ABSTRACT
On critically injured patient the decision to perform a damage control laparotomy is based on the volume of transfusion and shock. The aim of the surgery which is to obtain as fast as possible the best hemostasis to limit the peritoneal thermal loss and to perform as soon as possible physiologic restoration in the Intensive Care Unit.
Subject(s)
Abdominal Injuries/surgery , Laparotomy/methods , Blood Transfusion , Body Temperature/physiology , Hemoperitoneum/surgery , Hemorrhage/surgery , Hemostasis, Surgical/methods , Hemothorax/surgery , Humans , Liver/injuries , Resuscitation , Retroperitoneal Space/injuries , Shock/prevention & control , Time FactorsABSTRACT
The technique of abdominal wall closure by vacuum pack is described. Indications are essentially the abbreviated laparotomy or damage control (especially with abdominal packing), and the post traumatic abdominal compartment syndrome (in the treatment and prevention).
Subject(s)
Abdominal Wall/surgery , Laparotomy/methods , Abdominal Injuries/surgery , Humans , VacuumABSTRACT
AIM: Of the work: evaluation of a multidisciplinary strategy and a prospective medicosurgical protocol for the treatment of occlusion due to unresectable peritoneal carcinomatosis. PATIENTS AND METHODS: All the included patients had occlusion and intraabdominal carcinomatosis. None could benefit a curative treatment. 75 patients were included for 80 episodes of intestinal obstruction. The protocol involved three successive therapeutic phases. (i) Treatment during five days by corticosteroids associated to antiemetic agents, anticholinergic antisecretory agents, and analgesics as needed (Phase I); (ii) In the event of refractory occlusive symptoms treatment by somatostatin analog during 3 days (phase II); (iii) If this treatment was ineffective a gastrostomy was performed (phase III). RESULTS: Median survival was 31 days. Outcome showed that for the 80 episodes of obstruction, phase I medical treatment enabled relief in 50 cases (63%) and phase II medical treatment (somatostatin) enabled relief in 11 cases (14%). 10 more patients (13%) were relieved by the gastrostomie and one by a duodenal endoprothesis. Symptom control without a long-term nasogastric tube was achieved for 72 of the 80 episodes (90%). Fifty-eight episodes (72% of overall total) were controlled for 10 days or less. Median time to gastrostomy was 17 days. Eight patients experienced persistent vomiting and required a nasogastric aspiration until death. CONCLUSION: This multidisciplinary approach between Palliative Care and Specialized Medical and Surgical teams enabled relief of the occlusive symptoms for 90% of the patients of the study. The protocol was useful for the caregivers for the management of terminally ill patients. To enhance these results, it would be necessary to shorten the delay of relief, which has been longer than ten days for one third of the patients. The simplification of the protocol including two steps instead of three is on study.
Subject(s)
Carcinoma/complications , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Palliative Care , Peritoneal Neoplasms/complications , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aged, 80 and over , Analgesics/therapeutic use , Antiemetics/therapeutic use , Female , Humans , Male , Middle Aged , Patient Care Team , Prospective Studies , Survival Analysis , Terminal Care , Treatment OutcomeABSTRACT
AIM OF THE STUDY: Damage control laparotomy is a new approach to the more severe abdominal traumas. It stems from a better understanding of the physiopathology of the haemorragic shock. PATIENTS AND METHODS: A national retrospective study from 27 centers about 109 trauma patients who underwent a damage control procedure between January 1990 and December 2001, is analysed. Surgical procedures included 97 hepatic packing, 10 abdominal packing, 4 exclusive skin closure, 1 open laparotomy technique and 3 digestive stapplings. RESULTS: The mortality rate is 42%. Eleven abdominal compartment syndromes have occurred with 7 decompressive laparomy (4 deaths). CONCLUSION: This study is based on the largest series of damage control laparotomy published in France. Results in terms of mortality and morbidity are similar to those of published studies from the USA.
Subject(s)
Abdominal Injuries/surgery , Hemorrhage/surgery , Laparotomy/methods , Multiple Trauma/surgery , Resuscitation/methods , Traumatology/methods , Abdominal Injuries/complications , Abdominal Injuries/diagnosis , Abdominal Injuries/mortality , Adolescent , Adult , Age Distribution , Aged , Belgium/epidemiology , Child , Decompression, Surgical/methods , Female , France/epidemiology , Hemorrhage/etiology , Hemorrhage/mortality , Humans , Injury Severity Score , Male , Middle Aged , Multiple Trauma/complications , Multiple Trauma/diagnosis , Multiple Trauma/mortality , Patient Selection , Retrospective Studies , Risk Factors , Surgical Stapling/methods , Survival Analysis , Suture Techniques , Time Factors , Treatment Outcome , Tunisia/epidemiologyABSTRACT
The aim of this study was to report two cases of symptomatic and non-functional parathyroid cyst, diagnosed with ultrasonography and percutaneous punction and treated by surgical resection of the cystic gland.
