scholarly journals PATTERNS AND OUTCOME OF PENETRATING ABDOMINAL TRAUMA.

2019 ◽  
Vol 26 (07) ◽  
pp. 1067-1073
Author(s):  
Khan Muhammad Babar ◽  
Humera Sadaf Bugti ◽  
Fida Ahmed Baloch ◽  
Shakeel Akbar ◽  
Abdullah Makki ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Primary Repair ◽  
Damage Control ◽  
Hemodynamic Instability ◽  
Outcome Data ◽  
Cross Sectional ◽  
Penetrating Abdominal Trauma ◽  
Pattern Of Injury ◽  
Surgical Department ◽  
Gunshot Injuries

Objectives: To determine the mode of penetrating injuries to abdomen and to determine the effect of these injuries on outcome and to formulate recommendations for management of patients sustaining penetrating abdominal trauma. Study Design: Descriptive, cross sectional. Setting: Surgical Department Sandeman Provincial hospital, Quetta. Period: 1 year 2012-2013. Methodology: 147 consecutive cases of abdominal trauma presenting to emergency were studied for pattern of injury and management outcome. Data was recorded and analyzed using SPSS v10. Frequency tables were generated for various variables. Results: The commonest mode of injury was stabbing occurring in 76 cases (51.7%) followed by gunshot injuries in 60 cases (40.8%), 11 patients (7.4%) sustained blast pellet injuries. Patients were either managed conservatively or underwent laparotomy depending on mechanism of injury and clinical presentation. Stab and blast pallet wounds which were superficial were managed by local wound exploration those with peritoneal breach, hemodynamic instability and visceral evisceration were managed by Laprotomy. All gunshot injuries underwent mandatory Laprotomy. Gut was most commonly injured viscus followed by liver and kidney. Types of procedure performed were primary repair, bowel resection, protective ileostomy, splenectomy, nephrectomy, 2 patients were managed by damage control i.e. liver packing. Overall mortality was 5%. Conclusion: Mandatory laprotomy for all gunshots, and stabs and pellets that penetrate the peritoneal cavity proves to be safe and a prudent policy.

scholarly journals A case report of blunt liver trauma in times of COVID-19 pandemic

2020 ◽  
Vol 3 (2) ◽  
pp. 90-94
Author(s):  
Vlad Braga ◽  
Iulian Slavu ◽  
Adrian Tulin ◽  
Bogdan Socea ◽  
Lucian Alecu
Keyword(s):  
Abdominal Trauma ◽  
Continuous Monitoring ◽  
Damage Control ◽  
Liver Parenchyma ◽  
Hemodynamic Instability ◽  
Liver Trauma ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Accidental Fall ◽  
Blunt Liver Trauma

AbstractThe liver is one of the most affected organs in abdominal trauma mostly because of its considerable dimensions, the fragility of the liver parenchyma.We present the case of a 29-year-old patient who sustained an abdominal trauma after an accidental fall from a 3 m height. The patient tested positive at RT-PCR for SARS-CoV-2 at admission, without any symptoms of viral infection. The emergency CT scan revealed a blunt liver trauma with an expanding hematoma (grade III). The patient was initially hemodynamically stable but shortly after admission became unstable and required surgical treatment that initially consisted of damage control and liver packing. Reintervention was decided 36 hours later, after reevaluation unpacking and hepatorrhaphy were done. The postoperative evolution was uneventful. The case indicated the importance of continuous monitoring of the traumatic patient. In liver trauma, hemodynamic instability guarantees an emergency laparotomy. The time of operations in trauma patients with SARS-CoV-2 must be reduced to the maximum both as an objective of damage control and also to minimize the risk of contagion.

scholarly journals Outcome of primary repair in typhoid ileal perforation at Tertiary Care Hospital.

2020 ◽  
Vol 27 (06) ◽  
pp. 1128-1132
Author(s):  
Gulshan Ali Memon ◽  
Abdul Hakeem Jamali ◽  
Sajjad Hussain Qureshi ◽  
Altaf Hussain Ghumro ◽  
Mashooq Ali Khowaja ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Tertiary Care Hospital ◽  
Primary Repair ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cross Sectional ◽  
Ileal Perforation ◽  
Surgical Department ◽  
Male Patients ◽  
The Common

Typhoid ileal perforation is the common complication of typhoid fever in third week of its phase of progression. It is the most common cause of mortality in developing countries. Small perforations are dealt with primary repair and the more complicated disease is treated by multiple other options. Prognosis is good with primary repair with least postoperative complications. Objectives: To detect the outcome of typhoid ileal perforation treated by primary repair at tertiary care hospital. Study Design: Cross sectional study. Setting: Surgical Department of PMC Hospital Nawabshah. Period: From August 2017 to December 2018. Material & Methods: This study included total 70 patients. All patients were admitted from surgical OPD and emergency department of PMCH Nawabshah. Out of 70, 45 (64.28%) were females and 25 (35.71%) were male patients. Age ranged from 27 to 52 and 24 to 47 in females and males respectively. The common presentation was pain in whole abdomen along with distention and fever, vomiting. Plain X ray chest/ Abdomen and ultra sonography showed gas under diaphragm. Primary repair was done and also other surgical options but our study included only the postoperative outcomes of primary repair of typhoid ileal perforation. A few complications were detected after primary repair of the gut perforation. Results: Total 70 patients were included in this study. 45 (64.28%) were females and 25 (35.71%) were male patients. In females, 25 (55%) were found single perforations of less than 1cm whereas 7 (15.5%) had size of perforation less than 1.5 cm. In 25 males, 11 (44%) had single perforations of less than 1cm in size. 2 (8%) had < 1.5 cm size perforations and 12 (48%). Over all complication rate in this study was 26%. Conclusion: Primary repair is the best surgical option to treat typhoid ileal perforation in selected patients with least postoperative complications.

scholarly journals The Incidence and Surgical Approaches of Pancreatic Injuries Following Blunt and Penetrating Abdominal Trauma in Al-DiwaniyahTeaching Hospital

2020 ◽  
Vol 11 (3) ◽  
pp. 3691-3698
Author(s):  
Adel Shaker Al Tamimi ◽  
Raafa Jawad Kadhm
Keyword(s):  
Abdominal Trauma ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Pancreatic Injury ◽  
Surgical Approaches ◽  
Trauma Patients ◽  
Penetrating Abdominal Trauma ◽  
Surgical Department ◽  
Pancreatic Injuries ◽  
Control Study

The pancreas is a long J-shaped, soft, lobulated retroperitoneal organ. Pancreatic injury is relatively uncommon, occurring in 0.2–2 % of all trauma patients and 3–12 % of patients with abdominal injury. All traumatic pancreatic injuries are associated with significant morbidity with an overall rate of morbidity nearing 40%, higher grade pancreatic injuries are associated with higher rates of morbidity and mortality . To evaluate of surgical management of blunt and penetrating pancreatic trauma. During the period from January 2015 to September 2018, thirty patients with blunt and penetrating abdominal trauma were managed in emergency surgical department in Al-Diwaniya Teaching Hospital and assigned in prospective a case control study. Patients with proved associated pancreatic injury (regardless of the degree) at the time of laparotomy were included in the study . The mean age of patients was 34.4 year (17- 57 years) among them there was 25 male (83.3 %) and 5 females (16. 7% The overall mortality rate is 20% (6 patients). The predominant mechanism of injury was penetrating 24 patients (80%) from gunshots and 6 patients with blunt abdominal trauma resulted from road traffic accidents). Pancreatic injury is infrequent in abdominal trauma. Its frequency is little different between blunt and penetrating abdominal trauma.

Management of Full-Thickness Duodenal Laceration in the Damage Control Era: Evolution to Primary Repair Without Diversion or Decompression

2011 ◽  
Vol 77 (6) ◽  
pp. 681-685 ◽  
Author(s):  
John Mayberry ◽  
Loic Fabricant ◽  
Amy Anton ◽  
Bruce Ham ◽  
Martin Schreiber ◽  
...  
Keyword(s):  
At Risk ◽  
Abdominal Trauma ◽  
Retrospective Review ◽  
Primary Repair ◽  
Damage Control ◽  
Organ Injury ◽  
Fascial Closure ◽  
Full Thickness

The management of duodenal laceration (DL) is controversial. We sought to determine the influence of damage control (DC) on the use of decompression/diversion/exclusion (DDE) techniques and the risk of duodenal-related complications (DRC). We conducted a retrospective review of all patients with full-thickness DL surviving more than 72 hours in the years 1989 to 2009. Forty-one patients with a median duodenal organ injury scale of 3 and a mean abdominal trauma index (ATI) of 45 ± 24 underwent laparotomy. Twenty-five patients (61%) were treated with DC and 16 (39%) with fascial closure (FC). Although the ATI of the patients treated with DC was greater than the ATI of the patients treated with FC (56 ± 23 vs 28 ± 17, P < 0.001), DRCs were equivalent (two vs three, nonsignificant). Twenty-one patients were treated in the first decade and 20 in the second decade. Between the first and second decades, there were trends toward an increased use of DC (52 to 70%, nonsignificant) and a decreased use of DDE (52 to 35%, nonsignificant) with a significant reduction in DRC (5 vs 0, P = 0.04). Among the 18 patients (44%) who underwent DDE procedures there were 2 DRCs (11%) related to DDE. Among the 23 patients who did not have DDE, there were three DRCs (13%), including two obstructions, one partial and one complete. When DC is used after DL, DDE may be unnecessary. Diversion is recommended, however, when the duodenum is at risk for obstruction after primary repair.

scholarly journals Rectal damage control: when to do and not to do

2021 ◽  
Vol 52 (2) ◽  
pp. e4124776
Author(s):  
Luis Saldarriaga ◽  
Helmer Emilio Palacios-Rodríguez ◽  
Luis Fernando Pino ◽  
Adolfo González-Hadad ◽  
Linda M. Gallego ◽  
...  
Keyword(s):  
Primary Repair ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Hemodynamic Instability ◽  
Trauma Management ◽  
Conservative Approach ◽  
Control Techniques ◽  
Rectal Trauma ◽  
Abdominal Organs ◽  
The Difference

Rectal trauma is uncommon, but it is usually associated with injuries in adjacent pelvic or abdominal organs. Recent studies have changed the paradigm behind military rectal trauma management, showing better morbidity and mortality. However, damage control techniques in rectal trauma remain controversial. This article aims to present an algorithm for the treatment of rectal trauma in a patient with hemodynamic instability, according to damage control surgery principles. We propose to manage intraperitoneal rectal injuries in the same way as colon injuries. The treatment of extraperitoneal rectum injuries will depend on the percentage of the circumference involved. For injuries involving more than 25% of the circumference, a colostomy is indicated. While injuries involving less than 25% of the circumference can be managed through a conservative approach or primary repair. In rectal trauma, knowing when to do or not to do it makes the difference.

Is Time of the Essence: A Retrospective Analysis of Operating Room Procedure Length for First Phase Damage Control Trauma Surgery

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Alison A. Smith ◽  
Lynn Hakki ◽  
Jessica Friedman ◽  
Rebecca Schroll ◽  
Chrissy Guidry ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Operating Room ◽  
Abdominal Trauma ◽  
Damage Control ◽  
Univariate Analysis ◽  
Hospital Length Of Stay ◽  
Average Hospital ◽  
Penetrating Abdominal Trauma ◽  
Hemostatic Resuscitation ◽  
Modern Era

Background:The concept of Damage Control Surgery (DCS) consists of a truncated surgical intervention with main focus on hemorrhage and contamination control. Traditionally,DCS involves limiting operating room (OR) time for patients with multiple life-threatening injuries and coagulopathy who are reaching physiologic exhaustion. However, in the modern era of hemostatic resuscitation, there is a paucity of evidence to support a survival benefit with shorter OR times. The objective of this study was to determine the practice habits of trauma surgeons in the modern era of DCS and to determine if operation length affects mortality in trauma patients with abdominal injuries. Methods:An 8-year retrospective review of consecutive adult patients with DCSfor penetrating abdominal trauma at a Level I trauma center was conducted. Patient demographics, injury severity score (ISS), and penetrating abdominal trauma index (PATI) scores were obtained. Average operating room times for initial DCS were determined. Patient outcomes were analyzed with a t-test for univariate analysis and a Cox proportional hazard ratio modeling was used to predict factors for survival.  Results:A total of 193 patients were included in the study.  The overall patient mortality was 14.0% (n=27/193). Median OR time was 157 minutes (range, 59-573 min). Patients were stratified into short OR group (SHORT, n=95) and long OR group (LORT, n=98) based on the median operative time. Only one patient had an initial DCL less than 60 minutes.  The SHORT group received more blood transfusions (52.6% vs. 35.7%, p=0.02) in the ICU. Average operative room time was almost twice as long in the LORT group (214.6+6.2 vs. 121.4+2.6 minutes, p<0.0001). The average hospital length of stay (22.8+2.3 vs. 31.0+3.5 days, p=0.05) and ICU length of stay (10.6+1.2 vs. 12.6+1.4 days, p=0.28) were both lower in the LORT group compared to the SHORT group. The SHORT group had 22 patients with unplanned return to the OR compared to 3 in the LORT group (p<0.0001). On multivariate analysis, OR time was not an independent risk factor for mortality (OR 1.0, 95% CI 0.98-1.0, p=0.48). Conclusions: Modern damage control practices should focus on early and effective surgical hemorrhage control in combination with effective intra-op hemostatic resuscitation efforts and not on how time limitations. These findings suggest that OR time restrictions in the era of effective hemostatic resuscitation in combination with DCS does not impact mortality.

scholarly journals AN AUDIT OF LAPAROTOMIES;

2013 ◽  
Vol 20 (02) ◽  
pp. 279-283
Author(s):  
TAHIR AHMAD KHAN ◽  
SAFDAR HUSSAIN AWAN ◽  
SAFDAR ALI KHAN ◽  
Shahbaz Amin
Keyword(s):  
Retrospective Study ◽  
Intestinal Obstruction ◽  
Acute Abdomen ◽  
Intestinal Perforation ◽  
Acute Intestinal Obstruction ◽  
Military Hospital ◽  
Cross Sectional ◽  
Penetrating Abdominal Trauma ◽  
Surgical Department ◽  
Accident And Emergency

Objective: To make an audit of laparotomies carried out at Combined Military Hospital Pano Aqil over a three year period.Study design: Cross sectional, retrospective study. Place and duration of study: Study was carried out at surgical department ofcombined military hospital Panno Aqil over a period of three years from Jan 2009 to Dec 2011. Patients and methods: Patients withsignificant intra-abdominal pathology presenting as acute abdomen and who underwent laparotomy were included in study. Patientswere either electively admitted via outpatient department or through Accident and Emergency (A&E) department. Patient charts andrecords were used to collect data. Results: All 174 patients underwent laparotomy. In (27.6%) cases, intestinal perforation was theunderlying cause; gynaecological pathology was found in (21.2%) patients. In 19.5% cases blunt and penetrating abdominal trauma wasthe cause of acute abdomen. Acute intestinal obstruction was found in (21.3%), tumors were found in (7.9%) and miscellaneous causeswere identified in (2.3%) cases. Conclusions: Laparotomies carried out at Combined Military Hospital Pano Aqil fulfilled the evidencebased medicine criteria.

scholarly journals The management of penetrating abdominal trauma – challenging situations in emergency

2016 ◽  
Vol 11 (1) ◽  
pp. 76-80
Author(s):  
Dragoş ŞERBAN ◽  
◽  
Costel ŞAVLOVSCHI ◽  
Cristian BRĂNESCU ◽  
Ahed El KHATIB ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Conservative Treatment ◽  
Emergency Room ◽  
Abdominal Trauma ◽  
Stab Wound ◽  
Hemodynamic Instability ◽  
Therapeutic Management ◽  
Penetrating Abdominal Trauma ◽  
Immediate Surgery

The paper is a retrospective study on a group of 97 patients admitted to the emergency room between 2012 to 2015 for suspicion of penetrating abdominal trauma. We have analyzed clinical data, paraclinical tests and how they correlate with therapeutic management. Out of the 97 patients, 78 presented penetrating stab wound. In 62 cases, immediate surgery was decided and 15 cases underwent seriated clinical and imaging follow-up. Of these, 3 patients underwent delayed laparotomy, for developing signs of peritonitis. The rate of non-therapeutic laparotomies was 9.72% (6 cases). Shock, peritonitis and evisceration were indications for immediate laparotomy. When the depth of the wound was uncertain, imaging tests (ultrasound, especially CT) provide valuable information for therapeutic management. Conservative treatment is an option for patients with no signs of hemodynamic instability and peritonitis, under careful clinical and paraclinical surveillance.

scholarly journals Should we care about Plasmodium vivax and HIV co-infection? A systematic review and a cases series from the Brazilian Amazon

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Paola López Del-Tejo ◽  
Nadia Cubas-Vega ◽  
Cecilia Caraballo-Guerra ◽  
Bernardo Maia da Silva ◽  
Jefferson da Silva Valente ◽  
...  
Keyword(s):  
Systematic Review ◽  
Plasmodium Vivax ◽  
Vivax Malaria ◽  
Tertiary Care ◽  
Case Series ◽  
Brazilian Amazon ◽  
Outcome Data ◽  
Malaria Episode ◽  
Tertiary Care Centre ◽  
Cross Sectional

Abstract Background Malaria and HIV are two important public health issues. However, evidence on HIV-Plasmodium vivax co-infection (HIV/PvCo) is scarce, with most of the available information related to Plasmodium falciparum on the African continent. It is unclear whether HIV can change the clinical course of vivax malaria and increase the risk of complications. In this study, a systematic review of HIV/PvCo studies was performed, and recent cases from the Brazilian Amazon were included. Methods Medical records from a tertiary care centre in the Western Brazilian Amazon (2009–2018) were reviewed to identify HIV/PvCo hospitalized patients. Demographic, clinical and laboratory characteristics and outcomes are reported. Also, a systematic review of published studies on HIV/PvCo was conducted. Metadata, number of HIV/PvCo cases, demographic, clinical, and outcome data were extracted. Results A total of 1,048 vivax malaria patients were hospitalized in the 10-year period; 21 (2.0%) were HIV/PvCo cases, of which 9 (42.9%) had AIDS-defining illnesses. This was the first malaria episode in 11 (52.4%) patients. Seven (33.3%) patients were unaware of their HIV status and were diagnosed on hospitalization. Severe malaria was diagnosed in 5 (23.8%) patients. One patient died. The systematic review search provided 17 articles (12 cross-sectional or longitudinal studies and 5 case report studies). A higher prevalence of studies involved cases in African and Asian countries (35.3 and 29.4%, respectively), and the prevalence of reported co-infections ranged from 0.1 to 60%. Conclusion Reports of HIV/PvCo are scarce in the literature, with only a few studies describing clinical and laboratory outcomes. Systematic screening for both co-infections is not routinely performed, and therefore the real prevalence of HIV/PvCo is unknown. This study showed a low prevalence of HIV/PvCo despite the high prevalence of malaria and HIV locally. Even though relatively small, this is the largest case series to describe HIV/PvCo.

Sign in / Sign up

Export Citation Format

Share Document