Be careful of splenic rupture caused by hit by a pitch during a baseball game: a case report

Abstract Background To the best of our knowledge, splenic rupture caused by hit by a pitch (HBP) has not been previously reported. We present a patient who underwent emergency laparotomy for splenic rupture after being HBP during a baseball game. Case presentation A 41-year-old male was HBP in the left abdomen during his first at-bat during a baseball game. During the operation, vascular injury of the splenic hilum and a deeply extending parenchymal injury were observed, and splenectomy was performed. Histologic findings were consistent with splenic rupture. Conclusions The patient’s postoperative course was uneventful. Although extremely rare, the possibility of intra-abdominal organ injury should be considered in batters who are hit in the abdomen by a pitched baseball, as illustrated by our patient.

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A profile of 96 cases of penetrating injury of abdomen

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172975 ◽

2017 ◽

Vol 5 (7) ◽

pp. 2993

Author(s):

Chatragadda Ramya ◽

Kasula Jayasree

Keyword(s):

Penetrating Trauma ◽

Hemodynamic Instability ◽

Penetrating Injury ◽

Organ Injury ◽

Emergency Laparotomy ◽

Healthy Population ◽

Abdominal Organ ◽

Major Health Problem ◽

Radiological Criteria ◽

Generalized Peritonitis

Background: Trauma is a major health problem. Among various modes of trauma, penetrating trauma necessitates for immediate surgical intervention in most of the cases. Most commonly penetrating injuries in civilian group involves younger healthy population, who most productive and are very much responsible for the progress of the society and the country.Methods: This is a prospective study of 96 cases of penetrating injury to abdomen admitted to Gandhi Hospital, Secunderabad during the period August 2011 to September 2013. All the patients with history of penetrating abdominal trauma requiring admission during the study period are included in this study. All cases were evaluated for abdominal organ injury due to penetrating trauma by clinical and radiological criteria all cases were evaluated for abdominal organ injury due to stab. All the patients with peritoneal, evisceration, signs of peritonitis, shock underwent laparotomy.Results: 81 cases (84.3%) had significant abdominal injury requiring laparotomy. The criteria for laparotomy were evisceration (20.8%), shock (8.3%) and peritonitis (50%). Mere peritoneal penetration (83%) is a poor indicator of emergency laparotomy in stab injury. Erect X-ray abdomen is an unreliable criterion for laparotomy in presence of other signs.Conclusions: Majority of the patients required operative intervention particularly those with hemodynamic instability, generalized peritonitis, evisceration of omentum and bowel, and continuing haemorrhage. Peritoneal penetration as such is a poor indication of significant organ injury; hence it requires direct organ specific evaluation, such as computed tomography or laparoscopy to identify patients who can be safely treated without operations.

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Faecopneumothorax due to missing diaphragmatic hernia: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02606-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Resul Nusretoğlu ◽

Yunus Dönder

Keyword(s):

Computed Tomography ◽

Diaphragmatic Hernia ◽

Colon Resection ◽

Emergency Laparotomy ◽

Hernia Sac ◽

Case Presentation ◽

Abdominal Tenderness ◽

History Of ◽

Diaphragmatic Hernias ◽

Tomography Scan

Abstract Background Diaphragmatic hernias may occur as either congenital or acquired. The most important cause of acquired diaphragmatic hernias is trauma, and the trauma can be due to blunt or penetrating injury. Diaphragmatic hernia may rarely be seen after thoracoabdominal trauma. Case presentation A 54-year-old Turkish male patient admitted to the emergency department with abdominal pain and dyspnea ongoing for 2 days. He had general abdominal tenderness in all quadrants. He had a history of a stabbing incident in his left subcostal region 3 months ago without any pathological findings in thoracoabdominal computed tomography scan. New thoracoabdominal computed tomography showed a diaphragmatic hernia and fluid in the hernia sac. Due to respiratory distress and general abdominal tenderness, the decision to perform an emergency laparotomy was made. There was a 6 cm defect in the diaphragm. There were also necrotic fluids and stool in the hernia sac in the thorax colon resection, and an anastomosis was performed. The defect in the diaphragm was sutured. The oral regimen was started, and when it was tolerated, the regimen was gradually increased. The patient was discharged on the postoperative 11th day. Conclusions Acquired diaphragmatic hernia may be asymptomatic or may present with complications leading to sepsis. In this report, acquired diaphragmatic hernia and associated colonic perforation of a patient with a history of stab wounds was presented.

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Ileoileal knotting: a rare cause of intestinal obstruction: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02910-6 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Yusuf Mohammed ◽

Kirubel Tesfaye

Keyword(s):

Abdominal Pain ◽

Intestinal Obstruction ◽

Sudden Onset ◽

Rapid Progression ◽

Case Presentation ◽

Postoperative Course ◽

Child Bearing ◽

Mechanical Intestinal Obstruction ◽

Tentative Diagnosis ◽

Very High

Abstract Background Ileoileal knotting is one of the rarest causes of intestinal obstruction. The pathology involves knotting of the ileum around itself, leading to mechanical intestinal obstruction that can rapidly evolve to gangrene. Case presentation Here we will discuss the case of an 18-year-old Oromo girl who presented with sudden onset of severe abdominal pain and signs of generalized peritonitis.Ultrasound examination showed massive peritoneal and cul-de-sac fluid. Explorative laparotomy was done, with a tentative diagnosis of ruptured ovarian cyst. Intraoperative finding was a gangrenous ileoileal knot. The gangrenous segment was resected and ileotransverse anastomosis done. Postoperative course was uneventful, and the patient was discharged improved on the sixth postoperative day. Conclusion We present this case to highlight the diagnostic difficulty that one can face in females of child-bearing age and to create awareness of this rare cause of intestinal obstruction, as morbidity and mortality are very high because of rapid progression to gangrene.

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NonOperative Management of Blunt Solid Abdominal Organ Injury in Calabar, Nigeria

International Journal of Clinical Medicine ◽

10.4236/ijcm.2010.11006 ◽

2010 ◽

Vol 01 (01) ◽

pp. 31-36

Author(s):

Asuquo Maurice ◽

Bassey Okon ◽

Etiuma Anietimfon ◽

Ngim Ogbu ◽

Ugare Gabriel ◽

...

Keyword(s):

Nonoperative Management ◽

Organ Injury ◽

Abdominal Organ

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A meningocele complicating mastoidectomy – case considerations

Romanian Journal of Medical Practice ◽

10.37897/rjmp.2016.1.18 ◽

2016 ◽

Vol 11 (1) ◽

pp. 89-92

Author(s):

Dan-Cristian GHEORGHE ◽

◽

Adina ZAMFIR-CHIRU-ANTON ◽

◽

Keyword(s):

Middle Ear ◽

Long Term Results ◽

Middle Ear Surgery ◽

Common Complication ◽

Ear Surgery ◽

Case Presentation ◽

Postoperative Course ◽

Postoperative Intensive Care ◽

Middle Ear Disease

Objective. To discuss a less common complication of middle ear surgery. Meningoceles are dural herniations that can fill the mastoid cavities through congenital or acquired bony defects of the mastoid walls. They can complicate the postoperative course of surgery for chronic middle ear disease. Material and method. Case presentation showing one patient who developed a mastoid meningocele after extensive cholesteatoma surgery. Discussion. The causes of dural herniation into the mastoid cavities are presented. Some hypothesis regarding the factors that favor the occurrence of this complication are presented. Conclusions. Surgical closing of the bone gap in the mastoid wall was the treatment we used. We can not ascertain yet the long term results of such surgical maneuver, regarding the technique and the graft we used. Attention to the mastoid surgical detail and good postoperative intensive care could prevent such complications.

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Suprapubic penetrating abdominal trauma - defining peritoneal breach and choices in operative intervention

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz336 ◽

2019 ◽

Vol 2019 (11) ◽

Author(s):

Michael J Papanikolas ◽

Anik Sarkar ◽

Shivanthi Kandiah ◽

Navin Niles

Keyword(s):

Minimally Invasive ◽

Abdominal Trauma ◽

Operative Intervention ◽

Organ Injury ◽

Imaging Modalities ◽

Abdominal Organ ◽

Penetrating Abdominal Trauma ◽

Stab Injury ◽

Laparoscopic Techniques ◽

Invasive Management

Abstract Penetrating abdominal trauma is an uncommon cause of presentation to emergency departments in Australia and is frequently associated with the clinical need for emergent operative intervention. Advances in imaging modalities, improved laparoscopic techniques and structured approaches to resuscitation in trauma have now allowed potential minimally invasive management of such injuries, avoiding laparotomy and therefore defining peritoneal breach; the major determinant of intra-abdominal organ injury in this setting is critical. We present the case of a self-inflicted stab injury to the suprapubic region in an otherwise healthy man and describe the combination of imaging and operative modalities used to define peritoneal breach in this case which successfully reduced the patient’s morbidity by avoiding non-therapeutic laparotomy.

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Diaphragmatic hernia: a rare complication of hepatic ablation

Scottish Medical Journal ◽

10.1177/0036933020941498 ◽

2020 ◽

Vol 65 (3) ◽

pp. 103-106

Author(s):

Mark T Macmillan ◽

Shueh Hao Lim ◽

Hamish M Ireland

Keyword(s):

Microwave Ablation ◽

Rare Complication ◽

Diaphragmatic Injury ◽

Diaphragmatic Defect ◽

Emergency Laparotomy ◽

Effective Technique ◽

Case Presentation ◽

Hepatocellular Carcinomas ◽

Hepatic Ablation ◽

Life Threatening

Introduction Ablation has become an effective treatment for small hepatocellular carcinomas (HCC). Whilst ablation is a safe and effective technique, diaphragmatic injury is a rarely associated but significant complication. Case presentation: We present a case of a 67 year old patient who developed a diaphragmatic defect following microwave ablation (MWA) for HCC. The diaphragmatic defect progressed to herniation which was complicated by perforation of intrahernial large bowel. The patient was treated by emergency laparotomy and an extended right hemi-colectomy was performed. Conclusion Our report adds to the current available knowledge on diaphragmatic injury following hepatic ablation and demonstrates the potential for life threatening consequences associated with this complication.

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Abdominal organ protection strategy for aortic arch aneurysm surgery

Perfusion ◽

10.1177/0267659118768149 ◽

2018 ◽

Vol 33 (7) ◽

pp. 512-519 ◽

Cited By ~ 1

Author(s):

Satoshi Miyamoto ◽

Shinya Takahashi ◽

Shigeyuki Okahara ◽

Hidenobu Takahashi ◽

Keijiro Katayama ◽

...

Keyword(s):

Body Temperature ◽

Aortic Arch ◽

Circulatory Arrest ◽

Aortic Surgery ◽

Distal Anastomosis ◽

Organ Injury ◽

Lower Body ◽

Abdominal Organ ◽

Cord Injury ◽

Distal Perfusion

Introduction: Body temperature maintained during open distal anastomosis in patients who undergo aortic surgery has been showing an upward trend; however, a higher temperature may increase visceral organ and spinal cord injury. Distal perfusion may reduce abdominal organ injury, especially acute kidney injury (AKI). Methods: From 2009 to 2016, 56 patients who underwent ascending aortic and/or aortic arch surgery were enrolled. Open distal anastomosis was performed using one of three protection strategies: 1) systemic temperature of 25°C followed by selective cerebral perfusion (SCP) with lower body circulatory arrest (Group CA25, n=27); 2) systemic temperature of 28°C followed by SCP with lower body circulatory arrest (Group CA28, n=4); and 3) systemic temperature of 28°C followed by SCP with distal aortic perfusion (Group DP, n=25). Results: During the postoperative course, levels of blood urea nitrogen, creatinine, liver enzymes, lactate dehydrogenase and lactate in Groups CA28 and CA25 were significantly higher than those in Group DP. AKI defined by the AKI Network occurred in 28 cases (50%) and 3 cases required permanent hemodialysis. AKI was significantly higher in Groups CA25 and CA28 than in Group DP (p=0.026). Mid-term follow-up showed that patients who developed postoperative AKI were more likely to suffer from cardiovascular events. Conclusions: Distal perfusion during open distal anastomosis reduced kidney and liver injury after thoracic aortic surgery despite an increased body temperature of up to 28°C. This strategy may be useful to prevent AKI, liver dysfunction, the need for hemodialysis and multiple organ failure and could improve mid-term results.

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Hemorrhagic Shock as a Sequela of Splenic Rupture in a Patient with Infectious Mononucleosis: Focus on the Potential Role of Salicylates

Case Reports in Medicine ◽

10.1155/2012/497820 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Konstantinos Bouliaris ◽

Dimos Karangelis ◽

Marios Daskalopoulos ◽

Konstantinos Spanos ◽

Michael Fanariotis ◽

...

Keyword(s):

Hemorrhagic Shock ◽

Infectious Mononucleosis ◽

Potential Role ◽

Splenic Rupture ◽

Emergency Laparotomy ◽

Hemorrhagic Complication ◽

Spontaneous Splenic Rupture ◽

Predisposing Factor ◽

Life Threatening

Despite the fact that the vast majority of splenic ruptures are traumatic, infectious mononucleosis has been incriminated as a major predisposing factor that affects the integrity of the spleen, thus causing atraumatic ruptures and life-threatening hemorrhages. Herein we present a case of a 23-year-old Caucasian male who underwent an emergency laparotomy for acute abdomen and hemorrhagic shock, caused by spontaneous splenic rupture secondary to infectious mononucleosis. The potential role of salicylates in the development of a hemorrhagic complication in a patient with infectious mononucleosis is discussed.

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Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy

Scandinavian Journal of Surgery ◽

10.1177/1457496919828244 ◽

2019 ◽

Vol 109 (2) ◽

pp. 89-95 ◽

Cited By ~ 1

Author(s):

J. Kosola ◽

T. Brinck ◽

A. Leppäniemi ◽

L. Handolin

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Organ Injury ◽

General Surgeon ◽

Emergency Laparotomy ◽

Trauma Patients ◽

Emergency Procedures ◽

Complex Skills

Background and Aims: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. Materials and Methods: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006–2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. Results: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). Conclusion: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.

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