scholarly journals Laparoscopic Bullet Removal in a Penetrating Abdominal Gunshot

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Christos Stefanou ◽  
Nicolaos Zikos ◽  
George Pappas-Gogos ◽  
Spyridon Koulas ◽  
Ioannis Tsimoyiannis
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Exploratory Laparotomy ◽  
Stable Patient ◽  
Imaging Studies ◽  
Abdominal Injuries ◽  
Penetrating Abdominal Trauma ◽  
Entry Wound ◽  
Accepted Practice ◽  
Lower Abdominal Wall

Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. We report a case of a lower anterior abdominal gunshot patient treated laparoscopically. A 32-year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall. The patient had no symptoms or obvious bleeding and was vitally stable. On examination we identified 1 cm diameter entry wound at the left lower abdominal wall. The imaging studies showed the bullet in the peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera. We decided to remove the bullet laparoscopically. Twenty-four hours after the intervention the patient was discharged. The decision for managing gunshot patients should be based on clinical and diagnostic findings. Anterior abdominal injuries in a stable patient without other health problems can be managed laparoscopically.

scholarly journals Defunctioning loop ileostomy: not always a safe option

2011 ◽  
Vol 93 (6) ◽  
pp. e74-e76
Author(s):  
Philip T Davey ◽  
Nathan Burnside ◽  
Niall MacKenzie ◽  
David Conkey ◽  
James Carson ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Wall ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Skin Necrosis ◽  
Anterior Abdominal Wall ◽  
Loop Ileostomy ◽  
Rectal Adenocarcinoma ◽  
Extensive Area ◽  
Lower Abdominal Wall

A 74-year-old woman underwent a low anterior resection and defunctioning loop ileostomy for a T1 N1 M0 rectal adenocarcinoma. Three months following surgery she attended complaining of pain inferior to the loop ileostomy. A clinical examination demonstrated an extensive area of spreading cellulitis on the lower abdominal wall inferior to the loop ileostomy with associated crepitus and skin necrosis. The clinical diagnosis of necrotising fasciitis was confirmed radiologically on emergency computed tomography. The patient underwent an emergency debridement of the anterior abdominal wall.

scholarly journals Survival abdominal gunshot injury: a rare case

2018 ◽  
Vol 5 (5) ◽  
pp. 1935
Author(s):  
Ashok S. Gajbhiye ◽  
M. N. Deshmukh ◽  
Parag Jaipuriya ◽  
Parag Jaipuriya ◽  
P. Mehata ◽  
...  
Keyword(s):  
Foreign Body ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Exploratory Laparotomy ◽  
Abdominal Radiograph ◽  
Jejunal Segment ◽  
Firearm Injury ◽  
Single Entry ◽  
Restricted Use ◽  
Operative Recovery

A 55 years old male patient came to the casualty of a medical college and hospital with alleged history of assault with firearm injury on his back. Patient was conscious with GCS 15/15, his pulse rate was 133 beats per min, blood pressure was 100/60 mmHg, SpO2 was 95% and pallor was present. On local examination there was single entry wound at lower back on left side of size 1 cm X 1 cm with no exit wound. Generalized abdominal tenderness and guarding was present. Patient was immediately resuscitated. Blood grouping, cross match were sent immediately. Abdominal radiograph did not show any gas under the diaphragm but a foreign body (a bullet) was seen. Ultrasonography and computerized tomography scan of the abdomen was suggestive of hemoperitonium and a foreign body bullet in abdomen. Exploratory laparotomy showed moderate hemoperitonium of about 1000 ml which was sucked out completely. Evidence of retroperitoneal rent of size approximately 1 cm X 1 cm seen with oozing through it which was closed in layers. A bullet was seen in the anterior abdominal wall but skin was intact. Five jejunal perforations distal to 20 cm from the duodenojejunal flexure were seen and the bullet was removed from the anterior abdominal wall.  Resection of the jejunal segment with jejuno-jejunal anastomosis was done. Jejunal mesenteric rents were closed. Abdominal wall closed in layers. Post-operative recovery was uneventful. Patient was discharged on the 10th post-operative day. Early diagnosis and treatment in the golden hours can save the life of the patients. A mass education on the dangers of these guns and the harm they can cause as well as legal regulations for their restricted use seem to be necessary.

scholarly journals Skull bone flap preserved in anterior abdominal wall medicolegal aspects (a case report)

2019 ◽  
Vol 1 ◽  
pp. 43-45
Author(s):  
Parmod Kumar Goyal ◽  
Monika Gupta
Keyword(s):  
Case Report ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Great Difficulty ◽  
Bone Flap ◽  
Skull Bone ◽  
Abdominal Injuries ◽  
Neurosurgical Procedure ◽  
Medicolegal Aspects ◽  
The Family

A case of roadside accident in which neurosurgeon preserved the skull bone flap in abdominal layers during operation but the facts not explained to family considering it to be a routine neurosurgical procedure. Autopsy surgeon was unaware of such practice and casually informed family about operation on abdomen in spite of the absence of any abdominal injuries, which created hue and cry. With great difficulty finally, the family could be satisfied about the approved procedure. The importance of communicating to the family is stressed on although everything was meticulously documented in the hospital file.

Laparotomy Due to War-Related Penetrating Abdominal Trauma in Civilians: Experience From Syria 2011-2017

2020 ◽  
pp. 1-9
Author(s):  
Bayan Alsaid ◽  
Maryam Alhimyar ◽  
Ahmad Alnweilaty ◽  
Ehab Alhasan ◽  
Zein Al Abidin Shalhoum ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Penetrating Trauma ◽  
Exploratory Laparotomy ◽  
Abdominal Injuries ◽  
Penetrating Abdominal Trauma ◽  
Abdominal Organs ◽  
Negative Laparotomy ◽  
Organ Systems ◽  
Multiple Injured ◽  
The Impact

ABSTRACT Objectives: Penetrating abdominal trauma is one of the injuries that could affect civilians in wartime. This retrospective study investigates the commonly injured abdominal organs, and the impact of multiple injured organs on mortality. Methods: We reviewed the operating room (OR) logs of patients who presented to the surgical emergency department (SED) at Al-Mouwasat University Hospital with war-related abdominal penetrating trauma requiring exploratory laparotomy between April 1, 2011 and December 31, 2017. Results: Of 7826 patients with traumatic injuries, 898 patients (11.5%) required exploratory laparotomy. Of all patients who had an exploratory laparotomy (n = 898), 58 patients (6.5%) died in the perioperative period. Regarding complete laparotomies (n = 873 patients), small intestines, large intestines, and liver were the most commonly affected organs (36.4%, 33%, 22.9%, respectively). A total of 92 patients (10.2%) had negative laparotomy in which all the abdominal organs were not injured. The perioperative mortality rate (POMR) increased when more organs/organ systems were injured per patient reaching a peak at 3 organs/organ systems injuries with a POMR of 8.3%. POMR was highest in patients with musculoskeletal injuries (18.2%), followed by vascular injuries (11.8%), and liver injuries (7%). Conclusions: The management of civilians’ abdominal injuries remains a challenge for general and trauma surgeons, especially the civilian trauma team. The number and type of injured organs and their correlation with mortality should be considered during surgical management of penetrating abdominal injuries.

Determination of clinical efficiency of deproteinized dialysate from blood of milk-fed calves after endoprosthetics in patients with ventral hernias

2020 ◽  
Vol 28 (3) ◽  
pp. 323-333
Author(s):  
Sergej V. Ivanov ◽  
Ilya S. Ivanov ◽  
Evgenij G. Obyedkov ◽  
Liliya P. Popova
Keyword(s):  
Abdominal Wall ◽  
Inflammatory Reaction ◽  
Inflammatory Process ◽  
Anterior Abdominal Wall ◽  
Dynamic Change ◽  
Main Group ◽  
Control Group ◽  
Surgical Department ◽  
Regeneration Stage

Aim. To study the influence of deproteinized dialysate from blood of milk-fed calves on the type of exudative discharge and dynamics of inflammatory reaction after hernia repair with plastics of the anterior abdominal wall with hernioendoprosthesis of polypropylene. Materials and Methods. The study involved 59 patients being on stationary treatment in the surgical department of Kursk Regional Clinical Hospital. Patients were hospitalized for the herniation of small or medium dimension. The patients were divided to two groups: the main (n=30) and control (n=29) groups. After endoprosthetics, the patients of the control group were given complex conservative treatment. The patients of the main group, besides standard treatment, were administered deproteinized dialysate from blood of milk-fed calves intravenously in drips 10 ml + 200 ml of 0.9% sodium chloride solution within 7 days. For cytological examination and determination of the type of cytograms, the traumatic discharge was collected and analyzed using the method of M.F. Kamaev and M.A. Palthsev. Results. Cytomorphometric examination was conducted on the third, fifth and seventh day after endoprosthetics with the aim of studying dynamic changes. Determination of cell composition and also of its changes characteristic of each studied period, was necessary for obtaining further information characterizing inflammatory process in the region of placement of the endoprosthesis. After endoprosthetics in patients who were administered hemodialysate, the inflammatory reaction was less pronounced than in patients who did not receive the preparation. This was associated with a more dynamic change of stages of the inflammatory process. In patients of the main group who received deproteinized dialysate, regenerative type of inflammation first appeared on the fifth day and made 6.9%; by the seventh day the share of patients with the regenerative type rose to 17.5%, while in the patients of the control group no regeneration stage was observed in both periods. Conclusion. Analysis of the efficiency of influence of hemodialysate on the inflammatory reaction in plastics of the anterior abdominal wall with polypropylene endoprosthesis evidences faster course of all stages of inflammation and reduction of its intensity by 10%.

scholarly journals Epithelioid trophoblastic tumor coexisting with choriocarcinoma around an abdominal wall cesarean scar: a case report and review of the literature

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Chunfeng Yang ◽  
Jianqi Li ◽  
Yuanyuan Zhang ◽  
Hanzhen Xiong ◽  
Xiujie Sheng
Keyword(s):  
Abdominal Wall ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Unknown Origin ◽  
Exploratory Laparotomy ◽  
Cesarean Scar ◽  
Trophoblastic Tumor ◽  
Epithelioid Trophoblastic Tumor ◽  
Trophoblastic Tumors ◽  
Wall Lesion

Abstract Background Mixed gestational trophoblastic neoplasms are extremely rare and comprise a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors, and placental site trophoblastic tumors. We present a case of a patient with extrauterine mixed gestational trophoblastic neoplasm adjacent to the abdominal wall cesarean scar. On the basis of a literature review, this type of case has never been reported before due to the unique lesion location and low incidence. Case presentation Our patient was a 39-year-old Chinese woman who had a history of two cesarean sections and one miscarriage. She had a recurrent anterior abdominal wall mass around her cesarean scar, and the mass was initially suspected of being choriocarcinoma of unknown origin. The patient had concomitant negative or mildly increased serum β-human chorionic gonadotropin at follow-up and no abnormal vaginal bleeding or abdominal pain. However, she underwent local excision twice and had two courses of chemotherapy with an etoposide and cisplatin regimen. She finally opted for exploratory laparotomy with abdominal wall lesion removal, subtotal hysterectomy, bilateral salpingectomy, and left ovarian cyst resection, which showed the abdominal wall lesion, whose components were revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors and 10% choriocarcinomas from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar. Conclusions It is worth noting whether epithelioid trophoblastic tumor exists in the setting of persistent positive low-level β-human chorionic gonadotropin. More studies are required to provide mechanistic insights into these mixed gestational trophoblastic neoplasms.

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