RESUMO
Background: We present a successful staged surgical repair of an adolescent who sustained a high grade combined pancreaticoduodenal injury following a high-speed motor vehicle collision. Methods: We discuss our case as well as provide a thorough literature review made on databases such as PubMed, Google Scholar, and Embase. Summary: A fifteen-year-old female presented after a motor vehicle collision with abdominal pain and imaging suggestive of pancreatic and duodenal injuries. Emergent exploratory laparotomy confirmed a transection of the pancreatic neck in addition to disruption of the second portion of the duodenum. She sustained other injuries including an injury to the portal vein and a right colonic perforation. A damage control strategy was employed, and the patient underwent duodenal repair, wide drainage of the pancreatic injury, primary portal vein repair, right hemicolectomy, and temporary abdominal closure using negative pressure wound dressing placement. She remained stable overnight in the ICU and was taken back to the operating room for a pylorus-preserving pancreaticoduodenectomy with a hepatobiliary surgeon the following afternoon. The patient required additional surgery for fixation of an unstable vertebral fracture but was discharged to inpatient rehab within two weeks of presentation. She did not require TPN, and the only long-term sequelae have been admissions for acute uncomplicated pancreatitis that have been treated medically. Conclusion: Combined pancreatic and duodenal injury in the pediatric population is uncommon. We discuss our case of a patient requiring a pancreaticoduodenectomy. Despite postoperative pancreatitis and limited information in this field, we believe we provided the optimal surgical care, and this is a potential area for future investigation.
RESUMO
BACKGROUND: We present two patients: one with a blunt and one with a penetrating chest trauma mechanism and both with concomitant COVID-19 infections. FINDINGS: The first patient is a 23 year old previously healthy male who presented to a Level 1 trauma center following a motor vehicle collision with blunt chest trauma and respiratory failure. The second patient is a 30 year old previously healthy male who presented to a Level 1 trauma center for a stab wound to the anterior chest with a right ventricular injury. Both patients were incidentally found to be COVID positive. We discuss the impact of COVID positivity on management considerations in these trauma patients. CONCLUSION: Concurrent COVID infection in trauma patients with respiratory failure after pulmonary trauma can obscure the cause of the respiratory failure. At the time of this writing, management of both is similar, COVID-specific therapeutic agents are being investigated, and steroids carry the best evidence. Superimposed bacterial co-infections should be treated. Although timing of tracheostomy is institution-specific, when indicated it is still performed. COVID infection is often associated with a hypercoagulable state in trauma patients who are already at higher thrombotic risk. In keeping with normal practice after hemorrhagic resuscitation in trauma patients, an early aggressive initiation of prophylactic anticoagulation continues to be prudent. The benefit of empiric therapeutic anticoagulation is not yet known.
