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1.
Rev. habanera cienc. méd ; 20(4): e4196, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289620

ABSTRACT

Introducción: La hernia diafragmática traumática es una complicación grave del traumatismo abdominal o torácico. Se considera una entidad poco frecuente. El diagnóstico es difícil y, a menudo, puede pasar inadvertido. Objetivo: El propósito de este caso clínico es demostrar la necesidad de sospechar la presencia de hernia diafragmática en los pacientes con trauma toracoabdomial. Presentación del Caso: Paciente de 75 años que sufre accidente de tránsito, con evaluación inicial sin alteraciones clínico-radiológicas, que posteriormente presentan evolución desfavorable con hallazgo radiográfico de una hernia diafragmática traumática. Conclusiones: La hernia diafragmática cuando se presenta constituye un verdadero reto para el diagnóstico por parte del personal médico; pues esta requiere de un alto índice de sospecha y el uso adecuado de las imágenes diagnósticas. Se considera una entidad importante para la evaluación del paciente traumatizado(AU)


Introduction: Traumatic diaphragmatic hernia is a serious complication of abdominal or thoracic trauma. It is considered a rare pathology. The diagnosis is difficult and can often go unnoticed. Objective: The purpose of this clinical case is to demonstrate the need to suspect the presence of diaphragmatic hernia in patients with thoracoabdomial trauma. Case Presentation: Seventy-five-year-old patient who suffers a traffic accident. At initial evaluation no clinical-radiological alterations were observed, but later the patient presented an unfavorable evolution with radiographic finding of a traumatic diaphragmatic hernia. Conclusions: Diaphragmatic hernia, when present, is a real challenge for the diagnosis by the medical staff since it requires a high index of suspicion and an adequate use of diagnostic images. It is considered an important entity in the evaluation of the trauma patient(AU)


Subject(s)
Humans , Male , Aged , Accidents, Traffic/prevention & control , Hernia, Diaphragmatic, Traumatic/complications , Diaphragm/injuries , Early Diagnosis , Hernia, Diaphragmatic, Traumatic/diagnostic imaging , Abdominal Injuries/complications , Occupational Groups
2.
Rev. cir. (Impr.) ; 72(1): 43-47, feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1092889

ABSTRACT

Resumen Introducción Por su ubicación retroperitoneal, las lesiones de vena cava (LVC) son infrecuentes, presentándose en el contexto de un paciente con múltiples lesiones intraabdominales y en estado crítico. Objetivo Describir la experiencia de pacientes politraumatizados con LVC sometidos a resolución quirúrgica en Hospital Dr. Sotero del Río. Materiales y Método Análisis retrospectivo de 36 pacientes politraumatizados que dentro de la intervención quirúrgica se evidenció LVC en un período comprendido entre el 2010 y 2017. Resultados La serie estuvo compuesta por 36 pacientes, con LVC. El 88,8% son hombres, en el 97,2% el mecanismo de trauma es penetrante. Dentro de los niveles anatómicos vasculares más frecuentemente lesionados está la cava infrarrenal (41,6%), suprarrenal (25%), yuxtarrenal (22,2%) y la retrohepática e intratorácica (5,5% cada una). Las estructuras lesionadas asociadas más frecuentes fueron intestino delgado (38,8%), otros vasos de gran calibre (36,1%) y riñón (30,5%). Dentro del tipo de resolución quirúrgica, al 15,6% se realizó ligadura de vena cava y al 83,3% rafia simple. En 33,3% fue necesaria una toracotomía para el control vascular, siendo 2 de estas toracotomías resucitadoras. La media de hospitalización fue de 19,8 días. La mortalidad fue de 33,3%. Conclusiones De acuerdo a lo presentado, la alta mortalidad de LVC se encontró en el grupo de pacientes con inestabilidad hemodinámica y número de lesiones asociadas, en especial si involucran otros grandes vasos. Los esfuerzos para optimizar la supervivencia se deberían dirigir al traslado rápido prehospitalario y al entrenamiento de los cirujanos que enfrentan este tipo de lesiones.


Introduction For its retroperitoneal location, vena cava injuries are infrequent, however, occurring to a patient with multiple intra-abdominal injuries and in critical condition. Aim To describe the experience of polytraumatized patients with VCI who underwent surgical resolution in the Dr. Sotero del Rio hospital. Materials and Method Retrospective analysis of 36 polytraumatized patients that showed VCI during the surgical intervention within 2010 and 2017. Results The series was composed of 36 VCI patients. 88.8% are men, in 97.2% the mechanism of trauma is penetrating. Within the vascular anatomical levels, the most frequently injured are the infra-renal cava (41.6%) suprarenal (25%), yuxta-renal (22.2%) retro-hepatic and intrathoracic (5.5% each). The most frequent associated injured structures were the small intestine (38.8%) other vessels of large caliber (36.1%) and kidney (30.5%). In relation to the type of surgical resolution, 15.6% had a vena cava ligature and 83.3% simple raffia. In 33.3%, a thoracotomy was required for vascular control, two of them were resuscitative procedures. The average of hospitalization was 19.8 days. The mortality was 33.3%. Conclusions According to what presented, the high mortality of VCI was found in the group of patients with hemodynamic instability and the number of associated injuries; specially if other large vessels are involved. To optimize the survival, the efforts should be focused on a fast prehospital transfer and the training for surgeons who face this type of injury.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Vena Cava, Inferior/surgery , Vena Cava, Inferior/injuries , Abdominal Injuries/complications , Time Factors , Wounds, Gunshot/surgery , Wounds, Penetrating/surgery , Wounds, Stab/surgery , Chile , Treatment Outcome , Abdominal Injuries/surgery , Abdominal Injuries/mortality
3.
Rev. cir. (Impr.) ; 72(1): 76-81, feb. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1092895

ABSTRACT

Resumen Introducción La lesión de la vesícula biliar secundaria a trauma abdominal cerrado constituye un evento infrecuente de perforación traumática de ella, de presentación tardía. Objetivo Revisar la literatura científica actualmente disponible y además describimos un caso. Materiales y Método Utilizando la plataforma PubMed se buscan las siguientes palabras clave: " Blunt abdominal trauma ". Se seleccionan las series con lesiones de la vesícula biliar: " Traumatic gallbladder rupture". Se seleccionan los reportes de lesiones aisladas de la vesícula biliar: " Isolated gallbladder rupture ". Se seleccionan los reportes de presentación tardía de lesiones aisladas de la vesícula biliar: " Delayed presentation of isolated gallbladder rupture ". Resultados De todas estas publicaciones se seleccionan las que a criterio de los autores son relevantes para el presente caso. Discusión La mayoría de las perforaciones de la vesícula biliar se producen en vesículas sanas de paredes delgadas distendidas por el ayuno o el consumo de alcohol. No existe una presentación clínica clásica. Los estudios imagenológicos son inespecíficos y se llega al diagnóstico definitivo durante la exploración quirúrgica. El tratamiento de esta lesión es la colecistectomía. Conclusiones El diagnóstico no es fácil, pero la resolución es relativamente simple y el pronóstico es bueno. El presente caso ilustra este tipo de lesiones en pacientes con trauma abdominal cerrado.


Introduction Gallbladder injury secondary to blunt abdominal trauma is a rare event. Aim Review the current available scientific literature and describe a case. Materials and Method Using the PubMed platform, the following keywords were searched: "Blunt abdominal trauma". Series with gallbladder lesions were selected: "Traumatic gallbladder rupture". Reports of isolated lesions of the gallbladder were selected: "Isolated gallbladder rupture". Reports of late presentation of isolated lesions of the gallbladder were selected: "Delayed presentation of isolated gallbladder rupture". Of all these publications, those that were relevant to the present case were selected according to the criteria of the authors. Case report A 20 years-old male patient suffered an abdominal trauma two weeks before presentation at our Institution. He underwent an exploratory laparotomy showing bilious content and a gallbladder perforation over the peritoneal wall as an isolated injury. Discussion Most isolated gallbladder perforations occur in healthy gallbladders with thin walls and distended because fasting or alcohol consumption. There are no classical clinical features to diagnose this specific injury and radiologic studies are nonspecific. Definitive diagnosis is often reached during surgery as it was with our patient. Recommended treatment is cholecystectomy. Conclusions This case illustrates this unique kind of gallbladder injury in patients with blunt abdominal trauma. A clear diagnosis is not easy however, the treatment is simple and prognosis is good.


Subject(s)
Humans , Male , Young Adult , Wounds, Nonpenetrating/surgery , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnosis , Cholecystectomy/methods , Gallbladder/injuries , Tomography, X-Ray Computed , Gallbladder/surgery , Abdominal Injuries/surgery , Abdominal Injuries/complications , Abdominal Injuries/diagnosis
4.
Rev. cuba. cir ; 58(3): e808, jul.-set. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1098972

ABSTRACT

RESUMEN Introducción: Los índices de severidad en trauma son una serie de escalas que permiten describir la gravedad de un individuo traumatizado y se asocian con su pronóstico y probabilidad de sobrevida. Objetivo: Determinar el valor pronóstico de los índices de severidad anatómicos en la evolución de pacientes con lesiones traumáticas de colon y recto. Métodos: Se realizó un estudio observacional descriptivo y de corte transversal. Se incluyeron los pacientes con lesiones traumáticas de colon o recto intervenidos quirúrgicamente en cuatro hospitales de La Habana en el periodo 2008-2015. Los datos fueron recolectados de la historia clínica. Se utilizó análisis de distribución de frecuencias y las curvas de operación característica del receptor (curvas ROC). Resultados: La edad promedio de los pacientes 37,4 años (desviación estándar 13,6 años). Predominó el sexo masculino (76, 7 por ciento). De los 6 scores estudiados, solamente CIS Flint y COIS resultaron ser útiles para predecir sepsis de la herida quirúrgica. En la predicción de defunción, el área mayor bajo la curva correspondió a COIS (0,92), posteriormente le siguió NISS (0,86) y luego CIS Flint (0,81). Los puntos de corte óptimos calculados fueron: ( 3 para COIS, ( 24 para NISS y ( 2 para CIS Flint. Conclusiones: Se demuestra el valor de los índices COIS y Flint, para pronosticar la ocurrencia de complicaciones en los pacientes con lesiones traumáticas de colon y recto, y la utilidad de los diferentes índices, en el pronóstico de defunción(AU)


ABSTRACT Introduction: Trauma severity indices are a series of scales that describe the severity of a traumatized individual and are associated with their prognosis and probability of survival. Objective: To determine the prognostic value of anatomical severity indices in the evolution of patients with traumatic lesions of the colon and rectum. Methods: A descriptive observational and cross-sectional study was carried out. Patients with traumatic lesions of the colon or rectum who underwent surgery in four Havana hospitals in the period 2008-2015 were included. The data was collected from the medical history. Frequency distribution analysis and receiver characteristic operation curves (ROC curves) were used. Results: The average age of the patients 37.4 years (standard deviation 13.6 years). Male sex predominated (76.7 percent). Of the 6 scores studied, only CIS Flint and COIS were found to be useful in predicting sepsis of the surgical wound. In the prediction of death, the largest area under the curve corresponded to COIS (0.92), followed by NISS (0.86) and then CIS Flint (0.81). The calculated optimal cut-off points were: ( 3 for COIS, ( 24 for NISS and ( 2 for CIS Flint. Conclusions: The value of the COIS and Flint indices is demonstrated to predict the occurrence of complications in patients with traumatic lesions of the colon and rectum, and the usefulness of the different indices in the prognosis of death(AU)


Subject(s)
Humans , Male , Female , Adult , Severity of Illness Index , Colostomy/methods , Survival Analysis , Data Collection/statistics & numerical data , Abdominal Injuries/complications , Medical Records/statistics & numerical data , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as Topic
5.
Arch. argent. pediatr ; 116(6): 778-781, dic. 2018. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-973697

ABSTRACT

Las lesiones hepáticas y de las vías biliares por causa traumática son poco usuales en la edad pediátrica. Del total de pacientes con trauma abdominal cerrado, menos del 9 % presentan lesión hepática, y la frecuencia varía entre el 2 % y el 3 % de la lesión de las vías biliares. Actualmente, el tratamiento recomendado para el trauma abdominal cerrado con lesión hepática sin repercusión hemodinámica es conservador; en caso de presentar lesión de la vía biliar intra- o extrahepática, los abordajes de preferencia son mínimamente invasivos, como la cirugía percutánea o endoscópica, y se utiliza la laparotomía en casos seleccionados. Se presenta el caso de un paciente con trauma abdominal cerrado y trauma hepático, inicialmente laparotomizado en 2 ocasiones por inestabilidad hemodinámica y hemoperitoneo; presentó un bilioma subdiafragmático y coleperitoneo, en el que se realizó un manejo mínimamente invasivo por drenaje percutáneo bajo control tomográfico.


Hepatic and biliary tract injuries due to traumatic causes are rare in pediatric patients. Of the total number of patients with closed abdominal trauma, less than 9 % have liver injury, and the frequency varies between 2 and 3 % of biliary tract lesions. Currently, the recommended treatment for closed abdominal trauma with liver injury without hemodynamic repercussion is conservative. In case of presenting intra or extrahepatic biliary tract lesion, the preferred approaches are minimally invasive, such as percutaneous or endoscopic surgery, using laparotomy in selected cases. We present the case of a patient with closed abdominal trauma and liver trauma, initially laparotomized on 2 occasions due to hemodynamic instability and hemoperitoneum; presented a subdiaphragmatic and coleperitoneal bilioma; it was performed minimally invasive percutaneous drainage under tomographic control.


Subject(s)
Humans , Male , Child, Preschool , Wounds, Nonpenetrating/therapy , Biliary Tract/injuries , Drainage/methods , Abdominal Injuries/therapy , Wounds, Nonpenetrating/complications , Tomography, X-Ray Computed , Hemoperitoneum/etiology , Hemoperitoneum/therapy , Laparotomy/methods , Abdominal Injuries/complications , Liver/injuries
6.
Arch. argent. pediatr ; 116(2): 308-311, abr. 2018. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-887475

ABSTRACT

La pancreatitis consiste en la inflamación aguda del páncreas, que se caracteriza, clínicamente, por dolor abdominal. Para realizar el diagnóstico, es necesario que se presente la elevación de marcadores bioquímicos, como amilasa o lipasa pancreáticas. Esta afección es la enfermedad pancreática más frecuente tanto en niños como en adultos. Su presentación en la población pediátrica está en aumento y tiene varias etiologías, como infecciones, trauma, intoxicación y enfermedades metabólicas. Entre los mecanismos de trauma, se han descrito maltrato infantil, caídas, trauma con el manubrio de la bicicleta y accidentes de tránsito. En este artículo, se presenta un caso de pancreatitis secundaria a un trauma abdominal con el manubrio de una bicicleta en una paciente de 7 años.


Pancreatitis consists in acute inflammation of the pancreas that is clinically characterized by abdominal pain. To make the diagnosis it is necessary the elevation of biochemical markers like pancreatic amylase or lipase. It is the most frequent pancreatic disease in both children and adults. Its presentation in the pediatric population is increasing and has several etiologies such as: infections, trauma, intoxication and metabolic diseases. Trauma mechanisms have been described: child maltreatment, falls, trauma with the bicycle handle and traffic accidents. In this article, we present a case of pancreatitis secondary to an abdominal trauma with the handle of a bicycle in a patient of 7 years.


Subject(s)
Humans , Female , Child , Pancreas/injuries , Pancreatitis/etiology , Abdominal Injuries/complications , Acute Disease
7.
Rev. chil. cir ; 70(5): 409-417, 2018. tab, graf, ilus
Article in Spanish | LILACS | ID: biblio-978007

ABSTRACT

Resumen Introducción: La hernia diafragmática complicada de presentación tardía constituye una urgencia quirúrgica. Los objetivos del presente estudio son la descripción de las características del diagnóstico de las hernias diafragmáticas de presentación tardía, tratamiento, resultados y la identificación del punto de corte entre el inicio de los síntomas y el desarrollo de necrosis. Pacientes y Métodos: Estudio retrospectivo de una serie de casos constituida por todos los pacientes operados por hernia diafragmática complicada de presentación tardía entre los años 2006 y 2016. Se midieron variables categóricas y continuas que se presentan con estadística descriptiva. Se utilizaron curvas Receiver Operating Characteristics (ROC) a las 6 y 12 h desde el inicio de los síntomas, para determinar el punto de corte del tiempo de presentación clínica en pacientes sometidos a resección de algún órgano. Una vez establecido el punto de corte se calcularon la sensibilidad; especificidad; las razones de verosimilitud positiva y negativa; los valores predictivos positivo y negativo; y la prevalencia. Resultados: La presentación clínica, estudio, diagnóstico y tratamiento fue similar a lo descrito en la literatura quirúrgica. Se estableció el punto de corte a las 12 h con sensibilidad de 80% y especificidad de 83%. Conclusiones: El diagnóstico y tratamiento de estos pacientes debería ser llevado a cabo antes de las 6 h desde el inicio de los síntomas. Aun cuando el universo descrito es reducido, se sugiere que después de las 12 h desde el momento de la estrangulación, los órganos comprometidos se encontrarán necróticos requiriendo resección quirúrgica.


Introduction: Late presentation of traumatic diaphragmatic hernia constitutes a true surgical emergency. The purposes of this study were to describe the diagnostic characteristics, treatment and outcomes of late presentation diaphragmatic hernias and to identify a cutoff point from the onset of symptoms to necrosis development. Patients and Methods: A retrospective series of cases constituted by all patients subjected to emergency diaphragmatic hernia repair form 2006 to 2016 was studied. Categorical and continuous variables were measured and analyzed with descriptive statistics. Receiver Operating Characteristics (ROC) curves at 6 and 12 hours from the onset of symptoms were used to determine the cutoff point for organ resection. Once stablished the cutoff point, sensitivity, specificity, positive and negative predictive values and prevalence were calculated. Results: Clinical presentation, diagnostic study and surgical treatment were similar to what has been already described. The cutoff point was defined at 12 hours from the onset of symptoms with 80% sensitivity and 83% sensibility. Conclusions: The diagnosis and treatment of these cases should be carried on before the first 6 hours after the onset of symptoms. Even though the universe of this study was small, we may suggest that after 12 hours form the onset of symptoms, the implicated organs would be found necrotic requiring surgical resection.


Subject(s)
Humans , Male , Adolescent , Adult , Young Adult , Hernia, Diaphragmatic, Traumatic/complications , Hernia, Diaphragmatic, Traumatic/diagnostic imaging , Stomach Volvulus/etiology , Thoracic Injuries/complications , Time Factors , Radiography, Thoracic , Tomography, X-Ray Computed , Predictive Value of Tests , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Abdominal Injuries/complications , Necrosis/etiology
8.
Rev. Soc. Bras. Med. Trop ; 50(6): 864-867, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-897026

ABSTRACT

Abstract This is the first published case report of an 11-year-old patient with a rupture of a liver hydatid cyst (HC) into the peritoneal cavity after an abdominal trauma in Iran. The disease was diagnosed using focused abdominal sonography for trauma. To date, no cases of traumatic ruptures of liver HCs in children have been reported in Iran. In the endemic regions of the world, where patients suffer from a history of trauma and constant abdominal symptoms or anaphylactic shock, early diagnosis of HC is crucial as it may disseminate to other organs. The condition needs conservative surgery and follow-up.


Subject(s)
Humans , Male , Child , Peritoneal Cavity/parasitology , Rupture/etiology , Echinococcosis, Hepatic/complications , Abdominal Injuries/complications , Rupture/diagnostic imaging , Echinococcosis, Hepatic/diagnostic imaging , Iran
9.
Rev. chil. cir ; 69(4): 325-327, ago. 2017. ilus
Article in Spanish | LILACS | ID: biblio-899610

ABSTRACT

Objetivo: Reportar un caso clínico de lesión de la vía biliar intrapancreática tras traumatismo abdominal cerrado. Caso clínico: Paciente que acude a urgencias por intenso dolor abdominal, tras sufrir traumatismo toraco-abdominal cerrado al caer de una bicicleta. Posteriormente a su ingreso desarrolló fiebre, ictericia y patrón analítico de colestasis. Se solicitó colangiorresonancia magnética donde no se pudo valorar correctamente la vía biliar, pero se evidenció abundante líquido intraabdominal que no correspondía a sangre. Se indicó cirugía urgente ante la sospecha de lesión biliar. Se objetivó lesión de la vía biliar intrapancreática mediante colangiografía intra-operatoria y se decidió colocación de prótesis intrabiliar mediante colangiopancreatografía retrógrada endoscópica (CPRE) intraoperatoria. Conclusión: La cirugía ha sido el tratamiento convencional para la lesión de la vía biliar, pero en la actualidad la CPRE con esfinterotomía y colocación de prótesis intrabiliar es un tratamiento adecuado y resolutivo de este tipo de lesiones pudiéndose considerar como tratamiento de primera línea.


Aim: To report a clinical case of biliar injury intrapancreatic in closed abdominal trauma. Clinical case: Patient who comes to the emergency room by severe abdominal pain after suffering thoraco-abdominal blunt trauma after falling from a bicycle. After his admission he developed fever, jaundice and analytical standards of cholestasis. Magnetic resonance which failed to correctly assess the bile duct was requested but showed plenty of intra-abdominal fluid blood that did not match. Emergency surgery for suspected biliary injury was reported. Intrapancreatic injury bile duct was observed by intraoperative cholangiography and prosthesis was decided intrabiliary by intraoperative endoscopic retrograde cholangiopancreatography (ERCP). Conclusions: Surgery has been the standard treatment for bile duct injury, but now ERCP with sphincterotomy and placement of intrabiliary prosthesis is adequate and operative treatment of these injuries and can be considered as first-line treatment.


Subject(s)
Humans , Male , Middle Aged , Pancreas/injuries , Bile Ducts/surgery , Bile Ducts/injuries , Cholangiopancreatography, Endoscopic Retrograde , Abdominal Injuries/complications , Prostheses and Implants , Wounds, Penetrating/surgery , Wounds, Penetrating/complications , Bile Ducts/diagnostic imaging , Cholangiography , Jaundice/etiology , Abdominal Injuries/surgery
10.
Rev. chil. cir ; 68(2): 173-175, abr. 2016. ilus
Article in Spanish | LILACS | ID: lil-784849

ABSTRACT

Aim: Here we present a case associated with closed abdominal trauma. Case report: Male 21 years old with history of abdominal trauma when riding a bull, managed conservatively with analgesics and antibiotics. Two months later he presented an abdominal painful mass located in epigastrium and middle abdomen. Abdominal USG and CT scan showed the presence of a tumor dependent of the pancreatic tail, with regular margins, compatible with pancreatic pseudocyst; surgical management was decided performing cystogastro anastomosis. Conclusion: This clinical report represent traumatic origin of some pancreatic pseudocysts, surgical indication needs to be personalized.


Objetivo: Presentamos aquí un caso de pseudoquiste de páncreas asociado a traumatismo abdominal cerrado. Caso clínico: Paciente masculino de 21 años de edad que recibe traumatismo directo sobre abdomen por un toro y es manejado de forma conservadora con analgésicos y antibióticos. Dos meses después presenta nuevamente dolor abdominal y aumento de volumen en epigastrio y mesogastrio. El ultrasonido y la TC abdominal evidencian imagen compatible con pseudoquiste pancreático realizándose cistogastroanastomosis. Conclusión: El caso representa la etiología traumática de algunos pseudoquistes de páncreas; las indicaciones quirúrgicas necesitan ser individualizadas.


Subject(s)
Humans , Male , Adult , Young Adult , Pancreatic Pseudocyst/surgery , Pancreatic Pseudocyst/etiology , Abdominal Injuries/complications , Pancreatic Pseudocyst/diagnostic imaging , Laparoscopy
11.
Article in English | IMSEAR | ID: sea-159583

ABSTRACT

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.


Subject(s)
Abdominal Injuries/complications , Abdominal Injuries/etiology , Accidental Falls/epidemiology , Hernia, Diaphragmatic/diagnosis , Hernia, Diaphragmatic/epidemiology , Hernia, Diaphragmatic/etiology , Hernia, Diaphragmatic/surgery , Humans , Male , Middle Aged , Thoracic Injuries/complications , Thoracic Injuries/etiology , /complications , /etiology
13.
Rev. chil. radiol ; 20(3): 105-111, 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-726153

ABSTRACT

El trauma es la principal causa de muerte en los pacientes pediátricos mayores de 1 año, siendo el trauma abdominal responsable del 10 por ciento de las causas de muerte. Las lesiones de vísceras huecas es inferior al 1 por ciento , sin embargo, su mortalidad es del 20 por ciento en el caso de perforación intestinal. La tomografía computada es el método de elección en la identificación y cuantificación de las lesiones en trauma abdominal, dado su excelente rendimiento para lesiones de vísceras sólidas, con menor sensibilidad en lesiones de vísceras huecas, por lo que en estas últimas es importante una alta sospecha clínica y análisis minucioso de las imágenes por parte de los radiólogos. Se realizó una revisión retrospectiva de los hallazgos en pacientes pediátricos referidos a tomografía computarizada, con historia de trauma abdominal contuso. Los principales hallazgos en tomografía computada sugerentes de lesión de víscera hueca fueron: aire extraluminal, extravasación de medio de contraste, presencia de líquido libre intraperitoneal, coágulo centinela adyacente al asa comprometida y engrosamiento de la pared intestinal.


Trauma is the leading cause of death in pediatric patients older than 1 year, with abdominal trauma accounting for 10% of causes of death. Hollow viscera injuries are less than 1%, however its mortality is 20% in the case of intestinal perforation. Computed tomography is the method of choice for the identification and quantification of abdominal trauma injuries, given its excellent performance for solid viscera injuries, with less sensitivity in hollow visceral injuries, so that in the latter a high clinical suspicion and thorough analysis of the images by radiologists is important. A retrospective review was conducted of the findings in pediatric patients, with a history of blunt abdominal trauma, referred to computed tomography. The main findings on computed tomography suggestive of hollow visceral injury were: extraluminal air, extravasation of contrast medium, the presence of free intraperitoneal fluid, sentinel clot adjacent to the affected loop and thickening of the bowel wall.


Subject(s)
Humans , Child , Tomography, X-Ray Computed , Gastrointestinal Tract/injuries , Gastrointestinal Tract , Abdominal Injuries/complications , Contusions , Sensitivity and Specificity
14.
ABCD arq. bras. cir. dig ; 26(2): 129-132, abr.-jun. 2013. graf, tab
Article in Portuguese | LILACS | ID: lil-684425

ABSTRACT

RACIONAL: O fígado é o órgão intra-abdominal mais comumente lesado em pacientes vítimas de trauma. A lesão ocorre mais frequentemente no trauma penetrante do que no contuso. A mortalidade é de 10%. OBJETIVO: Avaliar a morbimortalidade dos pacientes com trauma hepático, o manuseio aplicado a esses pacientes e sua evolução. MÉTODO: Foram analisados, retrospectivamente, os prontuários de todos os pacientes com trauma hepático e indicação cirúrgica, admitidos na emergência. Consideraram-se: sexo, faixa etária, ISS (injury severity score), classificação do tipo de trauma abdominal (aberto ou fechado), instrumento causador dos traumas abertos, grau da lesão, segmentos hepáticos envolvidos, presença de lesões associadas, tipo de tratamento cirúrgico realizado: laparotomia não-terapêutica e laparotomia terapêutica, reoperações, complicações, tempo de internamento em dias e mortalidade. RESULTADOS: Cento e trinta e sete pacientes participaram do estudo. Destes, 124 eram do sexo masculino (90,5%). Quanto à faixa etária, a maioria (56,2%) encontrava-se entre 20-29 anos. O trauma abdominal fechado foi o mais comum (67,9%). Dos penetrantes, os originados por arma de fogo foram em maior número (24,8%). Cento e três pacientes apresentaram apenas um segmento lesado (75,2%) e 34 (24,8%) dois. As lesões de grau II foram as mais comuns (66,4%). Dos 137 pacientes submetidos à laparotomia, 89 foram não-terapêutica, enquanto que em 48 foi necessário reparos das lesões associadas. O baço e o diafragma foram as estruturas lesadas com maior frequência, 30% e 26%, respectivamente. O ISS variou de oito a 72, sendo o ISS > 50 (oito pacientes) associado com evolução fatal (cinco pacientes). Fístula biliar e abscesso hepático foram as principais complicações. Ocorreram sete óbitos no estudo. CONCLUSÃO: Os pacientes com trauma hepático e lesões orgânicas concomitantes e naqueles com ISS > 50 observou-se maior chance de complicações e óbito.


BACKGROUND: The liver is the intra-abdominal organ more injured in patient victims of trauma. The injury occurs more frequently in the penetrating trauma. The incidence of mortality for injuries of the liver is 10%. AIM: To evaluate the mortality of the patients with hepatic trauma, the treatment applied and its evolution. METHODS: Were analyzed, retrospectively, the charts of all patients with hepatic trauma and surgical indication. Were analyzed: gender, age, ISS (injury severity score), classification of the abdominal trauma type (open or closed), causing instrument of the open traumas, degree of the injury, hepatic segments involved, presence of associated injuries, type of surgical treatment: not-therapeutic laparotomy and therapeutic laparotomy, reoperations, complications, time of hospitalization in days and mortality. RESULTS: One hundred and thirty-seven patients participated. Of these, 124 were men (90.5%). The majority (56.2%) had 20-29 years old. Closed abdominal trauma was most prevalent (67.9%). Of the penetrating traumas, the originated with firearms were in 24.8%. One hundred and three patients had only one injured hepatic segment (75.2%) and 34 (24.8%) two. Grade II injuries were in 66.4%. Of the 137 patients with laparotomy, 89 had been not-therapeutic, while in 48 it was necessary to repair associated injuries. Spleen and diaphragm had been the more frequently injured structures, 30% and 26%, respectively. The ISS varied of eight to 72, being the ISS > 50 (eight patients) associate with fatal evolution (five patients). Biliary fistula and hepatic abscess had been the main complications. Seven deaths had occurred. CONCLUSIONS: Concomitant injuries, hepatic and other organs, associated with ISS > 50 presented higher possibility of complications and death.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Liver/injuries , Liver/surgery , Abdominal Injuries/complications , Abdominal Injuries/mortality , Abdominal Injuries/surgery , Retrospective Studies
15.
Medwave ; 13(2)mar. 2013. ilus
Article in Spanish | LILACS | ID: lil-679687

ABSTRACT

Introducción: las hernias diafragmáticas traumáticas se producen después de un traumatismo cerrado o penetrante. El caso que se reporta en el presente trabajo constituye un diagnóstico incidental e inusual en la clínica para especialistas y personal en formación. Caso clínico: se presenta una mujer con historia de trauma toraco-abdominal por accidente de tránsito hace 30 años, con imagen radiopaca en la radiografía de tórax en la base pulmonar derecha en ocasión de afección respiratoria. La persistencia de la imagen después de tratamiento y remisión del cuadro, hizo posible el diagnóstico incidental de hernia diafragmática por tomografía axial computarizada. Discusión: un alto índice de sospecha es esencial durante la evaluación inicial del paciente con trauma toraco-abdominal contuso o penetrante. Conclusiones: las hernias diafragmáticas postraumáticas representan un desafío clínico y quirúrgico para su diagnóstico.


Introduction. Traumatic diaphragmatic hernias occur after blunt or penetrating trauma. The case reported in this article is an incidental and unusual diagnosis in clinical practice. Case. We report a woman with a history of thoraco-abdominal trauma from a road accident that occurred 30 years ago. In the chest X-ray we found a radioopacity in the right lung base resulting from a respiratory infection. The image persisted in spite of effective treatment for the underlying respiratory condition, which made us suspect a diaphragmatic hernia corroborated by computed tomography. Discussion. A high level of suspicion is essential for the initial evaluation of patients with blunt or penetrating thoraco-abdominal trauma. Conclusions. Traumatic diaphragmatic hernias constitute a clinical challenge both for diagnosis and surgical treatment.


Subject(s)
Humans , Female , Middle Aged , Hernia, Diaphragmatic, Traumatic , Abdominal Injuries/complications , Thoracic Injuries/complications , Hernia, Diaphragmatic, Traumatic/diagnosis , Hernia, Diaphragmatic, Traumatic/etiology , Incidental Findings , Rupture , Tomography, X-Ray Computed
16.
Lima; s.n; 2013. 49 p. tab, graf.
Thesis in Spanish | LILACS, LIPECS | ID: biblio-1113376

ABSTRACT

Objetivos: Determinar la incidencia de las lesiones de colon en los pacientes intervenidos quirúrgicamente por trauma abdominal abierto en el servicio de emergencia en el Hospital Nacional Daniel Alcides Carrión en el periodo comprendido de Junio del 2008 a Abril del 2011. Material y métodos: Se realizó un estudio observacional, descriptivo, retrospectivo y transversal. Se revisaron 158 historias clínicas de pacientes operados por trauma abdominal abierto y que presentaron lesión de colon al momento de la laparotomía exploratoria, en el periodo que corresponde al estudio. Resultados: El 86.7 por ciento de los pacientes fueron de sexo masculino. El mecanismo de lesión más frecuente fue por arma blanca en el 56.3 por ciento de los casos. En el 89.3 por ciento de los casos se realizó cierre primario. Se observa un predominio de lesiones de primer y segundo grado, que sumadas llegan al 63.3 por ciento. La complicación más frecuente fue la infección de herida operatoria y la sepsis, que sumados llegan al 15.8 por ciento de los casos. La mortalidad fue del 3.8 por ciento. Conclusiones: La incidencia de las lesiones de colon en los pacientes intervenidos quirúrgicamente por trauma abdominal abierto fue de 35 por ciento. El manejo quirúrgico empleado en los pacientes intervenidos por trauma abdominal abierto con lesiones de colon fue el cierre primario. Dentro de las características de los pacientes, encontramos una mayor frecuencia de pacientes del sexo masculino sin enfermedad preexiste. Las complicaciones postquirúrgicas más frecuentes fueron la infección de herida operatoria y la sepsis. Los hallazgos quirúrgicos más frecuentes fueron las lesiones de colon izquierdo de I-II grado con daño de órganos asociados.


Subject(s)
Male , Female , Humans , Young Adult , Adult , Middle Aged , Aged , Colon/injuries , Abdominal Injuries/complications , Observational Study , Retrospective Studies , Case Reports
17.
Article in English | IMSEAR | ID: sea-142892

ABSTRACT

Simultaneous occurrence of traumatic abdominal wall hernia (TAWH) and traumatic diaphragmatic hernia (TDH) is uncommon. Our report documents the rare delayed presentation of simultaneous occurrence of TAWH and TDH in a patient who sustained a bicycle handlebar injury as a consequence of the bicycle he was riding colliding with a motorbike in a road-traffic accident. Excellent outcome could be achieved in this patient with surgical repair without requiring the use of a mesh.


Subject(s)
Abdominal Injuries/complications , Accidents, Traffic , Bicycling/injuries , Diaphragm/injuries , Hernia, Abdominal/diagnosis , Hernia, Abdominal/etiology , Hernia, Diaphragmatic/diagnosis , Hernia, Diaphragmatic/etiology , Humans , Male , Middle Aged
19.
Rev. chil. cir ; 63(1): 91-94, feb. 2011. ilus
Article in Spanish | LILACS | ID: lil-582954

ABSTRACT

We report a 34 years old male that while working in forest activities, suffered a blunt trauma caused by the trunk of a tree. On abdominal examination, a bulging on the right upper quadrant with ecchymoses was noted. And abdominal CAT scan showed a great defect of right oblique and transverse abdominis muscles with herniation of the ascending colon. The patient was operated, finding a hemoperitoneum. The abdominal cavity was washed thoroughly and the wall defect was covered with a mesh. The patient had an uneventful postoperative recovery and was discharged nine days later.


Las hernias traumáticas de pared abdominal (HTPA) son una patología poco frecuente. Se definen como la rotura musculofascial causada por un traumatismo directo, sin penetración de la piel ni evidencia de hernia previa en el sitio de la lesión. El 78 por ciento son causadas por accidentes viales y en menor frecuencia por patadas de animales, caídas de altura, traumas deportivos, utensilios profesionales y aplastamientos. Presentamos el caso de un paciente masculino de 34 años derivado al Servicio de Urgencia del Hospital de Chillan por atrición toracoabdominal derecha, en faena forestal, cuyo estudio tomográfico revela gran defecto de músculos oblicuos y transversos derechos con herniación de colon ascendente hacia la pared abdominal.


Subject(s)
Humans , Male , Adult , Hernia, Abdominal/surgery , Hernia, Abdominal/etiology , Polypropylenes/therapeutic use , Surgical Mesh , Abdominal Injuries/complications , Accidents, Occupational , Wounds, Nonpenetrating/complications , Hernia, Abdominal , Tomography, X-Ray Computed , Abdominal Injuries/surgery
20.
Article in English | WPRIM | ID: wpr-631383

ABSTRACT

Trauma is a leading cause of admissions to the surgical ward in Papua New Guinea (PNG), accounting for about 35% of cases. Of these, 15% of cases are abdominal injuries, of which 19% are penetrating injuries. Selective surgical management of patients with a low-velocity anterior abdominal wound (AAW) is beneficial in some patients. AIM: To determine if selective surgical management is a viable therapeutic option in PNG. METHODS: A non-random prospective study of consecutive cases was done on 60 patients with an AAW based entirely on clinical symptoms and signs. The outcome measures were length of hospital stay, morbidity and mortality. Data were analysed using SPSS 10.0 for Windows and Microsoft Excel. RESULTS: Immediate laparotomy was done on 24 (40%) of cases and 36 (60%) had nonoperative conservative management, of which 6 (17%) failed and went on to have laparotomy on demand. The average hospital stay was 4 days shorter (p = 0.0001) for the nonoperative group, which had significantly fewer complications (p = 0.01). No deaths were recorded in either of the two groups of patients. CONCLUSION: Selective nonoperative management of stable patients with an AAW with or without omental signs is a safe therapeutic option in PNG.


Subject(s)
Abdominal Injuries/complications , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Laparotomy , Length of Stay/statistics & numerical data , Male , Papua New Guinea , Patient Selection , Peritonitis/etiology , Prospective Studies , Treatment Outcome , Wounds, Penetrating/complications , Young Adult
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