RESUMO
INTRODUCTION: Secondary abdominal compartment syndrome (ACS) can occur in trauma patients without abdominal injuries. Surgical management of patients presenting with secondary ACS after isolated traumatic lower extremity vascular injury (LEVI) continues to evolve, and associated outcomes remain unknown. METHODS: From January 2006 to September 2011, 191 adult trauma patients presented to the Ryder Trauma Center, an urban level I trauma center in Miami, Florida with traumatic LEVIs. Among them 10 (5.2 %) patients were diagnosed with secondary ACS. Variables collected included age, gender, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications, and outcomes. RESULTS: Mean age was 37.4 ± 18.0 years (range 16-66 years), and the majority of patients were males (8 patients, 80 %). There were 7 (70 %) penetrating injuries (5 gunshot wounds and 2 stab wounds), and 3 blunt injuries with mean Injury Severity Score (ISS) 21.9 ± 14.3 (range 9-50). Surgical management of LEVIs included ligation (4 patients, 40 %), primary repair (1 patient, 10 %), reverse saphenous vein graft (2 patients, 20 %), and PTFE interposition grafting (3 patients, 30 %). The overall mortality rate in this series was 60 %. CONCLUSIONS: The association between secondary ACS and lower extremity vascular injuries carries high morbidity and mortality rates. Further research efforts should focus at identifying parameters to accurately determine resuscitation goals, and therefore, prevent such a devastating condition.
Assuntos
Hipertensão Intra-Abdominal , Extremidade Inferior , Lesões do Sistema Vascular , Adulto , Feminino , Florida/epidemiologia , Humanos , Escala de Gravidade do Ferimento , Hipertensão Intra-Abdominal/diagnóstico , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/mortalidade , Hipertensão Intra-Abdominal/prevenção & controle , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/complicações , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgiaRESUMO
The standard modality to treat colorectal cancer in potentially curable patients is, undoubtedly, surgery. The concept of precautional chemotherapy used in tumors located elsewhere, has put forward a clinical trial that proved its effectiveness and improved survival. We report the use of two modalities (chemotherapy and radiotherapy) along with surgery as part of a multidisciplinary treatment of patients with colorectal cancer.
