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.

Analysis on the Injury Mechanism and Characteristics of Ox Horn / 法医学杂志

OBJECTIVES@#To study the morphological characteristics of the injury caused by ox horn on human body and its injury mechanism, and to discuss the rules and characteristics of injury by ox horn and provide forensic evidences for identification of such cases.@*METHODS@#The comparative analysis of position and morphological characteristics were performed by summarizing the data of 100 victims gored by ox accepted by Heilongjiang agricultural areas public security bureau during 2004-2014.@*RESULTS@#The specific injuries only could be found at the contact positions such as thorax and abdomen, lower back and limbs of the victims gored by ox horn. Most of the skin wounds had the characteristics of sharp injuries, the bar-type injury by club which called "rail way bruise" was an obvious characteristic appeared on the soft tissue.@*CONCLUSIONS@#Ox horn can cause non-specific injuries on thorax and abdomen, lower back and limbs of human body, which are similar with the characteristics of sharp injury and injury by club. Careful analyzation and identification should be performed on such injury in daily work.

Traumatic Diaphragmatic Hernia.

Blunt traumatic diaphragmatic ruptures are uncommon yet associated with high mortality. They occur due to blunt or penetrating thoraco-abdominal injury. Diagnosis is often missed, and a high index of suspicion is vital. They may present acutely or delayed as respiratory distress or obstruction. They can be managed through a laparotomy or a thoracotomy and in the present day with minimal access surgery. We report an interesting case of blunt traumatic diaphragmatic hernia in a 48-year-old man presenting after abdomino-thoracic injury due to fall from height. He had herniation of the colon and stomach. Through a left subcostal incision, the herniated organs were reduced, and the diaphragmatic defect closed with prolene suture.

Victim profile and pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents.

The present research aims to highlight the pattern of thoraco-abdominal injuries sustained by the victims of fatal road traffic accidents (RTA) in Manipal, South India. The study is an autopsy based observation of thoraco-abdominal injuries in victims of fatal road traffic accidents during 1999 – 2003. Road traffic accidents accounted for most of the injury related deaths (77%) during the study period. A male preponderance (86%) was observed with a male-female ratio of 6:1. Individuals in the age group of 21 to 50 years formed the most vulnerable (83%) group. External thoracic injuries were more common than internal thoracic injuries in the thoracic region. In the abdominal region, internal injuries were more common than external injuries. Lungs (61%) and kidneys (23%) were the most commonly involved organs in the thoracic and abdominal regions respectively. Majority of the victims were two wheeler occupants (35%) followed by pedestrians (23%). The study indicates the pattern of thoraco-abdominal injuries sustained along with the trend of road traffic accidents in the region.

Death due to isolated mesenteric vascular injury following blunt abdominal trauma: A case report.

Death due to isolated injury to small bowel mesentery following abdominal trauma is rare. It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. Focal mesenteric infiltration associated with haemoperitoneum, particularly in the absence of solid organ injury, is highly suggestive of a mesenteric tear. In this report one such seat belt abdominal injury with subsequent mesenteric tear and bowel infarction with significant haemoperitoneum leading to death on the Operation table is being discussed. The main significance of this injury is delay and difficulty in diagnosis, especially when there is minimal signs and symptoms to warrant an exploratory laparotomy. Early detection and emergency surgical intervention when necessary are critical in improving the outcome of treatment.

Lesões abdominais por uso do fio guia em ensaios cirúrgicos do quadril: estudo em cadáver / Abdominal injuries due to the use of guide wire in hip surgery experiments: cadaveric study

OBJETIVO: Avaliar a relação entre lesões abdominais e a introdução de fios guia em ensaios cirúrgicos do quadril, propor um sistema de escorização e conduta médica em função da distância percorrida pelo fio guia a partir da placa quadrilátera e a estrutura anatômica lesionada. MATERIAL E MÉTODOS: Utilizou-se 18 quadris de cadáveres, um fio de Steimann de 3.2 x 300 mm, um perfurador elétrico e um paquímetro. Introduziu-se o fio no centro do colo femoral por via de acesso lateral no quadril sob visualização direta. Por via de acesso abdominal mediana longitudinal estendida à região pélvica, observou-se a placa quadrilátera até o fio a transfixar. A partir deste ponto, prolongou-se a inserção por mais 140 mm, a fim de observar seu trajeto abdominal e descrever as lesões apresentadas em função da distância percorrida. RESULTADOS: Houve cinco (27 por cento) lesões de cólon sigmóide e uma (5 por cento) lesão transfixante do nervo obturador. Artérias e veias ilíacas comuns contra laterais ao quadril fixado não foram lesionadas. CONCLUSÃO: O fio guia não deve ultrapassar a placa quadrilátera. Medidas de prevenção são importantes no pré e intra-operatório e o escore e a conduta médica propostos neste estudo devem ser criteriosamente observados nos casos de lesão comprovada.

OBJECTIVES: Evaluate the relationship between abdominal injuries and the introduction of guide wire in experimental hip surgery, to propose a scoring system and a medical management based on the distance traveled by the guide wire from the quadrilateral plate until the damaged anatomical structure. MATERIAL AND METHODS: 18 cadaveric hips, a Steimann pin of 3.2 x 300mm, an electric drill and a caliper were used. The wire was inserted in the center of the femoral neck through a lateral approach in the hip under direct visualization. Via median abdominal extended approach to the pelvic region, the quadrilateral plate was observed until the wire crossed it. From this point the wire was further inserted 140 mm in order to observe its abdominal path and describe the lesions presented based on the distance traveled. RESULTS: There were five lesions (27 percent) in the sigmoid colon, and one transfixing injury (5 percent) of the obturator nerve. The common iliac arteries and veins from the contralateral hip were not injured. CONCLUSION: The guide wire must not exceed the quadrilateral plate. Preventive measures are important in the pre- and intra-operatory stages and the score and medical management proposed in this study should be carefully observed in cases of injury.

Epidemiology and management of intra-abdominal injuries due to criminal abortion

To collect data about different aspects of epidemiology of intra-abdominal injuries due to criminal abortions and devise a plan of management for various categories of intra-abdominal injuries. This observational case series study was carried out in Surgical unit 2, Bahawal Victoria hospital, Bahawalpur, from January 2006 to December 2007. A total of 40 consecutive patients were studied. All patients of abdominal injuries due to criminal abortion were included in the study. Patients of criminal abortion having only gynaecological complications i.e. per vaginal bleeding, septicaemia and acute renal failure were excluded from the study and only the patients with abdominal injuries were included. Relevant history and appropriate physical examination was performed and necessary investigations were done. Exploratory laparotomy was performed and injuries were treated accordingly. The most common age group developing intra-abdominal injury due to criminal abortion was of 25-34 years [77.5%]. Most of these abortions were in first trimester [70%], in women belonging to poor socio-economic status [80%]. Sixty five percent of these abortions were induced by semi-skilled persons, mostly by dilatation and curettage [70%]. The most common clinical presentation was painful abdominal distention [57.5%]. On laparotomy, gut injury was found in 20 [50%] cases, out of which 12 [60%] cases underwent gut exteriorisation. Isolated uterine injury was observed in 13 [32%] cases, out of which 12 [92%] patients underwent primary uterine repair. Intra-abdominal injuries due to criminal abortions are a definite entity. They usually present as acute abdomen. Exploratory laparotorny is mandatory; viscera most commonly injured are gut and uterus

La colonoscopia: ¿es un estudio pre-operatorio indispensable para la restitución del tránsito intestinal en pacientes jóvenes: portadores de colostomía por traumatismo abdominal penetrante? / Colonoscopy: is a necessary pre-operatory study for intestinal transit restitution in young patients carrying a colostomy by penetrating abdominal trauma?

Determinar el impacto de la colonoscopia como procedimiento preoperatorio requisito para la restitución del tránsito intestinal en una población portadora de colostomía por un traumatismo abdominal penetrante. Estudio descriptivo, retrospectivo observacional, donde se evalúan informes de endoscopias digestivas inferiores realizadas por el servicio de Gastroenterología del Hospital General del Oeste "Dr. José Gregorio Hernández" de Caracas, como requisito preoperatorio para la restitución del transito intestinal en pacientes portadores de colostomía por traumatismo abdominal penetrante, en el período comprendido entre enero 2004 y diciembre 2008. De una población total de 46 pacientes, se les realizó una colonoscopia a 34 (73,91%). Los 12 restantes (26,08%), no cumplían con los criterios de inclusión. de los 34 pacientes incluidos para evaluación, 22 (64,70%), presentaron colitis y recidivas por deprivación, 7 (20,59%) con estudio normal y 4 (11,76%) presentaron alguna alteración en la endoscopia digestiva inferior. En este estudio no hay evidencia que sugiera que la realización de una colonoscopia preoperatoria en la cirugía electiva de restitución de tránsito intestinal, evite la aparición de complicaciones, ni permita el diagnóstico de patologías de relevancia en la población estudiada, no teniendo ésta la importancia que se le ha otorgado hasta la actualidad.

To determine the impact of the colonoscopy as pre-operating procedure as a requirement in the population carrying of colostomy by abdominal penetrating trauma for the restitution of the intestinal transit. Descriptive, retrospective and observational study, where the inferior digestive endoscopy made by the service of Gastroenterology in Hospital General del Oeste "Dr. José Gregorio Hernández", Caracas, was valued as pre-operating requirement in carrying patients of colostomy by abdominal penetrating trauma for the restitution of the intestinal transit, in the period between January 2004 to December 2008. In a population of 46 patients, only 34 (73.91%) were included to do the colonoscopy, the others 12 (26,08%) didn't fulfill the inclusion criteria. Of the 34 patients included, 22 (64.70%) were displayed colitis and rectitis by deprivation, 7 (20.59%) were normal study and 4 (11.76%) presented others alteration in the inferior digestive endocopy. In this study there is not evidence to suggest that the realization of preoperatory colonoscopy for surgery in the restitution of intestinal transit, avoid complications or permit diagnosis of diseases in the study population, doing less important the evidence exposed until present.

Empalamiento tóraco-abdominal: reporte de un caso / Impalement involving abdomen and thorax: report of one case

Impalements, especially those involving more than one anatomical region, are uncommon. We report a 30 years old male that was injured by a steel jimmy bar that entered by the left inguinal region and exited by the posterior part of the left hemithorax, causing multiple intestinal lesions, a lung and diaphragmatic lesion, costal and scapular fractures. He was operated, extracting the jimmy bar and correcting the multiple lesions. He was discharged ten days later.

Los casos de empalamiento son altamente infrecuentes, sobre todo aquellos que comprometen más de una región anatómica. Damos a conocer el caso de un obrero de 30 años que accidentalmente fue transfixiado por un chuzo, con entrada a nivel inguinal izquierdo y salida por hemitórax ipsilateral, lo que ocasionó múltiples lesiones intestinales, lesión diafragmática, lesión pulmonar y fracturas expuestas costales y escapular izquierda. Su evolución fue exitosa debido a un adecuado manejo pre e intrahospitalario.

Clampeamiento hepático prolongado: una alternativa en el trauma hepático severo / Clampeamiento prolonged liver: an alternative in severe hepatic trauma

Exponer la experiencia en el manejo del trauma hepático con clampeamiento prolongado, en el Servicio de Cirugía Uno. Hospital General del Este "Dr. Domingo Luciani". Paciente masculino de 28 años que ingresa a la Unidad de Politraumatizados (UPT) posterior a accidente en motocicleta. Hemodinámicamente estable, examen físico, tórax: murmullo vesicular disminuido en base derecha y abdomen; signos de irritación peritoneal, Rx de tórax hemoneumotórax y fractura del tercero al séptimo arcos costales derechos; toracotomía mínima que drena abundante burbujeo y 500 cc serohemático, FAST: moderada cantidad de líquido libre. Se realiza laparotomía exploradora con hallazgos de: hemoperitoneo 3000cc y lesión hepática grado IV; se realiza primera fase de control de daños, con clampeamiento y empaquetamiento hepático como estrategia para el control de la hemorragia; y cierre abreviado. Segunda fase de control de daños en la Unidad de Terapia Intensiva (UTI) durante 48 horas, posterior a lo cual, se realiza tercera fase de control de daños, con hallazgos de ausencia de hemoperitoneo, 100cc de secreción biliar, lesión en segmento VIII hepático no sangrante. Se retiran comprensas y clamps hemostático lavado, drenaje de cavidad y cierre con puntos de tensión. Evoluciona satisfactoriamente, egresando de la UTI, complicado con fístula biliar resuelta con papilotomía electiva en el postoperatorio tardio.

The use of pyloric exclusion for treating duodenal trauma: case series / Exclusão pilórica no tratamento do trauma duodenal: série de casos

CONTEXT AND OBJECTIVES: Significant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. DESIGN AND SETTING: Cross-sectional study followed by a case series in a university hospital. METHODS: Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed. RESULTS: The causes of the injuries included penetrating gunshot wounds (GSW) in five patients and motor vehicle accidents (blunt trauma) in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50 percent) or IV (50 percent) and the morbidity rate was 87.5 percent. Four patients (50 percent) died during the postoperative period from complications, including hypovolemic shock (one patient), sepsis (peritonitis following the missed injury) and pancreatitis with an anastomotic fistula (two patients). CONCLUSIONS: Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.

CONTEXTO E OBJETIVOS: Há controvérsias a respeito do melhor tratamento cirúrgico para as lesões duodenais complexas. O objetivo deste estudo é relatar uma série de oito casos de reparo duodenal utilizando a exclusão pilórica e descrever a evolução dos pacientes com trauma duodenal complexo submetidos a este procedimento. TIPO DE ESTUDO E LOCAL: Estudo transversal e descrição de série de casos em hospital universitário. MÉTODOS: Foram coletadas e analisadas as informações de oito pacientes com trauma duodenal submetidos à exclusão pilórica em um período de 17,5 anos. RESULTADOS: Os mecanismos de trauma envolvidos foram ferimentos por projétil de arma de fogo em cinco pacientes e acidente automobilístico em três pacientes. O atraso do tratamento cirúrgico foi maior nos pacientes vítimas de trauma fechado, e em um paciente a lesão pelo projétil passou despercebida, sendo o procedimento cirúrgico realizado em nova laparotomia após 36 horas. As lesões duodenais encontradas foram grau III (50 por cento) ou grau IV (50 por cento), e a taxa de morbidade foi de 87,5 por cento. Quatro pacientes (50 por cento) morreram durante o período pós-operatório, de complicações como choque hipovolêmico (um caso), sepse (peritonite por ferimento não identificado), ou pancreatite associada à fístula da anastomose (dois casos). CONCLUSÕES: A exclusão pilórica esteve associada à alta taxa de morbimortalidade. Esta técnica cirúrgica deve ser indicada em poucos casos de lesão complexa de duodeno e o cirurgião deve saber que, frente a uma lesão duodenal, a sutura primária pode ser o melhor tratamento.

Hernia de Bochdalek: caso clínico / Bochdalek hernia: clinical case

La Hernia Diafragmática es la penetración de una o más visceras abdominales en el tórax, a trvés de un orificio normal o anormal del diafragma. Se han descrito 4 formas diferentes de hernias diafragmáticas congénitas: Hernia de Hiato, Hernia paraesofágica, Hernia de Morgagni-Larrey y Hernia de Bochdalek, así como también se han descrito Hernias diafragmáticas post-traumáticas. La Hernia de Bochdalek (posterolateral) es el resultado de un defecto diafragmático congénito en la parte costal posterior del diafragma, en la región de las costillas X y XI. Es una patología frecuente en el recién nacido y rara en el adulto. En la revisión de la literatura mundial encontramos 100 casos reportados en el adulto. Suele haber una comunicación libre entre las cavidades torácica y abdominal. Este defecto es más frecuente (90 por ciento) en el lado izquierdo, aunque puede producirse en el lado derecho, donde el hígado a menudo impide su diagnóstico. Es dos veces más frecuente en el varón. Presentamos el caso de una paciente femenina de 76 años, quién ingresó con dificultad para respirar y dolor torácico, desde hace (04) meses, se constata en el hemitórax izquierdo ruidos respiratorios abolidos con ruidos hidroaéreos presentes. Se realizan métodos diagnósticos a través de imágenes y se confirma evidente desplazamiento apical de estructuras retroperitoneales, riñón y asas intestinales hacia el hemitórax izquierdo. Se le realizó toracotomía izquierda, posterolateral, nefrectomía izquierda y afrontamiento de defecto diafragmático. Se realiza la revisión de dicha patología.

Los costos del trauma en el Hospital General del Oeste "Dr. José Gregorio Hernández" / Trauma costs the Hospital General del Oeste Dr. José Gregorio Hernández

Conocer las características y el costo del trauma en el Hospital General del Oeste "Dr. José Gregorio Hernández", Caracas-Venezuela. Estudio prospectivo y descriptivo de casos que ingresaron por trauma. Ingresaron, entre enero y junio del 2004, 251 pacientes, 90 por ciento masculinos y 88 por ciento menores de 40 años. El principal mecanismo de lesión fue el arma de fuego, afectando principalmente extremidades y abdomen. Treinta y dos por ciento de los casos ameritó intervención quirúrgica, siendo la laparotomía exploradora la más frecuente, y la más costosa la exploración vascular. El promedio de hospitalización fue de 6,8 días con un costo de Bs. 222.653,89 - BF 222,66-por día y Bs. 2.377.135, -237,14 BF- promedio por caso (US$ 1.238,09). El trauma afecta con más frecuencia a la población masculina en edad productiva, prevaleciendo el penetrante sobre el cerrado, involucrando en orden de frecuencia las extremidades, el abdomen, el tórax, la cabeza y el cuello. La laparotomía exploradora fue la intervención más frecuente, siendo la más costosa la exploración vascular, seguida de la toracotomía y la laparotomía. El costo mínimo fue de Bs. 2.377.135 o 237,14 BF (US$ 1.238), hallándose la mayor inversión en el área de hospitalización, seguida por área quirúrgica y emergencias.

Lesiones por cinturón de seguridad en pediatría / Seat belt injuries in children

Antecedentes: Los usuarios de automóviles usan más los dispositivos de seguridad en los últimos años. Los médicos nos enfrentamos ahora a un nuevo síndrome provocado por la poca o mala instrucción de conductores y pasajeros. Los errores en la utilización del cinturón de seguridad producen un patrón característico de heridas que pueden evitarse. Objetivos: Mostrar las características del patrón lesional del cinturón de seguridad. Proponer pautas de manejo seguras que permitan un rápido diagnóstico y tratamiento. Disminuir la morbimortalidad por inadvertencia de lesiones ocultas. Lugar de aplicación: Departamento de Urgencia, Hospital de Niños Ricardo Gutiérrez de Buenos Aires, servicio de cirugía general y terapia intensiva. Diseño: Observacional y retrospectivo. Población: 7 pasajeros pediátricos de vehículos a motos. Edades entre los 18 meses y los 13 años. Todos víctimas de colisiones trontales con sistemas de sujeción colocados. Método: se enrolaron traumatismos provocados por cinturones mal colocados o con sólo 2 puntos de fijación al momento de impactos frontales. Incluimos una niña con peso inferior a 10 kg., extricada de una silla infantil de transporte mal orientada. Medidas de evaluación: "Triage" para categorización inicial: Indice de Trauma Pediátrico (ITP). Severidad lesional: Abbreviated Injury Scale - (AIS-90). Predicción de mortalidad: Injury Severity Scale (ISS). Algoritmo de manejo en dos fases. Incluye el manejo general del traumatismo abdominal cerrado (ver tablas). Resultados: Total: 7 pacientes. 6 presentaron signo del calcado o marca del cinturón. 6 requirieron cirugía. Uno presentó grave lesión vertebromedular, otro lesión hepatoesplénica, 4 presentaron lesiones de intestino desgado, 2 de ellas con laceraciones mesentéricas y/o hematomas. Uno presentó perforación de vejiga. Conclusiones: Pobre o mala educación vial de los responsable de vehiculos a motor. Insuficiente información para el diseño entre los fabricantes de automóviles...

Endoscopic removal of chicken bone that caused gastric perforation and liver abscess.

A 40-yr-old gentleman presented with abdominal pain, nausea and vomiting since 3 weeks. CT scan of the abdomen showed a liver abscess but also a bone penetrating the left lobe of the liver. A 5-cm-long chicken bone was removed endoscopically. He was discharged on day 8 and was asymptomatic 12 months later. Endoscopic retrieval of an extraluminal foreign body causing liver abscess has not been reported previously.

Mode of death shifting from coma to syncope sports utility vehicle (SUV) accidents.

Road traffic accident is a major cause of death assuming epidemic proportion worldwide. After America, India has the largest network of roads. The total length of the road is about 33, 44,000km, out of which national highways occupies only 2% of total road length, whereas they bear 20% of the traffic load. One of the main reasons of the overcrowding of the roads is the tremendous rise in number of vehicles due to increasing distance from residence to workplace, intensive marketing campaign of newer sports utility (SUV) cars by depicting them in movies, media advertisements and easy finance availability has developed a craving to possess these sports utility vehicles in youths (both in males and females). These sports utility vehicles are nowadays becoming the rapid killer of the victims met with road traffic accidents (pedestrians, pedal cyclist and motor cyclist). The present study is based on prospective and retrospective cases of road traffic accidents involving SUV’s, since January 2005 to December 2006. The present study has shown that young adults predominantly males in their most productive year of life (21-30 years) are especially prone to road traffic trauma2. Pedestrians constitute the largest group of victims 78 cases (65%) followed by cyclist 18 cases (50%), spot death unavoidable in 83 cases (55.33%) and the thoraco-abdominal trauma found in 97 cases (80.83%)2,4. The findings of study under score the continue need for preventive strategies; aim to reduce trauma related mortality, particularly those regarding road traffic safety. The study also suggest that the large proportion of death were preventable, if underlying lesion or sequelae of injuries had been promptly addressed but unfortunately the front design of these sports utility vehicles is responsible for causing thoraco-abdominal trauma, leading to rapid death by causing haemorrhagic shock generated from involvement of the structures of thoraco-abdominal region.

Maltrato infantil: rol del estudio radiológico / Child abuse: role of radiologic study

El MI es desafortunadamente frecuente y nuestro país no es la excepción. Se presenta en todos los niveles socioeconómicos, religiones, culturas y representa un desafío diagnóstico para el clínico y para el radiólogo. El rol de la radiología es crucial para su detección. Los padres son los principales causantes de MI y generalmente se excusan en accidentes comunes del hogar, por lo que debe tenerse un alto grado de sospecha. Los hallazgos radiológicos deben correlacionarse con los mecanismos del traumatismo e injuria entregados en la historia clínica. Las lesiones óseas se pueden producir en cualquier parte del cuerpo, pero hay cierto tipo de lesiones y localizaciones (fracturas metafisiarias, fracturas costales posteriores, fractura primera costilla, escápula, apófisis espinosas, esternales y fracturas en diferentes etapa de cicatrización) que deben aumentar la sospecha diagnóstica. Ante la sospecha de MI debe solicitarse un estudio completo de imágenes, incluyendo fundamentalmente estudio radiológico del esqueleto y TAC de cerebro o del resto del cuerpo si es necesario. Sólo con una alta sospecha y un adecuado estudio, será posible detectar y proteger a éstos niños víctimas de maltrato.

Penetrating ureteral trauma

OBJECTIVE: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. MATERIALS AND METHODS: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. RESULTS: All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90 percent) and stab wounds in two (10 percent). All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85 percent). Two ureteral injuries (10 percent) were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55 percent. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group. CONCLUSIONS: A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10 percent of our cases.