Hérnia diafragmática à direita por trauma contuso: uma revisão bibliográfica / Right diaphragmatic hernia due to blunt trauma: a literature review

As hérnias diafragmáticas são decorrentes principalmente de traumas contusos e são mais comuns à esquerda. Essa menor frequência à direita é explicada pela contenção e proteção do fígado ao hemidiafragma homolateral. Entretanto, apesar de as lesões à esquerda serem mais frequentes, aquelas situadas à direita associam-se a lesões mais graves e resultam em mais instabilidade hemodinâmica, o que gera elevada mortalidade no momento do trauma. Além disso, a hérnia diafragmática direita, pode permanecer assintomática por longo tempo, favorecendo a aparecimento de complicações como isquemia e ruptura das vísceras herniadas dentro do tórax. Assim é fundamental um diagnóstico precoce, a fim de se realizar o tratamento cirúrgico, uma vez que o diafragma não cicatriza espontaneamente. (AU)

The diaphragmatic hernias are mainly due to blunt trauma and are more common on the left. This lower frequency on the right side is explained by liver protection of the ipsilateral hemidiaphragm. However, despite the injuries are more frequent on the left, those situated on the right are associated with more severe injuries and result in more hemodynamic instability, which leads to high mortality at the time of trauma. Furthermore, the right diaphragmatic hernia can remain asymptomatic for long time, favoring the onset of complications such as ischemia and rupture of the herniated organs inside the chest. Therefore early diagnosis is fundamental in order to perform surgical treatment, since the diaphragm does not heal spontaneously. (AU)

Hernia diafragmática traumática: presentación de un caso / Traumatic diaphragmatic hernia: presentation of a case

La hernia diafragmática traumática constituye un problema poco frecuente para el cirujano general, necesitándose un elevado índice de sospecha para su diagnóstico, especialmente en los pacientes portadores de un trauma cerrado. Se presenta un paciente masculino de 40 años de edad, portador de una hernia diafragmática traumática formada por estómago y epiplón mayor, secundaria a un trauma toroco-abdominal en accidente automovilístico, en el que se práctica video toracoscopía izquierda, que permite realizar el diagnóstico correcto. Se exponen los datos clínicos del paciente, su manejo, tratamiento quirúrgico efectuado y su posterior evolución...

Traumatic diaphragmatic hernia is a little frequent problem for the general surgeon, needing a high level of suspicion for the diagnosis, especially in patients carrying a closed trauma. We present the case of a male, 40-years-old patient, with a traumatic diaphragmatic hernia formed by stomach and greater omentum, secondary to a thoraco-abdominal trauma in automobile accident. A left video thoracoscopy allows arriving to the correct diagnosis. We expose the clinical data of the patient, his management, the surgical treatment applied and his subsequent evolution...

Forensic medical assessment in post-trauma retinal detachment / 法医学杂志

OBJECTIVE@#To analyze risk factors associated with post-traumatic retinal detachment and to identify the cause-effect relationship between retinal detachment and blunt ocular trauma in forensic medical assessment.@*METHODS@#112 cases of forensic medical examination on post -traumatic retinal detachment were retrospectively analyzed.@*RESULTS@#A variety of retinal abnormalities were found in these cases, including tearing of the ora serrata retinae (4.28%), macular perforation (12.50%), small (<90 degrees) nonmacular retinal perforation (56.25%), larger (>90 degrees) retinal perforation (5.00%), and tractive retinal detachment without perforation (11.6%). Proliferative vitreoretinopathy (PVR) was found in 45 eyes examined. In most cases, retinal detachment occurred between 1 week to 2 months after blunt ocular trauma (61.60%), with 83.93% accompanied with severe myopia (>-3.00D) and 52.67% accompanied with vitreous floaters. Of all cases, 41.07% were directly and 52.68% were indirectly resulted from blunt ocular trauma, and the rest (6.25%) showed no association with blunt ocular trauma. CONCLUSION Many risk factors may result in retinal detachment including blunt ocular trauma and other causes. Accurate assessment of the relationship between blunt ocular trauma and retinal detachment is an important part of forensic examination.

Transcatheter coil embolization of a traumatic intrahepatic arterioportal fistula.

Traumatic arterioportal fistulas are rare lesions in the pediatric age group. This case highlights the safe and effective management of intrahepatic arterioportal fistulas by transcatheter coil embolization.

Hyphema post-contusif

Our material of study includes 100 hyphema cases, seen at the service of Ophtalmology A of Rabat in a 5 year period, from 1990 to 1995 The average age in our series is 19 with sex ratio of 3,7. The traumatic hypherna results from fighting and playing [43% and 40% respectively]. The occupational injuries are less frequent [only 5% of cases]. The hyphema resorption was noted in most of the cases [90%] and acuity of vision is below 1/10 in 73% of cases at the first examination. As for the associated lesions, we noted a clear prevalence of corneal erosions [25%] and Berlin's oedema [34%]. The bemated complications, the most frequently found to be present are the ocular hypertonia [4 cases]. The secondary hemorrhage occcured to 2 patients. The frequency of these complications dictates a permanent systematic observation of the patients

Traumatismo renal contuso en niños 56 casos: evolución hacia el tratamiento conservador / Renal contusous trauma in children 56 cases: evolution to preservation treatment

El presente trabajo pretende poner de manifiesto la evolución hacia la adopción de conductas terapéuticas cada vez más conservadoras frente a las lesiones renales secundarias a traumatismos contusos. De enero de 1989 a marzo de 1996 ingresaron 56 pacientes con traumatismo renal: 52 contusos y 4 penetrantes que no se analizaron. 36 varones y 20 niñas cuyas edades oscilan entre los 3 y 14 años. En 3 casos hubo asociación con lesión esplénica y en 2 laceración hepática. La evaluación lesional se realizó mediante ecografía, TAC, Orografía y arteriografía. La conducta terapéutica adoptada en cada caso, estuvo en función del grado de lesión al ingreso, así como de la situación clínica y heinodinárnica del paciente. Se requirió cirugía inmediata en 3 pacientes con traumatismo G' 111 de Hodges y en forma diferida en 7 pacientes con traumatismo G' 11. De estos 7, 5 fueron realizadas en los primeros 4 arios de este estudio. En ninguno de ellos se realizó nefrectomía total. De acuerdo a nuestra experiencia y a la hora de decidir el trataniiento adecuado del traumatismo renal contuso del niño, somos partidarios de la adopción de conductas conservadoras. Una adecuada y precisa valoración clínico-imagenológica permite conseguir resultados para salvar un riñón con la mínima morbilidad

Traumatismos vasculares / Vascular trauma

El trauma vascular sigue siendo una entidad trascendente en el ámbito de la cirugía. El presente artículo intenta actualizar logros recientes en este campo e incluirlos en una exposición global coherente. Se exponen aspectos generales del desarrollo histórico de la cirugía vascular, se señalan los diversos mecanismos que pueden ocasionar esta patología y se intenta normar sobre la terminología en ella involucrada. Se describen los caracteres semiológicos más relevantes de los traumatismos vasculares, se indican los recursos de laboratorio necesarios y se expone la técnica quirúrgica que debe emplearse en estas lesiones

Lestraumatismes de la VBP au cours des contusions de l'abdomen

The bile duct ruptures during abdominal contusions are uncommon and require often a violent trauma, Their mechanism is stilt unknown, but the theory of wrench of choledochus, firmly fixed to duodenum, by liver pressed back at the time of trauma in the diaphragmatic concavity, seems to be the very likely. Indeed, the seat of the lesion is most often at the junction between pedicular choledochus and retropancreatic choledochus, and it can be either partial or total. In general, it is diagnosed in peroperative stage and its diffIculty depends on the lesion type. The effective therapeutical management lies in the direct or canal suture associated or not to the kehr's drainage. The bilio-digestive anastomosis can be used when repair end to end is impossible. Secondary bile duct stenosis can occur in the operative sequelae

Traumatismes du grele au cours des contusions abdominales: [a propos de 17 cas]

We report here a retrospective study of 17 small intestine traumatismus during abdominal contusion, seen in the hospital Avicenne from 1985 thourgh Decembre 1989. From this study, it results that: The young male adult is the most Struck down by these traumatisms. Outwards the wounded who were admitted in hemorragie shockstate by the diagnosis was based mainly on abdominal clinical sings and their course; The presence of pneumopenitoneum at radio logic examination of abdomen without preparation induce to emergency surgery. This study proves usefulness of. peritoneum puncture-wash in the difficult cases. Lf echograph is avialable in emergency it can serve substitute of peritoneum puncture-wash, if we consider relibihty of its results at the present time. The therapeutical management is well codified. The early diagnosis alone can allow to improve the prognosis

Contusión ocular en el niño asociada con hipema: estudio de 200 pacientes / Ocular contusion in the child associated with hyphema: study of 200 patients

Se realiza un estudio de 200 historias clínicas de niños ingresados en el Servicio de Oftalmología Pediátrica del Hospital Provincial Docente "V. I Lenin", en el período de agosto de 1981 hasta agosto de 1986. Se analizan variables como edad, sexo, tiempo de evolución del trauma, cantidad de sangre en mm, tiempo de reabsorción de la misma, lesiones asociadas, complicaciones, secuelas, entre otras. Se realizan conclusiones