scholarly journals Step up approach for the management of late presentation of pancreatic trauma patients

2020 ◽  
Vol 7 (4) ◽  
pp. 1065
Author(s):  
Shabi Ahmad ◽  
Vikram Singh ◽  
Vinod Kumar Pandey ◽  
Shirish Kumar ◽  
Tabrej Alam ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Late Presentation ◽  
Trauma Patients ◽  
Delayed Presentation ◽  
Pancreatic Trauma ◽  
Delay In Diagnosis ◽  
Second Stage ◽  
Remnant Pancreas ◽  
Pancreatic Injuries ◽  
Time Of Admission

Background: Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities and these injuries are often overlooked in cases with extensive multi-organ trauma. Our study was conducted to evaluate the outcome of a step-up approach in the management of pancreatic trauma patients with late presentation.Methods: The study included 15 patients who presented with grade III AAST delayed presentation of pancreatic trauma from September 2017 to 2019. In our step-up approach 2 staged procedure was done, firstly laparotomy with necrosectomy along with closure of proximal pancreatic duct with external drainage of pancreatic duct, in second stage Roux-en-Y pancreaticojejunostomy was done to drain the remnant pancreas as a definitive procedure 3 to 6 months after initial procedure.Results: In our study, blunt trauma abdomen (83.30%) (n=10) was the most common mode of injury. The main reason for delay in diagnosis of pancreatic trauma was delayed presentation of patient (83.3%) (n=10). Total of 4 patients were admitted to intensive care unit (ICU) at the time of admission. 10 patients underwent both the stages of step up approach management among which one patient had pancreatic fistula as a complication (n=1) (10%) and one patient had post-operative abscess as a complication (n=1) (10%). No mortality was noted in our study.Conclusions: The step-up approach discussed above proves to be beneficial towards management of patients with delayed presentation of pancreatic trauma in our setting.

Novel Promising Technique for Traumatic Pancreatic Injury Management.

2020 ◽  
Author(s):  
Mohammed Hamada Takrouney ◽  
Vipul Prakash Bothara ◽  
Bhushan Jahhav ◽  
Mohamed Abdelkader Osman ◽  
Ibrahim Ali Ibrahim ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Median Time ◽  
Main Pancreatic Duct ◽  
Primary Repair ◽  
Pancreatic Injury ◽  
Pancreatic Trauma ◽  
Average Hospital ◽  
Pancreatic Injuries ◽  
The Status ◽  
Average Operative Time

Abstract Introduction: Pancreatic injuries in children are relatively uncommon. The precise location of the injury, the status of the main pancreatic duct, and the time between diagnosis and intervention are a potentially useful guide for management decisions. We report a successful endoscopic simple primary repair with the pancreatic preservation even with transected main pancreatic duct without duct stenting.Patients and Methods: Between May 2017and December 2019, 3 patients with pancreatic trauma and duct transection underwent endoscopic (laparoscopic and robotic) repair. Demographics, Operative data, Postoperative complications, and clinical outcomes were documented and analyzed.Results: Three patients with pancreatic fractures, 2 patients with grade IV, and one patient grade III injury. The median age was 11 years, the median time of hospital admission after the trauma was 72 hours. The median time of surgical intervention was 24 hours. Average operative time was160 minute and the average hospital stay was 9 days with no recorded postoperative or follow up complications till now.Conclusion: Primary simple pancreatic repair is a promising and plausible technique for the management of pancreatic trauma, especially with duct transaction it maybe instead of all other modalities of pancreatic trauma treatment. We implore all pediatric surgery centers to espouse this technique.

The bridge stenting-based internal drainage in pancreatic trauma patients with main pancreatic duct injury

2020 ◽  
Vol 72 (3) ◽  
pp. 717-726
Author(s):  
Xu-dong Wen ◽  
Dan-qing Liu ◽  
Bing-yin Zhang ◽  
Le Xiao ◽  
Hong-tao Yan ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Trauma Patients ◽  
Internal Drainage ◽  
Pancreatic Trauma

National temporal variation in major trauma in England, Wales and Northern Ireland

Trauma ◽  
2021 ◽  
pp. 146040862098226
Author(s):  
Will Kieffer ◽  
Daniel Michalik ◽  
Jason Bernard ◽  
Omar Bouamra ◽  
Benedict Rogers
Keyword(s):  
Northern Ireland ◽  
Temporal Variation ◽  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
Trauma Patients ◽  
Trauma Outcomes ◽  
Causes Of Mortality ◽  
Injured Patients ◽  
Time Of Admission

Introduction Trauma is one of the leading causes of mortality worldwide, but little is known of the temporal variation in major trauma across England, Wales and Northern Ireland. Proper workforce and infrastructure planning requires identification of the caseload burden and its temporal variation. Materials and Methods The Trauma Audit Research Network (TARN) database for admissions attending Major Trauma Centres (MTCs) between 1st April 2011 and 31st March 2018 was analysed. TARN records data on all trauma patients admitted to hospital who are alive at the time of admission to hospital. Major trauma was classified as an Injury Severity Score (ISS) >15. Results A total of 158,440 cases were analysed. Case ascertainment was over 95% for 2013 onwards. There was a statistically significant variation in caseload by year (p < 0.0001), times of admissions (p < 0.0001), caseload admitted during weekends vs weekdays, 53% vs 47% (p < 0.0001), caseload by season with most patients admitted during summer (p < 0.0001). The ISS varied by time of admission with most patients admitted between 1800 and 0559 (p < 0.0001), weekend vs weekday with more severely injured patients admitted during the weekend (p < 0.0001) and by season p < 0.0001). Discussion and Conclusion: There is a significant national temporal variation in major trauma workload. The reasons are complex and there are multiple theories and confounding factors to explain it. This is the largest dataset for hospitals submitting to TARN which can help guide workforce and resource allocation to further improve trauma outcomes.

OCULAR INJURY TREND IN COVID-19 ERA- A TERTIARY EYE CARE STUDY IN INDIA

2021 ◽  
pp. 158-160
Author(s):  
R. B. Goyal ◽  
Karishma Goyal
Keyword(s):  
Ocular Trauma ◽  
Care Center ◽  
Ocular Injury ◽  
Trauma Patients ◽  
Delayed Presentation ◽  
Eye Care ◽  
Education And Awareness ◽  
Future Strategy ◽  
Mass Health ◽  
Care Study

Aim- To study the change in demography and injury pattern of ocular trauma during the lockdown period tothat of a similar period of the previous year. Materials & Methods- This is a retrospective analysis of the data of 362 patients with ocular trauma during the lockdown period from 25 March 2020 to 3 May 2020 and during a similar period of the previous year at a tertiary eye care center in India. Results- There was a decrease of 62.87% of patients of ocular trauma during the lockdown period because of the restricted lifestyle. Although home related and violence-related trauma increased, there was a decrease in trafc and sports-related trauma. Patients with chemical injury by sodium hypochlorite also had a sharp rise. Majority of the patients presented after two days during this period. Conclusion- Guidelines for mass health education and awareness about the risk of ocular trauma, morbidity caused by delayed presentation, and need to adopt safety or preventive strategies should be formulated so that future strategy can be planned to ght with the next pandemic or epidemic.

scholarly journals Determinants of Timing of Presentation of Neurotrauma Patients to a Neurosurgical Center in a Developing Country

2018 ◽  
Vol 09 (04) ◽  
pp. 545-550 ◽  
Author(s):  
Toluyemi Adefolarin Malomo ◽  
Toyin Ayofe Oyemolade ◽  
Amos Olufemi Adeleye
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Late Presentation ◽  
Neurological Deficits ◽  
Delayed Presentation ◽  
Long Distance ◽  
College Hospital ◽  
Cross Sectional ◽  
Initial Care ◽  
Cord Injury

ABSTRACT Background: A major goal in neurotrauma management is the prevention of secondary neuronal injuries. This goal is time bound as neurological deficits once established are usually irreversible. Late presentation is the norm in most neurotrauma patients in developing countries. Aims: The aim of the study was to review the timing of presentation of neurotrauma patients and the possible causes of their late presentation for neurosurgical care in our practice. Methods: A cross-sectional study of a 4-month prospective database of neurotrauma patients presenting to the University College Hospital, Ibadan, was done. The participants’ biodata, injury characteristics, initial-care details before referral, and information on timing and causes of delay were analyzed. Results: The study subjects included 111 patients, 80.2% (89/111) were males, and 52.8% aged 21–40 years. Head injury (HI), spinal cord injury (SCI), and combined HI and SCI occurred, respectively, in 80.2%, 14.4%, and 5.4%. Road accidents followed by falls were seen in 73.9% and 14.4% (16), respectively. Just 46.8% (52/111) cases presented within 12 h of injury and only 37 (33.3%) within 4 h. Majority, 83.8% (93/111) were referrals from primary care. These referrals were delayed in 81.7% (76/93) of these. The referring health facilities were located intracity with our center in 54%. Other causes of delayed presentation of these study participants included long-distance travel to our center, lack of funds, or a combination of the above factors. Eighty-nine patients (80.2%) were brought in by family members and the remaining minority by passers-by and road safety personnel. Conclusions: Delayed referral from primary care features prominently in timing of presentation of neurotrauma patients in Nigeria. There is a need for collaboration as well as continuing medical education between the neurotrauma specialists and primary care physicians.

scholarly journals Pancreatic trauma: proposal for management algorithm

2020 ◽  
Author(s):  
Daisuke Hashimoto ◽  
Tomohisa Yamamoto ◽  
So Yamaki ◽  
Kazuhito Sakuramoto ◽  
Rintaro Yui ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Mortality Rate ◽  
Pancreatic Duct ◽  
Conservative Management ◽  
Main Pancreatic Duct ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Pancreatic Trauma ◽  
Endoscopic Nasopancreatic Drainage ◽  
Nasopancreatic Drainage

IntroductionPancreatic trauma is potentially lethal despite recent improvements in surgical techniques and conservative management. However, no guidelines for the management of pancreatic trauma have been established. In this report, we propose an algorithm for the management of pancreatic trauma based on our experience of nine cases and a literature review.Case presentationThis study included nine patients with pancreatic trauma (five men and four women). The patients’ median age was 40 years (range, 17–75 years). The overall mortality rate was 22.2%, and the postoperative mortality rate was 16.7%. Superficial trauma was present in two patients. Deep trauma without injury to the main pancreatic duct was present in one patient, and this patient was treated successfully with endoscopic nasopancreatic drainage. Active bleeding was present in two patients and controlled by interventional radiology. Deep trauma with injury to the main pancreatic duct was present in six patients. Among them, one patient died after conservative treatment with endoscopic nasopancreatic drainage. The other five patients underwent surgery (pancreatic resection in four and necrosectomy in one).ConclusionThe herein-described algorithm recommends interventional radiology for active arterial bleeding, conservative management for trauma without ductal injury, and surgery for trauma with ductal injury. This algorithm may provide a basis for future establishment of guidelines.

Late diagnosis, delayed presentation and late presentation in HIV: proposed definitions, methodological considerations and health implications

2013 ◽  
Vol 18 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Michael Kozak ◽  
Anne Zinski ◽  
Connie Leeper ◽  
James H Willig ◽  
Michael J Mugavero
Keyword(s):  
Late Presentation ◽  
Late Diagnosis ◽  
Delayed Presentation ◽  
Health Implications ◽  
Methodological Considerations

Outcomes after Distal Pancreatectomy for Trauma in the Modern Era

2016 ◽  
Vol 82 (6) ◽  
pp. 526-532 ◽  
Author(s):  
Gregory L. Peck ◽  
David N. Blitzer ◽  
Constantine S. Bulauitan ◽  
Lauren A. Huntress ◽  
Paul Truche ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Early Death ◽  
Outcome Data ◽  
Trauma Patients ◽  
Pancreatic Stump ◽  
Fibrin Sealants ◽  
Stump Closure ◽  
Pancreatic Injuries ◽  
Fistula Rate

Multiple stump closure techniques after distal pancreatectomy (DP) for trauma have been described, and all are associated with a significant fistula rate. With increasing emphasis on abbreviated laparotomy, stapled pancreatectomy has become more common. This study describes the outcomes of patients with different closure techniques of the pancreatic stump after resection following pancreatic trauma. Retrospective analysis of 50 trauma patients, who sustained grade III pancreatic injuries with subsequent DP and stapled stump closure, were conducted from 1995 to 2011. Demographic, operative, and outcome data were analyzed to characterize patients, and to directly compare closure techniques. After 12 patients were excluded because of early death (<72 hours), final analyses included 38 patients: 19 (50%) had stapled closure alone and 19 (50%) had stapling with adjunct, including additional closure with sutures, fibrin sealants, or a combination of sutures with fibrin sealants/omental coverage. Twenty-four patients (63%) had postoperative complications, most commonly pancreatic fistula (n = 11, 29%). There were no significant differences with regard to pancreatic fistula or other abdominal complications between closure groups, or were any factors associated with increased likelihood of complications. DP remains a morbid operation after trauma regardless of closure technique. Stapled closure alone is perhaps the method of choice in this setting due to the time constraints directly related to outcomes.

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