Pediatric Thoraco-Abdominal Trauma

2020 ◽  
pp. 405-409
Author(s):  
Christopher S. Amato
Keyword(s):  
Abdominal Trauma ◽  
Thoracic Trauma ◽  
Pediatric Trauma ◽  
Medical Personnel ◽  
Abdominal Injury ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Common Cause ◽  
Thoracic And Abdominal ◽  
Trauma Deaths

In children, injury is the most common cause of death. Thoracic and abdominal trauma are both associated with high morbidity and mortality, and they warrant a thorough evaluation. Abdominal trauma occurs in 25% of children with major trauma and is responsible for 9% of all trauma deaths. Because it can delay care, lack of recognition of intra-abdominal injury increases morbidity and mortality. Thoracic trauma comprises only 4–6% of pediatric trauma but is related to 14% of pediatric trauma-related deaths and is the second most common cause of mortality in pediatric trauma. This chapter discusses the keys to the evaluation of the pediatric trauma patient with thoraco-abdominal injury, including the evidence-based approach and algorithms to be utilized by medical personnel.

scholarly journals CLINICAL STUDY AND MANAGEMENT OF PERITONITIS SECONDARY TO PERFORATED PEPTIC ULCER

2020 ◽  
pp. 1-4
Author(s):  
Sanjay Kumar Suman ◽  
Mukesh Kumar ◽  
Pawan Kumar Jha ◽  
Debarshi Jana
Keyword(s):  
Peptic Ulcer ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Perforated Peptic Ulcer ◽  
Morbidity And Mortality ◽  
Duodenal Perforation ◽  
High Morbidity ◽  
Peptic Ulcer Perforation ◽  
Common Cause ◽  
Ulcer Perforation

Background: Perforated peptic ulcer is the most common cause among all causes of gastrointestinal tract perforationwhich is an emergency condition of the abdomen that requires early recognition and timely surgical management. Peptic ulcer perforation is associated significant morbidity and mortality. The aim of study is to evaluate the incidence, clinical presentation, management and outcomes of the patient with peptic ulcer perforation undergoing emergency laparotomy. Methods: This retrospective study includes 45 patients who were operated for perforated peptic ulcer peritonitis atDepartment of Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar from October 2018 to March 2020. Paediatricpatients of age less than 14 years, patients presenting as recurrent perforation were excluded from the study. A detailed history, clinical presentation and routine investigations were done in all cases. Results: In the present study, most of the patients were male. Most of these patients presents with clinical signs ofperitonitis between 24-48 hours after onset of the pain. Among the patients of peptic ulcer perforation, duodenal perforation (93.3%) is more common and which is the most common cause of perforation peritonitis. The diagnosis is made clinically and confirmed by presence of gas under diaphragm on radiograph. Exploratory laparotomy with simple closure of perforation with omental patch was done in all cases. The most common post-operative complication was wound infection (57.5%). The overall mortality was 11.1%. Conclusions: Late presentation of peptic ulcer perforation is common with high morbidity and mortality. Surgicalintervention with Graham’s omentopexy with broad spectrum antibiotics is still commonly practiced.

scholarly journals Clinical study and management of peritonitis secondary to perforated peptic ulcer

2017 ◽  
Vol 4 (8) ◽  
pp. 2721
Author(s):  
Dushyant Kumar Rohit ◽  
R. S. Verma ◽  
Grishmraj Pandey
Keyword(s):  
Peptic Ulcer ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Perforated Peptic Ulcer ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Peptic Ulcer Perforation ◽  
Common Cause ◽  
Ulcer Perforation ◽  
Tract Perforation

Background: Perforated peptic ulcer is the most common cause among all causes of gastrointestinal tract perforation which is an emergency condition of the abdomen that requires early recognition and timely surgical management. Peptic ulcer perforation is associated significant morbidity and mortality. The aim of study is to evaluate the incidence, clinical presentation, management and outcomes of the patient with peptic ulcer perforation undergoing emergency laparotomy.Methods: This retrospective study includes 45 patients who were operated for perforated peptic ulcer peritonitis at Bundelkhand Medical College and Associated Hospital, Sagar from March 2015 to April 2017. Paediatric patients of age less than 14 years, patients presenting as recurrent perforation were excluded from the study. A detailed history, clinical presentation and routine investigations were done in all cases.Results: In the present study, most of the patients were male. Most of these patients presents with clinical signs of peritonitis between 24-48 hours after onset of the pain. Among the patients of peptic ulcer perforation, duodenal perforation (93.3%) is more common and which is the most common cause of perforation peritonitis. The diagnosis is made clinically and confirmed by presence of gas under diaphragm on radiograph. Exploratory laparotomy with simple closure of perforation with omental patch was done in all cases. The most common post-operative complication was wound infection (57.5%). The overall mortality was 11.1%.Conclusions: Late presentation of peptic ulcer perforation is common with high morbidity and mortality. Surgical intervention with Graham’s omentopexy with broad spectrum antibiotics is still commonly practiced.

Abdominal Trauma and Complications

2019 ◽  
Author(s):  
Alia Aunchman ◽  
Ajai K Malhotra
Keyword(s):  
Abdominal Trauma ◽  
Damage Control ◽  
Abdominal Injury ◽  
Morbidity And Mortality ◽  
Lower Grade ◽  
Solid Organ ◽  
Abdominal Injuries ◽  
Hollow Viscus ◽  
Contrast Enhanced Ct ◽  
Operative Exploration

The abdomen, including pelvis, is injured in 10 to 15% of significantly injured patients: 80% by blunt and 20% by penetrating mechanisms. Abdominal injuries can be subtle and hence missed. The majority of injuries, if detected early, can be treated, and hence, delay in diagnosis or underappreciation of the severity of intra-abdominal injury is responsible for significant preventable morbidity and even mortality. The initial management is the same as any trauma patient, with the greatest threats to life addressed first. If the patient is in shock and the source is intra-abdominal, urgent laparotomy is indicated along with damage control resuscitation. If the patient remains in shock in the operating room, abbreviated damage control laparotomy should be pursued. In stable patients with penetrating mechanism, if the penetration extends into the peritoneal cavity, operative exploration to identify and address any injury is the safest approach; however, more selective approaches are increasingly being pursued. In stable patients with blunt mechanism, a thorough evaluation, usually including IV contrast-enhanced CT (CECT) is pursued to diagnose, and equally importantly, exclude intra-abdominal injury. High-quality IV CECT has a very high negative predictive value for intra-abdominal injuries. In stable patients, injuries to spleen, liver, and kidney, irrespective of grade, are managed nonoperatively with or without angioembolization. Lower-grade pancreatic injuries are managed nonoperatively or with drainage, whereas higher-grade injuries (involving major ducts) usually require resection. Majority of gastrointestinal hollow viscus injuries are managed with repair, resection with anastomosis or diversion. Delays as short as 8 hours in definitive management of such injuries increase morbidity and mortality. Intra and retro peritoneal genitourinary injuries are repaired and extraperitoneal ones are managed without surgery. Retroperitoneal hematomas are managed based on mechanism, stability, and location. Abdominal trauma is associated with a host of complications that need to be detected early and managed appropriately to prevent delayed morbidity and mortality. This review contains 5 figures, 6 tables, and 60 references. Key Words: abdomen, complications, damage control, diaphragm, hollow viscus, trauma, solid organ, retroperitoneum

Down a Slippery Slope

2020 ◽  
pp. 41-48
Author(s):  
Jennifer E. Melvin
Keyword(s):  
Thoracic Trauma ◽  
Chest Trauma ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Tracheobronchial Tree ◽  
Pulmonary Contusion ◽  
Common Cause ◽  
Isolated Injury ◽  
Clinically Significant ◽  
Sternal Fractures

Trauma is the most common cause of morbidity and mortality in the pediatric population. Although chest trauma represents less than 10% of all pediatric traumas, it accounts for 14% of all pediatric trauma-related deaths. Thoracic trauma includes injuries to the chest wall, lungs, heart, tracheobronchial tree, diaphragm, and aorta. The most common injuries include pneumothorax, hemothorax, pulmonary contusion, and rib fractures. Sternal fractures occur less commonly and may be seen in cases of isolated or severe chest trauma. Although chest trauma may result from a direct force and therefore result in an isolated injury, when present, it is most often secondary to an extreme mechanism and associated with other clinically significant injuries.

Pancreatic Trauma

2019 ◽  
Author(s):  
James C. Becker ◽  
Brian C. Beldowicz ◽  
Gregory J. Jurkovich
Keyword(s):  
Pediatric Trauma ◽  
Pancreatic Injury ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Rare Occurrence ◽  
Pancreatic Trauma ◽  
Spleen Preserving ◽  
Pancreatic Injuries ◽  
Trauma Injury

Pancreatic injury continues to present challenges to the trauma surgeon. The relatively rare occurrence of these injuries (0.2–12% of abdominal trauma), the difficulty in making a timely diagnosis, and high morbidity and mortality rates following complications justify the anxiety these unforgiving injuries invoke 1-3. Mortality rates for pancreatic trauma range from 9 to 34%, with a mean rate of 19%. Complications following pancreatic injuries are alarmingly frequent, occurring in 30 to 60% of patients 4. Nonetheless, if recognized early, the treatment of most pancreatic injuries is straightforward, with low morbidity and mortality. This review contains 10 figures, 2 tables, and 65 references. Key Words : Pancreatic trauma, injury, pediatric trauma, ERCP, MRCP, spleen-preserving pancreatectomy

scholarly journals A retrospective study of blunt trauma abdomen in a tertiary center in central India: evaluation, management and outcome

2020 ◽  
Vol 7 (8) ◽  
pp. 2696
Author(s):  
Sanjay Sisodiya ◽  
Prateek Malpani
Keyword(s):  
Retrospective Study ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Early Recognition ◽  
Imaging Techniques ◽  
Abdominal Injury ◽  
High Morbidity ◽  
Tertiary Center

Background: Blunt abdominal trauma is fairly common emergency and it is one of the important components of polytrauma. It requires high degree of suspicion, investigation and management. Inspite of improved imaging techniques leading to early recognition it is still associated with high morbidity and mortality. Trauma is the leading cause of blunt abdominal injury. This aim of the study was to find etiology, early diagnosis and management of patients with blunt abdominal trauma.Methods: This a retrospective study conducted in Gandhi medical college, Bhopal in which 90 cases of blunt abdominal trauma presented to emergency and outpatient department were included in the study duration of January 2019 to December 2019.Results: Motor vehicle accident was the most common mode of injury. Liver being the most common visceral organ injured while the most common surgery performed was the repair or resection and anastomosis of hollow viscous perforation. Rib fracture was the most common extra abdominal injury seen in 17.7% cases. Mortality rate was 5.5%. Most of the liver, spleen and renal injuries can be managed non-operatively whereas hollow viscous injury needs laparotomy.Conclusions: The result of present study is similar to other studies. Rapid diagnosis, early and timely referral, adequate and trained staff, close and careful monitoring, early wise and skilled decision to go for operative or non-operative management can help save many lives.

Field triage of children with abdominal trauma

Trauma ◽  
2020 ◽  
pp. 146040862093352
Author(s):  
Seth W Linakis ◽  
Julia K Lloyd ◽  
David Kline ◽  
James F Holmes ◽  
Rachel M Stanley ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Abdominal Trauma ◽  
Trauma Center ◽  
Thoracic Trauma ◽  
Abdominal Injury ◽  
Research Network ◽  
Abdominal Tenderness ◽  
Peritoneal Irritation ◽  
Breath Sounds ◽  
Field Triage

Objective Identify physical findings in children with abdominal trauma to inform prehospital providers regarding appropriate hospital destinations. Methods This is a secondary analysis of the Pediatric Emergency Care Applied Research Network Abdominal Trauma Public Use Dataset. Children involved in motor vehicle collisions; struck by motor vehicles at >20 mph; involved in all-terrain vehicle, motorcycle, or scooter accidents; or who fell from >10 ft ( n = 5575) were included. Stepwise multivariable multinomial logistic regression was used to compare clinical findings at presentation between children with no intra-abdominal injury, intra-abdominal injury without intervention, and intra-abdominal injury with intervention (laparoscopy/laparotomy, embolization, red blood cell transfusion, or admission >48 h on intravenous fluids). Results Compared to children with no intra-abdominal injury, children with intra-abdominal injury (with and without intervention) were more likely to have evidence of abdominal wall trauma, abdominal tenderness, peritoneal irritation, decreased breath sounds, distracting painful injury, and evidence of thoracic trauma. Children with intra-abdominal injury requiring intervention were more likely to have evidence of abdominal wall trauma (OR 3.32, 95% CI 2.03–5.44) and be intubated (OR 4.93, 95% CI 3.17–7.65) when compared to children with intra-abdominal injury without intervention. Conclusions The findings of abdominal tenderness, peritoneal irritation, decreased breath sounds, distracting painful injury, and thoracic trauma may be used to identify children who warrant evaluation at any trauma center because of increased risk of intra-abdominal injury, whereas intubation and evidence of abdominal wall trauma help identify children with intra-abdominal injury in need of transport to a pediatric trauma center due to risk of undergoing intervention.

Is FAST  Too FAST?

2020 ◽  
pp. 75-80
Author(s):  
Laurie Malia ◽  
Joni E. Rabiner
Keyword(s):  
Emergency Department ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Point Of Care ◽  
Pediatric Trauma ◽  
Abdominal Injury ◽  
Reliable Information ◽  
Highly Sensitive ◽  
Fast Exam

Blunt abdominal trauma is common in pediatric trauma. This chapter discusses a child who presents to the emergency department with left upper quadrant pain after being struck by a motor vehicle. The point-of-care focused assessment with sonography for trauma (FAST) examination provides quick, reliable information on bleeding into the peritoneal, pericardial, and pleural spaces in the setting of trauma. The FAST exam is highly sensitive for identification of hemoperitoneum but is less accurate for ruling out hemoperitoneum and intra-abdominal injury. Discussion of the trauma evaluation and utility of the FAST examination in the context of pediatric blunt abdominal trauma is presented.

Royal Naval Physician Sir John Jamison (1776-1844), Scurvy and Sweden's Medico-Surgical Institute

2002 ◽  
Vol 88 (3) ◽  
pp. 116-126
Author(s):  
Julius Rocca ◽  
Carl-Magnus Stolt
Keyword(s):  
Direct Consequence ◽  
Medical Personnel ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Karolinska Institute ◽  
Napoleonic Era ◽  
The Baltic

AbstractAs a direct consequence of Sweden’s devastating losses in its war with Russia in 1808-9, an institute for the training of military surgeons was established in Stockholm in December 1810. This establishment soon became known as the Karolinska Institute and is the forerunner of today’s eponymous institution. This paper records the nature of the British assistance that led indirectly to the founding of this institute. This aid took the form of a report into the high morbidity and mortality rates due to scurvy which were sustained by the Swedish Fleet in Carlscrona in the summer of 1808. This report, written by John Jamison, Fleet Physician to the Baltic Command of Sir James Saumarez, was used by the Stockholm medical authorities as part of their campaign for improved training of military medical personnel. Whilst Jamison’s report did not in itself lead to the establishment of the Stockholm medico-surgical institute, it was undoubtedly important, and serves both as an example of Anglo-Swedish relations during the Napoleonic era and a reminder of the ravages of scurvy.

Management of oesophageal anastomosis dehiscence after oesophagectomy for oesophageal cancer

2020 ◽  
Vol 99 (5) ◽  
pp. 200-206
Keyword(s):  
Oesophageal Cancer ◽  
Surgical Procedure ◽  
Anastomotic Dehiscence ◽  
Gastric Conduit ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Therapeutic Algorithm

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

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