Effects of Trauma Center Consolidation on Adult Trauma at a Rural Level 1 Trauma Center.

OBJECTIVE: The aim was to determine the impact of consolidation of two rural level 1 trauma centers on adult trauma patients presenting to the remaining level 1 trauma center. To our knowledge, a study assessing the impact of trauma center consolidation on adult trauma patients had yet to be performed. METHODS: A single institution, retrospective study was conducted at a rural level 1 trauma center. Adult trauma patients who presented to our center from January 2017 to January 2022 were included. The cohorts spanned 33 months pre- and post-consolidation. Multiple demographic and outcome measures were gathered. Data were analyzed using the student's t-test and Chi-squared testing. RESULTS: There was a 33% increase in overall trauma activations and 9% increase in transfers from outside facilities post-consolidation. The post-consolidation group was significantly older, had higher mean injury severity score, and decreased hospital-free days. The post-consolidation group also saw an increase in ICU admission and surgical intervention. While there were no significant differences in ICU-free days or ventilator days, patients in the post-consolidation group with the highest level of activation who required both surgical intervention and ICU admission experienced decreased mortality. CONCLUSION: The consolidation of trauma services to a single level 1 trauma center in a rural Appalachian health system led to higher trauma volume and acuity, but most importantly decreased mortality for the most severely injured trauma patients.

Incarcerated Inguinal Hernia Containing a Gallstone Found Decades After a Laparoscopic Cholecystectomy.

Iatrogenic gallbladder perforation and subsequent gallstone spillage is a common problem in laparoscopic cholecystectomy. While most commonly asymptomatic, complications due to spilled gallstones have been reported. In this case study, we report the case of a 96-year-old female with a history of laparoscopic cholecystectomy at an unknown time who presented with an incarcerated inguinal hernia and small bowel obstruction. Imaging revealed an extraluminal radiopaque foreign body located near the hernia sac. At the time of the repair, she was found to have a single gallstone located within the hernia sac, confirmed by pathology. The hernia was repaired using Lichtenstein, and her bowel obstruction was resolved postoperatively. Although gallstone spillage from iatrogenic gallbladder perforation during laparoscopic cholecystectomy is a relatively common problem, it is rarely symptomatic and may be associated with infection, abscess, and fistula formation. A rarer complication includes the formation of hernias containing gallstones, documented in fewer than 10 cases in the literature. This case demonstrates a rare consequence of leaving behind spilled gallstones following gallbladder perforation during laparoscopic cholecystectomy. It emphasizes the importance of preventing iatrogenic gallbladder perforation and retrieving any spilled gallstones during the procedure to minimize associated complications.

Two Cases of Isolated Ureteral Injury Secondary to Blunt Force Trauma.

Ureteral injuries although rare can cause serious issues. The mechanism of injury is most commonly penetrating but in some rare cases blunt forces can contribute. It is important to diagnose ureteral injuries as soon as possible because they can have significant morbidity and mortality. Here we present two cases of isolated ureteral injury secondary to blunt force trauma. Both patients had the ureteral injury diagnosed by computed tomography (CT) scan and confirmed by a ureterogram with extravasation of contrast. Both patients also had peripelvic cyst, which could have been a contributing risk factor for injury. In both cases, the ureteral injury was repaired using a stent and both patients had no complications. We present these cases along with presentation, diagnostic work-up, and treatment.