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Sample records for blunt splenic trauma

  1. Pediatric blunt splenic trauma: a comprehensive review

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    Lynn, Karen N.; Werder, Gabriel M.; Callaghan, Rachel M.; Jafri, Zafar H. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); Sullivan, Ashley N. [St. George' s University School of Medicine, Grenada, West Indies (Grenada); Bloom, David A. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); William Beaumont Hospital, Section of Pediatric Radiology, Department of Radiology, Royal Oak, MI (United States)

    2009-09-15

    Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic salvage techniques and nonoperative approaches are preferred to splenectomy in order to decrease perioperative risks, transfusion needs, duration/cost of hospitalization, and risk of overwhelming postsplenectomy infection. Early and accurate detection of splenic injury is critical in both adults and children; however, while imaging findings guide management in adults, hemodynamic stability is the primary determinant in pediatric patients. After initial diagnosis, the primary role of imaging in pediatric patients is to determine the level and duration of care. We present a comprehensive literature review regarding the mechanism of injury, imaging, management, and complications of traumatic splenic injury in pediatric patients. Multiple patients are presented with an emphasis on the American Association for the Surgery of Trauma organ injury grading system. Clinical practice guidelines from the American Pediatric Surgical Association are discussed and compared with our experience at a large community hospital, with recommendations for future practice guidelines. (orig.)

  2. Splenic artery embolisation in the non-operative management of blunt splenic trauma in adults

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    Richard J. Cormack

    2016-03-01

    Full Text Available Background: The purpose of this study was to evaluate the splenic salvage rate with angioembolisation in the non-operative management (NOM of blunt splenic injury.Methods: We conducted a retrospective analysis of patients presenting to our Level I trauma centre with computed tomography (CT-confirmed splenic injury following blunt trauma and in whom angioembolisation was utilised in the algorithm of NOM. Data review included CT and angiography findings, embolisation technique and patient outcomes.Results: Between January 2005 and April 2010, 60 patients with splenic injury following blunt trauma underwent NOM, which included splenic artery embolisation (SAE. All patients included in the study required a preadmission. CT scan was used to document the American Association for the Surgery of Trauma (AAST grade of splenic injury. The average injury grade was 3.0. The non-operative splenic salvage rate following SAE was 96.7% with statistically similar salvage rates achieved for grades II to IV injuries. The quantity of haemoperitoneum and the presence of a splenic vascular injury did not significantly affect the splenic salvage rate. The overall complication rate was 27%, of which 15% were minor and 13% were major.Conclusion: SAE is a safe and effective treatment strategy in the NOM of blunt splenic injury. The quantity of haemoperitoneum, the presence of vascular injury and embolisation technique did not significantly affect the splenic salvage rate.

  3. Blunt trauma induced splenic blushes are not created equal

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    Burlew Clay

    2012-03-01

    Full Text Available Abstract Background Currently, evidence of contrast extravasation on computed tomography (CT scan is regarded as an indication for intervention in splenic injuries. In our experience, patients transferred from other institutions for angioembolization have often resolved the blush upon repeat imaging at our hospital. We hypothesized that not all splenic blushes require intervention. Methods During a 10-year period, we reviewed all patients transferred with blunt splenic injuries and contrast extravasation on initial postinjury CT scan. Results During the study period, 241 patients were referred for splenic injuries, of whom 16 had a contrast blush on initial CT imaging (88% men, mean age 35 ± 5, mean ISS 26 ± 3. Eight (50% patients were managed without angioembolization or operation. Comparing patients with and without intervention, there was a significant difference in admission heart rate (106 ± 9 vs 83 ± 6 and decline in hematocrit following transfer (5.3 ± 2.0 vs 1.0 ± 0.3, but not in injury grade (3.9 ± 0.2 vs 3.5 ± 0.3, systolic blood pressure (125 ± 10 vs 115 ± 6, or age (38.5 ± 8.2 vs 30.9 ± 4.7. Of the 8 observed patients, 3 underwent repeat imaging immediately upon arrival with resolution of the blush. In the intervention group, 4 patients had ongoing extravasation on repeat imaging, 2 patients underwent empiric embolization, and 2 patients underwent splenectomy for physiologic indications. Conclusions For blunt splenic trauma, evidence of contrast extravasation on initial CT imaging is not an absolute indication for intervention. A period of observation with repeat imaging could avoid costly, invasive interventions and their associated sequelae.

  4. A rare case of splenic pseudoaneurysm in pediatric splenic blunt trauma patient: Review of diagnosis and management

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    Roger Chen Zhu; Vadim Kurbatov; Patricia Leung; Gainosuke Sugiyama; Valery Roudnitsky

    2015-01-01

    Introduction: Splenic pseudoaneurysms (SPA) are a rare but serious sequela of blunt traumatic injury to the spleen. Management of adult blunt splenic trauma is well-studied, however, in children, the management is much less well-defined. Presentation of case: A 15 year-old male presented with severe abdominal pain of acute onset after sustaining injury to his left side while playing football. FAST was positive for free fluid in the abdomen. Initial abdomen CT demonstrated a grade III/IV le...

  5. A rare case of splenic pseudoaneurysm in pediatric splenic blunt trauma patient: Review of diagnosis and management

    OpenAIRE

    Zhu, Roger Chen; Kurbatov, Vadim; Leung, Patricia; Sugiyama, Gainosuke; Roudnitsky, Valery

    2015-01-01

    Introduction Splenic pseudoaneurysms (SPA) are a rare but serious sequela of blunt traumatic injury to the spleen. Management of adult blunt splenic trauma is well-studied, however, in children, the management is much less well-defined. Presentation of case A 15 year-old male presented with severe abdominal pain of acute onset after sustaining injury to his left side while playing football. FAST was positive for free fluid in the abdomen. Initial abdomen CT demonstrated a grade III/IV left sp...

  6. A rare case of splenic pseudoaneurysm in pediatric splenic blunt trauma patient: Review of diagnosis and management

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    Roger Chen Zhu

    2015-01-01

    Discussion & conclusion: Questions still remain regarding the timing of repeat imaging for diagnosis of SPA following non-operative blunt splenic trauma, which patients should be imaged, and how to manage SPA upon diagnosis. More clinical study and basic science research is warranted to study the disease process of SPA in pediatric patient. We believe that our proposed management algorithm timely detect formation of delayed SPA formation and addresses the possible fatal disease course of pediatric SPA.

  7. Ruptured Aneurysm of the Splenic Artery: A Rare Cause of Abdominal Pain after Blunt Trauma

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    Jalalludin Khoshnevis

    2013-01-01

    Full Text Available Introduction: Splenic artery aneurysms (SAAs are rare (0.2-10.4%; however, they are the most common form of visceral artery aneurysms. Splenic artery aneurysms are important to identify, because up to 25% of the cases are complicated by rupture. Post- rupture mortality rate is 25% -70% based on the underlying cause. Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA.Case Presentation: A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock. Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found.Conclusions: It is important to consider rupture of a splenic artery aneurysm in patients with abdominal pain and hypovolemic shock.

  8. Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

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    Foley, P. T., E-mail: pfoley@doctors.org.uk [The Canberra Hospital, Department of Medical Imaging (Australia); Kavnoudias, H., E-mail: h.kavnoudias@alfred.org.au [The Alfred Hospital, Radiology Research Unit, Radiology Department (Australia); Cameron, P. U., E-mail: paul.cameron@unimelb.edu.au [The Alfred Hospital, Infectious Diseases Unit (Australia); Czarnecki, C., E-mail: caroline.czarnecki@gmail.com [Royal Melbourne Hospital, Radiology Department (Australia); Paul, E., E-mail: eldho.paul@monash.edu [Monash University, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Alfred Hospital (Australia); Lyon, S. M., E-mail: lyonsey@optusnet.com.au [Melbourne Endovascular (Australia)

    2015-10-15

    PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

  9. A review of the management of blunt splenic trauma in England and Wales: have regional trauma networks influenced management strategies and outcomes?

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    Yiannoullou, P; Hall, C; Newton, K; Pearce, L; Bouamra, O; Jenks, T; Scrimshire, A B; Hughes, J; Lecky, F; Macdonald, Adh

    2017-01-01

    INTRODUCTION The spleen remains one of the most frequently injured organs following blunt abdominal trauma. In 2012, regional trauma networks were launched across England and Wales with the aim of improving outcomes following trauma. This retrospective cohort study investigated the management and outcomes of blunt splenic injuries before and after the establishment of regional trauma networks. METHODS A dataset was drawn from the Trauma Audit Research Network database of all splenic injuries admitted to English and Welsh hospitals from 1 April 2010 to 31 March 2014. Demographic data, injury severity, treatment modalities and outcomes were collected. Management and outcomes were compared before and after the launch of regional trauma networks. RESULTS There were 1457 blunt splenic injuries: 575 between 2010 and 2012 and 882 in 2012-14. Following the introduction of the regional trauma networks, use of splenic artery embolotherapy increased from 3.5% to 7.6% (P = 0.001) and splenectomy rates decreased from 20% to 14.85% (P = 0.012). Significantly more patients with polytrauma and blunt splenic injury were treated with splenic embolotherapy following 2012 (61.2% vs. 30%, P networks. This may have resulted from improved access to specialist services and reduced practice variation since the establishment of these networks.

  10. Blunt splenic trauma: Can contrast enhanced sonography be used for the screening of delayed pseudoaneurysms?

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    Poletti, Pierre-Alexandre, E-mail: Pierre-Alexandre.Poletti@hcuge.ch [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Becker, Christoph D.; Arditi, Daniel; Terraz, Sylvain [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Buchs, Nicolas [Department of Surgery, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland); Shanmuganathan, Kathirkamanathan [Department of Diagnostic Radiology and Nuclear Medicine, 22 S. Greene Street, Baltimore, MD 21201 (United States); Platon, Alexandra [Department of Radiology, University Hospital of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14 (Switzerland)

    2013-11-01

    Purpose: To assess the value of contrast-enhanced sonography (CES) for the detection of delayed post-traumatic splenic pseudo-aneurysms, usually considered an indication for angiographic embolization. Methods: Sixty-three consecutive hemodynamically stable trauma patients in whom admission CT displayed a splenic injury of grade II or higher (AAST classification), without evidence of vascular involvement, were included in the study. CES of the spleen using a second generation contrast agent was systematically performed within 48–72 h after admission, for the detection of a pooling of contrast media suggestive of pseudoaneurysm. Within 6 h after contrast-enhanced sonography, all patients underwent an abdominal CT for control purposes. CES results were compared to CT findings, which were considered the reference standard. This study received approval from the institutional ethical board. Results: CES showed a blush of contrast consistent with a pseudoaneurysm in 6 of the 63 patients. All were confirmed at subsequent control CT. Pooling of contrast was found at CT in 2 patients in whom contrast-enhanced sonography was negative. There was no false positive CES examination for the suspicion of pseudoaneurysms. When compared to CT, the sensitivity, specificity, positive and negative predictive values of CES to suggest a pseudoaneurysms, were 75% (6/8), 100% (55/55), 100% (6/6), and 96% (55/57), respectively. Conclusion: Our data suggest that CES may be useful for the screening of delayed traumatic splenic pseudoaneurysms: if a negative CES does not absolutely rule out a pseudoaneurysm, a positive CES warrants an angiography, without need of control CT.

  11. MANAGEMENT OF SPLENIC INJURY AFTER BLUNT INJURY TO ABDOMEN

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    J. Bharath Prakash Reddy

    2016-07-01

    Full Text Available BACKGROUND The spleen is an important organ in the body’s immune system. It is the most frequently injured organ in blunt abdominal trauma. 1 Over the past several decades, diagnosis and management of splenic trauma has been evolved. The conservative, operative approach has been challenged by several reports of successful non-operative management aided by the power of modern diagnostic imaging. The aim of our prospective study was to compare non-operative management with surgery for cases of splenic injury. METHODS We conducted a prospective study of patients admitted with blunt splenic injury to our regional hospital over a three-year period (2012-2015. Haemodynamic status upon admission, FAST examination, computed tomography 2 grade of splenic tear, presence and severity of associated injuries have been taken into account to determine the treatment of choice. Therapeutic options were classified into non-operative and splenectomy. RESULTS Over a 3-year period, 24 patients were admitted with blunt splenic injury. Sixteen patients were managed operatively and eight patients non-operatively. 3,4 Non-operative management failed in one patient due to continued bleeding. The majority of grades I, II, and III splenic injuries were managed non-operatively and grades IV and V were managed operatively. Blood transfusion requirement was significantly higher among the operative group, but the operative group had a significantly longer hospital stay. Among those managed non-operatively (median age 24.5 years, a number of patients were followed up with CT scans with significant radiation exposure and unknown longterm consequences. CONCLUSION In our experience, NOM is the treatment of choice for grade I, II and III blunt splenic injuries. Splenectomy was the chosen technique in patients who met exclusion criteria for NOM, as well as for patients with grade IV and V injury.

  12. Non-operative management of adult blunt splenic injuries

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    YANG Jun; GAO Jin-mou; Jean-Claude Baste

    2006-01-01

    Objective: To investigate the indication of nonoperative management of adult blunt splenic injuries.Methods: A retrospective review was performed on all adult patients (age > 15 years ) with blunt splenic injuries admitted to the department of vascular surgery of Pellegrin hospital in France from 1999 to 2003. We managed splenic injuries non-operatively in all appropriate patients without regard to age.Results: During the 4 years, 54 consecutive adult patients with blunt splenic injuries were treated in the hospital. A total of 27 patients with stable hemodynamic status were treated non-operatively at first, of which 2 patients were failed to non-operative treatment. The successful percentage of non-operative management was 92.6 %. In the 54 patients, 7 of 8 patients older than 55 years were treated with non-operative management. Two cases developing postoperatively subphrenic infection were healed by proper treatment. In the series, there was no death.Conclusions: Non-operative management of low-grade splenic injuries can be accomplished with an acceptable low-failure rate. If the clinical and laboratory parameters difficult for surgeons to make decisions, they can depend on Resciniti' s CT (computed tomography)scoring system to select a subset of adults with splenic trauma who are excellent candidates for a trial of nonoperative management. The patients older than 55 years are not absolutely inhibited to receive non-operative management.

  13. MDCT in blunt intestinal trauma

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    Romano, Stefania [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy)]. E-mail: stefromano@libero.it; Scaglione, Mariano [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Tortora, Giovanni [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Martino, Antonio [Trauma Center, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Di Pietto, Francesco [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Romano, Luigia [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Grassi, Roberto [Department ' Magrassi-Lanzara' , Section of Radiology, Second University of Naples, 80138 Naples (Italy)

    2006-09-15

    Injuries to the small and large intestine from blunt trauma represent a defined clinical entity, often not easy to correctly diagnose in emergency but extremely important for the therapeutic assessment of patients. This article summarizes the MDCT spectrum of findings in intestinal blunt lesions, from functional disorders to hemorrhage and perforation.

  14. Management of blunt splenic injury in patients with concurrent infectious mononucleosis.

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    Meguid, Ahmed A; Ivascu, Felicia A; Bair, Holly A; Kerr, Hugh; Bendick, Phillip J; McFall, Roberta K; Howells, Greg A

    2004-09-01

    Selective nonoperative management is appropriate for most blunt splenic injuries in adults and children, but the efficacy of this approach is unknown when injury occurs in patients with concurrent infectious mononucleosis. We have reviewed our experience during the past 23 years with the selective nonoperative management of blunt splenic injury in these patients. Medical record review identified nine patients with blunt splenic injury and infectious mononucleosis from 1978 to 2001, representing 3.3 per cent of our total trauma population with blunt splenic injury treated during that interval. Two patients underwent immediate splenectomy because of hemodynamic instability. Seven patients were admitted with the intent to treat nonoperatively. Five patients were successfully managed nonoperatively. Two patients failed nonoperative management and underwent splenectomy, one because of hemodynamic instability and one because of an infected splenic hematoma. Concurrent infectious mononucleosis does not preclude the successful nonoperative management of blunt splenic injury. This small subset of patients may be managed nonoperatively using the same criteria as for patients whose splenic injuries are not complicated by infectious mononucleosis.

  15. Blunt Head Trauma and Headache

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    Ana B Chelse

    2015-04-01

    Full Text Available Investigators from New York Presbyterian Morgan Stanley Children’s Hospital examined whether having an isolated headache following minor blunt head trauma was suggestive of traumatic brain injury (TBI among a large cohort of children 2-18 years of age.

  16. Superman play and pediatric blunt abdominal trauma.

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    Machi, J M; Gyuro, J; Losek, J D

    1996-01-01

    Two pediatric patients with life-threatening intra-abdominal injuries associated with Superman play are presented. The cases illustrate the importance of knowing the mechanism of injury in the assessment of children with blunt abdominal trauma. The diagnostic value of liver enzymes and the controversies surrounding the radiographic assessment of pediatric blunt abdominal trauma are presented.

  17. [Non-operative management of splenic trauma].

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    Moog, R; Mefat, L; Kauffmann, I; Becmeur, F

    2005-02-01

    Non-operative management of splenic trauma is one of the most notable advances in paediatric surgery. It should be systematically proposed except for cases of hemodynamic instability. Abdominal CT scan without and with contrast injection is essential with initial optimal management. Stay in paediatric surgical intensive care unit with monitoring can prevent rare but serious complications. The time of hospitalisation stay lies between two and three weeks and will be followed by three months without contact activity. The advantages of this treatment are obvious safeguarding of splenic function and absence of postoperative complications. Consequently only one of the 88 children admitted these ten last past years for splenic trauma in our unity was operated.

  18. The efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury

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    Kwack, Kyu Sung; Kim, Young Ju; Lee, Myung Sub; Kim, Dong Jin; Hong, In Soo [Wonju Christian Hospital, College of Medicine, Yonsei University, Wonju (Korea, Republic of)

    2000-07-01

    To evaluate the efficacy and benefits of transcatheter arterial embolization (TAE) in patients with blunt splenic injury after blunt abdominal trauma. We retrospectively analyzed the results of transcatheter arterial embolization in 23 patients who suffered splenic injury after blunt abdominal trauma. Fourteen of the patients were male, and 9 were female; 13 were adults, and 10 were children. Transcatheter arterial embolization was performed in patients with hypotension, tachycardia, evidence of hemodynamic instability due, for example, to low levels of Hgb and Hct, or those who needed fluid therapy or blood transfusion. After embolization the patients' progress was monitored by CT scanning, abdominal sonography, or {sup 99m}Tc-sulfur colloid scintigraphy. The degree of splenic injury was classified according to the system devised by Mirvis et al.; nine cases were CT grade III, and 14 were grade IV. After demonstrating angiographically the site of contrast leakage, embolization was performed; for this, a coil only was used in 16 cases, gelfoam only in four, and both coil and gelfoam in three. There were three sites of vascular embolization: 16 procedures were performed in the proximal part of the main trunk of the splenic artery, four in a superselected branch of this same artery, and three in both the splenic artery and one of its superselected branches. Of the 23 cases, 18 recovered without splenectomy after embolization, three adult patients died from coexisting conditions (spinal or cerebral injuries, liver cirrhosis, or pelvic bone fracture) or complications (acute renal failure or disseminated intravascular coagulation). Due to co-existing pancreatic and mesenteric vessel injury, two of the adult patients who underwent TAE also underwent delayed surgery; intraoperatively, there was no evidence of splenic rebleeding. In all patients who did not undergo surgery, follow-up observation revealed a decreased volume of hemoperitoneum, increased uptake of

  19. Cardiac injuries in blunt chest trauma

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    Tobon-Gomez Catalina

    2009-09-01

    Full Text Available Abstract Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use of Cardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a 12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualization of myocardial damage resulting from the trauma.

  20. Splenic mass with remote trauma history: a management dilemma.

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    McCarthy, C J

    2011-03-02

    BACKGROUND: Delayed presentation of splenic trauma is a well described entity. METHOD: We report two patients who presented with splenic abnormality found incidentally on imaging for other medical problems. A remote history of splenic trauma was elicited during clinical evaluation; 18 months in one patient and 11 years in the second patient. Both patients underwent surgical exploration. CONCLUSIONS: Radiological investigations could not reassure us that the splenic abnormalities were benign, and their management was the subject of some debate.

  1. Splenic mass with remote trauma history: a management dilemma.

    LENUS (Irish Health Repository)

    McCarthy, C J

    2012-02-01

    BACKGROUND: Delayed presentation of splenic trauma is a well described entity. METHOD: We report two patients who presented with splenic abnormality found incidentally on imaging for other medical problems. A remote history of splenic trauma was elicited during clinical evaluation; 18 months in one patient and 11 years in the second patient. Both patients underwent surgical exploration. CONCLUSIONS: Radiological investigations could not reassure us that the splenic abnormalities were benign, and their management was the subject of some debate.

  2. [Experimental simulation of blunt cardiac trauma].

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    Tumanov, E V

    2010-01-01

    This paper was designed to analyse the main experimental models of blunt cardiac trauma proposed during a period of more than 100 years beginning from the study of the Italian scientist Felice Meola dated to the 1870s till the present time. The analysis demonstrated that even a mild injury to the anterior chest wall in the projection of the heart may cause serious changes in hemodynamics and ECG characteristics. It was shown that various methods employed to simulate blunt cardiac trauma place potential constraints related to the design of experiments.

  3. Isolated renal pelvis rupture secondary to blunt trauma: Case report

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    Kerem Taken

    2015-01-01

    Conclusion: Renal pelvic injury must be considered in the differential diagnosis of blunt trauma. Surgical intervention may be necessary in some cases. We present a case who underwent surgery due to isolated renal pelvis rupture caused by blunt abdominal trauma.

  4. Cardiogenic shock following blunt chest trauma

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    Rodríguez-González Fayna

    2010-01-01

    Full Text Available Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent cause of cardiac contusions resulting from a direct blow to the chest. Other causes of blunt cardiac injury are numerous and include violent fall impacts, interpersonal aggression, explosions, and various types of high-risk sports. Myocardial contusion is difficult to diagnose; clinical presentation varies greatly, ranging from lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. We present a case of cardiac contusion due to blunt chest trauma secondary to a fall impact, which manifested as cardiogenic shock.

  5. An evidence based blunt trauma protocol

    NARCIS (Netherlands)

    Vugt, R. van; Kool, D.R.; Lubeek, S.F.; Dekker, H.M.; Brink, M.; Deunk, J.; Edwards, M.J.R.

    2013-01-01

    OBJECTIVE: Currently CT is rapidly implemented in the evaluation of trauma patients. In anticipation of a large international multicentre trial, this study's aim was to evaluate the clinical feasibility of a new diagnostic protocol, used for the primary radiological evaluation in adult blunt high-en

  6. Tetanus after blunt lawn mower trauma

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    Camilla Normand

    2015-01-01

    Full Text Available A patient presented with tetanus ten days after blunt trauma with a lawn mower. Our case describes the diagnosis and treatment of this patient with an infectious disease commonly seen in the developing world but rarely seen in the developed world.

  7. Fatores prognósticos relacionados à falha do tratamento não-operatório de lesões esplênicas no trauma abdominal fechado Prognostic factors related to non surgical treatment failure of splenic injuries in the abdominal blunt trauma

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    Fábio Henrique de Carvalho

    2009-04-01

    Full Text Available OBJETIVO: Identificar fatores prognósticos relacionados com a falha do tratamento não-operatório (TNO de lesões esplênicas no trauma abdominal fechado. MÉTODOS: Análise prospectiva de 56 pacientes adultos submetidos à TNO e divididos em um grupo de sucesso e outro de falha, que foi definida como necessidade de laparotomia por qualquer indicação. As lesões foram diagnosticadas por tomografia computadorizada e classificadas de acordo com os critérios da AAST (American Association for Surgery of Trauma. Os parâmetros estudados foram: na admissão - pressão arterial sistólica, frequências cardíaca e respiratória, nível de consciência (Escala de Glasgow e RTS (Revised Trauma Score; durante a hospitalização - presença de lesões associadas, transfusão sanguínea e parâmetros hematológicos, tempo de internação e ISS (Injury Severity Score. RESULTADOS: As falhas do TNO (19,6% foram devidas à dor abdominal (45,4%, instabilidade hemodinâmica (36,4%, queda do volume globular associada a hematoma esplênico (9,1% e abscesso esplênico (9,1%. Não foram observadas diferenças entre os grupos de sucesso e de falha nos dados na admissão. A taxa de falha de acordo com o grau da lesão esplênica foi 0% nos graus I e II agrupados; 17,5% nos graus III e IV agrupados e 80% no grau V (p = 0,0008. O uso de hemoderivados foi maior e mais frequente no grupo de falha (p=0,05. As relação do ISS (Injury Severity Score com as taxas de falha foram 0% nos pacientes com ISS = 8; 15,9% nos com ISS entre 9 e 25, e 50% nos com ISS = 26 (p = 0,05. Não houve mortalidade e nem lesões de vísceras ocas despercebidas. CONCLUSÃO: O Injury Severity Score e grau da lesão esplênica relacionaram-se com a falha do tratamento não-operatório.OBJECTIVE: Identify prognostic factors related to treatment failure of blunt splenic injuries managed by non surgical treatment (NST. METHODS: Fifty six adult patients submitted to NST were prospectively studied

  8. Major gastroenteric injuries from blunt trauma.

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    Talton, D S; Craig, M H; Hauser, C J; Poole, G V

    1995-01-01

    Hollow visceral injuries are far less common in blunt abdominal trauma than in penetrating abdominal trauma. From 1982 through 1993 we treated 50 patients with 57 major blunt injuries to the gut, defined as perforation, transection, or devascularization. Thirty-two patients (64%) were injured in motor vehicle collisions. Of these, 29 wore no restraints; three were wearing lap belts (none wore lap-shoulder restraints). Mean injury Severity Score (ISS) in patients wearing lap belts was 13.3, compared with 28.6 in the 29 patients who were not using restraint devices (P injuries, followed by devascularization of the small bowel, colorectal injuries, duodenal, and gastric perforations. ISS and mortality rates were lowest in small bowel injuries and higher in the less common colonic and gastroduodenal injuries. Except for those patients with perforations of the small bowel, most patients had associated injuries to the head, chest, or abdominal solid organs that were largely responsible for morbidity and mortality. Injuries to the abdominal hollow viscera are unusual following blunt trauma, but are the result of very high energy truncal trauma, and are associated with multiple additional injuries. Most alert patients had physical findings suggestive of peritoneal irritation, but when diagnostic testing was necessary, peritoneal lavage was superior to computed tomography scanning (false negatives = 6.7% versus 36%, respectively; P < 0.05). A high index of suspicion is necessary to avoid diagnostic delays that can lead to severe complications and death.

  9. Trauma abdominal fechado: análise dos pacientes vítimas de trauma esplênico em um Hospital Universitário de Curitiba Blunt abdominal trauma: analysis of the patients victims of splenic trauma in a University Hospital of Curitiba

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    Luiz Carlos von Bahten

    2006-12-01

    . FC média e PA sistólica não variaram, tampouco quando comparado ao grupo sem lesão em órgão sólido. A probabilidade de lesão esplênica cresceu com fraturas de arcos costais esquerdos isolados. No presente estudo, há predomínio do grupo com lesões Grau III, IV ou V.BACKGROUND: determining the common characteristics referring to the trauma mechanism and to the anatomic and physiological lesion of patients victim of splenic trauma. METHODS: The records of December/1999 to January/2003 were revised, being selected 524 of those by the Software TNVT Plus (version 2.0.0.213 - year 1996, admitted in the Emergency Service victims of thoracic-abdominal disease and subsequently interned. Of these records, were excluded those which did not present mechanism of contused trauma, the ones that deceased in the emergency room and the minors of 16 years of age. A sample with N=200 patients were studied. The variables of interest in the study were: etiology of the trauma, organ with the lesion, degree and segment of the lesion, systolic arterial pressure, cardiac frequency in the hospital admission and rib fracture. RESULTS: the splenic injury isolated had the greater incidence 39%, the hepatic-splenic associated lesion represented 14%. Of the 116 patients with diagnosis of splenic lesion, the classified anatomically in Degree IV was the most common (44 patients. The majority of the lesions had an auto-engine vehicle as the trauma mechanism - 56 patients, among which the lesion Degree III had greater prevalence 33,93%, standard comparable with the lesion Degree IV 32,14%. It was observed that 20% of the patients with lesion Degree III, IV or V had not described abdominal pain in their records, and in the lesions Degree I or II 30,13% did not describe pain. Medium Cardiac Frequency and Systolic Arterial Pressure were shown equivalent among different lesions. The greater incidence of splenic lesion was related to the absence of rib fracture. When diagnosed fracture, there was

  10. Diagnostic Accuracy of Secondary Ultrasound Exam in Blunt Abdominal Trauma

    OpenAIRE

    Rajabzadeh Kanafi, Alireza; Giti, Masoumeh; Gharavi, Mohammad Hossein; Alizadeh, Ahmad; Pourghorban, Ramin; Shekarchi, Babak

    2014-01-01

    Background: In stable patients with blunt abdominal trauma, accurate diagnosis of visceral injuries is crucial. Objectives: To determine whether repeating ultrasound exam will increase the sensitivity of focused abdominal sonography for trauma (FAST) through revealing additional free intraperitoneal fluid in patients with blunt abdominal trauma. Patients and Methods: We performed a prospective observational study by performing primary and secondary ultrasound exams in blunt abdominal trauma p...

  11. Management of splenic and pancreatic trauma.

    Science.gov (United States)

    Girard, E; Abba, J; Cristiano, N; Siebert, M; Barbois, S; Létoublon, C; Arvieux, C

    2016-08-01

    The spleen and pancreas are at risk for injury during abdominal trauma. The spleen is more commonly injured because of its fragile structure and its position immediately beneath the ribs. Injury to the more deeply placed pancreas is classically characterized by discordance between the severity of pancreatic injury and its initial clinical expression. For the patient who presents with hemorrhagic shock and ultrasound evidence of major hemoperitoneum, urgent "damage control" laparotomy is essential; if splenic injury is the cause, prompt "hemostatic" splenectomy should be performed. Direct pancreatic injury is rarely the cause of major hemorrhage unless a major neighboring vessel is injured, but if there is destruction of the pancreatic head, a two-stage pancreatoduodenectomy (PD) may be indicated. At open laparotomy when the patient's hemodynamic status can be stabilized, it may be possible to control splenic bleeding without splenectomy; it is always essential to search for injury to the pancreatic duct and/or the adjacent duodenum. Pancreatic contusion without ductal rupture is usually treated by drain placement adjacent to the injury; ductal injuries of the pancreatic body or tail are treated by resection (distal pancreatectomy with or without splenectomy), with generally benign consequences. For injuries of the pancreatic head with pancreatic duct disruption, wide drainage is usually performed because emergency PD is a complex gesture prone to poor results. Postoperatively, the placement of a ductal stent by endoscopic retrograde catheterization may be decided, while management of an isolated pancreatic fistula is often straightforward. Non-operative management is the rule for the trauma victim who is hemodynamically stable. In addition to the clinical examination and conventional laboratory tests, investigations should include an abdominothoracic CT scan with contrast injection, allowing identification of all traumatized organs and assessment of the severity of

  12. Blunt pancreatic trauma: A persistent diagnostic conundrum?

    Institute of Scientific and Technical Information of China (English)

    Atin Kumar; Ananya Panda; Shivanand Gamanagatti

    2016-01-01

    Blunt pancreatic trauma is an uncommon injury but has high morbidity and mortality. In modern era of trauma care, pancreatic trauma remains a persistent challenge to radiologists and surgeons alike. Early detection of pancreatic trauma is essential to prevent subsequent complications. However early pancreatic injury is often subtle on computed tomography(CT) and can be missed unless specifically looked for. Signs of pancreatic injury on CT include laceration, transection, bulky pancreas, heterogeneous enhancement, peripancreatic fluid and signs of pancreatitis. Pan-creatic ductal injury is a vital decision-making parameter as ductal injury is an indication for laparotomy. While lacerations involving more than half of pancreatic parenchyma are suggestive of ductal injury on CT, ductal injuries can be directly assessed on magnetic resonance imaging(MRI) or encoscopic retrograde cholangio-pancreatography. Pancreatic trauma also shows temporal evolution with increase in extent of injury with time. Hence early CT scans may underestimate the extent of injures and sequential imaging with CT or MRI is important in pancreatic trauma. Sequential imaging is also needed for successful nonoperative management of pancreatic injury. Accurate early detection on initial CT and adopting a multimodality and sequential imaging strategy can improve outcome in pancreatic trauma.

  13. Segmental Renal Infarction due to Blunt Trauma.

    Science.gov (United States)

    Alevizopoulos, Aristeidis; Hamilton, Lauren; Stratu, Natalia; Rix, Gerald

    2016-05-01

    Segmental renal infarction is a rare situation which has been reported so far in the form of case reports. It's caused usually by cardiac conditions, such as atrial fibrillation, and systemic diseases (e.g. systemic lupus erythematous). We are presenting a case of a 31 year old healthy male, who sustained a left segmental renal infarction, following a motorbike accident. We report his presentation, management and outcome. We also review the literature in search of the optimal diagnostic and treatment pathway. To our knowledge, this is the first report of segmental renal infarction due to blunt trauma.

  14. Atrioventricular Dissociation following Blunt Chest Trauma

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    Salim Surani

    2014-01-01

    Full Text Available Blunt chest trauma (BCT is a common clinical presentation seen in emergency departments. Few cases of cardiac conduction abnormalities due to BCT have been reported in the medical literature. This dysrhythmias may present as permanent conduction defects requiring permanent pacemaker or may have temporary conduction abnormalities requiring temporary pacemaker or supportive care. We present the case of a young woman who suffered from BCT after being kicked by a horse with the development of a significant substernal hematoma. She developed temporary atrioventricular block, which was completely resolved with the decrease in the size of the substernal hematoma suffered.

  15. Blunt pancreatic trauma. Role of CT

    Energy Technology Data Exchange (ETDEWEB)

    Procacci, C. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Graziani, R. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Bicego, E. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Mainardi, P. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Bassi, C. [Dept. of Surgery, Univ. Hospital, Verona (Italy); Bergamo Andreis, I.A. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Valdo, M. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Guarise, A. [Dept. of Radiology, Univ. Hospital, Verona (Italy); Girelli, M. [Dept. of Radiology, Univ. Hospital, Verona (Italy)

    1997-07-01

    Purpose: To define the evolution patterns of blunt pancreatic trauma, and to point out the CT features most significant for the diagnosis. Material and Methods: Ten cases of pancreatic trauma, observed over a period of about 10 years, were analyzed in retrospect. The cases were divided into 3 groups according to the time that had elapsed between trauma and first CT: Early phase (within 72 h: n=3/10); late phase (after 10 days: n=3/10); and following pancreatic drainage (n=4/10). Results: In the early phase, one case showed a blood collection surrounding the pancreatic head and duodenum, and displacing the mesenteric vessels to the left. In the 2 other cases it was possible to demonstrate a tear in the pancreas at the neck, perpendicular to the main pancreatic axis. In the late phase in all 3 cases, one cystic lesion was present at the site of the tear, either surrounding the gland or embedded - more or less deeply - within the parenchyma. One of the lesions subsided spontaneously; the 2 others required surgery. In the postoperative phase, an external fistula was demonstrated in 2 cases following percutaneous drainage of pancreatic cysts; the fistula was fed by a cystic lesion in the pancreatic neck. In the 2 other cases a pseudocyst developed. (orig.).

  16. MULTI - DETECTOR COMPUTED TOMOGRAPHY AND INTRA - OPERATIVE CORRELATION IN BLUNT ABDOMINAL TRAUMA

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    Rakesh

    2014-01-01

    Full Text Available BACKGROUND : With the change in the pace of life fast , faster , fastest being the motto of the present day , the incidence of trauma and the associated mortality and morbidities is on a continuous rise.Imaging plays a very important role in the management of these injuries in deciding which injuries , in trauma the final verdict of organ injury in abdomen is intra - ope rative findings. AIMS : In view of the above said we considered to study to determine diagnostic accuracy of MDCT (Multi - Detector Computed Tomography in detection of intra - abdominal solid organ injury in blunt abdominal trauma and to highlight the importance of MDCT in evaluation of blunt abdominal trauma. METHODS AND MATERIALS : This was a prospective study done between over a period of 2 years from between January 2011 to February 2013 on patients who presented with blun t abdominal trauma after excluding patients who were managed conservatively and normal on imaging , the data we compared had 32 patients and the analysis was as follows. RESULTS : Blunt abdominal trauma was common in males , the male to female ratio was 9:1 , road traffic accident is the most common mode of injury in blunt abdominal trauma with 60% of the patients in this mode of injury , single organ injury is 22 patients (76% spleen is the most commonly injured organ 15(47% patients having splenic injury , wi th grade 3 being the commonest splenic injury 8 out of the 15 patients had splenic injury bowel injury was the second common organ injured in blunt trauma abdomen. In this study computed tomography grading correlated well with intra - operative grading with a PPV of= 95.45 % (95% ci: 84.50 % to 99.31 % Asensitivityof 76.36 % (95% ci: 62.98 % to 86.76 % . CONCLUSION : Computed tomography is an important imaging technique for diagnosis of organ injuries in patients with abdominal trauma. It helps in grading of the type of injury and accordingly deciding the management of patient. It is a highly

  17. Sonographic evaluation of blunt scrotal trauma

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    Lee, J.S.; Jun, Y.H.; Sohn, H.S.; Kim, O.B. [Seoun National University College of Medicine, Seoul (Korea, Republic of)

    1983-12-15

    Scrotal sonography provides rapid, painless, high-resolution tomographic imaging of scrotal contents. Therefore, it is useful for traumatized scrotum in which physical examination alone is either inadequate or equivocal. To analyze the value of sonography in guiding the therapeutic approach, we examined 19 cases of blunt scrotal trauma with special attention to testicular abnormality, origin and extent of scrotal hematoma. The results were as follows; 1. Five testicular abnormalities were properly detected by the demonstration of ill defined outline, separation of tunica albuginea, coarse echo pattern, small scattered echolucencies and/or echolucent mass(es) in the testis. 2. In most cases of scrotal hematomas, the exact extent and the effects of hematoma on the testis were visualized satisfactory. 3. In certain cases of hematoceles and a case of scrotal wall hematoma, sonographic findings alone were enough to determine the sites of origin

  18. Diagnosing Myocardial Contusion after Blunt Chest Trauma

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    Zahra Alborzi

    2016-10-01

    Full Text Available A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is a major cause of rapid death which happens after blunt chest trauma and should be suspected at triage in the emergency department. We demonstrated that suspected myocardial contusion patients who have normal electrocardiograms (ECGs and biomarker tests can be safely discharged. However, if the test results are abnormal, the next steps should be echocardiography and more advanced measures. Diagnosing myocardial contusion is very difficult because of its nonspecific symptoms. If a myocardial contusion happens, cardiogenic shock or arrhythmia must be anticipated, and the patient must be carefully monitored.

  19. A RETROSPECTIVE STUDY OF BLUNT TRAUMA ABDOMEN

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    Kumawat

    2015-07-01

    Full Text Available BACKGROUND: Blunt abdominal trauma is one of the important components of poly - trauma. It requires suspicion, investigation and proper management in time, to avoid morbidity & mortality. AIM: The aim of this retrospective study spanning 5 years w.e.f. Jan, 2010 to December, 2014 in this tertiary care institute of Geetanjali Medical College & Hospital, Udaipur was to find out BTA patients in RTA, fall from height, and assault like injuries. We studied type of injuries, male - female ratio, age group, urban & rural population involvement & their operative & non - operative management. MATERIAL & METHOD S : The study is based on 273 cases of BTA; managed in this institute from admission, investigation, management & possible follow up. Observations are depicted in different tables. RESULT: Liver is most commonly involved organ followed by spleen, kidney & pancreas respectively. Initially solid organ injuries cases where treated by surgery, but than non - operative management are tried in haemostatically stable patients. Hollow visceral injuries were always managed by laparotomy & repair or resection as and when needed . Mortality occurred in 35 patients out 273 patients because of delay to reach hospital or septicemia, renal failure and shock due to multi organ failure. CONCLUSION: Close supervision with sophisticated infrastructure and quick action significantly reduces mortality.

  20. Duodenal perforation as result of blunt abdominal trauma in childhood.

    Science.gov (United States)

    Hartholt, Klaas Albert; Dekker, Jan Willem T

    2015-12-23

    Blunt abdominal trauma may cause severe intra-abdominal injuries, while clinical findings could be mild or absent directly after the trauma. The absence of clinical findings could mislead physicians into underestimating the severity of the injury at the primary survey, and inevitably leads to a delay in the diagnosis. The Blunt Abdominal Trauma in Children (BATiC) score may help to identify children who are at a high risk for intra-abdominal injuries in an early stage and requires additional tests directly. A case of a 10-year-old girl with a duodenal perforation after a blunt abdominal trauma is presented. A delay in diagnosis may lead to an increased morbidity and mortality rate. A low admission threshold for children with abdominal pain after a blunt trauma is recommended.

  1. Isolated duodenal rupture due to blunt abdominal trauma

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    Celik Atilla

    2006-01-01

    Full Text Available Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis and final out comes.

  2. Pectus excavatum in blunt chest trauma: a case report

    Directory of Open Access Journals (Sweden)

    Liodakis Emmanouil

    2013-01-01

    Full Text Available Abstract Introduction Blunt cardiac rupture is an exceedingly rare injury. Case presentation We report a case of blunt cardiac trauma in a 43-year-old Caucasian German mother with pectus excavatum who presented after a car accident in which she had been sitting in the front seat holding her two-year-old boy in her arms. The mother was awake and alert during the initial two hours after the accident but then proceeded to hemodynamically collapse. The child did not sustain any severe injuries. Intraoperatively, a combined one-cm laceration of the left atrium and right ventricle was found. Conclusion Patients with pectus excavatum have an increased risk for cardiac rupture after blunt chest trauma because of compression between the sternum and spine. Therefore, patients with pectus excavatum and blunt chest trauma should be admitted to a Level I Trauma Center with a high degree of suspicion.

  3. Massive expanding hematoma of the chin following blunt trauma

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    K Thanvir Mohamed Niazi

    2016-01-01

    Full Text Available Posttraumatic hematoma of the face is common and usually self-limiting in nature. We report an unusual massive expanding hematoma of the chin within 9 h following a blunt trauma with no associated injuries or fracture.

  4. Blunt force trauma as a rare mechanism for chyluria.

    Science.gov (United States)

    Rycyna, Kevin J; Casella, Daniel; D'Agostino, Louis

    2016-06-01

    Chyluria is an uncommon clinical entity outside of the tropics. We present a rare case of blunt force trauma leading to the formation of a lymphorenal fistula. This was successfully managed via conservative endoscopic and dietary treatment.

  5. [Malignant glaucoma following blunt trauma of the eye

    NARCIS (Netherlands)

    Theelen, T.; Klevering, B.J.

    2005-01-01

    PURPOSE: Ciliary block glaucoma most commonly occurs after intraocular surgery. We report a case of malignant glaucoma following blunt trauma of the eye with no previous surgery or laser. PATIENT: A 54-year-old female suffered from acute elevation of intraocular pressure on her right eye after blunt

  6. Unrecognized blunt tracheal trauma with massive pneumomediastinum and tension pneumothorax

    Directory of Open Access Journals (Sweden)

    Nanda Shetty

    2011-01-01

    Full Text Available Blunt neck trauma with an associated laryngotracheal injury is rare. We report a patient with blunt neck trauma who came to the emergency room and was sent to ward without realizing the seriousness of the situation. He presented later with respiratory distress and an anesthesiologist was called in for emergency airway management. Airway management in such a situation is described in this report.

  7. Current experience with computed tomographic cystography and blunt trauma.

    Science.gov (United States)

    Deck, A J; Shaves, S; Talner, L; Porter, J R

    2001-12-01

    We present our experience with computed tomographic (CT) cystography for the diagnosis of bladder rupture in patients with blunt abdominal and pelvic trauma and compare the results of CT cystography to operative exploration. We identified all blunt trauma patients diagnosed with bladder rupture from January 1992 to September 1998. We also reviewed the radiology computerized information system (RIS) for all CT cystograms performed for the evaluation of blunt trauma during the same time period. The medical records and pertinent radiographs of the patients with bladder rupture who underwent CT cystography as part of their admission evaluation were reviewed. Operative findings were compared to radiographic findings. Altogether, 316 patients had CT cystograms as part of an initial evaluation for blunt trauma. Of these patients, 44 had an ultimate diagnosis of bladder rupture; 42 patients had CT cystograms indicating bladder rupture. A total of 28 patients underwent formal bladder exploration; 23 (82%) had operative findings that exactly (i.e., presence and type of rupture) matched the CT cystogram interpretation. The overall sensitivity and specificity of CT cystography for detection of bladder rupture were 95% and 100%, respectively. For intraperitoneal rupture, the sensitivity and specificity were 78% and 99%, respectively. CT cystography provides an expedient evaluation for bladder rupture caused by blunt trauma and has an accuracy comparable to that reported for plain film cystography. We recommend CT cystography over plain film cystography for patients undergoing CT evaluation for other blunt trauma-related injuries.

  8. Blunt splenic injury in a child with situs inversus totalis treated with transcatheter arterial embolization

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    Naoki Hashizume

    2016-10-01

    Full Text Available We report the first case of blunt splenic rupture in a child with situs inversus totalis treated with transcatheter arterial embolization (TAE. A 12-year-old girl fell roughly 4 feet onto the pavement while riding her bicycle. Contrast-enhanced computed tomography revealed situs inversus totalis, a massive hemorrhage in the abdominal cavity, and a ruptured spleen with extravasation. Arteriography showed that the internal organs were located opposite their normal positioning. TAE was carried out with gelfoam and a micro coils at the branch of the upper lobe of the splenic artery. TAE is effective for blunt splenic injury with extravasation in a child with situs inversus. In TAE, there is no technical difference about situs inversus excepted mirror image of abdominal vascular formation.

  9. Bedside Ultrasound in a Case of Blunt Scrotal Trauma

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    Mark Cannis

    2013-03-01

    Full Text Available This case study describes a patient who suffered blunt force trauma to the scrotum. Use of bedsideemergency ultrasound facilitated early diagnosis of a ruptured testicle and allowed for prompturological consultation and timely surgical repair. The utility of bedside emergency ultrasound inthe evaluation of testicular trauma, as well as the outcome of our case, is discussed here.

  10. Bowel and mesenteric injuries from blunt abdominal trauma: a review.

    Science.gov (United States)

    Iaselli, Francesco; Mazzei, Maria Antonietta; Firetto, Cristina; D'Elia, Domenico; Squitieri, Nevada Cioffi; Biondetti, Pietro Raimondo; Danza, Francesco Maria; Scaglione, Mariano

    2015-01-01

    The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.

  11. Pancreatic transection from blunt trauma associated with vascular and biliary lesions: A case report

    Institute of Scientific and Technical Information of China (English)

    Gian Luca Baiocchi; Guido AM Tiberio; Federico Gheza; Marco Gardani; Massimiliano CantO; Nazario Portolani; Stefano Maria Giulini

    2008-01-01

    Major injuries of the pancreas may result in considerable morbidity and mortality when associated with vascular and visceral injuries.In such cases,a right diagnosis and a prompt surgical intervention are necessary to give a chance to the patient.We herein describe a case of blunt abdominal trauma in a 29-year-old man whose pancreatic rupture was associated with hepatic artery,splenic vein and extrahepatic bile duct damage.Immediate surgery was performed after computer tomograghy (CT),the haemorrhagic lesions dictat the emergency transfer to the operating room.Spleno-pancreatic resection was done with reconstruction of the hepatic artery,ligation of the splenic vein and a Roux-en-Y bilio-jejunal diversion.The early post-operative course was complicated by stenosis of the arterial reconstruction,which was treated by endovascular angioplasty followed by percutaneous drainage of symptomatic pseudocyst,rest and antibiotics.Finally,the patient was discharged and was alive without clinical problems at the time when we wrote this case report.The present case underlines the clinical relevance of vascular and visceral injuries associated with pancreatic trauma and the problems arising in the diagnostic evaluation and the surgical strategy of complex multiple visceral and vascular lesions in blunt abdominal trauma.

  12. Isolated Gallbladder Injury in a Case of Blunt Abdominal Trauma

    OpenAIRE

    Birn, Jeffrey; Jung, Melissa; Dearing, Mark

    2012-01-01

    The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.

  13. Pancreatic laceration and portal vein thrombosis in blunt trauma abdomen

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    Rastogi Rajul

    2008-01-01

    Full Text Available Injuries to the pancreas by blunt trauma are uncommon. The association of pancreatic injury with acute portal vein thrombosis secondary to blunt trauma abdomen is furthermore rare. The early diagnosis of the pancreas with injury to the portal vein is challenging and difficult. These injuries are associated with high morbidity and mortality, particularly if the diagnosis is delayed. Accurate and early diagnosis is therefore imperative and computed tomography plays a key role in detection. We present a case of child with a rare combination of pancreatic laceration and acute portal vein thrombosis following a blunt trauma to the abdomen. With extensive literature search we found no such cases has been described previously.

  14. CT of blunt trauma to the bowel and mesentery.

    Science.gov (United States)

    Nghiem, H V; Jeffrey, R B; Mindelzun, R E

    1993-01-01

    The high mortality and morbidity rates associated with traumatic rupture of the hollow viscera have been attributed to the clinical difficulty in establishing an early diagnosis. CT has been shown to be accurate for detecting bowel and mesenteric injuries caused by blunt trauma and may be useful in predicting the need for either surgical repair or conservative management. However, many major gastrointestinal injuries have subtle CT findings. In this pictorial essay, we illustrate the broad spectrum of gastrointestinal abnormalities that can be shown by CT in patients with blunt abdominal trauma.

  15. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

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    João Palas

    2014-01-01

    Full Text Available Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  16. Multidetector computer tomography: evaluation of blunt chest trauma in adults.

    Science.gov (United States)

    Palas, João; Matos, António P; Mascarenhas, Vasco; Herédia, Vasco; Ramalho, Miguel

    2014-01-01

    Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  17. Are routine pelvic radiographs in major pediatric blunt trauma necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Lagisetty, Jyothi [Memorial Hermann Medical Center, Emergency Medicine Department, Houston, TX (United States); Slovis, Thomas [Wayne State University School of Medicine, Department of Radiology, Pediatric Imaging, Children' s Hospital of Michigan, Detroit, MI (United States); Thomas, Ronald [Children' s Hospital of Michigan, Wayne State University of Medicine, Department of Pediatrics, Detroit, MI (United States); Knazik, Stephen; Stankovic, Curt [Wayne State University of Medicine, Division of Emergency Medicine, Children' s Hospital of Michigan, Detroit, MI (United States)

    2012-07-15

    Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)

  18. Blunt adrenal gland trauma in the pediatric population.

    Science.gov (United States)

    Roupakias, Stylianos; Papoutsakis, Marinos; Mitsakou, Paraskevi

    2011-07-01

    A retrospective review of the literature was performed to determine the natural history, prevalence, prognosis and management of adrenal injury associated with blunt abdominal trauma in pediatric population. Blunt adrenal injury in children is uncommon, rarely isolated, and typically present as part of a multi organ trauma. Adrenal hemorrhage is being diagnosed more frequently since the emergence of computed tomography in modern emergency rooms. Obstetric birth trauma during vaginal delivery of a macrosomic fetus may result in neonatal adrenal hemorrhage. In children appear to be an incidental finding that resolves on follow-up imaging. Most of these injuries are self-limited and do not require intervention. The differential diagnosis of an adrenal neoplasm, especially in children with an isolated adrenal hemorrhage, must be considered. The presence of adrenal hemorrhage in the absence of a trauma history should alert to the possibility of pediatric inflicted injury.

  19. Multidetector CT Findings of Bowel Transection in Blunt Abdominal Trauma

    NARCIS (Netherlands)

    Cho, H.S.; Woo, J.Y.; Hong, H.S.; Park, M.H.; Ha, H.I.; Yang, I.; Lee, Y.; Jung, A.Y.; Hwang, J.Y.

    2013-01-01

    OBJECTIVE: Though a number of CT findings of bowel and mesenteric injuries in blunt abdominal trauma are described in literature, no studies on the specific CT signs of a transected bowel have been published. In the present study we describe the incidence and new CT signs of bowel transection in blu

  20. Optic Nerve Avulsion after Blunt Trauma

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    Hacı Halil Karabulut

    2014-05-01

    Full Text Available Optic nerve avulsion is an uncommon presentation of ocular trauma with a poor prognosis. It can be seen as complete or partial form due to the form of trauma. We assessed the complete optic nerve avulsion in a 16-year-old female patient complaining of loss of vision in her left eye after a traffic accident. (Turk J Ophthalmol 2014; 44: 249-51

  1. Factors Associated with ICU Admission following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Andrea Bellone

    2016-01-01

    Full Text Available Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1% were admitted to intensive care unit (ICU within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p=0.0018 and the severity of trauma score (p<0.0002 were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure.

  2. Delayed Presentation of Isolated Complete Pancreatic Transection as a Result of Sport-Related Blunt Trauma to the Abdomen

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    Andrew J. Healey

    2008-01-01

    Full Text Available Introduction: Blunt abdominal trauma is a rare but well-recognized cause of pancreatic transection. A delayed presentation of pancreatic fracture following sport-related blunt trauma with the coexisting diagnostic pitfalls is presented. Case Report: A 17-year-old rugby player was referred to our specialist unit after having been diagnosed with traumatic pancreatic transection, having presented 24 h after a sporting injury. Despite haemodynamic stability, at laparotomy he was found to have a diffuse mesenteric hematoma involving the large and small bowel mesentery, extending down to the sigmoid colon from the splenic flexure, and a large retroperitoneal hematoma arising from the pancreas. The pancreas was completely severed with the superior border of the distal segment remaining attached to the splenic vein that was intact. A distal pancreatectomy with spleen preservation and evacuation of the retroperitoneal hematoma was performed. Discussion/Conclusion: Blunt pancreatic trauma is a serious condition. Diagnosis and treatment may often be delayed, which in turn may drastically increase morbidity and mortality. Diagnostic difficulties apply to both paraclinical and radiological diagnostic methods. A high index of suspicion should be maintained in such cases, with a multi-modality diagnostic approach and prompt surgical intervention as required.

  3. About Usefulness of Kalemia Monitoring after Blunt Liver Trauma

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    Francesco Meriggi

    2012-01-01

    Full Text Available Background. The aim of this study is to investigate the evidence of hypokalemia as a suitable parameter for therapeutic decision making after severe blunt liver trauma. Methods. We reviewed the medical records of 11 patients (9 M, 2 F, mean age 32 years admitted to San Matteo Hospital of Pavia between 2007–2009. All of them were victims of road accidents hospitalized for blunt liver injury and submitted to surgery. Results. Hypokalemia was observed in 7/11 (63.6% patients during the preoperative period (mean value 2.91 mEq/L. Serum potassium concentration normalized in all patients at the 7th postoperative day only (<0.01. Conclusions. According to literature results, our study confirms that after blunt hepatic injury serum potassium levels may decrease significantly. Therefore, kalemia must be carefully monitored in order to establish appropriate treatment and avoid any complications.

  4. Pharyngeal perforation after blunt cervical trauma in child.

    Science.gov (United States)

    Svetlikova, Mariana; Starek, Ivo; Spenerova, Michaela; Potesil, Jan; Sulla, Igor; Hucko, Csaba; Mihal, Vladimir; Balik, Vladimir

    2014-01-01

    Pharyngeal perforation caused by non-penetrating cervical trauma is an extremely rare clinical entity both in adults and children. Data concerning management of this type of injury are quite rare in surgical and even scarcer in pediatric literature. Since delay in treatment may be associated with life-threatening complications, prompt diagnosis coupled with appropriate therapy is essential for achieving favorable clinical outcome. To the best of authors' knowledge, the present study illustrates for the first time the experience with successful treatment of pharyngeal perforation caused by a blunt cervical trauma in a child.

  5. Traumatic pseudocyst due to blunt trauma: Case report.

    Science.gov (United States)

    Becel, Sinan; Oztok, Beliz; Kurtoglu Celik, Gulhan; Icme, Ferhat; Sener, Alp; Pamukcu Gunaydin, Gul

    2015-09-01

    Damage to lung parenchyma due to blunt thoracic trauma often appears as contusion or hematoma. Cavitary lung lesions or pseudocyst formation due to trauma is a rare phenomenon. In the literature traumatic pseudocysts are also known as pseudocystic hematomas, traumatic lung cavity and traumatic pneumotocel. Traumatic pseudocysts usually have good clinical prognosis, recover spontaneously with supportive treatment and do not require surgery. In this article, we present the case of 52 year old male who was brought to the emergency department after a fall from height and was diagnosed with lung contusions and traumatic cyst.

  6. Isolated perforation of a duodenal diverticulum following blunt abdominal trauma

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    Metcalfe Matthew

    2010-01-01

    Full Text Available Only 10% of duodenal diverticula are symptomatic. We present the case of a man who fell from a height of 6 ft, landing on his abdomen and presenting 4 h later with severe back pain and a rigid abdomen. At laparotomy, a perforated retroperitoneal duodenal diverticulum was found and repaired with an omental patch. No other injury was noted. Not only is this perforation unusual, but the absence of other injuries sustained during this minor blunt trauma makes this case unique. This case highlights the need for a high index of suspicion when managing patients with back or abdominal pain following minor trauma.

  7. Blunt Facial Trauma Causing Isolated Optic Nerve Hematoma

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    R. Parab

    2013-01-01

    Full Text Available Traumatic optic neuropathy is an uncommon, yet serious, result of facial trauma. The authors present a novel case of a 59-year-old gentleman who presented with an isolated blunt traumatic left optic nerve hematoma causing vision loss. There were no other injuries or fractures to report. This case highlights the importance of early recognition of this rare injury and reviews the current literature and management of traumatic optic neuropathy.

  8. Acute aortic and mitral valve regurgitation following blunt chest trauma.

    Science.gov (United States)

    Bernabeu, Eduardo; Mestres, Carlos A; Loma-Osorio, Pablo; Josa, Miguel

    2004-03-01

    Traumatic rupture of intracardiac structures is an uncommon phenomenon although there are a number of reports with regards to rupture of the tricuspid, mitral and aortic valves. We report the case of a 25-year-old patient who presented with acute aortic and mitral valve regurgitation of traumatic origin. Both lesions were seen separated by 2 weeks. Pathophysiology is reviewed. The combination of both aortic and mitral lesions following blunt chest trauma is almost exceptional.

  9. Leukocytosis as a Predictor of Severe Injury in Blunt Trauma

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    Santucci, Claudia A

    2008-05-01

    Full Text Available Objective: The objective of this study was to determine if the white blood cell count can predict severity of injury in blunt trauma victims.Methods: This was a retrospective study comparing two groups of blunt trauma victims by severity of injury, one with significant injury and one without significant injury, and comparing their initial WBC in the emergency department (ED. We also examined if WBC correlates with degree of injury using Injury Severity Score (ISS in both groups combined. Further, we examined the WBC as a predictor of serious injury.Results: Our study showed a difference in mean WBC between the two groups that was statistically significant (p<0.001. A positive relationship between ISS and WBC was found, although the association was weak (correlation coefficient = 0.369. While the WBC had moderate discriminatory capability for serious injury, it could not, in isolation, reliably rule in or out serious injury. Nevertheless, this study supports using WBC on presentation to the ED as an adjunct for making disposition decisions.Conclusion: A significant elevation in WBC in a blunt trauma patient, even with minimal initial signs of severe injury, should heighten suspicion for occult injury.

  10. The role of computed tomography in blunt abdominal trauma in children.

    Science.gov (United States)

    Taylor, G A; Fallat, M E; Potter, B M; Eichelberger, M R

    1988-12-01

    This study was performed in order to test the hypothesis that abdominal computed tomography (CT) can assist in the decision to perform laparotomy in children following blunt trauma to the abdomen. Three hundred forty children with blunt abdominal trauma underwent evaluation with CT. Abdominal injuries were detected in 84 children (25%). These included: 75 injuries to solid viscera in 60 patients (30 splenic, 29 hepatic, 13 renal, and three pancreatic); four injuries to hollow viscera (three small bowel transections, and one rupture of the urinary bladder); and 23 skeletal injuries (21 fractures of the pelvis, and two lumbar spine subluxations). Injury to solid viscera was categorized as minor in 32 (43%), moderate in 18 (24%), or severe in 25 (33%) according to an assessment of the percentage of parenchyma involved. Hemoperitoneum was detected in 42 patients, and characterized as small in 18 (43%), moderate in nine (21%), and large in 15 (36%). CT was useful in establishing the location and extent of injuries, and in detecting the presence of blood or air in the peritoneal cavity. However, the extent of injury to solid viscera detected on CT did not correlate with the need for laparotomy. Of 46 moderate to severe anatomic injuries of the liver, spleen or kidney, only five (9%) required surgical intervention because of persistent bleeding or infection. Although laparotomy occurred more frequently in the presence of a large hemoperitoneum, only 6/24 (25%) with moderate to large hemoperitoneum required surgical exploration. This analysis confirms the usefulness of CT for detection of location and extent of injury in pediatric blunt abdominal trauma.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Imaging of blunt chest trauma; Bildgebung des stumpfen Thoraxtraumas

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, H. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Univ.-Klinik fuer Radiologie und Nuklearmedizin, Wien (Austria); Negrin, L. [Medizinische Universitaet Wien, Allgemeines Krankenhaus, Univ.-Klinik fuer Unfallchirurgie, Wien (Austria)

    2014-09-15

    Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [German] Stumpfe Thoraxtraumen gehen mit einer hohen Morbiditaet und Mortalitaet einher. Daher sollten Patienten mit Verdacht auf ein stumpfes Thoraxtrauma rasch radiologisch untersucht werden, damit die entsprechenden therapeutischen Schritte zeitgerecht eingeleitet werden koennen. Zur Abklaerung von Patienten nach einem stumpfen Thoraxtrauma sind seit Jahren das konventionelle Lungenroentgen und die Computertomographie bewaehrte Verfahren. In den letzten Jahren hat die fokussierte Ultraschalluntersuchung (eFAST, Extended Focused Assessment with Sonography for Trauma) von schwerverletzten Patienten vermehrt an Bedeutung gewonnen. Durch eine eFAST-Untersuchung kann in der Akutphase rasch geklaert werden, ob bei dem Patienten ein therapiebeduerftiger Pneumothorax, Haematoperikard oder Haematothorax vorliegen. Auch das Lungenroentgen wird zur Diagnose eines Pneumothorax oder Haematothorax eingesetzt, wenngleich seine Sensitivitaet deutlich eingeschraenkt ist. Die CT ist das diagnostische Verfahren der Wahl, um v. a. Patienten mit einem schweren Thoraxtrauma abzuklaeren. (orig.)

  12. Diagnostic accuracy of CT scan in abdominal blunt trauma

    Institute of Scientific and Technical Information of China (English)

    Javad Salimi; Khadyjeh Bakhtavar; Mehdi Solimani; Patrcia Khashayar; Ali Pasha Meysamie; Moosa Zargar

    2009-01-01

    Obiective: To evaluate the sensitivity and specificity of CT scan findings in Patients ith blunt abdominal trauma admitted to the university hospital.Methods: All the atients ith blunt abdominal trauma admitted at a tertiary teaching trauma center in Iran between 2005 and 2007 were enrolled in this study.In the absence of any clinical anifestations,he patients underwent a diagnostic CT scan.Laparatomy was performed in those with positive CT results.Others were observed for 48 hours and discharged in case no problem as reported;otherwise they underwent laparatomy.Information on patients'demographic ata,mechanism of trauma,indication for CT scan,CT scan findings,results of laparotomy ere gathered.The sensitivity,specificity and accuracy of the CT-scan images in regard ith the organ injured were calculated.The sensitivity,specificity and accuracy of the T scan were calculated in each case.Results: CT Scan had the highest sensitivity for etecting the injuries to liver (100%) and spleen (86.6%).The specificity of the method or detecting retroperitoneal hematoma (100%) and injuries to kidney (93.5%) was higher han other organs.The accuracy of CT images to detect the injuries to spleen,liver,idney and retroperitoneal hematoma was reported to be 96.1%,94.4%,91.6% and 91.6% espectively.Conclusion: The findings of the present study reveal that CT scan could econsidered as a good choice,especially for patients with blunt abdominal trauma in eaching hospitals where the radiologic academic staff is not present in the hospital in the night shifts.

  13. Factors Associated with ICU Admission following Blunt Chest Trauma

    Science.gov (United States)

    Etteri, Massimiliano; Cantaluppi, Francesca; Pina, Paolo; Guanziroli, Massimo; Bianchi, AnnaMaria; Casazza, Giovanni

    2016-01-01

    Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF) and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1%) were admitted to intensive care unit (ICU) within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p = 0.0018) and the severity of trauma score (p pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure. PMID:28044070

  14. Isolated Multiple Fragmented Cricoid Fracture Associated with External Blunt Neck Trauma: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Byung Hoon; Hwang, Yoon Joon; Kim, Yong Hoon; Seo, Jung Wook; Cho, Hyeon Je; Kim, Yeon Soo [Inje University School of Medicine, Ilsan Paik Hospital, Goyang (Korea, Republic of)

    2010-08-15

    Blunt laryngeal trauma is a relatively uncommon but possibly life-threatening injury. An isolated cricoid fracture associated with blunt trauma is rare. We report a case of an isolated multiple fragmented cricoid cartilage fracture that developed in a 20-year-old man after a blunt neck trauma that occurred during a baseball game and was diagnosed by 64-slice multidetector computed tomography (MDCT)

  15. Coronary artery rupture in blunt thoracic trauma: a case report and review of literature

    OpenAIRE

    Abu-Hmeidan, Jareer Heider; Arrowaili, Arief Ismael; Yousef, Raid Said; Alasmari, Sami; Kassim, Yasser M; Aldakhil Allah, Hamad Hamad; Aljenaidel, Abdullah Mohammed; Alabdulqader, Abdullah Abdulmohsen; Alrashed, Muath Hamad; Alkhinjar, Mulfi Ibrahim; Al-Shammari, Nawwaf Rahi

    2016-01-01

    Background Blunt thoracic trauma can rarely result in coronary artery injury. Blunt trauma can result in occlusion of any of the coronary arteries or can lead to its rupture and bleeding. Traumatic coronary artery occlusion can lead to myocardial infarction, while its rupture and bleeding can result in hemopericardium and cardiac tamponade, and can be rapidly fatal. Survival after coronary artery rupture in blunt thoracic trauma is exceedingly rare. Case Presentation We present a case of a yo...

  16. Distal thoracic oesophageal perforation secondary to blunt trauma: Case report

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    Tandon Ruchi

    2007-03-01

    Full Text Available Abstract Background Traumatic perforation of the distal oesophagus due to blunt trauma is a very rare condition and is still associated with a significant morbidity and mortality. This is further exacerbated by delayed diagnosis and management as symptoms and signs are often masked by or ascribed to more common blunt thoracic injuries. Case report We present a case of a distal oesophageal perforation, secondary to a fall from a third storey window, which was masked by concomitant thoracic injuries and missed on both computed tomography imaging and laparotomy. The delay in his diagnosis significantly worsened the patient's recovery by allowing the development of an overwhelming chest sepsis that contributed to his death. Conclusion Early identification of an intrathoracic oesophageal perforation requires deliberate consideration and is essential to ensure a favorable outcome. Treatment should be individualised taking into account the nature of the oesophageal defect, time elapsed from injury and the patient's general condition.

  17. Diagnosis and management of colonic injuries following blunt trauma

    Institute of Scientific and Technical Information of China (English)

    Yi-Xiong Zheng; Li Chen; Si-Feng Tao; Ping Song; Shao-Ming Xu

    2007-01-01

    AIM: To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma.METHODS: A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods,associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed.RESULTS: Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injuryrelated abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02).CONCLUSION: Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is most often used for colonic injuries.

  18. Flexion/extension cervical spine views in blunt cervical trauma

    Institute of Scientific and Technical Information of China (English)

    Sadaf Nasir; Manzar Hussain; Roomi Mahmud

    2012-01-01

    Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma,who show loss of cervical lordosis and neck pain.Methods: All patients who presented to our emergency department following blunt trauma were enrolled in this study,except those with schiwora,neurological deficits or fracture demonstrated on cross-table cervical spine X-rays,and those who were either obtunded or presented after cervical spine surgery.Adequacy of flexion and extension views was checked by the neurosurgery and radiology team members.All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain.Results: A total of 200 cases were reviewed,of whom 90 (45%) underwent repeat X-rays because of either inadequate exposure or limited motion.None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability.Conclusions: Our results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma,flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis.We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled.

  19. Blunt Cardiac Injury in Trauma Patients with Thoracic Aortic Injury

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    Rathachai Kaewlai

    2011-01-01

    Full Text Available Trauma patients with thoracic aortic injury (TAI suffer blunt cardiac injury (BCI at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG and serum creatine kinase-MB (CK-MB from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an elevated CK-MB or abnormal echocardiography. There were 26 patients (19 men, mean age 45.1 years, mean ISS 34.4 in the study group; 20 had evidence of BCI. Of 52 patients in the control group (38 men, mean age 46.9 years, mean ISS 38.7, eighteen had evidence of BCI. There was a significantly higher rate of BCI in trauma patients with TAI versus those without TAI (77% versus 35%, P<0.001.

  20. Facial palsy after blunt trauma and without facial bone fracture.

    Science.gov (United States)

    Coltro, Pedro Soler; Goldenberg, Dov Charles; Aldunate, Johnny Leandro Conduta Borda; Alessi, Mariana Sisto; Chang, Alexandre Jin Bok Audi; Alonso, Nivaldo; Ferreira, Marcus Castro

    2010-07-01

    A 14-year-old patient had a low-energy facial blunt trauma that evolved to right facial paralysis caused by parotid hematoma with parotid salivary gland lesion. Computed tomography and angiography demonstrated intraparotid collection without pseudoaneurysm and without radiologic signs of fracture in the face. The patient was treated with serial punctures for hematoma deflation, resolving with regression and complete remission of facial paralysis, with no late sequela. The authors discuss the relationship between facial nerve traumatic injuries associated or not with the presence of facial fractures, emphasizing the importance of early recognition and appropriate treatment of such cases.

  1. Testicular Infarction and Rupture After Blunt Trauma — Use of Diagnostic Ultrasound

    OpenAIRE

    Alistair Pace; Christopher Powell

    2004-01-01

    We report the case of a 23-year-old male who suffered localised testicular infarction and rupture following blunt trauma. This pathology is rare after blunt trauma and has not been previously described in literature. The appearance on ultrasound resembled malignancy, necessitating orchidectomy. An overview of the pathology of testicular trauma as well as its management is given with particular emphasis on the use diagnostic ultrasound in testicular trauma.

  2. Testicular Infarction and Rupture After Blunt Trauma — Use of Diagnostic Ultrasound

    Directory of Open Access Journals (Sweden)

    Alistair Pace

    2004-01-01

    Full Text Available We report the case of a 23-year-old male who suffered localised testicular infarction and rupture following blunt trauma. This pathology is rare after blunt trauma and has not been previously described in literature. The appearance on ultrasound resembled malignancy, necessitating orchidectomy. An overview of the pathology of testicular trauma as well as its management is given with particular emphasis on the use diagnostic ultrasound in testicular trauma.

  3. Testicular infarction and rupture after blunt trauma--use of diagnostic ultrasound.

    Science.gov (United States)

    Pace, Alistair; Powell, Christopher

    2004-06-14

    We report the case of a 23-year-old male who suffered localised testicular infarction and rupture following blunt trauma. This pathology is rare after blunt trauma and has not been previously described in literature. The appearance on ultrasound resembled malignancy, necessitating orchidectomy. An overview of the pathology of testicular trauma as well as its management is given with particular emphasis on the use diagnostic ultrasound in testicular trauma.

  4. The song remains the same although the instruments are changing: complications following selective non-operative management of blunt spleen trauma: a retrospective review of patients at a level I trauma centre from 1996 to 2007

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    Clancy Aisling A

    2012-03-01

    Full Text Available Abstract Background Despite a widespread shift to selective non-operative management (SNOM for blunt splenic trauma, there remains uncertainty regarding the role of adjuncts such as interventional radiological techniques, the need for follow-up imaging, and the incidence of long-term complications. We evaluated the success of SNOM (including splenic artery embolization, SAE for the management of blunt splenic injuries in severely injured patients. Methods Retrospective review (1996-2007 of the Alberta Trauma Registry and health records for blunt splenic trauma patients, aged 18 and older, with injury severity scores of 12 or greater, admitted to the Foothills Medical Centre. Results Among 538 eligible patients, 150 (26% underwent early operative intervention. The proportion of patients managed by SNOM rose from 50 to 78% over the study period, with an overall success rate of SNOM of 87%, while injury acuity remained unchanged over time. Among SNOM failures, 65% underwent surgery within 24 hours of admission. Splenic arterial embolization (SAE was used in only 7% of patients managed non-operatively, although at least 21% of failed SNOM had contrast extravasation potentially amenable to SAE. Among Calgary residents undergoing SNOM, hospital readmission within six months was required in three (2%, all of whom who required emergent intervention (splenectomy 2, SAE 1 and in whom none had post-discharge follow-up imaging. Overall, the use of post-discharge follow-up CT imaging was low following SNOM (10%, and thus no CT images identified occult hemorrhage or pseudoaneurysm. We observed seven cases of delayed splenic rupture in our population which occurred from five days to two months following initial injury. Three of these occurred in the post-discharge period requiring readmission and intervention. Conclusions SNOM was the initial treatment strategy for most patients with blunt splenic trauma with 13% requiring subsequent operative intervention

  5. Nonoperative management for patients with grade IV blunt hepatic trauma

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    Zago Thiago

    2012-08-01

    Full Text Available Abstract Introduction The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. Methods This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Results Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5% who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%; one patient developed a tracheal stenosis (secondary to tracheal intubation; one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. Conclusions In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.

  6. Politraumatizados com trauma craniencefálico grave: importância das lesões abdominais associadas Severe blunt head trauma: the relevance of associated abdominal lesions

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    José Gustavo Parreira

    2001-10-01

    Full Text Available OBJETIVO: Analisar as lesões abdominais dos politraumatizados com trauma craniencefálico (TCE grave. MÉTODO: Realizou-se avaliação retrospectiva dos prontuários das vítimas de TCE no período de 1996 a 1997. Foram selecionados para o estudo os com Escala de Coma de Glasgow (ECG BACKGROUND: The present study was carried out to analyze the abdominal lesions in victims of multiple trauma sustaining severe blunt head trauma. METHODS: We retrospectively reviewed charts and trauma protocols of patients admitted from January 1996 to July 1997, who sustained blunt head trauma and underwent head CT Scan. Those admitted with a Glasgow Coma Score (GCS < 8 were selected for this study. There were 52 patients who fulfilled the inclusion criteria, 44 male and 8 female, with a mean age of 37 years. Demographic data, mechanism of injury, trauma indices (RTS and ISS, diagnostic exams, treatment and evolution were evaluated. We employed the X² test, Student - t test, and Fisher exact test for the statistical analysis. RESULTS: Pedestrian versus auto was the most frequent mechanism of trauma, occurring in 25 cases. The mean RTS and ISS were 5.18 and 27 respectively. None of these patients had the diagnosis of abdominal lesion based only in physical examination. Forty four were assessed with diagnostic peritoneal lavage and 8 with abdominal ultrasound or computed tomography. Eight (15% patients sustained abdominal lesions, including 5 hepatic, 4 splenic and one colonic injury. There were 17 craniotomies and 8 laparotomies (4 non therapeutic. A higher incidence of abdominal lesions was observed in patients sustaining either shock on admission or orthopedic lesions requiring surgical repair. The mortality was 71%. CONCLUSION: Considering the incidence of abdominal lesions and the difficulties for their diagnosis in those patients sustaining severe head trauma, the objective assessment of abdomen by complementary methods is advisable in all cases.

  7. Outcome in patients with blunt chest trauma and pulmonary contusions

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    Vignesh T

    2004-01-01

    Full Text Available ABSTRACT: Severe pulmonary contusions occur in blunt chest trauma, especially with high velocity injuries. Pulmonary contusions following trauma may result in significant hypoxemia and decreased compliance which may progress over several days. Extensive contusions may result in respiratory difficulty or progress to adult respiratory distress syndrome, which increases mortality. We decided to review the cases of polytrauma with associated pulmonary contusions to determine the factors which influence outcome. MATERIALS AND METHODS: A retrospective chart review of all cases of trauma with pulmonary contusions on X-ray or CT scan. The cases were examined for age, type of injuries, admission APACHE II, SAPS II and SOFA scores, PaO2/FiO2 ratio, presence or absence of rib fractures, average positive fluid balance, average sedation dose, pulmonary haemorrhage, ventilator days, ICU days and hospital outcome. RESULTS: There were 18 cases of pulmonary contusions. All had associated injuries. 6 patients died, 4 in the ICU and 2 patients died 1 week after transfer to a high dependency unit, one due to sepsis and the other due to massive haemothorax. There was a significant difference in PaO2/FiO2 ratio at admission and throughout the ICU course, fluid balance and sedation dose, but not in ventilator days and ICU days between survivors and nonsurvivors. The incidence, frequency and amount of pulmonary haemorrhage were higher in the nonsurvivors. CONCLUSIONS: Close attention to improving gas exchange, and early management of hemoptysis might improve outcome in pulmonary contusions

  8. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review

    DEFF Research Database (Denmark)

    Bartels, Mette Damkjær; Nielsen, PE; Sleight, P

    2006-01-01

    Prompted by a case where a patient (with no risk factors, and single vessel disease) developed angina pectoris after previous blunt chest trauma, we searched Medline for blunt chest trauma and myocardial ischaemia. We found 77 cases describing AMI after blunt chest trauma, but only one reporting...... old, and only 2.5% more than 60 years old. The most common trauma was a road traffic accident, and the LAD was the vessel most often affected. Angiography revealed 12 cases with completely normal vessels, which might be due to spasm or recanalisation; 31 cases showed occlusion but no atherosclerosis...

  9. Anterior mediastinal abscess diagnosed in a young sumo wrestler after closed blunt chest trauma

    Institute of Scientific and Technical Information of China (English)

    Tatsuro Sassa; Ken-ichiro Kobayashi; Masayuki Ota; Takuya Washino; Mayu Hikone; Naoya Sakamoto; Sentaro Iwabuchi

    2015-01-01

    Most mediastinal abscesses result from infections after thoracotomy, esophageal perforation or penetrating chest trauma.This disease is rarely caused by closed blunt chest trauma.All previously reported such cases after closed blunt chest trauma presented with hematoma and sternal osteomyelitis resulting from sternal fracture.Here we report a 15-year-old sumo wrestler who presented with an anterior mediastinal abscess without any mediastinal fracture.The mediastinal abscess resulted from the hematogenous spread of Staphylococcus aureus to a hematoma that might have been caused by a closed blunt chest trauma incurred during sumo wrestling exercises.

  10. Isolated pancreatic injury following blunt abdominal trauma in a child

    Directory of Open Access Journals (Sweden)

    Jain Sandeep

    2007-01-01

    Full Text Available Pancreatic injury following blunt abdominal trauma is rare as compared to other visceral organs. Isolated injury to the pancreas is even more rare. The clinical presentation is subtle resulting in delayed treatment with high morbidity and mortality. A three-year-old female child presented with vomiting 18h following a motor vehicle accident. She was hemodynamically stable with no external signs of injury. Investigations revealed hyperamylasemia and isolated grade III pancreatic injury. Laparotomy with distal pancreatic resection and splenectomy was done. A high degree of clinical suspicion with due consideration to the mechanism of injury is the key to good outcome in these patients. Major ductal injury is the critical issue in the management and a number of therapeutic choices are available specific to the location of the insult.

  11. Sternal fractures and delayed cardiac tamponade due to a severe blunt chest trauma.

    Science.gov (United States)

    Liang, Huai-min; Chen, Qiu-lin; Zhang, Er-yong; Hu, Jia

    2016-04-01

    Sternal fractures caused by blunt chest trauma are associated with an increased incidence of cardiac injury. Reports of the incidence of cardiac injury associated with sternal fracture range from 18% to 62%. Delayed cardiac tamponade is a rare phenomenon that appears days or weeks after injury. Moreover, after nonpenetrating chest trauma, cardiac tamponade is very rare and occurs in less than 1 of 1000. This case describes a patient who had delayed cardiac tamponade 17 days after a severe blunt chest trauma.

  12. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1. Liver and spleen

    Energy Technology Data Exchange (ETDEWEB)

    Becker, C.D.; Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, Geneva (Switzerland); Mentha, G. [Department of Surgery, Division of Abdominal Surgery, Geneva University Hospital, Geneva (Switzerland)

    1998-05-01

    Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. (orig.) With 11 figs., 5 tabs., 64 refs.

  13. Imaging gastrointestinal perforation in pediatric blunt abdominal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Jamieson, D.H. [Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 (Canada); Babyn, P.S. [Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 (Canada); Pearl, R. [Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 (Canada)

    1996-03-01

    Objective. To assess the role of imaging, in particular CT, in the early detection of GI perforation. Subjects and methods. In a 10-year period, 43 patients with surgically confirmed GI perforation were identified from hospital records; 22 of these had preoperative CT evaluation. Medical records and radiology were retrospectively reviewed and CT studies were particularly assessed for extraluminal air, free intraperitoneal fluid, bowel wall thickening, bowel wall enhancement, and bowel dilatation. During the study period an additional 12 trauma patients were identified who had CT studies demonstrating the above findings, but who had hypovolemic shock bowel or nondisrupting bowel injury without perforation evident. Results. Extraluminal air was demonstrated in 47 % of the imaged perforations. There was one false-positive extraluminal air. Perforation was confirmed in patients who had all five of the above CT findings, but this was the case for only 18 % of patients with perforation. One or more of the five specified CT findings were present in all CT studies reviewed. No false-negative CT study was performed in the study period. Conclusion. Separating nondisrupting bowel injury from perforation is diagnostically difficult; however, CT remains a good modality for assessing GI perforation in pediatric blunt trauma, but it cannot replace diligent and repeated clinical evaluation of all potential perforation victims. (orig.). With 4 figs., 1 tab.

  14. Diagnostic value of pelvic radiography in the initial trauma series in blunt trauma

    Energy Technology Data Exchange (ETDEWEB)

    Their, Micael E.A.; Bensch, Frank V.; Koskinen, Seppo K. [Toeoeloe Trauma Center, Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Handolin, Lauri [Toeoeloe Trauma Center, Department of Orthopaedics and Traumatology, Helsinki (Finland); Kiuru, Martti J. [Toeoeloe Trauma Center, Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Research Institut of Military Medicine, Helsinki (Finland)

    2005-08-01

    The purpose of the study was to evaluate the diagnostic value of pelvic radiography in the initial trauma series when compared to multidetector CT (MDCT) findings in serious blunt trauma. Inclusion criteria were blunt trauma and pelvic radiography in the initial trauma series, followed by a whole-body MDCT. A total of 1386 patients (874 male, 512 female, age 16-91 years, mean 41 years) met the inclusion criteria. Imaging studies were evaluated retrospectively by anatomical region and classified, when possible, using the Tile classification. Based on MDCT, a total of 629 injuries occurred in 226 (16%) of these 1386 patients. Radiography depicted 405 fractures in these 226 patients, giving an overall sensitivity of 55%. In 24 patients (11%) radiography was false-negatively normal. The sensitivity of radiography was mainly good in the anteroinferior parts of the pelvis, fair in the acetabulum and ileum, and poor in the posterior ring. By MDCT 141 (62%) patients were classified using the Tile classification and by radiography 133 patients (59%) were classified. MDCT and radiography showed the same type of pelvic injury in 72 patients (59%) and the subtype in 17 patients (14%). In 48 patients (40%) the pelvis was shown to be stable by radiography but unstable by MDCT. In conclusion, the sensitivity of pelvic radiography is low, and it is not reliable for determining if the pelvic injury is stable or not. (orig.)

  15. Penile injury due to blunt trauma after circumcision in a male child: A case report

    Directory of Open Access Journals (Sweden)

    Hulya Ozturk

    2014-08-01

    Full Text Available Injury in the case presented here is different from the cause of penile trauma. Our case has been exposed to blunt trauma after circumcision. Type developments of the penile trauma, treatment, and precautions have been discussed with the literature.

  16. The Diagnostic Value of Intra-abdominal Pressure in Patients with Blunt Acute Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    Huseyin Narci

    2012-06-01

    Full Text Available Purpose:The objective of this study was to determine the diagnostic value of intra-abdominal pressure measurement in blunt abdominal trauma patients. Method: A prospective study was performed in 49 patients with blunt trauma in our university hospital for 1 years. Patients were randomly into two groups as intra-abdominal trauma (n=28 and extraabdominal trauma (n=21 groups. Intra-abdominal pressures was measured an classified as normal (10 cm H2O or less, elevated (more than 10 cm H2O determined indirectly. Results: No significant differences were found between abdominal trauma and extra-abdominal trauma groups from the point of intra-abdominal pressure (IAP. One the other hand, in abdominal trauma group; significant differences were observed between operated patients. Intra-abdominal bleeding was found in 10 patients and all of them elevated IAP values (exceeding 16 cm H2O. For determining the intra-abdominal injury, IAP had a sensitivity of 93%, specificity 38% in patients. Conclusion: IAP exceeding 16 cm H2O with blunt abdominal trauma patients abdominal trauma can be detected. It is thought that IAP, indirect monitoring of abdominal trauma patients is a reproducible, scientific guide and simple method.To determine the efficacy of the measurement of intra-abdominal pressure in blunt abdominal trauma patients, further studies should be done. [Cukurova Med J 2012; 37(3.000: 157-161

  17. Inferior mesenteric artery branch avulsion from blunt trauma--CT findings. Case report.

    Science.gov (United States)

    Olson, M; Posniak, H; Gomes, G

    1992-01-01

    Mesenteric arterial injuries are uncommon following blunt abdominal trauma. We describe the computed tomography (CT) findings of a patient with avulsion of a branch of the inferior mesenteric artery following a low-speed motor vehicle accident.

  18. COMPARATIVE STUDY OF MULTIDETECTOR COMPUTED TOMOGRAPHY AND ULTRASONOGRAPHY FINDINGS IN BLUNT ABDOMINAL TRAUMA

    Directory of Open Access Journals (Sweden)

    Okram Pusparani Devi

    2016-07-01

    Full Text Available BACKGROUND Blunt abdominal trauma usually has low sensitivity on physical examination and also subtle clinical manifestations. Improved resolution of the ultrasound machines and availability of multiple frequency probes has improved the specificity of ultrasound evaluation in blunt abdominal trauma. Despite this about 50% of the solid organ injuries are missed. Computed tomography has been used with better specificity to evaluate patients with blunt abdominal trauma who are FAST (Focused Assessment with Sonography for Trauma positive as well as indeterminate and clinically suspicious cases of solid organ, hollow viscera, spine and pelvic injury. AIM AND OBJECTIVES The purpose of this study was to determine sensitivity, specificity and diagnostic accuracy of USG and MDCT and compare the efficacy of the two imaging modalities in blunt abdominal trauma. METHOD A prospective observational study of 100 patients was conducted in the Department of Radiodiagnosis, Bharati Hospital, Pune. All patients with blunt abdominal trauma were included. FAST screening was done with ANTARES ACUSON SIEMENS followed by MDCT on 16-Slice Philips Brilliance. Sensitivity, specificity and diagnostic accuracy of USG and CT were determined by comparing with laparotomy findings. RESULTS Although USG was sensitive, specific and accurate in detecting free fluid in abdomen, CT was found better and also superior in detecting solid organ injury in patients with blunt abdominal trauma. CONCLUSION Ultrasound is an efficient modality in the initial evaluation of blunt abdominal trauma. But CT is the superior diagnostic modality and must be performed in symptomatic patient with ultrasound negative report and suboptimal ultrasound examination. CT scan thoroughly scrutinizes entire abdomen including retroperitoneum with additional assessment of thoracic trauma and bony pelvic trauma. Hence, CT increases diagnostic confidence and influences management decision.

  19. The Houdini effect--an unusual case of blunt abdominal trauma resulting in perforative appendicitis.

    LENUS (Irish Health Repository)

    O'Kelly, F

    2012-03-01

    We present a unique case of perforative appendicitis that occurred in an adult following blunt abdominal trauma. This case represents the first such reported case from Ireland. It also represents a modern practical example of Laplace\\'s theory of the effect of increased pressure on colonic wall tension leading to localized perforation, and serves to highlight not only the importance in preoperative imaging for blunt abdominal trauma, but also the importance of considering appendiceal perforation.

  20. Perioperative management of tracheobronchial injury following blunt trauma

    Directory of Open Access Journals (Sweden)

    Nilesh M Juvekar

    2013-01-01

    Full Text Available We describe tracheobronchial injury (TBI in a 17-year-old teenager following blunt trauma resulting from a road traffic accident. The patient presented to a peripheral hospital with swelling over the neck and face associated with bilateral pneumothorax for which bilateral intercostal drains were inserted and the patient was transferred to our institute. Fiber-optic videobronchoscopy (FOB was performed, the trachea and bronchi were visualized, and the site and extent of injury was assessed. Spontaneous respiration was maintained till assessment of the airway. Then the patient was anesthetized with propofol and paralyzed using succinylcholine and a double-lumen endobronchial tube was inserted; thereafter, the adequacy of controlled manual ventilation and air-leak through intercostal drains was assessed and the patient was transferred to operating room (OR for repair of the airway injury. The OR was kept ready during FOB to manage any catastrophe. This case describes the need for proper preparation and communication between health care team members to manage all possible scenarios of traumatic TBI.

  1. Role of focused assessment with sonography for trauma as a screening tool for blunt abdominal trauma in young children after high energy trauma

    NARCIS (Netherlands)

    Tummers, W.; Schuppen, J.V. (J Van); H.R. Langeveld-Benders (Hester); Wilde, J.; Banderker, E.; Van, A.

    2016-01-01

    textabstractBackground: The objective of the study was to review the utility of focused assessement with sonography for trauma (FAST) as a screening tool for blunt abdominal trauma (BAT) in children involved in high energy trauma (HET), and to determine whether a FAST could replace computed tomograp

  2. [Splenic trauma complicating translumbar aortography : a report on 2 cases (author's transl)].

    Science.gov (United States)

    Benhamou, A C; Kieffer, E; Maraval, M; Tricot, J F; Grellet, J; Natali, J

    1979-10-01

    Two very rare cases of splenic trauma following high translumbar aortography are described. Two types of clinical picture are observed : severe intraperitoneal hemorrhage, subcapsular and then intraperitoneal, from rupture of the spleen, and septic peritonitis following rupture of an intra- and perisplenic abscess. The authors review the frequency, mechanism, and prevention of complications following translumbar aortic puncture.

  3. Increased incidence of adrenal gland injury in blunt abdominal trauma: a computed tomography-based study from Pakistan

    Directory of Open Access Journals (Sweden)

    Aziz Muhammad Usman

    2014-02-01

    Full Text Available 【Abstract】Objective: To determine the frequency of adrenal injuries in patients presenting with blunt abdominal trauma by computed tomography (CT. Methods: During a 6 month period from January 1, 2011 to June 30, 2011, 82 emergency CT examinations were performed in the setting of major abdominal trauma and retrospectively reviewed for adrenal gland injuries. Results: A total of 7 patients were identified as having adrenal gland injuries (6 males and 1 female. Two patients had isolated adrenal gland injuries. In the other 5 patients with nonisolated injuries, injuries to the liver (1 case, spleen (1 case, retroperitoneum (2 cases and mesentery (4 cases were identified. Overall 24 cases with liver injuries (29 %, 11 cases with splenic injuries (13%, 54 cases with mesenteric injuries (65%, 14 cases (17% with retroperitoneal injuries and 9 cases with renal injuries were identified. Conclusion: Adrenal gland injury is identified in 7 patients (11.7% out of a total of 82 patients who underwent CT after major abdominal trauma. Most of these cases were nonisolated injuries. Our experience indicates that adrenal injury resulting from trauma is more common than suggested by other reports. The rise in incidence of adrenal injuries could be attributed to the mode of injury.

  4. Scapular Fractures in Blunt Chest Trauma – Self-Experience Study

    Directory of Open Access Journals (Sweden)

    Tabet A. Al-Sadek

    2016-11-01

    CONCLUSIONS:The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries, but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients.

  5. The blunt liver trauma: Review of current diagnostic and management strategies

    Directory of Open Access Journals (Sweden)

    Doklestic Krstina

    2013-12-01

    Full Text Available The liver is one of the most commonly injured organs in blunt abdominal trauma. Major liver trauma in polytraumatic patients accounts for significant morbidity and mortality. Therapeutic options for blunt hepatic trauma include both non-operative and operative management. Hemodynamic status, not the grade of the injury, should dictate the management. CT scan of the abdomen and pelvis is a standard diagnostic modality in hemodynamically stable trauma patients. Recent advancements in imaging studies and enhanced critical care strategies have shifted the paradigm for the management of liver injuries. Nonoperative management of both low- and high-grade injuries can be successful in hemodynamically stable patients. Direct suture of bleeding vessels, vascular isolation of the liver, and damage control surgery have improved outcomes in the hemodynamically unstable patients. We have reviewed current position in the treatment of blunt hepatic trau

  6. Blunt abdominal trauma – An important cause of portal venous pseuodoaneurysm

    OpenAIRE

    Wallis, Adam; Rogers, Timothy; Pope, Ian; Callaway, Mark

    2010-01-01

    Aneurysms and pseudoaneurysms of the portal venous system are rarely seen following abdominal trauma but clinicians need to be aware of them as possible vascular complications following blunt trauma. This case report of a 10 year old boy following a handlebar injury demonstrates a clear causal relationship between trauma and portal venous pseudoaneurysm. Portal venous aneurysms have a prevalence of less than 0.4% and most are found in patients with underlying hepatocellular disease. Many are ...

  7. Intraosseous injection of iodinated computed tomography contrast agent in an adult blunt trauma patient.

    Science.gov (United States)

    Knuth, Thomas E; Paxton, James H; Myers, Daniel

    2011-04-01

    Intraosseous venous access can be life-saving in trauma patients when traditional methods for obtaining venous access are difficult or impossible. Because many blunt trauma patients require expeditious evaluation by computed tomography (CT) scans with intravenous contrast, it is important to evaluate whether intraosseous catheters can be used for administering CT contrast agents in lieu of waiting until secure peripheral intravenous or central venous catheter access can be established. Previous case reports have demonstrated that tibial intraosseous catheters can be used to safely administer CT contrast in the pediatric patient population. Here we report a case in which intraosseous access was the only means of administering intravenous contrast agent in an adult blunt trauma patient. An intraosseous catheter was placed in the standard manner in the right proximal humerus. Intravenous contrast agent was administered through the intraosseous catheter, using the standard blunt trauma protocol at our institution. CT scans were evaluated by a staff radiologist and assessed for the adequacy of diagnosis for blunt traumatic injuries. CT scans of the thorax, abdomen, and pelvis were considered to be adequate for diagnostic purposes and subjectively equivalent to those of studies using traditional central venous access. The intraosseous catheter was discontinued the following day. No complications of intraosseous placement or of contrast administration were identified. Intraosseous catheterization appears to be a feasible and effective alternative to traditional methods of venous access in the administration of iodinated contrast agents for CT evaluation in adult blunt trauma patients. Further study is warranted.

  8. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

    Institute of Scientific and Technical Information of China (English)

    Mojtaba Chardoli; Toktam Hasan-Ghaliaee; Hesam Akbari; Vafa Rahimi-Movaghar

    2013-01-01

    Objective:Thoracic injuries are responsible for 25% of deaths of blunt traumas.Chest X-ray (CXR) is the first diagnostic method in patients with blunt trauma.The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT) in hemodynamically stable patients with blunt chest trauma.Methods:Study was conducted at the emergency department of S ina Hospital from March 2011 to March 2012.Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included.All patients underwent the same diagnostic protocol which consisted of physical examination,CXR and CT scan respectively.Results:Two hundreds patients (84% male and 16% female) were included with a mean age of(37.9±13.7) years.Rib fracture was the most common finding of CXR (12.5%) and CT scan (25.5%).The sensitivity of CXR for hemothorax,thoracolumbar vertebra fractures and rib fractures were 20%,49% and 49%,respectively.Pneumothorax,foreign body,emphysema,pulmonary contusion,liver hematoma and sternum fracture were not diagnosed with CXR alone.Conclusion:Applying CT scan as the first-line diagnostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome.

  9. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2013-12-01

    Full Text Available 【Abstract】 Objective: Thoracic injuries are respon- sible for 25% of deaths of blunt traumas. Chest X-ray (CXR is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT in hemodynami- cally stable patients with blunt chest trauma. Methods: Study was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively. Results: Two hundreds patients (84% male and 16% female were included with a mean age of (37.9±13.7 years. Chin J Traumatol 2013;16(6:351-354 Rib fracture was the most common finding of CXR (12.5% and CT scan (25.5%. The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and ster- num fracture were not diagnosed with CXR alone. Conclusion: Applying CT scan as the first-line diag- nostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome. Key words: Radiography; Thoracic injuries; Tomography, X-ray computed

  10. GLAUCOMA FOLLOWING BLUNT TRAUMA : AN EPIDEMIOLOGICAL AND CLINICAL STUDY

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    Purvi R

    2014-03-01

    Full Text Available AIMS: To study the demographic profile, clinical picture, treatment modalities and long term follow up of patients suffering from glaucoma developing after blunt trauma. MATERIALS AND METHODS: This was a prospective study over one year in which 75 eyes, newly diagnosed or referred with post traumatic glaucoma to M & J Institute of Ophthalmology were studied. All cases underwent thorough eye examination. Treatment was individualized and instituted. RESULTS: Patients ranged from 1 - 70 years with 32 patients (42.66% below 30 years of age. 61 patients (81.33% were males. 66.65% were students, laborers or housewives, with laborers topping the charts in vulnerability. In 46 cases (61.33%, left eye was affected, while in 29 pts. (38.66% right eye was affected. In 54.66% of cases, trauma was caused by stone, wooden stick or ball. Others included fist, firecracker, iron rod, handle, belt.16% patients presented with IOP in the normal range, 38 (50.66% patients had IOP in the range of 21-30 mm Hg, whereas 16 (21.33% patients had IOP more than 40 mm Hg. Within 1 week of instituting treatment, 41 (54.66% had IOP ≤ 20 mm Hg and only 3 patients had IOP more than 30 mm Hg. However, 70 (93.33% patients had IOP ≤ 20 mm Hg by the end of 6 months and all the patients were in this range after 6 months. On slit lamp examination, corneal edema, traumatic mydriasis and sphincter tears were seen in 32 patients each. 12 patients had hyphema and 19 patients had lens dislocated either into vitreous or into the anterior chamber. Iridodialysis was seen in 5 patients. Other findings included cataract, posterior synechiae, subluxation of lens and tobacco dusting. 57 (76% patients had vision less than 6/60, however after an interval of more than 6 months, 28 (37% patients had vision less than 3/60. The number of patients having vision ≥ 6/12 rose from 5 at initial presentation to 15 in follow-up more than 6 months. Disc changes could be assessed by ophthalmoscopy in 37

  11. Iliac Artery and Vein Injury Without Pelvic Fracture Due To Blunt Trauma: A Rare Case

    Directory of Open Access Journals (Sweden)

    Mustafa Cuneyt Cicek

    2014-08-01

    Full Text Available Iliac vascular injuries have high morbidity and mortality rates. Penetrant abdominal and pelvic vascular injuries are more common compared to blunt traumas. Pelvic vascular injuries associated with blunt trauma are quite likely to occur in accompaniment with pelvic fracture. A 23 year old male patient was admitted to the emergency room due to a motorcycle accident. Shock picture was prevalent in the patient. Shaft fracture was present in left femur and flow was not detected in arterial and venous colour Doppler ultrasonography. Patient underwent emergency surgery. Left main iliac artery and vein were normal, however, external iliac vein was lacerated in two spots, and blood vessel wall integrity was damaged in one part of left external iliac artery. Clinical presentation and traumatic retroperitoneal hematoma management of iliac artery and venous injuries due to blunt trauma without pelvic fracture are discussed in the presented case.

  12. Diagnostic accuracy of ultrasonography in detection of blunt abdominal trauma and comparison of early and late ultrasonography 24 hours after trauma

    OpenAIRE

    Feyzi, Ali; Rad, Masoud Pezeshki; Ahanchi, Navid; Firoozabadi, Jalil

    2015-01-01

    Objective: Despite the advantages of ultrasound scan, its use as a screening tool in blunt abdominal trauma is controversial. The aim of this study was to evaluate the diagnostic value of early and late ultrasound in patients with blunt abdominal trauma (BAT). Methods: In this study which was performed in a level I trauma center, firstly, 2418 patients with BAT had ultrasound (US) examination by two trauma expert radiologists. Results were compared with the best available gold standards such ...

  13. Double ischemic ileal stenosis secondary to mesenteric injury after blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    Valérie Bougard; Claude Avisse; Martine Patey; Denis Germain; Nathalie Levy-Chazal; Jean-Francois Delattre

    2008-01-01

    The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thickening. At surgery, a double stenotic bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the two resected segments showed fibrotic and ischemic lesions within the mesentery. Ischemic intestinal stenosis from mesenteric injury should be considered in the differential diagnosis in patients suffering from intestinal occlusion with a history of blunt abdominal trauma.

  14. Congenital spine deformities: a new screening indication for blunt cerebrovascular injuries after cervical trauma?

    Science.gov (United States)

    Capone, Christine; Burjonrappa, Sathyaprasad

    2010-12-01

    Blunt cerebrovascular injuries (BCVI) carry significant morbidity if not diagnosed and treated early. A high index of clinical suspicion is needed to recognize the injury patterns associated with this condition and to order the requisite imaging studies needed to diagnose it accurately. We report of BCVI associated with a congenital cervical spine malformation after blunt trauma. We recommend inclusion of cervical spine malformations to the current Eastern Association for the Surgery of Trauma screening criteria for BCVI and explain our rationale for the same.

  15. Airway management in laryngotracheal injuries from blunt neck trauma in children.

    Science.gov (United States)

    Chatterjee, Debnath; Agarwal, Rita; Bajaj, Lalit; Teng, Sarena N; Prager, Jeremy D

    2016-02-01

    Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare, but can be potentially catastrophic. Early diagnosis and skillful airway management is critical in avoiding significant morbidity and mortality associated with these cases. We present a case of a patient who suffered a complete tracheal transection and cervical spine fracture following a clothesline injury to the anterior neck. A review of the mechanisms of injury, clinical presentation, initial airway management, and anesthetic considerations in laryngotracheal injuries from blunt neck trauma in children are presented.

  16. The case of the missing testicle: blunt scrotal trauma in the pediatric emergency department.

    Science.gov (United States)

    Pesch, Megan H; Bradin, Stuart

    2014-11-01

    Serious blunt scrotal trauma in the pediatric population is rare and can pose significant danger to the viability of the testes. The following case describes an adolescent boy who presented with a single testis in his scrotum after low-impact perineal trauma, consistent with testicular dislocation. The literature regarding scrotal trauma includes few cases of testicular dislocation from low-impact perineal trauma. Included is a brief review of the most recent data including epidemiology, differential diagnosis, acute management, and complications pertinent to the pediatric emergency clinician.

  17. Thyroid gland rupture after blunt neck trauma: A case report and review of the literature

    Science.gov (United States)

    Arana-Garza, Sebastian; Juarez-Parra, Marco; Monterrubio-Rodríguez, Jeronimo; Cedillo-Alemán, Enrique; Orozco-Agüet, David; Zamudio-Vázquez, Zaire; Garza-Jasso, Tanya

    2015-01-01

    Introduction Soft tissue injuries are relatively common after blunt neck trauma, because of its complex anatomy, many vital structures can be compromised. Isolated trauma to the thyroid is highly uncommon and there are few cases reported in the literature. Presentation of case A 19 year-old female patient with no known pathologies who sustained direct blunt trauma to the right frontal half of the neck after falling down from a stair case. She arrived at the ER with moderate neck swelling and pain. There were no visible hematomas and no respiratory compromise was noted. Contrast enhanced CT-scan showed rupture and hematoma of the right thyroid lobe; she underwent surgical exploration with hemi thyroidectomy and recovered uneventfully. Discussion Despite soft tissue injuries are relatively common after blunt neck trauma, isolated thyroid gland injury is extremely rare and is present in about 1–2% of the cases and in most of the cases there is an underlining pathology within the gland. Most patients arrived at the emergency room hemodynamically stable, presenting neck swelling, pain, respiratory distress, dysphagia and hoarseness. Diagnosis strategy should be focused to rule out respiratory or vascular compromise. Surgical exploration remains the most common treatment strategy. Conclusions Although the rarity of this condition, physicians should take in mind the possibility of thyroid injury after blunt neck trauma. Early detection and prompt treatment, can reduce life threatening complications. Management should be individualized to patient’s characteristics and surgeon’s experience. PMID:26001363

  18. Pneumomediastinum in Blunt Chest Trauma: A Case Report and Review of the Literature

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    Gregory Mansella

    2014-01-01

    Full Text Available Blunt trauma is the most common mechanism of injury in patients with pneumomediastinum and may occur in up to 10% of patients with severe blunt thoracic and cervical trauma. In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river. He complained of persistent retrosternal pain with exacerbation during deep inspiration. Physical examination showed only a slight tenderness of the sternum and the extended Focused Assessment with Sonography for Trauma (e-FAST was normal. Pneumomediastinum was suspected by chest X-ray and confirmed by computed tomography, which showed a lung contusion as probable cause of the pneumomediastinum due to the “Mackling effect.” Sonographic findings consistent with pneumomediastinum, like the “air gap” sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal e-FAST a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma. Therefore, pneumomediastinum should always be considered to prevent missing major aerodigestive injuries, which can be associated with a high mortality rate.

  19. Evaluation of leadership skills during the simulation education course for the initial management of blunt trauma.

    Science.gov (United States)

    Schott, Eric; Brautigam, Robert T; Smola, Jacqueline; Burns, Karyl J

    2012-04-01

    Leadership skills of senior residents, trauma fellows, and a nurse practitioner were assessed during simulation training for the initial management of blunt trauma. This was a pilot, observational study, that in addition to skill development and assessment also sought to determine the need for a dedicated leadership training course for surgical residents. The study evaluated the leadership skills and adherence to Advance Trauma Life Support (ATLS) guidelines of the team leaders during simulation training. The team leaders' performances on criteria regarding prearrival planning, critical actions based on ATLS, injury identification, patient management, and communication were evaluated for each of five blunt-trauma scenarios. Although there was a statistically significant increase in leadership skills for performing ATLS critical actions, P skills for team leadership willbe a worthwhile endeavor at our institution.

  20. Diagnostic accuracy of emergency-performed focused assessment with sonography for trauma (FAST) in blunt abdominal trauma

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    Ghafouri, Hamed Basir; Zare, Morteza; Bazrafshan, Azam; Modirian, Ehsan; Farahmand, Shervin; Abazarian, Niloofar

    2016-01-01

    Introduction Intra-abdominal hemorrhage due to blunt abdominal trauma is a major cause of trauma-related mortality. Therefore, any action taken for facilitating the diagnosis of intra-abdominal hemorrhage could save the lives of patients more effectively. The aim of this study was to determine the accuracy of focused assessment with sonography for trauma (FAST) performed by emergency physicians. Methods In this cross-sectional study from February 2011 to January 2012 at 7th Tir Hospital in Tehran (Iran), 120 patients with abdominal blunt trauma were chosen and evaluated for abdominal fluid. FAST sonography was performed for all the subjects by emergency residents and radiologists while they were blind to the other tests. Abdominal CTs, which is the gold standard, were done for all of the cases. SPSS 20.0 was used to analyze the results. Results During the study, 120 patients with abdominal blunt trauma were evaluated; the mean age of the patients was 33.0 ± 16.6 and the gender ratio was 3/1 (M/F). The results of FAST sonography by emergency physicians showed free fluid in the abdomen or pelvic spaces in 33 patients (27.5%), but this was not observed by the results of CT scans of six patients; sensitivity and specificity were 93.1 and 93.4%, respectively. As for tests performed by radiology residents, sensitivity was a bit higher (96.5%) with lower specificity (92.3%). Conclusion The results suggested that emergency physicians can use ultrasonography as a safe and reliable method in evaluating blunt abdominal trauma.

  1. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-11-15

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.

  2. Diagnostic accuracy of Focused Abdominal Sonography for Trauma in blunt abdominal trauma patients in a trauma centre of Hong Kong

    Institute of Scientific and Technical Information of China (English)

    Cheung Kent Shek; Wong Hay Tai; Leung Ling Pong; Tsang Tat Chi; Leung Gilberto Ka Kit

    2012-01-01

    Objective: Focused Abdominal Sonography for Trauma (FAST) is widely used for the detection of intraperitoneal free fluids in patients suffering from blunt abdominal trauma (BAT).This study aimed at assessing the diagnostic accuracy of this investigation in a designated trauma centre.Methods: This was a retrospective study of BAT patients over a 6 year period seen in a trauma centre in Hong Kong.FAST findings were compared with laparotomy,abdominal computed tomography or autopsy findings,which served as the gold standard for presence of intrapcritoneal free fluids.The patients who did not have FAST or gold standard confirmatory test performed,had preexisting peritoneal fluid,died at resuscitation or had imcomplete documentation of FAST findings were excluded.The performance of FAST was expressed as sensitivity,specificity,predictive values (PV),likelihood ratios (LR) and accuracy.Results: FAST was performed in 302 patients and 153 of them were included in this analysis.The sensitivity,specificity,positive PV,negative PV,positive LR,negative LR and accuracy for FAST were respectively 50.0 %,97,3%,87.0%,84.6%,18.8,0.5 and 85.0%.FAST was found to be more sensitive in less severely injured patients and more specific in more severely injured patients.Conclusion: FAST is a reliable investigation iu the initial assessment of BAT patients.The diagnostic values of FAST could be affected by the severity of injury and staff training is needed to further enhance its effective use.

  3. A Clinical Study of Blunt Ocular Trauma in a Tertiary Care Centre

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    Shobha G Pai

    2013-08-01

    Full Text Available Purpose: To analyze blunt eye injuries with respect to mode of injury, sites involved and outcome. Method: This was a retrospective study of 32 patients with blunt ocular trauma from 2010 to 2012 in a tertiary care centre. Patient data, mode and extent of injury, management and outcome was noted and analyzed. Result: The commonest age of presentation was 10-20 years (28.125% and the commonest mode of injury was road traffic accident (28.125%. The most commonly involved structure was conjunctiva (84.375%, followed by lid and adnexa (62.5%. Anterior segment involvement included corneal epithelial defect (7 cases, hyphaema (4 cases, iritis (3 cases and anterior dislocation of lens (1 case. Posterior segment involvement included vitreous haemorrhage (1 case and commotio retinae (2 cases. Conclusion: This study reinforces that blunt trauma can cause any extent of damage to ocular structures and the final visual outcome is dependent on the structures injured.

  4. COMPARATIVE STUDY OF ULTRASOUND AND COMPUTED TOMOGRAPHY IN EVALUATION OF BLUNT ABDOMINAL TRAUMA

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    Jyothi

    2013-04-01

    Full Text Available The objective of o u r study was to evaluate role of ultrasound and computed tomography in blunt abdominal trauma patients.50 pati ents with blunt injury to the abdomen were assessed for injuries to various organs using organ injury scale using both USG and CT and the results were compared and the sensitivity and spe cificity of USG compared with CT was calculated and the positive predictive value and nega tive predictive value of USG for individual organs was calculated. The study was performed from August 2012 to February 2013 in the Department of Radiodiagnosis Konaseema Institute of Medical Scien ces, Amalapuram, Andhra Pradesh on 50 cases with blunt abdominal trauma

  5. Thyroid gland rupture after blunt neck trauma: A case report and review of the literature

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    Sebastian Arana-Garza

    2015-01-01

    Conclusions: Although the rarity of this condition, physicians should take in mind the possibility of thyroid injury after blunt neck trauma. Early detection and prompt treatment, can reduce life threatening complications. Management should be individualized to patient’s characteristics and surgeon’s experience.

  6. Duration of antibiotic treatment in surgical infections of the abdomen. Blunt abdominal trauma.

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    Melcher, G A; Rüedi, T P

    1996-01-01

    Blunt abdominal trauma is associated with a low risk of injury to the microorganism-containing hollow viscera. Therefore, routine pre-operative administration of antibiotics is not necessary. Antibiotics are given intraoperatively, if laparotomy discloses transmural injury of a hollow organ and peritoneal contamination. If intervention is early (injuries should be treated with antibiotics for a maximum of 5 days.

  7. Post-traumatic pulmonary pseudocyst with hemopneumothorax following blunt chest trauma: a case report

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    Fagkrezos Dimitris

    2012-10-01

    Full Text Available Abstract Introduction Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung and develops after blunt chest trauma and even more rarely following penetrating injuries. It is generally seen in young adults presenting with cough, chest pain, hemoptysis, and dyspnea. Post-traumatic pulmonary pseudocyst should be included in the differential diagnosis of cavitary pulmonary lesions. We describe the case of a 60-year-old Caucasian Greek woman who sustained traumatic pulmonary pseudocyst with hemopneumothorax due to a blunt chest trauma after a traffic accident. Case presentation After a traffic accident, a 60-year-old Caucasian Greek woman sustained a hemopneumothorax due to a blunt chest trauma. There was evidence of an extensive contusion in the posterior and lateral segments of the right lower lobe, a finding that was attributed to an early sign of a cavitation, and the presence of a thin-walled air cavity was detected on the anterior segment of the right lower lobe in the control computed tomography taken 24 hours after admission. Our patient was treated by catheter aspiration, and the findings of computed tomography evaluation about one month later showed complete resolution of one of the two air-filled cavitary lesions. The second pseudocyst also disappeared completely, as shown by the control computed tomography scan performed six months later. Conclusions Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma, and computed tomography is a more valuable imaging technique than chest radiograph for early diagnosis.

  8. Predictors of successful non-operative management of grade III & IV blunt pancreatic trauma

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    Suman B Koganti

    2016-09-01

    Conclusions: Non-operative measures should be attempted in a select group of grade III&IV blunt pancreatic trauma. In hemodynamically stable patients with a controlled leak walled off as a pseudocyst without associated organ injuries and pancreatic necrosis, NOM has a higher success rate.

  9. [Sonographic diagnosis of diaphragmatic rupture following blunt thoracic and abdominal trauma].

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    Schneider, K; Dietz, H G; Fendel, H

    1987-10-01

    A posttraumatic diaphragmatic hernia was diagnosed by ultrasound and x-ray examinations 1 year after a blunt trauma of the chest and abdomen. The diaphragmatic lesion could be seen retrospectively in the initial sonograms which were performed during the acute illness. It was however not possible to confirm the rupture during laparatomy.

  10. Ischemic jejunal stenosis and blind loop syndrome after blunt abdominal trauma.

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    Isaacs, P; Rendall, M; Hoskins, E O; Missen, G A; Sladen, G E

    1987-02-01

    One month after suffering blunt abdominal trauma a patient developed severe steatorrhea and profound weight loss in association with an ischemic distal jejunal stricture and blind loop syndrome. Evidence for a partial mesenteric tear was found at resection of the stricture, which resulted in complete cure.

  11. Mothers’ Unresolved Trauma Blunts Amygdala Response to Infant Distress

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    Kim, S.; Fonagy, P; Allen, J.; Strathearn, L.

    2014-01-01

    While the neurobiology of post-traumatic stress disorder has been extensively researched, much less attention has been paid to the neural mechanisms underlying more covert but pervasive types of trauma (e.g., those involving disrupted relationships and insecure attachment). Here, we report on a neurobiological study documenting that mothers' attachment-related trauma, when unresolved, undermines her optimal brain response to her infant's distress. We examined the amygdala blood oxygenation le...

  12. Extracorporeal Life Support in a Severe Blunt Chest Trauma with Cardiac Rupture

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    Launey Yoann

    2013-01-01

    Full Text Available This report presents a case of severe blunt chest trauma secondary to a horse riding accident with resultant free-wall rupture of the left ventricle in association with severe lung contusion. We describe the initial surgical and medical management of the cardiac rupture which was associated with a massive haemoptysis due to severe lung trauma. Extra corporeal membrane oxygenation (ECMO support was initiated and allowed both the acute heart and lung failure to recover. We discuss the successful use and pitfalls of ECMO techniques which are sparsely described in such severe combined cardiac and thoracic trauma.

  13. Pericardio-diaphragmatic rupture following blunt abdominal trauma: Case report and review of literature

    Science.gov (United States)

    Abou Hussein, Bassem; Khammas, Ali; Kaiyasah, Hadiel; Swaleh, Abeer; Al Rifai, Nazim; Al-Mazrouei, Alya; Badri, Faisal

    2015-01-01

    Introduction Traumatic diaphragmatic rupture (TDR) occurs in 0–5% of patients with major blunt thoraco-abdominal trauma, in most of them on the left side, and an early correct diagnosis is made in less than half of the cases (Meyers and McCabe, 1993; Ball et al., 1982). Presentation of the case We report a case of a forty-eight years old man who had a pericardio-diaphragmatic rupture after a high-velocity blunt abdominal trauma that was diagnosed and treated successfully. Discussion Pericardio-diaphragmatic rupture (PDR) is an uncommon problem that poses a diagnostic challenge to surgeons. The incidence of PDR is between 0.2% and 3.3% of cases with TDR (Sharma, 1999 [3]). Conclusion PDR should be suspected in any patient with high velocity thoraco-abdominal trauma. Early diagnosis is essential and needs a high index of suspicion. Early Management is important in decreasing morbidity and mortality. PMID:26773877

  14. A rare case of blunt thoracoabdominal trauma with small bowel perforation from air bags.

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    Liverani, A; Pezzatini, M; Conte, S; Mari, F; Milillo, A; Gasparrini, M; Marino, G; Catracchia, V; -Favi, F

    2009-05-01

    Vehicle collisions represent more than 75% of mechanism of blunt abdominal trauma. In spite of the incomparable improvement of car safety devices, recent studies pointed out that the air bags might cause injuries, specially when it is not associated with seatbelt. In fact, some studies pointed out that crash victims using air bags alone have increased injury severity, hospitalisations, thoracoabdominal procedure, and rehabilitation. Some of the most frequently injured organs reported from air bag deployment are the liver (38%), the spleen (23%) and digestive system (17%). Injury of the hollow viscera are far less common. In particular, blunt abdominal trauma resulting in small bowel perforation is an infrequent lesion. These injuries are difficult to diagnose because specific signs are poor and a delay in treatment increases mortality and morbidity of the patients. We describe a case of thoracoabdominal trauma that occurred during a head-on collision after an air bag deployment without seatbelt use.

  15. [Pulmonary contusion and acute respiratory distress syndrome (ARDS) as complications of blunt chest trauma].

    Science.gov (United States)

    Michalska, Agata; Jurczyk, Agnieszka P; Machała, Waldemar; Szram, Stefan; Berent, Jarosław

    2009-01-01

    Blunt chest traumas are common nowadays due to development of motor transport. They are associated with high mortality rates because of serious injuries of internal organs. The mechanisms of injuries are complex and may cause damages ranging from small ones, such as bruises or abrasions, to life-threatening trauma. Among typical injuries there are rib fractures, sternal fractures, pneumothorax, hemothorax, diaphragm lacerations, pulmonary contusions, cardiac tamponade, cardiac rupture and many others. The authors of the article would like to emphasize the pathophysiology and diagnostic difficulties in such blunt chest trauma complications as pulmonary contusions and acute respiratory distress syndrome, for which no causal treatment is available and only early diagnosis and administration of symptomatic treatment may increase the patients' chances to survive. In Forensic Medicine Department, Medical University of Łódź, an opinion was issued on a case which illustrates the clinical problem.

  16. Spinal cord injury and its association with blunt head trauma

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    Paiva WS

    2011-09-01

    Full Text Available Wellingson S Paiva, Arthur MP Oliveira, Almir F Andrade, Robson LO Amorim, Leonardo JO Lourenço, Manoel J TeixeiraDivision of Neurosurgery, University of São Paulo, BrazilBackground: Severe and moderate head injury can cause misdiagnosis of a spinal cord injury, leading to devastating long-term consequences. The objective of this study is to identify risk factors involving spine trauma and moderate-to-severe brain injury.Methods: A prospective study involving 1617 patients admitted in the emergency unit was carried out. Of these patients, 180 with moderate or severe head injury were enrolled. All patients were submitted to three-view spine series X-ray and thin cut axial CT scans for spine trauma investigations.Results: 112 male patients and 78 female patients, whose ages ranged from 11 to 76 years (mean age, 34 years. The most common causes of brain trauma were pedestrians struck by motor vehicles (31.1%, car crashes (27.7%, and falls (25%. Systemic lesions were present in 80 (44.4% patients and the most common were fractures, and lung and spleen injuries. 52.8% had severe and 47.2% moderate head trauma. Fourteen patients (7.8% suffered spinal cord injury (12 in cervical spine, one in lumbar, and one thoracic spine. In elderly patients, the presence of associated lesions and Glasgow Coma Scale (GCS < 9 were statistically significant as risk factors (P < 0.05 for spine injury.Conclusion: Spinal cord injury related to moderate and severe brain trauma usually affects the cervical spine. The incidence of spinal lesions and GCS < 9 points were related to greater incidence of spinal cord injury.Keywords: head injury, spine trauma, risk factors

  17. Spontaneous closure of macular hole following blunt trauma

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    Clovis Arcoverde Freitas-Neto

    2016-01-01

    Full Text Available Ocular trauma can result in macular hole and it can lead to complete loss of central vision. We are reporting a case of traumatic macular hole associated with retinal hemorrhages and choroidal ruptures with spontaneous resolution and total vision recovery.

  18. Transanal evisceration of bowel loops due to blunt trauma

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    Quraishi Abdul Haque

    2007-01-01

    Full Text Available A rare case of a five-year-old boy who sustained closed abdominal trauma with rectal tear and evisceration of ileum and sigmoid colon per anum, is presented. He was managed successfully with resection anastomosis of ileum and sigmoid colostomy, which was closed subsequently. The relevant literature is also reviewed.

  19. Mothers' unresolved trauma blunts amygdala response to infant distress

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    While the neurobiology of post-traumatic stress disorder has been extensively researched, much less attention has been paid to the neural mechanisms underlying more covert but pervasive types of trauma (e.g., those involving disrupted relationships and insecure attachment). Here, we report on a neur...

  20. INADEQUACY IN DIAGNOSIS OF BLUNT TRAUMA ABDOMEN - CAN ANAESTHESIOLOGIST BE BAFFLED BY CATASTROPHIC INTRAOPERATIVE FINDINGS?

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    Joyanta Kumar

    2015-08-01

    Full Text Available The magnitude of injury inflicted by Blunt trauma abdomen has varied manifestations ranging from minor single - system injury to devastating, multi - system injury .Blunt trauma abdomen alone or in association with polytrauma is a frequent presentation in the emergency department. High index of suspicion and clinical acumen is required during evaluation of blunt abdominal injuries because physical signs and symptoms indicating presence of visceral lesions may poorly correlate with clinical presentation. Diagnostic peritoneal tapping is considered safe initial option with high accuracy but carries possibility of significant false positive and false negative result. Ultrasonography (FAST ha s its own limitations; although CT findings can be conclusive it involves time for analysis and the patient should be cooperative. Blunt trauma abdomen may present with life threatening internal haemorrhage due to visceral or vascular injuries prompting em ergency surgical intervention at odd hours with limited investigations and resources, Pre anaesthetic optimization by maintenance of adequate tissue oxygenation with optimal blood volume replacement and judicious use of inotropes, determine outcome of such emergency procedures. Careful selection of anaesthetic techniques and drugs particularly the inducing agents can be life - saving. Agility of the attending anesthesiologist to handle unforeseen intra operative critical events plays a pivotal role in overall outcome. We are discussing Anaesthetic management of a 23 year old victim of road traffic accident, who sustained blunt trauma abdomen about 24 hrs. Back, was conscious, oriented and ambulatory till the time of shifting to the operating theatre but on exp loration sudden gush of blood from a preoperatively undetected 7 cms long tear of the sub diaphragmatic part of IVC, and lacerated liver almost exsanguinated the patient.

  1. Cardiac injuries caused by blunt trauma: an autopsy based assessment of the injury pattern.

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    Turan, Arzu Akcay; Karayel, Ferah Anik; Akyildiz, Elif; Pakis, Isil; Uzun, Ibrahim; Gurpinar, Kagan; Atilmis, Umit; Kir, Ziya

    2010-01-01

    Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common, particularly as a result of rapid deceleration in high-speed vehicular accidents, over the past 2-3 decades. The high mortality rate of cardiac injuries and possible late onset complications make blunt cardiac injuries an important challenging point for legal medicine. One hundred and ninety cases with blunt cardiac injuries in a period of 3 years were analyzed retrospectively in terms of patterns of cardiac injury, survival times, and demographic profiles of the cases in this study.

  2. Scapular Fractures in Blunt Chest Trauma – Self-Experience Study

    Science.gov (United States)

    Al-Sadek, Tabet A.; Niklev, Desislav; Al-Sadek, Ahmed; Al-Sadek, Lina

    2016-01-01

    AIM: The aim of this retrospective study was to report the scapular fractures in patients with blunt chest trauma and to present the type and the frequency of associated thoracic injuries. MATERIAL AND METHODS: Nine patients with fractures of the scapula were included in the study. The mechanisms of the injury, the type of scapular fractures and associated thoracic injuries were analysed. RESULTS: Scapular fractures were caused by high-energy blunt chest trauma. The body of the scapula was fractured in all scapular fractures. In all cases, scapular fractures were associated with other thoracic injuries (average 3.25/per case). Rib fractures were present in eight patients, fractured clavicula - in four cases, the affection of pleural cavity - in eight of the patients and pulmonary contusion in all nine cases. Eight patients were discharged from the hospital up to the 15th day. One patient had died on the 3rd day because of postconcussional lung oedema. CONCLUSIONS: The study confirms the role of scapular fractures as a marker for the severity of the chest trauma (based on the number of associated thoracic injuries), but doesn’t present scapular fractures as an indicator for high mortality in blunt chest trauma patients. PMID:28028415

  3. Nonoperative management for major blunt hepatic trauma. A case report.

    Science.gov (United States)

    Mingoli, Andrea; Saracino, Andrea; Brachini, Gioia; Mariotta, Giovanni; Migliori, Emanuele; Silvestri, Vania

    2015-03-16

    Negli ultimi 20 anni il trattamento del trauma epatico chiuso si è modificato radicalmente passando da una gestione quasi costantemente chirurgica ad una non operativa in tutti i casi in cui non vi siano le condizioni di instabilità emodinamica o di variazione nella clinica del paziente traumatizzato. A tutt’oggi però non è raro osservare un approccio a tale condizione clinica seguendo criteri che la Medicina Basata sull’Evidenza dimostra essere superati. Presentiamo in questo lavoro il caso clinico di una donna di 34 anni che subiva un trauma diretto della regione postero-laterale dell’emitorace destro cadendo accidentalmente da una scala. Nonostante la gravità della lesione evidenziata dalla TC (IV grado secondo AAST Liver Injury Scale), si è optato per un trattamento non operativo data la condizione di stabilità emodinamica ottenuta con un primo bolo di cristalloidi. Una complicanza di tipo respiratorio ha complicato il quadro in terza giornata dal trauma richiedendo una toracentesi e dei cicli di ventilazione non invasiva. A 4 anni di distanza dal trauma la paziente sta bene e non lamenta disturbi. La letteratura mostra che il trattamento conservativo viene impiegato oggi in oltre l’85% dei traumi epatici, indipendentemente dall’entità della lesione. Il successo del trattamento conservativo varia nelle diverse casistiche dall’82% al 100% dei casi, e le sue complicanze, quando si verificano (14% dei traumi maggiori) possono spesso essere trattate con procedure di radiologia interventistica, evitando ancora l’intervento chirurgico. Oggi, in assenza di altre lesioni addominali che richiedano l’esplorazione chirurgica, l’indicazione al trattamento operativo è solo l’instabilità emodinamica del paziente che persiste o si ripresenta subito dopo un corretto trattamento rianimatorio iniziale.

  4. Delayed presentation of a sigmoid colon injury following blunt abdominal trauma: a case report

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    Ertugrul Gokhan

    2012-08-01

    Full Text Available Abstract Introduction The low incidence of colon injury due to blunt abdominal trauma and the lack of a definitive diagnostic method for the same can lead to delays in diagnosis and treatment, subsequently resulting in high morbidity and mortality. Case presentation A 66-year-old woman with sigmoid colon injury was admitted to our emergency department after sustaining blunt abdominal trauma. Her physical examination findings and laboratory results led to a decision to perform a laparotomy; exploration revealed a sigmoid colon injury that was treated by sigmoid loop colostomy. Conclusions Surgical abdominal exploration revealed gross fecal contamination and a perforation site. Intra-abdominal irrigation and a sigmoid loop colostomy were performed. Our patient was discharged on post-operative day six without any problems. Closure of the sigmoid loop colostomy was performed three months after the initial surgery.

  5. Isolated Avulsion of the Common Hepatic Duct from Blunt Abdominal Trauma

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    Victor W. Wong

    2012-01-01

    Full Text Available Isolated extrahepatic biliary tract injury following blunt abdominal trauma is rare. The underlying pathogenic mechanisms remain obscure, but include shear and/or compression forces on the biliary system. Associated morbidity rates are high and largely the result of delays in diagnosis. Imaging modalities commonly employed for diagnosis include ultrasonography, computed tomography, nuclear medicine, and magnetic resonance imaging. Percutaneous and endoscopic techniques have been used both for diagnosis and treatment. Treatment options are dictated by the stability of the patient and the extent of bile duct and concomitant injuries. In this paper, we discuss a case of isolated avulsion of the hepatic duct confluence following blunt trauma that was successfully managed with Roux-en-Y hepaticojejunostomy. To our knowledge, this specific injury pattern has not been previously reported.

  6. Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

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    Daniel H. Wolbrom

    2016-01-01

    Full Text Available Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

  7. Blunt testicular trauma results in rupture of mixed germ cell tumor.

    Science.gov (United States)

    Luchey, Adam; Rogers, Aimee; Saunders, Susan E; Williams, H James; Fooks, Henry J; Zaslau, Stanley

    2009-12-01

    It is extremely rare that a documented case of blunt trauma results in rupture of a testicular tumor. We present the case of a 24-year-old man who was crushed by a tree who developed spontaneous testicular rupture. At surgical exploration, he was found to ultimately have a mixed germ cell tumor of the testicle. This case illustrates the importance of physical examination, patient clinical history, and scrotal ultrasound in the management of scrotal trauma. In this instance, the testicular mass ruptured and lead to significant testicular hemorrhage.

  8. Pediatric blunt renal trauma with wide fragments dislocation: successful organ saving management by internal stenting and percutaneous perirenal drain

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    C. Olivieri

    2014-12-01

    Full Text Available Children have an high risk of renal damage as a result of blunt trauma. Conservative management is always recommended for lower grades (I to III but is rather controversial whenever high grade injuries (grade IV and V are concerned. We describe a case of successful conservative management in grade IV renal injury occurred in a 9-years-old girl with blunt trauma.

  9. Clinical importance of the "seat belt sign" in blunt trauma to the neck.

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    DiPerna, Costanzo A; Rowe, Vincent L; Terramani, Thomas T; Salim, Ali; Hood, Douglas B; Velmahos, George C; Weaver, Fred A

    2002-05-01

    Currently a carotid duplex scan is the initial screening modality routinely used to evaluate occult extracranial carotid artery injuries secondary to blunt neck trauma. The objective of this study was to investigate the role of carotid artery duplex scanning in patients who suffered blunt trauma to the neck with a "seat belt sign." The medical records of 131 consecutive patients who sustained blunt trauma to the neck from a motor vehicle accident were reviewed. Patients with the cervical seat belt sign underwent a complete physical examination and carotid duplex scan in an accredited vascular laboratory. An intimal flap with severe carotid artery stenosis was found in one of 131 patients (0.76%). This patient has multiple injuries to the face, head, chest, lateralizing neurological signs, and a Glasgow Coma Scale score of 8. In an era of cost containment, resource consumption should target appropriate populations. A cervical seat belt sign should not serve as a sole indicator for evaluation of the carotid artery in the absence of other pertinent signs or symptoms.

  10. A rare consequence of blunt abdominal trauma: bilateral renal infarction.

    Science.gov (United States)

    Saritas, Ayhan; Kandis, Hayati; Gunes, Harun; Kayikci, Ali; Baltaci, Davut; Buyukkaya, Ramazan; Ozaydinli, Ismet

    2014-05-01

    A 28-year-old man was admitted to the emergency department with lumbar pain owing to a motorbike accident. On clinical examination, abdominal tenderness, pelvic and left cruris pains were present. Erythrocytes, leucocytes and protein was found to be positive in urine analysis. Abdominal computed tomography with intravenous contrast solution showed contrast enhancement in 80% of right kidney, and 30% of left kidney; some intra-abdominal free fluid was also seen. Conservative management was planned for bilateral renal infarction. Urine output was 1.1 L per day. He was discharged on the seventh day of the hospital stay. The patient had not got any problems on the sixth month follow-up. Urine output is a very important parameter for multiple trauma patients. Any decrease in urine output may not be seen inspite of the presence of bilateral renal damage as in the case of the patient, and this situation does not allow ruling out renal injury completely. Hence, emergency physician should still be careful about the risk of renal injury.

  11. Prevalence of Radiologic Findings in Patients with Blunt Chest Trauma in Isfahan

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    M. Haghighi

    2008-01-01

    Full Text Available Background/Objective: Chest trauma due to its vital organs can be very dangerous and lethal. Our country has the first grade of accidents in the word, so rapid diagnosis and treatment in patients with chest trauma is necessary. One cost benefit and available imaging modality in each Region of our country is X-ray."nCXR interpretation needs to knowledge about prevalence of abnormal Radiologic findings and their accuracy. Therefore, it is necessary to perform a study about the rate of CXR abnormal findings in patients with blunt chest trauma."nPatients and Methods: In this descriptive and prospective study, CXR of patients with blunt chest trauma that admitted in Alzahra and Kashani hospitals studied and percent of vital radiologic findings prevalence determined."nResults: The final results were as below:"n1- Rib FX (18.5% (143, 2- Hemothorax (13.6% (105, 3- Pneumothorax (11.8% (91, 4- Sub cutaneous emphysema (10.2% (79, 5- Lung laceration (8.1% (63, 6- Mediastinal winding (6.4% (50, 7- Clavicular and sternal FX (5.8% (44, 8- Pneumo mediastinum (4.1% (32, 9- spinal FX (3.5% (27, 10- Great vessels injury signs (1.4% (11."nConclusion: According to above results, accurate investigation of CXR, helps physician and radiologist to find any threatened finding, so determination of next step as clinical follow up or spiral CT, angiography or surgery; accordingly.

  12. The development of simple survival prediction models for blunt trauma victims treated at Asian emergency centers

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    Kimura Akio

    2012-02-01

    Full Text Available Abstract Background For real-time assessment of the probability of survival (Ps of blunt trauma victims at emergency centers, this study aimed to establish regression models for estimating Ps using simplified coefficients. Methods The data of 10,210 blunt trauma patients not missing both the binary outcome data about survival and the data necessary for Ps calculation by The Trauma and Injury Severity Score (TRISS method were extracted from the Japan Trauma Data Bank (2004-2007 and analyzed. Half (5,113 of the data was allocated to a derivation data set, with the other half (5,097 allocated to a validation data set. The data of 6,407 blunt trauma victims from the trauma registry of Khon Kaen Regional Hospital in Thailand were analyzed for validation. The logistic regression models included age, the Injury Severity Score (ISS, the Glasgow Coma Scale score (GCS, systolic blood pressure (SBP, respiratory rate (RR, and their coded values (cAGE, 0-1; cISS, 0-4; cSBP, 0-4; cGCS, 0-4; cRR, 0-4 as predictor variables. The coefficients were simplified by rounding off after the decimal point or choosing 0.5 if the coefficients varied across 0.5. The area under the receiver-operating characteristic curve (AUROCC was calculated for each model to measure discriminant ability. Results A group of formulas (log (Ps/1-Ps = logit (Ps = -9 + cISS - cAGE + cSBP + cGCS + cRR/2, where -9 becomes -7 if the predictor variable of cRR or cISS is missing was developed. Using these formulas, the AUROCCs were between 0.950 and 0.964. When these models were applied to the Khon Kean data, their AUROCCs were greater than 0.91. Conclusion: These equations allow physicians to perform real-time assessments of survival by easy mental calculations at Asian emergency centers, which are overcrowded with blunt injury victims of traffic accidents.

  13. Acute fatal coronary artery dissection following exercise-related blunt chest trauma.

    Science.gov (United States)

    Barbesier, Marie; Boval, Catherine; Desfeux, Jacques; Lebreton, Catherine; Léonetti, Georges; Piercecchi, Marie-Dominique

    2015-01-01

    Coronary artery injury such as acute coronary dissection is an uncommon and potentially life-threatening complication after blunt chest trauma. The authors report an unusual autopsy case of a 43-year-old healthy man who suddenly collapsed after receiving a punch to the chest during the practice of kung fu. The occurrence of the punch was supported by the presence of one recent contusion on the left lateral chest area at the external examination and by areas of hemorrhage next to the left lateral intercostal spaces at the internal examination. The histological examination revealed the presence of an acute dissection of the proximal segment of the left anterior descending coronary artery. Only few cases of coronary artery dissection have been reported due to trauma during sports activities such as rugby and soccer games, but never during the practice of martial arts, sports usually considered as safe and responsible for only minor trauma.

  14. Diagnostic accuracy of a step-up imaging strategy in pediatric patients with blunt abdominal trauma

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    Schuppen, J. van [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Olthof, D.C. [Trauma Unit Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Wilde, J.C.H. [Department of Paediatric Surgery, Emma' s Children Hospital/Academic Medical Centre, Amsterdam (Netherlands); Beenen, L.F.M.; Rijn, R.R. van [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Goslings, J.C., E-mail: j.c.goslings@amc.nl [Trauma Unit Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands)

    2014-01-15

    Introduction: Blunt abdominal trauma (BAT) is an important but often unrecognized cause of death in children. Imaging plays a vital role in the early detection of abdominal trauma. The exact role of imaging in the management of BAT in children is still under research. The aim of this study was to assess diagnostic accuracy of a step-up imaging strategy, where the decision to observe or to perform an intervention depends on the vital parameters of the patient, in combination with the presence or absence of free fluid at Focused Assessment with Sonography for Trauma (FAST) and the findings on CT (performed selectively), for pediatric patients presenting to the ED with a blunt abdominal trauma. Methods: Consecutive patients aged ≤16 years admitted between January 2008 and December 2012 to a Dutch level 1 trauma centre were included in this retrospective study. Sensitivity, negative predictive value (NPV) and the negative likelihood ratio (LR−) of the imaging strategy were calculated. Results: The cohort consisted of 122 patients; 66 (54%) patients were discharged home after primary survey, 51 (41%) patients were admitted and observed, 3 (2%) patients underwent transarterial embolization and 2 (2%) patients underwent surgery. Treatment failed in 1 patient, initially selected for observation. The sensitivity of the imaging strategy was 0.833 (0.446–0.990). The NPV and LR− were 0.991 (0.963–1.000) and 0.167 (0.028–0.997), respectively. Conclusion: The step-up imaging strategy that is applied in our academic level 1 trauma centre has a high sensitivity and a high negative predictive value. No clinically relevant injuries were missed without doing unnecessary harm, e.g. radiation or an intervention.

  15. Factors Associated with Complications in Older Adults with Isolated Blunt Chest Trauma

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    Lotfipour, Shahram

    2009-05-01

    Full Text Available OBJECTIVE: To determine the prevalence of adverse events in elderly trauma patients with isolated blunt thoracic trauma, and to identify variables associated with these adverse events.METHODS: We performed a chart review of 160 trauma patients age 65 and older with significant blunt thoracic trauma, drawn from an American College of Surgeons Level I Trauma Center registry. Patients with serious injury to other body areas were excluded to prevent confounding the cause of adverse events. Adverse events were defined as acute respiratory distress syndrome or pneumonia, unanticipated intubation, transfer to the intensive care unit for hypoxemia, or death. Data collected included history, physical examination, radiographic findings, length of hospital stay, and clinical outcomes.RESULTS: Ninety-nine patients had isolated chest injury, while 61 others had other organ systems injured and were excluded. Sixteen patients developed adverse events [16.2% 95% confidence interval (CI 9.5-24.9%], including two deaths. Adverse events were experienced by 19.2%, 6.1%, and 28.6% of those patients 65-74, 75-84, and >/=85 years old, respectively. The mean length of stay was 14.6 days in patients with an adverse event and 5.8 days in patients without. Post hoc analysis revealed that all 16 patients with an adverse event had one or more of the following: age >/=85, initial systolic blood pressure <90 mmHg, hemothorax, pneumothorax, three or more unilateral rib fractures, or pulmonary contusion (sensitivity 100%, CI 79.4-100%; specificity 38.6%, CI 28.1-49.9%.CONCLUSION: Adverse events from isolated thoracic trauma in elderly patients complicate 16% of our sample. These criteria were 100% sensitive and 38.5% specific for these adverse events. This study is a first step to identifying variables that might aid in identifying patients at high risk for serious adverse events.

  16. Diagnosis of an Inguinal Hernia after a Blunt Inguinal Trauma with an Intestinal Perforation

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    Farès Moustafa

    2014-01-01

    Full Text Available Introduction. Inguinal hernias are very common in men. A clinical exam can do the diagnosis easily. But bowel perforation inside an inguinal hernia caused by a directly blunt trauma is rare and can have important consequences. Up to now, there have been a few case reports that described blunt injury to the inguinal area causing traumatic perforation of the bowel in the inguinal hernia. Case Report. We present a case of a 45-year-old Eastern European man with a small perforation of ileal bowels and a peritonitis after direct blunt trauma to the inguinal hernia region, with no inguinal hernia known by the patient, and show how the diagnosis can be difficult. Conclusion. This case shows that external forces, that may seem too trivial to cause intraperitoneal injury, can cause significant injury when applied to a patient with a hernia and shows how a careful examination, with the help of an abdominal CT scan, is important even if the patient do not seem to have an inguinal hernia.

  17. Unenhanced Computed Tomography to Visualize Hollow Viscera and/or Mesenteric Injury After Blunt Abdominal Trauma

    Science.gov (United States)

    Yang, Xu-Yang; Wei, Ming-Tian; Jin, Cheng-Wu; Wang, Meng; Wang, Zi-Qiang

    2016-01-01

    Abstract To identify and describe the major features of unenhanced computed tomography (CT) images of blunt hollow viscera and/or mesenteric injury (BHVI/MI) and to determine the value of unenhanced CT in the diagnosis of BHVI/MI. This retrospective study included 151 patients who underwent unenhanced CT before laparotomy for blunt abdominal trauma between January 2011 and December 2013. According to surgical observations, patients were classified as having BHVI/MI (n = 73) or not (n = 78). Sensitivity, specificity, P values, and likelihood ratios were calculated by comparing CT findings between the 2 groups. Six significant CT findings (P < 0.05) for BHVI/MI were identified and their sensitivity and specificity values determined, as follows: bowel wall thickening (39.7%, 96.2%), mesentery thickening (46.6%, 88.5%), mesenteric fat infiltration (12.3%, 98.7%), peritoneal fat infiltration (31.5%, 87.1%), parietal peritoneum thickening (30.1%, 85.9%), and intra- or retro-peritoneal air (34.2%, 96.2%). Unenhanced CT scan was useful as an initial assessment tool for BHVI/MI after blunt abdominal trauma. Six key features on CT were correlated with BHVI/MI. PMID:26945375

  18. Isolated perforation of Meckel′s diverticulum following blunt trauma abdomen: A rare case report

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    Syeda Siddiqua Banu

    2015-01-01

    Full Text Available Meckel′s diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in about 2% of the population and, in most cases, incidentally being discovered during autopsy, laparotomy, or barium studies. Hemorrhage, obstruction, and inflammation are the complications that can occur in a Meckel′s diverticulum. Perforation in a Meckel′s diverticulum can occur in the presence of ectopic mucosa which is rare, but perforation following blunt abdominal injury is very rare and only few cases have been reported so far. We report a case of perforation of Meckel′s diverticulum in an 8-year-old boy following a blunt abdominal trauma due to fall from a bicycle.

  19. Acute direct inguinal hernia resulting from blunt abdominal trauma: Case Report

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    Hipkins Gabrielle

    2010-06-01

    Full Text Available Abstract We report a case of traumatic inguinal hernia following blunt abdominal trauma after a road traffic accident and describe the circumstances and technique of repair. The patient suffered multiple upper limb fractures and developed acute swelling of the right groin and scrotum. CT scan confirmed the acute formation of a traumatic inguinal hernia. Surgical repair was deferred until resolution of the acute swelling and subcutaneous haematoma. The indication for surgery was the potential for visceral strangulation or ischaemia with the patient describing discomfort on coughing. At surgery there was complete obliteration of the inguinal canal with bowel and omentum lying immediately beneath the attenuated external oblique aponeurosis. A modified prolene mesh hernia repair was performed after reconstructing the inguinal ligament and canal in layers. To our knowledge, this is the first documented case of the formation of an acute direct inguinal hernia caused as a result of blunt abdominal trauma with complete disruption of the inguinal canal. Surgical repair outlines the principles of restoration of normal anatomy in a patient who is physiologically recovered from the acute trauma and whose anatomy is distorted as a result of his injuries.

  20. Urgent-setting magnetic resonance imaging allows triage of extensive penoscrotal hematoma following blunt trauma

    Directory of Open Access Journals (Sweden)

    Massimo Tonolini

    2013-01-01

    Full Text Available Although uncommon, blunt trauma to the perineum may cause serious injury to the penis. Differentiation between penile fracture with torn tunica albuginea versus extratunical or cavernosal hematomas is crucial because the former condition needs early surgical repair to avoid future deformity and erectile dysfunction, whereas approach is conservative with even large penoscrotal hematomas with albugineal integrity. Urgent-setting magnetic resonance imaging including multiplanar images of the injured penoscrotal region allows precise identification or exclusion of presence, site, and extent of tears of the tunica albuginea, providing a consistent basis for therapeutic choice.

  1. Origin of the 44-mm Behind-Armor Blunt Trauma Standard

    Science.gov (United States)

    2012-08-01

    relate it to tissue damage. Gelatin blocks, 20 % ballistic gelatin , were used in the study to determine the loading rate (impulse) of deformation using...Deformation of the gelatin was mea- sured frame-by-frame with a focus on the depth and diameter of deformation. It was determined by Metker et al that BFS...appli- cation , the model also provided the ability to compare previous blunt-trauma data to the body-armor work that was going on at the time. 14•15•23

  2. Emergency department evaluation and management of blunt chest and lung trauma (Trauma CME).

    Science.gov (United States)

    Morley, Eric J; Johnson, Scott; Leibner, Evan; Shahid, Jawad

    2016-06-01

    The majority of blunt chest injuries are minor contusions or abrasions; however, life-threatening injuries, including tension pneumothorax, hemothorax, and aortic rupture can occur and must be recognized early. This review focuses on the diagnosis, management, and disposition of patients with blunt injuries to the ribs and lung. Utilization of decision rules for chest x-ray and computed tomography are discussed, along with the emerging role of bedside lung ultrasonography. Management controversies presented include the limitations of needle thoracostomy us¬ing standard needle, chest tube placement, and chest tube size. Finally, a discussion is provided related to airway and ventilation management to assist in the timing and type of interventions needed to maintain oxygenation.

  3. ICU management of patients with suspected positive findings of diagnostic peritoneal lavage following blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    缑东元; 金燕; 陈丽英; 魏琪

    2005-01-01

    Objective: To explore the management for blunt abdominal trauma victims with probable positive diagnostic peritoneal lavage (DPL) findings. Methods: Data of 76 patients with probable positive DPL findings accepted to ICU in previous 10 years were reviewed. After admission, the patients were evaluated in a settled time according to the protocols of Advanced Trauma Life Support (ATLS). Vital signs were continuously monitored and DPL, ultrasound and/or CT scan were repeated when necessary. Results: Eighteen (24%) of 76 patients presented positive DPL findings after repeated DPL. Surgical findings confirmed 7 cases of spleen rupture, 3 hepatorrhexis (infra-Glisson capsule), 4 intestinal perforation, 2 gastric perforation, 1 colon perforation and 1 injured mesentery.

  4. Cardiovascular magnetic resonance of myocardial infarction after blunt chest trauma: a heartbreaking soccer-shot

    Directory of Open Access Journals (Sweden)

    Fogarassy Peter

    2009-10-01

    Full Text Available Abstract Cardiac injury occasionally occurs as a result of blunt chest trauma. Most cardiac complications in chest trauma are due to myocardial contusion rather than direct damage to the coronary arteries. However, traumatic coronary injury has been reported, and a variety of underlying pathophysiological mechanisms have been proposed. We present a 26 year old patient presenting with an acute coronary syndrome as a consequence of a soccer-shot impact to the chest. CMR showed apical inferior infarction, as well as multiple small septal lesions which were presumed to have resulted from embolization. The culprit lesion was a proximal 75% LAD stenosis with a prominent plaque-rupture and thrombus-formation, and the distal LAD was occluded by thromboembolic material.

  5. Isolated free intra-abdominal fluid on CT in blunt trauma: The continued diagnostic dilemma

    Institute of Scientific and Technical Information of China (English)

    Victor Y.Kong; Damon Jeetoo; Leah C.Naidoo; George V.Oosthuizen; Damian L.Clarke

    2015-01-01

    Purpose: The clinical significance of isolated free fluid (FF) without solid organ injury on computed tomography (CT) continues to pose significant dilemma in the management of patients with blunt abdominal trauma (BAT).Methods: We reviewed the incidence of FF and the clinical outcome amongst patients with blunt abdominal trauma in a metropolitan trauma service in South Africa.We performed a retrospective study of 121 consecutive CT scans over a period of 12 months to determine the incidence of isolated FF and the clinical outcome of patients managed in a large metropolitan trauma service.Results: Of the 121 CTs, FF was identified in 36 patients (30%).Seven patients (6%) had isolated FF.Of the 29 patients who had free fluid and associated organ injuries, 33 organ injuries were identified.86% (25/ 29) of all 29 patients had a single organ injury and 14% had multiple organ injuries.There were 26 solid organ injuries and 7 hollow organ injuries.The 33 organs injured were: spleen, 12: liver, 8;kidney, 5;pancreas, 2;small bowel, 4;duodenum, 1.Six (21%) patients required operative management for small bowel perforations in 4 cases and pancreatic tail injury in 2 cases.All 7 patients with isolated FF were initially observed, and 3 (43%) were eventually subjected to operative intervention.They were found to have an intra-peritoneal bladder rupture in 1 case, a non-expanding zone 3 haematoma in 1 case, and a negative laparotomy in 1 case.Four (57%) patients were successfully managed without surgical interventions.Conclusions: Isolated FF is uncommon and the clinical significance remains unclear.Provided that reliable serial physical examination can be performed by experienced surgeons, an initial non-operative approach should be considered.

  6. A rat model for isolated bilateral lung contusion from blunt chest trauma.

    Science.gov (United States)

    Raghavendran, Krishnan; Davidson, Bruce A; Helinski, Jadwiga D; Marschke, Cristi J; Manderscheid, Patricia; Woytash, James A; Notter, Robert H; Knight, Paul R

    2005-11-01

    Lung contusion affects 17%-25% of adult blunt trauma patients, and is the leading cause of death from blunt thoracic injury. A small animal model for isolated bilateral lung contusion has not been developed. We induced lung contusion in anesthetized rats by dropping a 0.3-kg weight onto a precordial protective shield to direct the impact force away from the heart and toward the lungs. Lung injury was characterized as a function of chest impact energy (1.8-2.7 J) by measurements of arterial oxygenation, bronchoalveolar lavage (BAL) albumin and cytology, pressure-volume mechanics, and histopathology. Histology confirmed bilateral lung contusion without substantial cardiac muscle trauma. Rats receiving 2.7 J of chest impact energy had 33% mortality that exceeded prospectively defined limits for sublethal injury. Hypoxemia in rats with maximal sublethal injury (2.45 J) met criteria for acute lung injury at lung volumes at 48 h. We concluded that an impact energy of 2.45 J induces isolated, bilateral lung contusion and provides a useful model for future mechanistic pathophysiological assessments.

  7. An unusual complication of blunt ocular trauma: A horseshoe-shaped macular tear with spontaneous closure

    Directory of Open Access Journals (Sweden)

    Umut Karaca

    2014-01-01

    Full Text Available A case of horseshoe-shaped macular tear after blunt trauma with the course of the tear and the relevant findings obtained by spectral-domain optical coherence tomography (SD-OCT is described. A 21-year-old man who had suffered blunt trauma 5 days previously visited our clinic complaining of vision loss in his left eye. Ophthalmic examination and SD-OCT images revealed a horseshoe-shaped macular tear. A month later at the second visit, the macular tear was found to have spontaneously closed. There have been many cases reported previously of the spontaneous closure of traumatic macular holes. A horseshoe-shaped macular tear is an atypical clinical presentation. However, the mechanism of spontaneous closure is hypothetically as same as that for a macular hole. High-resolution images and three-dimensional maps taken with SD-OCT can provide more details on macular diseases and are more useful than time-domain OCT images.

  8. Tracheal rupture caused by blunt chest trauma: radiological and clinical features

    Energy Technology Data Exchange (ETDEWEB)

    Kunisch-Hoppe, M.; Rauber, K.; Rau, W.S. [Dept. of Diagnostic Radiology, Justus Liebig Univ., Giessen (Germany); Hoppe, M. [Dept. of Diagnostic Radiology, University Hospital, Philipps University, Marburg (Germany); Popella, C. [Dept. of ENT, Justus Liebig University, Giessen (Germany)

    2000-03-01

    The aim of this study was to assess radiomorphologic and clinical features of tracheal rupture due to blunt chest trauma. From 1992 until 1998 the radiomorphologic and clinical key findings of all consecutive tracheal ruptures were retrospectively analyzed. The study included ten patients (7 men and 3 women; mean age 35 years); all had pneumothoraces which were persistent despite suction drainage. Seven patients developed a pneumomediastinum as well as a subcutaneous emphysema on conventional chest X-rays. In five patients, one major hint leading to the diagnosis was a cervical emphysema, discovered on the lateral cervical spine view. Contrast-media-enhanced thoracic CT was obtained in all ten cases and showed additional injuries (atelectasis n = 5; lung contusion n = 4; lung laceration n = 2; hematothorax n = 2 and hematomediastinum n = 4). The definite diagnosis of tracheal rupture was made by bronchoscopy, which was obtained in all patients. Tracheal rupture due to blunt chest trauma occurs rarely. Key findings were all provided by conventional chest X-ray. Tracheal rupture is suspected in front of a pneumothorax, a pneumomediastinum, or a subcutaneous emphysema on lateral cervical spine and chest films. Routine thoracic CT could also demonstrate these findings but could not confirm the definite diagnosis of an tracheal rupture except in one case; in the other 9 cases this was done by bronchoscopy. Thus, bronchoscopy should be mandatory in all suspicious cases of tracheal rupture and remains the gold standard. (orig.)

  9. Asymptomatic diaphragmatic rupture with retroperitoneal opening as a result of blunt trauma

    Directory of Open Access Journals (Sweden)

    Narci Adnan

    2010-01-01

    Full Text Available Blunt traumas of the abdomen and thorax are important clinical problems in pediatric ages. Severity of trauma may not always be compatible with the patients′ clinical situation. A 2-year-old male child was admitted to our emergency clinic as a result of tractor crash accident. Physical examination of the child was normal. The abdominal and thoracic ultrasonography (USG examination performed in the emergency clinic was normal. In thoracic computed tomography (CT scan of the patient, there was irregularity of the right diaphragmatic contour that was described as micro perforation-rupture (the free air was just in the perihepatic and retroperitoneal area, which was not passing through the abdomen. The patient was followed-up for 1 week in the hospital with a diagnosis of retroperitoneal diaphragmatic rupture. It is not appropriate to decide the severity of trauma in childhood on the basis of clinical findings. Although severe trauma and sustaining radiological examinations, the patients′ clinical pictures may be surprisingly normal, as in our patient. In such cases, there may not be any clinical symptom. CT scan examination must be preferred to USG for both primary diagnosis and follow-up of these patients. According to the current literature, there is no reported case with retroperitoneal rupture of the diaphragm.

  10. Diaphragmatic rupture with right colon and small intestine herniation after blunt trauma: a case report

    Directory of Open Access Journals (Sweden)

    Muroni Mirko

    2010-08-01

    Full Text Available Abstract Introduction Traumatic diaphragmatic hernias are an unusual presentation of trauma, and are observed in about 10% of diaphragmatic injuries. The diagnosis is often missed because of non-specific clinical signs, and the absence of additional intra-abdominal and thoracic injuries. Case presentation We report a case of a 59-year-old Italian man hospitalized for abdominal pain and vomiting. His medical history included a blunt trauma seven years previously. A chest X-ray showed right diaphragm elevation, and computed tomography revealed that the greater omentum, a portion of the colon and the small intestine had been transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy, at which time the colon and small intestine were reduced back into the abdomen and the diaphragm was repaired. Conclusions This was a unusual case of traumatic right-sided diaphragmatic hernia. Diaphragmatic ruptures may be revealed many years after the initial trauma. The suspicion of diaphragmatic rupture in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only curative treatment for diaphragmatic hernias. Prosthetic patches may be a good solution when the diaphragmatic defect is severe and too large for primary closure, whereas primary repair remains the gold standard for the closure of small to moderate sized diaphragmatic defects.

  11. Evaluating clinical abdominal scoring system in predict- ing the necessity of laparotomy in blunt abdominal trauma

    Directory of Open Access Journals (Sweden)

    Erfantalab-Avini Peyman

    2011-06-01

    Full Text Available 【Abstract】 Objectives: Trauma is among the lead- ing causes of death. Medical management of blunt abdomi- nal trauma (BAT relies on judging patients for whom lap- arotomy is mandatory. This study aimed to determine BAT patients’ signs, as well as paraclinical data, and to clarify the accuracy, sensitivity, specificity, positive and negative predictive value of clinical abdominal scoring system (CASS, a new scoring system based on clinical signs, in predicting whether a BAT patient needs laparotomy or not. Methods: Totally 400 patients suspected of BAT that arrived at the emergency department of two university hos- pitals in Tehran from March 20, 2007 to March 19, 2009 were included in this study. They were evaluated for age, sex, type of trauma, systolic blood pressure, Glasgow coma scale (GCS, pulse rate, time of presentation after trauma, abdomi- nal clinical findings, respiratory rate, temperature, hemoglo- bin (Hb concentration, focused abdominal sonography in trauma (FAST and CASS. Results: Our measurements showed that CASS had an accuracy of 94%, sensitivity of 100%, specificity of 88%, positive predictive value of 90% and negative predictive value of 100% in determining the necessity of laparotomy in BAT patients. Moreover, in our analysis, systolic blood pressure, GCS, pulse rate, Hb concentration, time of presen- tation after trauma, abdominal clinical findings and FAST were also shown to be helpful in confirming the need for laparotomy (P<0.05. Conclusion: CASS is a promising scoring system in rapid detection of the need for laparotomy as well as in minimizing auxiliary expense for further evaluation in BAT patients, thus to promote the cost-benefit ratio and accu- racy of diagnosis. Key words: Abdominal injuries; Laparotomy; Patients; Wounds, nonpenetrating

  12. Evaluating clinical abdominal scoring system in predicting the necessity of laparotomy in blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    Peyman Erfantalab-Avini; Nima Hafezi-Nejad; Mojtaba Chardoli; Vafa Rahimi-Movaghar

    2011-01-01

    Objectives: Trauma is among the leading causes of death. Medical management of blunt abdominal trauma (BAT) relies on judging patients for whom laparotomy is mandatory. This study aimed to determine BAT patients' signs, as well as paraclinical data, and to clarify the accuracy, sensitivity, specificity, positive and negative predictive value of clinical abdominal scoring system (CASS), a new scoring system based on clinical signs, in predicting whether a BAT patient needs laparotomy or not.Methods: Totally 400 patients suspected of BAT that arrived at the emergency department of two university hospitals in Tehran from March 20, 2007 to March 19, 2009 were included in this study. They were evaluated for age, sex,type of trauma, systolic blood pressure, Glasgow coma scale (GCS), pulse rate, time of presentation after trauma, abdominal clinical findings, respiratory rate, temperature, hemoglobin (Hb) concentration, focused abdominal sonography in trauma (FAST) and CASS.Results: Our measurements showed that CASS had an accuracy of 94%, sensitivity of 100%, specificity of 88%,positive predictive value of 90% and negative predictive value of 100% in determining the necessity of laparotomy in BAT patients. Moreover, in our analysis, systolic blood pressure, GCS, pulse rate, Hb concentration, time of presentation after trauma, abdominal clinical findings and FAST were also shown to be helpful in confirming the need for laparotomy (P<0.05).Conclusion: CASS is a promising scoring system in rapid detection of the need for laparotomy as well as in minimizing auxiliary expense for further evaluation in BAT patients, thus to promote the cost-benefit ratio and accuracy of diagnosis.

  13. A case study involving a blunt abdominal trauma leading to disruption of the aortic bifurcation in an infant

    Directory of Open Access Journals (Sweden)

    Seleno Glauber de Jesus-Silva

    2014-04-01

    Full Text Available The incidence of aortic disruption secondary to blunt abdominal trauma is rarely reported in the pediatric population. In general, most of the cases described are the result of motor vehicle accidents. We report on the treatment and outcomes of a 5-year-old child with aortic bifurcation disruption secondary to an unusual case of blunt abdominal trauma who was admitted to the emergency room in hypovolemic shock and subjected to immediate exploratory laparotomy and vascular repair. The mechanical forces involved in aortic disruption and the management options for repair and treatment of this injury will be discussed.

  14. New scoring system for intra-abdominal injury diagnosis after blunt trauma

    Directory of Open Access Journals (Sweden)

    Shojaee Majid

    2014-02-01

    Full Text Available 【Abstract】Objective: An accurate scoring system for intra-abdominal injury (IAI based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagno- sis of IAI after blunt trauma. Methods: This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT admitted to the emergency department (ED of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chisquare test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β was given based on the contribution of each of them. Scoring system was developed based on the obtained total βof each factor. Results: Altogether 261 patients (80.1% male were enrolled (48 cases of IAI. A 24-point blunt abdominal trauma scoring system (BATSS was developed. Patients were divided into three groups including low (score<8, moderate (8≤score<12 and high risk (score≥12. In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%. Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%. The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%. Conclusion: The present scoring system furnishes a

  15. Evaluation of the safety of high-frequency chest wall oscillation (HFCWO) therapy in blunt thoracic trauma patients

    OpenAIRE

    Becker Brian; Ney Arthur L; Palmer Cassandra A; Anderson Casandra A; Schaffel Steven D; Quickel Robert R

    2008-01-01

    Abstract Background Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO) has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequent...

  16. Endovascular treatment of intramural hematoma of internal carotid artery after blunt trauma of neck inflicted with the seatbelt.

    Science.gov (United States)

    Stanisic, M; Winckiewicz, M; Juszkat, R; Gabriel, M; Jawien, A; Staniszewski, R

    2009-08-01

    Blunt trauma of the neck caused by a seatbelt may cause dissection with intramural hematoma of the internal carotid artery. The following case report discusses the differential diagnosis and the potential of endovascular treatment of symptomatic intramural hematoma of the internal carotid artery.

  17. Blunt abdominal trauma: The role of focused abdominal sonography in assessment of organ injury and reducing the need for CT

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    Samer Malak Boutros

    2016-03-01

    Conclusion: Ultrasonography is considered the best modality in initial evaluation of blunt abdominal trauma patients as it is noninvasive, readily available, and requires minimal preparation time. Ultrasonography is very useful in follow up of patients with intra-abdominal injury and decreases use of CT which has the disadvantages of being expensive, high dose radiation.

  18. Predictors for the selection of patients for abdominal CT after blunt trauma: a proposal for a diagnostic algorithm.

    NARCIS (Netherlands)

    Deunk, J.; Brink, M.; Dekker, H.M.; Kool, D.R.; Blickman, J.G.; Vugt, A.B. van; Edwards, M.J.R.

    2010-01-01

    OBJECTIVE: To select parameters that can predict which patients should receive abdominal computed tomography (CT) after high-energy blunt trauma. SUMMARY BACKGROUND DATA: Abdominal CT accurately detects injuries of the abdomen, pelvis, and lumbar spine, but has important disadvantages. More evidence

  19. Evaluation of amylase and lipase levels in blunt trauma abdomen patients

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    Subodh Kumar

    2012-01-01

    Full Text Available Background: There are studies to prove the role of amylase and lipase estimation as a screening diagnostic tool to detect diseases apart from acute pancreatitis. However, there is sparse literature on the role of serum and urine amylase, lipase levels, etc to help predict the specific intra-abdominal injury after blunt trauma abdomen (BTA. Aim: To elucidate the significance of elevation in the levels of amylase and lipase in serum and urine samples as reliable parameters for accurate diagnosis and management of blunt trauma to the abdomen. Materials and Methods: A prospective analysis was done on the trauma patients admitted in Jai Prakash Narayan Apex Trauma Center, AIIMS, with blunt abdomen trauma injuries over a period of six months. Blood and urine samples were collected on days 1, 3, and 5 of admission for the estimation of amylase and lipase, liver function tests, serum bicarbonates, urine routine microscopy for red blood cells, and complete hemogram. Clinical details such as time elapsed from injury to admission, type of injury, trauma score, and hypotension were noted. Patients were divided into groups according to the single or multiple organs injured and according to their hospital outcome (dead/discharged. Wilcoxon′s Rank sum or Kruskal-Wallis tests were used to compare median values in two/three groups. Data analysis was performed using STATA 11.0 statistical software. Results: A total of 55 patients with median age 26 (range, 6-80 years, were enrolled in the study. Of these, 80% were males. Surgery was required for 20% of the patients. Out of 55 patients, 42 had isolated single organ injury [liver or spleen or gastrointestinal tract (GIT or kidney]. Patients with pancreatic injury were excluded. In patients who suffered liver injuries, urine lipase levels on day 1, urine lipase/amylase ratio along with aspartate aminotransferase (AST, alanine aminotransferase (ALT, and alkaline phosphatase (ALP on days 1, 3, and 5, were found to

  20. Mediastinal mature teratoma with rupture into pleural cavity due to blunt trauma.

    Science.gov (United States)

    Miyazawa, Masahisa; Yoshida, Kazuo; Komatsu, Kazunori; Kobayashi, Nobutaka; Haba, Yoshiaki

    2012-03-01

    We report a rare case of mediastinal mature teratoma with rupture due to blunt trauma. A 15-year-old boy had received a strong head-butt in the left upper chest wall and was admitted with the sudden onset of left-sided severe chest pain and dyspnea. Chest computed tomography (CT) scan on admission revealed a heterogeneous mass lesion in the anterior mediastinum. The contrast-enhanced CT scans obtained 2 days after admission showed not only mediastinal mass lesion but also left pleural effusion. On the radiologic finding at 5 months later, the lesion became larger and was thought to be a typical mediastinal mature teratoma. The patient underwent extirpation of the tumor. Microscopically, the tumor was typically composed of adult-type tissues and was confirmed to be mature teratoma.

  1. Ruptured Cystic Mesothelioma Diagnosed after Blunt Trauma; Case Report and Literature Review

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    Francisco Igor B. Macedo

    2016-10-01

    Full Text Available The majority of blunt trauma is secondary to motor vehicle crashes,especially in those wearing seatbelts or sitting in the front or passenger seat location.Hollow viscus gastrointestinal injuries occur more frequently in small bowel, followed by colorectal, duodenum, stomach and appendix. A 25-year-old male presents after being involved in a motor vehicle accident. Initialworkup was significant for moderate amount of pelvic free fluid and curvilinear,cystic­like structures in the pelvis. He subsequently developed peritonitis and underwentdiagnostic laparoscopy, which revealed multiple cystic nodules arising from theperitoneum. Pathology demonstrated benign cystic mesothelioma (BCM. BCM is a very rarecondition of mesothelial­lined, variably sized, fluid­filled cysts that arises from theserous, pericardial or peritoneal lining. Due to the scarcity of cases, its management and prognosis are not fully established. This singular case highlights the necessity for a clinician to have a widedifferential forunusual causes of free pelvic fluid after blunt abdominaltrauma.

  2. SURGICAL TREATMENT OF BLUNT CARDIAC TRAUMA IN CHHDREN: REPORT OF 2 CASES AND REVIEW OF LITERATURES

    Institute of Scientific and Technical Information of China (English)

    朱宏斌; 苏肇伉; 丁文祥; 郑景浩

    2005-01-01

    Objective Summarizing the clinical experience of surgical treatment in 2 cases of blunt cardiac trauma and reviewing the relevant literatures. Methods A 6-year-old girl was diagnosed muscular ventricular septal defect and left ventricular aneurysm 2d after automobile accident and underwent ventricular septal defect repair 2 weeks after injury. Another 9-year-old boy was diagnosed severe mitral regurgitation resulted from rupture of posterior papillary muscle 9d after automobile accident and underwent mitral valvuloplasty 2 weeks after injury.Results Heart function of the first patient was in New York Heart Association ( NYHA ) class Ⅰ , echocardiography showed no residual septal defect and the size of left ventricular aneurysm reduced. Heart function of the second patient is in NYHA class Ⅱ, echocardiography showed mild mitral regurgitation. Conclusion Blunt traumatic heart disease occurs either because of heart compression between sternum and the spine and/or because of myocardi-al contusion; A more aggressive strategy with surgical treatment earlier before deterioration of heart function is advocated; Earlier surgical correction of anatomic deformity will achieve a good result and a long time follow-up is necessary.

  3. Laparoscopic treatment of biliary peritonitis following nonoperative management of blunt liver trauma

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    Bachellier Philippe

    2010-09-01

    Full Text Available Abstract Introduction Nonoperative management (NOM of hemodynamically stable patients with blunt hepatic injuries is considered the current standard of care. However, it is associated with several in-hospital complications. In selected cases laparoscopy could be proposed as diagnostic and therapeutic means. Case report A 28 years-old male was admitted in the Emergency Unit following a motor vehicle crash. CT-scan showed an isolated stade II hepatic injury at the level of the segment IV. Firstly a NOM was decided. Laparoscopic exploration was then performed at day 4 due to a biliary peritonitis. Intraoperative trans-cystic duct cholangiography showed a biliary leaks of left hepatic biliary tract, involving sectioral pedicle to segment III. Cholecystectomy, trans-cystic biliary drainage, application of surgical tissue sealing patch and abdominal drainage were performed. Postoperative outcome was uneventful, with fast patient recovery. Conclusion Laparoscopy has gained a role as diagnostic and therapeutic means in treatment of complications following NOM of blunt liver trauma. This approach seems feasible and safety, with satisfactory postoperative outcome.

  4. Role of plasma ammonia level in detecting intra-abdominal hemorrhage following blunt abdominal trauma

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    Davood Farsi

    2014-01-01

    Full Text Available Background: Blunt abdominal injury is a leading cause of death in trauma patients. A reliable test predicting intra-abdominal hemorrhage would be a novel method. The study objective was to assess the diagnostic accuracy of plasma ammonia in detection of intra-abdominal bleeding in patients with blunt abdominal trauma (BAT. Materials and Methods: In this observational study, all patients suffering from BAT, referred to our university teaching hospital included. The levels of ammonia were measured at the time of emergency department admission and 1 h after initial treatment. Demographic data, vital signs, and venous blood gas reports were recorded. Findings of contrast-enhanced abdominopelvic computed tomography scan and laparotomy were assumed as a gold standard for abdominal injuries. Results: A total of 104 patients was enrolled in the study. 15 patients (14.4% had intra-abdominal hemorrhage and the mean plasma ammonia level in this group was significantly higher than the other patients on admission time (101.73 ± 5.41 μg/dL vs. 47.36 ± 26.31 μg/dL, P < 0.001. On receiver-operator characteristic curve analysis, in cutoff point of 89 μg/dL, the sensitivity, specificity, positive and negative likelihood ratios were 100% (95% confidence interval [CI], 79.6-100, 93.26% (95% CI, 86-96.8, 14.83 (95% CI, 6.84-32.12, and 0, respectively. Conclusion: The study findings suggest the measurement of ammonia level at the time of admission in the patients with BAT would be a useful test predicting intra-abdominal hemorrhage. Furthermore, decrease in the ammonia level could be a useful marker for monitoring response to treatment in these patients.

  5. Vertebral artery pseudoaneurysms secondary to blunt trauma: Endovascular management by means of neurostents and flow diverters.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Rajz, Gustavo; Rosenthal, Guy; El Hassan, Hosni Abu; Moscovici, Samuel; Itshayek, Eyal

    2016-10-01

    Extracranial vertebral pseudoaneurysms that develop following blunt trauma to the cervical area may have a benign course; however, embolic or ischemic stroke and progressive pseudoaneurysm enlargement may occur. We review the presentation and endovascular management of pseudoaneurysms of the cervical vertebral artery (VA) due to blunt trauma in nine patients (eight male, mean age 27years). Pseudoaneurysms occurred in dominant vessels in seven patients and coexisted with segmental narrowing in six. We favored endovascular intervention during the acute phase only in cases with significant narrowing of a dominant VA, especially when anticoagulation was contraindicated. Four patients were treated during the acute stage (contraindication to anticoagulation, mass effect, severely injured dominant VA/impending stroke); five during the chronic phase (pseudoaneurysm growth, ischemic stroke on aspirin prophylaxis, patient preference). Reconstructive techniques were favored over deliberate endovascular occlusion when dominant vessels were involved. Arterial reconstruction was performed in eight of nine patients using a flow-diverter implant (5 patients), stent-assisted coiling (1), overlapping stent implant (1), or implantation of a balloon-expandable stent (1). Deliberate VA occlusion with coils was performed in one of nine patients due to suboptimal expansion of the stented artery after flow-diverter implant. No neurological complications occurred during follow-up. All cases treated by reconstructive techniques showed complete, persistent pseudoaneurysm occlusion and full arterial patency. Endovascular therapy of traumatic VA pseudoaneurysms using neurostents and flow-diverters resulted in occlusion of the pseudoaneurysms, preservation of the parent vessel, and no periprocedural or delayed clinical complications, supporting the feasibility and safety of the approach.

  6. Blunt cerebrovascular trauma causing vertebral arteryd issection in combination with a laryngeal fracture: a case report

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    Krettek Christian

    2011-08-01

    Full Text Available Abstract Introduction The diagnosis and therapy of blunt cerebrovascular injuries has become a focus since improved imaging technology allows adequate description of the injury. Although it represents a rare injury the long-term complications can be fatal but mostly prevented by adequate treatment. Case presentation A 33-year-old Caucasian man fell down a 7-meter scarp after losing control of his quad bike in a remote area. Since endotracheal intubation was unsuccessfully attempted due to the severe cervical swelling as well as oral bleeding an emergency tracheotomy was performed on scene. He was hemodynamically unstable despite fluid resuscitation and intravenous therapy with vasopressors and was transported by a helicopter to our trauma center. He had a stable fracture of the arch of the seventh cervical vertebra and fractures of the transverse processes of C5-C7 with involvement of the lateral wall of the transverse foramen. An abort of the left vertebral artery signal at the first thoracic vertebrae with massive hemorrhage as well as a laryngeal fracture was also detected. Further imaging showed retrograde filling of the left vertebral artery at C5 distal of the described abort. After stabilization and reconfirmation of intracranial perfusion during the clinical course weaning was started. At the time of discharge, he was aware and was able to move all extremities. Conclusion We report a rare case of a patient with vertebral artery dissection in combination with a laryngeal fracture after blunt trauma. Thorough diagnostic and frequent reassessments are recommended. Most patients can be managed with conservative treatment.

  7. Paediatric Blunt Torso Trauma; Injury mechanisms, patterns and outcomes among children requiring hospitalisation at the Sultan Qaboos University Hospital, Oman

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    Khalid M. Bhatti

    2016-05-01

    Full Text Available Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital (SQUH in Muscat, Oman. Methods: This retrospective single-centre study involved all children ≤12 years old with blunt torso trauma admitted for paediatric surgical care at SQUH between January 2009 and December 2013. Medical records were analysed to collect demographic and clinical data. Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 (55.7% male patients. The mean age was 5.19 ± 2.66 years. Of the cohort, 35 children (50.0% received their injuries after having been hit by cars as pedestrians, while 19 (27.1% were injured by falls, 12 (17.1% during car accidents as passengers and four (5.7% by falling heavy objects. According to computed tomography scans, thoracic injuries were most common (65.7%, followed by abdominal injuries (42.9%. The most commonly involved solid organs were the liver (15.7% and spleen (11.4%. The majority of the patients were managed conservatively (92.9% with a good outcome (74.3%. The mortality rate was 7.1%. Most deaths were due to multisystem involvement. Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach.

  8. Strangulated intercostal liver herniation subsequent to blunt trauma. First report with review of the world literature

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    Bendinelli Cino

    2012-07-01

    Full Text Available Abstract Traumatic transdiaphragmatic intercostal hernia, defined as an acquired herniation of abdominal contents through disrupted intercostal muscles, is a rarely reported entity. We present the first reported case of a traumatic transdiaphragmatic intercostal hernia complicated by strangulation of the herniated visceral contents. Following blunt trauma, a 61-year old man developed a traumatic transdiaphragmatic intercostal hernia complicated by strangulation of liver segment VI. Due to pre-existing respiratory problems and the presence of multiple other injuries (grade III kidney laceration and lung contusion the hernia was managed non-operatively for the first 2 weeks. The strangulated liver segment eventually underwent ischemic necrosis. Six weeks later the resulting subcutaneous abscess required surgical drainage. Nine months post injury the large symptomatic intercostal hernia was treated with laparoscopic mesh repair. Twelve months after the initial trauma, a small recurrence of the hernia required laparoscopic re-fixation of the mesh. This paper outlines important steps in managing a rare post traumatic entity. Early liver reduction and hernia repair would have been ideal. The adopted conservative approach caused liver necrosis and required staged procedures to achieve a good outcome.

  9. N-terminal pro-B-type natriuretic peptide as a marker of blunt cardiac contusion in trauma.

    Science.gov (United States)

    Dogan, Halil; Sarikaya, Sezgin; Neijmann, Sebnem Tekin; Uysal, Emin; Yucel, Neslihan; Ozucelik, Dogac Niyazi; Okuturlar, Yıldız; Solak, Suleyman; Sever, Nurten; Ayan, Cem

    2015-01-01

    Cardiac contusion is usually caused by blunt chest trauma and, although it is potentially a life-threatening condition, the diagnosis of a myocardial contusion is difficult because of non-specific symptoms and the lack of an ideal test to detect myocardial damage. Cardiac enzymes, such as creatine kinase (CK), creatine kinase MB fraction (CK-MB), cardiac troponin I (cTn-I), and cardiac troponin T (cTn-T) were used in previous studies to demonstrate the blunt cardiac contusion (BCC). Each of these diagnostic tests alone is not effective for diagnosis of BCC. The aim of this study was to investigate the serum heart-type fatty acid binding protein (h-FABP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), CK, CK-MB, and cTn-I levels as a marker of BCC in blunt chest trauma in rats. The eighteen Wistar albino rats were randomly allocated to two groups; group I (control) (n=8) and group II (blunt chest trauma) (n=10). Isolated BCC was induced by the method described by Raghavendran et al. (2005). All rats were observed in their cages and blood samples were collected after five hours of trauma for the analysis of serum h-FABP, NT-pro BNP, CK, CK-MB, and cTn-I levels. The mean serum NT-pro BNP was significantly different between group I and II (10.3 ± 2.10 ng/L versus 15.4 ± 3.68 ng/L, respectively; P=0.0001). NT-pro BNP level >13 ng/ml had a sensitivity of 87.5%, a specificity of 70%, a positive predictive value of 70%, and a negative predictive value of 87.5% for predicting blunt chest trauma (area under curve was 0.794 and P=0.037). There was no significant difference between two groups in serum h-FABP, CK, CK-MB and c Tn-I levels. A relation between NT-Pro BNP and BCC was shown in this study. Serum NT-proBNP levels significantly increased with BCC after 5 hours of the blunt chest trauma. The use of NT-proBNP as an adjunct to other diagnostic tests, such as troponins, electrocardiography (ECG), chest x-ray and echocardiogram may be beneficial for diagnosis of

  10. Management of high-risk popliteal vascular blunt trauma: clinical experience with 62 cases

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    Ali Pourzand

    2010-07-01

    Full Text Available Ali Pourzand, Bassir A Fakhri, Ramin Azhough, Mohammad Ali Hassanzadeh, Shahryar Hashemzadeh, Amrollah M BayatDepartment of General Surgery, Tabriz University of Medical Sciences, Tabriz, East Azarbaijan Province, IranPurpose: The purpose of this study is to report the clinical and functional outcomes of patients, treated between 2004 and 2009, with high-risk popliteal vascular injuries due to compound fractures about the knee.Patients and methods: A retrospective analysis was conducted of prospectively collected data from Tabriz Medical Trauma Center. Our aim was to perform surgical revascularization as soon as the arterial injury was recognized. The mechanism of injury was blunt in the entire cohort of patients, and all of them had bone fractures about the knee. The treatment of arterial injury included vein graft interposition in 39 (63%, primary anastomosis in 20 (32.3%, and lateral repair in 3 (4.8% patients. The patients were divided into 2 study groups: limb salvage group (group 1 and amputation group (group 2. Subgroup analysis consisted of univariate analysis comparing the 2 groups and multivariate analysis examining the factors associated negatively and positively with the primary endpoint, limb salvage.Results: In the entire cohort of patients, 60 patients (97% were male and 2 were female (3%; the mean age was 34.1 years (16–49 years. The overall amputation rate in this study was 37.1% (23 amputations. Significant (P < 0.05 independent factors associated negatively with limb salvage were combined tibia and fibula fracture, concomitant artery and vein injury, ligation of venous injury, and lack of backflow after Fogarty catheter thrombectomy, while repair of popliteal artery and vein injury, when present, was associated with improved early limb salvage. For 40 patients, we adopt a liberal attitude toward open 4-compartment fasciotomy through both medially and laterally placed incisions.Conclusion: Expeditious recognition of vascular

  11. Predictors of Mortality and Prehospital Monitoring Limitations in Blunt Trauma Patients

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    Matej Strnad

    2015-01-01

    Full Text Available This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients’ charts. Prehospital vital signs, Injury Severity Score (ISS, initial Glasgow Coma Scale (GCS, Revised Trauma Score (RTS, arterial blood gases, and lactate were compared in two study groups: survivors (n=40 and nonsurvivors (n=30. There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P=0.006, with lower initial GCS (P<0.001 and higher ISS (P<0.001, along with higher lactate (P<0.001 and larger base deficit (BD; P=0.006, whereas RTS (P=0.001 was lower in nonsurvivors. For predicting mortality, area under the curve (AUC was calculated: for lactate 0.82 (P<0.001, for ISS 0.82 (P<0.001, and for BD 0.69 (P=0.006. Lactate level of 3.4 mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P=0.037, GCS (P=0.033, and age (P=0.002 were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P<0.001. Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.

  12. Invading of intrauterine contraceptive device into the sigmoid colon through uterine perforation caused by a blunt trauma

    Institute of Scientific and Technical Information of China (English)

    Abdoulhossein Davoodabadi; Mahdi Mohammadzadeh; Mahdieh Amirbeigi; Hoda Jazayeri

    2015-01-01

    Intrauterine contraceptive device (IUCD) is relatively safe but still with some serious risks.Uterus perforation is rare and would be fatal.A case of Cu-7 IUCD invading into the sigmoid colon through uterine perforation caused by a pelvic blunt trauma was presented.Our case showed that uterus perforation by an IUCD could induce utero-sigmoid fistula which is likely to be missed.Imaging is required when the patients with IUCD present abdominal pain,particularly with a history of trauma.

  13. A review of computerized tomography in blunt abdominal trauma at Christchurch Hospital

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    Bohmer, R.D.; Cowan, I [Christchurch Hospital (New Zealand)

    1997-02-01

    A review was undertaken of computerized tomography (CT) of the abdomen, performed between March 1993 and December 1994 for blunt abdominal trauma at Christchurch Hospital. CT findings were correlated with the clinical outcome. The outcome was either recovery from an abdominal point of view with or without laparotomy, or post mortem. A total of 116 CTs were reviewed, of which 76 were normal. CT was highly sensitive and specific for a variety of abdominal traumatic lesions. there were 1 false positive and 4 false negatives (only 2 of these significant). There was 1 non-therapeutic laparotomy based on CT findings. There was only 1 case of delayed treatment based on CT results. Three patients had unexplained findings of pneumoperitoneum. Care should be taken when interpreting the presence of free intraperitoneal air on CT scan. The possibility of missed bowel perforation should be considered, especially in the presence of free intra-abdominal fluid and no solid organ injury to account for it. CT scans are useful in the conservative management of solid organ injuries. 15 refs., 1 tab., 1 fig.

  14. Electroencephalographic evaluation of the effectiveness of blunt trauma to induce loss of consciousness for on-farm killing of chickens and turkeys.

    Science.gov (United States)

    Cors, J-C; Gruber, A D; Günther, R; Meyer-Kühling, B; Esser, K-H; Rautenschlein, S

    2015-02-01

    Euthanasia of small numbers of birds in case of injury or other illness directly on the farm may be necessary for welfare reasons. This should be done without transportation of the moribund animals in order to minimize pain and distress. Blood loss has to be avoided to minimize the risk of contaminating the environment. Cervical dislocation in combination with a blunt trauma may be an appropriate way to achieve this aim but the bird's age and body weight may influence the practicability of this method in the field. In this study, we evaluated broilers, broiler breeders, and turkeys of different age groups and weights up to nearly 16 kg for the efficacy of blunt trauma to induce unconsciousness, allowing subsequent killing of the bird without pain. The effect of blunt trauma on the brain was determined by electroencephalography (EEG). Auditory evoked potentials (AEPs) were recorded for each animal. Convulsions or tonic seizures were observed in all investigated animals after blunt trauma, including strong wing movements, torticollis, and stretching of legs. The EEG results demonstrate that the blunt trauma induced by a single, sufficiently strong hit placed in the frontoparietal region of the head led to a reduction or loss of the AEP in all groups of birds. These results clearly indicate a loss of sensibility and induction of unconsciousness, which would allow painless killing of the birds immediately after the induction of the blunt trauma.

  15. The evolution of isolated bilateral lung contusion from blunt chest trauma in rats: cellular and cytokine responses.

    Science.gov (United States)

    Raghavendran, Krishnan; Davidson, Bruce A; Woytash, James A; Helinski, Jadwiga D; Marschke, Cristi J; Manderscheid, Patricia A; Notter, Robert H; Knight, Paul R

    2005-08-01

    Lung contusion is the leading cause of death from blunt thoracic trauma in adults, but its mechanistic pathophysiology remains unclear. This study uses a recently developed rat model to investigate the evolution of inflammation and injury in isolated lung contusion. Bilateral lung contusion with minimal cardiac trauma was induced in 54 anesthetized rats by dropping a 0.3-kg hollow cylindrical weight onto a precordial shield (impact energy, 2.45 Joules). Arterial oxygenation, pressure-volume (P-V) mechanics, histology, and levels of erythrocytes, leukocytes, albumin, and inflammatory mediators in bronchoalveolar lavage (BAL) were assessed at 8 min, at 4, 12, 24, and 48 h, and at 7 days after injury. The role of neutrophils in the evolution of inflammatory injury was also specifically studied by depleting these cells with intravenous vinblastine before lung contusion. Arterial oxygenation was severely reduced at 8 min to 24 h postcontusion, but became almost normal by 48 h. Levels of erythrocytes, leukocytes, and albumin in BAL were increased at lung injury based on total lung volume at 4 h and on BAL albumin levels at 24 h postcontusion. Inflammatory injury from isolated bilateral lung contusion in rats is most severe in the acute period (8 min-24 h) after initial blunt trauma, and includes a component of neutrophil-dependent pathology.

  16. Evaluation of gastrointestinal injury in blunt abdominal trauma "FAST is not reliable": the role of repeated ultrasonography

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    Mohammadi Afshin

    2012-01-01

    Full Text Available Abstract Background To determine the diagnostic Accuracy of Focused Assessment Sonography for Trauma (FAST and repeated FAST in the patients with blunt abdominal trauma. Methods In this retrospective study we collected the data of all patients from September 2007 to July 2011 with gastrointestinal injury. The intraoperative outcome was compared with FAST technique and the repeated or delayed sonography. Results A total number of 1550 patients with blunt abdominal trauma underwent FAST in a period of 4 years in our hospital. Eighty-eight (5.67% patients were found to have gastrointestinal injury after exploratory laparotomy. Fifty-five (62.5% patients had isolated gastrointestinal injury and 33 (37.5% patients had concomitant injury to the other solid organs. In those with isolated gastrointestinal injury, the sensitivity of FAST was 38.5%. Repeated ultrsonography was performed in 34 patients with false negative initial FAST after 12-24 hours. The sensitivity of repeated ultrasonography in negative initial FAST patients in detection of gastrointestinal injury was 85.2% (95% CI, 68.1%, and 94.4%. Conclusion Repeated sonography after 12 to 24 hours in patients with negative initial FAST but sustain abdominal symptom can facilitated a diagnosis of GI tract injury and can be as effective method instead of Computed tomography in developing country.

  17. Blunt abdominal trauma with handlebar injury: A rare cause of traumatic amputation of the appendix associated with acute appendicitis

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    Amanda Jensen

    2016-04-01

    Full Text Available We describe traumatic appendicitis in a 7-year-old boy who presented after sustaining blunt abdominal trauma to his right lower abdomen secondary to bicycle handlebar injury. With diffuse abdominal pain following injury, he was admitted for observation. Computed axial tomography (CT obtained at an outside hospital demonstrated moderate stranding of the abdomen in the right lower quadrant. The CT was non-contrasted and therefore significant appendiceal distention could not be confirmed. However, there was a calcified structure in the right pelvis with trace amount of free fluid. Patient was observed with conservative management and over the course of 15 h his abdominal pain continued to intensify. With his worsening symptoms, we elected to take him for diagnostic laparoscopy. In the operating room we found an inflamed traumatically amputated appendix with the mesoappendix intact. We therefore proceeded with laparoscopic appendectomy. Pathology demonstrated acute appendicitis with fecalith. It was unclear as to whether the patient's appendicitis and perforation were secondary to fecalith obstruction, his blunt abdominal trauma or if they concurrently caused his appendicitis. Acute appendicitis is a common acute surgical condition in the pediatric population and continues to be a rare and unique cause of operative intervention in the trauma population.

  18. Effects of Trauma-Hemorrhage and IL-6 Deficiency on Splenic Immune Function in a Murine Trauma Model

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    P. Mommsen

    2012-01-01

    Full Text Available Splenic immune function is known to be depressed following hemorrhage. The present study investigates the effects of femoral shaft fracture, isolated or in combination with hemorrhage, on early stage cytokine production capacity of splenocytes and observes the role of IL-6 under these conditions. Male IL-6 knockout (IL-6−/− and wild-type mice (WT were randomly divided into three groups: sham (S, isolated femoral fracture (Fx, and femoral fracture + volume controlled hemorrhage (TH-Fx (=6 per group. Animals were sacrificed four hours after induction of hemorrhage and fracture. Cytokine release (TNF-α, IL-6, and IL-10 of isolated and LPS-stimulated splenocytes was determined by cytometric bead array. Femoral fracture with or without hemorrhage caused a suppression of in vitro cytokine production capacity of splenocytes at an early posttraumatic stage in WT and IL-6−/−. In the absence of IL-6, the profile of splenic cytokine secretion is significantly altered, identifying this cytokine as a potential therapeutic target to modulate the posttraumatic immune response.

  19. Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma

    Science.gov (United States)

    Hammer, Frank; Tombal, Bertrand

    2017-01-01

    Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications.

  20. [Blunt chest trauma with total rupture of the right main stem bronchus--a case report].

    Science.gov (United States)

    Moerer, O; Heuer, J; Benken, I; Roessler, M; Klockgether-Radke, A

    2004-01-01

    Tracheo-bronchial lesions in blunt chest trauma are rare--the incidence is about 1%--but potentially life-threatening events. Indirect signs such as pneumothorax, pneumomediastinum, subcutaneous emphysema or an insufficient expansion of the lungs after drainage of a pneumothorax are ominous. The fastest and most reliable method to assess the definite diagnosis of tracheo-bronchial lesion is fibre-optic tracheobronchoscopy. Early surgical treatment is mandatory to prevent major pulmonary resection. This case shows that computer tomography might fail to provide the right diagnosis. Independent lung ventilation is an option to protect the bronchial anastomosis during the early postoperative period. Reported here is the case of a young man who sustained a total traumatic rupture of the right main stem bronchus after being thrown from the passenger seat through the windshield of a motor vehicle. When the emergency doctor arrived on the scene, he found the patient with dyspnoea and massive thoracic subcutaneous emphysema. Reduced breath sounds on the left and no breath sounds on the right side led to an immediate placement of two chest tubes and controlled mechanical ventilation. After primary care in a district hospital, the patient was transferred to our university hospital for further treatment of his head injury. On admission, the patient was making breath sounds on both sides and a CT scan showed no clear sign of a tracheo-bronchial lesion. After neurosurgical intervention, the diagnosis of a rupture of the right main stem bronchus was made with delay by fibre-optic bronchoscopy. The patient was intubated with a left-sided double lumen endotracheal tube followed by surgical end-to-end anastomosis of the lesion. The initial postoperative ventilator support consisted of BIPAP-mode ventilation of the left lung, while the right lung was kept open with positive airway pressure. Forty-eight hours later, synchronised independent lung ventilation with two ventilators was

  1. Characteristics of behind armor blunt trauma produced by bullets with different structural materials: an experimental study

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    Ling-qing WANG

    2013-07-01

    Full Text Available Objective To investigate the effect of structural materials of bullets on behind armor blunt trauma (BABT. Methods Ten healthy male Landraces were randomly divided into two groups (5 each: 56 type 7.62-mm rifle bullet group and SS109 5.56-mm rifle bullet group. The kinetic energy of two types of bullets was adjusted to the same level (about 1880J by the way of grow downwards gunpowder. Then the animals as protected with both grade NIJ Ⅲ ceramic hard armor and grade Ⅱ police soft body armor, were shot at the left midclavicular line of fourth intercostal space (shooting distance was 25m. The damage to the animals was observed. Other 2 healthy male Landraces were selected, and biomechanical sensor was subcutaneously implanted into the soft tissue in precordium and intracalvarium to detect the pressure at the time point of bullet contact under the protection of armor, and the relationship between pressure and damage was analyzed. Results Respiration, heart rate and systolic arterial pressure of animals in two groups were all elevated after injury, but there was no significant difference between the two groups. No obvious change was found on blood oxygen saturation of both groups. Gross anatomy showed the predominant local injury was cardiac and pulmonary contusions. The area of pulmonary hemorrhage of 7.62mm group was 6.00%±3.18%, significantly higher than that of 5.56mm group (3.59%±2.11%, P<0.05. Histopathological examination revealed acute injuries of lung tissues, myocardial tissue and cerebral cortical neurons. The contents of cardiac troponin T (TnT, creatine kinase (CK and creatine kinase-MB (CK-MB isoenzyme were all increased 3 hours after injury, and the rise was higher in 7.62mm group than in 5.56mm group (P<0.05. Biomechanical testing showed the pressure of precordium and intracalvarium was elevated at the moment of bullet contact, and the rise was higher in 7.62mm group than in 5.56mm group (P<0.05. Conclusions

  2. Seatbelt compliance among morbidly obese versus non obese patients suffering severe blunt trauma in Mississippi - biomed 2013.

    Science.gov (United States)

    Powe, Christopher B; Porter, John; Russell, George; Tucci, Michelle; Benghuzzi, Hamed

    2013-01-01

    We describe the preliminary findings of seatbelt compliance among severely injured blunt trauma patients involved in motor vehicle crashes in Mississippi. Stratification of the sample size of 1,405 patients included obese versus the non-obese patients with sub-stratification of weight classes to include normal weight, overweight, obese and morbidly obese. An overview of the design of the study is included. The results demonstrate no significant difference between the numbers of restrained and unrestrained obese patients compared to their normal weight counterparts. Our findings suggest unrestrained patients regardless of weight class had higher ISS than restrained individuals. The data for Mississippi is similar to those reported nationally. Interestingly, we observed the injury severity scores in the restrained obese and morbidly obese patients were higher than the unrestrained motorists within the same weight cohort. This may reflect less movement within the vehicle resulting in less trauma.

  3. Splenic abscess after splenic blunt injury angioembolization.

    Science.gov (United States)

    Tartaglia, Dario; Galatioto, Christian; Lippolis, Piero Vincenzo; Modesti, Matteo; Gianardi, Desirée; Bertolucci, Andrea; Cucinotta, Monica; Zocco, Giuseppe; Seccia, Massimo

    2014-11-03

    L’angioembolizzazione splenica è una efficace procedura nel corso del trattamento non operativo dei pazienti emodinamicamente stabili con traumi splenici di grado OIS III, IV, V. L’ascesso spenico rappresenta una rara complicanza maggiore di questa procedura. Di seguito riportiamo il caso di un paziente di 38 anni, giunto in Pronto Soccorso dopo una caduta accidentale domestica, con contusione del quadrante superiore sinistro dell’addome. La TC addome documentava una frattura del polo inferiore della milza, con pseudoaneurismi intraparenchimali (grado IV OIS). Vista la stabilità emodinamica, il paziente veniva sottoposto a trattamento non operatvo. Successivamente si eseguiva un’angioembolizzazione della parte distale dell’ arteria splenica con spongostan gel e spirali metalliche. Per la comparsa di febbre e per l’evidenza di sepsi agli esami ematochimici, si effettuava un’ ulteriore TC addome che evidenziava la presenza di una voluminosa raccolta di circa 11 cm all’ interno della milza con multiple bolle aree nel suo contesto, con segni di emoperitoneo diffuso nei recessi addominali. Per tale motivo, ad una settimana dalla procedura, il paziente veniva sottoposto ad intervento chirurgico di splenectomia con evacuazione del versamento ematico. Gli esami colturali eseguiti sull’ematoma perisplenico risultavano negativi, ma l’esame istologico della milza documentava multiple aree ascessualizzate ed emorragiche. Dopo un ciclo di terapia antibiotica a largo spettro con Tigeciclina e Teicoplanina, il paziente veniva dimesso in sedicesima giornata post-operatoria. In letteratura, è stato riportato che gli ascessi splenici dopo la procedura di angioembolizzazione splenica nel corso di un trattamento non operativo dei traumi splenici, si verificano nel range dello 0-1,9%. In circa un terzo dei casi richiedono un trattamento chirurgico. Nel caso riportato l’ascesso splenico si è sviluppato nel giro di una settimana dalla procedura. In conclusione, dal momento che questa rara complicanza maggiore, si può verificare in un tempo relativamente breve da una spleno- embolizzazione, sarebbe opportuno monitorizzare i pazienti sottoposti a questa procedura, non solo da un punto di vista emodinamico ma anche infettivo e infiammatorio.

  4. Evaluation of the safety of high-frequency chest wall oscillation (HFCWO therapy in blunt thoracic trauma patients

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    Becker Brian

    2008-10-01

    Full Text Available Abstract Background Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequently have chest tubes, drains, catheters, etc. which could become dislodged during HFCWO. This prospective observational study was conducted to determine if HFCWO treatment, as provided by The Vest™ Airway Clearance System (Hill-Rom, Saint Paul, MN, was safe and well tolerated by these patients. Methods Twenty-five blunt thoracic trauma patients were entered into the study. These patients were consented. Each patient was prescribed 2, 15 minute HFCWO treatments per day using The Vest® Airway Clearance System (Hill-Rom, Inc., St Paul, MN. The Vest® system was set to a frequency of 10–12 Hz and a pressure of 2–3 (arbitrary unit. Physiological parameters were measured before, during, and after treatment. Patients were free to refuse or terminate a treatment early for any reason. Results No chest tubes, lines, drains or catheters were dislodged as a result of treatment. One patient with flail chest had a chest tube placed after one treatment due to increasing serous effusion. No treatments were missed and continued without further incident. Post treatment survey showed 76% experienced mild or no pain and more productive cough. Thirty days after discharge there were no deaths or hospital re-admissions. Conclusion This study suggests that HFCWO treatment is safe for trauma patients with lung and chest wall injuries. These findings support further work to demonstrate the airway clearance benefits of HFCWO treatment.

  5. Catastrophic necrotizing fasciitis after blunt abdominal trauma with delayed recognition of the coecal rupture--case report.

    Science.gov (United States)

    Pecic, Vanja; Nestorovic, Milica; Kovacevic, Predrag; Tasic, Dragan; Stanojevic, Goran

    2014-03-01

    Necrotizing fasciitis (NF) is a rare bacterial infection with dramatic course, characterized by widespread necrosis of the skin, subcutaneous tissue, and superficial fascia which can often lead to death. We present a case of a 27-year-old male with NF. One day after experiencing blunt abdominal trauma caused by falling over bike handlebars, the patient was admitted to a regional hospital and treated for diffuse abdominal pain and large hematoma of the anterior abdominal wall. Due to worsening of general condition, he was referred to our hospital the following day and operated on urgently. Surgery revealed rupture of the coecum with peritonitis and abdominal wall infection. After surgery, fulminant necrotizing fasciitis developed. Antibiotics were prescribed according to wound cultures and subsequent necrectomies were performed. After 25 days, reconstruction of the abdominal wall with skin grafts was obtained. Despite all resuscitation measures including fluids, blood transfusions, and parenteral nutrition, lung infection and MODS caused death 42 days after initial operation. Blunt abdominal trauma can cause the rupture of intestine, and if early signs of peritoneal irritation should present, emergency laparotomy should be performed. Disastrous complication are rare but lethal.

  6. Blunt renal trauma: comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kitase, M.; Mizutani, M.; Tomita, H.; Kono, T.; Sugie, C.; Shibamoto, Y. [Nagoya City University, Nagoya, (Japan). Graduate School of Medical Sciences. Dept. of Radiology

    2007-07-15

    Full text: Background: The purpose of this study was to evaluate the role of contrast-enhanced CT and the usefulness of super selective embolization therapy in the management of arterial damage in patients with severe blunt renal trauma. Patients and Methods: Nine cases of severe renal trauma were evaluated. In all cases, we compared contrast enhanced CT findings with angiographic findings, and performed transcatheter arterial embolization (TAE) in six of them with microcoils and gelatin sponge particles. Morphological changes in the kidney and site of infarction after TAE were evaluated on follow-up CT Chronological changes in blood biochemistry findings after injury, degree of anemia and renal function were investigated. Adverse effects or complications such as duration of hematuria, fever, abdominal pain, renovascular hypertension and abscess formation were also evaluated. Results: The CT finding of extravasation was a reliable sign of active bleeding and useful for determining the indication of TAE. In all cases, bleeding was effectively controlled with super selective embolization. There was minimal procedure-related loss of renal tissue. None of the patients developed abscess, hypertension or other complications. Conclusions: In blunt renal injury, contrast-enhanced CT was useful for diagnosing arterial hemorrhage. Arterial bleeding may produce massive hematoma and TAE was a useful treatment for such cases. By using selective TAE for a bleeding artery, it was possible to minimize renal parenchymal damage, with complications of TAE rarely seen. (author)

  7. Ruptured chordae tendineae of the posterior leaflet of the tricuspid valve as a cause of tricuspid regurgitation following blunt chest trauma.

    Science.gov (United States)

    dos Santos, J; de Marchi, C H; Bestetti, R B; Corbucci, H A; Pavarino, P R

    2001-01-01

    A 12-year-old boy suffered a blunt chest trauma. Some hours later, a pulsatile bilateral jugular venous distension, a holosystolic murmur heard at the low parasternal border and hepatomegaly were observed. On echocardiography, ruptured chordae tendineae of the posterior leaflet of the tricuspid valve, as well as tricuspid regurgitation were detected. He remained asymptomatic during hospital stay and was discharged home in good condition. Thus, isolated ruptured chordae tendineae of the posterior leaflet of the tricuspid valve is another cause of tricuspid regurgitation following blunt chest trauma.

  8. Management of blunt splenic injuries Retrospective cohort study of early experiences in an Acute Care Surgery Service recently established.

    Science.gov (United States)

    Occhionorelli, Savino; Morganti, Lucia; Andreotti, Dario; Cappellari, Lorenzo; Stano, Rocco; Portinari, Mattia; Vasquez, Giorgio

    2015-01-01

    Il trattamento conservativo dei trauma splenici è ormai il “gold standard” per i bassi gradi di lesione splenica (III grado), mentre è ancora dibattuta la gestione dei traumi splenici severi (IV-V grado). Controversa rimane la gestione dei traumi splenici di III grado, che potrebbero beneficiare del trattamento conservativo, associato o meno ad angioembolizzazione dell’arteria splenica, in centri specializzati ed idonei alla gestione conservativa dei traumi degli organi parenchimatosi. Le ultime linee guida pubblicate dalla “Eastern Association of Surgery of Trauma” risalgono al 2012 e provvedono a dare solo delle raccomandazioni di livello II-III sulla gestioni dei traumi splenici. Il fattore che maggiormente influenza il successo del trattamento conservativo è la selezione dei pazienti che potrebbero beneficiare di tale gestione. Alla luce di ciò, l’obiettivo primario del nostro studio è di identificare i pazienti con lesioni spleniche post-traumatiche, che dovrebbero essere sottoposti a trattamento conservativo; l’obiettivo secondario è di confrontare il decorso clinico e la durata della degenza nei pazienti trattati conservativamente e in quelli sottoposti a splenectomia. Tutti i pazienti con trauma splenico, ricoverati presso l’U.O. di Chirurgia d’Urgenza dell’Azienda Ospedaliera- Universitaria Sant’Anna, Ferrara (Italia) tra Novembre 2010 (anno in cui è stata istituita l’U.O.) e Dicembre 2014, sono stati inclusi nello studio, per un totale di 54 pazienti. Di questi 54 pazienti, 29 (53.7%) sono stati immediatamente sottoposti ad intervento chirurgico di laparotomia esplorativa e splenectomia, mentre 25 (46.3%) sono stati sottoposti a trattamento conservativo. I pazienti sottoposti ad angioembolizzazione sono stati 9 su 25 (36%). Sono stati raccolti dati epidemiologici, dati riguardanti il decorso clinico e le indagini laboratoristiche e radiologiche a cui i pazienti sono stati sottoposti al momento dell’accesso in Pronto

  9. Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma

    Directory of Open Access Journals (Sweden)

    Milanchi S

    2009-01-01

    Full Text Available Background: The role of video-assisted Thoracoscopic Surgery (VATS is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. Materials and Methods: All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. Results: Twenty-three trauma patients underwent 25 cases of VATS. The most common indication for VATS was retained haemothorax. Thoracotomy was avoided in 21 patients. VATS failed in two cases. On an average VATS was performed on trauma day seven (range 1-26 and the length of hospital stay was 20 days (range 3-58. There was no mortality. VATS was performed in an emergency (day 1-2, or in the early (day 2-7 or late (after day 7 phases of trauma. Conclusion: VATS can be performed safely for the management of thoracic traumas. VATS can be performed before or after thoracotomy and at any stage of trauma. The use of VATS in trauma has a trimodal distribution (emergent, early, late, each with different indications.

  10. N-Acetylcysteine counteracts oxidative stress and protects alveolar epithelial cells from lung contusion-induced apoptosis in rats with blunt chest trauma.

    Science.gov (United States)

    Topcu-Tarladacalisir, Yeter; Tarladacalisir, Taner; Sapmaz-Metin, Melike; Karamustafaoglu, Altemur; Uz, Yesim Hulya; Akpolat, Meryem; Cerkezkayabekir, Aysegul; Turan, Fatma Nesrin

    2014-08-01

    The aim of this study was to investigate the protective effects of N-acetylcysteine (NAC) on peroxidative and apoptotic changes in the contused lungs of rats following blunt chest trauma. The rats were randomly divided into three groups: control, contusion, and contusion + NAC. All the rats, apart from those in the control group, performed moderate lung contusion. A daily intramuscular NAC injection (150 mg/kg) was given immediately following the blunt chest trauma and was continued for two additional days following cessation of the trauma. Samples of lung tissue were taken in order to evaluate the tissue malondialdehyde (MDA) level, histopathology, and epithelial cell apoptosis using terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay and active caspase-3 immunostaining. In addition, we immunohistochemically evaluated the expression of surfactant protein D (SP-D) in the lung tissue. The blunt chest trauma-induced lung contusion resulted in severe histopathological injury, as well as an increase in the MDA level and in the number of cells identified on TUNEL assay together with active caspase-3 positive epithelial cells, but a decrease in the number of SP-D positive alveolar type 2 (AT-2) cells. NAC treatment effectively attenuated histopathologic, peroxidative, and apoptotic changes, as well as reducing alterations in SP-D expression in the lung tissue. These findings indicate that the beneficial effects of NAC administrated following blunt chest trauma is related to the regulation of oxidative stress and apoptosis.

  11. Neurodegeneration and Vision Loss after Mild Blunt Trauma in the C57Bl/6 and DBA/2J Mouse.

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    Courtney Bricker-Anthony

    Full Text Available Damage to the eye from blast exposure can occur as a result of the overpressure air-wave (primary injury, flying debris (secondary injury, blunt force trauma (tertiary injury, and/or chemical/thermal burns (quaternary injury. In this study, we investigated damage in the contralateral eye after a blast directed at the ipsilateral eye in the C57Bl/6J and DBA/2J mouse. Assessments of ocular health (gross pathology, electroretinogram recordings, optokinetic tracking, optical coherence tomography and histology were performed at 3, 7, 14 and 28 days post-trauma. Olfactory epithelium and optic nerves were also examined. Anterior pathologies were more common in the DBA/2J than in the C57Bl/6 and could be prevented with non-medicated viscous eye drops. Visual acuity decreased over time in both strains, but was more rapid and severe in the DBA/2J. Retinal cell death was present in approximately 10% of the retina at 7 and 28 days post-blast in both strains. Approximately 60% of the cell death occurred in photoreceptors. Increased oxidative stress and microglial reactivity was detected in both strains, beginning at 3 days post-injury. However, there was no sign of injury to the olfactory epithelium or optic nerve in either strain. Although our model directs an overpressure air-wave at the left eye in a restrained and otherwise protected mouse, retinal damage was detected in the contralateral eye. The lack of damage to the olfactory epithelium and optic nerve, as well as the different timing of cell death as compared to the blast-exposed eye, suggests that the injuries were due to physical contact between the contralateral eye and the housing chamber of the blast device and not propagation of the blast wave through the head. Thus we describe a model of mild blunt eye trauma.

  12. Presacral retroperitoneal hematoma after blunt trauma presents with rectal bleeding — A case report

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    Sanne Jensen Dich

    2016-01-01

    Conclusion: Rectal bleed after trauma, in a patient receiving anticoagulant treatment, should raise suspicion of a penetrating hematoma, and such patients should be managed at highly specialized facilities.

  13. Mesenteric thrombosis in patient victim of blunt abdominal trauma Trombose mesentérica em vítima de trauma abdominal fechado

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    Iwan Augusto Collaço

    2008-06-01

    Full Text Available INTRODUCTION: Mesenteric thrombosis related to trauma is an uncommon entity and has poor prognosis when associated to low perfusion and hemorrhagic shock. Usually presents a challenging diagnosis and high mortality rates, despite appropriate treatment. OBJECTIVE: To relate a case of a car accident and blunt abdominal trauma with terminal ileum and right colon necrosis. CASE REPORT: After initial procedures, complementary exams showed ribs and humerus fractures. Computerized tomography evidenced aerial distension in small bowel, gastric stasis and hidro-pneumothorax. Hypotension was observed during clinical observation followed by cardiopulmonary arrest, responding to reanimation. At surgery, it was found extensive necrosis of right colon and terminal ileum, and an ileum-transversostomy was performed with primary anastomosis. During the staying in intensive care unit, oliguria, miosis, convulsion and pulseless electric activity happened with death in three days after hospital admission. CONCLUSION: Although uncommon, mesenteric ischemia with venous thrombosis might be secondary to blunt abdominal trauma and must be considered in a bad abdominal evolution.INTRODUÇÃO: Trombose mesentérica, relacionada à trauma é entidade incomum com pobre prognóstico quando seguida de estados de baixo fluxo e choque hipovolêmico. Geralmente se apresenta com quadro de difícil diagnóstico, mortalidade elevada a despeito de tratamento adequado. OBJETIVO: Apresentar um caso de vítima de atropelamento que evoluiu com necrose de cólon direito e íleo terminal. RELATO DO CASO: Após admissão hospitalar e atendimento inicial, os exames complementares mostraram fratura de costela e úmero. Tomografia computadorizada evidenciou distensão aérea em intestino delgado associada à estase gástrica e hidropneumotórax. O paciente evoluiu com hipotensão durante o período de observação clínica, com parada cardiorespiratória, respondendo à reanimação. Levado

  14. Delayed cardiac tamponade in a patient with previous minor blunt chest trauma

    NARCIS (Netherlands)

    Hermens, Jeannine A.J.M.; Wajon, Elly M.C.J.; Grandjean, Jan G.; Haalebos, Max M.P.; Birgelen, von Clemens

    2009-01-01

    Hemopericardium with cardiac tamponade after non-penetrating chest trauma is a very rare but life-threatening condition. If this complication develops after an interval of several weeks following the non-penetrating chest trauma, the causal relation with the traumatic event is less evident, which ma

  15. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

    NARCIS (Netherlands)

    Schotanus, M.; Middendorp, J.J. van; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Prospective single cohort study. OBJECTIVE: To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. SUMMARY OF BACKGROUND DAT

  16. [A case of postcardiac injury syndrome with repeated pleuritis after blunt chest trauma].

    Science.gov (United States)

    Namba, Ryoichi; Yamamoto, Yusuke; Nawa, Takeshi; Endo, Katuyuki

    2009-12-01

    A 59-year-old man suffered blunt injury to the left chest during a fall in August 2004. He had 5 repeated episodes of back and left chest pain in three years since August 2005. Since these symptoms were accompanied by left pleural effusion and serum inflammatory reaction, the tentative diagnosis was pleuritis. Although examinations of pleural effusion showed exudation with marked augmentation of inflammatory cells, there were no findings that suggested the cause of repetitive pleuritis. All symptoms were relieved within one or two weeks following administration of non-steroid anti-inflammatory drugs. Surgical thoracoscopy was carried out to investigate the cause of repeated pleuritis, and an acquired deficit of the left pericardium was noted. We considered this case to be postcardiac injury syndrome causing repeated pleuritis following blunt chest injury.

  17. Delayed recurrent pericarditis complicated by pericardial effusion and cardiac tamponade in a blunt trauma patient

    OpenAIRE

    Khidir, Hazar H.; Bloom, Jordan P; Hawkins, Alexander T.

    2015-01-01

    A 19-year-old male suffered orthopedic fractures, blunt solid organ injury and pneumopericardium after a fall from 40 feet. With the exception of an external fixation device, he was managed non-operatively and discharged to a rehabilitation unit after 8 days. He was readmitted 4 days later with chest pain and clinical evidence of pericardititis that resolved with the initiation of non-steroidal anti-inflammatory drugs and colchicine. He returned to the rehabilitation hospital, but was readmit...

  18. Isolated perforation of Meckel′s diverticulum following blunt trauma abdomen: A rare case report

    OpenAIRE

    Syeda Siddiqua Banu; Joshi, Sanjeev B; Vidyadhar A Kinhal; Desai, Mahesh S.

    2015-01-01

    Meckel′s diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in about 2% of the population and, in most cases, incidentally being discovered during autopsy, laparotomy, or barium studies. Hemorrhage, obstruction, and inflammation are the complications that can occur in a Meckel′s diverticulum. Perforation in a Meckel′s diverticulum can occur in the presence of ectopic mucosa which is rare, but perforation following blunt abdominal injury is very rare an...

  19. Unusual case of life threatening subcutaneous hemorrhage in a blunt trauma patient

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    Ashraf F. Hefny

    2015-01-01

    Conclusion: Bleeding into the subcutaneous plane in closed degloving injury can cause severe hypovolemic shock. It is important for the clinicians managing trauma patients to be aware this serious injury.

  20. Pseudoaneurysm of the Profunda Femoris Artery following Blunt Trauma Treated by Endovascular Coil Embolization: Review of Two Cases and Relevant Literature

    Science.gov (United States)

    McNerney, Patrick; Kiproff, Paul

    2017-01-01

    Profunda femoris artery (PFA) pseudoaneurysm after blunt trauma without associated femur fracture is a rare occurrence. Most of the reported cases of PFA pseudoaneurysm in the English literature developed after penetrating trauma, surgical procedures, and femur fractures. We present two such cases following blunt trauma and without any associated long bone injury. After initial imaging failed to show any long bone fracture, CT angiography confirmed pseudoaneurysm of the branch of the PFA. Both patients were then treated with emergent coil embolization of the bleeding vessel. Pseudoaneurysms typically present late and signs of persistent hip pain, thigh swelling, presence of a pulsatile mass, and even unexplained anemia all may suggest the diagnosis. Recognition of PFA pseudoaneurysm requires high index of suspicion and is often difficult to diagnose clinically because of its location. PMID:28246563

  1. Histone deactylase gene expression profiles are associated with outcomes in blunt trauma patients

    DEFF Research Database (Denmark)

    Sillesen, Martin; Bambakidis, Ted; Dekker, Simone E

    2016-01-01

    BACKGROUND: Treatment with histone deacetylase (HDAC) inhibitors, such as valproic acid, increases survival in animal models of trauma and sepsis. Valproic acid is a pan-inhibitor that blocks most of the known HDAC isoforms. Targeting individual HDAC isoforms may increase survival and reduce...

  2. Hemodynamic Changes Following Routine Fluid Resuscitation in Patients With Blunt Trauma

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    Paydar

    2016-05-01

    Full Text Available Background The management of trauma patients is often difficult. The American college of surgeons suggests using advanced trauma life support (ATLS measures. ATLS is regarded as the gold standard for the resuscitation of cases with acute life threatening injuries. Objectives To assess the change in base excess (BE values and central venous pressure (CVP one and six hours after injection of 1000 cc normal saline in trauma patients admitted to the ICU. Patients and Methods According to the inclusion and exclusion criteria, patients were randomly selected to participate in the project. Inclusion criteria included trauma patients admitted to the ICU with a CVP line and who had indication for hydration. In trauma patients, at the zero time period, BP, PR, RR and CVP were measured, and a blood gas test was used to assess Hb, pH, BE, PO2, HCO3 and PCO2. Then 1000 cc of normal saline was injected, and after one and six hours, the same values were re-evaluated. Results The mean age of the patients was 38.1 ± 3.9 (range 15 - 60. The mean duration of hospitalization was 7.4 ± 4.4 (range 1 - 21 days. The mean ISS for these patients was 14.33 ± 5.3. BE changes in both groups of patients, based on Hb primary division, showed a significant difference (P ≤ 0.05. The results showed that there was no significant relation between the measured ISS and the changes in base values (P ≥ 0.05. Conclusions According to our results, the infusion of one liter normal saline will cause a statistically significant decrease only in BD, after one hour, in patients with moderate to severe ISS. The changes in SBP, PR, CVP and also pH, HCO3 and Hb were not statistically remarkable.

  3. Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important?

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    Schneir, Aaron

    2001-07-01

    Full Text Available The purpose of this study was to describe the clinical findings in patients with splenic injury and to determine if isolated left lower chest injury may be the single clinical indicator of splenic injury. The medical records of all adult blunt trauma patients with splenic injury over a 14 month period were reviewed. Significant left lower chest injury was considered present if the patient had left sided pleuritic chest pain with tenderness to ribs 7-12 or if these ribs were visualized as fractured on any imaging study. Patients were considered to have clinical findings suggestive of splenic injury if they had pre-hospital or emergency department hypotension, abdominal pain or tenderness, a Glasgow coma scale < 15, or gross hematuria. Ninety patients had splenic injury. Thirty-nine (43%. 95% CI 33, 54% patients had significant left lower chest injury. In five (6%. 95% CI 2, 12% patients, injury to this portion of the chest was the single indicator of splenic injury. Nearly half the patients with splenic injury will have significant injury to the left lower chest and this finding may be the only indicator of splenic injury.

  4. Delayed recurrent pericarditis complicated by pericardial effusion and cardiac tamponade in a blunt trauma patient

    Directory of Open Access Journals (Sweden)

    Hazar H Khidir

    2015-01-01

    Full Text Available A 19-year-old male suffered orthopedic fractures, blunt solid organ injury and pneumopericardium after a fall from 40 feet. With the exception of an external fixation device, he was managed non-operatively and discharged to a rehabilitation unit after 8 days. He was readmitted 4 days later with chest pain and clinical evidence of pericardititis that resolved with the initiation of non-steroidal anti-inflammatory drugs and colchicine. He returned to the rehabilitation hospital, but was readmitted once again for chest pain and hypotension. Echocardiogram revealed cardiac tamponade that required emergent drainage. He tolerated the procedure well and was discharged home from the hospital to continue treatment for his pericarditis. He is doing well at 3 months of follow-up.

  5. Laryngeal Fracture after Blunt Cervical Trauma in Motorcycle Accident and Its Management

    Science.gov (United States)

    Carneiro Sousa, Pedro; Abreu Pereira, Diogo; Azevedo, Paula; Duarte, Delfim

    2017-01-01

    Laryngeal fracture is a rare traumatic injury, potentially fatal, with an estimated incidence of 1 in 30,000 patients admitted to severe trauma centers. Because of the rarity of this injury, physician may be not aware of its existence, leading to a late diagnosis of this entity. We report a case of a 59-year-old woman admitted to the emergency room after a motorcycle accident with cervical trauma. The patient presented with dysphonia, hemoptysis, cervical subcutaneous emphysema, and increasing respiratory distress that led to the intubation of the patient. CT-scan demonstrated displaced fracture of the cricoid and thyroid cartilage. The patient was submitted to tracheostomy and the fracture was surgically repaired. Tracheostomy was removed in third postoperative month. The patient presented a good recovery, reporting only hoarseness but without swallowing or breathing problems at 6-month follow-up.

  6. Blunt transection of rectus abdominis following seatbelt related trauma with associated small and large bowel injury☆

    Science.gov (United States)

    Patel, K.; Doolin, R.; Suggett, N.

    2013-01-01

    INTRODUCTION Closed rupture of rectus abdominis following seatbelt related trauma is rare. PRESENTATION OF CASE We present the case of a 45 year old female who presented with closed rupture of the rectus abdominis in conjunction with damage to small bowel mesentery and infarction of small and large bowel following a high velocity road traffic accident. Multiple intestinal resections were required resulting in short bowel syndrome and abdominal wall reconstruction with a porcine collagen mesh. Post-operative complications included intra-abdominal sepsis and an enterocutaneous fistula. DISCUSSION The presence of rupture of rectus abdominis muscle secondary to seatbelt injury should raise the suspicion of intra-abdominal injury. CONCLUSION Our case highlights the need for suspicion, investigation and subsequent surgical management of intra-abdominal injury following identification of this rare consequence of seatbelt trauma. PMID:24055917

  7. Laryngeal Fracture after Blunt Cervical Trauma in Motorcycle Accident and Its Management

    Directory of Open Access Journals (Sweden)

    Nuno Ribeiro-Costa

    2017-01-01

    Full Text Available Laryngeal fracture is a rare traumatic injury, potentially fatal, with an estimated incidence of 1 in 30,000 patients admitted to severe trauma centers. Because of the rarity of this injury, physician may be not aware of its existence, leading to a late diagnosis of this entity. We report a case of a 59-year-old woman admitted to the emergency room after a motorcycle accident with cervical trauma. The patient presented with dysphonia, hemoptysis, cervical subcutaneous emphysema, and increasing respiratory distress that led to the intubation of the patient. CT-scan demonstrated displaced fracture of the cricoid and thyroid cartilage. The patient was submitted to tracheostomy and the fracture was surgically repaired. Tracheostomy was removed in third postoperative month. The patient presented a good recovery, reporting only hoarseness but without swallowing or breathing problems at 6-month follow-up.

  8. SPLENIC VOLVULUS WITH LACERATION AFTER TRIVIAL TRAUMA IN A CASE OF WANDERING SPLEEN: A RARE CASE REPORT

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    Vinayak

    2016-03-01

    Full Text Available BACKGROUND Volvulus of wandering spleen is a rare clinical occurrence with fewer than 500 cases reported and an incidence of less than 0.2%. We present a case of a 27-year-old man, who complained of a short history of severe abdominal pain with the background of recurrent abdominal pain. Ultrasound revealed wandering spleen with splenic vein thrombosis. An abdominal contrast enhanced computerized tomography scan revealed a torted wandering spleen with splenic vein thrombosis with infarction. This required a splenectomy due to splenic infarction. This report highlights the investigations including USG and CECT necessary for a patient who presents with an ischaemic torted wandering spleen.

  9. Mid- and Long-Term Results of Endovascular Treatment in Thoracic Aorta Blunt Trauma

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    Luigi Irace

    2012-01-01

    Full Text Available Study Aim. Evaluation of results in blunt injury of the thoracic aorta (BAI endovascular treatment. Materials and Methods. Sixteen patients were treated for BAI. Thirteen patients had associated polytrauma, 4 of these had a serious hypotensive status and 4 had an hemothorax. In the remaining 3, two had a post-traumatic false aneurysm of the isthmus and 1 had a segmental dissection. In those 13 patients a periaortic hematoma was associated to hemothorax in 4. All patients were submitted to an endovascular treatment, in two cases the subclavian artery ostium was intentionally covered. Results. One patient died for disseminated intravascular coagulation. No paraplegia was recorded. No ischemic complications were observed. A type I endoleak was treated by an adjunctive cuff. During the followup (1–9 years 3 patients were lost. A good patency and no endoleaks were observed in all cases. One infolding and 1 migration of the endografts were corrected by an adjunctive cuff. Conclusion. The medium and long term results of the endovascular treatment of BAI are encouraging with a low incidence rate of mortality and complications. More suitable endo-suite and endografts could be a crucial point for the further improvement of these results.

  10. A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

    Energy Technology Data Exchange (ETDEWEB)

    Demir, F. [Department of Pediatric Cardiology, Faculty of Medicine, Dicle University, Diyarbakır (Turkey); Güzel, A. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Katı, C. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Karadeniz, C. [Pediatric Cardiology Services, Behçet Uz Children' s Hospital, İzmir (Turkey); Akdemir, U. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Okuyucu, A. [Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Gacar, A. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey); Özdemir, S. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Güvenç, T. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey)

    2014-08-01

    Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg{sup −1}·day{sup −1}), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

  11. Early diagnosis of hollow viscus injury using intestinal fatty acid–binding protein in blunt trauma patients

    Science.gov (United States)

    Matsumoto, Shokei; Sekine, Kazuhiko; Funaoka, Hiroyuki; Funabiki, Tomohiro; Shimizu, Masayuki; Hayashida, Kei; Kitano, Mitsuhide

    2017-01-01

    Abstract A delay in diagnosing hollow viscus injury (HVI) causes an increase in mortality and morbidity. HVI remains a challenge to diagnose, and there is no specific diagnostic biomarker for HVI. We evaluated the utility of intestinal fatty acid–binding protein (I-FABP) in diagnosing HVI in blunt trauma patients. Within a 5-year period, 93 consecutive patients with clinically suspected HVI at our trauma center were prospectively enrolled. The diagnostic performance of I-FABP for HVI was compared with that of other various parameters (physical, laboratory, and radiographic findings). HVI was diagnosed in 13 patients (14%), and non-HVI was diagnosed in 80 patients (86%). The level of I-FABP was significantly higher in patients with HVI than in those with non-HVI (P = 0.014; area under the curve, 0.71). The sensitivity, specificity, positive predictive value, and negative predictive value were 76.9%, 70.0%, 29.4%, and 94.9%, respectively (P = 0.003). However, all other biomarkers were not significantly different between the groups. Presence of extraluminal air, bowel wall thickening on computed tomography (CT), and peritonitis signs were significantly higher in patients with HVI (P < 0.05). Of 49 patients (52.7%) who had a negative I-FABP and negative peritonitis signs, none developed HVI (sensitivity, 100%; negative predictive value, 100%). This is the first study that demonstrated the diagnostic value of a biomarker for HVI. I-FABP has a higher negative predictive value compared to traditional diagnostic tests. Although the accuracy of I-FABP alone was insufficient, the combination of I-FABP and other findings can enhance diagnostic ability. PMID:28272208

  12. Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit

    OpenAIRE

    Dunham, C Michael; Brocker, Brian P; Collier, B David; Gemmel, David J

    2008-01-01

    Introduction In blunt trauma, comatose patients (Glasgow Coma Scale score 3 to 8) with a negative comprehensive cervical spine (CS) computed tomography assessment and no apparent spinal deficit, CS clearance strategies (magnetic resonance imaging [MRI] and prolonged cervical collar use) are controversial. Methods We conducted a literature review to delineate risks for coma, CS instability, prolonged cervical collar use, and CS MRI. Results Based on our search of the literature, the numbers of...

  13. Open partial splenectomy for trauma using GIA-Stapler and FloSeal matrix haemostatic agent.

    Science.gov (United States)

    Costamagna, Daniela; Rizzi, Sabrina; Zampogna, Annunziatino; Alonzo, Amedeo

    2010-08-09

    A ruptured spleen caused by blunt abdominal injury is often treated by splenectomy. In view of the gravity of the 'postsplenectomy syndrome,' a conservative approach has been increasingly used. We present the case of a 29-year-old man with a Grade III splenic lesion for a blunt abdominal trauma after a car accident. We performed a partial splenectomy of the upper pole using GIA-Stapler. A supplemental haemostasis of the stapled line was successfully achieved by the application of FloSeal matrix haemostatic agent. The splenic remnant was fixed into the left-upper quadrant using human fibrin glue.

  14. Evaluation of magnetic resonance imaging for the diagnosis of acute blunt testicular trauma.%急性睾丸闭合性损伤的MRI诊断价值

    Institute of Scientific and Technical Information of China (English)

    雷益; 李顶夫; 郭琪; 侯严振; 伍晓六

    2011-01-01

    Objective To investigate the value of MRI in the diagnosis of acute blunt tesficular trauma.Methods 12 cases with clinical diagnosis as acute blunt testicular trauma, were selected to receive MRI examination within 72h after injury. The imaging data were retrospectively analyzed. Results Testis parenchymal hemorrhage in 7 cases combined with subalbugineous hematoma in 2 cases, rupture of testis in 5 cases which showed disappear of normal structure, rupture of albuginea and protruding of the testis tissue. Conclusion MRI scan could precisely demonstrate all types of blunt testicular trauma and offer reliable evidence for clinical diagnosis.%目的 探讨MRI对急性睾丸闭合性损伤的诊断价值.方法 回顾性分析12例临床诊断为睾丸闭合性损伤患者的伤后72h内MRI表现.结果 睾丸实质出血7例,其中2例伴有白膜下血肿;睾丸破裂5例,均伴有不同程度鞘膜囊积血及阴囊肿大.结论 MRI能清楚显示各种类型的睾丸闭合性损伤,明确睾丸损伤程度,有助于临床治疗方案的选择.

  15. Isolated extrahepatic bile duct rupture: a rare consequence of blunt abdominal trauma. Case report and review of the literature

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    Balzarotti Ruben

    2012-05-01

    Full Text Available Abstract A 16-year-old girl suffered blunt abdominal trauma. Clinically, a severe motor impairment with paraesthesia of the legs was found. Posterior osteosynthesis in T10-L1 with laminectomy in T10-T12 and posterolateral arthrodesis in T11-T12 was performed because of a dorsal traumatic vertebral fracture. On hospital day 7, because of an acute abdomen, surgical laparoscopic exploration showed sterile bloody fluid without any evident hemorrhagic injury. On hospital day 11, the patient was reoperated on by the laparoscopic approach for increasing abdominal pain and fever: a peritoneal biliary fluid was aspirated. After conversion to open surgery, cholecystectomy was performed. Intraoperative cholangiography was considered as normal. On arrival at our institution 13 days after injury, the patient was operated on for a biliary peritonitis. Intraoperatively, a trans-cystic cholangiography showed a biliary leakage of the common bile duct; a T-tube was placed into the common bile duct; a subhepatic drainage was placed too. On postoperative day 30, a T-tube cholangiography showed a normal biliary tree, without any leakage, and the T-tube was subsequently removed. The patient had a complete recovery.

  16. When Physics Meets Biology: Low and High Velocity Penetration, Blunt Trauma and Blast Injuries to the Brain

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    Leanne eYoung

    2015-05-01

    Full Text Available The incidence of TBI in the US has reached epidemic proportions with well over 2 million new cases reported each year. TBI can occur in both civilians and warfighters, with head injuries occurring in both combat and non-combat situations from a variety of threats, including ballistic penetration, acceleration, blunt impact, and blast. Most generally, TBI is a condition in which physical loads exceed the capacity of brain tissues to absorb without injury. More specifically, TBI results when sufficient external force is applied to the head and is subsequently converted into stresses that must be absorbed or redirected by protective equipment. If the stresses are not sufficiently absorbed or redirected, they will lead to damage of extracranial soft tissue and the skull. Complex interactions and kinematics of the head, neck and jaw cause strains within the brain tissue, resulting in structural, anatomical damage that is characteristic of the inciting insult. This mechanical trauma then initiates a neuro-chemical cascade that leads to the functional consequences of TBI, such as cognitive impairment. To fully understand the mechanisms by which TBI occurs, it is critically important to understand the effects of the loading environments created by these threats. In the following, a review is made of the pertinent complex loading conditions and how these loads cause injury. Also discussed are injury thresholds and gaps in knowledge, both of which are needed to design improved protective systems.

  17. Concomitant abducens and facial nerve palsies following blunt head trauma associated with bone fracture.

    Science.gov (United States)

    Ji, Min-Jeong; Han, Sang-Beom; Lee, Seung-Jun; Kim, Moosang

    2015-07-15

    A 22-year-old man was referred for horizontal diplopia that worsened on left gaze. He had been admitted for a head trauma caused by a traffic accident. Brain CT scan showed a longitudinal fracture of the left temporal bone with extension to the left carotid canal and central skull base, including sphenoid lateral wall and roof, and left orbit medial wall non-displaced fracture. Prism cover test revealed 20 prism diopters of esotropia and abduction limitation in the left eye. Hess screening test results were compatible with left abducens nerve paralysis. Symptoms suggesting complete lower motor neuron palsy of the left facial nerve, such as unilateral facial drooping, inability to raise the eyebrow and difficulty closing the eye, were present. As there was no improvement in facial paralysis, the patient received surgical intervention using a transmastoidal approach. Three months postoperatively, prism cover test showed orthotropia, however, the facial nerve palsy persisted.

  18. Socio-economic outcome after blunt orthopaedic trauma: Implications on injury prevention

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    Zilkens Anna

    2011-05-01

    Full Text Available Abstract Background Several large studies have identified factors associated with long-term outcome after orthopaedic injuries. However, long-term social and economic implications have not been published so far. The aim of this investigation is to study the long-term socio-economic consequences of patients sustaining severe trauma. Methods Patients treated at a level one trauma center were invited for a follow-up (at least 10 years examination. There were 637 patients who responded and were examined. Inclusion criteria included injury severity score (ISS ≥ 16 points, presence of lower and upper extremity fractures, and age between 3 and 60 years. Exclusion criteria included the presence of amputations and paraplegia. The socio-economic outcome was evaluated in three age groups: group I ( 50 years. The following parameters were analyzed using a standardized questionnaire: financial losses, net income losses, pension precaution losses, need for a bank loan, and the decrease in number of friends. Results 510 patients matched all study criteria, and breakdown of groups were as follows: 140 patients in group I, 341 patients in group II, and 29 patients in group III. Financial losses were reported in all age groups (20%-44%. Younger patients (group I were associated with less income losses when compared with other groups (p Conclusions Economic consequences are reported by polytraumatized patients even ten or more years after injury. Financial losses appear to be common in patients between 19 and 50 years. In contrast, social deprivation appears to be most pronounced in the younger age groups. Early socio-economic support and measures of injury prevention should focus on these specific age groups.

  19. Angiographic embolization in the treatment of intrahepatic arterial bleeding in patients with blunt abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    Ya-Lin Kong; Hong-Yi Zhang; Xiao-Jun He; Gang Zhao; Cheng-Li Liu; Mei Xiao and Yu-Ying Zhen

    2014-01-01

    BACKGROUND: Angiographic embolization (AE) as an adjunct non-operative treatment of intrahepatic arterial bleeding has been widely used. The present study aimed to evaluate the efifcacy of selective AE in patients with hepatic trauma. METHODS: Seventy patients with intrahepatic arterial bleeding after blunt abdominal trauma who had undergone selective AE in 10 years at this institution were retrospectively reviewed. The  criteria  for  selective  AE  included  active  extravasation on  contrast-enhanced  CT,  an  episode  of  hypotension  or a  decrease  in  hemoglobin  level  during  the  non-operative treatment. The data of the patients included demographics, grade of liver injuries, mechanism of blunt abdominal trauma, associated  intra-abdominal  injuries,  indications  for  AE, angiographic ifndings, type of AE, and AE-related hepatobiliary complications. RESULTS: In the 70 patients, 32 (45.71%) had high-grade liver injuries. Extravazation during the early arterial phase mainly involved the right hepatic segments. Thirteen (18.57%) patients underwent  embolization  of  intrahepatic  branches  and  the extrahepatic trunk and these patients all developed AE-related hepatobiliary complications. In 19 patients with AE-related complications, 14 received minimally invasive treatment and recovered without severe sequelae. CONCLUSIONS: AE is an adjunct treatment for liver injuries. Selective and/or super-selective AE should be advocated to decrease the incidence and severity of AE-related hepatobiliary complications.

  20. Presacral retroperitoneal hematoma after blunt trauma presents with rectal bleeding - A case report

    DEFF Research Database (Denmark)

    Dich, Sanne Jensen; El-Hussuna, Alaa Abdul-Hussein Hmood

    2016-01-01

    INTRODUCTION: We present a case of a presacral hematoma, which penetrated into the rectum resulting in rectal bleeding. This is an unusual presentation of a presacral hematoma. PRESENTATION OF THE CASE: A 76-year-old woman, using warfarin anticoagulant prophylaxis, presented with a rectal bleed t......: Rectal bleed after trauma, in a patient receiving anticoagulant treatment, should raise suspicion of a penetrating hematoma, and such patients should be managed at highly specialized facilities....... in the gastrointestinal tract. In this report the patient's anticoagulant treatment has likely contributed to bleeding and the formation of the hematoma. To our knowledge, this is the first case report of a presacral hematoma acutely penetrating into the rectum and causing lower gastrointestinal bleeding. CONCLUSION......INTRODUCTION: We present a case of a presacral hematoma, which penetrated into the rectum resulting in rectal bleeding. This is an unusual presentation of a presacral hematoma. PRESENTATION OF THE CASE: A 76-year-old woman, using warfarin anticoagulant prophylaxis, presented with a rectal bleed two...

  1. Blunt Abdominal Trauma Patients Are at Very Low Risk for Intra-Abdominal Injury after Emergency Department Observation

    Directory of Open Access Journals (Sweden)

    Jason S Haukoos

    2011-05-01

    Full Text Available Introduction: Patients are commonly admitted to the hospital for observation following blunt abdominal trauma (BAT, despite initially negative emergency department (ED evaluations. With the current use of screening technology, such as computed tomography (CT of the abdomen and pelvis, ultrasound, and laboratory evaluations, it is unclear which patients require observation. The objective of this study was to determine the prevalence of intra-abdominal injury (IAI and death in hemodynamically normal and stable BAT patients with initially negative ED evaluations admitted to an ED observation unit and to define a low-risk subgroup of patients and assess whether they may be discharged without abdominal/pelvic CT or observation. Methods: This was a retrospective cohort study performed at an urban level 1 trauma center and included all BAT patients admitted to an ED observation unit as part of a BAT key clinical pathway. All were observed for at least 8 hours as part of the key clinical pathway, and only minors and pregnant women were excluded. Outcomes included the presence of IAI or death during a 40-month follow-up period. Prior to data collection, low-risk criteria were defined as no intoxication, no hypotension or tachycardia, no abdominal pain or tenderness, no hematuria, and no distracting injury. To be considered low risk, patients needed to meet all low-risk criteria. Results: Of the 1,169 patients included over the 2-year study period, 29% received a CT of the abdomen and pelvis, 6% were admitted to the hospital from the observation unit for further management, 0.4% (95% confidence interval [CI], 0.1%–1% were diagnosed with IAI, and 0% (95% CI, 0%–0.3% died. Patients had a median combined ED and observation length of stay of 9.5 hours. Of the 237 (20% patients who met low-risk criteria, 7% had a CT of the abdomen and pelvis and 0% (95% CI, 0%–1.5% were diagnosed with IAI or died. Conclusion: Most BAT patients who have initially negative

  2. Bilateral dissection of the internal carotid artery at the base of the skull due to blunt trauma: incidence and severity.

    Science.gov (United States)

    Alimi, Y; Di Mauro, P; Tomachot, L; Albanese, J; Martin, C; Alliez, B; Juhan, C

    1998-11-01

    , severe permanent hemiplegia in two cases, and minimal or no sequels in two cases. Following blunt trauma, arteriography of supraaortic vessels should be performed to detect BCAD in any patient with immediate or delayed neurologic symptoms that cannot be explained by CT-scan findings. To better understand the natural course of these lesions and define the indications for surgery, we propose a three-grade classification according to arteriographic findings. If surgery is undertaken, vein grafting should be performed following resection of the carotid artery lesions.

  3. Unenhanced Computed Tomography to Visualize Hollow Viscera and/or Mesenteric Injury After Blunt Abdominal Trauma: A Single-Institution Experience.

    Science.gov (United States)

    Yang, Xu-Yang; Wei, Ming-Tian; Jin, Cheng-Wu; Wang, Meng; Wang, Zi-Qiang

    2016-03-01

    To identify and describe the major features of unenhanced computed tomography (CT) images of blunt hollow viscera and/or mesenteric injury (BHVI/MI) and to determine the value of unenhanced CT in the diagnosis of BHVI/MI. This retrospective study included 151 patients who underwent unenhanced CT before laparotomy for blunt abdominal trauma between January 2011 and December 2013. According to surgical observations, patients were classified as having BHVI/MI (n = 73) or not (n = 78). Sensitivity, specificity, P values, and likelihood ratios were calculated by comparing CT findings between the 2 groups. Six significant CT findings (P < 0.05) for BHVI/MI were identified and their sensitivity and specificity values determined, as follows: bowel wall thickening (39.7%, 96.2%), mesentery thickening (46.6%, 88.5%), mesenteric fat infiltration (12.3%, 98.7%), peritoneal fat infiltration (31.5%, 87.1%), parietal peritoneum thickening (30.1%, 85.9%), and intra- or retro-peritoneal air (34.2%, 96.2%). Unenhanced CT scan was useful as an initial assessment tool for BHVI/MI after blunt abdominal trauma. Six key features on CT were correlated with BHVI/MI.

  4. The accuracy of FAST in relation to grade of solid organ injuries: A retrospective analysis of 226 trauma patients with liver or splenic lesion

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    Candinas Daniel

    2009-03-01

    Full Text Available Abstract Background This study investigated the role of a negative FAST in the diagnostic and therapeutic algorithm of multiply injured patients with liver or splenic lesions. Methods A retrospective analysis of 226 multiply injured patients with liver or splenic lesions treated at Bern University Hospital, Switzerland. Results FAST failed to detect free fluid or organ lesions in 45 of 226 patients with spleen or liver injuries (sensitivity 80.1%. Overall specificity was 99.5%. The positive and negative predictive values were 99.4% and 83.3%. The overall likelihood ratios for a positive and negative FAST were 160.2 and 0.2. Grade III-V organ lesions were detected more frequently than grade I and II lesions. Without the additional diagnostic accuracy of a CT scan, the mean ISS of the FAST-false-negative patients would be significantly underestimated and 7 previously unsuspected intra-abdominal injuries would have been missed. Conclusion FAST is an expedient tool for the primary assessment of polytraumatized patients to rule out high grade intra-abdominal injuries. However, the low overall diagnostic sensitivity of FAST may lead to underestimated injury patterns and delayed complications may occur. Hence, in hemodynamically stable patients with abdominal trauma, an early CT scan should be considered and one must be aware of the potential shortcomings of a "negative FAST".

  5. 严重钝性胸部外伤伴大量血胸的手术治疗%Blunt thoracic trauma partner massive hemothoraxes surgery treatment

    Institute of Scientific and Technical Information of China (English)

    邹恭道; 苏永红; 李鸣

    2012-01-01

    Objective To introduce the clinical experience the surgical operation treats the serious blunt thoracic trauma partner massive hemothoraxes. Methods Scases at the shock condition the serious blunt thoracic trauma partner massive hemo-thoraxes patient while anti- shock, the emergency medical treatment execution chest operation stops bleeding the surgery. Results 4 cases cure leave the hospital. After the operation the 5-10th day wiping out chest cavity drainage tube, 1 case once appeared separately stress ulcer, convalesced after the just right for the illness treatment; 1 case appears the pyothorax, but died because of the economical difficult giving up treatment. Conclusion The serious blunt thoracic trauma patient which continues the chest cavity internal hemorrhage should accumulate thoracotomy.%目的 介绍外科手术治疗严重钝性胸部外伤伴大量血胸的临床经验.方法 对5例处于休克状态的严重钝性胸部外伤伴大量血胸的患者在抗休克的同时,急诊施行剖胸止血手术.结果 4例均治愈出院,分别在术后第5~10天拔除胸腔引流管,其中1例曾出现应激性溃疡,经对症治疗后痊愈;1例出现脓胸,因经济困难放弃治疗而出院.结论 伴有持续胸腔内出血的严重钝性胸部外伤患者,应积极行剖胸探查术.

  6. A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT

    Directory of Open Access Journals (Sweden)

    Iyore AO James

    2014-01-01

    Full Text Available Clearance of cervical spine injury (CSI in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT, magnetic resonance imaging of the cervical spine (CS-MRI is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI website (www.ncbi.nlm.nih.gov for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%. The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%. Eleven patients (0.7% had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.

  7. Splenic infarction

    Science.gov (United States)

    Splenic infarction is the death of tissue (necrosis) in the spleen due to a blockage in blood flow. ... Common causes of splenic infarction include: Blood clots Blood diseases such as sickle cell anemia Infections such as endocarditis

  8. Blunt Trauma Data Correlation

    Science.gov (United States)

    1975-05-01

    Weapons (and other exciting protection, security and survival products). Product Brochure. 45. Roberts, Verne L. "Stun Gun" Preliminary Effects Study...1971. 57, Cruz-Jibaja, Julio C. Report Number4. Physiology of Respiration of High Elevations. DAHC 19-7I-GO001. University of Peru, Lima, Peru

  9. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

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    Kodai Suzuki

    Full Text Available Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions.This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching.In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1% underwent emergency resuscitative thoracotomy and 893 (64.9% received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P < 0.001 and 28 d after arrival (1.2% vs. 6.0%, respectively, P < 0.001. Multivariable generalized mixed-effects regression analysis with and without a propensity score-matched dataset revealed that the odds ratio for an unfavorable survival rate after 24 h was lower for

  10. Splenic rupture following colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Juan Francisco Guerra; Ignacio San Francisco; Fernando Pimentel; Luis Ibanez

    2008-01-01

    Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insufflation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.

  11. Preservation of the kidney with delayed diagnosis of traumatic pelvi-ureteric junction disruption secondary to blunt abdominal trauma in children

    Institute of Scientific and Technical Information of China (English)

    LI Ming-lei; LI Ning; SUN Ning; ZHANG Wei-ping; HUANG Cheng-ru; BAI Ji-wu; LIANG Ruo-xin; TIAN Jun; XIE Xiang-hui; SONG Hong-cheng

    2011-01-01

    Background The delayed diagnosis of pelvi-ureteric junction (PUJ) disruption in children following blunt abdominal trauma can result in loss of function of the involved kidney. We examined the potential for kidney preservation and the limits of diagnostic delays. Methods A retrospective review of 17 cases of PUJ disruption at Beijing Children's Hospital from 1993 to 2009 was done with respect to diagnosis, treatment and follow-up. Results The interval from trauma to diagnosis of PUJ disruption was (52±52) days. If one case with nephrectomy was excluded, the interval from trauma to diagnosis was (40±20) days. The average time between injury and first treatment was (49±25) days. Pelvi-ureteric reanastomosis and caliceal ureterostomy were performed separately in 11 and 4patients, respectively. lleal replacement for ureter injuries was finally performed in one patient. Hydronephrosis of the injured kidney was reduced and the function improved in 15 out of 17 patients (88%). Only one patient received nephrectomy and the nephrectomy rate was 5.9%. Conclusion Differential renal function at the PUJ disruption side can be saved and the rate of nephrectomy reduced by appropriate surgery if the time to diagnosis and first treatment is limited to within two months.

  12. Splenic abscess: a rare presentation

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    Mohit Bhatia

    2015-01-01

    Full Text Available Splenic abscess is a rare clinical entity with an incidence of 0.2-0.7% in autopsy-based studies. When untreated, splenic abscess is associated with nearly 100% mortality; in treated patients, the mortality rate is 16.6% during the first 90 days. It mostly occurs in patients with neoplasia, immunodeficiency, trauma, diabetes or splenic infarct. The incidence of splenic abscess is thought to be growing because of the increase in the number of immunocompromised patients who are particularly at risk for this disease and also because of the widespread use of diagnostic modalities. However, the optimal treatment for this remains unclear. We present a case of a 42-year-old man diagnosed with multiloculated splenic abscess and was subjected to splenectomy.

  13. Isolated Pediatric Pancreatic Transection Secondary to Ocean-Related Trauma

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    Afif N Kulaylat

    2013-03-01

    Full Text Available Context Isolated pancreatic transection is a rare but well-recognized complication following blunt trauma of the abdomen. Diagnosis at presentation may be difficult and delayed due to subtle initial symptoms and evolving nature of the injury. Case report We describe an isolated complete pancreatic transection in a 14-year-old female secondary to a previously unreported and highly unusual mechanism (being tossed by a wave. Diagnosis was obtained by computed tomography scan 24 hours following initial trauma. She was managed operatively with an open distal pancreatectomy with splenic preservation and no subsequent complications. Conclusions The force sustained from the blunt abdominal trauma of being tossed by a wave can be significant. The management of pancreatic injuries in children, particularly in the context of ductal transection, is controversial. Timely recognition and management is critical to optimal outcomes. Early operative intervention may help to avoid complications such as abscess or pseudocyst formation.

  14. Ruptura isolada da pelve renal secundária ao trauma abdominal contuso Isolated disruption of the renal pelvis by blunt trauma

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    Sizenando Vieira Starling

    2007-06-01

    Full Text Available Blunt rupture of the renal pelvis is a exceedingly rare injury. Hematuria is absent in one-third of cases. Such injuries are usually caused by desacceleration forces. Despite improved imaging techniques, diagnosis of this injuries is frequently delayed. Diagnosis is suggested by the presence of massive medial extravasation of contrast material at excretory urography or computed tomography. Surgical treatment consists in pyeloplasty or pyeloraphy with stent placement (double J or nephrostomy.

  15. The Impact of Transient Hepatic Attenuation Differences in the Diagnosis of Pseudoaneurysm and Arteriovenous Fistula on Follow-Up CT Scans after Blunt Liver Trauma

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    Andreas Hjelm Brandt

    2014-09-01

    Full Text Available A feared complication to liver trauma is delayed vascular complication, such as pseudoaneurysm and arteriovenous fistula (PS/AF seen as focal enhancement on contrast-enhanced computed tomography (CT in the arterial phase. A hyperdense area termed transient hepatic attenuation difference (THAD representing altered hepatic blood flow can be seen in the arterial phase near the liver lesion. The objective of this study was to describe THAD and PS/AF on follow-up CT after blunt liver trauma, and to evaluate if THAD influenced the evaluation of PS/AF. Three radiology residents retrospectively evaluated scans of 78 patients. The gold standard for PS/AF was an evaluation by an experienced senior radiologist, while THAD was a consensus between the residents. PS/AF was present in 14% and THAD in 54%. THAD was located in the periphery of the lesion with hazy borders and mean HU levels of 100, while PS/AF was located within the lesion with focal enhancement and mean HU levels of 170 (p < 0.05. In evaluation of PS/AF, the likelihood of agreement between the observers and the gold standard was 89% when THAD was present, and 98% when THAD was absent (p = 0.04. THAD is common and can hamper the evaluation of PS/AF.

  16. Value of CT to predict surgically important bowel and/or mesenteric injury in blunt trauma: performance of a preliminary scoring system

    Energy Technology Data Exchange (ETDEWEB)

    Faget, Claire; Taourel, Patrice; Ruyer, Alban; Alili, Chakib; Millet, Ingrid [CHU Lapeyronie, Department of Medical Imaging, Montpellier (France); Charbit, Jonathan [CHU Lapeyronie, Department of Intensive Care and Anesthesiology, Montpellier (France); Molinari, Nicolas [UMR 729 MISTEA, CHU Montpellier, Department of Medical Information and Statistics, Montpellier (France)

    2015-12-15

    To evaluate the performance of a computed tomography (CT) diagnostic score to predict surgical treatment for blunt bowel and/or mesentery injury (BBMI) in consecutive abdominal trauma. This was a retrospective observational study of 805 consecutive abdominal traumas with 556 patients included and screened by an abdominal radiologist blinded to the patient outcome, to evaluate numerous CT findings and calculate their diagnostic performances. These CT findings were compared using univariate and multivariate analysis between patients who had a laparotomy-confirmed BBMI requiring surgical repair, and those without BBMI requiring surgery. A CT score was obtained with an internal bootstrap validation. Fifty-six patients (10.1 %) had BBMI requiring surgery. Nine CT signs were independently associated with BBMI requiring surgery and were used to develop a CT diagnostic score. The AUC of our model was 0.98 (95 % CI 0.96-100), with a ≥5 cut-off. Its diagnostic performance was determined by internal validation: sensitivity 91.1-100 %, specificity 85.7-97.6 %, positive predictive value 41.4-82.3 % and negative predictive value 98.9-100 %. Bowel wall discontinuity and mesenteric pneumoperitoneum had the strongest association with BBMI requiring surgery (OR = 128.9 and 140.5, respectively). We developed a reliable CT scoring system which is easy to implement and highly predictive of BBMI requiring surgery. (orig.)

  17. Splenic abscesses.

    Science.gov (United States)

    Al-Hajjar, Nadim; Graur, Florin; Hassan, Aboul B; Molnár, Geza

    2002-03-01

    Splenic abscesses are rare entities (autopsy incidence between 0.14-0.7%). The most frequent etiology is the septic emboli seeding from bacterial endocarditis (about 20% of cases) or other septic foci (typhoid fever, malaria, urinary tract infections, osteomielitis, otitis). The treatment of splenic abscesses was until recently splenectomy with antibiotherapy. The actual trends are more conservative (mini invasive or non-invasive) because the immunologic role of the spleen has been better understood over the last year

  18. Successful Use of Targeted Temperature Management After Repair of Myocardial Rupture from Blunt Chest Trauma: A Case Report.

    Science.gov (United States)

    Choi, Wook-Jin; Kim, Yun Seok; Hong, Jung Seok; Kim, Jeong Won

    2017-03-01

    Targeted temperature management (TTM) improves survival and neurological outcome after nontraumatic cardiac arrest. However, TTM is not used widely after traumatic cardiac arrest because of concerns that it might exacerbate bleeding. We report the use of postarrest TTM after repair of blunt myocardial rupture. A 48-year-old man was admitted after being rescued from a major traffic accident by the local emergency service. Focused sonography showed pericardial fluid without cardiac tamponade. Computed tomography showed a large hematoma in the anterior mediastinum associated with hemopericardium. The patient developed cardiac arrest during the operative preparations. Repeat bedside sonography revealed a large pericardial effusion and signs of cardiac tamponade. Spontaneous circulation was restored after ultrasound-guided pericardiocentesis. His Glasgow Coma Scale score was 3. The patient was transported promptly to the operating room and underwent median sternotomy without cardiopulmonary bypass. A rupture of the junction of the superior vena cava/right atrium and left atrial appendage was detected and was closed by direct suturing. Immediately after return to the intensive care unit, we performed TTM (target body temperature 34.5°C) using a surface-cooling device at 4 hours postarrest. TTM was maintained for 24 hours and controlled gradual rewarming was then initiated. He regained consciousness 36 hours postrewarming with limited speech ability. The patient recovered with no further cardiac events and was discharged 3 weeks after admission, with no other serious complications. The patient was neurologically intact (cerebral performance category 1) at 6 months of follow-up. This case demonstrates the potential benefit and applicability of postarrest TTM in patients after repair of blunt myocardial rupture.

  19. ACCURACY OF PREDICTIVE FACTORS AND FOCUSED ASSESSMENT WITH SONOGRAPHY FOR TRAUMA (FAST IN MANAGEMENT OF ADULT BLUNT ABDOMINAL TRAUMA AND ITS OUTCOME

    Directory of Open Access Journals (Sweden)

    Adel Elbaih

    2016-04-01

    Full Text Available Background:Abdominal trauma is a major public health problem for all nations and all socioeconomic strata. Methods:The studyincluded adult patientsattending emergency department in Suez Canal University Hospital,Data was collected in pre-organized data sheet by the researcher. Then, the patients were followed up and recorded till they reached one of these final outcomesLater on, the actual outcome of the patient was compared to the predictors and FAST results, then sensitivity, specificity and accuracy were calculated. Results:Seventy five patients were eligible, of which ten patients had a FAST-positive result, and seven patients underwent a therapeutic laparotomy. In multivariate analysis,the factors correlating with a therapeutic laparotomy were pulse (>100beat/minute, respiratory rate (>29 cycle /minute, O2 saturation, abdominal gardening by examination and a FAST-positive result (sensitivity 80%, Specificity 100%, accuracy 97%, positive predictive value 100% and negative predictive value 97.3% ,were pulse as the most sensitive predictor (99% followed by respiratory rate (98% while the most specific predictors were pulse (97.1%. Conclusions:The management of trauma patients depends upon their clinical status, imaging findings, and the resources and expertise available. Rapid recognition of key abnormalities on FAST and abdominal CT can help select trauma patients for the most appropriate treatment: surgery, interventional radiology or conservative management. Physical examination alone is not sufficient to determine the need for emergent interventions.

  20. A comparative study of cranial, blunt trauma fractures as seen at medicolegal autopsy and by Computed Tomography

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    Lynnerup Niels

    2009-10-01

    Full Text Available Abstract Background Computed Tomography (CT has become a widely used supplement to medico legal autopsies at several forensic institutes. Amongst other things, it has proven to be very valuable in visualising fractures of the cranium. Also CT scan data are being used to create head models for biomechanical trauma analysis by Finite Element Analysis. If CT scan data are to be used for creating individual head models for retrograde trauma analysis in the future we need to ascertain how well cranial fractures are captured by CT scan. The purpose of this study was to compare the diagnostic agreement between CT and autopsy regarding cranial fractures and especially the precision with which cranial fractures are recorded. Methods The autopsy fracture diagnosis was compared to the diagnosis of two CT readings (reconstructed with Multiplanar and Maximum Intensity Projection reconstructions by registering the fractures on schematic drawings. The extent of the fractures was quantified by merging 3-dimensional datasets from both the autopsy as input by 3D digitizer tracing and CT scan. Results The results showed a good diagnostic agreement regarding fractures localised in the posterior fossa, while the fracture diagnosis in the medial and anterior fossa was difficult at the first CT scan reading. The fracture diagnosis improved during the second CT scan reading. Thus using two different CT reconstructions improved diagnosis in the medial fossa and at the impact points in the cranial vault. However, fracture diagnosis in the anterior and medial fossa and of hairline fractures in general still remained difficult. Conclusion The study showed that the forensically important fracture systems to a large extent were diagnosed on CT images using Multiplanar and Maximum Intensity Projection reconstructions. Difficulties remained in the minute diagnosis of hairline fractures. These inconsistencies need to be resolved in order to use CT scan data of victims for

  1. Splenic artery pseudoaneurysm due to seatbelt injury in a glucose-6-phosphate dehydrogenase-deficient adult.

    Science.gov (United States)

    Lau, Yu Zhen; Lau, Yuk Fai; Lai, Kang Yiu; Lau, Chu Pak

    2013-11-01

    A 23-year-old man presented with abdominal pain after suffering blunt trauma caused by a seatbelt injury. His low platelet count of 137 × 10(9)/L was initially attributed to trauma and his underlying hypersplenism due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Despite conservative management, his platelet count remained persistently reduced even after his haemoglobin and clotting abnormalities were stabilised. After a week, follow-up imaging revealed an incidental finding of a pseudoaneurysm (measuring 9 mm × 8 mm × 10 mm) adjacent to a splenic laceration. The pseudoaneurysm was successfully closed via transcatheter glue embolisation; 20% of the spleen was also embolised. A week later, the platelet count normalised, and the patient was subsequently discharged. This case highlights the pitfalls in the detection of a delayed occurrence of splenic artery pseudoaneurysm after blunt injury via routine delayed phase computed tomography. While splenomegaly in G6PD may be a predisposing factor for injury, a low platelet count should arouse suspicion of internal haemorrhage rather than hypersplenism.

  2. Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential "near miss" injuries

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    Bravman Jonathan T

    2008-11-01

    Full Text Available Abstract Background Low energy trauma to the upper extremity is rarely associated with a significant vascular injury. Due to the low incidence, a high level of suspicion combined with appropriate diagnostic algorithms are mandatory for early recognition and timely management of these potentially detrimental injuries. Methods Review of the pertinent literature, supported by the presentation of two representative "near miss" case examples. Results A major diagnostic pitfall is represented by the insidious presentation of significant upper extremity arterial injuries with intact pulses and normal capillary refill distal to the injury site, due to collateral perfusion. Thus, severe vascular injuries may easily be missed or neglected at the upper extremity, leading to a long-term adverse outcome with the potential need for a surgical amputation. Conclusion The present review article provides an outline of the diagnostic challenges related to these rare vascular injuries and emphasizes the necessity for a high level of suspicion, even in the absence of a significant penetrating or high-velocity trauma mechanism.

  3. Blunt testicular trauma:evaluation of sonographic appearances and its clmical application%睾丸损伤的超声分型及临床应用评价

    Institute of Scientific and Technical Information of China (English)

    薛恩生; 林礼务; 叶真; 何以敉; 高上达

    2000-01-01

    Objective To evaluate the sonographic appearances of testicular trauma and its clinical application.Methods The appearances of high frequency color Doppler ultrasound were analysed in 15 patients with the blunt scmtal trauma.Results Of the 15 patients,testicular rupture was present in 6 canes,blunt injury in4 cases.subcapsular hematoma in 3 cases,and normal testis in 2 cases.Nine patients undergwent surgery. The accuracy rate of ultrasound diagnosis of blunt scrotal trauma was 93.3%(14/15).The sonographic appearances of testicular trauma may be divided into four types:shatter type,rupture type,blunt injury type and subcapsular hematoma type.Conclusions The sonographic typing of testicular trauma is conduce to choice of treannent manner.Testieular crush and rupture should be managed by orchiectomy or pavial orchiectomy.Taking which treatment method to testicular blunt injury and subcapsular hematoma is dependent on the extent of testicular trauma.The lesions in less extent may be healed with the conservative treatment.%目的 探讨睾丸损伤的超声分型及其临床应用价值.方法 分析15例阴囊闭合性损伤的高频彩色多普勒超声表现和手术所见.结果 15例阴囊外伤中,睾丸完全破裂2例,部分破裂4例,挫伤4例,单纯血肿3例,正常2例.睾丸损伤的超声诊断符合率为93.3%(14/15).睾丸损伤的超声表现可分为破碎型、破裂型、钝挫型和包膜下血肿型.结论 超声检查不但能够对睾丸损伤进行分型,而且有助于临床治疗方案的选择.

  4. Case Report: Urgent endovascular treatment of subclavian artery injury after blunt trauma [v1; ref status: indexed, http://f1000r.es/4x8

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    Taka-aki Nakada

    2014-12-01

    Full Text Available Subclavian arterial injury is rare and potentially life-threatening, particularly when it leads to arterial occlusion, causing limb ischemia, retrograde thromboembolization and cerebral infarction within hours after injury. Here we report a blunt trauma case with subclavian arterial injury, upper extremity ischemia, and the need for urgent treatment to salvage the limb and prevent cerebral infarction. A 41-year-old man had a left, open, mid-shaft clavicle fracture and left subclavian artery injury accompanied by a weak pulse in the left radial artery, decreased blood pressure of the left arm compared to the right, and left hand numbness. Urgent debridement and irrigation of the open clavicle fracture was followed by angiography for the subclavian artery injury. The left distal subclavian artery had a segmental dissection with a thrombus. Urgent endovascular treatment using a self-expanding nitinol stent successfully restored the blood flow and blood pressure to the left upper extremity. Endovascular treatment is a viable option for cases of subclavian artery injury where there is a risk of extremity ischemia and cerebral infarction.

  5. Clinical Applications of Contrast-Enhanced Ultrasound in the Pediatric Work-Up of Focal Liver Lesions and Blunt Abdominal Trauma: A Systematic Review

    Science.gov (United States)

    Laugesen, Nicolaj Grønbæk; Nolsoe, Christian Pallson; Rosenberg, Jacob

    2017-01-01

    In pediatrics ultrasound has long been viewed more favorably than imaging that exposes patients to radiation and iodinated contrast or requires sedation. It is child-friendly and diagnostic capabilities have been improved with the advent of contrast-enhanced ultrasound (CEUS). The application of CEUS is indeed promising. However, no ultrasound contrast agent manufactured today is registered for pediatric use in Europe. The contrast agent SonoVue® has recently been approved by the FDA under the name of Lumason® to be used in hepatic investigations in adults and children. This article reviews the literature with respect to 2 specific applications of CEUS in children: 1) identification of parenchymal injuries following blunt abdominal trauma, and 2) classification of focal liver lesions. Applications were chosen through the CEUS guidelines published by the European Federation of Societies for Ultrasound in Medicine and Biology and World Federation for Ultrasound in Medicine and Biology. Literature was obtained by searching Medline and Pubmed Central (using Pubmed), Scopus database and Embase. CEUS proved to be an effective investigation in the hemodynamically stable child for identifying parenchymal injuries and for the characterization of focal liver lesions. CEUS showed comparable performance to CT and MRI with a specificity of 98% for identifying benign lesions and a negative predictive value of 100%. For the applications reviewed here, CEUS holds promising perspectives and can help reduce radiation exposure and use of iodinated contrast agents in pediatrics, thereby potentially reducing complications in routine imaging.

  6. Elevated Admission Base Deficit Is Associated with a Complex Dynamic Network of Systemic Inflammation Which Drives Clinical Trajectories in Blunt Trauma Patients

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    Othman Abdul-Malak

    2016-01-01

    Full Text Available We hypothesized that elevated base deficit (BD ≥ 4 mEq/L upon admission could be associated with an altered inflammatory response, which in turn may impact differential clinical trajectories. Using clinical and biobank data from 472 blunt trauma survivors, 154 patients were identified after excluding patients who received prehospital IV fluids or had alcohol intoxication. From this subcohort, 84 patients had a BD ≥ 4 mEq/L and 70 patients with BD < 4 mEq/L. Three samples within the first 24 h were obtained from all patients and then daily up to day 7 after injury. Twenty-two cytokines and chemokines were assayed using Luminex™ and were analyzed using two-way ANOVA and dynamic network analysis (DyNA. Multiple mediators of the innate and lymphoid immune responses in the BD ≥ 4 group were elevated differentially upon admission and up to 16 h after injury. DyNA revealed a higher, sustained degree of interconnectivity of the inflammatory response in the BD ≥ 4 patients during the initial 16 h after injury. These results suggest that elevated admission BD is associated with differential immune/inflammatory pathways, which subsequently could predispose patients to follow a complicated clinical course.

  7. Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: a sociotechnical analysis.

    Science.gov (United States)

    Sheehan, Barbara; Nigrovic, Lise E; Dayan, Peter S; Kuppermann, Nathan; Ballard, Dustin W; Alessandrini, Evaline; Bajaj, Lalit; Goldberg, Howard; Hoffman, Jeffrey; Offerman, Steven R; Mark, Dustin G; Swietlik, Marguerite; Tham, Eric; Tzimenatos, Leah; Vinson, David R; Jones, Grant S; Bakken, Suzanne

    2013-10-01

    Integration of clinical decision support services (CDSS) into electronic health records (EHRs) may be integral to widespread dissemination and use of clinical prediction rules in the emergency department (ED). However, the best way to design such services to maximize their usefulness in such a complex setting is poorly understood. We conducted a multi-site cross-sectional qualitative study whose aim was to describe the sociotechnical environment in the ED to inform the design of a CDSS intervention to implement the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules for children with minor blunt head trauma. Informed by a sociotechnical model consisting of eight dimensions, we conducted focus groups, individual interviews and workflow observations in 11 EDs, of which 5 were located in academic medical centers and 6 were in community hospitals. A total of 126 ED clinicians, information technology specialists, and administrators participated. We clustered data into 19 categories of sociotechnical factors through a process of thematic analysis and subsequently organized the categories into a sociotechnical matrix consisting of three high-level sociotechnical dimensions (workflow and communication, organizational factors, human factors) and three themes (interdisciplinary assessment processes, clinical practices related to prediction rules, EHR as a decision support tool). Design challenges that emerged from the analysis included the need to use structured data fields to support data capture and re-use while maintaining efficient care processes, supporting interdisciplinary communication, and facilitating family-clinician interaction for decision-making.

  8. 超声造影引导肝脾创伤介入性治疗的实验研究%Interventional treatment of hepatic or splenic trauma under the guidance of contrast-enhanced ultrasound:an animal experiment

    Institute of Scientific and Technical Information of China (English)

    吕发勤; 唐杰; 李文秀; 张惠琴; 罗渝昆; 李俊来; 安力春

    2008-01-01

    Objective To determine whether hemostatic agents directly injected into injury sites under the guidance of contrast-enhanced ultrasound(CEUS)can effectively control hemorrhage from hepatic or splenic trauma. Methods Healthy adult dogs were impacted by a impactor to create hepatic or splenic trauma. Among 32 dogs,28 had hepatic or splenic injury of grade Ⅲ~Ⅳ according to Injury Scale of the American Association for the Surgery of Trauma(AAST),which were divided into two groups,the treatment group and the control. In the treatment group,hemocoagulase and α-cyanoacrylate were injected respectively into the injury site and transected micro-vessel tinder the guidance of CEUS,while in the control group,normal saline was injected. Results All animals of the two groups survived after the injection. CEUS demonstrated that active hemorrhage disappeared in treatment group but still existed in the control group.In the treatment group,laparotomy showed that hepatic or splenic injury had been covered and adhered with clot and glue membrane of hemostatic agents and free intraperitoneal blood volume was significantly less than that in the control group(P=0.000),while in the control group injury bleeding did not stop after injection. Conclusions Hemostatic agents injected under the guidance of CEUS can effectively control hemorrhage from hepatic or splenic trauma of grade Ⅲ~Ⅳ. This therapy was simple,convenient and effective. It may be performed immediately after hepatic or splenic injury was diagnosed.%目的 探讨超声造影引导局部注射治疗闭合性肝、脾创伤出血的价值.方法 使用健康成年杂种犬.用自制的小型生物撞击器建立肝和脾闭合性外伤模型.符合美国创伤外科协会分级(AAST)的Ⅲ~Ⅳ级的28只犬纳入实验,并随机分为治疗组与对照组,治疗组采用超声造影引导病灶内注射蛇毒凝血酶和α-氰基丙烯酸酯黏合胶,对照组于病灶局部注射等量的生理盐水.结果 两

  9. Severe lung contusion and death after high-velocity behind-armor blunt trauma: relation to protection level.

    Science.gov (United States)

    Gryth, Dan; Rocksén, David; Persson, Jonas K E; Arborelius, Ulf P; Drobin, Dan; Bursell, Jenny; Olsson, Lars-Gunnar; Kjellström, Thomas B

    2007-10-01

    The most-used safety recommendation for protective vests is that the impact should not cause more than a 44-mm impression in plasticine. The aim of this study was to investigate whether this criterion was sufficient if the vest was exposed to a high-velocity projectile. We tested the hypothesis with pigs divided into a 40-mm group (n = 10) and a 34-mm group (n = 8) protected by a vest allowing a 40-mm or 34-mm impression in plasticine, respectively. Five (50%) of 10 animals in the 40-mm group and 2 (25%) of 8 in the 34-mm group died due to the trauma. We observed severe lung hematoma, impaired circulation, desaturation, and electroencephalogram changes. These effects were more aggravated in the 40-mm group compared to the 34-mm group. Based on our results, the overall judgment is that the safety criterion of 44-mm impression is insufficient when a vest is exposed to a high-velocity projectile.

  10. A rare splenic pseudocyst

    Science.gov (United States)

    Verma, Ankit; Yadav, Amit; Sharma, Sourabh; Saini, Devender; Om, Prabha; Khoja, Hanuman; Banerjee, Kinjal; NL, Harish

    2013-01-01

    Pseudocysts of the spleen are very rare, found in <1% of the splenectomies done and usually develop secondary to trauma. Pseudocysts of spleen rarely grow to large size and most of these remain asymptomatic, they require exploration only in symptomatic cases and chances for spleen preservation in these cases are usually less. Here, we present two cases of this rare entity developing secondary to abdominal trauma in the past, both presented with complaints of pain and lump in the abdomen. After thorough investigations, laparotomy was done preserving spleen in one case and doing splenectomy in the other. On histopathological examination, diagnosis of splenic pseudocysts was confirmed by the absence of lining epithelium. We would like to report these two cases because of their rarity and as diagnostic dilemmas. PMID:24963908

  11. The Sentinel Clot Sign: a Useful CT Finding for the Evaluation of Intraperitoneal Bladder Rupture Following Blunt Trauma

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Sang Soo; Jeong, Yong Yeon; Chung, Tae Woong; Yoon, Woong; Kang, Heoung Keun; Kang, Taek Won; Shin, Hee Young [Chonnam National University Medical School, Gwangju (Korea, Republic of)

    2007-12-15

    To evaluate the frequency and relevance of the 'sentinel clot' sign on CT for patients with traumatic intraperitoneal bladder rupture in a retrospective study. During a recent 42-month period, 74 consecutive trauma patients (45 men, 29 women; age range, 12 84 years; mean age, 50.8 years) with gross hematuria were examined by the use of intravenous contrast enhanced CT of the abdomen and pelvis, followed by retrograde cystography. Contrast-enhanced CT scanning was performed by using a helical CT scanner. CT images were retrospectively reviewed in consensus by two radiologists. The CT findings including the sentinel clot sign, pelvic fracture, traumatic injury to other abdominal viscera, and the degree of intraperitoneal free fluid were assessed and statistically analyzed using the two-tailed x{sup 2} test. Twenty of the 74 patients had intraperitoneal bladder rupture. The sentinel clot sign was seen for 16 patients (80%) with intraperitoneal bladder rupture and for four patients (7%) without intraperitoneal bladder rupture (p < 0.001). Pelvic fracture was noted in five patients (25%) with intraperitoneal bladder rupture and in 39 patients (72%) without intraperitoneal bladder rupture (p < 0.001). Intraperitoneal free fluid was found in all patients (100%) with intraperitoneal bladder rupture, irrespective of an associated intraabdominal visceral injury, whereas 19 (35%) of the 54 patients without intraperitoneal bladder rupture had intraperitoneal free fluid (p < 0.001). Detection and localization of the sentinel clot sign abutting on the bladder dome may improve the accuracy of CT in the diagnosis of traumatic intraperitoneal bladder rupture, especially when the patients present with gross hematuria.

  12. Embolization Therapy for Traumatic Splenic Lacerations

    Energy Technology Data Exchange (ETDEWEB)

    Dasgupta, Niloy; Matsumoto, Alan H., E-mail: ahm4d@virginia.edu; Arslan, Bulent; Turba, Ulku C.; Sabri, Saher; Angle, John F. [University of Virginia Health System, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

    2012-08-15

    Purpose: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma. Methods: A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes. Results: Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16-80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies. Conclusions: Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.

  13. Blunt traumatic diaphragmatic rupture

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira

    2011-09-01

    Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.

  14. Blunt abdominal injury with rupture of giant hepatic cavernous hemangioma and laceration of the spleen.

    Science.gov (United States)

    Kang, Lung-Yun; Huang, Fong-Dee; Liu, Yuan-Yuarn

    2015-02-01

    A 41-year-old woman with blunt abdominal trauma due to a motor vehicle accident presented to our emergency department. The patient had a history of a giant hepatic cavernous hemangioma. Emergency exploratory laparotomy was performed for suspected intra-abdominal bleeding with abdominal compartment syndrome, and more than 4 liters of blood and blood clots were removed. An active bleeding laceration (5 cm) of a hepatic cavernous hemangioma was detected in segment III of the liver. The bleeding was controlled by sutures, Teflon patches and tamponade. The abdomen was closed temporarily using the vacuum-assisted method. Because of the presence of persistent fresh blood through abdominal drainage at a rate of >1 L/h, splenectomy was performed to control the bleeding again by sutures and Teflon patches. Finally, the abdomen was closed using a biologic mesh. The patient was discharged home 30 days after trauma. Bleeding of trauma-caused hepatic hemangioma is rare, but splenic injury due to blunt abdominal trauma is common. An in-depth investigation is necessary to avoid second intervention.

  15. Horner's syndrome after blunt cervical and chest trauma: case report Síndrome de Horner após trauma cérvico-torácico fechado: relato de caso

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    Wellingson Silva Paiva

    2007-12-01

    Full Text Available Horner‘s syndrome is the triad of miosis, ptosis, and anhidrosis, resulting from disruption of the sympathetic pathways. This article describes an uncommon case of Horner‘s syndrome in a 22-year-old man after blunt trauma to the neck and chest without carotid artery dissection. The patient was brought to the emergency service after motorcycle fall. Neurologic examination revealed a patient presenting the score 15 at Glasgow Coma Scale. The left eyelid was 1-2 mm lower than the right. Carotid Doppler and angiotomography were undertaken and revealed no abnormalities of the carotid artery. CT disclosed a mediastinal hematoma extending to the left apex, compressing the left sympathetic chain. The understanding of this clinical entity may help the surgeon to make a better differential diagnosis in trauma patients in whom prompt diagnosis is critical to stablish the correct treatment.A síndrome de Horner compreende a tríade de miose, ptose e anidrose, resultado de lesão em algum ponto das vias simpáticas. O referido estudo apresenta um caso da referida síndrome em um jovem de 22 anos vitima de queda de moto, com escoriações no tórax e no pescoço, sem dissecção carotídea. Ao exame neurológico, encontrava-se com 15 pontos na Escala de Coma de Glasgow, com miose à esquerda e ptose palpebral ipsilateral. Realizado Doppler de carótidas e angiotomografia dos vasos cérvico-cranianos não sendo evidenciadas anormalidades. A tomografia de tórax mostrou um hematoma no ápice pulmonar esquerdo, comprimindo a cadeia simpática ipsilateral. O conhecimento desta entidade clínica pode ajudar o cirurgião a fazer um diagnóstico diferencial adequado nos pacientes vítimas de traumas, nos quais o diagnóstico correto e eficaz pode ser fundamental para a definição da conduta a ser tomada.

  16. Tratamento das lesões de aorta nos traumatismos torácicos fechados Management of aortic lesions in blunt chest trauma

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    Boulanger Mioto Neto

    2005-09-01

    Full Text Available OBJETIVO: Rever a casuística, etiologia, lesões associadas, tipos de tratamento e evolução das lesões da aorta por trauma torácico fechado. MÉTODOS: Estudo retrospectivo em prontuário dos pacientes atendidos no Pronto-Socorro do Hospital das Clínicas da Universidade de São Paulo e tratados pelo Grupo de Cirurgia Vascular de janeiro de 2001 a junho de 2004. Foram analisados 10 pacientes, todos do sexo masculino, sendo sete com técnica endovascular e três com técnica operatória aberta. RESULTADOS: Quanto à localização, foram observadas oito lesões da aorta descendente junto ao istmo, uma lesão da aorta descendente na transição tóraco-abdominal e uma dissecção traumática da aorta. O intervalo de tempo para o tratamento cirúrgico foi, em média, de 10,62 ± 3,45 horas para os que receberam tratamento endoluminal e 28 ± 32,39 para os operados de forma convencional. Já o período de internação total variou de 9 a 180 dias (média de 23,33 ± 6,66 dias para os tratados com endoprótese e 42,55 ± 52,7 para os operados de forma convencional. Foram utilizadas uma endoprótese Excluder®, uma Apolo® e cinco Talent®. Dos pacientes operados, dois utilizaram bomba átrio femoral. Ocorreram dois óbitos, um entre os operados de forma convencional e um entre os operados com endopróteses. CONCLUSÕES: As lesões da aorta em casos de trauma torácico fechado são pouco freqüentes e geralmente associadas a um grande número de lesões associadas. O diagnóstico precoce e preciso é fundamental para a evolução do paciente. A correção com endopróteses nos pacientes estáveis do ponto de vista hemodinâmico apresenta-se como solução eficaz.OBJECTIVE: To review the population, etiology, associated injuries, types of treatment, and evolution of aortic injuries due to blunt chest trauma. METHODS: Retrospective study of medical charts of patients admitted to the Emergency Department at Hospital das Clínicas of Universidade de S

  17. Blunt abdominal trauma in sports.

    Science.gov (United States)

    Rifat, Sami F; Gilvydis, Rimas P

    2003-04-01

    Abdominal injuries are rare in sports, but when they do occur it is important that the physician recognize the warning signs of potentially life-threatening injury to the liver, spleen, or hollow abdominal viscera. Though the sports medicine physician may not always provide definitive treatment of many of these conditions, he or she should be familiar with the preferred diagnostic modalities and latest treatment options. This information is not only essential to appropriately participate in treatment decisions, but is also important in order to make return-to-play determinations.

  18. Association of splenic and renal infarctions in acute abdominal emergencies

    Energy Technology Data Exchange (ETDEWEB)

    Romano, Stefania E-mail: stefromano@libero.it; Scaglione, Mariano; Gatta, Gianluca; Lombardo, Patrizia; Stavolo, Ciro; Romano, Luigia; Grassi, Roberto

    2004-04-01

    Introduction: Splenic and renal infarctions are usually related to vascular disease or haematologic abnormalities. Their association is infrequent and rarely observed in trauma. In this study, we analyze our data to look at the occurrence of renal and splenic infarctions based on CT findings in a period of 4 years. Materials and Methods: We retrospectively reviewed the imaging findings of 84 patients admitted to our Department of Diagnostic Imaging from June 1998 to December 2002, who underwent emergency abdominal spiral CT examination and in whom there was evidence of splenic and/or renal infarction. Results: We found 40 cases of splenic infarction and 54 cases of renal infarction, associated in 10 patients. In 26 patients, there was also evidence of intestinal infarction. A traumatic origin was found in 19 cases; non-traumatic causes were found in 65 patients. Association between renal and splenic infarction in the same patient was related to trauma in two cases. Conclusions: Although renal and splenic infarctions are a common manifestation of cardiac thromboembolism, other systemic pathologies, infections or trauma may lead to this occurrence. Renal infarction may be clinically and/or surgically managed with success in most cases. There are potential complications in splenic infarction, such as development of pseudocysts, abscesses, hemorrhage, subcapsular haematoma or splenic rupture; splenectomy in these cases may be necessary. Some patients with splenic and/or renal infarction may be clinically asymptomatic. The high accuracy of CT examination is needed to allow a correct evaluation of infarcted organs.

  19. Nonoperative Management of Splenic Injury in Combat: 2002-2012

    Science.gov (United States)

    2015-03-01

    Sonography for Trauma ( FAST ) at North American Treaty Organization (NATO) Role II and III medical treatment facilities (MTFs) facilitates...blunt abdominal trauma (BAT) clinical practice guideline (CPG); it stated that BAT patients with a positive FAST or CT abdomen/pelvis suggestive of hemo...of the November 2008 blunt abdominal trauma clinical practice guideline that permitted selective nonoperative management of some patients with

  20. Blunt colon injury sustained during a kickboxing match.

    Science.gov (United States)

    Rood, Loren K

    2007-02-01

    Emergency physicians routinely evaluate patients for injury from blunt abdominal trauma. Most serious injuries result from high energy mechanisms such as motor vehicle collisions. This case report describes a patient who sustained blunt trauma to the descending colon during a martial arts match, necessitating a hemicolectomy.

  1. Clinical Application of Partial Splenic Embolization

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    Yong-Song Guan

    2014-01-01

    Full Text Available Partial splenic embolization (PSE is one of the intra-arterial therapeutic approaches of diseases. With the development of interventional radiology, the applications of PSE in clinical practice are greatly extended, while various materials are developed for embolization use. Common indications of PSE include hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, splenic trauma, idiopathic thrombocytopenic purpura, splenic hemangioma, and liver cancer. It is also performed to exclude splenic artery aneurysms from the parent vessel lumen and prevent aneurysm rupture, to treat splenic artery steal syndrome and improve liver perfusion in liver transplant recipients, and to administer targeted treatment to areas of neoplastic disease in the splenic parenchyma. Indicators of the therapeutic effect evaluation of PSE comprise blood routine test, changes in hemodynamics and in splenic volume. Major complications of PSE include the pulmonary complications, severe infection, damages of renal and liver function, and portal vein thrombosis. The limitations of PSE exist mainly in the difficulties in selecting the arteries to embolize and in evaluating the embolized volume.

  2. Clinical application of partial splenic embolization.

    Science.gov (United States)

    Guan, Yong-Song; Hu, Ying

    2014-01-01

    Partial splenic embolization (PSE) is one of the intra-arterial therapeutic approaches of diseases. With the development of interventional radiology, the applications of PSE in clinical practice are greatly extended, while various materials are developed for embolization use. Common indications of PSE include hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, splenic trauma, idiopathic thrombocytopenic purpura, splenic hemangioma, and liver cancer. It is also performed to exclude splenic artery aneurysms from the parent vessel lumen and prevent aneurysm rupture, to treat splenic artery steal syndrome and improve liver perfusion in liver transplant recipients, and to administer targeted treatment to areas of neoplastic disease in the splenic parenchyma. Indicators of the therapeutic effect evaluation of PSE comprise blood routine test, changes in hemodynamics and in splenic volume. Major complications of PSE include the pulmonary complications, severe infection, damages of renal and liver function, and portal vein thrombosis. The limitations of PSE exist mainly in the difficulties in selecting the arteries to embolize and in evaluating the embolized volume.

  3. Value of emergency bedside ultrasound in diagnosis of blunt abdominal trauma%急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

    Institute of Scientific and Technical Information of China (English)

    张惠萍; 刘燕; 尹毅

    2010-01-01

    目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.%Objective To discuss the value of emergency bedside ultrasound in diagnose of blunt abdominal injury. Methods Portable ultrasound was used in 184 patients with blunt abdominal trauma in emergency department. The abnormal changes of the sound and image of the abdomen were observed,paying equal attention to free intraperitoneal fluid and gas. Results The emergency bedside ultrasound identified 169 (91.8%) patients with blunt abdominal injury, of whom 149 patients (95.5%) with single-organ injury and 20 patients (71.4%) with multi-organ injury. There were 21 patients missed diagnosis and three misdiagnosed, with rate of missed diagnosis and misdiagnosis of 13%. Surgical treatment was performed in 119 patients and conservative treatment in 65, which were proved by CT/MRI examination or clinic conservative treatment. Conclusion Emergency bedside ultrasound can provide fast and credible diagnostic information for blunt abdominal trauma, with high diagnosis accordance rate.

  4. Multi-slice CT in the diagnosis of blunt laryngotracheal trauma%钝性喉气管损伤的MSCT诊断

    Institute of Scientific and Technical Information of China (English)

    王小鹏; 杨军; 刘伟

    2011-01-01

    目的:探讨多层螺旋CT在钝性喉气管损伤(B-LTT)中的临床应用价值.方法:对喉颈部外伤后156例患者使用GE LightSpeed 16层及32层螺旋CT设备行CT检查,其中平扫111例和对比剂增强扫描45例,并通过最大密度投影(MIP)、多平面重组(MPR)、仿真内镜(VE)及客积再现(VR)等影像后处理技术进行喉软骨、喉部软组织三维成像.结果:共发现43例患者喉部损伤,包括软组织损伤28例,喉软骨骨折14例及舌骨骨折1例.喉软骨骨折14例中,甲状软骨骨折12例(右侧甲状软骨5例,左侧甲状软骨骨折3例,甲状软骨前部正中骨折4例).同时合并环状软骨骨折3例,杓状软骨骨折2例,环杓关节脱位3例,环甲关节脱住2例.甲状腺损伤2例,皮下气肿12例,咽喉部血肿3例,颈2椎体骨折1例.MSCT显示喉软骨骨折的直接征象为喉软骨边缘不连续,可见低密度骨折线影,也可伴移位.软组织损伤表现为声门及气道狭窄,伴咽喉部血肿、皮下气肿.喉周围软组织内出现气泡是喉黏膜撕裂的间接征象.结论:螺旋CT可多方位显示喉软骨骨折部位、程度以及气道狭窄和喉黏膜撕裂情况,是诊断喉损伤快速有效的方法.%Objective : To evaluate the value of multi-slice spiral computed tomography (MSCT) in blunt laryngotracheal trauma ( B-LTT). Methods: MSCT was performed in 156 patients with BLTT including 111 patients had plain CT and 45 patients had enhanced CT.3-dimcnsional images of laryngeal cartilages and soft tissues were obtained with post-processing reconstruction techniques including MIP 、 MPR 、 VE and VR. Results: Altogether 43 patients were found to have laryngeal injuries including soft tissue injury ( n=28) ,laryngcal cartilage fracture ( n=14) and hyoid fracture ( n=1). In 14 patients having laryngeal cartilage fracture , there were thyroid cartilage fracture (n= 12 ; with right side , n= 5 ,left side.n= 3 ,anterior-median area n= 4). Concurrently complicated

  5. Trauma during pregnancy.

    Science.gov (United States)

    Tweddale, Carla J

    2006-01-01

    Trauma is the leading nonobstetrical cause of maternal death. The effect of trauma on the pregnant woman and unborn fetus can be devastating. The major causes of maternal injury are blunt trauma, penetrating trauma, burns, falls, and assaults. There are specific changes associated with pregnancy that are important for the clinician to consider when providing care to these patients. Initial management of traumatic injuries during pregnancy is essential for maternal and fetal well-being. This review outlines common causes of maternal trauma, the initial assessment of the pregnant trauma patient, and ongoing care for the pregnant trauma patient and unborn fetus.

  6. [Chest trauma].

    Science.gov (United States)

    Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

    2011-01-01

    Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe.

  7. Percutaneous therapy of hemostatics of injected gelatin matrix under the guidance of contrast-enhanced ultrasound for splenic trauma in canine%超声造影引导下注射明胶基止血剂治疗犬脾脏创伤的疗效

    Institute of Scientific and Technical Information of China (English)

    田江克; 谢霞; 武荣; 吕发勤; 罗渝昆; 唐杰

    2013-01-01

    Objective To evaluate the efifcacy and safety of hemostatics of injected gelatin matrix (HIGM) under the guidance of contrast-enhanced ultrasound (CEUS) for treating splenic trauma in canine model. Methods A total of 24 commercial hybrid dogs underwent celiotomy with creation of uniformly blunt splenic trauma lesion of 4.0 cm×4.0 cm×2.5 cm (length, width and depth, respectively) by hemostatic clamp. Subjects were prospectively randomized into two groups. The treatment group was treated with HIGM under the guidance of CEUS and the positive control group received thrombin solution. Conventional ultrasound and CEUS were performed to record the ascites and the splenic lesion areas at 1st, 3rd, 7th, 14th and 21st day. The ifne needle biopsy and splenectomy were performed for histopathologic examination. The weight, free intraperitoneal lfuid and injury site were compared with t test between HIGM and postive group. Results All animals in two groups survived. All dogs stopped hemorrhage after injection of HIGM under CEUS guidance. The area of injury site was (12.91±0.89) cm2, (4.45±0.75) cm2 and (1.38±0.23) cm2 at 1st, 3rd and 7th day and splenic lesions were not found at 14th and 21st day in all dogs (n=12) of HIGM group. The splenic lesion was (16.74±0.91) cm2, (11.26±0.99) cm2, (8.02±0.82) cm2 and (1.58±0.36) cm2 in the postive group at 1st, 3rd, 7th and 14th day and splenic lesions were not found at 21st day in all dogs (n=12). At 7th and 14th day post-injection, lesion areas were statistically significant between two groups (t=27.162, P=0.008;t=15.129, P=0.001). Free intraperitoneal lfuid was (0.91±0.05) cm at 1st day detected by conventional ultrasound and free intraperitoneal fluid was not found at 3rd, 7th, 14th and 21st day in all dogs (n=12) of HIGM group. The free intraperitoneal fluid in thepositive group was (1.96±0.17) cm, (1.30±0.11) cm and (0.81±0.12) cm at 1st, 3rd and 7th day and free intraperitoneal lfuid was not found at 14th and 21st day

  8. Effects of dexmedetomidine on acute lung injury following blunt chest trauma: experiment with rats%右美托咪定对大鼠胸部撞击性肺损伤的保护效应

    Institute of Scientific and Technical Information of China (English)

    吴述轩; 田华; 叶刚; 刘川鄂; 李宁涛; 夏中元

    2011-01-01

    目的 研究右美托咪定对大鼠胸部撞击所致肺损伤的影响.方法 雄性SD大鼠32只,体重250~300g随机均分为4组:正常对照组(C)、右美托咪定组(D,持续泵注5μg·kg-1·h-1)、胸部创伤模型组(T,接受砝码高处落下垂直撞击胸部)、胸部撞击伤后右美托咪定处理组(TD,建模后持续泵注右美托咪定5μg·kg-1.h-1(1.5μg/ml).6 h后股动脉放血处死大鼠,测量肺湿干,比(WID);支气管肺泡灌洗液(BALF)内嗜中性粒细胞占白细胞百分比(PMN%);HE染色光镜下观察肺组织病理改变.结果 T、TD组大鼠肺W/D比和BALF中PMN%均显著高于C组(P0.05).胸部撞击伤后6 h T组肺泡结构严重破坏,肺泡内及肺泡壁大量充血、实变,肺间隔严重增厚,肺泡腔和间质渗出严重,可见大量中性粒细胞浸润,而TD组肺泡结构破坏程度明显轻于T组,肺泡及间质中性粒细胞和红细胞较少.结论 右美托咪定对胸部撞击致急性肺损伤有一定的保护作用.%Objective To investigate the effects of dexmedetomidine on acute lung injury (ALI) following blunt chest trauma. Methods Thirty-two SD rats were randomly divided into 4 equal groups: normal control group (Croup C), dexmedetomidine group (Croup D, undergoing continuous infusion of dexmedetomidine 5 μg· kg-1 ·h-1), chest trauma group (Group T, undergoing falling of a weight to cause chest trauma), and trauma and dexmedetomidine group (Group TD, undergoing continuous infusion of dexmedetomidine 5 μg· kg-1 · h-1 after chest trauma). All rats were killed through bleeding from femoral artery 6 hours later. The lung wet/dry (W/D) ratio and the percentage of polymorphonuclear neutrophilic leucocytes in the whole leucocytes (PMN%) in the bronchoalveolar lavage fluid (BALF) were observed. And the lung tissue underwent pathological examination.Results The lung W/D ratio and PMN% in Groups T and TD were all significantly higher than those in Group C (P<0.05 , P<0.01), and the

  9. Blunt cardiac rupture in a toddler

    Directory of Open Access Journals (Sweden)

    Peep Talving

    2016-08-01

    Full Text Available Blunt cardiac rupture is typically a fatal injury with overall mortality exceeding 90%. Most of the patients never reach the hospital alive. In pediatric patients, only 0.03% of cases following blunt trauma admissions have a cardiac injury. This report presents a rare survivor of 16-months old toddler injured in a domestic accident suffering a right atrial rupture repaired through a median sternotomy. To the best of our knowledge this is the youngest case reported in the literature.

  10. Campylobacter jejuni, an uncommon cause of splenic abscess diagnosed by 16S rRNA gene sequencing.

    Science.gov (United States)

    Seng, Piseth; Quenard, Fanny; Menard, Amélie; Heyries, Laurent; Stein, Andreas

    2014-12-01

    Splenic abscess is a rare disease that primarily occurs in patients with splenic trauma, endocarditis, sickle cell anemia, or other diseases that compromise the immune system. This report describes a culture-negative splenic abscess in an immunocompetent patient caused by Campylobacter jejuni, as determined by 16S rRNA gene sequencing.

  11. Indicadores clínicos e pré-hospitalares de sobrevivência no trauma fechado: uma análise multivariada Indicadores clínicos y prehospitalarios de supervivencia al trauma cerrado: un análisis multivariado Clinical and prehospital survival indicators in blunt trauma: a multivariate analysis

    Directory of Open Access Journals (Sweden)

    Marisa Aparecida Amaro Malvestio

    2010-06-01

    protector en todos los períodos. Los resultados sugieren que la magnitud de la hipoxemia y la inestabilidad hemodinámica debida a la hemorragia influyeron de manera significativa en la muerte temprana y tardía en este grupo de víctimas.The aim of the study was to identify the clinical and prehospital indicators associated to the survival of blunt trauma victims. The Kaplan Meier survival analysis and the Cox proportional hazards model were used to analyze the association of 33 variables to early and late death, proposing multivariate models. The final models until 48 hours post-trauma showed high rates of risk promoted by abdominal injuries, Injury Severity Score > 25, advanced respiratory procedures and prehospital chest compressions. In the model up to 7 days, a systolic blood pressure in accident site lower than 75mmHg was associated with increased risk of death, and if absent it was associated with higher risk of death after 7 days. The prehospital volume replacement showed a protective effect in all periods. Results suggest that the magnitude of hypoxemia and hemodynamic instability due to bleeding had a significant influence on early and late death in this group of victims.

  12. 钝性胸部损伤后内乳动脉损伤的评价%Assessment of internal mammary artery injury after blunt chest trauma:a literature review

    Institute of Scientific and Technical Information of China (English)

    Jin-ming CHEN; Jin LV; Kai MA; Jing YAN

    2014-01-01

    研究目的:评价钝性胸部损伤后内乳动脉损伤的发病率,出血情况和治疗效果。  创新要点:通过分析患者由于钝性胸部损伤导致内乳动脉破裂的病情发展,为快速诊断和治疗提供理论指导,并首次探讨了内乳动脉损伤后出血部位的形成机制。  研究方法:通过MEDLINE文献数据库共检索出49例由于钝性胸部损伤引起内乳动脉破裂的患者(1977年7月至2014年2月),进行了系统性分析。  重要结论:在分析的49例患者中,男性和左内乳动脉有更高的发病率。内乳动脉破裂出血能引起纵隔血肿﹑血胸﹑假性动脉瘤﹑动静脉瘘和胸膜外血肿。其中20例患者给予栓塞治疗,22例选择外科手术,4例进行临床观察,3例未描述治疗情况。内乳动脉损伤的不同程度和范围、临近的静脉损伤以及胸膜的完整性决定了患者的出血类型。在患者的治疗中,推荐快速诊断、彻底止血、加强复苏和团队合作。%The occurrence, bleeding, and treatment of internal mammary artery (IMA) injury after blunt chest trauma have not been wel described in the literature. We reviewed articles published from July 1977 to February 2014 de-scribing IMA injury after blunt chest trauma in 49 patients. There was a predominant incidence in males and on the left side. Blunt trauma to the IMA can cause anterior mediastinal hematoma, hemothorax, pseudoaneurysm, arteriove-nous fistula, and extra-pleural hematoma. Of the 49 patients studied, 20 underwent embolization, 22 underwent sur-gical operation, 4 were managed by clinical observation, and 3 had undescribed treatment. Different parts and extents of IMA injury, adjacent vein injury, as wel as the integrity of the pleura determined differences in bleeding modality. Prompt diagnosis, complete hemostasis, aggressive resuscitation, and multidisciplinary teams are recommended for patients with IMA injury.

  13. COMPARATIVE ROLE AND EVALUATION OF ULTRASOUND AND MULTISLICE COMPUTED TOMOGRAPHY IN THE GRADING OF HEMOPERITONEUM IN PATIENTS WITH ACUTE BLUNT ABDOMINAL TRAUMA AND ITS CORRELATION WITH THE GRADING OF ORGAN INJURY

    Directory of Open Access Journals (Sweden)

    Kunwarpal

    2015-06-01

    Full Text Available AIMS AND OBJECTIVES: 1. To assess the role of Ultrasound (US and Multislice Computed Tomography (MSCT in detecting hemoperitoneum in patients with acute blunt abdominal trauma. 2. To study the use of US and MSCT in grading of hemoperitoneum in blunt abdominal trauma patients. 3. To compare the US and MSCT grading of hemoperitoneum with the grading of organ injury. 4. To compare and statistically analyze the spectrum of findings observed in each modality. MATERIAL AND METHODS: The study was conducted at advanced diagnostics and institute of imaging , Amritsar. The study comprised of 50 patients who were stable enough to undergo both US and CT scans.US was preceded by MSCT in most of the patients and the time gap between the imaging modalities was less than 1 hour to make the study comparable. TECHNIQUES ADOPTED : 1. US was performed on Versa plus (Siemens and Xario (Toshiba with Cardiac , 3.5 - 5 Mhz - Convex and 5 - 7.5 Mhz - Line ar probes. Particular attention was paid to the amount of free fluid in the abdomen and pelvis. 2. MSCT was performed with MSCT Volume Zoom (Siemens Forchheim Germany AG. 500 - 1000cc of water orally or through nasogastric tube was given 15 - 20 minutes before the study , followed by 120cc I/V contrast at the rate of 2 - 3ml/second using power injector. Parameters used: Single breath hold ; A. 165 mAs . B. 120 kvp . C. Scan delay - 40 seconds . D. Collimation - 4x2.5mm . E. Pitch - 5mm . Following findings were observed : a. Presence of peritoneal fluid. B. Any tear or hematoma in the solid abdominal organs like spleen and liver. C. Status of hollow viscera like small bowel , large bowel and urinary bladder. Hemoperitoneum was scored on both US and MSCT. Visceral injuries were graded according to O.I.S grading system. Score was correlated with the underlying organ injury and the management of the patient. US scoring (Table A and MSCT quantification of hemoperitoneum was done. (Table B Location of hemoperitoneum . A

  14. Análise comparativa entre as lesões encontradas em motociclistas envolvidos em acidentes de trânsito e vítimas de outros mecanismos de trauma fechado Comparative analysis of injuries observed in motorcycle riders involved in traffic accidents and victims of other blunt trauma mechanisms

    Directory of Open Access Journals (Sweden)

    José Gustavo Parreira

    2012-02-01

    Full Text Available OBJETIVO: Realizar uma análise comparativa entre as lesões encontradas em motociclistas envolvidos em acidentes de trânsito e vítimas de outros mecanismos de trauma fechado. MÉTODOS: Análise dos protocolos (colhidos prospectivamente dos traumatizados com idade superior a 13 anos, admitidos de 10/06/2008 a 01/09/2009, vítimas de trauma fechado. Foram coletadas informações sobre mecanismo de trauma, dados vitais à admissão, exames complementares, lesões e tratamento. A estratificação da gravidade do trauma e das lesões foi realizada pelo cálculo dos índices de trauma: RTS, escala de coma de Glasgow (ECG, AIS, ISS e TRISS. Comparamos as variáveis entre os motociclistas (grupo A e os demais (grupo B. Consideramos graves as lesões com AIS > 3. Para a análise estatística, utilizamos os testes t de Student, Mann Whitney, qui-quadrado e Fisher, considerando p OBJECTIVE: To conduct a comparative analysis of the lesions found among motorcycle riders involved in traffic accidents and victims of other mechanisms of blunt trauma. METHODS: Analysis of data prospectively collected on protocols for trauma patients older than 13 years, admitted from 06/10/2008 to 09/01/2009, victims of blunt trauma. Data collected included trauma mechanism, vital signs at admission, laboratory tests, injuries, and treatment.Stratification of trauma and lesion severity was performed by calculating the trauma index: Glasgow Coma Scale (GCS, Revised Trauma Score (RTS, Abbreviated Injury Scale (AIS, Injury Severity Score (ISS and TRISS. We compared the variables between motorcycle riders (group A and the others (group B. Severe injuries were considered when AIS > 3. For statistical analysis, we used Student's t, Mann Whitney, chi-square and Fisher's test, with p < 0.05 considered statistically significant. RESULTS: The study included 3,783 blunt trauma victims, aged 14 to 99 years, of which 76.0% were males. The most frequent trauma mechanisms were accidents

  15. Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline

    Energy Technology Data Exchange (ETDEWEB)

    Leschied, Jessica R.; Smith, Ethan A.; Ladino-Torres, Maria F.; Dillman, Jonathan R. [University of Michigan Health System, Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Mazza, Michael B.; Chong, Suzanne T.; Hoff, Carrie N. [University of Michigan Health System, Department of Radiology, Division of Emergency Radiology, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Davenport, Matthew S. [University of Michigan Health System, Department of Radiology, Division of Abdominal Imaging, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Khalatbari, Shokoufeh [University of Michigan, Michigan Institute for Clinical and Health Research, Ann Arbor, MI (United States); Ehrlich, Peter F. [University of Michigan Health System, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States)

    2016-02-15

    The American Pediatric Surgical Association (APSA) advocates for the use of a clinical practice guideline to direct management of hemodynamically stable pediatric spleen injuries. The clinical practice guideline is based on the CT score of the spleen injury according to the American Association for the Surgery of Trauma (AAST) CT scoring system. To determine the potential effect of radiologist agreement for CT scoring of pediatric spleen injuries on an established APSA clinical practice guideline. We retrospectively analyzed blunt splenic injuries occurring in children from January 2007 to January 2012 at a single level 1 trauma center (n = 90). Abdominal CT exams performed at clinical presentation were reviewed by four radiologists who documented the following: (1) splenic injury grade (AAST system), (2) arterial extravasation and (3) pseudoaneurysm. Inter-rater agreement for AAST injury grade was assessed using the multi-rater Fleiss kappa and Kendall coefficient of concordance. Inter-rater agreement was assessed using weighted (AAST injury grade) or prevalence-adjusted bias-adjusted (binary measures) kappa statistics; 95% confidence intervals were calculated. We evaluated the hypothetical effect of radiologist disagreement on an established APSA clinical practice guideline. Inter-rater agreement was good for absolute AAST injury grade (kappa: 0.64 [0.59-0.69]) and excellent for relative AAST injury grade (Kendall w: 0.90). All radiologists agreed on the AAST grade in 52% of cases. Based on an established clinical practice guideline, radiologist disagreement could have changed the decision for intensive care management in 11% (10/90) of children, changed the length of hospital stay in 44% (40/90), and changed the time to return to normal activity in 44% (40/90). Radiologist agreement when assigning splenic AAST injury grades is less than perfect, and disagreements have the potential to change management in a substantial number of pediatric patients. (orig.)

  16. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 2: Gastrointestinal tract and retroperitoneal organs

    Energy Technology Data Exchange (ETDEWEB)

    Becker, C.D.; Terrier, F. [Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, 24, Rue Micheli-du-Crest, CH-1211 Geneva 14 (Switzerland); Mentha, G. [Department of Surgery, Division of Abdominal Surgery, Geneva University Hospital, 24, Rue Micheli-du-Crest, CH-1211 Geneva 14 (Switzerland); Schmidlin, F. [Department of Surgery, Division of Urology, Geneva University Hospital, 24, Rue Micheli-du-Crest, CH-1211 Geneva 14 (Switzerland)

    1998-06-02

    Computed tomography plays an important role in the detection and management of blunt visceral injuries in adults. Current standard examination techniques enable detection of the majority of perforating or devascularizing bowel injuries, although diagnostic findings are often subtle and meticulous inspection is required. Computed tomography may demonstrate pancreatic contusions and lacerations and help in distinguishing minor traumatic lesions without involvement of the pancreatic duct (organ injury scale, grades I and II) from deep lacerations with ductal involvement (grades III and V). Computed tomography enables distinguishing renal contusions and minor cortical lacerations that can usually be managed conservatively (injuries of grades I-III) from corticomedullary lacerations and injuries of the major renal vessels (grades IV and V) that have a less favorable prognosis and more commonly require surgical repair. In addition, CT is well suited for the detection of active renal hemorrhage and guidance of transcatheter embolization treatment and delineation of preexisting benign or malignant pathologies that may predispose to posttraumatic hemorrhage. The radiologist`s awareness of the diagnostic CT findings of abdominal visceral injuries as well as their clinical and surgical implications are important prerequisites for optimal patient management. (orig.) With 11 figs., 5 tabs., 56 refs.

  17. Experience in the surgical treatment of 16 cases of cardiac rupture caused by blunt chest trauma%闭合性胸部外伤致心脏破裂16例

    Institute of Scientific and Technical Information of China (English)

    李晓峰; 马建欣; 刘建伟; 雷威

    2012-01-01

    Objective To retrospectively analyze the experience in the treatment of cardiac rupture caused by blunt chest trauma and to explore the approaches and methods to improve patient survival.Methods From 2004 to 2010,16 cases of closed chest trauma caused by cardiac rupture,who were treated in our hospital,were treated by heart repair using median sternotomy incision approach.Results Except for 1 patient occurred cardiac arrest before the establishment of CPB,who was failed for cardiopulmonary resuscitation after surgical repair,the remaining 15 patients were all successfully treated.Conclusion The diagnosis of cardiac rupture should be made as soon as possible once it occurs.Timely and decisive rescue and emergency surgery should be given.Heart repair can greatly improve the patient's survival.%目的 探讨闭合性胸部外伤致心脏破裂的手术抢救入路与方法.方法 2004年1月至2010年12月我院抢救闭合性胸部外伤致心脏破裂患者16例,均采用胸骨正中切口行心脏破裂修补术,分析其效果.结果 除1例在体外循环建立前出现心跳停止、手术修补后心肺复苏失败外,余15例全部救治成功.结论 闭合性胸部外伤致心脏破裂应及时果断进行抢救和急诊手术,心脏破裂修补术可以提高患者的存活率.

  18. No further incidence of sepsis after splenectomy for severe trauma: a multi-institutional experience of the trauma registry of the DGU with 1,630 patients

    Directory of Open Access Journals (Sweden)

    Heuer M

    2010-06-01

    Full Text Available Abstract Objective Non-operative management of blunt splenic injury in adults has been applied increasingly at the end of the last century. Therefore, the lifelong risk of overwhelming post-splenectomy infection has been the major impetus for preservation of the spleen. However, the prevalence of posttraumatic infection after splenectomy in contrast to a conservative management is still unknown. Objective was to determine if splenectomy is an independent risk factor for the development of posttraumatic sepsis and multi-organ failure. Methods 13,433 patients from 113 hospitals were prospective collected from 1993 to 2005. Patients with an injury severity score > 16, no isolated head injury, primary admission to a trauma center and splenic injury were included. Data were allocated according to the operative management into 2 groups (splenectomy (I and conservative managed patients (II. Results From 1,630 patients with splenic injury 758 patients undergoing splenectomy compared with 872 non-splenectomized patients. 96 (18.3% of the patients with splenectomy and 102 (18.5% without splenectomy had apparent infection after operation. Additionally, there was no difference in mortality (24.8% versus 22.2% in both groups. After massive transfusion of red blood cells (> 10 non-splenectomy patients showed a significant increase of multi-organ failure (46% vs. 40% and sepsis (38% vs. 25%. Conclusions Non-operative management leads to lower systemic infection rates and mortality in adult patients with moderate blunt splenic injury (grade 1-3 and should therefore be advocated. Patients with grade 4 and 5 injury, patients with massive transfusion of red blood cells and unstable patients should be managed operatively.

  19. Flexion/extension cervical spine views in blunt cervical

    OpenAIRE

    Nasir Sadaf; Hussain Manzar; Mahmud Roomi

    2012-01-01

    【Abstract】Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain. Methods: All patients who presented to our emer-gency department following blunt trauma were enrolled in this study, except those with schiwora, neurological defi-cits or fracture demonstrated on cross-table cervical spine X-rays, and tho...

  20. Investigation of surfactant protein-D and interleukin-6 levels in patients with blunt chest trauma with multiple rib fractures and pulmonary contusions: a cross-sectional study in Black Sea Region of Turkey

    Science.gov (United States)

    Kurt, Aysel; Turut, Hasan; Acipayam, Ahmet; Kirbas, Aynur; Yuce, Suleyman; Cumhur Cure, Medine; Cure, Erkan

    2016-01-01

    Objective Multiple rib fractures (RFs) and pulmonary contusions (PCs), with resulting systemic lung inflammation, are the most common injuries caused by blunt chest trauma (BCT) in motor vehicle accidents. This study examined levels of the inflammation marker interleukin (IL)-6 and those of the acute-phase reactant surfactant protein (SP)-D in patients with BCT. Design Prospective, cross-sectional, observational study. Setting Single-centre, tertiary care hospital in the Black Sea Region of Turkey. Participants The study included 60 patients with BCT who were hospitalised in our thoracic surgery department. Parameters measures The SP-D and IL-6 serum levels of patients with RFs (two or more RFs) (n=30) and patients with PCs (n=30) were measured after 6 hours, 24 hours and 7 days, and compared with those of age-matched and gender-matched healthy participants. Results The 6-hour serum SP-D levels of the RFs (p=0.017) and PCs (plung injury. The levels of the systemic inflammation marker IL-6 and those of the acute-phase reactant SP-D were elevated in the present study. The SP-D level may be used as a marker in the follow-up of BCT-related complications. PMID:27733410

  1. Endoscopic ultrasound (EUS diagnosis of blunt pancreatic trauma associated to the superior mesenteric vein thrombosis Diagnóstico de trauma pancreático associado à trombose da veia mesentérica feito através da ultrassonografia endoscópica

    Directory of Open Access Journals (Sweden)

    Everson L. A. Artifon

    2010-03-01

    Full Text Available BACKGROUND: Blunt pancreatic injuries occur when a high-energy crushing force is applied to the upper abdomen. In adults, the majority of blunt pancreatic injuries result from motor vehicle accidents. CASE REPORT: Male with 32 years old had a high-energy crushing history in witch he was pressured by the chest on the front car area. His life signs demonstrated to be regular. Ct scan demonstrated body pancreatic edema. All routine laboratorial exams were normal, EUS revealed pancreatic lesion grade II without involvement of the pancreatic duct and an impressive superior mesenteric vein thrombosis. He was sustained by means of anti- coagulation for about two months and after that time the multislice CT scan showed a mesenteric vein recanalization and a normal pancreatic parenchyma. The patient had an uneventfull follow-up. CONCLUSION: Patients presenting possible pancreatic trauma associated to superior mesenteric vein thrombosis, EUS must be used firstly.INTRODUÇÃO: Traumas pancreáticos fechados ocorrem em acidentes que promovem força intensa no abdome superior, principalmente em acidentes automobilísticos. RELATO DO CASO: Homem de 32 anos foi jogado contra a área frontal de seu automóvel. Seus sinais vitais eram normais. CT mostrou edema pancreático. EUS mostrou lesão pancreática grau II sem envolvimento do ducto pancreático, mas com impressionante trombose da veia mesentérica superior. Ele foi mantido com anticoagulants por dois meses e após este period novo scan mostrou recanalização e pâncreas normal. Teve seguimento favorável. CONCLUSÃO: Paciente apresentando edema pancreático associado a possível trombose de veia mesentérica superior deve ser submetido à EUS para monitorização e acompanhamento.

  2. Role of splenic artery embolization in management of traumatic splenic injuries: a prospective study.

    Science.gov (United States)

    Parihar, Mohan Lal; Kumar, Atin; Gamanagatti, Shivanand; Bhalla, Ashu Seith; Mishra, Biplab; Kumar, Subodh; Jana, Manisha; Misra, Mahesh C

    2013-10-01

    The objective of our study was to evaluate the role of splenic artery embolization (SAE) in the management of traumatic splenic injuries. From September 2008 to September 2010, a total of 67 patients underwent nonoperative management (NOM) for blunt splenic injuries. Twenty-two patients were excluded from the study because of associated significant other organ injuries. Twenty-five patients underwent SAE followed by NOM (group A) and 20 patients underwent standard NOM (group B). Improvement in clinical and laboratory parameters during hospital stay were compared between two groups using Chi-square test and Mann-Whitney test. SAE was always technically feasible. The mean length of the total hospital stay was lower in the group A patients (5.4 vs. 6.6 day, [P = 0.050]). There was significant increase in hemoglobin and hematocrit levels and systolic blood pressure (SBP) in group A patients after SAE, whereas in group B patients there was decrease in hemoglobin and hematocrit levels and only slight increase in SBP (pre- and early posttreatment relative change in hemoglobin [P = 0.002], hematocrit [P = 0.001], and SBP [P = 0.017]). Secondary splenectomy rate was lower in group A (4 % [1/25] vs. 15 % [3/20] [P = 0.309]). No procedure-related complications were encountered during the hospital stay and follow-up. Minor complications of pleural effusion, fever, pain, and insignificant splenic infarct noted in 9 (36 %) patients. SAE is a technically feasible, safe, and effective method in the management of splenic injuries. Use of SAE as an adjunct to NOM of splenic injuries results improvement in hemoglobin, hematocrit levels, and SBP. SAE also reduces secondary splenectomy rate and hospital stay.

  3. Syncope as the Presenting Feature of Splenic Rupture after Colonoscopy

    Directory of Open Access Journals (Sweden)

    Daniel Jamorabo

    2014-01-01

    Full Text Available Splenic rupture is a rare, catastrophic complication of colonoscopy and an exceptional cause of syncope. This injury is believed to be from direct trauma or tension on the splenocolic ligament with subsequent capsule avulsion or else from direct instrument-induced splenic injury. Diagnosis requires a high index of suspicion that may be absent because presentation can be subtle, nonspecific, and delayed anywhere from hours to days and therefore not easily attributed to a recent endoscopy. We describe a case of syncope as the initial manifestation of splenic rupture after colonoscopy. Our patient’s pain was delayed; his discomfort was mild and not localized to the left upper quadrant. Clinicians should consider syncope, lightheadedness, and drop in hemoglobin in absence of rectal bleeding following a colonoscopy as possible warning signs of imminent or emergent splenic injury.

  4. Critical care issues in solid organ injury: Review and experience in a tertiary trauma center

    Directory of Open Access Journals (Sweden)

    Chhavi Sawhney

    2014-01-01

    Full Text Available Background and Aim: Solid organ (spleen and liver injuries are dreaded by both surgeons and anesthesiologists because of associated high morbidity and mortality. The purpose of this review is to describe our experience of critical care concerns in solid organ injury, which otherwise has been poorly addressed in the literature. Materials and Methods: Retrospective cohort of solid organ injury (spleen and liver patients was done from January 2010 to December 2011 in tertiary level trauma Center. Results: Out of 624 abdominal trauma patients, a total of 212 patients (70% were admitted in intensive care unit (ICU. Their ages ranged from 6 to 74 years (median 24 years. Nearly 89% patients in liver trauma and 84% patients in splenic trauma were male. Mechanism of injury was blunt abdominal trauma in 96% patients and the most common associated injury was chest trauma. Average injury severity score, sequential organ failure assessment, lactate on admission was 16.84, 4.34 and 3.42 mmol/L and that of dying patient were 29.70, 7.73 and 5.09 mmol/L, respectively. Overall mortality of ICU admitted solid organ injury was 15.55%. Major issues of concern in splenic injury were hemorrhagic shock, overwhelming post-splenectomy infection and post-splenectomy vaccination. Issues raised in liver injury are damage control surgery, deadly triad, thromboelastography guided transfusion protocols and hemostatic agents. Conclusions: A protocol-based and multidisciplinary approach in high dependency unit can significantly reduce morbidity and mortality in patients with solid organ injury.

  5. Critical care issues in solid organ injury: Review and experience in a tertiary trauma center

    Science.gov (United States)

    Sawhney, Chhavi; Kaur, Manpreet; Gupta, Babita; Singh, P. M.; Gupta, Amit; Kumar, Subodh; Misra, M. C.

    2014-01-01

    Background and Aim: Solid organ (spleen and liver) injuries are dreaded by both surgeons and anesthesiologists because of associated high morbidity and mortality. The purpose of this review is to describe our experience of critical care concerns in solid organ injury, which otherwise has been poorly addressed in the literature. Materials and Methods: Retrospective cohort of solid organ injury (spleen and liver) patients was done from January 2010 to December 2011 in tertiary level trauma Center. Results: Out of 624 abdominal trauma patients, a total of 212 patients (70%) were admitted in intensive care unit (ICU). Their ages ranged from 6 to 74 years (median 24 years). Nearly 89% patients in liver trauma and 84% patients in splenic trauma were male. Mechanism of injury was blunt abdominal trauma in 96% patients and the most common associated injury was chest trauma. Average injury severity score, sequential organ failure assessment, lactate on admission was 16.84, 4.34 and 3.42 mmol/L and that of dying patient were 29.70, 7.73 and 5.09 mmol/L, respectively. Overall mortality of ICU admitted solid organ injury was 15.55%. Major issues of concern in splenic injury were hemorrhagic shock, overwhelming post-splenectomy infection and post-splenectomy vaccination. Issues raised in liver injury are damage control surgery, deadly triad, thromboelastography guided transfusion protocols and hemostatic agents. Conclusions: A protocol-based and multidisciplinary approach in high dependency unit can significantly reduce morbidity and mortality in patients with solid organ injury. PMID:25538517

  6. A CLINICAL STUDY ON BLUNT INJURY ABDOMEN

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    G. Kishore Babu

    2016-10-01

    Full Text Available BACKGROUND Abdominal trauma continues to account for a large number of trauma-related injuries and deaths. Motor vehicle accidents and urban violence, respectively, are the leading causes of blunt and penetrating trauma to this area of the body. Unnecessary deaths and complications can be minimized by improved resuscitation, evaluation and treatment. The new techniques and diagnostic tools available are important in the management of abdominal trauma. These improved methods, however, still depend on experience and clinical judgment for application and determination of the best care for the injured patient. The aim of the study is to 1. Analyse the incidence, clinical characteristics, diagnosis, indications for laparotomy, therapeutic methods and morbidity & mortality rates. 2. To study nature of blunt abdominal trauma. 3. To assess patient for surgical intervention and to avoid negative laparotomy. 4. To assess morbidity rate in different organs injury. 5. To evaluate modalities of treatment, complications and prognosis. MATERIALS AND METHODS This study is a prospective study on 97 patients with Blunt injuries to the abdomen admitted in S.V.R.R.G.G. Hospital, Tirupati during October 2013-15. Inclusion Criteria Patients > 13 years, with Blunt injury to abdomen either by RTA, fall, object contact, assault giving written informed consent. Exclusion Criteria Patients <13 yrs. Blunt injuries due to blasts, patients with severe cardiothoracic and head injuries who are hemodynamically unstable. CONCLUSION Blunt Trauma to abdomen is on rise due to excessive use of motor vehicles. It poses a therapeutic and diagnostic dilemma for the attending surgeon due to wide range of clinical manifestations ranging from no early physical findings to progression to shock. So, the Trauma surgeon should rely on his physical findings in association with use of modalities like x-ray abdomen, USG abdomen and abdominal paracentesis. Hollow viscus perforations are

  7. Levosimendan no tratamento da contusão miocárdica grave pós-trauma torácico fechado: relato de caso = Levosimendan treatment for severe myocardial contusion after blunt chest trauma: case report

    OpenAIRE

    Benincasa,Cristian Chassot

    2007-01-01

    Introdução: a contusão miocárdica é causada usualmente por trauma torácico fechado, principalmente em pacientes com história de acidente de carro ou moto. Os pacientes com manifestações clínicas graves devem manejados com intubação, reposição volêmica, vasopressor e inotrópicos. O levosimendan é uma nova droga com ação inodilatadora, que age sensibilizando os canais de cálcio. O objetivo deste relato é documentar o tratamento de um caso de choque cardiogênico secundário a contusão miocárdica,...

  8. 胍丁胺对创伤小鼠过度炎症反应及脾细胞增殖的影响%Effects of agmatine on excessive inflammatory reaction and proliferation of splenic cells in mice with trauma

    Institute of Scientific and Technical Information of China (English)

    刘政; 侯凤艳; 靳贺; 肖雅; 范霞; 杨雪; 严军; 梁华平

    2015-01-01

    determined with ELISA.Results Compared with control group, 3 hours after trauma/hemorrhage, the levels of serum TNF-α, IL-6, and IL-1β in model group were significantly elevated [TNF-α (ng/L): 145.38±31.50 vs. 23.06±11.14, IL-6 (ng/L): 496.94±50.76 vs. 47.13±17.47, IL-1β (ng/L): 321.31±43.02 vs. 29.25±16.24,allP< 0.01]. It was found that AGM treatment could alleviate the increase in serum pro-inflammatory mediators induced by trauma/hemorrhage, such as TNF-α (ng/L:111.56±25.47 vs. 145.38±31.50), IL-6 (ng/L: 412.56±44.33 vs. 496.94±50.76), IL-1β (ng/L: 273.38±45.25 vs. 321.31±43.02,P< 0.05 orP< 0.01). Twenty-four hours after trauma/hemorrhage, serum pro-inflammatory mediators were recovered to the levels in control group. There was no significant difference in TNF-α and IL-6 levels at 3 hours after trauma/hemorrhage among groups. Compared with control group, the expressions of liver TNF-α and IL-6 in model group were increased at 24 hours following trauma [TNF-α (ng/mg): 32.93±4.90 vs. 26.58±2.33, IL-6 (ng/mg): 11.20±1.66 vs. 8.38±0.89,bothP< 0.01]. However, AGM inhibited the level of TNF-α (ng/mg:28.92±3.16 vs. 32.93±4.90) and IL-6 (ng/mg: 9.03±1.28 vs. 11.20±1.66) in the liver as induced by trauma/hemorrhage (P< 0.05 andP< 0.01). At 24 hours after modeling, model group and AGM group had distinctly higher serum AST, ALT, LDH levels than those of control group [AST (U/L): 405.9±31.2, 245.7±22.1 vs. 128.2±15.9; ALT (U/L): 92.1±6.3, 51.6±5.0 vs. 30.1±3.2; LDH (U/L): 606.7±36.3, 478.7±25.3 vs. 384.0±16.6, allP< 0.01]. Nevertheless,the increase in serum AST, ALT and LDH was alleviated in AGM group (allP< 0.01). Meantime, trauma/hemorrhage produced a noticeable depression of proliferation of splenic cells and IFN-γ and IL-2 release stimulated with ConA compared with control group [proliferation rate: (40.97±4.13)% vs. (89.99±7.76)%, IFN-γ(ng/L): 91.6±12.3 vs. 353.2±21.5,IL-2 (ng/L): 53.4±6.4 vs. 91.0±12.2,allP< 0.01]. In contrast, AGM

  9. Sonography of scrotal trauma

    Directory of Open Access Journals (Sweden)

    Meka Srinivasa Rao

    2012-01-01

    Full Text Available The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance.

  10. [Scrotal trauma: management strategy].

    Science.gov (United States)

    Culty, T; Ravery, V

    2006-04-01

    Scrotal traumas are rare. Most are blunt traumas caused by a direct blow on the scrotum. The testicle is projected against the pubic arch. Early surgical investigation has considerably improved the prognosis of testicular trauma, and reduced orchidectomy rate. ULtrasonography has also improved the management of scrotal trauma. But there is a controversy about accuracy of ultrasonography in predicting presence or absence of testicular disruption. ULtrasonography should not challenge the dogma regarding systematic surgical investigation of hematocele and enlarged scrotum. Long term outcomes (testicular atrophy, infertility) may be more frequent as previously thought and should be detected.

  11. 创伤重点超声评估法联合腹部穿刺在腹部闭合性损伤中的作用%Trauma focused ultrasound assessment method combined abdominal puncture in the role of blunt abdo-minal trauma

    Institute of Scientific and Technical Information of China (English)

    吴多虎

    2014-01-01

    Objective To research the role of trauma focused ultrasound assessment method combined abdominal puncture in blunt abdominal trauma. Method Used trauma focused ultrasound assessment method combined abdominal puncture to diagnosis 196 cases of patients with blunt abdominal trauma in our hospital. Compared the results of examination with results of corresponding CT. Result There were 174 cases with abdominal cavity effusion after analysis of FAST, and there were actually 168 cases with abdominal cavity effusion conifrmed by operation, the accuracy was 96.55%. FAST diagnosised 184 cases with abdominal injury, including 43 cases with spleen, 82 cases with liver damage, 59 cases with kidney injury. And there were actually 180 cases wirh abdominal injury, the accuracy was 97.82%. Time of FAST combined abdominal puncture was (2.1±0.4) minutes, the cost for check was (146.3±35.1) yuan, the difference was statistically signiifcan (P<0.05). Conclusion FAST combined abdominal puncture is more accurate in diagnosis and more faster than CT inspectio to patients with BAT, worthy of popularizing in clinical application.%目的:研究创伤重点超声评估法(FAST)联合腹部穿刺在腹部闭合性损伤(BAT)中的作用。方法运用FAST联合腹部穿刺对本院收治的196例BAT患者进行诊断,将检查结果与其对应的CT检查结果比较并进行分析。结果经FAST检查分析,腹腔积液174例,经手术证实腹腔积液168例,准确率为96.55%;腹部损伤184例,其中包括脾脏损伤43例,肝脏损伤82例,肾脏损伤59例,经手术证实腹部损伤180例,准确率为97.82%。FAST联合腹部穿刺的检查时间为(2.1±0.4)分钟,检查费用为(146.3±35.1)元,显著低于CT检查[(16.5±6.3)分钟、(352.4±51.3)元],差异具有显著(P<0.05)。结论 FAST联合腹部穿刺在BAT患者诊断结果方面较为准确,相对于CT等检查手段更为快捷,值得在临床推广应用。

  12. Ligustrazine prevents lung cell apoptosis in the acute stage of pulmonary contusion induced by blunt chest trauma%川芎嗪干预钝性肺挫伤急性期大鼠肺组织细胞的凋亡*

    Institute of Scientific and Technical Information of China (English)

    曹晨; 邓应忠; 郑明安; 刘芳; 孟庆涛

    2013-01-01

      背景:急性胸部撞击后所致的肺挫伤(钝性肺挫伤)常引起呼吸功能异常和继发性炎性反应,并参与全身炎性反应综合征和多器官功能障碍综合征,其发病原因及致病机制亟待明确。目的:观察胸部撞击所致钝性肺挫伤急性期细胞凋亡的变化及其川芎嗪对其的影响。方法:健康雄性 SD 大鼠随机分为正常对照组、模型组、川芎嗪治疗组,后两组制备胸部撞击伤模型,川芎嗪治疗组建模后立即腹腔注射川芎嗪80 mg/kg 1次。在创伤发生后1,2,3 h 观察肺组织病理形态学及细胞凋亡的改变、检测肺水肿程度和肺血管通透性改变,免疫组织化学检测肺组织 Bcl-2、Bax和 Caspase-3的表达及血液中肿瘤坏死因子α水平变化。结果与结论:模型组肿瘤坏死因子α水平在创伤后1 h 即显著增加,创伤后2 h 及3 h 间急剧增加(P <0.05);创伤后2 h 及3 h 肺组织细胞凋亡指数及肺组织损伤程度显著增高(均 P <0.05);肺血管通透性及肺水肿程度增加(P <0.05);Caspase-3表达显著增高(P <0.05),Bcl-2/Bax 比值显著降低(P <0.05)。川芎嗪治疗组在相应时间点相对于模型组肿瘤坏死因子α水平显著降低(P <0.05),肺组织内细胞凋亡指数及肺组织损伤程度降低(P <0.05),肺血管通透性及肺水肿程度减轻(P <0.05);Caspase-3表达下降(P <0.05),Bcl-2/Bax 比值增加(P <0.01)。结果提示,川芎嗪可通过抑制肿瘤坏死因子α表达,下调 Caspase-3的表达并提高 Bcl-2/Bax 的比值,以降低胸部撞击所致肺组织急性期的异常凋亡并减轻胸部撞击所致急性期肺挫伤。%BACKGROUND: Pulmonary contusion induced by blunt chest trauma can result in respiratory dysfunction and secondary inflammatory reaction, which can take part in the occurrence of systemic inflammatory response syndrome and multiple-organ dysfunction syndrome. However, the reason and mechanism

  13. MR imaging for blunt pancreatic injury

    Energy Technology Data Exchange (ETDEWEB)

    Yang Lin [Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000 (China); Zhang Xiaoming, E-mail: cjr.zhxm@vip.163.co [Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000 (China); Xu Xiaoxue; Tang Wei; Xiao Bo; Zeng Nanlin [Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000 (China)

    2010-08-15

    Objective: To study the MR imaging features of blunt pancreatic injury. Materials and methods: Nine patients with pancreatic injury related to blunt abdominal trauma confirmed by surgery performed MR imaging. Two abdominal radiologists conducted a review of the MR images to assess pancreatic parenchymal and pancreatic duct injury, and associated complications. Result: Diagnostic quality MR images were obtained in each of the nine patients. In the nine patients, pancreatic fracture, laceration and contusion were depicted on MR imaging in five, one and three patients, respectively. There were six patients with pancreatic duct disruption, eight patients with peripancreatic fluid collections, and four patients with peripancreatic pseudocyst or hematoma, respectively. All of the MR imaging findings was corresponded to surgical findings. Conclusion: MR imaging is an effective method to detect blunt pancreatic injury and may provide information to guide management decisions.

  14. Splenic injury after colonoscopy

    DEFF Research Database (Denmark)

    Petersen, C.R.; Adamsen, S.; Gocht-Jensen, P.;

    2008-01-01

    Splenic injury is a rare and serious complication of colonoscopy. The most likely mechanism is tension on the splenocolic ligament and adhesions. Eight cases were identified among claims for compensation submitted to the Danish Patient Insurance Association during the period 1992-2006, seven of w...

  15. Embolisation of the splenic artery

    Energy Technology Data Exchange (ETDEWEB)

    Essler, G.; Duex, A.

    1982-09-01

    In bleeding of oesophageal varices with resistance to common treatment embolisation of the splenic artery causes depression of the portal hypertension by forty per cent. Thrombosis of the splenic or portal vein as in splenectomies are not to be expected. The splenic vein remains open for later spleno-renal anastomosis. By occlusion of the splenic artery we were successful in stopping oesophageal bleeding. In a patient with dominant hypersplenism in portal hypertension the severity of the syndrome decreased after embolisation of the splenic artery. Thrombocytes, leukocytes and gammaglobulin increased.

  16. Linear abdominal trauma.

    Science.gov (United States)

    Danto, L A; Wolfman, E F

    1976-03-01

    Three cases of blunt abdominal trauma are presented to exemplify the mechanism of trauma and the problems of diagnosis associated with any linear blow to the abdomen. The mechanisms of visceral injury are reviewed, and special attention is directed to the abdominal wall injury that can be present in these patients. This injury has special implications in directing the operative approach and repair. An unusual aortic occlusion is described which is peculiar to this type of injury.

  17. Partial Splenic Artery Embolization

    Directory of Open Access Journals (Sweden)

    Gh. Shadmani

    2010-05-01

    Full Text Available Background/Objective: Hypersplenism often accompanies chronic liver disease and splenomegaly is one of the four cardinal signs of hypersplenism, the other three being cytopenia, normal or hyperplastic bone marrow and response splenectomy. Surgical splenectomy is the traditional treatment."nIn the recent years, partial splenic embolization has been widely used in patients with hypersplenism and cirrhosis.This study was conducted to assess the safety and efficacy of partial splenic embolization using PVA (poly vinyl alcohol and steel coil in the management of hypersplenism."nPatients and Methods: Between Aban 1387 and Aban 1388, ten patients with hypersplenism related hematologic abnormalities (leukopenia, thrombocytopenia, variceal hemorrhage or other sequels underwent partial splenic embolization with PVA and coil. A comparison between pre-procedure and post-procedure lab data, endoscopy and splenic volumetery was done."nResults: All patients showed dramatic improvement in platelet and leukocyte counts. Platelet and leukocyte counts remained at an appropriate level during the follow up period. In one patient after one year progressive decline in the platelet count was noted, however the values remained significantly higher than before PSE (70000 vs 15000."nAlmost all patients had problems related to post embolization syndrome. In one patient severe pain was noted that lasted nearly ten days, in the other patients, pain was less severe. No significant complication (splenic abscess, pancreatitis, portal vein thrombosis developed in this study."nConclusion: The efficacy of PSE observed in our study confirms the results of previous studies in pa-tients with hypersplenism. This safe, fast method can be used bridging therapy for cirrhotic patients waiting for liver transplantation. Hematological response is related to the extension of embolization.

  18. [Adrenal injury in blunt abdominal trauma].

    Science.gov (United States)

    Abakumov, M M; Smoliar, A N; Barmina, T G; Boĭko, A V; Shalimova, I G

    2009-01-01

    10 patients with adrenal damage were observed during 2.5 years. It amounted 0.93% of all patients with closed abdominal injuries. The right adrenal gland was traumatized in all cases evidently due to it's compression between right lobe of liver and vertebral column. Adrenal damage is observed quite often in combination with injuries of right liver lobe, right kidney and retroperitoneal hematoma formation. 5 patients underwent laparotomy on account of intra-abdominal bleeding, but adrenal damage was never revealed. Ultrasound and tomographic semiotics of adrenal damage was worked out, which allowed ascertaining diagnosis in 80% on application of ultrasound study and in 100% at computer tomography. Injury of one adrenal gland was not accompanied by adrenal failure and did not require hormonal replacement therapy.

  19. Post trauma abdominal cocoon.

    Science.gov (United States)

    Kaur, Supreet; Doley, Rudra Prasad; Chabbhra, Mohinish; Kapoor, Rajeev; Wig, Jaidev

    2015-01-01

    Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

  20. Blunt Cardiac Injury in the Severely Injured - A Retrospective Multicentre Study.

    Directory of Open Access Journals (Sweden)

    Marc Hanschen

    Full Text Available Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients.In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009, characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6, the revised injury severity score (RISC allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6 (2.3% of patients.Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%. The overall mortality rate was 13.9%, minor cardiac injury (AIS 1 and severe cardiac injury (AIS 2-6 are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6 is associated with a higher mortality (OR 2.79 and 4.89, respectively as compared to the predicted average mortality (OR 2.49 of the study collective.Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients' outcome is dependent on the severity of cardiac injury.

  1. Splenic abscess owing to cancer at the splenic flexure

    Science.gov (United States)

    Awotar, Gavish K.; Luo, Fuwen; Zhao, Zhengdong; Guan, Guoxin; Ning, Shili; Ren, Jinshuai; Liu, Yaqing; Wang, Guangzhi; Liu, Pixu

    2016-01-01

    Abstract Background: The cancer of the splenic flexure of the colon is a rare medical entity with severe morbidity because of its insidious onset. Methods: We present the case of a 59-year-old male patient with dull left upper quadrant pain, leukocytosis, and anemia. A splenic abscess described as an air-fluid level with splenocolic fistula was found on CT scan imaging. Surgery was done for splenic pus drainage. He was again admitted 2 months later for intestinal obstruction. Results: An exploratory laparotomy showed multiple hard, gray liver nodules as well as a hard mass in the small bowel. Owing to extensive adhesions and a late stage of cancer involvement, the splenic flexure tumor was not resected. A loop transverse colostomy was done and a ColoplastTM Colostomy bag placed. We also reviewed the literature-linking colon cancer and splenic abscess with specific attention to the carcinoma of the splenic flexure. As the latter invades through the spleen matter, there is the creation of a splenocolic fistula, which allows the migration of normal gut flora into the spleen. This leads to the formation of the splenic abscess. Conclusion: This is the 13th case report pertaining to invading colonic cancer causing a splenic abscess. Although the treatment for splenic abscesses is shifting from splenectomy to image-guided percutaneous pus drainage, the few reported cases make the proper management of such complication still unclear. PMID:27661050

  2. Closed lung trauma.

    Science.gov (United States)

    Feden, Jeffrey P

    2013-04-01

    Pulmonary injuries from blunt thoracic trauma are seen regularly with high-energy mechanisms but described less frequently in association with sports. Pneumothorax, hemothorax, pneumomediastinum, and pulmonary contusion are uncommon with athletic participation and often follow a benign clinical course. Life-threatening complications may arise, and athletes with chest trauma deserve close attention. Appropriate diagnosis is suggested by history and physical examination; conventional chest radiography is preferred as the initial imaging study but has limitations. Use of CT for trauma has improved diagnostic sensitivity for occult injury, although this may not alter management or outcomes. Return to play is guided by resolution of symptoms and radiographic findings.

  3. Infarto do miocárdio causado por lesão arterial coronariana após trauma torácico fechado Infarto de miocardio causado por lesión arterial coronaria post traumatismo torácico cerrado Myocardial infarction caused by coronary artery injury after a blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Márcio Silva Miguel Lima

    2009-07-01

    Full Text Available Relatamos o caso de um indivíduo do sexo masculino de 29 anos de idade, vítima de um acidente de carro no qual sofreu trauma torácico fechado, evoluindo com insuficiência cardíaca congestiva. O paciente apresentava boa saúde previamente, sem sintomas de doença cardiovascular. Na avaliação inicial, o eletrocardiograma mostrou ondas Q nas derivações precordiais e o ecocardiograma mostrou disfunção ventricular esquerda importante. A angiografia coronária mostrou uma lesão na artéria coronária descendente anterior esquerda (ADE, com acinesia da parede anterior na ventriculografia com contraste. A tomografia computadorizada por emissão de fóton único (SPECT com Tálio-201 não mostrou viabilidade. O paciente foi mantido em tratamento clínico com boa evolução.Relatamos el caso de un individuo del sexo masculino, de 29 años de edad, víctima de accidente automovilístico en el cual sufrió traumatismo torácico cerrado, evolucionando con insuficiencia cardíaca congestiva. El paciente presentaba buena salud previamente, sin síntomas de enfermedad cardiovascular. En la evaluación inicial, el electrocardiograma mostró ondas Q en las derivaciones precordiales y el ecocardiograma mostró disfunción ventricular izquierda importante. La angiografía coronaria mostró una lesión en la arteria coronaria descendente anterior izquierda (ADI, con acinesia de la pared anterior en la ventriculografía de contraste. La tomografía computada por emisión de fotón único (SPECT con Talio-201 no mostró viabilidad. El paciente fue mantenido en tratamiento clínico con buena evolución.We report the case of a 29-year-old man, victim of a car accident, who suffered a severe blunt chest trauma, with evolving congestive heart failure. He had previously had a good overall health status, with no symptoms of cardiovascular disease. At the initial assessment, the electrocardiogram showed Q waves in the precordial leads and the echocardiogram

  4. External air compression: A rare cause of blunt esophageal injury, managed by a stent

    Directory of Open Access Journals (Sweden)

    Mohammed Muneer

    2014-01-01

    CONCLUSION: High index of suspicion is needed for early diagnosis of esophageal perforation after blunt trauma. Appropriate drainage, antibiotic and temporary endoscopic esophageal stenting may be an optimal approach in selected patients, especially with delayed diagnosis.

  5. CLINICAL STUDY AND MANAGEMENT OF BLUNT INJURY ABDOMEN PERTAINING TO SOLID ORGANS

    Directory of Open Access Journals (Sweden)

    Katta Srinivasa

    2015-09-01

    Full Text Available Blunt Abdominal trauma is one of the most common causes among injuries caused mainly due to road traffic accidents. 1 The rapid increase in number of motor vehicles and its aftermath has caused rapid increase in number of victims to blunt abdominal trauma. Motor vehicle accidents account for 75 to 80% of blunt abdominal trauma. 2 Blunt injury of abdomen is also a result of fall from height, assault with blunt objects, industrial mishaps, sport injuries, bomb blast and fall from riding bicycle. 2 In view of increasing number of vehicles and consequently road traffic accidents, this topic is chosen to study the cases of blunt abdominal trauma with reference to the patients presenting at Govt. General Hospital, attached to Guntur Medical College, Guntur. OBJECTIVES: The objectives of the study are: 1. To evaluate the impact of blunt abdominal trauma on solid viscera. 2. To evaluate etiology and various modes of presentation. 3. To evaluate various available investigations for the detection of solid organ injuries. 4. To evaluate various modalities of treatment available with aim to reduce the mortality and morbidity. 5. To evaluate common complications of solid organ injury in blunt trauma abdomen. MATERIALS AND METHODS: Patients admitted in Government General Hospital, Guntur, from November 2012 to October 2014 and studied 50 cases. This is a prospective study conducted over 2 years. RESULTS: Male patients were commonly affected (80%, Peak age group being 21 – 30 years (48%. The commonest mode of injury was road traffic accident (58%. The common organ injured was spleen (54% followed by liver. 70% of the patients were treated by surgery, 30% conservatively. The mortality in this study was 14%. CONCLUSIONS : Blunt injury abdomen forms considerable load and health care system, most common age group is youngsters in road traffic accidents , so efforts should be made to formulate and execute road traffic regulations. Well established trauma care

  6. The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Mallarini, Giorgio (Dept. of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari (Italy)), email: lucasaba@tiscali.it; Anzidei, Michele; Lucatelli, Pierleone (Dept. of Radiological Sciences, Univ. of Rome La Sapienza, Rome (Italy))

    2011-06-15

    Splenic artery aneurysm is the most frequent visceral artery aneurysm and rupture of the aneurysm is associated with a high mortality rate. It is important to discriminate between a true aneurysm and a pseudoaneurysm that may be caused by pancreatitis, iatrogenic and postoperative causes, trauma and peptic ulcer disease. Multidetector-row CT angiography (MDCTA) allows detailed visualization of the vascular anatomy and may allow identification of aneurysms and pseudoaneurysms that affect the splenic artery. The objective of this article is to provide a review of the general characteristics of splenic artery aneurysms and pseudoaneurysms and to describe the findings of MDCTA

  7. The Focused Assessment With Sonography For Trauma (FAST) Examination And Pelvic Trauma: Indications And Limitations.

    Science.gov (United States)

    Shaukat, Nadia Maria; Copeli, Nikolai; Desai, Poonam

    2016-03-01

    Pelvic trauma accounts for only 3% of all skeletal injuries but may have mortality as high as 45% in cases of severe trauma. Significant high-grade-mechanism trauma to the pelvis must always take the abdomen into consideration for evaluation. The focused assessment with sonography for trauma (FAST) examination has been shown to be a valuable tool in assessing the unstable trauma patient with blunt abdominal injury, though its diagnostic utility is much less well-defined than in primary pelvic trauma. This systematic review explores the utility and limitations of the FAST examination in patients with blunt pelvic trauma and discusses the timing for the examination during the trauma survey. Newer techniques for emergency department management of the unstable trauma patient are also addressed.

  8. Blunt injury to the inferior gluteal artery: case report of a rare "near miss" event

    OpenAIRE

    Chen Wei; Pan Jinshe; Smith Wade R; Liu Huaijun; Zhang Qi; Zhang Yingze

    2008-01-01

    Abstract Traumatic injuries of the inferior gluteal artery are rare, the majority of which are aneurysms due to sharp or blunt trauma. We report the rare case of a "near miss" event of a patient with an acute hemorrhagic mass in the right buttock caused by blunt trauma to the inferior gluteal artery without "hard" clinical signs of vascular injury. Despite the unusual presentation, diffuse injury of the inferior gluteal artery branches was diagnosed by ultrasonography and angiography. This ar...

  9. Smart, Injury-Triggered Therapy for Ocular Trauma

    Science.gov (United States)

    2015-10-01

    vitreoretinopathy (PVR), a form of intraocular fibrosis, is often the primary reason for the loss of vision after ocular trauma, and frequently occurs after blunt...metalloproteinase activity by shedding/releasing tagged- ectodomains in the vicinity of affected cells after traumatic eye injury and induction of PVR. We...primary reason for the loss of vision after ocular trauma, and frequently occurs after blunt trauma and open globe injuries caused by penetration

  10. Image guided percutaneous splenic interventions

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Mandeep [Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India)], E-mail: mandykang2005@yahoo.com; Kalra, Naveen; Gulati, Madhu; Lal, Anupam; Kochhar, Rohit [Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India); Rajwanshi, Arvind [Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India)

    2007-10-15

    Aim: The objective of this study is to evaluate the efficacy and safety of image-guided percutaneous splenic interventions as diagnostic or therapeutic procedures. Materials and methods: We performed a retrospective review of our interventional records from July 2001 to June 2006. Ninety-five image-guided percutaneous splenic interventions were performed after informed consent in 89 patients: 64 men and 25 women who ranged in age from 5 months to 71 years (mean, 38.4 years) under ultrasound (n = 93) or CT (n = 2) guidance. The procedures performed were fine needle aspiration biopsy of focal splenic lesions (n = 78) and aspiration (n = 10) or percutaneous catheter drainage of a splenic abscess (n = 7). Results: Splenic fine needle aspiration biopsy was successful in 62 (83.78%) of 74 patients with benign lesions diagnosed in 43 (58.1%) and malignancy in 19 (25.67%) patients. The most common pathologies included tuberculosis (26 patients, 35.13%) and lymphoma (14 patients, 18.91%). Therapeutic aspiration or pigtail catheter drainage was successful in all (100%) patients. There were no major complications. Conclusions: Image-guided splenic fine needle aspiration biopsy is a safe and accurate technique that can provide a definitive diagnosis in most patients with focal lesions in the spleen. This study also suggests that image-guided percutaneous aspiration or catheter drainage of splenic abscesses is a safe and effective alternative to surgery.

  11. Eye trauma in boxing.

    Science.gov (United States)

    Corrales, Gustavo; Curreri, Anthony

    2009-10-01

    In boxing, along with a few other sports, trauma is inherent to the nature of the sport; therefore it is considered a high-risk sport for ocular injuries. The long-term morbidity of ocular injuries suffered by boxers is difficult to estimate due to the lack of structured long-term follow-up of these athletes. Complications of blunt ocular trauma may develop years after the athlete has retired from the ring and is no longer considered to be at risk for boxing-related injuries. This article describes the wide range of eye injuries a boxer can sustain, and their immediate and long-term clinical management.

  12. Post trauma abdominal cocoon

    Directory of Open Access Journals (Sweden)

    Supreet Kaur

    2015-01-01

    Full Text Available Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

  13. Clinical Study on Ocular Trauma in Children

    Institute of Scientific and Technical Information of China (English)

    Zicai Huang; Hongni Li; Yixia Huang; Zhongxia Zhou

    2002-01-01

    Purpose: To investigate the clinical characteristics of ocular trauma in children and put forward the major treatment and prevention of ocular trauma in children.Methods: To analyze the clinical data by 77 eyes in 77 cases of ocular trauma in children from April 1999 to February 2002. Results: The male and female were in the ratio of 2.21: 1. Right eye ocular traumas were more than left ones. Ocular penetrating trauma was 83.12% and blunt trauma 12.99%. 41 cases (53.25%) were injured by themselves while 33 cases by others. 90.91% patients came from the countryside.Conclusion: The rate of blindness of children with ocular trauma could be reduced by prompt treatment. The study indicated that ocular trauma preventive publicity should be faced in the countryside in order to improve the understanding of the severity of ocular trauma and treat it as a social problem.

  14. 枪弹射击致防弹衣后长白猪远达脑组织损伤特点及其机制%Characteristics and mechanism of behind armour blunt trauma in Landrace brain

    Institute of Scientific and Technical Information of China (English)

    苏正林; 许民辉; 赖西南; 张波; 黄艺峰; 王丽丽

    2011-01-01

    Objective To study the characteristics of behind armor blunt trauma extending to the brain and to investigate the biomechanics mechanism of the remote injury. Methods Eighteen male Landraces were randomly divided into a sham injury group (n =4) , a bullet velocity 910 m/s group (re =6), a 740 m/s group (n =4) and a S90 m/s group (n =4). The injury model was anesthetized Landrace in right lateral position and wrapped in a two-layer bullet-proof vest. The outer layer was ceramic hard armor with NIJ Ⅲ protection grade. The inner layer was police grade II ultra-high molecular polyethylene soft body armor. Caliber 5. 8 mm ballistic guns were fired at 25 m range and three different projectile velocities, aimed at the left midclavicular line 4, 5 intercostal (heart window). Air bomb shooting was applied to sham injury group. EEG, ECG, invasive arterial blood pressure, heart rate and respiratory changes before and after injury were continuously monitored. Plasma was collected at 1, 2 and 3 h before and after injury to detect markers of brain injury. Lumbar puncture was taken at 3 h before and after injury to test specific brain injury protein in cerebrospinal fluid. In 3 h after injury the animals were deep anesthetized and bled to death. Their brain blocks were collected for toluidine blue staining and electron microscopy. The other 4 Landrace pigs were used for biomechanical testing. On the basis of the above model pressure sensors were placed in the subcutaneous layer of precordium at the point of impact, pericardial cavity, left chest, left common carotid artery and cranial cavity. Acceleration sensors and force sensors were placed in the sixth rib at precordial midclavicular line. When the target was hit, each parts biomechanical parameters and duration were recorded and analyzed. Results In the 3 groups of different speed, spectrum intensity of low-frequency EEG Delta and Theta wave within 2 minutes after injury was significantly lower than that before injury (P

  15. Experiences of nuring a case of acute myocardial infarction following blunt chest trauma due to traffic accident%1例车祸致急性心肌梗死患者择期介入治疗的护理

    Institute of Scientific and Technical Information of China (English)

    荆丽敏; 金海英; 孟荣英

    2009-01-01

    急性心肌梗死(acute myrocardial infarction,AMI)多数由过度劳累、情绪激动、暴饮暴食、便秘、寒冷低温等引起。2006年12月,我科收治1例车祸后钝性胸部外伤(blunt chest trauma,BCT)所致的AMI患者,由于患者多处骨折,并有大量胸腔积液,择期行介入治疗(percuta—neous coronary intervention,PCI),现将护理体会总结如下。

  16. Risk of venous thromboembolism in patients with splenic injury and splenectomy. A nationwide cohort study.

    Science.gov (United States)

    Lin, Jiun-Nong; Chen, Hsuan-Ju; Lin, Ming-Chia; Lai, Chung-Hsu; Lin, Hsi-Hsun; Yang, Chih-Hui; Kao, Chia-Hung

    2016-01-01

    The spleen is a crucial organ in humans. However, little is known about the association of venous thromboembolism (VTE) with splenic injury and splenectomy in trauma patients. The aim of this study was to determine the subsequent risk of VTE following splenic injury and splenectomy. A nationwide retrospective cohort study was conducted by analysing data from the National Health Insurance Research Database in Taiwan. We included 6,162 splenic injury patients (3,033 splenectomised and 3,129 nonsplenectomised patients) and 24,648 comparison patients who were selected by frequency match based on sex, age, and the index year during 2000-2006. All patients were followed until the occurrence of VTE, 31 December, 2011, death, or withdrawal from the insurance program. The age of patients with splenic injury was 41.93 ± 16.44 years. The incidence rates of VTE were 11.81, 8.46, and 5.21 per 10,000 person-years in the splenic injury patients with splenectomy, splenic injury patients without splenectomy, and comparison patients, respectively. Compared with the comparison cohort, splenic injury patients with splenectomy exhibited a 2.21-fold risk of VTE (95% confidence interval [CI], 1.43-3.43), whereas those without splenectomy exhibited a 1.71-fold risk of VTE (95% CI, 1.05-2.80). The overall incidence rate of VTE was 1.97-fold higher in the splenic injury cohort than the comparison cohort (95% CI, 1.38-2.81). Although splenectomy increased the risk of VTE 1.35-fold compared with no splenectomy, the difference was not statistically significant (95% CI, 0.74-2.45). These results may alert physicians and patients to the complications of splenic injury and splenectomy.

  17. Disseminated tuberculosis causing isolated splenic vein thrombosis and multiple splenic abscesses.

    Science.gov (United States)

    Jain, Deepak; Verma, Kamal; Jain, Promil

    2014-09-01

    Tuberculosis is a common infectious cause of splenic enlargement in developing countries, but tubercular splenic abscesses are a rare presentation, found predominantly in immunocompromised populations. We report a case of tubercular splenic abscesses with isolated splenic vein thrombosis in an immunocompetent person.

  18. Large primary splenic cyst: A laparoscopic technique.

    LENUS (Irish Health Repository)

    Geraghty, M

    2009-01-01

    Splenic cysts are rare lesions with around 800 cases reported in the world literature. Traditionally splenectomy was the treatment of choice. However, with the recognition of the important immunological function of the spleen, new techniques to preserve splenic function have been developed. This case emphasizes that in selected cases splenic preservation is appropriate.

  19. Splenic rupture following routine colonoscopy.

    Science.gov (United States)

    Rasul, Tabraze; Leung, Edmund; McArdle, Kirsten; Pathak, Rajiv; Dalmia, Sanjay

    2010-10-01

    Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent.

  20. Splenic Hydatid Cysts: 17 Cases.

    Science.gov (United States)

    Ozogul, Bunyami; Kisaoglu, Abdullah; Atamanalp, Sabri Selcuk; Ozturk, Gurkan; Aydinli, Bulent; Yıldırgan, Mehmet İlhan; Kantarcı, A Mecit

    2015-12-01

    Hydatid cyst disease, which is endemically observed and an important health problem in our country, involves the spleen at a frequency ranking third following the liver and the lungs. In this study, we aimed to evaluate the efficacy and results of management in splenic hydatid cysts. The demographic data, localization, diagnosis, treatment methods, and the length of postoperative hospital stay of patients with splenic hydatid cysts in a 12-year period were evaluated retrospectively. Seventeen cases were evaluated. Among these, 13 were females and four were males. Seven had solitary splenic involvement, eight had involvement of both the spleen and the liver, and two had multiple organ involvement. Ten had undergone splenectomy, one had undergone distal splenectomy, and the remaining cases had undergone different surgical procedures. The patients had received albendazole treatment in the pre- and postoperative period. One patient had died secondary to hypernatremia on the first postoperative day. The clinical picture in splenic hydatid cysts, which is seen rarely, is usually asymptomatic. The diagnosis is established by ultrasonography and abdominal CT. Although splenectomy is the standard mode of treatment, spleen-preserving methods may be used.

  1. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

    Directory of Open Access Journals (Sweden)

    Aubrey-Bassler F

    2012-08-01

    Full Text Available Abstract Background Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. Methods Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. Results We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143, haematologic (n = 84 and non-haematologic neoplasms (n = 48. Amyloidosis (n = 24, internal trauma such as cough or vomiting (n = 17 and rheumatologic diseases (n = 10 are less frequently reported. Colonoscopy (n = 87 was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6, infarction (n = 6 and hamartomata (n = 5. Medications associated with rupture include anticoagulants (n = 21, thrombolytics (n = 13 and recombinant G-CSF (n = 10. Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm

  2. Blunt injury to the inferior gluteal artery: case report of a rare "near miss" event

    Directory of Open Access Journals (Sweden)

    Chen Wei

    2008-10-01

    Full Text Available Abstract Traumatic injuries of the inferior gluteal artery are rare, the majority of which are aneurysms due to sharp or blunt trauma. We report the rare case of a "near miss" event of a patient with an acute hemorrhagic mass in the right buttock caused by blunt trauma to the inferior gluteal artery without "hard" clinical signs of vascular injury. Despite the unusual presentation, diffuse injury of the inferior gluteal artery branches was diagnosed by ultrasonography and angiography. This article highlights the importance of considering an arterial injury following blunt trauma to the buttock with subsequent pain and swelling. Appreciation of this rare injury pattern is necessary in order to facilitate rapid diagnosis and appropriate treatment.

  3. Isolated splenic vein thrombosis secondary to splenic metastasis: A case report

    Institute of Scientific and Technical Information of China (English)

    Kunihiko Hiraiwa; Kyoei Morozumi; Hiroshi Miyazaki; Keiichi Sotome; Akio Furukawa; Makoto Nakamaru; Yoichi Tanaka; Hisami Iri

    2006-01-01

    A 49-year-old, previously healthy woman sought treatment for abdominal pain. Colonoscopy revealed ascending colon cancer. Computed tomography and angiography showed splenic metastasis and thrombosis extending from the splenic vein to the portal vein. She underwent right hemicolectomy, splenectomy, and distal pancreatomy. Histological findings showed no malignant cell in the splenic vein which was filled with organizing thrombus. We postulate the mechanism of splenic vein thrombosis in our case to be secondary to the extrinsic compression of the splenic vein by the splenic metastasis or by the inflammatory process produced by the splenic metastasis. In conclusion, we suggest that splenic metastasis should be added to the list of differential diagnosis which causes splenic vein thrombosis. In the absence of other sites of neoplastic disease, splenectomy seems to be the preferred therapy because it can be performed with low morbidity and harbors the potential for long-term survival.

  4. Imaging in spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium); Algemeen Ziekenhuis Maria Middelares, Department of Radiology, Sint-Niklaas (Belgium); Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium)

    2005-03-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  5. Endovascular repair of blunt popliteal arterial injuries

    Energy Technology Data Exchange (ETDEWEB)

    Zhong, Shan; Zhang, Xiquan; Chen, Zhong; Zhu, Wei; Pan, Xiaolin [Dept. of nterventional Vascular, The 148th Hospital of Chinese People' s Liberation Army, Zibo (China); Dong, Peng; Sun, Yequan [Dept. of Medical Imaging, Weifang Medical University, Weifang (China); Qi, Deming [Dept. of Medical Imaging, Qilu Medical University, Zibo (China)

    2016-09-15

    To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries. A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries. Technical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18–24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up. Endovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.

  6. Computed tomography of splenic infarcts

    Energy Technology Data Exchange (ETDEWEB)

    Triller, J.; Bona, E.; Barbier, P.

    1985-04-01

    Splenic infarcts are represented by wedge-shaped, oval or linear areas. Haemorrhagic infarcts are characterised by being hyperdense. Disseminated infarction occurs predominantly in myeloproliferative diseases. During the early stages, the infarct appears as an ill-defined hypodense defect, with non-homogeneous contrast enhancement. During the acute and sub-acute stage, the density of the infarct is low and there is no contrast enhancement. During the chronic stage, its density increases and there is slight contrast enhancement. Complications following splenic infarcts, such as abscesses, bleeding and rupture can be demonstrated by CT with great accuracy. Problems in differential diagnosis may occur if there are atypical manifestations of the infarct, with respect to abscess or leukaemic infiltrations.

  7. Trauma in pregnancy

    Directory of Open Access Journals (Sweden)

    A Rudra

    2007-01-01

    Full Text Available Trauma is the most common non-obstetrical cause of death in pregnant women. Pregnancy must always be suspected in any female trauma patient of childbearing age until proved otherwise. Unique changes in anatomy and physiology that takes place during pregnancy alter the pathophysiology and location of maternal injuries in pregnancy, which may be significantly different from the non-pregnant state. Trauma from road traffic accidents, falls and domestic violence are the most common causes of abdominal blunt trauma. As pregnancy progresses, the change of accidental injury increases. Head and neck injuries, respiratory failure, and hypovolemic shock constitute the most frequent causes of trauma related maternal death in pregnancy. Even the pregnant woman with minor injuries should be carefully observed. Initial management is directed at resuscitation and stabilization of the mother that takes precedence over that of the fetus, unless vital signs cannot be maintained and perimortem cesarean section decided upon. Fetal monitoring should be maintained after satisfactory resuscitation and stabilization of the mother. Preventive measures include proper seat belt use and identifying and counseling victims of suspected domestic violence.

  8. Atraumatic splenic rupture as a complication of acute exacerbation of chronic pancreatitis, an unusual disease.

    Science.gov (United States)

    Moya Sánchez, Elena; Medina Benítez, Antonio

    2017-02-27

    We report the case of a patient with acute exacerbation of chronic pancreatitis and he suffered an atraumatic splenic rupture. Splenic rupture not associated with trauma is a rare entity that can occurs in normal spleen (spontaneous) or damaged spleen (pathological). This entity may be associated with local inflammatory processes, such as pancreatitis. Ultrasound is a non-invasive technique which is used in unstable patients. CT is useful for making a diagnosis of extension in patients with hemodynamic stability. Atraumatic splenic rupture as a complication of chronic pancreatitis is an unusual disease that requires a high index of suspicion which allows us an early diagnosis because it is a treatable entity that compromises the patient's life.

  9. Colonoscopic Splenic Injury: A Simplified Radiologic Approach

    Directory of Open Access Journals (Sweden)

    Tara Chen

    2016-01-01

    Full Text Available Colonoscopy is a commonly performed procedure for diagnosis and treatment of large bowel diseases. Recognized complications include bleeding and perforation. Splenic injury during colonoscopy is a rare complication. We report a case of a 73-year-old woman who presented with left-sided abdominal pain after colonoscopy with finding of splenic injury on CT scan. She was managed conservatively. We discuss the diagnostic and therapeutic approach to colonoscopic splenic injury.

  10. Colonoscopic Splenic Injury: A Simplified Radiologic Approach

    Science.gov (United States)

    Chen, Tara; Kurchin, Alexander

    2016-01-01

    Colonoscopy is a commonly performed procedure for diagnosis and treatment of large bowel diseases. Recognized complications include bleeding and perforation. Splenic injury during colonoscopy is a rare complication. We report a case of a 73-year-old woman who presented with left-sided abdominal pain after colonoscopy with finding of splenic injury on CT scan. She was managed conservatively. We discuss the diagnostic and therapeutic approach to colonoscopic splenic injury. PMID:28078148

  11. Tratamento não-operatório e operatório de lesões esplênicas em crianças Non-operative and operative treatment of splenic injuries in children

    Directory of Open Access Journals (Sweden)

    Vivian Resende

    2003-10-01

    Full Text Available OBJETIVO: Comparar dois grupos de pacientes pediátricos com lesões esplênicas sendo um tratado conservadoramente e outro com cirurgia. MÉTODO: Foram avaliadas prospectivamente 32 crianças com lesões esplênicas. Os pacientes foram divididos em dois grupos, Grupo I (tratamento não-operatório, n=16 e Grupo II (tratamento operatório, n=16. O critério para inclusão no tratamento não-operatório foi estabilidade hemodinâmica, escala de coma de Glasgow maior que 12, ausência de lesões associadas de vísceras ôcas. Na avaliação clínica foram verificadas a necessidade de hemotransfusão e de tratamento em Unidade de Terapia Intensiva (UTI. As complicações, tempo de permanência hospitalar,o índice de trauma (RTS, ISS e TRISS foram analisados. Os exames complementares por imagem foram a ultra-sonografia abdominal seguida de tomografia computadorizada. RESULTADOS: As lesões grau II e III predominaram no Grupo I enquanto as de grau IV e V no Grupo II. As lesões associadas mais freqüentes foram o TCE seguido pelo trauma de extremidades. Com os critérios adotados se obteve total sucesso no tratamento não operatório. CONCLUSÕES: O tratamento não-operatório é uma opção segura para o trauma abdominal fechado com lesão esplênica, desde que seja indicado mediante critérios técnicos explicitados. O tratamento não-operatório da lesão esplênica só pode ser feito em serviços que estejam adequadamente equipados com recursos materiais ( ultra-sonografia e tomografia computadorizada e com equipe cirúrgica em tempo integral para avaliação continuada dos pacientes.BACKGROUND: The objective of this study is to compare nonoperative and surgical treatment of splenic injuries in children. METHODS: The charts of 32 patients with blunt splenic injuries were examined prospectively. Of these, 16 were submitted to nonoperative treatment (Group I and 16 underwent surgical approach (Group II. The criteria for nonoperative treatment were

  12. Non-interventional management of splenic abscess

    Directory of Open Access Journals (Sweden)

    Saket Kumar

    2014-01-01

    Full Text Available Splenic abscess is not an uncommon entity in tropics. In Indian subcontinent, where the incidence of enteric fever is high, abscess formation in spleen is frequently seen in clinical practice. In view of immunological functions, splenic preservation is preferred over splenectomy, especially in children and young adults. Medical management with antibiotics alone is considered inadequate for management of splenic abscess. Hereby, we report an unusual case of complete resolution of a florid splenic abscess with antibiotics alone without the need for any invasive intervention.

  13. Male genital trauma in sports.

    Science.gov (United States)

    Hunter, Stanley R; Lishnak, Timothy S; Powers, Andria M; Lisle, David K

    2013-04-01

    Male genital trauma is a rare but potentially serious sports injury. Although such an injury can occur by many different mechanisms, including falls, collisions, straddle injuries, kicks, and equipment malfunction, the clinical presentation is typically homogeneous, characterized by pain and swelling. Almost all sports-related male genital injury comes from blunt force trauma, with involvement of scrotal structures far more common than penile structures. Most injuries can be treated conservatively, but catastrophic testicular injury must first be ruled out. Despite being relatively uncommon compared with other sports injuries, more than half of all testicular injuries are sustained during sports.

  14. Marijuana May Blunt Bone Health

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_161575.html Marijuana May Blunt Bone Health Study finds heavy users ... 19, 2016 WEDNESDAY, Oct. 19, 2016 (HealthDay News) -- Marijuana may be bad to the bone, a new ...

  15. James Blunt matuselaulude edetabeli tipus

    Index Scriptorium Estoniae

    2006-01-01

    Bereavement Registeri andmetel Suurbritannias matustel tellitavate laulude edetabelis: James Blunt "Goodbye My Lover", Robbie Williams "Angels", Jennifer Warnes ja Bill Medley "I've Had the Time Of My Life", Elton John "Candle in the Wind", Righteous Brothers "Unchained Melody"

  16. Effects of penehyclidine hydrochloride on acute lung injury induced by blunt chest trauma-hemorrhagic shock and resuscitation in rats%盐酸戊乙奎醚对胸部撞击-失血性休克/复苏致大鼠急性肺损伤的影响

    Institute of Scientific and Technical Information of China (English)

    吴晓静; 冷燕; 赵博; 江莹; 夏中元; 孟庆涛; 詹丽英

    2014-01-01

    目的 探讨盐酸戊乙奎醚对胸部撞击-失血性休克/复苏致大鼠急性肺损伤的影响.方法 健康雄性SD大鼠40只,体重250~300 g,8周龄,采用随机数字表法将其分为4组(n=10):假手术组(S组)、胸部撞击-失血性休克/复苏组(THSR组)、盐酸戊乙奎醚预防组(P1组)和盐酸戊乙奎醚治疗组(P2组).THSR组、P1组和P2组制备胸部撞击-失血性休克/复苏致急性肺损伤模型:将砝码(300g)于95 cm高处自由落体,撞击大鼠心前区,5 min后经左侧股动脉放血,使MAP在15 min内降至35~45 mmHg,并维持60 min,然后进行复苏.P1组于胸部撞击前30 min时静脉注射盐酸戊乙奎醚2mg/kg;P2组于失血性休克后60 min时静脉注射盐酸戊乙奎醚2 mg/kg.模型制备后6h,采集动脉血样进行血气分析,计算氧合指数(OI),采用ELISA法测定血清IL-6和IL-1β的浓度.取血后处死大鼠,收集肺泡灌洗液(BALF),行白细胞计数,测定蛋白浓度;取肺组织,光镜和电镜下观察肺组织病理学结果,采用Western blot法检测Toll样受体4(TLR4)和磷酸化p38丝裂原活化蛋白激酶(p-p38MAPK)的表达.结果 与S组比较,THSR组、P1组和P2组PaO2和OI降低,PaCO2、BLAF蛋白浓度、白细胞计数和血清IL-6、IL-1β的浓度升高,肺组织TLR4和p-p38MAPK的表达上调(P<0.05);与THSR组比较,P1组和P2组PaO2和OI升高,PaCO2、BLAF蛋白浓度、白细胞计数和血清IL-6、IL-1β的浓度降低,肺组织TLR4和p-p38MAPK表达下调(P<0.05);P1组和P2组上述各指标比较差异无统计学意义(P>0.05).结论 盐酸戊乙奎醚可减轻胸部撞击-失血性休克/复苏致大鼠急性肺损伤,其机制可能与抑制TLR4/p38MAPK信号通路的激活,减轻炎性反应有关.%Objective To investigate the effects of penehyclidine hydrochloride (PHC) on acute lung injury induced by blunt chest trauma-hemorrhagic shock and resuscitation in rats.Methods Forty male SpragueDawley rats,aged 8 weeks,weighing 250-300 g

  17. An unusual presentation of non pathological delayed splenic rupture: a case report.

    LENUS (Irish Health Repository)

    Khan, Suhail Aslam

    2009-01-01

    The diagnosis of Delayed Splenic Rupture poses a major challenge to even the most astute clinician, as it can mimic other medical emergencies. We present a case of an unusual presentation of delayed splenic rupture in a 23-year-old Caucasian man, who presented to the emergency department with a 2 day history of left upper quadrant pain. He initially denied any history of trauma. There were no signs of generalized peritonisim on examination but his haemoglobin level was low (8.9 gm\\/dl) for which there was no obvious cause identified. He was resuscitated and a computed tomography of the abdomen was performed. This revealed complete rupture of the splenic capsule with haemorrhagic fluid in the abdomen. With the computed tomography abdomen findings and further questioning of the patient, the only potential precipitating event that he could remember was a minor kick to the left upper quadrant more than 2 weeks ago while playing football. An urgent splenectomy was performed and histology confirmed complete rupture of the splenic capsule with a large adherent haematoma to the capsule. This case illustrates the difficulty in diagnosing delayed splenic rupture especially when accurate history is not available. A high index of suspicion is essential as delay in diagnosis can be fatal. Early diagnosis in suspected cases can be achieved by performing computed tomography of the abdomen.

  18. Splenic abscess due to Salmonella enteritidis

    Directory of Open Access Journals (Sweden)

    Hatice Çabadak

    2012-02-01

    Full Text Available Splenic abscess is a very rare complication of non-typhoidal Salmonella infections. We report a case of splenic abscess caused by Salmonella enteritidis. The patient is a 63-year-old woman with diabetes mellitus and underwent splenectomy. This case suggests that the patients with comorbities are at increased risk for invasive infections in non-typhoidal Salmonella infections.

  19. Value of Multidetector Computed Tomography in Assessing Blunt Multitrauma Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ahvenjaervi, L.; Mattila, L.; Ojala, R.; Tervonen, O. [Oulu Univ. Hospital (Finland). Dept. of Diagnostic Radiology

    2005-04-01

    Purpose: To find out if multidetector computed tomography (MDCT), using a dedicated trauma protocol, provides sufficient diagnostic information of the injuries of blunt multitrauma patients to enable the planning of treatment for all body compartments. Material and Methods: One-hundred-and-thirty-three patients exposed to high-energy trauma were referred and scanned with the standardized MDCT multitrauma protocol. The imaging protocol consisted of axial scanning of the head and helical scanning of the facial bones, cervical spine, thorax, abdomen, and pelvis. The scanning times were 12 s for the head, 19-21 s for the facial bones and cervical spine (1 mm collimation), and 32-50 s for the thorax, abdomen, and pelvis (2 mm collimation). One-hundred-and-forty milliliters of non-iodinated contrast material (300 mg I/ml) was administered intravenously at 3 ml/s. Results: Ninety-nine of the patients (74%) had at least one finding consistent with trauma. The most frequent findings were in the thorax in 58 patients (44%). Nineteen false-negative findings and two false-positive findings were made. The overall sensitivity of MDCT was 94%, specificity 100%, and accuracy 97%. Conclusion: MDCT is accurate in the assessment of blunt multitrauma patients. The decision to treat the patient can be made on the basis of MDCT with a reasonable level of certainty.

  20. Are trauma patients better off in a trauma ICU?

    Directory of Open Access Journals (Sweden)

    Duane Therese

    2008-01-01

    Full Text Available There is very little data on the value of specialized intensive care unit (ICU care in the literature. To determine if specialize ICU care for the trauma patient improved outcomes in this patient population. Level I Trauma Center Compared outcomes of trauma patients treated in a surgical trauma ICU (STICU to those treated in non- trauma ICUs (non-STICU. Retrospective review of trauma registry data. Statistical Analysis: Wilcoxon Rank Test , Fischer′s Exact test, logistic regression. There were 1146 STICU patients compared to 1475 non-STICU. In all ISS groups there were more penetrating trauma patients in the STICU (32.54% STICU vs. 18.15% non-STICU, P < 0.0001 (ISS< 15, (21.03% STICU vs. 12.98% non-STICU, P =0.0074 (ISS between 15-25, and (19.42% STICU vs. 11.35% non-STICU, P =0.0026 (ISS> 25. All groups had similar lengths of stay. The blunt trauma patients were sicker in the STICU (20.8 ISS ± 12.2 STICU vs. 19.7 ISS ± 11.9 non-STICU, P =0.03 yet had similar outcomes to the non-STICU group. Logistic regression identified penetrating trauma and not ICU location as a predictor of mortality. Sicker STICU patients do as well as less injured non-STICU patients. Severely injured patients should be preferentially treated in a STICU where they are better equipped to care for the complex multi-trauma patient. All patients, regardless of location, do well when their management is guided by a surgical critical care team.

  1. Chest wall, lung, and pleural space trauma.

    Science.gov (United States)

    Miller, Lisa A

    2006-03-01

    Chest radiographs frequently underestimate the severity and extent of chest trauma and, in some cases, fail to detect the presence of injury. CT is more sensitive than chest radiography in the detection of pulmonary, pleural, and osseous abnormalities in the patient who has chest trauma. With the advent of multidetector CT (MDCT), high-quality multiplanar reformations are obtained easily and add to the diagnostic capabilities of MDCT. This article reviews the radiographic and CT findings of chest wall, pleural, and pulmonary injuries that are seen in the patient who has experienced blunt thoracic trauma.

  2. Flexion/extension cervical spine views in blunt cervical

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    Nasir Sadaf

    2012-06-01

    Full Text Available 【Abstract】Objective: To examine the contribution of flexion and extension radiographs in the evaluation of ligamentous injury in awake adults with acute blunt cervical spine trauma, who show loss of cervical lordosis and neck pain. Methods: All patients who presented to our emer-gency department following blunt trauma were enrolled in this study, except those with schiwora, neurological defi-cits or fracture demonstrated on cross-table cervical spine X-rays, and those who were either obtunded or presented after cervical spine surgery. Adequacy of flexion and exten-sion views was checked by the neurosurgery and radiology team members. All these patients underwent cross-table cervical spine view followed by flexion/extension views based on the loss of lordosis on cross-table imaging and the presence of neck pain. Results: A total of 200 cases were reviewed, of whom 90 (45% underwent repeat X-rays because of either inadequate exposure or limited motion. None of the patients with loss of lordosis on cross-table view had positive flexion and extension views of cervical spine for instability. Conclusions: Our results show that in patients who underwent acute radiographic evaluation of blunt cervical spine trauma, flexion and extension views of the cervical spine are unlikely to yield positive results in the presence of axial neck pain and/or loss of cervical lordosis. We can also hypothesize that performing flexion and extension views will be more useful once the acute neck pain has settled. Key words: X-rays; Cervical vertebrae; Lordosis

  3. Trauma renal Renal trauma

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    Gerson Alves Pereira Júnior

    1999-02-01

    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  4. A case of thoracic splenosis in a post-splenectomy patient following abdominal trauma: Hello Howell-Jolly.

    Science.gov (United States)

    Viviers, Petrus J

    2014-08-01

    Seeding of splenic tissue to extra-abdominal sites is a relatively infrequent consequence of open abdominal trauma. Immunological function of these small foci of ectopic splenic tissue is unknown and their use in determining the splenic function may be limited. In this case report, a patient is described who had previously undergone an emergency splenectomy. The absence of Howell-Jolly bodies on the blood smear in a patient who had previously undergone surgical splenectomy raised the suspicion of splenosis. The immunological features as well as non-invasive evaluation of these ill-defined splenic tissue sites are discussed.

  5. Endovascular Treatment of Active Splenic Bleeding After Colonoscopy: A Systematic Review of the Literature

    Energy Technology Data Exchange (ETDEWEB)

    Corcillo, Antonella, E-mail: antonella.corcillo@chuv.ch [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Medecine Interne (Switzerland); Aellen, Steve, E-mail: steve.aellen@hopitalvs.ch; Zingg, Tobias [Centre Hospitalier Universitaire Vaudois (CHUV), Service de Chirurgie Viscerale (Switzerland); Bize, Pierre [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Radiologie Interventionnelle (Switzerland); Demartines, Nicolas [Centre Hospitalier Universitaire Vaudois (CHUV), Service de Chirurgie Viscerale (Switzerland); Denys, Alban [Centre Hospitalier Universitaire Vaudois (CHUV), Departement de Radiologie Interventionnelle (Switzerland)

    2013-10-15

    Purpose: Colonoscopy is reported to be a safe procedure that is routinely performed for the diagnosis and treatment of colorectal diseases. Splenic rupture is considered to be a rare complication with high mortality and morbidity that requires immediate diagnosis and management. Nonoperative management (NOM), surgical treatment (ST), and, more recently, proximal splenic artery embolization (PSAE) have been proposed as treatment options. The goal of this study was to assess whether PSAE is safe even in high-grade ruptures. Methods: We report two rare cases of post colonoscopy splenic rupture. A systematic review of the literature from 2002 to 2010 (first reported case of PSAE) was performed and the three types of treatment compared. Results: All patients reviewed (77 of 77) presented with intraperitoneal hemorrhage due to isolated splenic trauma. Splenic rupture was high-grade in most patients when grading was possible. Six of 77 patients (7.8 %) were treated with PSAE, including the 2 cases reported herein. Fifty-seven patients (74 %) underwent ST. NOM was attempted first in 25 patients with a high failure rate (11 of 25 [44 %]) and requiring a salvage procedure, such as PSAE or ST. Previous surgery (31 of 59 patients), adhesions (10 of 13), diagnostic colonoscopies (49 of 71), previous biopsies or polypectomies (31 of 57) and female sex (56 of 77) were identified as risk factors. In contrast, splenomegaly (0 of 77 patients), medications that increase the risk of bleeding (13 of 30) and difficult colonoscopies (16 of 51) were not identified as risk factors. PSAE was safe and effective even in elderly patients with comorbidities and those taking medications that increase the risk of bleeding, and the length of the hospital stay was similar to that after ST. Conclusion: We propose a treatment algorithm based on clinical and radiological criteria. Because of the high failure rate after NOM, PSAE should be the treatment of choice to manage grade I through IV splenic

  6. Vascular Injury in Orthopedic Trauma.

    Science.gov (United States)

    Mavrogenis, Andreas F; Panagopoulos, George N; Kokkalis, Zinon T; Koulouvaris, Panayiotis; Megaloikonomos, Panayiotis D; Igoumenou, Vasilios; Mantas, George; Moulakakis, Konstantinos G; Sfyroeras, George S; Lazaris, Andreas; Soucacos, Panayotis N

    2016-07-01

    Vascular injury in orthopedic trauma is challenging. The risk to life and limb can be high, and clinical signs initially can be subtle. Recognition and management should be a critical skill for every orthopedic surgeon. There are 5 types of vascular injury: intimal injury (flaps, disruptions, or subintimal/intramural hematomas), complete wall defects with pseudoaneurysms or hemorrhage, complete transections with hemorrhage or occlusion, arteriovenous fistulas, and spasm. Intimal defects and subintimal hematomas with possible secondary occlusion are most commonly associated with blunt trauma, whereas wall defects, complete transections, and arteriovenous fistulas usually occur with penetrating trauma. Spasm can occur after either blunt or penetrating trauma to an extremity and is more common in young patients. Clinical presentation of vascular injury may not be straightforward. Physical examination can be misleading or initially unimpressive; a normal pulse examination may be present in 5% to 15% of patients with vascular injury. Detection and treatment of vascular injuries should take place within the context of the overall resuscitation of the patient according to the established principles of the Advanced Trauma Life Support (ATLS) protocols. Advances in the field, made mostly during times of war, have made limb salvage the rule rather than the exception. Teamwork, familiarity with the often subtle signs of vascular injuries, a high index of suspicion, effective communication, appropriate use of imaging modalities, sound knowledge of relevant technique, and sequence of surgical repairs are among the essential factors that will lead to a successful outcome. This article provides a comprehensive literature review on a subject that generates significant controversy and confusion among clinicians involved in the care of trauma patients. [Orthopedics. 2016; 39(4):249-259.].

  7. Lateral abdominal wall hernia following blunt trauma - a rare case

    OpenAIRE

    Michael Walsh; Antony Pittathankal; Nnamdi Nwaejike

    2009-01-01

    The presence of superficial bruising, no abnormal signs on abdominal examination and a negative FAST scan of the abdomen may not be enough to rule out intra-abdominal pathology. We report on the usefulness of CT in diagnosing a post-traumatic abdominal wall hernia.

  8. Ear trauma.

    Science.gov (United States)

    Eagles, Kylee; Fralich, Laura; Stevenson, J Herbert

    2013-04-01

    Understanding basic ear anatomy and function allows an examiner to quickly and accurately identify at-risk structures in patients with head and ear trauma. External ear trauma (ie, hematoma or laceration) should be promptly treated with appropriate injury-specific techniques. Tympanic membrane injuries have multiple mechanisms and can often be conservatively treated. Temporal bone fractures are a common cause of ear trauma and can be life threatening. Facial nerve injuries and hearing loss can occur in ear trauma.

  9. Splenic vasculopathy in portal hypertension patients

    Institute of Scientific and Technical Information of China (English)

    Tao Li; Ji-Yuan Ni; Yan-Wu Qi; Hai-Yang Li; Tong Zhang; Zhen Yang

    2006-01-01

    AIM: To investigate the interaction between portal hypertension, splanchnic hyperdynamic circulation and splanchnic vasculopathy by observing splenic arterial and venous pathological changes and the role of extracellular matrix in the pathogenesis of portal hypertensive vasculopathy by measuring the expression of type Ⅰ and type Ⅲ procollagen mRNA in splenic venous walls of portal hypertensive patients.METHODS: Morphological changes of splenic arteries and veins taken from portal hypertensive patients (n = 20)and normal controls (n = 10) were observed under optical and electron microscope. Total RNA was extracted and the expression of type Ⅰ and type Ⅲ procollagen mRNA in splenic venous walls of portal hypertensive patients (n = 20) was semi-quantitatively detected using reverse transcription-polymerase chain reaction (RT- PCR).RESULTS: Under optical microscope, splenic arterial intima was destroyed and internal elastic membrane and medial elastic fibers of the splenic arterial walls were degenerated and broken. Splenic venous intima became remarkably thick. Endothelial cells were not intact with formation of mural thrombus. The tunica media became thickened significantly due to hypertrophy of smooth muscles. Fibers and connective tissues were increased obviously. Under electron microscope, smooth muscle cells of the splenic arteries were degenerated and necrotized. Phenotypes of smooth muscle cells changed from constrictive into synthetic type. Red blood cells and platelets accumulated around the damaged endothelial cells. Synthetic smooth muscle cells were predominant in splenic veins and their cytoplasma had plentiful rough endoplasmic reticulum ribosomes and Golgi bodies. Along the vascular wall, a lot of collagen fibers were deposited,the intima was damaged and blood components accumulated. There was no significant difference in the expression of type Ⅰ procollagen mRNA in splenic venous wall between the patients with portal hypertension and those

  10. Spontaneous Splenic Hemorrhage in the Newborn

    OpenAIRE

    2015-01-01

    Spontaneous splenic hemorrhage in the newborn is a rare entity. The presentation is usually with a triad of bleeding, abdominal distension, and hemoperitoneum. Rapid diagnosis is essential as left untreated, death is inevitable. We present a case with an unusual initial presentation of a scrotal hematocele and ultrasonography suggesting an adrenal hemorrhage. At laparotomy, splenic preservation was unsuccessful, and therefore, splenectomy was performed. The child recovered well from the proce...

  11. 盐酸戊乙奎醚对大鼠胸部撞击致急性肺损伤及肺组织Toll样受体4表达的影响%Effects of penehyclidine hydrochloride on acute lung injury induced by blunt chest trauma and Toll-like receptor 4 expression in lung tissues in rats

    Institute of Scientific and Technical Information of China (English)

    吴晓静; 李宁涛; 夏中元; 王伶俐

    2011-01-01

    目的 探讨盐酸戊乙奎醚对大鼠胸部撞击致急性肺损伤及肺组织Toll样受体4(TLR4)表达的影响.方法 健康雄性SD大鼠96只,体重250~300 g,采用随机数字表法,将大鼠随机分为3组(n=32):对照组(C组)只麻醉,不制备模型;肺损伤组(ALI组);盐酸戊乙奎醚组(PHcD组)模型制备后即刻,腹腔注射盐酸戊乙奎醚2 mg/kg.砝码(300g)于95 cm高处自由落体撞击大鼠心前区以制备急性肺损伤模型.于模型制备后2、8、12和24h时取8只大鼠,取动脉血样,测定血清TNF-α浓度.于模型制备后8 h取8只大鼠,取动脉血样,行动脉血气分析,随后处死大鼠,取肺组织观察病理学结果,测定干/湿重比(W/D比)、髓过氧化物酶(MPO)活性和TLR4表达水平.结果 与c组比较,ALI组和PHCD组pH值和PaO2下降,PaCO2、乳酸浓度、肺组织MPO活性、W/D比及TLR4表达和血清TNF-α浓度升高(P<0.01);与ALI组比较,PHcD组pH值和PaO2升高,PaCO2、乳酸浓度、肺组织MPO活性、W/D比及TLR4表达和血清TNF-α浓度降低(P<0.05).PHcD组肺组织病理性损伤较ALI组减轻.结论 盐酸戊乙奎醚可减轻大鼠胸部撞击诱发的急性肺损伤,其机制与下调肺组织TLR4表达,降低炎性反应有关.%Objective To investigate the effects of penehyclidine hydrochloride (PHCD) on acute lung injury (ALI) induced by blunt chest trauma and Toll-like receptor 4 (TLR4) expression in the lung tissues in rats.Methods Ninety-six male SD rats weighing 250-300 g were randomly divided into 3 groups ( n = 32 each):control group (group C), ALI group and PHCD group. ALI was induced by dropping a 300 g weight onto a precordial protective shield to direct the impact force away from the heart and toward the lungs in anesthetized rats according to the method described by Raghavendran et al. PHCD 2 mg/kg was injected intraperitoneally immediately after ALI was induced in group PHCD. Eight rats were selected at 2, 8, 12 and 24 h after ALI was induced, and

  12. Life-threatening autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura: successful seletive splenic artery embolization

    Directory of Open Access Journals (Sweden)

    matteo molica

    2016-04-01

    Full Text Available Selective splenic artery embolization (SSAE is a nonsurgical intervention characterized by the transcatheter occlusion of the splenic artery and/or its branch vessels using metallic coils or other embolic devices. It has been applied for the management of splenic trauma, hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia and splenic hemangioma. We hereby describe a case of a patient affected by idiopathic thrombocytopenic purpura (ITP and warm auto-immune hemolytic anemia (AIHA both resistant to immunosuppressive and biological therapies, not eligible for a surgical intervention because of her critical conditions. She underwent SSAE and achieved a hematologic complete response within a few days without complications. SSAE is a minimally invasive procedure to date not considered a standard option in the management of AIHA and ITP. However, following the progressive improvement of the techniques, its indications have been extended, with a reduction in morbidity and mortality compared to splenectomy in patients with critical clinical conditions. SSAE was a lifesaving therapeutic approach for our patient and it may represent a real alternative for the treatment of resistant AIHA and ITP patients not eligible for splenectomy.

  13. Life-Threatening Autoimmune Hemolytic Anemia and Idhiopatic Thrombocytopenic Purpura. Successful Selective Splenic Artery Embolization

    Science.gov (United States)

    Molica, Matteo; Massaro, Fulvio; Annechini, Giorgia; Baldacci, Erminia; D’Elia, Gianna Maria; Rosati, Riccardo; Trisolini, Silvia Maria; Volpicelli, Paola; Foà, Robin; Capria, Saveria

    2016-01-01

    Selective splenic artery embolization (SSAE) is a nonsurgical intervention characterized by the transcatheter occlusion of the splenic artery and/or its branch vessels using metallic coils or other embolic devices. It has been applied for the management of splenic trauma, hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia and splenic hemangioma. We hereby describe a case of a patient affected by idiopathic thrombocytopenic purpura (ITP) and warm auto-immune hemolytic anemia (AIHA) both resistant to immunosuppressive and biological therapies, not eligible for a surgical intervention because of her critical conditions. She underwent SSAE and achieved a hematologic complete response within a few days without complications. SSAE is a minimally invasive procedure to date not considered a standard option in the management of AIHA and ITP. However, following the progressive improvement of the techniques, its indications have been extended, with a reduction in morbidity and mortality compared to splenectomy in patients with critical clinical conditions. SSAE was a lifesaving therapeutic approach for our patient and it may represent a real alternative for the treatment of resistant AIHA and ITP patients not eligible for splenectomy. PMID:27158433

  14. A Case of a Chronic Pancreatic Pseudocyst Causing Atraumatic Splenic Rupture without Evidence of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    P. Moori

    2016-01-01

    Full Text Available Atraumatic splenic rupture is a rare complication of a pancreatic pseudocyst (PP, described in the setting of chronic pancreatitis. There is common understanding, within the literature, that an inflammatory process at the tail of the pancreas may disrupt the spleen and result in such splenic complications. The authors present a case report of a 29-year-old male with a PP, associated with chronic pancreatitis. The patient had a history of excessive alcohol intake and presented to the emergency department with a short history of abdominal pain and vomiting. He denied any significant history of trauma and serum amylase levels were normal. An admission computed tomography (CT scan of the abdomen confirmed the presence of a PP in direct contact with the spleen. The CT also demonstrated a heterogenous hypodense area of the splenic hilum, along with perisplenic fluid. The patient was admitted for observation. His abdominal pain progressed, and he became haemodynamically unstable. An emergency ultrasound scan (USS at this time revealed intra-abdominal haemorrhage. A subsequent CT confirmed splenic rupture, which was managed surgically with a full recovery. Few such cases are documented within the literature and more understanding of preempting such events is needed.

  15. Rare splenic complications and specific serology: decisive diagnostic tools in two cases of visceral leishmaniasis

    Directory of Open Access Journals (Sweden)

    Andrea Celestini

    2012-01-01

    Full Text Available Introduction: Visceral leishmaniasis (VL is a major endemic vector-borne disease in Southern Europe. We present two cases of VL, both characterized by splenic complications. Methods and results: Case 1: A 47-year-old female presented with effort angina, hepatosplenomegaly and pancytopenia. The clinical course was complicated by splenic infarction. Although bone marrow biopsy failed to show amastigotes, diagnosis was performed by a fast agglutinating screening test (FAST and confirmed by a direct agglutinating test (DAT. The patient was treated successfully with AmBisome. Case 2: A 22-year-old male who had undergone a splenectomy to treat splenic rupture related to a minor trauma four months earlier presented with fever, nocturnal sweats and weight loss. The lack of pancytopenia was due to the absence of the spleen. The first biopsy did not identify parasites, but because the FAST had been positive, another bone marrow biopsy was performed, which demonstrated leishmaniasis. This patient was treated with the same schedule of AmBisome infusion. Discussion: 1 The clinical presentation of VL can be atypical, 2 splenic complications can characterize this disease, and 3 specific serology may be an important tool to reach a diagnosis.

  16. Idiopathic Splenic Artery Pseudoaneurysm Rupture as an Uncommon Cause of Hemorrhagic Shock

    Directory of Open Access Journals (Sweden)

    Richard A. Schatz MD

    2015-04-01

    Full Text Available Splenic artery pseudoaneurysms are infrequently encountered but critical to recognize. Limited literature to date describes associations with pancreatitis, trauma, and rarely peptic ulcer disease. Hemorrhage and abdominal pain are the most common manifestations. There is typically overt gastrointestinal blood loss but bleeding can also extend into the peritoneum, retroperitoneum, adjacent organs, or even a pseudocyst. Most patients with ruptured splenic artery pseudoaneurysms present with hemodynamic instability. Here, we describe a patient recovering from acute illness in the intensive care unit but with otherwise no obvious risk factors or precipitants for visceral pseudoaneurysm. He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock. The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation. He was successfully treated with arterial coiling and embolization. Thus, we herein emphasize the importance of prompt recognition of hemorrhagic shock and of aggressive hemodynamic stabilization, as well as a focused diagnostic approach to this problem with specific treatment for splenic artery pseudoaneurysm. Finally, we recommend that multidisciplinary management should be the standard approach in all patients with splenic artery pseudoaneurysm.

  17. Splenic abscess in typhoid fever -Surgical management

    Institute of Scientific and Technical Information of China (English)

    Col Prasan Kumar Hota

    2009-01-01

    Splenic abscess is an uncommon clinical presentation in surgical practice,associated with high morbidity and mortality.Mortality may be 100 % if left untreated.Splenic abscess is also rarely encountered as a complica-tion of typhoid fever.We present here a case of multiple splenic abscesses with neuropsychiatric complications due to typhoid fever,which was managed successfully with splenectomy and other supportive therapies.Anoth-er case of single splenic abscess due to enteric fever was treated successfully with CT-guided aspiration and ap-propriate antibiotics.Being a rare entity in clinical practice,splenic abscess has been poorly studied.Haemat-ogenous seeding of the spleen due to typhoid is a common cause of splenic abscess in the tropical countries.In multiple or multiloculated abscesses aspiration usually does not succeed,which happened in our case.Sple-nectomy remains the definitive choice of treatment.However,Ultra sonography (USG)or CT-guided aspira-tion may be tried in selective cases.

  18. Epidemiology of injuries and outcomes among trauma patients receiving prehospital care at a tertiary teaching hospital in Kigali, Rwanda

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    Gabin Mbanjumucyo

    2016-12-01

    Conclusion: A linked prehospital and hospital database provided critical epidemiological information describing trauma patients in a low-resource setting. Blunt trauma from motor vehicle collisions involving young males constituted the majority of traumatic injury. Among this cohort, hospital resource utilisation was high as was mortality. This data can help guide the implementation of interventions to improve trauma care in the Rwandan setting.

  19. Systemic trauma.

    Science.gov (United States)

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

  20. Trivial trauma and delayed rupture of a normal spleen: a case report

    Directory of Open Access Journals (Sweden)

    Sowers Nicholas

    2011-12-01

    Full Text Available Abstract Introduction Although a majority of splenic ruptures present acutely with a known mechanism of injury, a minority of patients present days to weeks following trauma with a delayed rupture. Also uncommon is the atraumatic rupture, the vast majority of which occur in patients with underlying splenic pathology. A handful of cases of apparently spontaneous rupture of a normal spleen are reported; however, there is debate about whether these actually represent delayed ruptures following a history of trauma that is not elicited. Although a few cases of delayed rupture of the spleen following trivial trauma have been reported, the majority of these present evidence of an underlying disease process. We found only two such cases that documented a normal spleen and three cases where underlying splenic pathology was not reported. We review the literature and discuss the phenomenon of delayed rupture of the normal spleen following trivial trauma. Case presentation A 27-year-old Caucasian man with no underlying splenic pathology presented with splenic rupture one week after playfully wrestling with his partner. The patient did not present at the time of the injury and only recalled it upon repeated questioning after computed tomography diagnosis. Conclusions This case lends support to the theory that the normal spleen can rupture some time after trivial trauma, which seems like a more plausible explanation than rupture without cause. However, given the dearth of similar reports in the literature, the possibility remains that the association we have observed is not causational.

  1. Spontaneous Splenic Rupture in Melanoma

    Directory of Open Access Journals (Sweden)

    Hadi Mirfazaelian

    2014-01-01

    Full Text Available Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen.

  2. Radiological management of blunt polytrauma with computed tomography and angiography: an integrated approach

    Energy Technology Data Exchange (ETDEWEB)

    Kurdziel, J.C.; Dondelinger, R.F.; Hemmer, M.

    1987-01-01

    107 polytraumatized patients, who had experienced blunt trauma have been worked up at admission with computed tomography of the thorax, abdomen and pelvis following computed tomography study of the brain: significant lesions were revealed in 98 (90%) patients. 79 (74%) patients showed trauma to the thorax, in 69 (64%) patients abdominal or pelvic trauma was evidenced. No false positive diagnosis was established. 5 traumatic findings were missed. Emergency angiography was indicated in 3 (3%) patients, following computed tomography examination. 3 other trauma patients were submitted directly to angiography without computed tomography examination during the time period this study was completed. Embolization was carried out in 5/6 patients. No thoracotomy was needed. 13 (12%) patients underwent laparotomy following computed tomography. Overall mortality during hospital stay was 14% (15/107). No patient died from visceral bleeding. Conservative management of blunt polytrauma patients can be advocated in almost 90% of visceral lesions. Computed tomography coupled with angiography and embolization represent an adequate integrated approach to the management of blunt polytrauma patients.

  3. Preceding trauma in childhood hematogenous bone and joint infections.

    Science.gov (United States)

    Pääkkönen, Markus; Kallio, Markku J T; Lankinen, Petteri; Peltola, Heikki; Kallio, Pentti E

    2014-03-01

    Preceding trauma may play a role in the etiology and pathogenesis of hematogenous bone and joint infections. Among 345 children with an acute hematogenous bone and/or joint infection, 20% reported trauma during a 2-week period leading to infection. Blunt impact, bruises, or excoriations were commonly reported. The rate was similar to that in the general pediatric population obtained from the literature. In the study group, patients with and without trauma were similar in age, serum C-reactive protein and erythrocyte sedimentation rate, length of hospitalization, and late sequelae. Preceding minor trauma did not prove to be significant as an etiological or as a prognostic factor.

  4. Spontaneous splenic rupture due to uremic coagulopathy and mortal sepsis after splenectomy.

    Science.gov (United States)

    Gazel, Eymen; Açıkgöz, Gazel; Kasap, Yusuf; Yiğman, Metin; Güneş, Zeki Ender

    2015-01-01

    Nontraumatic spontaneous splenic rupture (NSSR) has been encountered much more rarely compared with the traumatic splenic rupture. Although NSSR generally emerges in dialysis patients on account of such causes as the use of heparin during hemodialysis, uremic coagulopathy, infections, and secondary amyloidosis. Herein, we aimed to present a case of spontaneous splenic rupture which had developed soon after the inclusion of the case suffering from end-stage renal disease in routine hemodialysis program in the absence of any trauma or other prespecified risk factors for splenic rupture. A 55-year-old male patient was admitted to our hospital to have the ureteral double J stent removed. The operation was completed without any complication. Complaining an abdominal pain more prominent in the left upper abdominal quadrant in the first postoperative day, the patient underwent a through physical examination which disclosed abdominal distension, widespread tenderness, and rebound and defense positivity. The abdominal tomography depicted 122 × 114 × 95 mm lesion compatible with a hematoma. On the basis of these findings, an emergency exploratory operation was decided to be performed. Following clearance of the retroperitoneal hematoma, splenectomy was implemented. Experiencing progressive deterioration in his clinical status despite antibiotherapy, the patient unfortunately died of sepsis with multiorgan failure on the 25(th) postoperative day. In conclusion, NSSR is such an entity that may be missed out, can pursue variable clinical courses, and requires emergency therapy upon definitive diagnosis. The possibility of spontaneous bleedings should be kept in mind in any case with the history of hyperuricemia even in the absence of overt trauma, no matter if they are included in routine hemodialysis or not.

  5. Management of splenic artery aneurysm associatedwithextrahepaticportal veinobstruction

    Institute of Scientific and Technical Information of China (English)

    Pramod Kumar Mishra; Sundeep Singh Saluja; Ashok K Sharma; Premanand Pattnaik

    2012-01-01

    BACKGROUND: Splenic artery aneurysms although rare are clinically signiifcant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS:  The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. Surgery is the mainstay of treatment. Although technically dififcult, it can be safely performed in an experienced center with minimal morbidity and good outcome.

  6. Splenic artery embolization in a woman with bleeding gastric varices and splenic vein thrombosis: a case report

    Directory of Open Access Journals (Sweden)

    Schmid Roland M

    2010-08-01

    Full Text Available Abstract Introduction Gastric variceal bleeding due to splenic vein thrombosis is a life-threatening situation and is often difficult to manage by endoscopy. In the worst cases, an emergency splenectomy may be required to stop variceal bleeding. Case presentation We report the case of a 60-year-old Caucasian woman with bleeding gastric varices secondary to splenic vein thrombosis treated by splenic artery embolization. Successful embolization was performed by depositing coils into the splenic artery resulting in cessation of variceal bleeding. After embolization there was no recurrence of bleeding. Conclusion Splenic artery embolization can be an effective and definite treatment for variceal bleeding secondary to splenic vein thrombosis.

  7. Splenic injuries in children: The challenges of non operative management in a developing country

    Directory of Open Access Journals (Sweden)

    Osifo O

    2007-01-01

    Full Text Available Aim: This is to report the challenges and experience gained with non operative management of splenic injuries in a developing country where sophisticated imaging facilities are either not available or exorbitantly expensive. Materials and Methods: All patients who presented with splenic injury at the University of Benin Teaching Hospital between January, 2000 and December, 2006 were assessed and those who met the criteria were recruited for non operative management. Diagnosis of splenic injury was made by combining clinical assessment and ultrasound findings. Results: A total of 24 children with a mean age 12 ± 0.04 years and male/female ratio 1.7:1 were treated during the period. Road traffic accident, accounting for 50% of the cases was the major cause of trauma followed by falls from heights. Delay in presentation was a major concern as 62.5% of them were not referred until shock supervened. None of the patients could afford CT scan but ultrasound scan was able to confirm diagnosis in all. Basing decision on clinical parameters, non operative management was successfully done in 75% while 25% were operated as they could not meet the criteria. No mortality was recorded in the non operated group while one was recorded in those operated. The average length of hospitalization was two weeks. Conclusion: Non operative management of splenic injuries can be successfully done in a developing country using clinical parameters as a guide. The 75% of patients with splenic injury treated can be improved upon by health awareness campaign/improvement in government policy that will result in early presentation.

  8. Massive splenic infarction and splenic venous thrombosis observed in a patient with acute splenic syndrome of sickle cell traits on contrast-enhanced thin-slice computed tomography.

    Science.gov (United States)

    Hayashi, Takana Yamakawa; Matsuda, Izuru; Hagiwara, Kazuchika; Takayanagi, Tomoko; Hagiwara, Akifumi

    2016-09-01

    We report a case of splenic infarction in a patient with sickle cell traits (SCT), focusing on the computed tomography (CT) findings. The patient was an African-American man in his twenties with no past medical history who experienced sudden left upper quadrant pain while climbing a mountain (over 3000 m above sea level). Dynamic contrast-enhanced CT revealed massive non-segmental splenic infarction accompanied with nodule-like preserved splenic tissue. The region of splenic infarction did not coincide with the arterial vascular territory and differed from the features of infarction caused by large arterial embolism. In addition, thrombotic occlusion of the distal splenic vein was depicted on plain and contrast-enhanced thin-slice CT images. Early-phase contrast-enhanced images also showed inhomogeneous enhancement of the hepatic parenchyma. The patient's symptoms improved with conservative therapy. A hemoglobin electrophoresis test confirmed the diagnosis of SCT. SCT is usually asymptomatic, but hypoxic environments may induce acute splenic syndrome, which is commonly manifested as splenic infarction. We observed splenic venous thrombosis and inhomogeneous hepatic parenchymal enhancement in addition to a huge splenic infarction in our patient. To the best of our knowledge, this is the first report describing the specific imaging findings, particularly splenic venous thrombosis and inhomogeneous hepatic parenchymal enhancement, of acute splenic syndrome in a patient with previously undiagnosed SCT. These findings demonstrate the pathophysiology of SCT, and may help with the diagnosis of this disease.

  9. 8. Book Review: ‘Broken Bones: Anthropological Analysis of Blunt Force Trauma’ 2 nd edition, 2014

    Directory of Open Access Journals (Sweden)

    R. Gaur

    2014-04-01

    Full Text Available 'Broken Bones: Anthropological Analysis of Blunt Force Trauma' 2nd edition, 2014. Editors: Vicki L. Wedel and Alison Galloway; Publisher: Charles C. Thomas, Illinois. pp 479 + xxiii ISBN: 978-0-398-08768-5 (Hard ISBN: 978-0-398-08769-2 (eBook

  10. Management of liver trauma.

    LENUS (Irish Health Repository)

    Badger, S A

    2012-02-01

    BACKGROUND: Blunt and penetrating liver trauma is common and often presents major diagnostic and management problems. METHODS: A literature review was undertaken to determine the current consensus on investigation and management strategies. RESULTS: The liver is the most frequently injured organ following abdominal trauma. Immediate assessment with ultrasound has replaced diagnostic peritoneal lavage in the resuscitation room, but computerised tomography remains the gold standard investigation. Nonoperative management is preferred in stable patients but laparotomy is indicated in unstable patients. Damage control techniques such as perihepatic packing, hepatotomy plus direct suture, and resectional debridement are recommended. Major complex surgical procedures such as anatomical resection or atriocaval shunting are now thought to be redundant in the emergency setting. Packing is also recommended for the inexperienced surgeon to allow control and stabilisation prior to transfer to a tertiary centre. Interventional radiological techniques are becoming more widely used, particularly in patients who are being managed nonoperatively or have been stabilised by perihepatic packing. CONCLUSIONS: Management of liver injuries has evolved significantly throughout the last two decades. In the absence of other abdominal injuries, operative management can usually be avoided. Patients with more complex injuries or subsequent complications should be transferred to a specialist centre to optimise final outcome.

  11. Splenic abscess in a patient with fecal peritonitis

    Institute of Scientific and Technical Information of China (English)

    Spiros G Delis; Petros N Maniatis; Charikleia Triantopoulou; John Papailiou; Christos Dervenis

    2007-01-01

    Splenic abscess is a rare entity normally associated with underlying diseases. We report a case of splenic abscess with large gas formation in a non-diabetic and non-immunosuppressed patient after surgery for colon perforation. The most frequent cause of splenic abscess is septic embolism arising from bacterial endocarditis. Splenic abscess has a high rate of mortality when it is diagnosed late. Computed tomography resolved any diagnostic doubt, and subsequent surgery confirmed the diagnosis.

  12. Sympathetic empyema arising from streptococcus anginosus splenic abscess

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    Wissa E

    2012-03-01

    Full Text Available We report a 52 year old male with a history splenic infarction, abdominal pain and shortness of breath. CT scanning revealed a splenic abcess and empyema. Cultures from both sites grew Streptococcus anginosus. These resolved with drainage and antibiotics. Physicians should consider Streptococcus species when confronted with a patient with splenic infarction.

  13. Multidetector computed tomography-spectrum of blunt chest wall and lung injuries in polytraumatized patients

    Energy Technology Data Exchange (ETDEWEB)

    Peters, S., E-mail: soeren.peters@rub.d [Department of Radiology and Nuclear Medicine, BG Universitaetsklinikum Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789 Bochum (Germany); Nicolas, V.; Heyer, C.M. [Department of Radiology and Nuclear Medicine, BG Universitaetsklinikum Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789 Bochum (Germany)

    2010-04-15

    Accidental injuries are the leading cause of death in the 15 to 44-year-old age group. Blunt chest trauma is often encountered in these patients and is associated with a mortality of up to 25%. Although conventional radiography still plays an important role in the initial emergency room setting, for follow-up in the intensive care unit, multidetector computed tomography has established itself as the standard imaging method for the evaluation of chest trauma patients. The following review presents salient radiological findings of the chest wall and shoulder girdle, thoracic spine, pleural space, and lung in polytraumatized patients.

  14. Cortical necrosis secondary to trauma in a child: contrast-enhanced ultrasound comparable to magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Yusuf, Gibran T.; Sellars, Maria E.; Huang, Dean Y.; Deganello, Annamaria; Sidhu, Paul S. [King' s College Hospital, King' s College London, Department of Radiology, London (United Kingdom)

    2014-04-15

    Cortical necrosis is an uncommon cause of renal impairment and is rarely a consequence of blunt abdominal trauma. We present a case of unilateral traumatic acute cortical necrosis in a child demonstrated on contrast-enhanced US with confirmation on MRI. Contrast-enhanced US provides a rapid, accurate evaluation of renal parenchyma abnormalities in blunt abdominal trauma in children without exposure to ionising radiation or the risk of sedation. (orig.)

  15. Blunt traumatic tension chylothorax: Case report and mini-review of the literature

    OpenAIRE

    Idris, Kamal; Sebastian, Michael; Hefny, Ashraf F; Khan, Navidul Haq; Fikri M Abu-Zidan

    2016-01-01

    Tension chylothorax following blunt thoracic trauma is an extremely rare condition. Here we report such a case and review its management. A 31-year-old man was involved in a road traffic collision. The car rolled over and the patient was ejected from the vehicle. On arrival at the Emergency Department the patient was conscious and haemodynamically stable. Clinical examination of the chest and abdomen was normal. The patient had sustained fractures of the sixth cervical vertebra and the tenth ...

  16. Profile of care given to patients with blunt chest injuries within the first 48 hours

    Directory of Open Access Journals (Sweden)

    E Nyangena

    2000-09-01

    Full Text Available This study was conducted in the trauma unit of a large academic hospital in Johannesburg, South Africa. The study aimed at describing the nature of care that patients with blunt chest injuries received during the first 48 hours after injury. A descriptive survey was chosen using retrospective and prospective record review to obtain data. The sample comprised 60 records of patients who were admitted to the hospital due to blunt chest injuries between January 1997 and June 1998. Descriptive statistics were used to present and analyse data. The study showed that: (i Blunt chest trauma victims received a thorough initial assessment and care. No missed injuries were identified on subsequent assessment; (ii More than half of the patients spent over one hour in the accident/emergency department before admission to the trauma ward or intensive care unit (ICU; (iii Motor vehicle accidents (MVA were the commonest cause of injury while pedestrian vehicle accidents (PVA were often fatal; (iv Nurses are good providers of care but poor in prescribing and documenting care; (v Pain assessment and psychosocial care was often neglected; (vi Less than half the patients developed complications during the first 48 hours; pain and pneumonia being the most common complications encountered.

  17. National Trauma Database (NTrD)--improving trauma care: first year report.

    Science.gov (United States)

    Sabariah, F J; Ramesh, N; Mahathar, A W

    2008-09-01

    The first Malaysian National Trauma Database was launched in May 2006 with five tertiary referral centres to determine the fundamental data on major trauma, subsequently to evaluate the major trauma management and to come up with guidelines for improved trauma care. A prospective study, using standardized and validated questionnaires, was carried out from May 2006 till April 2007 for all cases admitted and referred to the participating hospitals. During the one year period, 123,916 trauma patients were registered, of which 933 (0.75%) were classified as major trauma. Patients with blunt injury made up for 83.9% of cases and RTA accounted for 72.6% of injuries with 64.9% involving motorcyclist and pillion rider. 42.8% had severe head injury with an admission Glasgow Coma Scale (GCS) of 3-8 and the Revised Trauma Score (RTS) of 5-6 were recorded in 28.8% of patients. The distribution of Injury Severity Score (ISS) showed that 42.9% of cases were in the range of 16-24. Only 1.9% and 6.3% of the patients were reviewed by the Emergency Physician and Surgeon respectively. Patients with admission systolic blood pressure of less than 90 mmHg had a death rate of 54.6%. Patients with severe head injury (GCS report has successfully demonstrated its significance in giving essential data on major trauma in Malaysia, however further expansion of the study may reflect more comprehensive trauma database in this country.

  18. Ulcerative colitis flare with splenic ven thrombosis.

    Science.gov (United States)

    Bozkurt, Huseyin Sancar; Kara, Banu; Citil, Serdal

    2015-01-01

    Patients with ulcerative colitis (UC) have an increased risk of thromboembolic events. Here, we present a 28-year-old man with active ulcerative pancolitis presenting via splenic vein thrombosis and left renal superior infarct that was not associated with a surgical procedure.

  19. Puzzles in practice: splenic vein thrombosis.

    Science.gov (United States)

    McIntyre, Brittany; Marsh, Melanie; Walden, Jeffrey

    2016-06-01

    This report details a 58-year-old gentleman who presented to his outpatient primary care physician's clinic several times over four weeks for ongoing epigastric pain radiating into his left flank, dry heaving, and constipation. He was presumed to have gastritis at each visit and prescribed escalating doses of proton pump inhibitors. Due to the unrelenting pain, he eventually was admitted to the hospital and diagnosed with splenic vein thrombosis after computed tomography imaging of the abdomen. Our literature search revealed that pancreatic pathology is overwhelmingly the contributing factor to splenic vein thrombosis. Our patient had prominent collateral vasculature, suggesting that his splenic vein thrombosis was chronic in nature and likely the cause of his ongoing abdominal pain. Splenic vein thrombosis is an uncommon cause of abdominal pain, but one that should be included in the treating physician's differential diagnoses when abdominal pain is ongoing despite medical therapy. Although he had no evidence of initial findings on radiography, our patient was eventually diagnosed with biopsy-proven pancreatic cancer. Our case report demonstrates how patients presenting with persistent or worsening abdominal pain despite the use of proton pump inhibitors or other acid reducing agents and potential 'red flag' findings such as decreased appetite and weight loss should be worked up for other potential sources of abdominal pathology.

  20. Trauma Reports. Volume 12, Number 6, November/December 2011

    Science.gov (United States)

    2011-12-01

    Lipman, MD, FACEP, Clinical Assistant Professor of Surgery, Division of Emergency Medicine, Stanford University School of Medicine, Palo Alto , CA...1091-1095. 15. Kaiser M, Whealon M, Barrios C, et al. The clinical significance of occult tho- racic injury in blunt trauma patients. Am Surgeon

  1. Implementing and applying the Ocular Trauma Score: the challenges

    Directory of Open Access Journals (Sweden)

    Desirée C Murray

    2016-01-01

    Full Text Available Ocular trauma is a significant cause of unilateral blindness in the Caribbean in both adults and children. In Trinidad and Tobago, blunt ocular injury will typically account for around a third of all referrals from the Accident and Emergency department to the ophthalmology unit.

  2. Endovascular treatment of post-laparoscopic pancreatectomy splenic arteriovenous fistula with splenic vein aneurysm.

    Science.gov (United States)

    Ueda, Tatsuo; Murata, Satoru; Yamamoto, Akira; Tamai, Jin; Kobayashi, Yuko; Hiranuma, Chiaki; Yoshida, Hiroshi; Kumita, Shin-Ichiro

    2015-07-01

    Splenic arteriovenous fistulas (SAVFs) with splenic vein aneurysms are extremely rare entities. There have been no prior reports of SAVFs developing after laparoscopic pancreatectomy. Here, we report the first case. A 40-year-old man underwent a laparoscopic, spleen-preserving, distal pancreatectomy for an endocrine neoplasm of the pancreatic tail. Three months after surgery, a computed tomography (CT) scan demonstrated an SAVF with a dilated splenic vein. The SAVF, together with the splenic vein aneurysm, was successfully treated using percutaneous transarterial coil embolization of the splenic artery, including the SAVF and drainage vein. After the endovascular treatment, the patient's recovery was uneventful. He was discharged on postoperative day 6 and continues to be well 3 mo after discharge. An abdominal CT scan performed at his 3-mo follow-up demonstrated complete thrombosis of the splenic vein aneurysm, which had decreased to a 40 mm diameter. This is the first reported case of SAVF following a laparoscopic pancreatectomy and demonstrates the usefulness of endovascular treatment for this type of complication.

  3. Epidemiological evaluation of hepatic trauma victims undergoing surgery

    Directory of Open Access Journals (Sweden)

    Mitre Kalil

    2016-02-01

    Full Text Available Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01. The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05. Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

  4. Pathogenesis of splenic marginal zone lymphoma

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    Ming-Qing Du

    2015-11-01

    Full Text Available Splenic marginal zone lymphoma (SMZL is a distinct low grade B-cell lymphoma with an immunophenotype similar to that of splenic marginal zone B-cells. Like the normal splenic marginal zone B-cells, SMZLs also show variable features in somatic mutations of their rearranged immunoglobulin genes, with ∼90% of cases harbouring somatic mutations but at remarkably variable degrees, suggesting that SMZL may have multiple cell of origins, deriving from the heterogeneous B-cells of the splenic marginal zone. Notably, ∼30% of SMZLs show biased usage of IGHV1-2*04, with the expressed BCR being potentially polyreactive to autoantigens. Recent exome and targeted sequencing studies have identified a wide spectrum of somatic mutations in SMZL with the recurrent mutations targeting multiple signalling pathways that govern the development of splenic marginal zone B-cells. These recurrent mutations occur in KLF2 (20–42%, NOTCH2 (6.5–25%, NF-κB (CARD11 ∼7%, IKBKB ∼7%, TNFAIP3 7–13%, TRAF3 5%, BIRC3 6.3% and TLR (MYD88 5–13% signalling pathways. Interestingly, the majority of SMZL with KLF2 mutation have both 7q32 deletion and IGHV1-2 rearrangement, and these cases also have additional mutations in NOTCH2, or TNFAIP3, or TRAF3. There is a potential oncogenic cooperation among concurrent genetic changes, for example between the IGHV1-2 expressing BCR and KLF2 mutation in activation of the canonical NF-κB pathway, and between KLF2 and TRAF3 mutations in activation of the non-canonical NF-κB pathway. These novel genetic findings have provided considerable insights into the pathogenesis of SMZL and will stimulate the research in both normal and malignant marginal zone B-cells.

  5. Trauma Africa

    Directory of Open Access Journals (Sweden)

    Victor Y. Kong

    2013-11-01

    Full Text Available “Major Trauma. Dr. Kong, please come to the Trauma Unit immediately. Dr. Kong, please come to the Trauma Unit immediately.” Even though I have been working at Edendale Hospital as a trauma registrar for over a year, whenever I hear this announcement over the hospital intercom system, my heart beats just a little faster than normal. When I first arrived at Edendale my colleagues told me that the adrenaline rush I would experience after being called out to attend a new emergency would decrease over time, and indeed they were right. However, it is also true to say that on some occasions more than others, it is still felt more strongly than ever.

  6. Age-related differences in mechanism, cause, and location of trauma deaths

    DEFF Research Database (Denmark)

    Meisler, Rikke; Thomsen, Annemarie Bondegaard; Theilade, Peter

    2011-01-01

    BACKGROUND: Trauma death has traditionally been described as primarily occurring in young men exposed to penetrating trauma or road traffic accidents. The epidemiology of trauma fatalities in Europe may change as a result of the increasing proportion of elderly patients. The goal of this study...... was to describe age-related differences in trauma type, mechanism, cause and location of death in a well-defined European region. METHODS: We prospectively registered all trauma patients and severe burn patients in eastern Denmark over 12 consecutive months. We analyzed all trauma fatalities in our region...... regarding the trauma type, mechanism, cause and location of death. RESULTS: A total of 2923 patients were registered, of which 292 (9.9%) died within 30 days. Mortality increased with age, with a mortality of 46.1% in patients older than 80 years old. Blunt trauma was the most frequent trauma type at all...

  7. Management of blunt pulmonary injury.

    Science.gov (United States)

    Gallagher, John J

    2014-01-01

    Thoracic injuries account for 25% of all civilian deaths. Blunt force injuries are a subset of thoracic injuries and include injuries of the tracheobronchial tree, pleural space, and lung parenchyma. Early identification of these injuries during initial assessment and resuscitation is essential to reduce associated morbidity and mortality rates. Management of airway injuries includes definitive airway control with identification and repair of tracheobronchial injuries. Management of pneumothorax and hemothorax includes pleural space drainage and control of ongoing hemorrhage, along with monitoring for complications such as empyema and chylothorax. Injuries of the lung parenchyma, such as pulmonary contusion, may require support of oxygenation and ventilation through both conventional and nonconventional mechanical ventilation strategies. General strategies to improve pulmonary function and gas exchange include balanced fluid resuscitation to targeted volume-based resuscitation end points, positioning therapy, and pain management.

  8. Carcinoma of the duodenum after trauma, radiotherapy and chemotherapy.

    Science.gov (United States)

    Bayens, Y C; Wiggers, T; Meerwaldt, J H; Vroom, T M; Van Geel, A N

    1991-10-01

    The case history is reported of a patient with a carcinoma of the duodenum 30 years after blunt abdominal trauma at the site of the 'scar' in the duodenum. Thirteen years after the trauma the patient was treated with chemotherapy and abdominal irradiation for a relapse of Hodgkin's disease. At follow-up, 25 months after the operation, he had no local recurrence of Hodgkin's disease or duodenal cancer. The possible relation between the cancer and the abdominal trauma, chemotherapy and abdominal irradiation is discussed.

  9. Abdominal closed trauma in children. Trauma abdominal cerrado en el niño.

    Directory of Open Access Journals (Sweden)

    Rogelio Rodríguez Castillo

    Full Text Available Blunt abdominal trauma constitutes 90% approximately of the abdominal injuries in children. Due to the augmented size of the child trunk in relation to their extremities, the abdominal lesions are extremely frequents. The abdominal trauma is present in 20-30% of the patients with serious trauma. It's the second cause of death for accidents after the cranial traumatism in the pediatric patient. We presented the Good Clinical Practices Guideline for Blunt Abdominal Trauma, approved by consensus in the 2nd National Good Clinical Practices Workshop in Pediatric Surgery (Manzanillo, Cuba, September 31 - October 3, 2002.

    El trauma abdominal cerrado constituye aproximadamente el 90 % de los traumatismos abdominales en niños. Debido al tamaño aumentado del tronco del niño en relación con sus extremidades las lesiones abdominales son extremadamente frecuentes. El trauma abdominal está presente en el 20-30 % de los pacientes con trauma grave. Es la segunda causa de muerte por accidentes, después del traumatismo craneal, en el paciente pediátrico. Se presenta la Guía de Buenas Prácticas Clínicas para trauma abdominal cerrado, aprobada por consenso en el 2º Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Manzanillo, 31 de septiembre al 3 de octubre del 2002.

  10. Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports

    Directory of Open Access Journals (Sweden)

    Galloway Robert

    2009-12-01

    Full Text Available Abstract Background Blunt Traumatic Pericardial Rupture (BTPR with resulting cardiac herniation following chest trauma is an unusual and often fatal condition. Although there has been a multitude of case reports of this condition in past literature, the recurring theme is that of a missed injury. Its occurrence in severe blunt trauma is in the order of 0.4%. It is an injury that frequently results in pre/early hospital death and diagnosis at autopsy, probably owing to a combination of diagnostic difficulties, lack of familiarity and associated polytrauma. Of the patients who survive to hospital attendance, the mortality rate is in the order of 57-64%. Methods We present two survivors of BTPR and cardiac herniation, one with a delayed penetrating cardiac injury secondary to rib fractures. With these two cases and literature review, we hope to provide a greater awareness of this injury Conclusion BTPR and cardiac herniation is a complex and often fatal injury that usually presents under the umbrella of polytrauma. Clinicians must maintain a high index of suspicion for BTPR but, even then, the diagnosis is fraught with difficulty. In blunt chest trauma, patients should be considered high risk for BTPR when presenting with: Cardiovascular instability with no obvious cause Prominent or displaced cardiac silhouette and asymmetrical large volume pneumopericardium Potentially, with increasing awareness of the injury and improved use and availability of imaging modalities, the survival rates will improve and cardiac Herniation could even be considered the 5th H of reversible causes of blunt traumatic PEA arrest.

  11. Electroacupuncture inhibits apoptosis of splenic lymphocytes in traumatized rats through modulation of the TNF-α/NF-κB signaling pathway.

    Science.gov (United States)

    Wang, Kun; Wu, Huaxing; Chi, Meng; Zhang, Jian; Wang, Guonian; Li, Hulun

    2015-01-01

    Surgical trauma leads to a severe deterioration of the immune system. Electroacupuncture (EA) may improve the immunodeficiency that occurs following surgery; however, the underlying signaling mechanisms require further study. In the present study, 40 rats were equally randomized into four groups: Control; Control + EA; Trauma; Trauma + EA. EA was applied at the 'Zusanli' (ST36) and 'Lanwei' (Extra37) acupoints, immediately following surgery. The splenic T cells were isolated from the rats 24 h after surgery. The apoptotic rate of the lymphocytes was measured by flow cytometric analysis, and western blotting was used to determine the protein expression levels of caspase-3, caspase-8, tumor necrosis factor (TNF)-α and TNF receptor 1 (TNFR1). The DNA binding activity of nuclear factor (NF)-κB was determined using Trans-AM® ELISA-based kits. The results of the present study showed that surgical trauma induced apoptosis of splenic lymphocytes, and significantly increased the protein expression levels of caspase-3 and caspase-8. This was accompanied by increased expression levels of TNF-α and TNFR1, and a marked reduction in the activity of NF-κB in splenic T cells. Administration of EA significantly decreased the expression levels of caspase-3, caspase-8, TNF-α and TNFR1, elevated the activity of NF-κB, and suppressed the apoptotic rate of the lymphocytes. The data suggests that EA may inhibit the apoptosis of splenic lymphocytes induced by surgical trauma, and ameliorate the postoperative immunosuppression. This may be mediated by the downregulation of TNF-α expression levels and upregulation of the activity of NF-κB.

  12. Roentogenological diagnosis of splenic arterial aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Morita, Yutaka; Saito, Hiroya; Hiromura, Tadao; Choji, Kiyoshi; Shinohara, Masahiro; Fujita, Nobuyuki; Irie, Goro; Kumagai, Midori; Kumagai, Akifumi.

    1988-09-01

    The purpose of this paper is clarification of noninvasive diagnostic images of pre-ruptured splenicarterial aneurysm. Splenic arterial aneurysm is relatively rare, with only 159 cases reported in Japan previously. But because of improvements in abdominal US, CT and angiography, reports of this rare lisease are expected to increase. An analysis of 169 cases of splenic arterial aneurysm, with the addition of 10 cases of our own, has been carried out and the following conclusions were made. 1) Ultrasonographic findings are round hypoechoic mass with pulsation. The detectability is about 70 % and its detectable limitation of aneurysmal diameter is more than 2 cm. 2) Computed tomographic findings are round or oval low density area between spleen and left kidney. By the contrast emhancement, the lesion is oppacified high as same as aort. Dynamic CT is more useful and its limitation of detectability is more than 5 cm. Ultrasonography is the most useful tool for the detection of pre-ruptured splenic arterial aneurysm, but it is necessary to keep this rare disease in mind during the examination of portal hypertention, chronic pancreatitis, arteriosclerosis and others.

  13. Specific remodeling of splenic architecture by cytomegalovirus.

    Directory of Open Access Journals (Sweden)

    Chris A Benedict

    2006-03-01

    Full Text Available Efficient immune defenses are facilitated by the organized microarchitecture of lymphoid organs, and this organization is regulated by the compartmentalized expression of lymphoid tissue chemokines. Mouse cytomegalovirus (MCMV infection induces significant remodeling of splenic microarchitecture, including loss of marginal zone macrophage populations and dissolution of T and B cell compartmentalization. MCMV preferentially infected the splenic stroma, targeting endothelial cells (EC as revealed using MCMV-expressing green fluorescent protein. MCMV infection caused a specific, but transient transcriptional suppression of secondary lymphoid chemokine (CCL21. The loss of CCL21 was associated with the failure of T lymphocytes to locate within the T cell zone, although trafficking to the spleen was unaltered. Expression of CCL21 in lymphotoxin (LT-alpha-deficient mice is dramatically reduced, however MCMV infection further reduced CCL21 levels, suggesting that viral modulation of CCL21 was independent of LTalpha signaling. Activation of LTbeta-receptor signaling with an agonistic antibody partially restored CCL21 mRNA expression and redirected transferred T cells to the splenic T cell zone in MCMV-infected mice. These results indicate that virus-induced alterations in lymphoid tissues can occur through an LT-independent modulation of chemokine transcription, and targeting of the LT cytokine system can counteract lymphoid tissue remodeling by MCMV.

  14. Specific remodeling of splenic architecture by cytomegalovirus.

    Science.gov (United States)

    Benedict, Chris A; De Trez, Carl; Schneider, Kirsten; Ha, Sukwon; Patterson, Ginelle; Ware, Carl F

    2006-03-01

    Efficient immune defenses are facilitated by the organized microarchitecture of lymphoid organs, and this organization is regulated by the compartmentalized expression of lymphoid tissue chemokines. Mouse cytomegalovirus (MCMV) infection induces significant remodeling of splenic microarchitecture, including loss of marginal zone macrophage populations and dissolution of T and B cell compartmentalization. MCMV preferentially infected the splenic stroma, targeting endothelial cells (EC) as revealed using MCMV-expressing green fluorescent protein. MCMV infection caused a specific, but transient transcriptional suppression of secondary lymphoid chemokine (CCL21). The loss of CCL21 was associated with the failure of T lymphocytes to locate within the T cell zone, although trafficking to the spleen was unaltered. Expression of CCL21 in lymphotoxin (LT)-alpha-deficient mice is dramatically reduced, however MCMV infection further reduced CCL21 levels, suggesting that viral modulation of CCL21 was independent of LTalpha signaling. Activation of LTbeta-receptor signaling with an agonistic antibody partially restored CCL21 mRNA expression and redirected transferred T cells to the splenic T cell zone in MCMV-infected mice. These results indicate that virus-induced alterations in lymphoid tissues can occur through an LT-independent modulation of chemokine transcription, and targeting of the LT cytokine system can counteract lymphoid tissue remodeling by MCMV.

  15. Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess: A case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed. A.54-year-old woman with abdominal pain and fever was admitted to our department. Abdominal CT revealed two low-density areas in the spleen and wall-thickening of the left colonic flexure, which was indistinguishable from the spleen parenchyma. The patient underwent emergency celiotomy, with the presumptive diagnosis of obstructing colon carcinoma of the splenic flexure, and concomitant splenic abscess. Subtotal colectomy and splenectomy were performed. Pathological findings were consistent with mucinous colonic carcinoma, synchronous isolated splenic metastasis and concomitant splenic abscess.This paper is also a review of the existing literature on the association between colorectal cancer and splenic metastasis. Only 41 cases of isolated splenic metastasis from colon carcinoma have been reported in the literature. This report is the third described case of synchronous isolated splenic metastasis from colon carcinoma. Only one case with concomitant splenic abscess has been previously reported. When obstructing left-sided colorectal cancer is suspected, careful CT examination can allow early diagnosis of splenic involvement by the tumor. The literature review suggests that there might be a significant improvement in survival following splenectomy for a metachronous isolated splenic metastasis from colon carcinoma. Prognosis for synchronous splenic metastasis seems to be related to the advanced stage of the disease. Nevertheless, no definitive conclusions can be drawn because of the small number of cases.

  16. Sonographic Scoring for Operating Room Triage in Trauma

    Directory of Open Access Journals (Sweden)

    Raghavendran, Krishnan MD

    2010-05-01

    Full Text Available Objective: The focused assessment with sonography for trauma (FAST exam is a routine diagnostic adjunct in the initial assessment of blunt trauma victims but lacks the ability to reliably predict which patients require laparotomy. Physiologic data play a major role in decision making regarding the need for emergent laparotomy versus further diagnostic testing or observation. The need for laparotomy often influences the decision to transfer the patient to a trauma center. We set out to derive a simple scoring system using both ultrasound findings and immediately available physiologic data that would predict which patients require laparotomy.Methods: We conducted a prospective observational study of victims of blunt trauma who presented to a Level 1 Trauma Center. We collected FAST findings, physiologic data, and lab values. A previously-developed ultrasound scoring system was applied to the FAST findings. Patients were followed to determine if they underwent laparotomy. We used logistic regression analysis to determine which variables correlated with laparotomy and developed a new scoring system.Results: We enrolled a convenience sample of 1,393 patients. A simple scoring system (range 0-6 was developed that included both FAST findings and vital signs (heart rate and blood pressure. Patients with a score of 0 or 1 had a less than 1% chance of requiring laparotomy.Conclusion: The combination of FAST findings with vital signs in our scoring system predicted which victims of blunt trauma did not undergo laparotomy. Applying this to trauma patients who present to non-trauma centers could help prevent unnecessary patient transfers. This derivation set must be validated prior to use in patient care. [West J Emerg Med. 2010; 11(2:138-143.

  17. Children and Facial Trauma

    Science.gov (United States)

    ... an ENT Doctor Near You Children and Facial Trauma Children and Facial Trauma Patient Health Information News ... staff at newsroom@entnet.org . What is facial trauma? The term facial trauma means any injury to ...

  18. Combat Trauma Surgery Using a Portable Contact ND-(YAG) Laser in the Porcine and Ovine Models (HSC) (CIC3)

    Science.gov (United States)

    1991-01-28

    trauma to the abdomen, and the second most commonly injured organ in blunt abdominal trauma. (1) Lacerations and stellate fractures can cause massive intra...anesthetized with a combination of Ketamine HCI (5 mg/kg) and Diazepam (0.25 mg/kg) intravenously and maintained on a surgical plane of anesthesia during the

  19. Case of microgastria in association with splenic-gonadal fusion

    Energy Technology Data Exchange (ETDEWEB)

    Mandell, G.A.; Alavi, A.; Heyman, S.; Ziegler, M.M.

    1983-03-01

    Microgastria is a rare congenital anomaly usually associated with asplenia. In this 2 1/2-year-old presenting with left hydrocele and inguinal hernia multiple accessory spleens were found in the inguinal-scrotal region compatible with splenic-gonadal fusion. sup(99m)Tc-sulfur colloid scanning is helpful in microgastria searching for the presence of splenic tissue and in splenic-gonadal fusion for the location of accessory heterotopic spleens.

  20. Initial evaluation of the "Trauma surgery course"

    Directory of Open Access Journals (Sweden)

    Tugnoli Gregorio

    2006-03-01

    Full Text Available Abstract Background The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course, developed as a model for teaching operative trauma techniques, and assess its efficacy. Method the two-day course consisted of theoretical lectures and practical experience on large-sized swine. Data of the first 126 participants were collected and analyzed. Results All of the 126 general surgeons who had participated in the course judged it to be an efficient model to improve knowledge about the surgical treatment of trauma. Conclusion A two-day course, focusing on trauma surgery, with lectures and life-like operation situations, represents a model for simulated training and can be useful to improve surgeons' confidence in managing trauma patients. Cooperation between organizers of similar initiatives would be beneficial and could lead to standardizing and improving such courses.

  1. Splenic hematoma in acute pancreatitis. Role of coagulation disorders.

    Science.gov (United States)

    Clavé, P; Guillaumes, S; Blanco, I; Martínez de Hurtado, J; Esquius, J; Marruecos, L; Fontcuberta, J; Pérez, C; Farré, A; Lluís, F

    1992-08-01

    Splenic hematomas are infrequent complications of acute pancreatitis. In some cases, local factors that may play a role in the pathogenesis of the hematoma (thrombosis of the splenic artery or veins, intrasplenic pseudocysts, perisplenic adhesions, enzymatic digestion) are found. In the absence of local factors, the etiology of splenic hemorrhage remains unknown. We report two cases of splenic hematoma occurring during an acute necro-hemorrhagic pancreatitis associated with renal failure that required renal replacement therapy (hemodialysis and continuous arteriovenous hemodialysis). In both cases, more than half of splenic parenchyma was affected by multiple infarctions. No local factors responsible for the splenic abnormalities were detected in either case. Thrombosis of the splenic arterial microcirculation and a coagulation disorder consistent with disseminated intravascular coagulation was detected in one patient. In the second patient, coagulation disorders secondary to either liver disease, pancreatitis and its septic complications, or extracorporeal circuit heparinization for renal replacement therapy were present. Coagulation disorders should be considered whenever a splenic hematoma is found in a patient with acute pancreatitis. Disseminated intravascular coagulation may be the etiology of a splenic hematoma in acute pancreatitis.

  2. Trauma Theory

    DEFF Research Database (Denmark)

    Pedersen, Bodil Maria

    There are two main trends in psychological approaches to human suffering related to what we term trauma. Although they have their respective limitations both approaches may help us explore and alleviate human suffering. One trend, primarily using concepts like traumatic events and traumatisation ...

  3. Trauma Ultrasound.

    Science.gov (United States)

    Wongwaisayawan, Sirote; Suwannanon, Ruedeekorn; Prachanukool, Thidathit; Sricharoen, Pungkava; Saksobhavivat, Nitima; Kaewlai, Rathachai

    2015-10-01

    Ultrasound plays a pivotal role in the evaluation of acute trauma patients through the use of multi-site scanning encompassing abdominal, cardiothoracic, vascular and skeletal scans. In a high-speed polytrauma setting, because exsanguinations are the primary cause of trauma morbidity and mortality, ultrasound is used for quick and accurate detection of hemorrhages in the pericardial, pleural, and peritoneal cavities during the primary Advanced Trauma Life Support (ATLS) survey. Volume status can be assessed non-invasively with ultrasound of the inferior vena cava (IVC), which is a useful tool in the initial phase and follow-up evaluations. Pneumothorax can also be quickly detected with ultrasound. During the secondary survey and in patients sustaining low-speed or localized trauma, ultrasound can be used to help detect abdominal organ injuries. This is particularly helpful in patients in whom hemoperitoneum is not identified on an initial scan because findings of organ injuries will expedite the next test, often computed tomography (CT). Moreover, ultrasound can assist in detection of fractures easily obscured on radiography, such as rib and sternal fractures.

  4. Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients

    Institute of Scientific and Technical Information of China (English)

    Javad Salimi; Mohammad Ghodsi; Maryam Nassaji Zavvarh; Ali Khaji

    2009-01-01

    Objective: Today, trauma is a major public health problem in some countries. Abdominal trauma is the source of significant mortality and morbidity with both blunt and penetrating injuries. We performed an epidemiological study of abdominal trauma (AT) in Tehran, Iran. We used all our sources to describe the epidemiology and outcome of patients with AT.Methods: This study was done in Tehran. The study population included trauma patients admitted to the emergency department of six general hospitals in Tehran during one year. The data were collected through a questionnaire that was completed by a trained physician at the trauma center. The statistical analysis was performed using the SPSS software (version 11.5 for Windows). The statistical analysis was conducted using the chi-square and P<0.05 was accepted as being statistically significant.Results: Two hundred and twenty-eight (2.8%) out of 8 000 patients were referred to the above mentioned centers with abdominal trauma. One hundred and twenty-five (54.9%)of the patients were in their 2nd and 3rd decades of life and 189 (83%) of our patients were male. Road traffic accidents (RTA) were the leading cause of AT with 119 (52.2%) patients. Spleen was the commonly injured organ with 51 cases. Following the analysis of injury severity, 159 (69.7%) patients had mild injuries (ISS<16) and 69 (30.3%) patients had severe injuries (ISS= 16). The overall mortality rate was 46 (20.2%).Conclusions: Blunt abdominal trauma is more common than penetrating abdominal trauma. Road traffic accidents and stab wound are the most common causes of blunt and penetrating trauma, respectively. Spleen is the most commonly injured organ in these patients. The mortality rate is higher in blunt trauma than penetrating one.

  5. Management of Giant Splenic Artery Aneurysm

    Science.gov (United States)

    Akbulut, Sami; Otan, Emrah

    2015-01-01

    Abstract To provide an overview of the medical literature on giant splenic artery aneurysm (SAA). The PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to SAA. Keywords used were splenic artery aneurysm, giant splenic artery aneuryms, huge splenic artery aneurysm, splenic artery aneurysm rupture, and visceral artery aneurysm. SAAs with a diameter ≥5 cm are considered as giant and included in this study. The language of the publication was not a limitation criterion, and publications dated before January 15, 2015 were considered. The literature review included 69 papers (62 fulltext, 6 abstract, 1 nonavailable) on giant SAA. A sum of 78 patients (50 males, 28 females) involved in the study with an age range of 27–87 years (mean ± SD: 55.8 ± 14.0 years). Age range for male was 30–87 (mean ± SD: 57.5 ± 12.0 years) and for female was 27–84 (mean ± SD: 52.7 ± 16.6 years). Most frequent predisposing factors were acute or chronic pancreatitis, atherosclerosis, hypertension, and cirrhosis. Aneurysm dimensions were obtained for 77 patients with a range of 50–300 mm (mean ± SD: 97.1 ± 46.0 mm). Aneurysm dimension range for females was 50–210 mm (mean ± SD: 97.5 ± 40.2 mm) and for males was 50–300 mm (mean ± SD: 96.9 ± 48.9 mm). Intraperitoneal/retroperitoneal rupture was present in 15, among which with a lesion dimension range of 50–180 mm (mean ± SD; 100 ± 49.3 mm) which was range of 50–300 mm (mean ± SD: 96.3 ± 45.2 mm) in cases without rupture. Mortality for rupture patients was 33.3%. Other frequent complications were gastrosplenic fistula (n = 3), colosplenic fistula (n = 1), pancreatic fistula (n = 1), splenic arteriovenous fistula (n = 3), and portosplenic fistula (n = 1). Eight of the patients died in early postoperative period while 67 survived. Survival status of the

  6. Spleen volume on CT and the effect of abdominal trauma.

    Science.gov (United States)

    Cruz-Romero, Cinthia; Agarwal, Sheela; Abujudeh, Hani H; Thrall, James; Hahn, Peter F

    2016-08-01

    The aim of this study is to determine the magnitude of change in spleen volume on CT in subjects sustaining blunt abdominal trauma without hemorrhage relative to patients without disease and how the spleen volumes are distributed. Sixty-seven subjects with blunt abdominal trauma and 101 control subjects were included in this retrospective single-center, IRB-approved, and HIPAA-compliant study. Patients with an injured spleen were excluded. Using a semiautomatic segmentation program, two readers computed spleen volumes from CT. Spleen volume distribution in male and female trauma and control cohorts were compared nonparametrically. Spleen volume plotted against height, weight, and age were analyzed by linear regression. The number of females and males are, respectively, 35 and 32 in trauma subjects and 69 and 32 among controls. Female trauma patients (49.6 years) were older than males (39.8 years) (p = 0.02). Distributions of spleen volume were not normal, skewed above their means, requiring a nonparametric comparison. Spleen volumes in trauma patients were smaller than those in controls with medians of 230 vs 294 mL in males(p volume correlated positively with weight in females and with height in male controls, and negatively with age in male controls (p volume in controls was 245 mL, the largest ever reported. Spleen volume decreases in response to blunt abdominal trauma. Spleen volumes are not normally distributed. Our population has the largest spleen volume reported in the literature, perhaps a consequence of the obesity epidemic.

  7. [Diagnostic-therapeutic Algorithm in a Blunt Injury of the Thorax.].

    Science.gov (United States)

    Vyhnánek, F; Fanta, J; Lisý, P; Vojtísek, O; Cáp, F

    2000-01-01

    Based on the group of 22 patients operated on for a blunt injury of the thorax a diagnostic-therapeutic algorithm was evaluated in the procedure of the treatment of a severe trauma of the thorax. Acute thoracotomy or laparotomy was performed in 17 patients and in 5 of them thoracotomy was indicated only after some time interval. In the patients with acute surgery the indication was a rupture of diaphragm, massive hemotorax in case of lung laceration of bleeding from thoracic wall, rupture of bronchus and an associated injury of intra-abdominal parenchymal organs. Thoracotomy was after some time interval performed in case of empyema of thorax, post-injury paresis of diaphragm and residual hematoma in the lung parenchyma. Key words: blunt injury of thorax, diagnostic-therapeutic algorithm, indication to an acute or postponed operation.

  8. Dentoalveolar trauma.

    Science.gov (United States)

    Olynik, Christopher R; Gray, Austin; Sinada, Ghassan G

    2013-10-01

    Dentoalveolar injuries are an important and common component of craniomaxillofacial trauma. The dentition serves as a vertical buttress of the face and fractures to this area may result in malalignment of facial subunits. Furthermore, the dentition is succedaneous with 3 phases-primary dentition, mixed dentition, and permanent dentition-mandating different treatment protocols. This article is written for nondental providers to diagnose and treat dentoalveolar injuries.

  9. Management of liver trauma in RIPAS Hospital

    Directory of Open Access Journals (Sweden)

    Kenneth Yuh Yen KOK

    2010-06-01

    Full Text Available Introduction: The management of blunt and penetrating liver trauma continues to pose a tremendouschallenge to surgeons. This study reviews the pattern of liver trauma and its management, bothoperative and non-operative, in RIPAS Hospital, the only tertiary referral center in Brunei Darussalam.Material and Methods: A retrospective study of patients admitted with liver trauma, with and withoutother associated injuries between January 2002 and December 2006 to RIPAS Hospital was undertaken.The patients’ case records were retrieved. Details on age, sex, mode of injury, pre-operativeimaging, severity of liver injury based on the Liver Injury Scale (LIS, grades I to VI, presence of otherassociated injuries, overall management, complications and outcome were collected and analysed. Results:Twenty patients (male, n = 12 with a mean age of 36 years old (range 20 to 75 were treatedfor liver trauma (median LIS grade of III, range I to V during the study period. Road traffic accidentsaccounted for 75% of the injuries. Thirteen (65% had high grade injuries (6 LIS grade III. Seventeen(85% patients underwent surgical procedures for liver and other associated injuries. Four patients(20% had non-operative management with one failure (5%. This patient subsequently requiredsurgery. There were six post-operative deaths (mortality 30%. There were three major morbidities(15%: right hepatic artery aneurysm, a right hepatic duct bile leak and left hemiplegia secondaryto cerebrovascular accident. Conclusions: In our local setting, blunt liver trauma is often due toroad traffic accidents and is associated with a high mortality rate. A majority was of high grades andrequired urgent surgical interventions. Non-operative management is an option for those with lowgrade injuries and who are stable.

  10. Efficacy and Safety of Trans-Arterial Splenic Embolization

    Directory of Open Access Journals (Sweden)

    Ali Cadili

    2012-02-01

    Conclusions: Trans-arterial splenic embolization is a safe and effective procedure that does not lead to longterm compromise of splenic function. Complications and failures of this procedure, however, cannot be predicted based on either patient or procedure characteristics examined in this study. [Arch Clin Exp Surg 2012; 1(1.000: 22-26

  11. Non-parasitic splenic cysts: A report of three cases

    Institute of Scientific and Technical Information of China (English)

    Macheras A; Misiakos EP; Liakakos T; Mpistarakis D; Fotiadis C; Karatzas G

    2005-01-01

    Primary splenic cyst is a relatively rare disease, and the majority of cases are classified as epithelial cysts. Three cases with nonparasitic splenic cysts are presented: two epithelial and one pseudocyst. All cases had an atypical symptomatology, consisted mainly of fullness in the left upper abdomen and a palpable mass. Preoperative diagnosis was established with ultrasonography and computerized tomography. Two cases with large cysts located in the splenic hilum were treated with open complete splenectomy. The most recent case, a pseudocyst, was managed laparoscopically with partial cystectomy. All cases did not have any problems or recurrence during follow-up. Laparoscopic partial cystectomy is an acceptable procedure for the treatment of splenic cysts, because it cures the disease preserving the splenic tissue. Complete splenectomy is reserved for cases in which cyst excision cannot be done otherwise.

  12. Medical image of the week: splenic infarction

    Directory of Open Access Journals (Sweden)

    Casey DJ

    2016-08-01

    Full Text Available No abstract available. Article truncated after 150 words. A 52-year-old Hispanic woman with a past medical history significant for Type 1 Diabetes Mellitus, hypertension, and rheumatoid arthritis presented with left upper quadrant pain for one day. Her review of systems was positive for bloating, severe epigastric and left upper quadrant tenderness that radiated to the back and left shoulder, nausea with non-bilious emesis, and diarrhea for one day prior to admission. Physical exam only revealed epigastric and left upper quadrant tenderness to light palpation without rebound or guarding. Abdominal computed tomography of the abdomen demonstrated a new acute or subacute splenic infarct with no clear evidence of an embolic source in the abdomen or pelvis (Figure 1. Echocardiogram with bubble study and contrast did not demonstrate valve abnormalities, cardiac mass, vegetation, valve or wall motion abnormalities and no evidence of patent foramen ovale. Splenic infarction should be suspected when patients present with sharp, acute left upper quadrant pain ...

  13. Liver Trauma: Operative and Non-operative Management

    Directory of Open Access Journals (Sweden)

    Moosa Zargar

    2010-04-01

    Full Text Available Background: The liver is the second most commonly injured organ in abdominal trauma, but liver damage is the most common cause of death after abdominal injury. Although urgent surgery continues to be the standard for hemodynamically compromised patients with hepatic trauma, there has been a paradigm shift in the management of patients who have stable hemodynamic. A marked change toward a more conservative approach in the treatment of abdominal trauma has been noted during the last decades. Modern treatment of liver trauma is increasingly non-operative.Purpose: To find the epidemiology, etiologies and managements of liver trauma in a population based study in Iran.Material and Method: A study including 16,287 trauma patients referred to the main hospitals of seven cities with different geographic patterns was done in Iran. Eighty-four patients with hepatic trauma during the 1-year period ending March 2000 included in this Cross-Sectional study. We determined the incidence, etiology and management of the patients suffering liver injury. Analysis was done using SPSS 18. Statistical significance was set at PResults: Out of 16287 trauma patients 84 (0.5% had hepatic trauma with male predominance 68(81%. The most type of trauma was blunt and the main cause was motor vehicle crashes. Thirty patients (35.7% managed non-operatively. There was no significant difference in hospital stay between patients operated and managed non-operatively. There was no mortality in the patients managed non-surgically.Conclusion: In this study hepatic trauma was in 3.7% of abdominal trauma patients. This study concluded non-operative management of hepatic injuries is associated with a low overall morbidity and does not result in increases in length of stay. Non-operative management is a safe approach for the patients of liver trauma with stable hemodynamic.

  14. Study of airfoil trailing edge bluntness noise

    DEFF Research Database (Denmark)

    Zhu, Wei Jun; Shen, Wen Zhong; Sørensen, Jens Nørkær

    2010-01-01

    This paper deals with airfoil trailing edge noise with special focus on airfoils with blunt trailing edges. Two methods are employed to calculate airfoil noise: The flow/acoustic splitting method and the semi-empirical method. The flow/acoustic splitting method is derived from compressible Navier...... design or optimization. Calculations from both methods are compared with exist experiments. The airfoil blunt noise is found as a function of trailing edge bluntness, Reynolds number, angle of attack, etc.......-Stokes equations. It provides us possibilities to study details about noise generation mechanism. The formulation of the semi-empirical model is based on acoustic analogy and then curve-fitted with experimental data. Due to its high efficiency, such empirical relation is used for purpose of low noise airfoil...

  15. Blunt traumatic superior gluteal artery pseudoaneurysm presenting as gluteal hematoma without bony injury: A rare case report

    Institute of Scientific and Technical Information of China (English)

    Annu Babu; Amit Gupta; Pawan Sharma; Piyush Ranjan; Atin Kumar

    2016-01-01

    Blunt traumatic injuries to the superior gluteal artery are rare in clinic.A majority of injuries present as aneurysms following penetrating trauma,fracture pelvis or posterior dislocation of the hip joint.We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury.The gluteal hematoma was suspected clinically,confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma.Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery,which was successfully angioembolized.The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma.This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling.Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.

  16. [Isolated chest trauma in elderly patients].

    Science.gov (United States)

    Yersin, Bertrand; Carron, Pierre-Nicolas; Pasquier, Mathieu; Zingg, Tobias

    2015-08-12

    In elderly patients, a blunt trauma of the chest is associated with a significant risk of complications and mortality. The number of ribs fractures (≥ 4), the presence of bilateral rib fractures, of a pulmonary contusion, of existent comorbidities or acute extra-thoracic traumatic lesions, and lastly the severity of thoracic pain, are indeed important risk factors of complications and mortality. Their presence may require hospitalization of the patient. When complications do occur, they are represented by alveolar hypoventilation, pulmonary atelectasia and broncho-pulmonary infections. When hospitalization is required, it may allow for the specific treatment of thoracic pain, including locoregional anesthesia techniques.

  17. Low hemorrhage-related mortality in trauma patients in a Level I trauma center employing transfusion packages and early thromboelastography-directed hemostatic resuscitation with plasma and platelets

    DEFF Research Database (Denmark)

    Johansson, Pär I; Sørensen, Anne Marie Møller; Larsen, Claus F;

    2013-01-01

    % with blunt trauma). Overall 28-day mortality was 12% with causes of death being exsanguinations (14%), traumatic brain injury (72%, two-thirds expiring within 24 hr), and other (14%). One-fourth, 16 and 15% of the patients, received red blood cells (RBCs), plasma, or platelets (PLTs) within 2 hours from...

  18. Intravenous pyelogram results in association with renal pathology and therapy in trauma patients.

    Science.gov (United States)

    Bergren, C T; Chan, F N; Bodzin, J H

    1987-05-01

    The charts of 127 consecutive patients who sustained renal trauma between December 1977 and January 1984 were reviewed in order to relate the results of intravenous pyelogram (IVP) to the magnitude of renal pathology. Eighty-eight cases resulted from blunt trauma and 39 cases had penetrating injuries. There were 34 gunshot wounds and five stab wounds. An IVP was performed in 116 patients. All cases of blunt trauma with an IVP reported as normal had no renal pathology greater than contusion. Intravenous pyelogram results in penetrating injuries had a 75% false negative rate. Findings of nonvisualization or extravasation were significant for fractures, perforation, or pedicle injuries in all trauma. Eight of the patients with nonpenetrating wounds and 37 of the patients with penetrating injury underwent exploratory laparotomy. Sixteen nephrectomies were performed for a nephrectomy rate of 12.6% of the total series. This nephrectomy rate is comparable to similar studies which are reviewed.

  19. Splenic artery embolization for the treatment of bleeding gastric varices secondary to splenic vein thrombosis.

    Science.gov (United States)

    Stone, Patrick A; Phang, David; Richmond, Bryan; Gill, Gurpreet; Campbell, John E

    2014-04-01

    Splenic vein thrombosis can lead to gastric varices. Subsequent upper gastrointestinal bleeding may ensue related to the change in venous outflow to the portal system. Vascular surgeons are infrequently asked to assist in the management of this entity. However, with many vascular surgeons providing diverse endovascular-based interventions, understanding catheter-based solutions is imperative. This report presents a case in which arterial embolization was used to treat gastric variceal bleeding.

  20. Can ultrasound help to manage patients with scrotal trauma?

    Science.gov (United States)

    Adlan, T; Freeman, S J

    2014-11-01

    Traumatic injuries to the scrotum are uncommon but, when they do occur, frequently lead to serious complications. Early complications include testicular infarction, necrosis and abscess formation; in the longer-term trauma may result in testicular atrophy and subfertility. Early surgical intervention in patients with testicular rupture can significantly improve the clinical outcome and reduce the need for delayed orchidectomy. However, clinical examination of the scrotum following trauma is difficult and frequently inaccurate; this may result in incorrect triage of patients for surgical exploration. Scrotal ultrasound can reliably assess scrotal injuries and diagnose testicular rupture with a high level of accuracy. Additionally, ultrasound can provide important information regarding testicular perfusion, which can further inform decisions on surgical management. This article reviews the sonographic findings that may be encountered in patients with scrotal trauma, with an emphasis on blunt trauma. It describes the pivotal role that ultrasound can play in the accurate triage of these patients to surgical or conservative management.

  1. Pelvic and scrotal trauma: CT and triage of patients.

    Science.gov (United States)

    Ezra, Navid; Afari, Arash; Wong, Jimmie

    2009-07-01

    Traumatic dislocation of the testicles was first reported during crush injury but is now more commonly related to motor vehicle accidents. Approximately 55 cases had been reported by 2003. Virtually no papers discuss the role of CT in the rapid diagnosis of penoscrotal trauma, although most polytrauma or "pelvic trauma" patients are rapidly evaluated by CT in the emergency room setting. As more patients with pelvic trauma are triaged and evaluated using CT scanners with greater multidetector capability, more patients will be seen with testicular injury. It is important for the emergency physicians, radiologists, and traumatologists not to overlook unsuspected cases of penoscrotal injury which are typically initially evaluated by history, physical exam, and ultrasound. We describe a recent case of initial diagnosis of bilateral testicular dislocation from blunt trauma using modern multidetector CT imaging technique.

  2. Risk factors for vertebral artery injuries in cervical spine trauma

    Directory of Open Access Journals (Sweden)

    Nanjundappa S. Harshavardhana

    2014-10-01

    Full Text Available Blunt cerebrovascular injuries (i.e. involvement of carotid and vertebral arteries are increasingly being recognized in setting of cervical spine trauma/fractures and are associated with high incidence of stroke/morbidity and mortality. The incidence of vertebral artery injuries (VAI is more common than previously thought and regular screening is seldom performed. However there exists no screening criteria and conflicting reports exists between spine and trauma literature. Many clinicians do not routinely screen/evaluate patients presenting with cervical spine trauma for potential VAI. This article provides a brief summary of existing evidence regarding the incidence of VAI in the background of cervical trauma/fractures. The type and fracture pattern that is associated with a high risk of VAI warranting mandatory screening/further work-up is discussed. A brief overview of diagnostic modalities and their respective sensitivity/specificity along with available treatment options is also summarized.

  3. Splenic hypofunction in the nephrotic syndrome of childhood

    Energy Technology Data Exchange (ETDEWEB)

    McVicar, M.I.; Chandra, M.; Margouleff, D.; Zanzi, I.

    1986-05-01

    The reticuloendothelial system, including the spleen, subserves important immunologic functions. Loss of splenic function results in an increased incidence of severe bacterial infections and is accompanied by thrombocytosis. Several nephrotic children were noted to have remarkably high platelet counts and predisposition to bacterial infection with encapsulated organisms. We, therefore, investigated the splenic function of nine children with primary nephrotic syndrome and measured the phagocytic function of the spleen by sequestration of Technetium-99-labelled heat-treated autologous RBC, administered intravenously. Four children had decreased splenic function. Repeat studies performed in two of these children after remission of the nephrotic syndrome gave normal results. There were six episodes of bacterial infection (3 peritonitis, 1 septic arthritis, 1 cellulitis, and 1 Escherichia coli urinary tract infection) among the four patients with decreased splenic function. There were no episodes of bacterial infection among the five nephrotic children with normal splenic function. Nephrotic patients with decreased splenic function had significantly increased platelet counts (921,000 +/- 196,000; mean +/- SEM) compared to those with normal function (435,000 +/- 46,000; P less than 0.001). Our findings suggest the possibility that some nephrotic children may have decreased splenic function in association with increased susceptibility to bacterial infections.

  4. Hemobilia. An unusual complication of liver trauma

    Directory of Open Access Journals (Sweden)

    Baeza Herrera Carlos

    2014-07-01

    Full Text Available Introduction. Hemobilia is a complication following a hepatic trauma. It is common in adults, but it is very rare in children. Clinically it is characterized by a triad including jaundice, inter- mittent abdominal pain and gastrointestinal hemorrhage. Case report. We report a case of hemobilia in a four-year-old boy who sustained an abdominal blunt trauma caused by a motor vehicle. He had to be operated. A laparotomy disclosed a ruptured spleen which required a splenorraphy. He was subsequently discharged. Eighteen days later he was readmitted presenting with the classic triad. A computed tomography (CT scan showed an image sug- gestive of hemobilia. Management was conservative. The child had an uneventful course.

  5. Imaging of diaphragmatic rupture after trauma

    Energy Technology Data Exchange (ETDEWEB)

    Eren, S. [Department of Radiology, Faculty of Medicine, Atatuerk University, Erzurum (Turkey)]. E-mail: suateren@atauni.edu.tr; Kantarci, M. [Department of Radiology, Faculty of Medicine, Atatuerk University, Erzurum (Turkey); Okur, A. [Department of Radiology, Faculty of Medicine, Atatuerk University, Erzurum (Turkey)

    2006-06-15

    Traumatic rupture of the diaphragm usually results from blunt or penetrating injuries, or iatrogenic causes. Most cases are initially overlooked in the acute phase because they present with variable clinical and radiological signs. An overlooked diaphragmatic injury presents as a hernia many years later with potentially serious complications, therefore selection of the most appropriate radiological technique and accurate diagnosis of traumatic diaphragmatic hernias (DH) on the first admission is important. Although the diagnosis of diaphragmatic injuries is problematic, various investigations may be used for diagnosis. We describe the imaging findings of 19 traumatic DH cases with various imaging techniques. The patients were acute trauma cases or cases with prior trauma or thoraco-abdominal surgery with clinical suspicion of DH. An evaluation of the imaging techniques used in the diagnosis of DH is presented.

  6. Splenic Involvement in Hereditary Hemorrhagic Telangiectasia

    Directory of Open Access Journals (Sweden)

    Susumu Takamatsu

    2016-01-01

    Full Text Available A 33-year-old man who presented with prolonged epigastric pain was referred to our hospital. He had experienced recurrent epistaxis and had a family history of hereditary hemorrhagic telangiectasia. Computed tomography and magnetic resonance imaging revealed splenomegaly and a 9 cm hypervascular mass in his spleen. Computed tomography also showed a pulmonary arteriovenous malformation and heterogeneous enhancement of the liver parenchyma, suggesting the presence of arteriosystemic shunts and telangiectases. Based on these findings, the patient was definitely diagnosed with hereditary hemorrhagic telangiectasia according to Curaçao criteria. He underwent splenectomy, and his symptoms disappeared after surgery. Pathological examination of the resected specimen revealed that the hypervascular lesion of the spleen was not a tumor but was composed of abnormal vessels associated with hereditary hemorrhagic telangiectasia. Symptomatic splenic involvement may be a rare manifestation of hereditary hemorrhagic telangiectasia but can be revealed by imaging modalities.

  7. Biliary peritonitis due to "fallen" hydatid cyst after abdominal trauma.

    Science.gov (United States)

    Kara, Melih; Tihan, Deniz; Fersahoglu, Tuba; Cavda, Faruk; Titiz, Izzet

    2008-01-01

    Hepatic hydatid cysts may cause serious complications. Intraperitoneal rupture of hepatic hydatid cyst is rarely seen and the prognosis can be fatal. By experience, we know that it might be difficult to diagnose an unruptured cyst expulsed into the peritoneal cavity. In this report, we present the case of a 54-year-old man with an intraperitoneal cystic mass of 10 cm of diameter which had extruded out from the liver due to a blunt abdominal trauma.

  8. Splenic Rupture Diagnosed with Bedside Ultrasound in a Patient with Shock in the Emergency Department Following Colonoscopy

    Directory of Open Access Journals (Sweden)

    William Mulkerin

    2015-10-01

    Full Text Available A 64-year-old male presented to the emergency department (ED with near syncope and worsening left flank and shoulder pain. He had undergone a difficult colonoscopy two days prior due to a tortuous colon. Initial vital signs were normal. He looked uncomfortable and had significant left upper quadrant abdominal tenderness with guarding. Thirty minutes after ED arrival, his blood pressure dropped to 73/59 mmHg, requiring aggressive fluid resuscitation. Bedside focused assessment with sonography in trauma (FAST exam demonstrated free fluid in the abdomen with mixed echogenicity of the spleen, suggestive of splenic injury. Computed tomography (CT demonstrated a large subcapsular splenic hematoma with active extravasation and surrounding intraperitoneal free fluid (Figure, Video. He was admitted to the surgical intensive care unit. Hemorrhage continued after interventional radiology performed embolization of the splenic artery. He then required laparoscopic splenectomy on hospital day 2 to control bleeding. He subsequently did well and was discharged on hospital day 10.

  9. Splenic tuberculosis. Report of twelve cases; La tuberculose splenique

    Energy Technology Data Exchange (ETDEWEB)

    Adil, A.; Chikhaoui, N.; Ousehal, A.; Kadiri, R. [Centre Hospitalier Universitaire Ibn Rochd, Casablanca (Morocco)

    1995-12-31

    Tuberculosis of the spleen is not exceptional. The authors report ten cases which occurred with a predominance in young male adults. All patients had at least one other site of tuberculosis without any HIV infection. All patients had focal splenic lesions in the form of scattered hypo-echogenic and hypodense nodules. These nodules had a pseudo-tumor appearance in one case. CT-guided puncture was performed in one case. Splenic tuberculosis is not as rare as is sometimes thought. The CT-guided splenic puncture is now performed routinely and remains the ideal diagnostic approach. (authors). 9 refs., 5 figs.

  10. Large Multiloculated Splenic Mesothelial Cyst: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Roumina Hasan

    2015-12-01

    Full Text Available The mesothelial splenic cyst is a rare clinical entity, comprising <10% of all the primary splenic cysts. They usually present as a well-defined unilocular cystic lesion. We present a large multiloculated mesothelial splenic cyst in middle-aged women, which was radiologically indistinguishable from hydatid cyst. We discuss the importance of the clinical, radiological, and histopathological correlation in the diagnosis of this rare non-parasitic cyst of the spleen. [J Interdiscipl Histopathol 2015; 3(4.000: 146-148

  11. Splenic artery aneurysm: a case report with review of literature

    Directory of Open Access Journals (Sweden)

    A. Bhagya Lakshmi

    2014-06-01

    Full Text Available Splenic Artery Aneurysm (SAA is very rare in occurrence and they occur in approximately 1% of the population and are usually an incidental finding, but the necropsy studies have given rates as high as 10%. For its rarity in occurrence here we present a case of splenic artery aneurysm in a 40 year old alcoholic presenting with upper and lower gastrointestinal bleeding. He was diagnosed as splenic artery aneurysm on CT scan and confirmed by laparotomy and pathological examination. [Int J Res Med Sci 2014; 2(3.000: 1220-1222

  12. Outcome of severely injured trauma patients at a designated trauma centre in the Hong Kong Special Administrative Region

    Institute of Scientific and Technical Information of China (English)

    LEUNG Ka Kit Gilberto; HO Wendy; TONG King Hung Daniel; YUEN Wai Key

    2010-01-01

    Background The Hong Kong Special Administrative Region (HKSAR) of the People's Republic of China (PRG) has seen significant changes in its trauma service over the last ten years including the implementation of a regional trauma system.The author's institution is one of the five trauma centres designated in 2003.This article reports our initial clinical experience.Methods A prospective single-centre trauma registry from January 2004 to December 2008 was reviewed.The primary clinical outcome measure was hospital mortality.The Trauma and Injury Severity Score (TRISS) methodology was used for bench-marking with the North America Major Trauma Outcome Study (MTOS) database.Results There were 1451 patients.The majority (83.9%) suffered from blunt injury.The overall mortality rate was 7.8%.Severe injury, defined as the Injury Severity Score >15, occurred in 22.5% of patients, and was associated with a mortality rate of 31.6%.A trend of progressive improvement was noted.The M-statistic was 0.99, indicating comparable case-mix with the MTOS.The Z- and W-statistics of each individual year revealed fewer, but not significantly so, number of survivors than expected.Conclusions Trauma centre designation was feasible in the HKSAR and was associated with a gradual improvement in patient care.Trauma system implementation may be considered in regions equipped with the necessary socio-economic and organizational set-up.

  13. A report of three cases and review of the literature on rectal disruption following abdominal seatbelt trauma.

    Science.gov (United States)

    El Kafsi, J; Kraus, R; Guy, R

    2016-02-01

    Seatbelt associated blunt trauma to the rectum is a rare but well recognised injury. The exact mechanism of hollow visceral injury in blunt trauma is unclear. Stress and shear waves generated by abdominal compression may in part account for injury to gas containing structures. A 'seatbelt sign' (linear ecchymosis across the abdomen in the distribution of the lap belt) should raise the suspicion of hollow visceral injuries and can be more severe with disruption of the abdominal wall musculature. Three consecutive cases of rectal injury following blunt abdominal trauma, requiring emergency laparotomy and resection, are described. Lumbar spine injury occurred in one case and in the other two cases, there was injury to the iliac wing of the pelvis; all three cases sustained significant abdominal wall contusion or muscle disruption. Abdominal wall reconstruction and closure posed a particular challenge, requiring a multidisciplinary approach. The literature on this topic is reviewed and potential mechanisms of injury are discussed.

  14. Forensic medical study on morphology and formative mechanism of blunt head injury

    Directory of Open Access Journals (Sweden)

    LI Hong-wei

    2012-12-01

    Full Text Available 【Abstract】 Objective: To study the patterns and morphologic characteristics of blunt head injury and analyse its formative mechanism in attempt to provide references for medicolegal expertise. Methods: The statistical analysis was done in terms of gender, age, as well as the nature, pattern, location, and feature of the injuries. Results: Among the 202 cases of head injury-induced death, 124 were male and 78 female with the age ranging from 1-81 years. Death caused by homicide was dominant (106, 52.5%, followed by suicide (49, 24.3% and accident (44, 21.8%. The majority of suicide-induced death were by falling from height, and traffic crash was responsible for majority of unexpected death cases. The morphology and pathogenesis of the injuries varied according to differences on the mode, magnitude, and orientation of the outside force giving rise to blunt injury as well as the character of vulnerants. Conclusion: Studies on the morphology and its forma-tive rationale of blunt head injury will offer easy access to medicolegal expertise on the mode and character of the injury. Key words: Brain; Head injuries, closed; Cranioce-rebral trauma; Forensic medicine

  15. Ectopic pancreatic islets in Splenic hilum and peripancreatic fat

    Directory of Open Access Journals (Sweden)

    Vasishta RK

    2008-01-01

    Full Text Available Abstract The presence of pancreatic islets alone in the peripancreatic region and splenic hilum is an uncommon occurrence. Herein, we describe their presence in this rare location.

  16. Testicular Dislocation After Scrotal Trauma: A Case Report and Brief Literature Review.

    Science.gov (United States)

    Zavras, Nick; Siatelis, Argyrios; Misiakos, Evangelos; Bagias, George; Papachristos, Vassilios; Machairas, Anastasios

    2014-05-01

    Traumatic dislocation of the testis is a rare event after blunt trauma of the scrotum or abdominopelvic injury. The diagnosis may be overlooked because of associated major injuries. In this study, we report on an adult who presented with a left traumatic dislocation of the testis after a falling astride injury. A brief literature review is also cited.

  17. Testicular dislocation: the importance of scrotal examination in a trauma patient.

    Science.gov (United States)

    Naseer, A; King, D; Lee, H; Vale, J

    2012-03-01

    Testicular dislocation after blunt perineal trauma is a rare event and a diagnosis that can be easily overlooked. Careful examination can help facilitate early and appropriate treatment. Timely diagnosis and surgical management are of paramount importance to preserve normal spermatogenic function in the dislocated testicle. We describe a case of testicular dislocation and discuss some of the issues surrounding diagnosis and treatment.

  18. Testicular Dislocation After Scrotal Trauma: A Case Report and Brief Literature Review

    Directory of Open Access Journals (Sweden)

    Nick Zavras

    2014-05-01

    Full Text Available Traumatic dislocation of the testis is a rare event after blunt trauma of the scrotum or abdominopelvic injury. The diagnosis may be overlooked because of associated major injuries. In this study, we report on an adult who presented with a left traumatic dislocation of the testis after a falling astride injury. A brief literature review is also cited.

  19. Changes of color coordinates of biological tissue with superficial skin damage due to mechanical trauma

    Science.gov (United States)

    Pteruk, Vail; Mokanyuk, Olexander; Kvaternuk, Olena; Yakenina, Lesya; Kotyra, Andrzej; Romaniuk, Ryszard S.; Dussembayeva, Shynar

    2015-12-01

    Change of color coordinates of normal and pathological biological tissues is based on calculated spectral diffuse reflection. The proposed color coordinates of normal and pathological biological tissues of skin provided using standard light sources, allowing accurately diagnose skin damage due to mechanical trauma with a blunt object for forensic problems.

  20. [Videothoracospy in thoracic trauma and penetrating injuries].

    Science.gov (United States)

    Lang-Lazdunski, L; Chapuis, O; Pons, F; Jancovici, R

    2003-03-01

    Videothoracoscopy represents a valid and useful approach in some patients with blunt chest trauma or penetrating thoracic injury. This technique has been validated for the treatment of clotted hemothorax or posttraumatic empyema, traumatic chylothorax, traumatic pneumothorax, in patients with hemodynamic stability. Moreover, it is probably the most reliable technique for the diagnosis of diaphragmatic injury. It is also useful for the extraction of intrathoracic projectiles and foreign bodies. This technique might be useful in hemodynamically stable patients with continued bleeding or for the exploration of patients with penetrating injury in the cardiac area, although straightforward data are lacking to confirm those indications. Thoracotomy or median sternotomy remain indicated in patients with hemodynamic instability or those that cannot tolerate lateral decubitus position or one-lung ventilation. Performing video-surgery in the trauma setting require expertise in both video-assisted thoracic surgery and chest trauma management. The contra-indications to videothoracoscopy and indications for converting the procedure to an open thoracotomy should be perfectly known by surgeons performing video-assisted thoracic surgery in the trauma setting. Conversion to thoracotomy or median sternotomy should be performed without delay whenever needed to avoid blood loss and achieve an adequate procedure.

  1. Splenic arteriovenous fistula treated with percutaneous transarterial embolization

    DEFF Research Database (Denmark)

    Madsen, M.A.; Frevert, S.; Madsen, P.L.;

    2008-01-01

    Splenic arteriovenous fistula is a rare complication following splenectomy. We report a case of a large splenic arteriovenous fistula 23 years after splenectomy in a 50-year old male with abdominal pain, gastro-intestinal bleeding, ascites, diarrhoea, dyspnoea, portal hypertension and heart failure....... The arteriovenous fistula was successfully treated with percutaneous transarterial embolization and the patient gained almost complete recovery. This case demonstrates the usefulness of embolization of an otherwise surgical demanding arteriovenous fistula Udgivelsesdato: 2008/11...

  2. Outcome analysis of management of liver trauma: A 10-year experience at a trauma center

    Institute of Scientific and Technical Information of China (English)

    Wong; Hoi; She; Tan; To; Cheung; Wing; Chiu; Dai; Simon; HY; Tsang; Albert; CY; Chan; Daniel; KH; Tong; Gilberto; KK; Leung; Chung; Mau; Lo

    2016-01-01

    AIM: To review the outcomes of liver trauma in patients with hepatic injuries only and in patients with associated injuries outside the liver.METHODS: Data of liver trauma patients presented to our center from January 2003 to October 2013 were reviewed. The patients were divided into two groups. Group 1 consisted of patients who had hepatic injuries only. Group 2 consisted of patients who also had associated injuries outside the liver.RESULTS: Seven(30.4%) patients in group 1 and 10(28.6%) patients in group 2 received non-operative management; the rest underwent operation. Blunt trauma occurred in 82.8%(48/58) of the patients and penetrative trauma in 17.2%(10/58). A higher injury severity score(ISS) was observed in group 2(median 45 vs 25, P < 0.0001). More patients in group 1 were hemodynamically stable(65.2% vs 37.1%, P = 0.036). Other parameters were comparable between groups. Group 1 had better 30-d survival(91.3% vs 71.4%, P = 0.045). On multivariate analysis using the logistic regression model, ISS was found to be associated with mortality(P = 0.004, hazard ratio = 1.035, 95%CI:CONCLUSION: Liver trauma patients with multiple injuries are relatively unstable on presentation. Despite a higher ISS in group 2, non-operative management was possible for selected patients. Associated injuries outside the liver usually account for morbidity and mortality.

  3. Airbag-Associated Severe Blunt Eye Injury Causes Choroidal Rupture and Retinal Hemorrhage: A Case Report

    Directory of Open Access Journals (Sweden)

    Shih Hao Wang

    2017-01-01

    Full Text Available A case of choroidal rupture caused by airbag-associated blunt eye trauma and complicated with massive subretinal hemorrhage and vitreous hemorrhage that was successfully treated with intravitreal injection of expansile gas and bevacizumab is presented. A 53-year-old man suffered from loss of vision in his right eye due to blunt eye trauma by a safety airbag after a traffic accident. On initial examination, the patient had no light perception in his right eye. Dilated ophthalmoscopy revealed massive subretinal hemorrhage with macular invasion and faint vitreous hemorrhage. We performed intravitreal injection of pure sulfur hexafluoride twice for displacement, after which visual acuity improved to 0.03. For persistent subretinal hemorrhage and suspicion of choroidal neovascularization (CNV, intravitreal bevacizumab (1.25 mg/0.05 mL injection was administered. After 3 weeks, the visual acuity of his right eye recovered to 0.4. For early-stage choroidal rupture-induced subretinal hemorrhage and complications of suspected CNV, intravitreal injection of expandable gas and intraocular injection of antiangiogenesis drugs seem to be an effective treatment.

  4. Acute pancreatitis complicated with splenic rupture: A case report

    Institute of Scientific and Technical Information of China (English)

    Bruno; L; Hernani; Pedro; C; Silva; Ricardo; T; Nishio; Henrique; C; Mateus; José; C; Assef; Tercio; De; Campos

    2015-01-01

    Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography(CT) of the abdomen, the pancreatitis was scored as Balthazar C grade, and a suspicious area of necrosis affecting 30% of the pancreas with splenic vein thrombosis was revealed. Seventytwo hours after admission, the patient had significant improvement in symptoms. However, he showed clinical worsening on the sixth day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma and contrast extravasation along the spleen artery. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was then performed, followed by ultrasound-guided percutaneous drainage.

  5. Acute pancreatitis complicated with splenic rupture: A case report.

    Science.gov (United States)

    Hernani, Bruno L; Silva, Pedro C; Nishio, Ricardo T; Mateus, Henrique C; Assef, José C; De Campos, Tercio

    2015-09-27

    Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography (CT) of the abdomen, the pancreatitis was scored as Balthazar C grade, and a suspicious area of necrosis affecting 30% of the pancreas with splenic vein thrombosis was revealed. Seventy-two hours after admission, the patient had significant improvement in symptoms. However, he showed clinical worsening on the sixth day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma and contrast extravasation along the spleen artery. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was then performed, followed by ultrasound-guided percutaneous drainage.

  6. Implementation and Analysis of Initial Trauma Registry in Iquitos, Peru

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    Vincent Duron

    2016-10-01

    Full Text Available Background: In Peru, 11% of deaths are due to trauma. Iquitos is a large underserved Peruvian city isolated from central resources by its geography. Our objective was to implement a locally driven trauma registry to sustainably improve trauma healthcare in this region. Methods: All trauma patients presenting to the main regional referral hospital were included in the trauma registry. A pilot study retrospectively analyzed data from the first two months after implementation. Results: From March to April 2013, 572 trauma patients were entered into the database. Average age was 26.9 years. Ten percent of patients presented more than 24 hours after injury. Most common mechanisms of injury were falls (25.5%, motor vehicle collisions (23.3%, and blunt assault (10.5%. Interim analysis revealed that 99% of patients were entered into the database. However, documentation of vital signs was poor: 42% of patients had temperature, 26% had oxygen saturation documented. After reporting to registry staff, a significant increase in temperature (42 to 97%, P < 0.001 and oxygen saturation (26 to 92%, P < 0.001 documentation was observed. Conclusion: A trauma registry is possible to implement in a resource-poor setting. Future efforts will focus on analysis of data to enhance prevention and treatment of injuries in Iquitos.

  7. Portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula.

    Science.gov (United States)

    Ding, Pengxu; Li, Zhen; Han, Xin-Wei; Wang, Zhong-Gao; Zhang, Wen-Guang; Fu, Ming-Ti

    2014-07-01

    We present an unusual case of portal, mesenteric, and splenic vein thromboses after endovascular embolization for gastrointestinal bleeding caused by a splenic arteriovenous fistula. The thromboses were successfully treated with anticoagulation therapy. The patient was a 37-year-old woman who presented with portal hypertension manifested by gastrointestinal bleeding with no evidence of liver disease. Splenic arteriography confirmed the presence of a high-flow arteriovenous fistulous communication from the splenic artery directly into the splenic vein. The arteriovenous fistula was successfully treated with percutaneous transarterial embolization by embolization coils and the patient achieved effective hemostasis. Low-molecular-weight heparin and warfarin were administrated to prevent thrombosis in the portal venous system after the procedure. Although anticoagulants were immediately administered, thromboses of the portal, mesenteric, and splenic veins were diagnosed by contrast-enhanced computed tomography after 10 days. Complete recanalization of the portal venous system confirmed by contrast-enhanced computed tomography was achieved by administering warfarin orally for 3 months.

  8. Isolated Retroperitoneal Hydatid Cyst Invading Splenic Hilum

    Directory of Open Access Journals (Sweden)

    Safak Ozturk

    2014-01-01

    Full Text Available Introduction. Hydatid disease (HD is an infestation that is caused by the larval stage of Echinococcus granulosus. The liver is affected in approximately two-thirds of patients, the lungs in 25%, and other organs in a small proportion. Primary retroperitoneal hydatid cyst is extremely rare. The most common complaint is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst. Case Presentation. A 43-year-old female was admitted with the complaint of abdominal pain. Her physical examination was normal. Computed tomography (CT revealed a 17 × 11 cm cystic lesion, with a thick and smooth wall that is located among the left liver lobe, diaphragm, spleen, tail of the pancreas, and transverse colon and invading the splenic hilum. Total cystectomy and splenectomy were performed. Pathological examination was reported as cyst hydatid. Discussion. Cysts in the peritoneal cavity are mainly the result of the spontaneous or traumatic rupture of concomitant hepatic cysts or surgical inoculation of a hepatic cyst. Serological tests contribute to diagnosis. In symptomatic and large hydatid peritoneal cysts, surgical resection is the only curative treatment. Total cystectomy is the gold standard. Albendazole or praziquantel is indicated for inoperable and disseminated cases. Percutaneous aspiration, injection, and reaspiration (PAIR technique is another nonsurgical option.

  9. Use of video-assisted intubation devices in the management of patients with trauma.

    Science.gov (United States)

    Aziz, Michael

    2013-03-01

    Patients with trauma may have airways that are difficult to manage. Patients with blunt trauma are at increased risk of unrecognized cervical spine injury, especially patients with head trauma. Manual in-line stabilization reduces cervical motion and should be applied whenever a cervical collar is removed. All airway interventions cause some degree of cervical spine motion. Flexible fiberoptic intubation causes the least cervical motion of all intubation approaches, and rigid video laryngoscopy provides a good laryngeal view and eases intubation difficulty. In emergency medicine departments, video laryngoscopy use is growing and observational data suggest an improved success rate compared with direct laryngoscopy.

  10. Identification of Cardiac and Aortic Injuries in Trauma with Multi-detector Computed Tomography.

    Science.gov (United States)

    Shergill, Arvind K; Maraj, Tishan; Barszczyk, Mark S; Cheung, Helen; Singh, Navneet; Zavodni, Anna E

    2015-01-01

    Blunt and penetrating cardiovascular (CV) injuries are associated with a high morbidity and mortality. Rapid detection of these injuries in trauma is critical for patient survival. The advent of multi-detector computed tomography (MDCT) has led to increased detection of CV injuries during rapid comprehensive scanning of stabilized major trauma patients. MDCT has the ability to acquire images with a higher temporal and spatial resolution, as well as the capability to create multiplanar reformats. This pictorial review illustrates several common and life-threatening traumatic CV injuries from a regional trauma center.

  11. Identification of Cardiac and Aortic Injuries in Trauma with Multi-detector Computed Tomography

    Directory of Open Access Journals (Sweden)

    Arvind K Shergill

    2015-01-01

    Full Text Available Blunt and penetrating cardiovascular (CV injuries are associated with a high morbidity and mortality. Rapid detection of these injuries in trauma is critical for patient survival. The advent of multi-detector computed tomography (MDCT has led to increased detection of CV injuries during rapid comprehensive scanning of stabilized major trauma patients. MDCT has the ability to acquire images with a higher temporal and spatial resolution, as well as the capability to create multiplanar reformats. This pictorial review illustrates several common and life-threatening traumatic CV injuries from a regional trauma center.

  12. The sequential trauma score - a new instrument for the sequential mortality prediction in major trauma*

    Directory of Open Access Journals (Sweden)

    Huber-Wagner S

    2010-05-01

    score is available at: http://www.sequential-trauma-score.com Conclusions This score is the first sequential, dynamic score to provide a prognosis for patients with blunt major trauma at several points in time. With every additional piece of information the precision increases. The medical team has a simple, useful tool to identify patients at high risk and to predict the prognosis of an individual patient with major trauma very early, quickly and precisely.

  13. Febre crônica associada a abscesso esplênico causado por Staphylococcus epidermidis Chronic fever associated with splenic abscess due to Staphylococcus epidermidis

    Directory of Open Access Journals (Sweden)

    Juliana Salles de Carvalho

    2007-10-01

    Full Text Available Abscessos ocultos são causa freqüente de febre crônica. Os abscessos esplênicos são entidades raras, usualmente associadas a quadros subjacentes de cirurgia abdominal, endocardite ou imunodepressão. Apresenta-se um caso de paciente com febre prolongada causada por um abscesso esplênico, cujo principal diagnóstico diferencial era leishmaniose visceral, que provavelmente esteve associado a traumatismo abdominal. O tratamento consistiu em antibioticoterapia seguida de esplenectomia.Occult abscesses are frequent causes of chronic fever. Splenic abscesses are rare entities that are usually associated with underlying conditions such as abdominal surgery, endocarditis or immunodepression. We report on the case of a patient with prolonged fever caused by a splenic abscess, whose main differential diagnosis was visceral leishmaniasis. However, this condition was probably related to abdominal trauma. The treatment consisted of antibiotics followed by splenectomy.

  14. Percutaneous Treatment of Splenic Cystic Echinococcosis: Results of 12 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan, E-mail: akhano@tr.net; Akkaya, Selçuk, E-mail: selcuk.akkaya85@gmail.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Dağoğlu, Merve Gülbiz, E-mail: drmgkartal@gmail.com [Istanbul University, Department of Radiology, Istanbul School of Medicine (Turkey); Akpınar, Burcu, E-mail: burcu-akpinar@yahoo.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Erbahçeci, Aysun, E-mail: aysunerbahceci@yahoo.com [Istanbul Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Department of Radiology (Turkey); Çiftçi, Türkmen, E-mail: turkmenciftci@yahoo.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Köroğlu, Mert, E-mail: mertkoroglu@hotmail.com [Antalya Education and Research Hospital, Department of Radiology (Turkey); Akıncı, Devrim, E-mail: akincid@hotmail.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey)

    2016-03-15

    PurposeCystic echinococcosis (CE) in the spleen is a rare disease even in endemic regions. The aim of this study was to examine the efficacy of percutaneous treatment for splenic CE.Materials and MethodsTwelve patients (four men, eight women) with splenic CE were included in this study. For percutaneous treatment, CE1 and CE3A splenic hydatid cysts were treated with either the PAIR (puncture, aspiration, injection, respiration) technique or the catheterization technique.ResultsEight of the hydatid cysts were treated with the PAIR technique and four were treated with catheterization. The volume of all cysts decreased significantly during the follow-up period. No complication occurred in seven of 12 patients. Abscess developed in four patients. Two patients underwent splenectomy due to cavity infection developed after percutaneous treatment, while the spleen was preserved in 10 of 12 patients. Total hospital stay was between 1 and 18 days. Hospital stay was longer and the rate of infection was higher in the catheterization group. Follow-up period was 5–117 months (mean, 44.8 months), with no recurrence observed.ConclusionThe advantages of the percutaneous treatment are its minimal invasive nature, short hospitalization duration, and its ability to preserve splenic tissue and function. As the catheterization technique is associated with higher abscess risk, we suggest that the PAIR procedure should be the first percutaneous treatment option for splenic CE.

  15. Splenic Artery Pseudoaneurysm Presenting as Massive Hematemesis: A Diagnostic Dilemma

    Directory of Open Access Journals (Sweden)

    Peeyush Varshney

    2014-01-01

    Full Text Available Introduction. Splenic artery Pseudoaneurysm, a complication of chronic pancreatitis, presenting as massive hematemesis is a rare presentation. Case Report. We present a case of 38-year-old male admitted with chief complaints of pain in the upper abdomen and massive hematemesis for the last 15 days. On examination there was severe pallor. On investigating the patient, Hb was 4.0 gm/dL, upper GI endoscopy revealed a leiomyoma in fundus of stomach, and EUS Doppler also supported the UGI findings. On further investigation of the patient, CECT of the abdomen revealed a possibility of distal pancreatic carcinoma encasing splenic vessels and infiltrating the adjacent structure. FNA taken at the time of EUS was consistent with inflammatory pathology. Triple phase CT of the abdomen revealed a splenic artery pseudoaneurysm with multiple splenic infarcts. After resuscitation we planned an emergency laparotomy; splenic artery pseudoaneurysm densely adherent to adjacent structures and associated with distal pancreatic necrosis was found. We performed splenectomy with repair of the defect in the stomach wall and necrosectomy. Postoperative course was uneventful and patient was discharged on day 8. Conclusion. Pseudoaneurysm can be at times a very difficult situation to manage; options available are either catheter embolisation if patient is vitally stable, or otherwise, exploration.

  16. [VARIANT ANATOMY OF SPLENIC LIGAMENTS AND ARTERIES PASSING THROUGH THEM].

    Science.gov (United States)

    Gaivoronskiy, I V; Kotiv, B N; Alekseyev, V S; Nichiporuk, G I

    2015-01-01

    The research was performed on 15 non embalmed bodies and 32 abdominal complexes of adult individuals. The comparative study of variant anatomy of splenic ligaments and architectonics of arteries passing through them was carried out to substantiate the mobilization of splenopancreatic complex. Anatomical and angiographic restudied were carried out using preparation, morphometry, injection of gastric, pancreatic and splenic vascular bed with red lead suspension. It was established that the form and sizes of splenic ligaments and their interrelation with the branches of the splenic artery were variable. The minimal and maximal sizes of gastrolienal, phrenicosplenic and splenocolic ligaments differed 2-3 times. In most cases, spleen was fixed in abdominal cavity by many short ligaments. It was shown that architectonics and topography of main branches of spleen artery were determined by morphometric characteristics of the spleen proper and its ligaments. The knowledge of splenic ligament variant anatomy allows a new perspective to approach to substantiate different methods of the mobilization of spleno-pancreatic complex during surgical operations on organs of the upper part of the peritoneal cavity and organ-preserving surgery of the spleen.

  17. Spontaneous splenic rupture in Waldenstrom's macroglobulinemia: a case report

    Directory of Open Access Journals (Sweden)

    Charakidis Michail

    2010-09-01

    Full Text Available Abstract Introduction We report the case of a patient with Waldenstrom's macroglobulinemia complicated by spontaneous splenic rupture. Case presentation A 49-year-old Caucasian woman was referred to our emergency department by her general practitioner following a three-week history of malaise, night sweats, six kilograms of weight loss, intermittent nausea and vomiting, progressive upper abdominal pain and easy bruising. On the fourth day following her admission, she had a rapid clinical deterioration, with subsequent radiological investigations revealing a splenic rupture. Her morphology, biochemistry, flow cytometry and histology were strongly suggestive of Waldenstrom's macroglobulinemia. Conclusions Spontaneous splenic rupture is not an expected complication of low-grade lymphoplasmacytic lymphomas, such as Waldenstrom's macroglobulinemia. To the best of our knowledge, this is the only reported case of early spontaneous splenic rupture due to Waldenstrom's macroglobulinemia. Our case highlights that despite the typical disease course of low-grade hematological malignancies, signs and symptoms of imminent splenic rupture should be considered when formulating a clinical assessment.

  18. Clinical predictors of injuries not identified by focused abdominal sonogram for trauma (FAST) examinations.

    Science.gov (United States)

    Hoffman, Lance; Pierce, Daniel; Puumala, Susan

    2009-04-01

    This study's objective was to identify clinical characteristics of patients with a blunt traumatic injury that increased the risk of peritoneal or pericardial fluid collections and abdominal organ injuries not identified by a bedside focused abdominal sonogram for trauma (FAST) examination. This observational study used a retrospective chart review of a cohort of patients identified through a query of the University of Nebraska Medical Center's trauma registry, a tertiary referral center for portions of Nebraska, Iowa, and Missouri. Adult patients presenting to the Emergency Department (ED) for an evaluation of blunt traumatic injury from September 1996 to December 2002 were eligible if their ED course included admission to the trauma service after completion of a bedside FAST examination (US) and a confirmatory study (Conf) such as an abdominopelvic computed tomography scan or exploratory laparotomy within 12 h of completion of the ED FAST examination. The medical records of those patients with a US+/Conf+ or US-/Conf+ examination were reviewed. Clinical characteristics were recorded on a standard data collection form. Statistically significant predictors of a US-/Conf+ examination were found using a stepwise logistic regression procedure. A query of the trauma registry for the study period revealed 1453 adult individuals with blunt abdominal trauma, with 458 patients meeting the inclusion criteria. The clinical characteristics of the 79 US+/Conf+ examinations were compared to those of the 53 US-/Conf+ examinations. The presence of a radiographically proven pelvic fracture (odds ratio 3.459; 95% confidence interval of 1.308-9.157) and a radiographically or operatively proven renal injury (odds ratio 3.667; 95% confidence interval of 1.013-13.275) were found to be significant predictors. The presence of a pelvic fracture or renal injury in adult victims of blunt abdominal trauma increases the likelihood of a US-/Conf+ examination. Patients with a negative FAST

  19. Kuula. Kellele ei meeldiks James Blunt? / Mart Juur

    Index Scriptorium Estoniae

    Juur, Mart, 1964-

    2007-01-01

    Heliplaatidest: James Blunt "Back To Bedlam", Enrique Iglesias "Insomniac", Prince "Planet Earth", Garbage "Absolut Garbage", Justice "Cross", Interpol "Our Love To Admire", Rufus Wainwright "Release The Stars"

  20. Suspension Trauma / Orthostatic Intolerance

    Science.gov (United States)

    ... of Science and Technology Assessment Printer Friendly Version Suspension Trauma/Orthostatic Intolerance Safety and Health Information Bulletin ... information about the hazards of orthostatic intolerance and suspension trauma when using fall arrest systems. This bulletin: ...

  1. The usefulness of {sup 99m}Tc-Sn colloid scintigraphy for the evaluation of splenic autotransplantation

    Energy Technology Data Exchange (ETDEWEB)

    Kikuchi, Yoshirou; Oshima, Motoo; Shirai, Tatsuo; Yokokawa, Tokuzou; Kaminaga, Tatsurou; Yasukouchi, Hiroshi; Furui, Shigeru [Teikyo Univ., Tokyo (Japan). Faculty of Medicine

    1997-07-01

    The purpose of this study is to examine whether splenic scintigraphy is useful for an evaluation of viability of graft after splenic autotransplantation. Nine patients who underwent splenic autotransplantation for the diseases of liver cirrhosis (8 patients) and pancreas cancer (one patient) were examined of abdominal CT scan and splenic scintigraphy with {sup 99m}Tc-Sn colloid. Detection of splenic graft was difficult with CT scan. However, visualization of graft of spleen was obtained with splenic scintigraphy in all cases three months later after the surgery. In conclusion, splenic scintigraphy with {sup 99m}Tc-Sn colloid is useful for the evaluation of viability of splenic graft. (author)

  2. Massive variceal bleeding secondary to splenic vein thrombosis successfully treated with splenic artery embolization: a case report

    Directory of Open Access Journals (Sweden)

    Michalopoulos Antonis

    2010-05-01

    Full Text Available Abstract Introduction Splenic vein thrombosis results in localized portal hypertension called sinistral portal hypertension, which may also lead to massive upper gastrointestinal bleeding. Symptomatic sinistral portal hypertension is usually best treated by splenectomy, but interventional radiological techniques are safe and effective alternatives in the management of a massive hemorrhage, particularly in cases that have a high surgical risk. Case presentation We describe a 23-year-old Greek man with acute massive gastric variceal bleeding caused by splenic vein thrombosis due to a missing von Leiden factor, which was successfully managed with splenic arterial embolization. Conclusions Interventional radiological techniques are attractive alternatives for patients with a high surgical risk or in cases when the immediate surgical excision of the spleen is technically difficult. Additionally, surgery is not always successful because of the presence of numerous portal collaterals and adhesion. Splenic artery embolization is now emerging as a safe and effective alternative to surgery in the management of massive hemorrhage from gastric varices due to splenic vein thrombosis, which often occurs in patients with hypercoagulability.

  3. A Case of Ruptured Splenic Artery Aneurysm in Pregnancy

    Directory of Open Access Journals (Sweden)

    Elizabeth K. Corey

    2014-01-01

    Full Text Available Background. Rupture of a splenic artery aneurysm is rare complication of pregnancy that is associated with a significant maternal and fetal mortality. Case. A multiparous female presented in the third trimester with hypotension, tachycardia, and altered mental status. A ruptured splenic artery aneurysm was discovered at the time of laparotomy and cesarean delivery. The patient made a full recovery following resection of the aneurysm. The neonate survived but suffered severe neurologic impairment. Conclusion. The diagnosis of ruptured splenic artery aneurysm should be considered in a pregnant woman presenting with signs of intra-abdominal hemorrhage. Early intervention by a multidisciplinary surgical team is key to preserving the life of the mother and fetus.

  4. Unusual long-term complications of a splenic cyst.

    LENUS (Irish Health Repository)

    Ward, E V M

    2010-01-01

    Splenic cysts are relatively uncommon, and are usually asymptomatic. They are benign, typically treated conservatively and followed up with ultrasound examination, with few reported complications. We report a case of a simple splenic cyst that was followed up on imaging over a seven-year period. During that time, the cyst gradually enlarged from 5 cm to 12 cm in diameter, however the patient remained asymptomatic. After seven years, the patient was admitted with abdominal pain and a pelvic mass. The spleen was located within the pelvis, which was felt to be due to the weight of the cyst which caused the spleen to migrate out of its normal position. This case illustrates an extremely unusual complication, and suggests that while most splenic cysts may be managed conservatively, enlarging cysts may be prone to gravitational effects and prophylactic treatment should be considered.

  5. Unusual long-term complications of a splenic cyst.

    LENUS (Irish Health Repository)

    Ward, E V M

    2012-02-01

    Splenic cysts are relatively uncommon, and are usually asymptomatic. They are benign, typically treated conservatively and followed up with ultrasound examination, with few reported complications. We report a case of a simple splenic cyst that was followed up on imaging over a seven-year period. During that time, the cyst gradually enlarged from 5 cm to 12 cm in diameter, however the patient remained asymptomatic. After seven years, the patient was admitted with abdominal pain and a pelvic mass. The spleen was located within the pelvis, which was felt to be due to the weight of the cyst which caused the spleen to migrate out of its normal position. This case illustrates an extremely unusual complication, and suggests that while most splenic cysts may be managed conservatively, enlarging cysts may be prone to gravitational effects and prophylactic treatment should be considered.

  6. Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization

    Directory of Open Access Journals (Sweden)

    Damiano Patrono

    2014-01-01

    CONCLUSION: Splenic artery embolization may be a valuable adjunct in case of left-sided portal hypertension requiring splenectomy, allowing a safe dissection of the splenic vessels even by laparoscopy.

  7. Variation of Blunt Traumatic Injury with Age in Older Adults: Statewide Analysis 2011-14

    Directory of Open Access Journals (Sweden)

    Emily Earl-Royal

    2016-11-01

    Full Text Available Introduction: Traumatic injury is a leading cause of death and disability in adults ≥ 65 years old, but there are few epidemiological studies addressing this issue. The aim of this study was to assess how characteristics of blunt traumatic injuries in adults ≥ 65 vary by age. Methods: Using data from the a single-state trauma registry, this retrospective cohort study examined injured patients ≥ 65 admitted to all Level I and Level II trauma centers in Pennsylvania between 2011 and 2014 (n=38,562. Patients were stratified by age into three subgroups (age 65-74; 75-84; ≥85. We compared demographics, injury, and system-level across groups. Results: We found significant increases in the proportion of female gender, (48.6% vs. 58.7% vs. 67.7%, white race (89.1% vs. 92.6% vs. 94.6%, and non-Hispanic ethnicity (97.5% vs. 98.6% vs. 99.4% across advancing age across age groups, respectively. As age increased, the proportion of falls (69.9% vs. 82.1% vs. 90.3%, in-hospital mortality (4.6% vs. 6.2% vs. 6.8%, and proportion of patients arriving to the hospital via ambulance also increased (73.6% vs. 75.8% vs. 81.1%, while median injury severity plateaued (9.0% all groups and the proportion of Level I trauma alerts (10.6% vs. 8.2% vs. 6.7% decreased. We found no trend between age and patient transfer status. The five most common diagnoses were vertebral fracture, rib fracture, head contusion, open head wound, and intracranial hemorrhage, with vertebral fracture and head contusion increasing with age, and rib fracture decreasing with age. Conclusion: In a large cohort of older adults with trauma (n= 38,000, we found, with advancing age, a decrease in trauma alert level, despite an increase in mortality and a decrease in demographic diversity. This descriptive study provides a framework for future research on the relationship between age and blunt traumatic injury in older adults.

  8. Implementation and analysis of initial trauma registry in Iquitos, Peru

    Science.gov (United States)

    Duron, Vincent; DeUgarte, Daniel; Bliss, David; Salazar, Ernesto; Casapia, Martin; Ford, Henri; Upperman, Jeffrey

    2016-01-01

    Background: In Peru, 11% of deaths are due to trauma. Iquitos is a large underserved Peruvian city isolated from central resources by its geography. Our objective was to implement a locally driven trauma registry to sustainably improve trauma healthcare in this region. Methods: All trauma patients presenting to the main regional referral hospital were included in the trauma registry. A pilot study retrospectively analyzed data from the first two months after implementation. Results: From March to April 2013, 572 trauma patients were entered into the database. Average age was 26.9 years. Ten percent of patients presented more than 24 hours after injury. Most common mechanisms of injury were falls (25.5%), motor vehicle collisions (23.3%), and blunt assault (10.5%). Interim analysis revealed that 99% of patients were entered into the database. However, documentation of vital signs was poor: 42% of patients had temperature, 26% had oxygen saturation documented. After reporting to registry staff, a significant increase in temperature (42 to 97%, P analysis of data to enhance prevention and treatment of injuries in Iquitos.

  9. Trauma Facts for Educators

    Science.gov (United States)

    National Child Traumatic Stress Network, 2008

    2008-01-01

    This paper offers facts which can help educators deal with children undergoing trauma. These include: (1) One out of every 4 children attending school has been exposed to a traumatic event that can affect learning and/or behavior; (2) Trauma can impact school performance; (3) Trauma can impair learning; (4) Traumatized children may experience…

  10. Trauma resuscitation time.

    NARCIS (Netherlands)

    Olden, G.D.J. van; Vugt, A.B. van; Biert, J.; Goris, R.J.A.

    2003-01-01

    Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this

  11. Aseptic Splenic Abscess as Precursory Extraintestinal Manifestation of Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Joel Brooks

    2014-01-01

    Full Text Available Splenic abscesses are most often secondary to aerobic bacterial infections due to Streptococcus, Staphylococcus, and Enterococcus species of organisms. Sterile splenic abscesses rarely occur and diagnosis and treatment of those are challenging. We report a case of a previously healthy young female presenting with aseptic splenic abscesses as the initial manifestation of Crohn’s disease along with a review of the literature on aseptic splenic abscess as an extraintestinal manifestation of Crohn’s disease.

  12. Tuberculous splenic abscess in a neonate with thrombocytopenia

    Energy Technology Data Exchange (ETDEWEB)

    Amodio, John; Biskup, Darius; Rivera, Rafael; Fefferman, Nancy [New York University Medical Center, Department of Radiology, NY (United States); Shah, Shetal [New York University Medical Center, Division of Neonatology, Department of Pediatrics, Avenue, NY (United States)

    2005-09-01

    We present a case of a premature neonate who presented with anemia and persistent thrombocytopenia. The patient was ultimately diagnosed with disseminated tuberculosis. Initial sonographic evaluation of the abdomen revealed a heterogeneous but predominately hypoechoic spleen; there was subsequent evolution of a splenic abscess. The patient was treated medically with anti-tubercular drugs. Follow-up post-treatment sonograms of the spleen showed diminution of the abscess and the evolution of multiple calcifications compatible with calcified granulomas. This case is an unusual presentation of tuberculosis in an infant with splenic abscess associated with thrombocytopenia and anemia. (orig.)

  13. Splenic Vein Leiomyosarcoma: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Damiano Patrono

    2014-09-01

    Full Text Available Context Primary venous leiomyosarcoma (LMS is a rare disease, most commonly affecting the retroperitoneal veins and in particular the inferior vena cava. Five-year survival rate ranges between 33% and 68%. Case Report Complete surgical resection represents the only potentially curative treatment, occasionally achieving long-term survival. LMS of the splenic vein is extremely rare, with only three cases reported in the literature. Conclusion We report a case of primary venous LMS arising from the splenic vein and we briefly review the relevant literature.

  14. Splenic duplication: a rare cause of acute upper gastrointestinal bleeding.

    Science.gov (United States)

    Sharma, Pankaj; Alkadhi, Hatem; Gubler, Christoph; Bauerfeind, Peter; Pfammatter, Thomas

    2013-02-01

    Acute gastrointestinal bleeding represents a common medical emergency. We report the rare case of acute upper gastrointestinal bleeding caused by varices in the gastric fundus secondary to splenic duplication. Splenic duplication has been only rarely reported in the literature, and no case so far has described the associated complication of gastrointestinal bleeding, caused by venous drainage of the upper spleen via varices in the gastric fundus. We describe the imaging findings from endoscopy, endosonography, computed tomography (CT), flat-panel CT, and angiography in this rare condition and illustrate the effective role of intra-arterial embolization.

  15. Salmonella sepsis following posttraumatic splenectomy and implantation of autologous splenic tissue

    DEFF Research Database (Denmark)

    Schrøder, H M; Hovendal, C

    1985-01-01

    A severe complication following implantation of autologous splenic tissue occurred in a 51-year-old man. Indirect injury to abdomen resulted in a lesion of the splenic artery. Following splenectomy and reimplantation of splenic tissue into three pouches, a severe Salmonella sepsis developed withi...

  16. Imaging of thoracic trauma; Radiologie des Thoraxtraumas

    Energy Technology Data Exchange (ETDEWEB)

    Uffmann, M.; Herold, C.J. [Universitaetsklinik Vienna (Austria). Inst. fuer Radiodiagnostik; Fuchs, M. [Universitaetsklinik Vienna (Austria). Inst. fuer Unfallchirurgie

    1998-08-01

    Blunt trauma to the chest results from transfer of kinetic energy to the human body. It may cause a wide range of mostly life-threatening injuries, including fractures of the thoracic skeleton, disintegration of the pleural space, contusion or laceration of pulmonary parenchyma and damage to the mediastinal structures. For a systematic approach it may be helpful to follow an organ-based evaluation of thoracic trauma. However, it should be borne in mind that subtle injuries may be associated with serious complications. Trauma to the chest may affect different anatomic compartments at the same time, requiring and extending diagnostic approach. Conventional radiography plays a major role in diagnosting thoracic trauma, complemented by ultrasound examination of the pleura and abdomen. It is well documented that CT scanning represents a major technological improvement for assessment of thoracic trauma. With the advent of fast helical CT scanning this method becomes more applicable for severly traumatized patients and potentially replaces other time-consuming procedures. State-of-the-art imaging of both projection and cross-sectional techniques provides useful information for immediate and appropriate treatment mandatory in patients with thoracic trauma. (orig.) [Deutsch] Das Trauma des Thorax ist Folge einer erheblichen, meist stumpfen Gewalteinwirkung auf den Brustkorb und geht mit einem weiten Spektrum an groesstenteils lebendsbedrohlichen Organverletzungen einher. Aus Gruenden der Uebersichtlichkeit koennen die thorakalen Verletzungen in solche des Skeletts, der Pleura, der Lungen und der mediastinalen Strukturen eingeteilt werden. Haeufig besteht jedoch eine enge Verzahnung der Pathologien, und einzelne Symptome koennen Indikatoren fuer weitere, schwerwiegende Verletzungen sein. Darueber hinaus sind extrathorakale Koerperpartien und Organsysteme oftmals mitbetroffen, so dass eine umfassende diagnostische Strategie angewendet werden muss. Die schnelle Erstversorgung

  17. Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank.

    Science.gov (United States)

    Oyetunji, Tolulope A; Jackson, Hope T; Obirieze, Augustine C; Moore, Danier; Branche, Marc J; Greene, Wendy R; Cornwell, Edward E; Siram, Suryanarayana M

    2013-07-01

    Sternal fractures occur infrequently with blunt force trauma. The demographics and epidemiology of associated injuries have not been well characterized from a national trauma database. The National Trauma Data Bank was queried for patients with closed sternal fractures. The demographics were analyzed by age, gender, mechanism and indicators of anatomic and physiologic injuries. Types of commonly associated injuries were also determined. A total of 23,985 records were analyzed. Males accounted for 68.3 per cent and whites 70.9 per cent. Motor vehicle crash was the leading mechanism. More than 56 per cent had severe injuries based on Injury Severity Score (greater than 15) and 17 per cent with Glasgow Coma Score 8 or less. Crude mortality was 7.9 per cent. The majority (57.8%) and approximately one-third (33.7%) of the patients had rib fractures and lung contusions, respectively, 22.0 per cent with closed pneumothorax, 21.6 per cent had a closed thoracic vertebra fracture, 16.9 per cent with lumbar spine fracture, 3.9 per cent with concussion, and blunt cardiac injury in 3.6 per cent. Sternal fractures are usually associated with severe blunt trauma. Lung contusion remains the leading associated injury followed by vertebral spine fractures. Cardiac injuries are less frequent and vascular injuries less so. Mechanism of injury and presence of sternal fractures should alert providers to these potential associated injuries.

  18. US of acute scrotal trauma: optimal technique, imaging findings, and management.

    Science.gov (United States)

    Deurdulian, Corinne; Mittelstaedt, Carol A; Chong, Wui K; Fielding, Julia R

    2007-01-01

    The primary causes of scrotal trauma are blunt, penetrating, degloving, and electrical burn injuries to scrotal contents. Knowledge of the scrotal anatomy and appropriate imaging techniques are key for accurate evaluation of scrotal injuries. Ultrasonography (US) is the first-line imaging modality to help guide therapy for scrotal trauma, except in degloving injury, which results in scrotal skin avulsion. Blunt injury (eg, from an athletic accident or motor vehicle collision) is the most common cause of scrotal trauma, followed by penetrating injury from gunshot or other assault. Trauma often may result in hematoma, hydrocele, hematocele, testicular fracture, or testicular rupture. The timely diagnosis of rupture, based on a US finding of discontinuity of the echogenic tunica albuginea, is critical because emergent surgery results in salvage of the testis in 80%-90% of rupture cases. The radiologist should be familiar also with other nuances associated with penetrating trauma, iatrogenic and postoperative complications, and electrical injury. Color flow and duplex Doppler imaging are highly useful techniques not only for assessing testicular viability and perfusion but also for evaluating associated vascular injuries such as pseudoaneurysms. A thorough familiarity with the US findings of scrotal trauma helps facilitate appropriate management. Supplemental material available at radiographics.rsnajnls.org/cgi/content/full/27/2/357/DC1.

  19. Spontaneous Rupture of Splenic Hemangioma in a Neonate

    Science.gov (United States)

    Martinez-Leo, Bruno; Vidal-Medina, Jorge; Cervantes-Ledezma, Jesús; Díaz De León-Rivera, Arid; Díaz-Velasco, Edith

    2016-01-01

    Spleen vascular tumors such as hemangiomas, albeit rare, can present during neonatal period with unexplained circulatory shock. We present a case of a newborn with refractory hypovolemic shock and acute abdomen that underwent emergency splenectomy due to spontaneous rupture of a splenic hemangioma. PMID:27433454

  20. Spontaneous Rupture of Splenic Hemangioma in a Neonate

    Directory of Open Access Journals (Sweden)

    Bruno Martinez-Leo

    2016-07-01

    Full Text Available Spleen vascular tumors such as hemangiomas, albeit rare, can present during neonatal period with unexplained circulatory shock. We present a case of a newborn with refractory hypovolemic shock and acute abdomen that underwent emergency splenectomy due to spontaneous rupture of a splenic hemangioma.