The use of pyloric exclusion for treating duodenal trauma: case series

CONTEXT AND OBJECTIVES: Significant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. DESIGN AND SETTING: Cross-sectional study followed by a case series in a university hospital. METHODS: Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed. RESULTS: The causes of the injuries included penetrating gunshot wounds (GSW) in five patients and motor vehicle accidents (blunt trauma) in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50%) or IV (50%) and the morbidity rate was 87.5%. Four patients (50%) died during the postoperative period from complications, including hypovolemic shock (one patient), sepsis (peritonitis following the missed injury) and pancreatitis with an anastomotic fistula (two patients). CONCLUSIONS: Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.

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Malaria among migrants in a university hospital in Colombia during 2018: A case series

Tropical Doctor ◽

10.1177/0049475520981301 ◽

2020 ◽

pp. 004947552098130

Author(s):

Fabián R Carreño-Almánzar ◽

Adán Coronado-Galán ◽

Sonia A Cala-Gómez ◽

Agustín Vega-Vera

Keyword(s):

Latin American ◽

Previous History ◽

Case Series ◽

Cross Sectional Study ◽

Imported Malaria ◽

University Hospital ◽

Sectional Study ◽

Cross Sectional ◽

History Of ◽

Clinical Profiles

Imported malaria has increased in Colombia since 2015 and has been attributed to migrants coming from Venezuela. We present a series of malaria cases, nested in a retrospective cross-sectional study between 2017 and 2018, aimed at calculating the prevalence of medical diseases among immigrants in a University Hospital in Colombia. Among 154 immigrants admitted for medical causes between 2017 and 2018, 8 were diagnosed with malaria, all due to Plasmodium vivax. Of these, seven had uncomplicated malaria, five had a previous history of malaria, one was critically ill, but none died. We highlight that, similar to other case series of imported malaria, Latin American migrants were young, with similar clinical profiles, having a low proportion of severe cases, and P. vivax was the most frequent cause.

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A Case Series of Severe Dengue with Neurological Presentation in Children from a Colombian Hyperendemic Area

Case Reports in Medicine ◽

10.1155/2021/6643738 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Jaime E. Castellanos ◽

Paula Esteban ◽

Juanita Panqueba-Salgado ◽

Daniela Benavides-del-Castillo ◽

Valentina Pastrana ◽

...

Keyword(s):

Fungal Infections ◽

Hypovolemic Shock ◽

Case Series ◽

University Hospital ◽

Severe Dengue ◽

Laboratory Findings ◽

Dengue Disease ◽

Neurological Signs ◽

Csf Analysis ◽

Neurological Patients

Dengue transmission is sustained in Colombia with increasing prevalence mainly in children. This work aimed to describe a case series of children diagnosed with dengue presenting neurological disease in Huila Province of Colombia. Eleven pediatric febrile patients confirmed for dengue disease and presenting neurological signs were studied in the University Hospital of Neiva, Huila Province. Clinical and laboratory findings, CSF cytochemical analysis, neurology images, and serology and molecular studies were performed. Viral RNA was detected in all patients’ sera by RT-PCR. Nine out of 11 were primary infections. Tonic-clonic seizures (73%), consciousness alterations (27%), irritability (27%), and ataxia (18%) were the most frequent neurological signs. None of the patients had plasma leakage, hypovolemic shock, or liver disease, confirming the encephalitis diagnosis. Diagnostic images did not show abnormal findings, but neither bacterial nor fungal infections were detected in CSF analysis. All patients survived without sequelae except for one patient that presented ataxia for months. In conclusion, we described a group of children with neurological signs during severe dengue disease as the main finding, indicating the importance to including dengue as a differential diagnosis in neurological patients from endemic areas.

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Comparative study of primary repair versus ileostomy in patients of typhoid perforation

Annals of King Edward Medical University ◽

10.21649/akemu.v12i1.828 ◽

2016 ◽

Vol 12 (1) ◽

Author(s):

Tariq Waqar ◽

Safdar Ali Khan

Keyword(s):

Mortality Rate ◽

Comparative Study ◽

General Health ◽

Primary Repair ◽

The Other ◽

Morbidity Rate ◽

Double Blind ◽

Cross Sectional ◽

Good General Health ◽

Surgical Option

Objective: To evaluate the better surgical option in cases of typhoid perforation comparing ileostomy and the primary repair. Study design: It was a cross sectional comparative study. Place and duration of study: Department of Surgery, Nishtar hospital Multan during December 2003 to November 2004. Patients and methods: A total of 50 cases of typhoid perforation which presented in less than 24 hours after perforation. The patients were divided into two groups of 25 patients each in double blind randomized pattern. In one group ileostomy was done and in the other group primary repair was done. Results: The mortality rate in the ileostomy was 8% and the morbidity rate was 56%. In the patients with primary repair the mortality rate was 12% and the morbidity rate was 24%. Conclusion: If patient present within 24 hours after perforation provided that the patient is in good general health and with no other concomitant illness primary repair of the typhoid perforation should be done in every patient.

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PARASITIC INFESTATIONS

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.03.1346 ◽

2015 ◽

Vol 22 (03) ◽

pp. 306-311

Author(s):

Shahnawaz Abro ◽

Ashfaque Ahmed Bhurgiri ◽

Ahmed Hussain ◽

Syed Zulfiquar Ali Shah ◽

Musaib Ali Khero

Keyword(s):

Ascaris Lumbricoides ◽

Case Series ◽

Intestinal Resection ◽

University Hospital ◽

Parasitic Infections ◽

Cross Sectional ◽

Case Series Study ◽

The Mean ◽

The Tropics

Parasitic infections lead to burden of morbidity and mortality in developingcountries. Surgeons practicing in the tropics are familiar with the parasitic disorders. Objectives:To determine the role of surgery in parasitic infestations of Echinococcus granulosus and Ascarislumbricoides. Design: Cross sectional case series study. Period: Two years. Setting: LiaquatUniversity Hospital Hyderabad. Patients and methods: All the patients with Echinococcusgranulosus and Ascaris lumbricoides were admitted in the ward and were observed for differentmanifestations and surgical procedures aimed to cure the echinococcosis and ascariasisinfestation. The data was analyzed in SPSS 16 and the frequency and percentage wascalculated. Results: During two years study period, total sixty cases of parasitic infestations(50 cases of Echinococcus granulosis and 10 cases of Ascaris Lumbricoides) were detectedat Liaquat University Hospital Hyderabad / Jamshoro. The hydatid cysts was more common inthe age group of 30-39 years while the mean age ± SD in overall patients with Echinococcusgranulosis infestation was 38.74±7.84 whereas it was 35.87±8.64 and 40.43±6.73 in male andfemale population respectively. The Ascaris Lumbricoides was more common in the age groupof 15-20 years while the mean age ± SD in overall patients with Ascaris lumbricoides infestationwas 16.62±5.21 whereas it was 15.42±7.31 and 16.43±5.41 in male and female populationrespectively. Among 47 surgically treated cases of echinococcus, the approach used werecyst evacuation and tube drainage in 40 patients, total cystopericystectomy in 04 patients andlaparoscopically in 03 subjects accordingly. Seven (70%) cases of intestinal obstruction dueto ascariasis underwent surgical intervention like external milking of the obstructing bolus ofworms from the ileum into colon in 03 patients, intestinal resection and end to end anastomosisin 01 case and enterotomy and manual extraction of worms in 03 subjects accordingly.Conclusions: Hydatid disease and Ascaris lumbricoides may cause fatal complications andsurgical intervention has been the valuable option.

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Temporary Intravascular Shunts: When Are We Really Using Them According to the NTDB?

The American Surgeon ◽

10.1177/000313480907500712 ◽

2009 ◽

Vol 75 (7) ◽

pp. 605-607 ◽

Cited By ~ 14

Author(s):

Chad G. Ball ◽

Andrew W. Kirkpatrick ◽

Ravi R. Rajani ◽

Amy D. Wyrzykowski ◽

Christopher J. Dente ◽

...

Keyword(s):

Soft Tissue ◽

Injury Severity ◽

Motor Vehicle ◽

Damage Control ◽

Venous Blood ◽

Case Series ◽

Soft Tissue Injuries ◽

Gunshot Wounds ◽

Venous Blood Flow ◽

Penetrating Injuries

Temporary intravascular shunts (TIVS) are synthetic intraluminal conduits that maintain arterial and/or venous blood flow. This technique can be used for: 1) replantation; 2) open extremity fractures with extensive soft tissue and arterial injuries; or 3) damage control (extremity/truncal). The literature defining TIVS is composed exclusively of small case series (primarily penetrating injuries). Our goal was to identify the injured population who actually undergoes TIVS using the National Trauma Data Bank (2001 to 2005). TIVS were placed in 395 patients (mean Injury Severity Score = 26; initial hemodynamic instability = 24%; mean based deficit = –7.2; mortality = 14%). Blunt mechanisms caused 64 per cent (251 of 395) of cases. Penetrating injuries were primarily gunshot wounds (97%). Concurrent severe extremity fractures and/or soft tissue defects were present in 185 (74%) blunt-injured patients. Only six of 111 centers performing TIVS used this technique five or more times. Only three centers used TIVS more than 10 times. The volume of TIVS use was similar across the study period ( P > 0.05). TIVS is primarily used in blunt motor vehicle collision trauma with concurrent severe extremity fractures and soft tissue injuries. This provides distal perfusion while surgeons assess/fixate the limb. TIVS are placed relatively uncommonly by a large number of trauma centers with a few hospitals using them much more frequently for penetrating injuries.

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Merkel Cell Carcinoma and Diagnostic Experience in a Reference Hospital: A Case Series

Case Reports in Medicine ◽

10.1155/2020/8391510 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Rocio del Pilar López Panqueva ◽

David A. Suarez-Zamora ◽

Luis E. Barrera-Herrera ◽

Mariam Rolón Cadena

Keyword(s):

Cell Carcinoma ◽

Merkel Cell Carcinoma ◽

Case Reports ◽

Case Series ◽

Recurrence Risk ◽

Cross Sectional Study ◽

University Hospital ◽

Merkel Cell ◽

Cross Sectional ◽

Exposed Skin

Merkel cell carcinoma (MCC) is a rare poorly differentiated neuroendocrine tumor, usually located in sun-exposed skin, with aggressive behavior and with high recurrence risk and metastatic disease. In Latin America, case series have been published, and it does not exceed 32 patients in 10 years, and in Colombia, there are case reports. We present a descriptive retrospective cross-sectional study in patients diagnosed with MCC in the Department of Pathology and Laboratories at the University Hospital Fundación Santa Fe de Bogotá(FSFB) between January 2003 and December 2018. We present the demographic, clinical, and pathological variables of these patients, as well as a literature review.

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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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Detection of SARS-CoV-2 in the tears and conjunctival secretions of Coronavirus disease 2019 patients

The Journal of Infection in Developing Countries ◽

10.3855/jidc.13224 ◽

2020 ◽

Vol 14 (09) ◽

pp. 977-981 ◽

Cited By ~ 1

Author(s):

Hüseyin Kaya ◽

Ahmet Çalışkan ◽

Mehmet Okul ◽

Tuğba Sarı ◽

İsmail Hakkı Akbudak

Keyword(s):

Case Series ◽

Cross Sectional Study ◽

University Hospital ◽

Cross Sectional ◽

Ocular Manifestations ◽

Case Series Study ◽

Eye Symptoms ◽

Polymerase Chain ◽

Mean Time ◽

Series Study

Introduction: Current studies suggest that tears and conjunctival secretions may be an important transmission route in coronavirus disease 2019 (COVID-19). The study aims to evaluate the presence of severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) virus in tears and conjunctival secretion of patients with COVID-19. Methodology: A prospective interventional case series study was performed, and 32 patients with COVID-19 were selected at the Pamukkale University Hospital from 15 to 22 May 2020. The tear and conjunctival samples were collected by a conjunctival swab. Each specimen was sent to the laboratory for reverse transcription-polymerase chain reaction (RT-PCR) analyses. To avoid cross-infection, gloves and personal protective equipment were changed after collecting each sample. Results: 32 patients (18 male, 14 female) with Covid-19 were included in this cross-sectional study. The average age of the patients was 52.81 ± 16.76 years. By the time of the first collection of conjunctival-tear samples, the mean time of the onset of complaints was 6.84 ± 6.81 (1-35) days. Tear-conjunctival samples from 5 patients (16%) without conjunctivitis yielded positive PCR results, 3 of whom had positive and 2 negative nasopharyngeal PCR results. Conclusions: Five of 32 patients (16 %) without conjunctivitis or any eye symptoms had viral RNA in their tear-conjunctival samples. The possibility of transmission via tears and conjunctival secretions should be recognized even in the absence of conjunctivitis or other ocular manifestations.

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Early Abdominal Wall Reconstruction with Biologic Mesh is Feasible after Catastrophic Abdominal Wall Disruption from Blunt Trauma

Surgical Technology Online ◽

10.52198/21.sti.38.hr1435 ◽

2021 ◽

Author(s):

Agon Kajmolli ◽

Asad Azim ◽

Matthew McGuirk ◽

Kartik Prabhakaran ◽

David Samson ◽

...

Keyword(s):

Abdominal Wall ◽

Blunt Trauma ◽

Motor Vehicle ◽

Abdominal Wall Reconstruction ◽

Surgical Techniques ◽

Case Series ◽

Biological Mesh ◽

Motor Vehicle Crash ◽

Common Mechanism ◽

Abdominal Wall Disruption

Introduction: Traumatic abdominal wall hernias (TAWHs) after blunt trauma, while rare, are typically associated with severe injuries, particularly those involved with the seatbelt triad of abdominal wall disruption. The aim of this study is to present a case series of patients with TAWHs that were managed at an early stage post injury with a biological mesh. Materials and Methods: Patients with TAWH undergoing complex abdominal wall reconstruction (CAWR) between 2017 and 2020 were identified from our institutional database. All patients underwent definitive reconstruction using advanced surgical techniques including a posterior component separation with biological mesh (STRATTICE™, Allergan, Inc., Dublin, Ireland) placed in a sublay fashion. Results: Seven patients underwent definitive TAWH repair during their index admission: the median age was 56 years (range 20–77) and the median Injury Severity Score (ISS) was 34 (29–50). The most common mechanism of injury was motor vehicle crash (MVC) at 86%, while the most common intra-abdominal concomitant injury was small bowel. Traumatic hernia location was on the right side of the abdominal wall in three patients, left in three patients, and bilaterally in one patient. There were no hernia recurrences or deaths in this small cohort. Conclusion: Traumatic abdominal wall disruption can be safely reconstructed using advanced surgical techniques with a biological mesh during the acute phase or same index hospitalization.

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Profile of pediatric eye trauma at Hospital de Base do Distrito Federal (HBDF), Brasília, Brazil

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.04.324 ◽

2016 ◽

Vol 62 (4) ◽

pp. 324-329 ◽

Cited By ~ 4

Author(s):

Juliana Tessari Dias Rohr ◽

Procópio Miguel dos Santos ◽

Regina Candido Ribeiro dos Santos ◽

Camila Viana Vieira ◽

Lylian Moura Fé ◽

...

Keyword(s):

Visual Acuity ◽

Blunt Trauma ◽

Family Income ◽

Ocular Trauma ◽

Primary Repair ◽

P Value ◽

Severe Injuries ◽

Cross Sectional ◽

Adult Supervision ◽

At Home

Summary Objective: To describe the epidemiological profile of ocular trauma in children at the HBDF emergency department. Method: Descriptive, cross-sectional study. We evaluated 103 cases of ocular trauma in children less than 15 years between July 2012 and January 2013. The factors evaluated through semi-structured questionnaire available online were: age, gender, adult supervision, mechanism, type of trauma, time and place, site and nature of injury, visual acuity, need for hospitalization and/or surgery, type of surgery, mother’s level of education, and family income. Results: The average age of patients studied was 7.5 years. Boys (68%) predominate in all age groups. Blunt trauma prevailed (55.3%), followed by open (20%). Most of the cases occurred at home, 14 to 20 hours before seeking hospital care. The most common causes were: wood, stone, bicycle, broken glass, and falls. The cornea was affected in 54%. Visual acuity was ≥20/40 in 68.9%. Primary repair of the eye wall was indicated in 70.37% (p-value=0.022). Open traumas were more severe (p-value=0.005) and had more need for intervention (p-value=0.000). The injuries occurred despite the presence of adult supervision in 54% (p-value=0.002). The most severe injuries predominated in the age range 7-15 years (p=0.001). Conclusion: Ocular trauma was more frequent among boys. The mechanisms of injury are the most diverse, and prevail at home. Blunt trauma prevails, but the visual impact is due to open trauma. Programs of prevention and education on child ocular trauma are needed.

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