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Chu M, How N, Laviolette A, Bilic M, Tang J, Khalid M, Bos C, Rice TJ, Engels PT. Delayed laparoscopic peritoneal washout in non-operative management of blunt abdominal trauma: a scoping review. World J Emerg Surg 2022; 17:37. [PMID: 35780121 PMCID: PMC9250192 DOI: 10.1186/s13017-022-00441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Non-operative management (NOM) of blunt abdominal trauma has become increasingly common in hemodynamically stable patients. There are known complications of NOM from undrained intra-abdominal fluid accumulations including hemorrhage and peritonitis that require delayed operation. Thus, delayed operation can be considered as part of the overall management plan, instead of failure, of NOM. The aim of this scoping review is to establish key concepts regarding delayed laparoscopic peritoneal washout (DLPW) following NOM of blunt abdominal trauma patients. METHODS MEDLINE, EMBASE, CENTRAL, and gray literature were systematically searched. Studies were included if they investigated or reported on the use of delayed laparoscopy involving peritoneal washout following NOM of blunt abdominal trauma patients. Bibliographies of included studies were manually reviewed to identify additional articles for inclusion. RESULTS From 910 citations, 28 studies met inclusion criteria. This included seven case reports, eleven case series or observational cohort studies, six review articles, two management guidelines, one textbook chapter, and one randomized clinical trial. For those reported, medium grade liver injuries proved most common (95.2%). Indications for DLPW were primarily clinical features and changes in imaging findings, highlighting the importance of close observation. Authors reported clinical improvement after DLPW regarding symptomatology, vital signs, and biochemistry. A relatively high transfusion demand was reported with a mean of four units of packed red blood cells pre-operatively. Length of stay and post-operative complications were consistent with previously reported experiences with blunt abdominal injuries. CONCLUSIONS DLPW is beneficial in blunt abdominal trauma patients following NOM with improvement in symptoms, SIRS features, and a possible reduction in hospital length of stay. This study is limited by low-quality evidence and skewing of data toward isolated hepatic injuries. Future prospective cohort study comparing NOM with and without DLPW is required.
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Affiliation(s)
- Megan Chu
- Division of General Surgery, McMaster University, Hamilton, Canada.
| | - Nathan How
- Division of General Surgery, McMaster University, Hamilton, Canada
| | - Alysha Laviolette
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Monika Bilic
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Jennifer Tang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maham Khalid
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Cecily Bos
- Division of General Surgery, McMaster University, Hamilton, Canada.,Trauma Program, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Canada
| | - Timothy J Rice
- Division of General Surgery, McMaster University, Hamilton, Canada.,Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul T Engels
- Division of General Surgery, McMaster University, Hamilton, Canada.,Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
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Gritsiuta AI, Bracken A, Lara-Gutierrez J, Gilleland WN. Sit-ups and emergency abdominal surgery: a rare case of intestinal volvulus and resultant chylous ascites incited by abdominal exercises. J Surg Case Rep 2022; 2022:rjac155. [DOI: 10.1093/jscr/rjac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Chylous ascites is a unique phenomenon defined in the literature by ascitic fluid with a triglyceride content >200 mg/dl. This rather rare entity can be associated with a number of different pathologies related to abnormalities within the lymphatic system. This case report serves to demonstrate an intestinal volvulus and resultant chylous ascites found on exploratory laparotomy in an otherwise healthy individual who participated in routine, extreme abdominal exercises.
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Affiliation(s)
- Andrei I Gritsiuta
- Department of Surgical Services, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alexander Bracken
- Department of Surgical Services, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jorge Lara-Gutierrez
- Department of Surgical Services, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - William N Gilleland
- Department of Surgical Services, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Du M, Wang L, Zhao L, Huang W, Fang X, Xia X. Independent Risk Factors of Postoperative Lymphatic Leakage in Patients with Gynecological Malignant Tumor: A Single-Center Retrospective Study. Med Sci Monit 2021; 27:e932678. [PMID: 34226438 PMCID: PMC8272396 DOI: 10.12659/msm.932678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background We aimed this investigation to screen and analyze the risk factors of postoperative lymphatic leakage of gynecological malignant tumors that contribute to the treatment of the diseases. Material/Methods According to the occurrence of lymphatic leakage after an operation, 655 patients with pelvic lymph node and/or abdominal para-aortic lymph node dissection for gynecological malignant tumor were retrospectively analyzed and divided into a case group and a control group. Univariate and multivariate logistic regression analysis were used to screen the effective independent risk factors and establish a clinical prediction model. The differentiation and calibration of the clinical prediction model were evaluated, and we performed internal and external validation of the model with 207 cases. Results The surgeons, the number of removed lymph nodes, the field and range of lymph nodes to be removed, the method of drainage, and postoperative infection are the independent risk factors of lymphatic leakage after lymph node dissection for gynecological malignant tumors. The area under the ROC curve of the clinical prediction model was 0.839 (P<0.001), the calibration Hosmer-Lemeshow test shows χ2=4.381, P=0.821. Through 10-fold cross-validation, the average correct rate of the prediction model was 0.899, the area under the ROC curve of the external verification group was 0.741, and the calibration Hosmer-Lemeshow test showed χ2=12.728, P=0.122. Conclusions The new logistic prediction model showed a good degree of differentiation and calibration in both the modeling and verification groups, and it can be used for early warning of the occurrence of lymphatic leakage after lymph node dissection.
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Affiliation(s)
- Min Du
- Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Lei Wang
- The NHC Key Laboratory of Carcinogenesis and The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute, School of Basic Medical Science, Central South University, Changsha, Hunan, China (mainland)
| | - Liyun Zhao
- Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Wei Huang
- Research Center of Carcinogenesis and Targeted Therapy, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland).,The Higher Educational Key Laboratory for Cancer Proteomics and Translational Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Xiaoling Fang
- Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Xiaomeng Xia
- Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
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Wolf R, Smolinski-Zhao S. Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist. Semin Intervent Radiol 2021; 38:131-138. [PMID: 33883810 DOI: 10.1055/s-0041-1726003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In addition to acute injury requiring interventional radiologic treatments, patients with traumatic injuries can develop delayed or chronic complications. These injuries can involve nearly all solid organs in the abdomen. Coupled with significant improvements in visualizing these injuries with advanced imaging techniques such as minimally invasive procedures, nonoperative management of both acute traumatic injuries and their longer term sequelae has become the norm. This article reviews frequently seen complications of traumatic injury and their management by interventional radiologists.
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Affiliation(s)
- Robert Wolf
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Sara Smolinski-Zhao
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Fernandes V, Queirós J, Soares C. Chylous ascites: Case report of a rare presentation of blunt abdominal trauma. Int J Surg Case Rep 2020; 77:799-802. [PMID: 33395899 PMCID: PMC7724093 DOI: 10.1016/j.ijscr.2020.11.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Chylous ascites is the accumulation of a milk-like peritoneal fluid rich in triglycerides, due to the presence of intestinal lymph in the abdominal cavity. The most common causes of chylous acites in adults are abdominal malignancy and cirrhosis. Very few cases of chylous ascites associated to blunt abdominal trauma have been published in the literature. CLINICAL CASE A 27-year-old, female patient was admitted to the emergency department (ED) with abdominal pain due to a deceleration-type traffic accident. During surveillance the patient presented a progressive decrease in hemoglobin levels and an increase in free intra-abdominal fluid detected on computed tomography scan. The patient underwent an exploratory laparoscopy and a milky-looking peritoneal fluid was identified. The diagnosis of chylous ascites was confirmed by the determination of increased triglyceride levels in the peritoneal fluid. A low-fat diet, with a restriction of long-chain triglycerides, was started in the post-operative period and the patient presented a progressive decrease in abdominal drainage. The patient had a favorable clinical and analytical evolution and was discharged on the fifth post-operative day. DISCUSSION Chylous ascites is an uncommon finding in trauma. Although surgery may be indicated in selected patients, conservative treatment can be effective in most patients, with or without abdominal drainage. A high-protein and low-fat diet, with medium-chain triglycerides, is the indicated dietary regimen to decrease the amount of lymphatic fluid produced. CONCLUSION Chylous ascites, although rare in trauma patients must be considered in the diferential diagnosis of free peritoneal fluid. Conservative treatment should be considered in the majority of cases reserving invasive treatments for specific situations.
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Affiliation(s)
- Vânia Fernandes
- General Surgery Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.
| | - Jacinta Queirós
- General Surgery Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Carlos Soares
- General Surgery Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
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Abstract
Isolated thoracic duct injury is an uncommon clinical event and is rare in the setting of trauma. We describe a case of an isolated thoracic duct injury resulting in the development of bilateral chylothorax following a motor vehicle collision in the absence of any other definable injury. We outline the initial patient presentation and diagnosis. After failing a trial of conservative management the patient underwent lymphangiography followed by thoracic duct ligation with pleurodesis. This case highlights the importance of recognizing thoracic duct injury following trauma.
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Affiliation(s)
- Shelby Champion
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Daniele Wiseman
- Department of Medical Imaging, London Health Science Centre, London, Ontario, Canada
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