RESUMO
BACKGROUND: Obesity represents a growing global health threat, which generally portends increased morbidity and mortality in the context of traumatic injuries. We hypothesized that there may exist a protective effect related to increased weight and truncal girth provided for obese patients in penetrating torso injuries, although this may not exert a significant positive impact overall upon clinical outcomes. METHODS: A comprehensive review of the literature was conducted across five databases up to March 2021 (Medline, Pubmed, Embase, Web of Science and the Cochrane library) to examine the effect of obesity on penetrating thoracoabdominal injuries. The primary outcome was to determine the rate of nonsignificant injury and injury patterns. Secondary outcomes examined were lengths of stay, complications, and mortality. Comparisons were drawn by meta-analysis. The study protocol was registered with PROSPERO under CRD42020216277. RESULTS: There were 2,952 publications assessed with 12 meeting the inclusion criteria for review. Nine studies were included for quantitative analysis, including 5,013 patients sustaining penetrating thoracoabdominal injuries, of which 29.6% were obese. Obese patients that sustained stab injuries underwent more nontherapeutic operations. Obese patients that sustained gunshot injuries had longer intensive care and total hospital length of stay. Obese patients suffered more respiratory complications and were at an increased risk of death during their admission. CONCLUSION: The "armor phenomenon" does not truly protect obese patients, a population that experiences increased morbidity and mortality following penetrating thoracoabdominal injuries. LEVEL OF EVIDENCE: Systematic Review and Meta-Analysis; Level IV.
Assuntos
Traumatismos Abdominais , Ferimentos por Arma de Fogo , Ferimentos Penetrantes , Ferimentos Perfurantes , Traumatismos Abdominais/cirurgia , Humanos , Obesidade/complicações , Estudos Retrospectivos , Ferimentos Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgiaAssuntos
Dor Abdominal/etiologia , Constipação Intestinal/complicações , Perfuração Intestinal/etiologia , Dor Abdominal/diagnóstico , Idoso , Doença Crônica , Colectomia/métodos , Colostomia/métodos , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Laparoscopia/métodos , Peritonite/diagnóstico , Peritonite/etiologia , Peritonite/cirurgia , Pneumoperitônio/diagnóstico por imagem , Doenças do Colo Sigmoide/patologia , Doenças do Colo Sigmoide/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoAssuntos
Dor Abdominal/etiologia , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/diagnóstico , Neoplasias de Tecido Fibroso/complicações , Neoplasias de Tecido Fibroso/diagnóstico , Anormalidade Torcional/complicações , Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Humanos , Neoplasias do Jejuno/cirurgia , Masculino , Neoplasias de Tecido Fibroso/cirurgia , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/cirurgia , Adulto JovemRESUMO
A 27-year-old man presented with acute right upper quadrant abdominal pain and vomiting. He was clinically in hypovolaemic shock. Investigations revealed normocytic anaemia with a normal bilirubin and moderate liver function test abnormalities. CT abdomen and pelvis demonstrated haemoperitoneum and a large solitary hepatic mass in segments V and VI, suspicious for a ruptured hepatic tumour. Massive transfusion protocol was commenced and angioembolisation of the inferior branch of the right hepatic artery was undertaken. Despite this, his haemorrhagic shock was resistant to resuscitation. Thus, he underwent emergent exploratory laparotomy, which resulted in segments V and VI liver resection and packing. Re-look laparotomy 2 days following initial exploration was performed where haemostasis was confirmed. Histopathology revealed a ruptured well-differentiated hepatocellular adenoma. The patient made a good recovery following a 2-week admission.
Assuntos
Adenoma de Células Hepáticas/complicações , Hemorragia/etiologia , Hepatopatias/etiologia , Neoplasias Hepáticas/complicações , Adulto , Humanos , Masculino , Ruptura Espontânea/complicaçõesRESUMO
A 62-year-old patient was admitted with an acute unprovoked portal vein thrombosis with splenic and mesenteric extension. His progress was complicated by progressive small bowel ischaemia and increasing clot burden despite systemic anticoagulation. This case report describes the use of catheter-directed thrombolysis via a transjugular intrahepatic portosystemic shunt, with the disease and its treatment complicated by a ruptured iatrogenic pseudoaneurysm, abdominal compartment syndrome and small bowel infarction necessitating extensive small bowel resection.