ABSTRACT
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.
Subject(s)
Humans , Therapeutics , Wounds and Injuries , Tomography, X-Ray Computed , Abdomen , Abdominal InjuriesABSTRACT
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.
Subject(s)
Humans , Male , Child , Adolescent , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/therapy , Bicycling/injuries , Abdominal Injuries/diagnosis , Abdominal Injuries/therapy , Wounds, Nonpenetrating/etiology , Tomography, X-Ray Computed , Emergency Service, Hospital , Abdominal Injuries/etiologyABSTRACT
A lesão de vísceras intra-abdominais por trauma abdominal contuso vem crescendo como causa de morbimortalidade, principalmente pelo aumento do número de veículos motorizados. Objetivo: traçar um perfil dos pacientes internados por trauma abdominal fechado no Hospital Universitário Evangélico de Curitiba (HUEC). Método: estudo retrospectivo, avaliou prontuários eletrônicos de todos os pacientes com idade igual ou maior que 18 anos, internados no HUEC por trauma abdominal contuso. Resultados: coletados os seguintes dados: idade, sexo, mecanismo, lesões abdominais e associadas, cirurgia, óbitos. Avaliados 57 pacientes, 68.4% do sexo masculino, 75.4% com idade entre 18 e 45 anos. Conclusão: acidente por auto foi responsável por 36.8% e 26.4% acidente com moto. O baço foi a víscera mais lesada (29.8%), seguido do fígado (26.3%) e intestino delgado (19.3%). A lesão associada mais comum foi de tórax, ocorrendo em 42.1%. O trauma abdominal contuso é cada vez mais frequente, ainda com alta morbimortalidade.
The injury of intra-abdominal organs by blunt abdominal trauma is growing as a cause of morbimortality, specially for the raise of the number of motor vehicles. To draw a profile of the inpatients for blunt abdominal trauma in the Hospital UniversitárioEvangélico de Curitiba. Retrospective study, analyzed electronic medical records of all patients with at least 18 years old, hospitalized in HUEC for blunt abdominal trauma. Collected data: age, gender, mechanism, abdominal injuries and associated, surgery, deaths. Measured 57 patients, 68.4% were male, 75.4% with age between 18 and 45 years old. Accident by car is responsible for 36.8% and 26.4% motorcycle accident. The spleen was the most injured organ (29.8%), followed by liver (26.3%) and small bowel (19.3%). The most common associated injury was the chest (42.1%). The blunt abdominal trauma is getting more frequent, and still with a high morbimortality.