Delayed Mesenteric Hematoma of the Sigmoid Colon Following Blunt Abdominal Trauma

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Motor Vehicle ◽  
Pelvic Fractures ◽  
Motor Vehicle Crash ◽  
Organ Injury ◽  
Contrast Extravasation ◽  
Body Fracture ◽  
Mesenteric Hematoma ◽  
Level I ◽  
Hispanic Male ◽  
Trauma Bay

A 25-year-old Hispanic male was transferred to our level I trauma center after being ejected 40 feet from a motor vehicle crash. Once stabilized in the trauma bay, a computed tomography (CT) scan of the abdomen/pelvis with IV contrast revealed two AAST Organ Injury Scale grade III liver lacerations without contrast extravasation, bilateral pulmonary contusions, right posterior non-displaced fourth rib fracture, non-displaced right scapular body fracture, and bilateral anterior and posterior pelvic fractures [Figures 1–2]. A non-operative approach to the hepatic lacerations was chosen and the patient underwent closed reduction and percutaneous pinning of his posterior pelvic fractures as well as anterior external fixation of his bilateral pubic rami fractures.

Duodenal penetration of an inferior vena cava filter: case report and literature review

Vascular ◽  
2013 ◽  
Vol 21 (6) ◽  
pp. 386-390 ◽  
Author(s):  
William H Ward ◽  
David R Donahue ◽  
Timothy A Platz ◽  
Christopher D Scibelli
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Motor Vehicle ◽  
Vena Cava ◽  
Psoas Muscle ◽  
Motor Vehicle Crash ◽  
Organ Injury ◽  
Common Procedure ◽  
Vena Cava Filters ◽  
Cord Injury

The insertion of inferior vena cava filters (IVCF) is a well-known therapy used in the prevention of pulmonary embolism (PE). The incidence of IVCF-related complications is low and complete caval penetration of a filter with adjacent organ injury has a reported incidence of 0–1%. We report the case of an 18-year-old male who sustained a spinal cord injury after a motor vehicle crash. The patient received a prophylactic IVCF and subsequently presented with right flank pain, postprandial nausea, and vomiting. His exam was benign and a computed tomography scan revealed extra-caval penetration of the filter with struts within the duodenal lumen and psoas muscle. The patient underwent an exploratory laparotomy with extraction of the filter, inferior vena cava venorrhaphy, and repair of the duodenal injury. This complication illustrates the potential morbidity of a common procedure and emphasizes the importance of investigating the IVCF as a possible source of abdominal pain.

Prehospital Extrication Techniques: Neurological Outcomes Associated with the Rapid Extrication Method and the Kendrick Extrication Device

2018 ◽  
Vol 84 (2) ◽  
pp. 248-253
Author(s):  
Adam Misasi ◽  
Jeanette G. Ward ◽  
Fanglong Dong ◽  
Elizabeth Ablah ◽  
Chad Maurer ◽  
...  
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Motor Vehicle Crash ◽  
Motor Vehicle Collision ◽  
Injury Score ◽  
Emergency Medical Service Personnel ◽  
Neurological Outcomes ◽  
Vehicle Collision ◽  
Level I ◽  
Abbreviated Injury Score

Most emergency medical service personnel rely on one of two techniques to extricate motor vehicle crash victims; the Rapid Extrication Maneuver (REM) or the Kendrick Extrication Device (KED). The purpose of this study was to compare pre- and postextrication neurological outcomes between these two techniques. A retrospective review was conducted of all adult patients with a vertebral column injury resulting from motor vehicle collision and admitted to a Level I trauma center between January 1, 2003 and December 31, 2010. Standardized pre- and postextrication neurological examinations were reviewed for all patients. More than half of patients (N = 81) were extricated using the KED (53.1%, n = 43) and 46.9 per cent (n = 38) were extricated with the REM. Except for the thoracic Abbreviated Injury Score, no differences between groups emerged related to the Glasgow Coma Scale score, Injury Severity Score or Abbreviated Injury Score. There were no pre- and postextrication changes for motor to all extremities and sensation to all extremities using either method. The results of this study suggest that the REM and the KED are equivalent in protecting the patient from neurologic injury after motor vehicle collision.

Pediatric Pelvic Fractures: A Marker for Injury Severity

2006 ◽  
Vol 72 (6) ◽  
pp. 481-484 ◽  
Author(s):  
Lisa Spiguel ◽  
Loretto Glynn ◽  
Donald Liu ◽  
Mindy Statter
Keyword(s):  
Pelvic Fracture ◽  
Trauma Center ◽  
Motor Vehicle ◽  
Pediatric Trauma ◽  
Operative Management ◽  
Pelvic Fractures ◽  
Associated Injuries ◽  
Level I ◽  
The University ◽  
Pediatric Trauma Center

Pelvic fractures comprise a small number of annual Level I pediatric trauma center admissions. This is a review of the University of Chicago Level I Pediatric Trauma Center experience with pediatric pelvic fractures. This is a retrospective review of the University of Chicago Level I Pediatric Trauma Center experience with pediatric pelvic fractures during the 12-year period from 1992 to 2004. From 1992 to 2004, there were 2850 pediatric trauma admissions. Thirteen patients were identified with pelvic fractures; seven were boys and six were girls. The average age was 8 years old. The mechanism of injury in all cases was motor vehicle related; 11 patients (87%) sustained pedestrian-motor vehicle crashes. According to the Torode and Zeig classification system, type III fractures occurred in eight patients (62%) and type IV fractures occurred in six patients (31%). Associated injuries occurred in eight patients (62%). Seven of these patients (88%) had associated injuries involving two or more organ systems. Of the associated injuries, additional orthopedic injuries were the most common, occurring in 62 per cent of our patients. Neurological injuries occurred in 54 per cent of patients, vascular injuries in 39 per cent, pulmonary injuries in 31 per cent, and genitourinary injuries in 15 per cent. Five patients (38%) were treated operatively; only two patients underwent operative management directly related to their pelvic fracture. The remaining three patients underwent operative management of associated injuries. The mortality rate was 0 per cent. Although pelvic fractures are an uncommon injury in pediatric trauma patients, the morbidity associated with these injuries can be profound. The majority of pelvic fractures in children are treated nonoperatively, however, more than one-half of these patients have concomitant injuries requiring operative management. When evaluating and treating pediatric pelvic fractures, a systematic multidisciplinary approach must be taken to evaluate and prioritize the pelvic fracture and the associated injuries.

Pediatric Pancreatic Trauma: Trending toward Nonoperative Management?

2012 ◽  
Vol 78 (11) ◽  
pp. 1204-1210 ◽  
Author(s):  
Alex G. Cuenca ◽  
Saleem Islam
Keyword(s):  
Motor Vehicle ◽  
Nonoperative Management ◽  
Motor Vehicle Crash ◽  
Organ Injury ◽  
Ct Scans ◽  
Common Finding ◽  
Common Mechanism ◽  
Lower Grade ◽  
Pancreatic Trauma ◽  
Pancreatic Injuries

Pancreatic trauma is rare in children and optimal care has not been defined. We undertook this study to review the cumulative experience from three centers. After obtaining Institutional Review Board approval at each site, the trauma registries of three institutions were searched for pancreatic injuries. The charts were reviewed and data pertaining to demographics, hospital course, and outcome were obtained and analyzed. During the study period, a total of 79 pancreatic injuries were noted. The most common mechanism of injury was motor vehicle crash (44%) followed by child abuse (11%) and bicycle crashes (11%). Computed tomographic (CT) scans were obtained in 95 per cent with peripancreatic fluid the most common finding. Median Injury Severity Score (ISS) was 9, whereas median organ injury score was 2, and a higher grade correlated with need for operation ( P = 0.001). Pancreatic operations were performed in 32 patients, whereas non-operative management was noted in 47 cases. We noted no differences in length of stay, age, ISS, or initial blood pressure in operative versus nonoperatively managed cases. Pancreatic injuries were rare in children with trauma. CT scans were the most common method of diagnosis. Nonoperative management appeared to be safe and was more common, especially for the lower grade injuries.

Trauma Laparotomy: Evaluating the Necessity of Histological Examination

2009 ◽  
Vol 75 (11) ◽  
pp. 1124-1127
Author(s):  
Carrie Laituri ◽  
Andre Teixeira ◽  
Matthew W. Lube ◽  
Aaron Seims ◽  
Jeremy Cravens
Keyword(s):  
Histological Examination ◽  
Care Setting ◽  
Current Practice ◽  
Motor Vehicle ◽  
Traumatic Injury ◽  
Penetrating Trauma ◽  
Motor Vehicle Crash ◽  
Normal Specimen ◽  
Level I ◽  
Abnormal Pathology

Trauma laparotomy is the most commonly performed procedure in the acute care setting. As current practice, removed specimens are sent for histological examination. A retrospective review of all trauma laparotomies with specimens removed and sent to pathology during a 12-month period was performed in a Level I trauma center. One hundred five procedures of 244 trauma laparotomies yielded specimens sent for examination. Eighty-six patients were male and 19 patients were female with an average age of 34 ± 14 years. Fifty-six per cent of the injuries resulted from penetrating trauma and 44 per cent were from blunt trauma. Gunshot wound and motor vehicle crash were the most common penetrating and blunt injuries, respectively. One hundred thirteen specimens were sent to pathology. Forty-three per cent of the specimens were spleen, 24 per cent small bowel, 16 per cent large bowel, 4 per cent kidney, 2 per cent omentum, 3 per cent appendix, 3 per cent pancreas, and 1 per cent for gallbladder and lung. One hundred twelve of 113 grossly normal specimens had normal pathology. One grossly normal specimen exposed abnormal pathology revealing benign appendiceal mucocele. Therefore, 99.1 per cent of grossly normal specimens sent for histological examination after trauma laparotomy were normal. Based on our review, in select patients routine histological examination of tissues removed for traumatic injury is unnecessary.

Experimental Application of Global Positioning system To Locate Motor Vehicle Crashes: Impact on Time and Accuracy

1998 ◽  
Vol 1625 (1) ◽  
pp. 41-49 ◽  
Author(s):  
John S. Miller ◽  
Duane Karr
Keyword(s):  
Global Positioning System ◽  
Human Error ◽  
Motor Vehicle ◽  
Motor Vehicle Crash ◽  
Positioning System ◽  
Gps Receivers ◽  
Crash Data ◽  
Vehicle Crash ◽  
Global Positioning ◽  
Conventional Methods

Motor vehicle crash countermeasures often are selected after an extensive data analysis of the crash history of a roadway segment. The value of this analysis depends on the accuracy or precision with which the crash itself is located. yet this crash location only is as accurate as the estimate of the police officer. Global Positioning System (GPS) technology may have the potential to increase data accuracy and decrease the time spent to record crash locations. Over 10 months, 32 motor vehicle crash locations were determined by using both conventional methods and hand-held GPS receivers, and the timeliness and precision of the methods were compared. Local crash data analysts were asked how the improved precision affected their consideration of potential crash countermeasures with regard to five crashes selected from the sample. On average, measuring a crash location by using GPS receivers added up to 10 extra minutes, depending on the definition of the crash location, the technology employed, and how that technology was applied. The average difference between conventional methods of measuring the crash location and either GPS or a wheel ranged from 5 m (16 ft) to 39 m (130 ft), depending on how one defined the crash location. Although there are instances in which improved precision will affect the evaluation of crash countermeasures, survey respondents and the literature suggest that problems with conventional crash location methods often arise from human error, not a lack of precision inherent in the technology employed.

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