ABSTRACT
Resumen El bazo es el órgano que se lesiona con más frecuencia en el trauma abdominal cerrado, presentándose en 30 a 50% de los casos, principalmente por su fragilidad y localización, su tratamiento ha estado en constante cambio a lo largo del tiempo, siendo hoy en día más utilizado el manejo conservador por sobre el intervencionista, considerando sobre todo el mayor riesgo de mortalidad y las condiciones fisiológicas posteriores a la esplenectomía principalmente en niños y adolescentes. Objetivo. Realizar una revisión actual del diagnóstico, clasificación y tratamiento del trauma esplénico. Metodología . Se realizó una revisión bibliográfica incluyendo los descriptores relacionados con trauma esplénico y su tratamiento. Resultados. La identificación del trauma esplénico es de vital importancia para la supervivencia del paciente, el diagnostico se puede realizar mediante estudios de imagen eco-FAST o tomografía en dependencia del estado hemodinámico del paciente, la clasificación depende de las características anatómicas de las lesiones y orienta el tratamiento adecuado. Conclusiones. Actualmente el tratamiento conservador está recomendado para lesiones I-III; los estadios mayores (IV y V) o cualquier grado siempre y cuando exista compromiso hemodinámico implican tratamiento intervencionista o quirúrgico, no existe una diferencia significativa entre la utilización de técnica abierta vs laparoscópica.
Abstract The spleen is the organ that is most frequently injured in blunt abdominal trauma, occurring in 30 to 50% of cases, mainly due to its fragility and location, its treatment has been in constant change over time, today the conservative management is more widely used than interventionist, considering above all the greater risk of mortality and the physiological conditions after splenectomy, mainly in children and adolescents. Objective . To carry out a current review of the diagnosis, classification and treatment of splenic trauma. Methodology . A bibliographic review was carried out including the descriptors related to splenic trauma and its treatment. Results .The identification of splenic trauma is of vital importance for the survival of the patient, the diagnosis can be made by imaging studies, FAST ultrasound or tomography depending on the hemodynamic status of the patient, the classification depends on the anatomical characteristics of the lesions and guides the appropriate treatment. Conclusions . Conservative treatment is currently recommended for lesions I-III; the major stages (IV and V) or any grade whit hemodynamic compromise imply interventional or surgical treatment, there is no significant difference between the use of open versus laparoscopic technique.
Resumo O baço é o órgão mais frequentemente lesado no trauma abdominal fechado, ocorrendo em 30 a 50% dos casos, principalmente devido à sua fragilidade e localização, seu tratamento tem mudado constantemente ao longo do tempo, sendo hoje o manejo conservador mais utilizado que o intervencionista, considerando sobretudo o maior risco de mortalidade e as condições fisiológicas após a esplenectomia, principalmente em crianças e adolescentes. Objetivo . Fazer uma revisão atual do diagnóstico, classificação e tratamento do trauma esplênico. Metodologia . Foi realizada uma revisão bibliográfica incluindo os descritores relacionados ao trauma esplênico e seu tratamento. Resultados . A identificação do trauma esplênico é de vital importância para a sobrevida do paciente, o diagnóstico pode ser feito por exames de imagem echo-FAST ou tomografia dependendo do estado hemodinâmico do paciente, a classificação depende das características anatômicas das lesões e orienta o tratamento adequado. Conclusões . O tratamento conservador é atualmente recomendado para lesões I-III; os estágios principais (IV e V) ou em qualquer grau, desde que haja comprometimento hemodinâmico, implicam em tratamento intervencionista ou cirúrgico, não havendo diferença significativa entre o uso da técnica aberta e laparoscópica.
ABSTRACT
INTRODUCTION: We report this large neck mass, located behind the sternocleidomastoid (SCM) within the posterior cervical space and anterior to the prevertebral fascia. The mass is displacing the carotid sheath and its neurovascular contents medially. It extends almost the whole length of the SCM muscle all the way down to the lung apex. CASE PRESENTATION: A 30-year-old female patient presented to our clinic with a left anterior neck mass for a few months with dysphagia. The lipoma was excised completely along with level II to IV lymphadenectomy. A very small volume chyle leak was noted intraoperatively. The drain was removed 2 weeks later only to recur in one month. A new drain was placed by interventional radiology, and the drainage resolved completely. DISCUSSION: The patient with mild dysphagia had a lipoma large enough to push vital structures away from their normal anatomical position. Due to the difficult location and the size of the lipoma, a meticulous formal lateral neck dissection was required. A 3D imaging like CT or MRI would be helpful to preoperatively plan the dissection. Substernocleidomastoid neck lipoma in our case is a rare benign tumor that was challenging to excise.
ABSTRACT
Abstract Objective. Earlier use of plasma and red blood cells (RBCs) has been associated with improved survival in trauma patients with substantial hemorrhage. We hypothesized that prehospital transfusion (PHT) of thawed plasma and/or RBCs would result in improved patient coagulation status on admission and survival. Methods. Adult trauma patient records were reviewed for patient demographics, shock, coagulopathy, outcomes, and blood product utilization from September 2011 to April 2013. Patients arrived by either ground or two different helicopter companies. All patients transfused with blood products (either pre- or in-hospital) were included in the study. One helicopter system (LifeFlight, LF) had thawed plasma and RBCs while the other air (OA) and ground transport systems used only crystalloid resuscitation. Patients receiving PHT were compared with all other patients meeting entry criteria to the study cohort. All comparisons were adjusted in multilevel regression models. Results. A total of 8,536 adult trauma patients were admitted during the 20-month study period, of which 1,677 met inclusion criteria. They represented the most severely injured patients (ISS = 24 and mortality = 26%). There were 792 patients transported by ground, 716 by LF, and 169 on OA. Of the LF patients, 137 (19%) received prehospital transfusion. There were 942 units (244 RBCs and 698 plasma) placed on LF helicopters, with 1.9% wastage. PHT was associated with improved acid-base status on hospital admission, decreased use of blood products over 24 hours, a reduction in the risk of death in the sickest patients over the first 6 hours after admission, and negligible blood products wastage. In this small single-center pilot study, there were no differences in 24-hour (odds ratio 0.57, p = 0.117) or 30-day mortality (odds ratio 0.71, p = 0.441) between LF and OA. Conclusions. Prehospital plasma and RBC transfusion was associated with improved early outcomes, negligible blood products wastage, but not an overall survival advantage. Similar to the data published from the ongoing war, improved early outcomes are associated with placing blood products prehospital, allowing earlier infusion of life-saving products to critically injured patients.
