Chyloperitoneum after Blunt Abdominal Injury

The objective of this study was to evaluate incidence of chylous injury in blunt trauma using a retrospective chart review. We present two patients who sustained chyle duct injury after blunt trauma. The first patient is a pedestrian struck by car. Abdominal CT scan revealed duodenal thickening and a moderate amount of paraduodenal fluid, which prompted surgical exploration. At laparotomy, the patient was found to have a disruption of his lymphatics at the level of the inferior vena cava (IVC) without duodenal injury treated with hemoclips, fibrin sealant and elemental gastrojejunal feeds. The second patient was involved in a high speed motor vehicle collision (MVC) resulting in transection of the mesentery of the transverse colon. Disrupted lacteals were treated intra-operatively with hemoclips and fibrin sealant decreasing the lymph leak. In both cases, the leak completely resolved with use of tube feedings with medium chain triglycerides. On literature review, six prior patients with spontaneous chylous retroperitoneum were described undergoing similar operative management. Chylous leakage due to blunt trauma is a rare finding. Mechanism of injury includes hyperextension or flexion resulting in stretching and shearing of the tethered lymphatics. Open ligation or clipping of the injured ducts seems effective. Tube feeds with medium chain triglycerides may enhance efficacy of operative treatment.

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MRI as an Adjunct to Cervical Spine Clearance: A Utility Analysis

The American Surgeon ◽

10.1177/000313481207800710 ◽

2012 ◽

Vol 78 (7) ◽

pp. 741-744 ◽

Cited By ~ 12

Author(s):

Michael C. Soult ◽

Leonard J. Weireter ◽

Rebecca C. Britt ◽

Jay N. Collins ◽

Timothy J. Novosel ◽

...

Keyword(s):

Cervical Spine ◽

Physical Examination ◽

Blunt Trauma ◽

Motor Vehicle ◽

Retrospective Chart Review ◽

Persistent Pain ◽

Acute Injury ◽

Trauma Patients ◽

Magnetic Resonance Imaging Mri ◽

Motorcycle Crashes

Cervical spine (CS) injury occurs in 1 to 3 per cent of blunt trauma patients. The goal of this study is to evaluate the use of magnetic resonance imaging (MRI) as an adjunct to CS computed tomography (CT) in the presence of persistent pain with a normal physical examination or obtundation. A retrospective chart review was performed on 389 blunt trauma patients undergoing both CS CT and MRI between 2007 and 2010. Abnormal CT findings were found in 199. The remaining 190 patients with normal CT scans underwent MRI for persistent pain (109), neurologic symptoms (57), or obtundation (24). Motor vehicle crashes predominated (50%) followed by falls (19%) and motorcycle crashes (12%). In the patients with persistent pain, CT showed no acute injury (89%) with subsequent MRI demonstrating ligamentous edema or injury not seen on CT in 12 per cent of patients. No patient required an operation for CS instability. All the obtunded patients demonstrated localizing motion of four extremities. MRI of these patients demonstrated ligamentous edema or injury not seen on CT in 20 per cent of patients. No obtunded patient had CS instability or needed operative intervention. A localizing physical examination in conjunction with normal CS CT safely precludes a CS injury requiring cervical fixation. MRI does not add substantially to this decision-making and the cervical collar can be safely removed.

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Isolated Chyle Duct Injury in Blunt Trauma

The American Surgeon ◽

10.1177/000313480607200203 ◽

2006 ◽

Vol 72 (2) ◽

pp. 116-117

Author(s):

Sharmila Dissanaike ◽

John A. Griswold ◽

Ari Halldorsson ◽

Eldo E. Frezza

Keyword(s):

Blunt Trauma ◽

High Speed ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Chyle Leak ◽

Cisterna Chyli ◽

Vehicle Accident ◽

Isolated Injury ◽

The Right ◽

Gallbladder Fossa

We present a case of a patient sustaining an isolated injury to the right main branch of the cysterna chyli due to a high-speed motor vehicle accident. A 42-year-old man presented after a high-speed collision. CT revealed a collection of hypodense fluid in the gallbladder fossa, which was the clue to take him to the OR. We proceeded to laparoscopic exploration, and based on the milky white color of the fluid, identified a chyle leak. In an open fashion, the retroperitoneum was explored and the injury was identified as disruption of the right lumbar branch entering the cisterna chyli, and this was ligated with silk ties. Chyle duct injury secondary to blunt trauma is a rare finding. The use of CT imaging can identify this injury. Laparoscopy can confirm the injury. Open ligation of the injured duct is the best treatment.

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Atypical profile of aortic injury associated with blunt trauma in the metropolitan area of Japan

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000342 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000342

Author(s):

Shusuke Mori ◽

Tomohiko Ai ◽

Yasuhiro Otomo

Keyword(s):

Blunt Trauma ◽

Metropolitan Area ◽

High Speed ◽

Motor Vehicle ◽

Type A ◽

Aortic Injury ◽

University Hospital ◽

Type B ◽

Aortic Injuries ◽

Aortic Dissections

BackgroundAortic injury caused by blunt trauma is a critical medical condition that requires extraordinary caution in the treatment. It is often caused by direct hit and high-speed deceleration in motor vehicle accidents. We reviewed and analysed the cases of aortic injury that referred to our institution located in the midst of the metropolitan area of Tokyo, Japan.MethodsWe retrospectively reviewed the blunt trauma cases transferred to Tokyo Medical and Dental University Hospital in the past 10 years. All cases with aortic injury were analyzed regardless of the AIS scores. Results: Between 2007 and 2017, a total of 3500 blunt trauma cases were transferred. Nineteen cases showed aortic injuries associated with blunt trauma (Age: 63.5±15.6 y.o.; 15 males). Thirteen patients were injured by fall, four patients were senior pedestrians hit by cars, one was injured while riding a motor bike, and one was hit by a train. A total of 11 cases presented a cardiopulmonary arrest on arrival; 8 severe aortic injuries, 1 cardiac rupture; and 2 multiple injuries. Eight cases were alive on arrival; 3 Stanford type A aortic dissections, 3 Stanford type B aortic dissections, and 2 aortic ruptures. Two cases of Stanford type A dissection underwent emergency repairs, whereas all 3 type B dissections went on a good course with conservative treatment.ConclusionsAortic injury caused by blunt trauma seems to be rare in a metropolitan area in Japan. In addition, the leading cause in our cases was fall, which might be a rare cause of aortic injuries in the other countries. Our observation might be a manifestation of population aging.

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) enables operative management of the peripartum trauma patient in hemorrhagic shock

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i1.78 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Kelvin Allenson ◽

Laura Moore

Keyword(s):

Maternal Death ◽

Motor Vehicle ◽

Operative Management ◽

Balloon Occlusion ◽

Motor Vehicle Accidents ◽

Gravid Uterus ◽

Intrauterine Pregnancy ◽

Vehicle Accidents ◽

Pelvic Hemorrhage ◽

Endovascular Balloon Occlusion

Trauma related injury is the leading cause of non-obstetric maternal death. The gravid uterus is at risk for injury, particularly during motor vehicle accidents. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a means of controlling pelvic hemorrhage in the setting of trauma. We report the use of REBOA in a hemodynamically unstable, multiply-injured young woman with viable intrauterine pregnancy.

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