scholarly journals Early pancreaticogastrostomy: a better and novel approach for high grade traumatic pancreatic injuries - case report from tertiary care centre in India

2021 ◽  
Vol 8 (12) ◽  
pp. 3735
Author(s):  
Shashwat Vyas ◽  
Pankaj Porwal
Keyword(s):  
Road Traffic ◽  
Tertiary Care ◽  
Exploratory Laparotomy ◽  
Pancreatic Injury ◽  
Distal Segment ◽  
Organ Injury ◽  
High Grade ◽  
Tertiary Care Centre ◽  
Vascular Structures ◽  
Head Of Pancreas

Traumatic pancreatic injury is a rare entity which is associated with severe morbidity and mortality. The management varies according to the American association for the surgery of trauma-organ injury scale (AAST-OIS) grading of injury, hemodynamic status and time of definitive diagnosis. Non-operative versus operative management has potential risks and benefits and long term debate on the ideal management is still ongoing. A 19-year boy, with severe, generalised pain abdomen was admitted after road traffic accident. Upon admission, the investigations: ultrasonography (USG) and computed tomography (CT) scan abdomen, showed traumatic pancreatic injury (AAST-OIS, grade V), was taken for exploratory laparotomy which revealed lacerated head of pancreas along with normal distal segment of pancreas with no associated injury to nearby hollow viscera, vascular structures. He underwent primary closure of head of pancreas with distal segment pancreaticogastrostomy. Postoperatively he recovered well with no complications. In the present case, as he had traumatic pancreatic injury (AAST-OIS, grade V) and there was no involvement of hollow viscera and vascular structures, the operative intervention can decrease morbidity as by pancreaticogastrostomy we have diverted the pancreatic fluid into stomach, subsequently decreasing the chances of pseudocyst, fistula, necrosis of pancreas. Thus we conclude, high grade blunt traumatic abdomen injuries should be managed with adequate resection and subsequent reconstruction and/or drainage procedure. Pancreaticoduodenectomy, distal pancreatectomy, pancreaticogastrostomy, pancreaticojejunostomy are the available options to be used according to the grading of injury and associated injuries.

scholarly journals Management of pancreatic trauma in adult patients at tertiary care institute of Gujarat, India

2020 ◽  
Vol 6 (5) ◽  
pp. 310-315
Author(s):  
Dr. Krunal Chandana ◽  
◽  
Dr. Priyank Patel ◽  
Keyword(s):  
Road Traffic ◽  
Demographic Data ◽  
Tertiary Care ◽  
Pancreatic Injury ◽  
Solid Organ ◽  
Pancreatic Trauma ◽  
Tertiary Center ◽  
Fall From Height ◽  
Study Population ◽  
Grade Ii

Background and Aim: Pancreatic trauma is rare compared to other solid organ injuries of theabdomen. These injuries are difficult to diagnose and pose a problem in treatment strategy. Thisretrospective study aims to report our tertiary center experience in the management of pancreatictrauma. Material and Methods: The present study is one and half year observational study of 30patients who underwent pancreatic trauma management in the Department of Surgery, tertiary careinstitute of Gujarat. Demographic data and baseline characteristics were recorded, including age,sex, medical co-morbidities, mechanism of pancreatic trauma, length of the hospital stay, andassociated extrapancreatic injuries. All patients underwent a CT scan for the diagnosis of pancreaticinjury. Grading of pancreatic trauma was carried out according to the American Association forsurgery for Trauma (AAST). Results: Road traffic accident (RTA) (n=20) was the leading cause ofpancreatic trauma in the study population followed by fall from height (n=7) and assault (n=3). Themajority of the study population had Grade III pancreatic injury (n=12) followed by Grade IV (n=8),Grade II (n=7), and Grade I (n=3) injuries. No patients had Grade V injury. Isolated pancreatictrauma was seen in 13 patients. Associated liver and spleen injury was seen in 15 patients. Renaltrauma was seen in 2 patients. The extra-abdominal injury was seen to be associated withpancreatic injury in 7 patients. Conclusion: Pancreatic trauma can be managed conservativelyirrespective of the grade of injury supported by radiological percutaneous drainage and pancreaticduct stenting in selective cases.

scholarly journals Blunt Pancreatic Injury in Major Trauma: Decision-Making between Nonoperative and Operative Treatment

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Christopher Ull ◽  
Sebastian Bensch ◽  
Thomas Armin Schildhauer ◽  
Justyna Swol
Keyword(s):  
Decision Making ◽  
Motor Vehicle ◽  
Sports Injuries ◽  
Exploratory Laparotomy ◽  
Pancreatic Injury ◽  
Initial Therapy ◽  
Complete Healing ◽  
Organ Injury ◽  
Pancreatic Trauma ◽  
Poor Outcomes

Blunt trauma injuries to the pancreas are rare but are associated with significant overall mortality and a high complication rate. Motor vehicle collisions are the leading cause of blunt pancreatic trauma, followed by falls, and sports injuries. We discuss the decision-making process used during the clinical courses of 3 patients with life-threatening blunt pancreatic injuries caused by traumatic falls. We also discuss the utility of the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS), which provides a system for grading pancreatic trauma. Retrospectively, the cases reviewed were classified as AAST-OIS grade II, III, and IV in each one patient. Although the nonoperative approach was initially preferred, surgery was required in each case due to pseudocyst formation, pancreatic necrosis, and posttraumatic pancreatitis. In each case, complete healing was achieved through exploratory laparotomy with extensive lavage and placement of abdominal drains for several weeks postoperatively. These cases show that nonoperative management of pancreatic ductal trauma results in poor outcomes when initial therapy is less than optimal.

scholarly journals EPIDEMIOLOGICAL STUDY OF TRAUMA IN A TERTIARY CARE CENTRE IN NORTHWEST INDIA

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Mohit Badgurjar ◽  
Vaibhav Lakhanpal ◽  
Pankaj Saxena ◽  
Suman Parihar ◽  
Poojan Thakor ◽  
...  
Keyword(s):  
Road Traffic ◽  
Tertiary Care ◽  
Total Mortality ◽  
Public Health Problem ◽  
Common Mechanism ◽  
Mechanism Of Injury ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Keywords Trauma ◽  
Number Of Patients

Objective: Traumatic injuries are a matter of concern worldwide. However, the rapidly changing socio economical dynamics in a developing country like India deeply influence the epidemiology behind trauma. The aim of this study was to document and analyze the epidemiological parameters and characteristics behind trauma victims admitted to our tertiary care centre. Methods: The observational study was carried out over a period of one year (January 2019 to December 2019) enrolling a total of 300 trauma patients. The age, sex, locality, delay in hospitalization, mechanism of injury, sites of injury and outcomes were documented. Results: Injuries occurred predominantly in the 20-40 age group with males being the chief victims. There was a considerable amount of delay in hospitalization ranging from one hour to more than 24 hours while only 7 patients arrived to the emergency within one hour of trauma. Vehicular trauma (54%) was the most common mechanism of injury. Injuries to the extremities (38.6%) and head (28.6%) were the most common sites. A considerable number of patients (45.3%) required care in the intensive care unit. A total of 172 patients required surgical interventions of various kinds and there was a total mortality rate of 6%. Amongst the polytrauma cases, 54 patients (81.8%) required ICU admission, 42 patients (63.6%) required surgical intervention and 6 patients (9.1%) died after admission. Conclusion: The results of this study highlight some of the problems with our existing infrastructure bringing to light the need for stricter enforcement of traffic safety laws and improvement of infrastructure particularly the roadways in rural areas as well as the referral systems. Vehicular trauma should be seen as a public health problem and appropriate interventions should be implemented. Keywords: Trauma, Road Traffic Accidents, Epidemiology, Head injuries

scholarly journals Study of Trauma Profile and its Outcomes at a Tertiary Care Centre: A Cohort Study of 1000 Cases

2021 ◽  
Author(s):  
Bhupinder Singh Walia ◽  
Pankaj Dugg ◽  
Kanwaldeep Singh Aulakh ◽  
Sanjeev Sharma ◽  
Venita Kapur
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Emergency Surgery ◽  
Road Traffic ◽  
Tertiary Care ◽  
P Value ◽  
Age Group ◽  
Tertiary Care Centre ◽  
Male Population ◽  
Male Predominance

Introduction: Trauma has been the leading cause of mortality and morbidity. However, there are changes in pattern of trauma and their outcomes with time. Aim: To study the mode and nature of injury and mortality associated with trauma of head, chest and abdomen. Materials and Methods: A prospective cohort study was conducted on 1000 individuals that presented to emergency surgery ward from 2014 to 2019. Patients presented to emergency surgery of Government Medical College, Amritsar, Punjab, India were observed for various characteristics i.e., age group, mode of injury, site of injury, outcomes and management. Results: The mean age of patients was 33.91±16.29 years with significant male predominance (n=794, 79.4%) (p-value 0.00001). Road Traffic Injuries (RTIs) were the most common mode of trauma affecting 490 patients (49%). Head injury was the most common of all injuries (n=834). Overall mortality was 3.6% (n=36). Mortality was higher in males (p-value 0.00933) and mortality rate of 25% was seen in age group of 61-70 years. Conclusion: RTIs followed by assaults are the most common cause of trauma and it significantly affects young male population. However, mortality rate increases with increase in age group with higher rates in older age groups.

scholarly journals A retrospective analysis of twenty two cases of floating knee

2020 ◽  
Vol 6 (4) ◽  
pp. 797
Author(s):  
Umesh Yadav ◽  
Ajay Sheoran ◽  
Mayank Dutta ◽  
Ashish Devgan ◽  
Amit Dahiya ◽  
...  
Keyword(s):  
Functional Assessment ◽  
Knee Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Damage Control ◽  
Tertiary Care ◽  
Knee Injuries ◽  
Trauma Centre ◽  
Tertiary Care Centre ◽  
Floating Knee Injury

<p class="abstract"><strong>Background:</strong> With increase in road traffic accidents, incidence of floating knee injuries is increasing day by day. Along with bony injuries, multiorgan injuries are generally present which require urgent intervention. Despite advance in surgical management and implants, achieving a good functional knee still remains a challenge to the surgeons.</p><p class="abstract"><strong>Methods:</strong> This retrospective study was conducted to assess management, functional outcome and complications of patient presenting with floating knee injury to a tertiary care centre. 22 patients with floating knee injury admitted in trauma centre from 2017 to 2019 were analysed and functional assessment was done.<strong></strong></p><p class="abstract"><strong>Results:</strong> Males with mean age 33.5 years were exclusively victims of road traffic accident. 14 patients presented with multisystem injury. After stabilization fractures were fixed with nails/plates/screws. Knee stiffness was most common complication seen in 37% cases. Functional assessment was done using modified Karlstrom Olerud criteria which revealed excellent results in 22.7% cases while poor results in 18.2% cases.</p><p><strong>Conclusions:</strong>Floating knee injury is not merely bony injury but a multisystem injury and should be managed on principles of Damage control Orthopaedics. Regarding bony injuries, achieving union and acceptable range of motion remains the prime target. </p>

scholarly journals Epidemiology of fractures in indoor patients at a tertiary care centre in India: a study of 3000 cases

2021 ◽  
Vol 8 (1) ◽  
pp. 39
Author(s):  
Mohan M. Desai ◽  
Deven R. Kuruwa ◽  
Easwar Elango ◽  
Roshan Wade
Keyword(s):  
Road Traffic ◽  
Tertiary Care ◽  
Age Groups ◽  
Control Measures ◽  
Age Group ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Treatment Protocols ◽  
Female Ratio ◽  
Femur Fractures

<p class="abstract"><strong>Background: </strong>Implementing appropriate fracture control measures and treatment protocols is crucial to maximizing health and development gains. This requires an in depth understanding of age-specific, sex-specific and cause-specific injury patterns at the national and subnational levels. No such study on fracture epidemiology has been undertaken in the Indian population.</p><p class="abstract"><strong>Methods: </strong>Study was conducted in a tertiary care centre (KEM hospital, Mumbai) which is one of the highest volume trauma centres in the country. Data of 3000 patients was obtained from the medical records department for the year 2016-2019. Patients were segregated with respect to their genders and into three age groups. Etiology of fracture was noted, and fractures classified according to the anatomical area. Whether the patient received conservative or operative management was also recorded.</p><p class="abstract"><strong>Results: </strong>43.83% of the fractures occurred in 18-50 years age group. 41.33% in the above 50 group and only 14.73% in the below 18 age group. Overall male to female ratio was 1.4: 1. Vehicular accident was the most common mode of injury (47.07%) followed by fall from height (21.03%). Proximal femur fractures were the most common accounting for 19.57% of all fractures followed by forearm (10.53%), tibia diaphysis (8.10%). Talus was the least common. 81.07% cases were managed operatively and 18.93% conserved.</p><p class="abstract"><strong>Conclusions: </strong>Our study highlights that Indian epidemiology is unique from our Western counterparts. Population affected is much younger, old age males are affected more than females. Lower limb fractures are more prevalent and road traffic accidents are responsible for almost half the fractures.</p>

scholarly journals Injury amongst Medicolegal Cases in Department of Forensic Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (244) ◽  
pp. 1277-1282
Author(s):  
Arbin Shakya ◽  
Jenash Acharya ◽  
Sunil Joshi
Keyword(s):  
Confidence Interval ◽  
Road Traffic ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Physical Assault ◽  
Care Centre ◽  
Sectional Study ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Life Threatening

Introduction: Victim of injuries presenting to a hospital is a medico-legal issue. So, with medical management, proper documentation of injuries should be done as a legal duty by all physicians attending such cases. The study aims to find the prevalence of injury amongst medicolegal cases inthe Department of Forensic Medicine in a tertiary care centre. Methods: A descriptive cross-sectional study was done amongst 328 medicolegal cases presenting at a tertiary center, from January 2019 to February 2021. Ethical approval was obtained from the Institutional Review Committee (Reference number: 2603202101). Convenience sampling was used to select study samples. After detailed history regarding the incidence, injuries were examined and documented in a performa. The data were entered in Statistical Package for Social Sciences version 18. Point estimate at 95% Confidence Interval was calculated along with frequency and percentagefor binary data. Results: Among 328 cases presenting to hospital for medicolegal issues, 237 (72.25%) (67.40-77.09 at 95% Confidence Interval) had injuries, out of which 170 (71.73%) cases were due to physical assault, 64 (27%) cases due to accident; 2 (1.26%) were undetermined. Majority of victims of injury were adult males, with mean age of 32.41±13.96 years. In most accidental injuries internal organs were also injuries and life-threatening. Conclusions: The prevalence of injuries amongst medicolegal cases was found to be higher in our study in comparison to other studies done in similar settings. Most of the injuries were due to physical assault; however, the majority of road traffic injuries were life-threatening. These road traffic injuries could have been prevented by following a safe system approach to road safety.

scholarly journals Management of blunt trauma abdomen in a tertiary care teaching hospital: a surgical audit

2018 ◽  
Vol 5 (6) ◽  
pp. 2177
Author(s):  
Shashikumar H. B. ◽  
Madhu B. S. ◽  
Ajo Sebastian
Keyword(s):  
Blunt Trauma ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Tertiary Care ◽  
Operative Management ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Surgical Audit ◽  
Non Operative Management

Background: Blunt abdominal trauma is a common scenario in Emergency department and the common cause being road traffic accidents. With this study we present our experience with blunt trauma of abdominal solid organ injuries over a period of 12 months.Methods: A retrospective study was conducted among 45 blunt trauma of abdominal solid organ injuries who presented to the emergency room of Department of General Surgery of Mysore Medical College and Research Institute, Mysore from 1st January 17 to 31st December 2017.All date were retrieved from medical records and statistical analysis was performed using Epi info version 7.Results: Mean age of study population was 31.46 years. 78.2% of the patients were males. Thirty-three (73.3%) patients undergone non-operative management. Splenic injury was reported as the most common abdominal solid organ injury followed by liver.Conclusions: With the advent of newer investigative modalities like contrast enhanced computed tomography (CECT) abdomen, more and more cases of blunt trauma abdominal solid organ injury can be managed non-operatively with effective ICU care. High-grade injuries do not preclude non-operative management.

scholarly journals Prevalence of surgical site infection in general surgery in a tertiary care centre in India

2017 ◽  
Vol 4 (9) ◽  
pp. 3101 ◽  
Author(s):  
Ansul Kumar ◽  
Arpita Rai
Keyword(s):  
Surgical Site Infection ◽  
General Surgery ◽  
Surgical Procedure ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Exploratory Laparotomy ◽  
Site Infection ◽  
Tertiary Care Centre ◽  
One Year

Background: Surgical site infection (SSI) can be defined as an infection that is present up to 30 days after a surgical procedure if no implants are placed and up to one year if an implantable device was placed in the patient. SSI is a significant problem associated with major surgeries and is the 3rd most frequently reported nosocomial infection. This study aims to study the prevalence of SSI in the Department of Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi.Methods: A retrospective study was undertaken at the Department of General Surgery for a period of one year. Retrospective chart review was conducted from the hospital database. The rate of SSI was studied in relation to its type, the type of surgical procedure and elective vs emergency surgeries.Results: The present study revealed 12.5% prevalence of SSI in Department of General Surgery, RIMS. Among the 3 types, superficial incision SSI was most prevalent followed by deep incisional SSI and finally by organ/space SSI. The surgical procedure most commonly associated with SSI was exploratory laparotomy. An alarming 17.7% of SSI was associated with emergency surgeries as compared to 12.5% of elective surgeries.Conclusions: The consequences of SSIs greatly impact patients and the healthcare systems. Prevention of SSI requires a multifaceted approach targeting pre-, intra-, and postoperative factors. It is imperative that facilities have open-minded management teams, regulatory agencies and medical associations that want to provide the foundation required to generate a culture of patient safety in our health care systems.

scholarly journals When the Disease is Known but the Patient is not. Outcome of 118 such Patients at a Tertiary Care Centre

2018 ◽  
Vol 32 (2) ◽  
pp. 505-512
Author(s):  
Gaurav Jaiswal ◽  
Praveen Kumar Tripathi ◽  
Vardan Kulshreshtha ◽  
Tarun Kumar Gupta
Keyword(s):  
Head Injury ◽  
Road Traffic ◽  
Tertiary Care ◽  
Good Recovery ◽  
Tertiary Care Centre ◽  
Medical College ◽  
Discharged Patients ◽  
History Of ◽  
A Prospective Study ◽  
Lost To Follow Up

Abstract This is a prospective study, carried out at the Department of Neurosurgery at M.B.G Hospital, R.N.T Medical College, Udaipur, Rajasthan (India). Many patients with history of trauma with head injury, whose identity cannot be ascertained, are admitted in our hospital. The management of these unattended patients from pre-hospital till discharge, rehabilitation or death is full of difficulties especially when surgical intervention has to be done. From March 16, 2015, until March 30, 2016, 118 consecutive patients unattended patients admitted in our department with history of head injury were enrolled in the study. Out of 118 patients, 107 (91%) were male, most were in the age group of 30-39 years. In majority of patients, 115 (97%) principal cause of head injury was road traffic accident. Majority of the patients 49 (41%) had Glasgow coma scale >13 on admission. Twenty three patients 23 (20%) died in hospital, 71 (60%) patients had good recovery. During the course of treatment identity of 115 patients was established and 92 (78%) patients, who survived were discharged to home. Three (3%) patients were shifted to destitute home. All discharged patients were followed at 1 month and 6 month interval. 78 (82%) & 76 (80%) patients showed good recovery (GOS) at 1 month & 6 month respectively. One patient expired at home within one month of discharge and 6 patients lost to follow up at 6 months.

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