Assessing the true risk of abdominal solid organ injury in hospitalized rib fracture patients.

BACKGROUND: Despite the lack of evidence, traditional trauma teaching has suggested that low rib fractures increase the risk of abdominal solid organ injury (ASOI). This study was designed to assess if in fact this is true, and to try and define other factors that increased the risk of ASOI in rib fracture patients. METHODS: The charts of 476 hospitalized rib fracture trauma patients were reviewed. Data were collected for age; sex; Injury Severity Score (ISS); rib fracture location; and the presence or absence of injuries to the abdominal organs, head, neck, face, thorax, great vessel, heart, thoracolumbar spine, pelvis, and extremities. RESULTS: The probability of liver injury increased with the presence of any right-sided rib fracture, any low rib fracture, female gender, young age, and an elevated ISS. The probability of splenic injury increased with the presence of left-sided rib fractures only, any low rib fracture, young age, and an elevated ISS. CONCLUSION: In hospitalized trauma patients, low rib fractures, right-sided rib fractures, female gender, young age, and an elevated ISS increased the probability of liver injury; and low rib fractures, left-sided only rib fractures, young age, and an elevated ISS increased the probability of splenic injury. Associated pelvic fractures and long bone fractures did not increase the likelihood of ASOI in this cohort.

Annuloplasty and aortoplasty as modifications of the Ross procedure for the correction of geometric mismatch.

BACKGROUND AND AIM OF THE STUDY: Pulmonary autograft replacement of the aortic valve (the Ross procedure) is reliable and durable; however, geometric mismatch of the autograft and systemic outflow tract may lead to poor results. Manipulation of the aortic annulus and sinotubular diameters to match the autograft can prevent geometric mismatch, and improve results. METHODS: Annuloplasty and/or aortoplasty were combined with the Ross procedure in 26 of 44 patients (median age 42.5 years; range: 3 days to 62 years) undergoing surgery between April 1994 and July 1998. Plication of the aortic annulus at either two or three of the commissures was done in five cases, aortic annulus fixation with an external pericardial pledget incorporated in the proximal suture line in 12 cases, and tailoring aortoplasty in nine patients. RESULTS: There was one operative death. Two patients required reoperation; one for progressive autograft dysfunction and one for homograft dysfunction. Annular fixation was performed on the patient requiring reoperation for autograft dysfunction. Doppler echocardiography during the follow up (median 9 months; range: 1-50 months) revealed 10 patients with trace 1+ and one patient with 2+ aortic insufficiency. Trace 1+ and 2+ aortic stenosis were present in one patient each. None of the patients undergoing commissural plication had significant regurgitation or stenosis. Both patients with stenosis underwent annular fixation. Aortoplasty was associated with 1+ insufficiency in two patients. CONCLUSION: Prevention of geometric mismatch between the autograft and systemic outflow tract at the annulus and sinotubular junction by plication techniques allows better performance of the autograft, and extends the Ross procedure to patients who otherwise may be unable to undergo such surgery. Fixation may provide similar benefit, but appears to be more susceptible to insufficiency and stenosis.

Eosinophilic gastroenteritis presenting as an obstructing cecal mass--a case report and review of the literature.

The causes of colonic obstruction are protean. Less common is the diagnosis of eosinophilic gastroenteritis (EGE). EGE is more common as a cause of more proximal bowel obstruction. To our knowledge, this case represents one of the only reported cases of such a lesion causing obstruction in the cecum.

Purposeful delay in the repair of a traumatic rupture of the aorta with coexistent liver injury.

Purposeful delay in the repair of traumatic aortic injury by appropriate medical management is indicated when the risk of immediate thoracotomy is high. A grade V liver injury implies parenchymal disruption of greater than 75% of a hepatic lobe. We report the successful management of a patient with a class IB proximal descending aortic transection and concomitant grade V liver injury that precluded aortic repair until its resolution.