Liver trauma: What current management?

BACKGROUND: The liver is the most commonly damaged organ in abdominal trauma. The management of liver trauma has experienced many changes over the last two decades. Currently there is a trend toward a non-operative treatment warranted by the successful pediatric experience and better results recorded in many trauma centers worldwide. This study aimed to evaluate outcomes of operative and non-operative management of liver trauma in our institution over the last five years. METHODS: The patients with a diagnosis of blunt or penetrating liver injuries, admitted and managed in our hospital from January 2012 to December 2016 were retrospectively studied. The patients were divided into 2 groups, operated and non-operated groups, according to the initial management considered appropriate at the time of patient admission. Clinical features and outcomes were analyzed. RESULTS: The study involved 83 patients, with a mean age of 33 years and a marked male predominance (85.5%). The most common type of lesions was blunt trauma and the main cause was road traffic accidents. Sixty-eight liver injuries (81.9%) were of low severity (grades I, II, III), while 15 (18.1%) were of high severity (grade IV or greater). Fifty-six patients (67.5%) had multiple injuries. Surgical treatment was performed in 26 (31.3%) patients. Non-operative management was undertaken in 57 cases (68.7%). The morbidity and mortality rates were clearly lower in non-operative patients compared to those in the operated group. CONCLUSIONS: Careful non-operative management is an adequate therapeutic strategy for the patients suffering from liver trauma with stable hemodynamics. Patients with complex hepatic trauma and especially those with other organ injuries continue to have significantly higher mortality.

Small bowel volvulus with intussusception: an unusual revelation of neuroendocrine tumor.

The primary malignant tumors of the small bowel are rare, representing 1 to 1.4% of all gastrointestinal tumors. We report a case of a 33 year-old women, admitted to our emergency department of visceral surgery for acute abdomen. The clinical examination revealed diffuse abdominal distension, defenseless, the hernia orifices were free and the rectal examination was normal. The biological test showed no hydro electrolytic disorders with normal hemoglobin and normal renal function. The abdominal CT-Scan showed signs of bowel obstruction due to a volvulus with intussusception without ischemia. The patient was operated urgently; the exploration has revealed a small bowel obstruction in the ileum with volvulus, an intussusceptum associated with a retractile mesenteritis, and the hepatic exploration found no metastases. The patient underwent a bowel resection taking away the intussusceptum with the infiltrated mesentery. The postoperative course was uneventful. The pathological result has proved a well-differentiated neuroendocrine tumor with five free nodes. Through this observation, we aim to highlight that an obstruction of small bowel with volvulus and intussusception could be exceptionally due to a neuroendocrine tumor, this complication has enabled a relatively early diagnosis in the absence of metastases and a 6-month follow-up without recurrence is a demonstration.

Solitary preperitoneal neurofibroma: a case report.

BACKGROUND: Neurofibroma is a rare benign tumor. The isolated presence of such lesions in the preperitoneal space with no evidence of systemic disease has never been reported in the literature. CASE PRESENTATION: A 29-year-old white man presented with a 12 months history of progressive abdominal distension. Clinical examination revealed a bulky hypogastric mass. Abdominal computed tomography and pelvic magnetic resonance imaging showed a large, well defined preperitoneal tumor measuring 18 x 17 cm extending in the pelvis. A computed tomography guided biopsy was performed which revealed a neurofibroma. Exploratory laparotomy showed a well encapsulated elastic soft tumor in the preperitoneal space which measured 17 x 18 cm and weighted 2 Kg. The tumor was completely excised. No recurrence occurred after one year of follow-up. CONCLUSION: Solitary preperitoneal neurofibroma is an extremely rare benign tumor. Its clinical and radiological signs are nonspecific. Preoperative histology can be useful to guide the surgical approach which is the only curative treatment.