el de caso de paciente masculino de 16 años que ingresa en el Servicio de Emergencias por dolor abdominal en hipocondrio izquierdo y antecedente de traumatismo cerrado de abdomen reciente. Se establece protocolo de TNO basado en cuadro clínico e imágenes pero, en forma posterior, ante la evolución desfavorable, se cambia la conducta y se realiza tratamiento laparoscópico conservador de órgano.

ABSTRACT Nonoperative management (NOM) of organ injuries in abdominal blunt trauma (ABT) is based on clinical and imaging test findings. We herein present a 16-year-old male patient with a history of recent blunt abdominal trauma was admitted to the emergency department for abdominal pain in the left hypochondrium. A protocol for NOM was established based on the clinical picture and imaging findings, but afterwards, in view of the unfavorable progression, the approach was modified to laparoscopic organ-preserving surgery.

Concomitant paracentral acute middle maculopathy and acute macular neuroretinopathy in eyes post-blunt trauma

Purpose: To analyze the imaging characteristics and the clinical course of patients showing concomitant paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) post?blunt trauma. Methods: PAMM and AMN lesions post?blunt trauma diagnosed on enhanced depth imaging optical coherence tomography (EDI?OCT) were recruited for the study. Results: Thirteen eyes of 13 individuals with a history of blunt trauma were included in the study, of whom 11 (85%) were males. Mean age of the patients was 33.62 (range 16–67) years. Mean visual acuity at presentation and the last visit was 1.67 log of minimum angle of resolution (logMAR) and 0.82 logMAR, respectively. Mean interval between trauma and imaging was 5.08 (range 1–15) days. All patients had unilateral involvement, with the right eye being involved in 10 patients (77%). All patients had concomitant PAMM and AMN lesions. Conclusion: Presence of coincident PAMM and AMN suggests a common pathophysiologic etiology, but the description of concomitant PAMM and AMN in the setting of blunt trauma to eye is hitherto unreported. Identifying AMN in a setting of PAMM requires meticulous examination of the OCT and OCTA images. It can be a cause of suboptimal visual recovery in such eyes.

A RETROSPECTIVE STUDY BETWEEN CLINICAL EXAMINATION, FOCUSSED ABDOMINAL SONOGRAM IN TRAUMA AND CT SCAN IN BLUNT INJURY ABDOMEN IN A TERTIARY CARE CENTRE

Aims and Objectives: Blunt abdominal trauma (BAT) accounts for the majority (80 percent) of abdominal injuries seen in the Emergency Department and is responsible for substantial morbidity and mortality in developing countries. It requires high degree of suspicion, investigation and management. The most commonly injured abdominal organs are liver and spleen. The aim of this study was to find etiology, early diagnosis and management of patients with blunt abdominal trauma based on clinical examination, FAST and CT scan. A retrospective study of 60 cases of blunt Abdominal trauma patients Methods: presenting to emergency and outpatient department of Surgery of Silchar Medical College and Hospital from September 2020 to September 2021 was done. Amongst the studied cases most Results: common age group involved was (21–30) years (28 cases). Liver was found to be the most common injured organ (22 cases) followed by bowel and spleen. FAST was the most commonly used investigation after blunt abdominal trauma. CT was used only in hemodynamically stable patients (19 cases). The most common intra-operative finding was Intestinal perforation and the most common surgery performed was the repair or resection and anastomosis of intestinal perforation. Most common mode of injury wa Conclusions: s road traffic accidents and predominantly, men were affected. Clinical examination alone is inadequate because patients may have altered mental status. Initial resuscitation followed by physical examination and monitoring of clinical parameters and FAST and computed tomography (CT) abdomen are very important to detect patients with minimal and clinically untraceable sign of abdominal injury. Rapid diagnosis, early timed referral, adequate and trained staff, careful monitoring, early decision to go for operative or nonoperative management can help save many lives.

Rare Coincidence of Gallbladder Perforation in Blunt Traumatic Injury: A Case Report

@#Traumatic gallbladder perforation is an unusual but potentially life-threatening injury that can occur following blunt or penetrating abdominal trauma. A 46-year-old male presented to the emergency department following a motor vehicle accident (MVA). He complained of severe abdominal pain and sustained ecchymosis with localized tenderness over the right upper quadrant. Despite a positive focused assessment with sonography in trauma scan, initial computed tomography of the abdomen revealed grade 1 liver and splenic injury but was unable to identify gallbladder perforation. He was initially managed conservatively until he developed secondary signs of sepsis after 24 hours. An exploratory laparotomy revealed a perforated gallbladder. A subtotal cholecystectomy was done. A retrospective review revealed a missed gallbladder perforation from an earlier CT scan assessment. We report a case of missed gallbladder perforation following MVA which was only diagnosed intraoperatively after failing non-operative management, following which the patient underwent laparotomy and subtotal cholecystectomy.

Resultados del manejo no operatorio en trauma hepático de los pacientes que se presentaron al servicio de urgencias del Hospital San Vicente Fundación, Medellín / Outcomes of non-operative management of liver trauma in patients who presented to the Emergency Department of Hospital San Vicente Fundación, Medellín

Introducción. El hígado continúa siendo uno de los órganos más afectados en los pacientes con trauma. Su evaluación y manejo han cambiado sustancialmente con los avances tecnológicos en cuanto a diagnóstico y las técnicas de manejo menos invasivas. El objetivo de este estudio fue realizar un análisis de los resultados del manejo no operatorio del trauma hepático en cuanto a incidencia, eficacia, morbimortalidad, necesidad de intervención quirúrgica, tasa y factores relacionados con el fallo del manejo no operatorio. Métodos. Se realizó un estudio descriptivo observacional retrospectivo, analizando pacientes con trauma hepático confirmado con tomografía o cirugía, durante un periodo de 72 meses, en el Hospital Universitario San Vicente Fundación, un centro de IV nivel de atención, en Medellín, Colombia. Resultados. Se incluyeron 341 pacientes con trauma hepático, 224 por trauma penetrante y 117 por trauma cerrado. En trauma penetrante, 208 pacientes fueron llevados a cirugía inmediatamente, el resto fueron manejados de manera no operatoria, con una falla en el manejo en 20 pacientes. En trauma cerrado, 22 fueron llevados a cirugía inmediata y 95 sometidos a manejo no operatorio, con una falla en 9 pacientes. La mortalidad global fue de 9,7 % y la mortalidad relacionada al trauma hepático fue de 4,4 %. El grado del trauma, el índice de severidad del trauma y las lesiones abdominales no hepáticas no se consideraron factores de riesgo para la falla del manejo no operatorio. Conclusiones. El manejo no operatorio continúa siendo una alternativa segura y efectiva para pacientes con trauma hepático, sobretodo en trauma cerrado. En trauma penetrante se debe realizar una adecuada selección de los pacientes.

Introduction. The liver continues to be one of the most affected organs in trauma patients. Its evaluation and management have changed substantially with technological advances in diagnosis and less invasive techniques. The objective of this study was to perform an analysis of the results of non-operative management of liver trauma in terms of incidence, efficacy, morbidity and mortality, need for surgical intervention, rate and factors related to the failure of non-operative management.Methods. A retrospective observational descriptive study was performed, analyzing patients with hepatic trauma confirmed by tomography or surgery, during a period of 72 months at the Hospital Universitario San Vicente Fundación level 4 medical center, in Medellín, Colombia.Results. 341 patients with liver trauma were analyzed, 224 with penetrating trauma and 117 with blunt trauma. In the penetrating trauma group, 208 patients were taken to surgery immediately, the rest were managed nonoperatively with a failure in 20 patients. In the blunt trauma group, 22 were taken to immediate surgery and 95 underwent nonoperative management, with failure in nine patients. Overall mortality was 9.7% and mortality related to liver trauma was 4.4%. Trauma grade, trauma severity index, and non-hepatic abdominal injuries were not considered risk factors for failure of nonoperative managementConclusions. Nonoperative management continues to be a safe and effective alternative for patients with liver trauma, especially in blunt trauma. In penetrating trauma, an adequate selection of patients must be made.

Post-traumatic posterior giant retinal tear and macular hole associated retinal detachment

Background: Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma occurs most commonly at the equatorial region or anterior to the equator. GRT posterior to the equator is rare. Purpose: To demonstrate the successful management of a post?traumatic posterior GRT and full?thickness macular hole (MH) associated retinal detachment (RD). Synposis: A 21?year?old?male presented with sudden diminution of vision in the right eye (RE) following blunt?trauma with cricket ball. RE vision at presentation was hand movement close to face. Anterior segment of RE revealed pupillary sphincter tear, posterior synechiae and posterior subcapsular cataract (PSC). RE fundus revealed a posterior?GRT, full thickness MH, mild vitreous haemorrhage and rhegmatogenous RD. He was managed with pars plana vitrectomy, encircling scleral band, perfluorocarbon liquid?assisted flattening of GRT, internal limiting membrane peeling, and endotamponade. Post?operatively the retina was attached, MH was closed and the patient achieved an ambulatory vision of 1/60. Highlights: This video demonstrates the successful management of a posterior?GRT and MH associated RD. Removal of adherent hyaloid from the long anterior flap of posterior GRT, peeling of ILM from temporal narrow mobile strip of retina (which has a risk of radial extension of GRT edges) and manoeuvring in suboptimally dilated pupil are illustrated in this video.

Iridodialysis repair – A simplified approach

Background: Iris root is the thinnest and weakest portion of the iris stroma. It can detach easily due to blunt trauma or accidental engagement of the iris during intraocular surgery resulting in glare, photophobia and monocular diplopia. Multiple techniques described for iridodialysis repair such as hang back technique, stroke and dock technique and sewing machine technique are technically challenging. Purpose: To describe an simplified approach of iridodialysis repair using 9?0 prolene suture. Synopsis: We demonstrate the technique of iridodialysis repair using animation for better understanding. Scleral flap is made adjacent to the iridodialysis area and a paracentesis is made oppsite to the iridodialysis. One arm of the double armed straight needle with 9?0 prolene suture is passed through the paracentesis into the iris root and docked in the 26G needle which is passed underneath the scleral flap 1.5mm posterior to the limbus. Then the needle is pulled out underneath the scleral flap and the manoeuvre is repeated for the second arm as well. The sutures are secured with 5?6 knots under the scleral flap. Intra? operative surgical videos of two patients with traumatic cataract and iridodialysis following blunt trauma are shown. After stabilizing the detached iris using iris hooks, phacoemlsification is done with implantation of foldable acrylic IOL, followed by iridodialysis repair as described above. Both the patients were relieved of their pre?operative symtoms and had good visual recovery. Highlights: We describe a simplified approach of iridodialysis repair that can significantly reduce the patient’s troublesome symptoms such as glare and monocular double vision.

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

Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience / 世界急诊医学杂志（英文）

@#BACKGROUND: Traumatic aortic dissection (TAD) has a low incidence but extremely high mortality. It always presents atypical clinical manifestations that are easily missed or misdiagnosed. This study mainly aims to describe the imaging characteristics and management of TAD patients. METHODS: A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020. Demographic features, imaging characteristics, and management were analyzed. RESULTS: Twenty-seven patients with type B aortic dissection (age 56.04±16.07 years, 20 men) were included. Aortic intimal tears were mostly initiated from the aortic isthmus. The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature (1.78±0.56 cm vs. 1.24±0.52 cm, P=0.031). Compared with those in the control group, the maximum diameters of the aortic arch, thoracic aorta, and abdominal aorta in the TAD patients were all significantly widened (all P<0.050). Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD, with a predictive value with an area under the receiver operating characteristic curve (AUC) of 0.673. Finally, 26 patients successfully underwent delayed thoracic endovascular aortic repair (TEVAR), and the remaining one patient was treated conservatively. No progression of aortic dissection or death occurred during the six-month follow-up period. CONCLUSIONS: In blunt trauma, the aortic isthmus is the most common site of proximal intimal tears. An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics. Delayed TEVAR might be an effective therapeutic option for TAD.

Correlation of rib fracture patterns with abdominal solid organ injury: A retrospective observational cohort study / 中华创伤杂志(英文版)

PURPOSE@#Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma.@*METHODS@#This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient.@*RESULTS@#Altogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 patients (34.91%) and were significantly associated with middle zone rib fractures.@*CONCLUSION@#There is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.

Spinal cord injury in the setting of traumatic thoracolumbar fracture is not reliably associated with increased risk of associated intra-abdominal injury following blunt trauma: An analysis of a National Trauma Registry database / 中华创伤杂志(英文版)

PURPOSE@#There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries, specifically for intra-abdominal injury (IAI). The impact of concomitant spinal cord injury (SCI) with the risk of associated IAI has not been well clarified. The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.@*METHODS@#A retrospective cohort study using the Israeli National Trauma Registry was conducted. Patients with thoracic, lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1, 1997 to December 31, 2018 were examined, comparing the incidence, severity and mortality of IAIs in patients with or without SCI. The collected variables included age, gender, mechanism of injury, incidence and severity of the concomitant IAIs and pelvic fractures, abbreviated injury scale, injury severity score, and mortality. Statistical analysis was performed using GraphPad InStat ® Version 3.10, with Chi-square test for independence and two sided Fisher's exact probability test.@*RESULTS@#Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures. Combined thoracic and lumbar fractures were observed in 1272 patients (7.5%), isolated thoracic fractures in 4967 patients (29.4%) and isolated lumbar fractures in 10,639 patients (63.0%). The incidence of concomitant SCI was found in 4.95% (63/1272), 7.65% (380/4967) and 2.50% (266/10639) of these patients, respectively. The overall mortality was 2.5%, proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts (11.3% vs. 4.6%, p < 0.001). Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts (8.2% vs. 3.1%, p < 0.001). There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures; although isolated lumbar fractures patients with SCI were more likely to have renal (3.4% vs. 1.6%, p = 0.02) or bowel injuries (2.3% vs. 1.0%, p = 0.04) than the non-SCI counterparts.@*CONCLUSION@#SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI. However, in a subset of isolated lumbar fractures, SCI patient is associated with increased risks for renal and bowel injury.

Penetrating Scrotal Injury: Two Unusual Case Reports in Children and Brief Review of Literature

Introduction:Scrotal trauma is a rare surgical emergency that accounts for less than 1% of all traumatic injuries. They are more prevalent in 15-40 years age group. Blunt scrotal trauma contributes to about 80% of all scrotal injuries whilst penetrating scrotal injuries constitute the remaining 20%. Penetrating scrotal injuries are however, more rare in children but can result from bicycle handlebars, falls with impalement, and animal bites. Case Reports: We did a retrospective review of our records over a 7-year period for penetrating scrotal injuries and report two (2) cases involving 13-year old and 14-year old males who sustained injuries from a tree branch and an iron rod respectively after falling from heights. Discussion:Penetrating scrotal trauma can present with complex injury patterns involving the testes and other surrounding structures, and all invariably need urgent scrotal exploration Consequently, both of our cases had immediate surgical exploration with conservative debridement of non-viable tissue and surprisingly both were spared any testicular injury. Conclusion:Penetrating scrotal trauma may spare the testis and the scrotal contents despite the gravity of the injury.

A Clinical Study of Blunt Trauma Abdomen in a Tertiary Care Hospital of Uttarakhand

Background: Blunt abdominal injuries are met more often nowadays due to increased industrialization and a greater numberof vehicles, and is the third most common form of injury in road traffic accidents (RTAs) after orthopedic injuries and headinjuries. Blunt injury to the abdomen can also occur as a result of fall from height, assault with blunt object and sports injuries,etc. Blunt trauma abdomen is seen in increasing number in the emergency department and therefore, the early diagnosis andtreatment are very important and crucial for patients.Methods: The study was carried out from January 2018 to December 2019. A total of 100 patients were studied. After detailedclinical history, physical examination various investigations such as complete blood count, X-rays, ultrasound of the abdomen,and computed tomography scan of the abdomen were done to complete the diagnosis. Then, data were statically analyzed.Results: In our study, male patients were commonly affected (73%). The younger population between the age group of 18 and40 years was predominantly affected (73%). The common mode of injury was RTAs (62%). The organ that was found to bemost commonly injured in our study was the liver (27%) than spleen (22%). About 59% patients were managed conservativelywhile 41% were operated. The most common cause of death was cardiorespiratory failure followed by septicemia.Conclusions: This research article shows that blunt injury abdomen is a major cause of morbidity and mortality in young agepatients with RTA being the most common cause. Patients that are received in the emergency department should be givenimmediate attention and a quick and thorough evaluation of the patient must be done. Early diagnosis reduces the mortalityrates and plays a major role in good outcome and lead to successful treatment in these patients.

Management of traumatic and non traumatic hollow visceral perforation in North India

Background:Hollow visceral perforation is the commonest perforation among all the hollow viscera in the body. The perforation can be traumatic or non-traumatic and it constitute commonest surgical emergency worldwide. The diagnosis of perforation can be made clinically but for confirmation basic radiological investigations and sometimes special investigation are required. Methods:This is a prospective observational study conducted in our institute in the Department of General Surgery. The patients who are included in this study were more than 15 years of age in both sexes having hollow visceral perforation presenting in accident and emergency department.Results:Out of 624 patients, 530 (84.93%) were males while only 94 (15.06%) were females, with a male: female ratio of 5.63:1. The site of perforation are ileum 37.01% duodenum, 28.36% maximum sites of hollow viscous perforation. Acid peptic disease was the cause of perforation in 27.40% of 171 cases. Enteric fever accounted maximally for 29% of 181 cases and all in the ileum. Acute appendicitis resulted in perforation of the appendix in 64 cases (10.25%) while blunt trauma abdomen causes perforation in 12.66% of 79 cases. Perforation due to stab injury accounted for 5.12% and fire arm injury perforation seen in 19 patients (3.04%).Conclusions:Early diagnosis of perforation, resuscitation with crystalloids with broad spectrum antibiotic coverage and urgent surgical intervention whenever patient is fit for anaesthesia are the important factors which decides the ultimate fate of the patient in case of hollow visceral perforation peritonitis.

A rare case of isolated gall bladder perforation in blunt trauma abdomen: a case report

Blunt trauma abdomen leading to gallbladder perforation is a rare event usually recognized on evaluation and treatment of other visceral injuries during laparotomy. The gallbladder is relatively a well-protected organ. Isolated gallbladder perforation is extremely rare. The clinical presentation is variable, early diagnosis and treatment is of extreme importance to reduce morbidity and mortality associated with gallbladder perforation. We report a case of a patient who sustained isolated gallbladder injury following blunt trauma abdomen to emergency department in Safdarjung Hospital, New Delhi.

A Comparative Study of Chest X-ray and Chest High-resolution Computed Tomography in Blunt Trauma Chest Patients

Introduction: Computed tomography (CT) scan is an accurate tool for the detection of injuries in a trauma setting and is able to find the injuries that were occult in chest X-ray (CXR). In past years, the utility of CT scan was limited to severe trauma injuries but now is used in less severely injured trauma patients. The study aimed to compare the efficacy of CXR and chest CT scans in patients with chest trauma. Materials and Methods: The present study was conducted in the Department of Surgery of Medical Institute. For the study, we prospectively view the previous medical records of the patients who were admitted in our surgical ward for blunt chest trauma and received both CXR and high resolution CT chest scans. A total of 95 patients were included in the study. Data regarding the study were collected. Results: Out of 95 patients, 79 were males and 16 females. The mean age of the patients was 32.42 years ranging from 2 to 90 years. The most common cause for blunt trauma to the chest according to our results was a road traffic accident. We observed that CT scan is more accurate as compared to CXR in the detection of certain cases such as sternum fracture, rib fracture, scapula fracture, lung contusion, hemothorax, and pneumothorax. Conclusion: Chest CT scan is highly sensitive in the detection of thoracic injuries following blunt chest trauma. In day-to-day practice, CT scan is better in visualizing as sternum fracture, rib fracture, scapula fracture, lung contusion, hemothorax, and pneumothorax

Epidemiology of Adult Trauma at a Tertiary Hospital in Riyadh, Saudi Arabia

Objective: To identify the type and mechanism of trauma-based on patients’ characteristics at a tertiary hospital in Riyadh, Saudi Arabia. Methods: The study was a retrospective cohort observational study using the Trauma Registry of King Abdulaziz Medical City, Riyadh, Saudi Arabia. The study period was from January 2015 to December 2018. The data gathered were demographic information, mortality, type and mechanism of injury, Glasgow Coma Scale (GCS), Injury Severity Score (ISS) and the Triage Revised Trauma Scale (T-RTS). Categorical data are described with percentage and frequency, and numerical data with mean and standard deviation. A Chi-square was used to assess the relationship between the type of trauma and patient characteristics. A Fisher exact test was used to compare the type of injury with the other variables. A p-value of less than 0.05 was considered statistically significant. Results: A total of 4083 participants. The majority were male (79.9%, n=3263). Blunt trauma was the most prevalent type of injury (87.4%, n=3570, p<0.001). A motor vehicle accident was the most prevalent mechanism of injury (42.1%, n=1717). The highest proportion of trauma per age group was in the 21-30 year age group (32.6%, n=1331). The lowest GCS and RTS mean scores were observed in blunt trauma (p<0.001 and 0.001 respectively). In addition, the highest ISS mean score was observed in the blunt trauma subgroup (p<0.001). Conclusion: The study highlights the type and mechanism of trauma at KAMC in Riyadh, Saudi Arabia, based on gender, age groups, types of trauma and mechanisms of injury. This data will be a valuable resource for the local healthcare system.

Blunt abdominal trauma in Sanglah Hospital Bali, Indonesia: a study of 65 cases

Abdominal trauma is a challenge for every surgeon, whether related to diagnosis or treatment. In developing countries, the number of traumatic events associated with death makes it necessary for a study to be carried out to see the patterns and damage caused by abdominal trauma and the organs involved. Material and Method is all patients with blunt trauma of the abdomen who came to emergency unit Sanglah Hospital Bali, from January 2017 up to May 2018 that undergo laparotomy exploration were enrolled, the data were collected retrospectively using patient medical records. Results is 65 patients with blunt abdominal trauma came to the emergency department and undergoes laparotomy exploration, range of age was 4-74 year old and 75.3% of them were men. The most common injured organs were spleen and liver, both are 26 and 15 cases (40 and 23%). Another intraoperative finding are Ileum Perforation (10 cases) Left Zone II Retroperitoneal Haematoma (7 cases), and Mesenterium Rupture (5 cases). Splenectomy was the most performed procedure (26 cases). The most common cause of blunt abdominal trauma was motor vehicle accident. Hypovolemic shock was the most common clinical presentation (48 patient). The Conclusions are according to this study, men consisted 75.3% cases of blunt abdominal trauma and the range age of patients was 4-74 year old. The most common cause was motor vehicle accident. Among patients with intra-abdominal organ damage, spleen and liver were most commonly involved. About 84.6% of all patients with blunt abdominal trauma were discharged without complication and morbidity.

The role of laparoscopy in patients with abdominal trauma

Background: Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted.Methods: All adult patients who presented with abdominal trauma laparoscopic surgery was considered in patients who were deemed fit for the same in the Department of General Surgery, MMIMSR, Mullana, Ambala during a period of 18 months starting from January 1st 2015 to June 30th 2016. Data was analysed using descriptive statistics.Results: A total of 53 patients with either blunt or penetrating abdominal trauma that required surgery were included in the study. Exploratory laparotomy was performed in 45 patients (84.91%) and laparoscopy was performed in 8 patients (15.09%). Overall mesenteric injury (45.28%) was the most common intra-abdominal injury noted. The most common organ involved in blunt trauma was the spleen (68.97%). The mean operating time of laparoscopy was lesser by 57 minutes as compared to exploratory laparotomy. The use of laparoscopy avoided negative and non-therapeutic laparotomy in 2 patients (25%). Therapeutic laparoscopy was performed in 3 patients with repair of bowel and mesenteric injuries. There was no documented procedure‑related morbidity and mortality.Conclusions: The positive outcomes from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal trauma patients.

Clinical Profile of Blunt Trauma Chest: A Hospital based Study

Introduction: Blunt trauma to the chest is a very commonoccurrence in setting of traumatic incidents occurring withhighest frequency in young adults between 15-35 years ofage. Traumatic chest injuries lead to significant burden ofmortality and morbidity in the young population. The mostcommon modes of injury in such patients is motor vehicleaccidents followed by other high energy traumatic scenarioslike falls from height, contact sports, violence etc. This studywas aimed at the evaluation and management of BCT with ribfractures and associated injuries.Material and Methods: The present study was a retrospectivecum prospective hospital based study done in SKIMS MedicalCollege Hospital, Srinagar, J & K, India. Sixty four patientswho attended the Emergency Department with history of bluntchest injury were included in the study. Patients of all gendersbetween 18 and 65 years of age were included in the study.The data regarding age, gender, mode of injury, presence ofthoracic injuries, abdominal injuries, skeletal injuries wasgathered and tabulated.Results: We observed a strong male preponderance with45 out of 64 patients being male. Most common mode ofinjury was traffic accidents followed by falls from height,fall of heavy objects, hit by animals, violence and contactsports. Associated injuries were seen in both thoracic andextra-thoracic organs. Musculoskeletal injuries were alsocommonly seen. Patients were managed according to ATLSprotocol; fifteen patients were managed with intercostal tubedrainage four of which required thoracotomy, four patientsrequired laparotomy for visceral injuries, four patientsrequired fixation of vertebral fractures and musculoskeletalinjuries were managed according to the orthopaedic protocols.In the present study four (6.25%) died as a result of massivethoracic injuries.Conclusion: Blunt chest injury is a serious injury whichcan result in life threatening complications which need to beanticipated, identified and adequately managed to reduce therates of poor outcome. Integrated management employingthe general surgeon, anesthetist, orthopaedician, internistand relevant paramedics is essential. Strict adherence toATLS protocol is imperative. Adequate fluid resuscitation,ventilatory support, O2 inhalation, pulmonary physical therapyand efficient analgesia can lead to quick recovery and reducedrates of surgical intervention