Hemoperitoneum Due to Penetrating Intercostal Artery Injury: A Case Report of a Rare and Still Understudied Entity

Intercostal artery injury may be life-threatening and usually presents as hemothorax. We report a unique case of penetrating injury, causing hemoperitoneum due to intercostal artery injury, without thoracic involvement. During urgent laparotomy, no intra-abdominal organ injury was found. Hemostasis was successfully achieved via suturing through an additional lateral 10cm incision through the left thorax.

Prevention of hypothermia in newborn submitted to surgical procedures: an integrative review

ABSTRACT Objective: to discuss in the scientific literature the strategies used to prevent hypothermia in newborns undergoing surgical procedures. Methods this is an integrative literature review, with structured search in April and May 2020 in 08 databases, using the descriptors: Hypothermia; Surgical Procedures, Operative; Infant, Newborn; Protocols. Four primary studies were selected and analyzed using three instruments to assess the methodological quality of the Joanna Briggs Institute and content analysis. Results: Among the strategies used, the following stand out: room temperature control; establishment of humidification and quality of air conditioning cleanliness; use of a heated incubator or cradle; use of thermal mattress; use of caps and blanket; heated fluids; temperature monitoring and abdominal organ coverage. Conclusion good hypothermia prevention strategies were identified, despite the small number of publications on this topic; thus, it points out the need for research with strong evidence.

Recommendations From the Society for the Advancement of Transplant Anesthesiology Fellowship Committee: Core Competencies and Milestones for the Kidney/Pancreas Component of Abdominal Organ Transplant Anesthesia Fellowship

The Society for the Advancement of Transplant Anesthesia (SATA) is dedicated to improving patient care in all facets of transplant anesthesia. The anesthesia fellowship training recommendations for thoracic transplantation (heart and lungs) and part of the abdominal organ transplantation (liver) have been presented in previous publications. The SATA Fellowship Committee has completed the remaining component of abdominal transplant anesthesia (kidney/pancreas) and has assembled core competencies and milestones derived from expert consensus to guide the education and overall preparation of trainees providing care for kidney/pancreas transplant recipients. These recommendations provide a comprehensive approach to pre-operative evaluation, vascular access procedures, advanced hemodynamic monitoring, assessment of coagulation and metabolic abnormalities, operative techniques, and post-operative pain control. As such, this document supplements the current liver/hepatic transplant anesthesia fellowship training programs to include all aspects of “Abdominal Organ Transplant Anesthesia” recommended knowledge.

Active extraperitoneal hematoma in the anterior abdominal wall after blunt injury

A 65-year-old male patient had extraperitoneal hematoma of the anterior abdominal wall after blunt trauma. The patient was treated with conservative management because of stable hemodynamics without deterioration of physical examination and laboratory tests; however, computed tomography revealed active bleeding. In abdominal wall hematoma, physical examination, hemodynamic monitoring, and laboratory tests may be the most important factor in determining a therapeutic plan. Repetitive imaging can be obtained and invasive treatment should be considered if these indices suggest hematoma exacerbation. Patients with abdominal trauma who have altered coagulation status should be carefully monitored for abdominal wall hematoma. Detecting abdominal wall hematoma is important because it may be the clue for potential intra-abdominal organ injury or delayed complication.

Be careful of splenic rupture caused by hit by a pitch during a baseball game: a case report

Background To the best of our knowledge, splenic rupture caused by hit by a pitch (HBP) has not been previously reported. We present a patient who underwent emergency laparotomy for splenic rupture after being HBP during a baseball game. Case presentation A 41-year-old male was HBP in the left abdomen during his first at-bat during a baseball game. During the operation, vascular injury of the splenic hilum and a deeply extending parenchymal injury were observed, and splenectomy was performed. Histologic findings were consistent with splenic rupture. Conclusions The patient’s postoperative course was uneventful. Although extremely rare, the possibility of intra-abdominal organ injury should be considered in batters who are hit in the abdomen by a pitched baseball, as illustrated by our patient.

A Modified Approach for the Ultrasound-Guided Quadratus Lumborum Block in Dogs: A Cadaveric Study

Ultrasound-guided quadratus lumborum block (QLB) is a locoregional technique described in canine cadavers. The aim of this study was to assess a modified approach to QLB to minimise potential complications such as abdominal organ puncture. Nine canine cadavers were included and were positioned in lateral recumbency. An ultrasound-guided QLB was performed on each side. The probe was placed in the transverse position over the lumbar muscles just caudal to the last rib, and a needle was advanced in-plane from a dorso-lateral to a ventro-medial. A volume of 0.2 mL kg−1 of a mixture of iomeprol and methylene blue was injected. Computed tomography (CT) and dissection were performed to evaluate the spreading. Success was defined as staining of the nerve with a length of more than 0.6 cm. Potential complications such as intra-abdominal, epidural, or intravascular spreading of the mixture were also assessed. The CT images showed a T13 to L7 vertebra distribution, with a median of 5 (3–6). Dissection showed staining of the nerves from T13 to L4, with a median of 3 (2–5). No complications were found. This modified approach to QLB is safe and shows similar results to the previous studies in canine carcass.

Pattern of intra-peritoneal intra-abdominal injuries in polytrauma patients admitted to general surgery department at El-Demerdash Hospital

Background Severe or major trauma is a worldwide pandemic and one of the leading causes of death and disability. Polytrauma always involves young, productive individuals and represents a substantial burden on the society. Aim of the Work To detect the incidence and the pattern of intra-abdominal injuries in polytraumatized patients admitted to the general surgery department at El-Demerdash Hospital and to estimate the trauma burden in General Surgery Department Ain Shams University. Patients and Methods Retrospective study of records of polytrauma patients admitted to general surgery department at El-Demerdash Hospital from the period of January 2018 to June 2018. Results In the specified study period of 6 months from 1/1 /2018 to 31/6 /2018, the ER department of Ain Shams University hospital (El-Demerdash hospital) received 3,328 cases of trauma out of which 40 cases were admitted at General Surgery Department with incidence rate 1.2% of total polytrauma patients admitted in the hospital in various departments. There were 37.5% of patients with intra-abdominal collection with no documented organ injury. Most common intra-abdominal organ injured was spleen 17.5% then liver the largest intra-abdominal organ 5% and stomach 5%, least to be injured were bowel loops 2.5%. Conclusion Polytrauma is a major health problem and a major cause of death in Egypt. 40 trauma cases were admitted to general surgery department. 80% of them were males and 20% were females. The mean age of trauma victims was 33.3 years old. 42.5% of them had surgeries. The study recorded 7.5% fatalities.

Trauma-Induced Rupture of Liver Hydatid Cyst: A Rare Cause of Anaphylactic Shock

Hydatid disease is rare; nevertheless, several areas of the world are endemic. Lebanon is one of the endemic countries. This disease requires careful management, as its diagnosis is tough, and its complications are severe and can lead to sudden death. These complications include fistulas, infection, and rupture. Rupture of a hydatid cyst can mimic acute abdomen and show an array of nonspecific symptoms. It could be mistaken for hemorrhagic shock, trauma, or injury to an intra-abdominal organ. The diagnosis of ruptured hydatid cyst should be kept in mind in cattle-raising countries. We report the case of a polytrauma patient who was suspected to have severe intra-abdominal bleeding and hemorrhagic shock, but imaging and laparotomy showed the rupture of a liver hydatid cyst that drove the patient into anaphylactic shock. This article reviews similar cases in the literature and discusses the diagnostic tools, appropriate management, and expected complications.