Don’t Lose Your Heart to a Car. Extracorporeal Ejection of the Heart by Forceful Upward Thoraco-abdominal Blunt Trauma in Human and Animal

The traumatic extracorporeal ejection of a beating heart has not been witnessed and reported in the literature previously, to our knowledge. Here we present two cases of vehicle accidents leading to this fatal injury, both in a rabbit and a human. Case 1. One late evening in June, in the land of the midnight sun, a young man was driving to his favourite fishing river for a spot of trout fishing in a remote part of Eastern Finland. While driving his aged Nissan Almera at 60 km/h down a dusty gravel road on this dusky night, suddenly a young male rabbit jumped onto the road and appeared in the beam of his headlights. Despite the man’s evasive manoeuvres, the rabbit was struck by the left front corner of the car. After hitting the brakes and the car eventually coming to a standstill, the young man went to inspect the animal he had hit…. In conclusion, we present that in a very rare constellation of forceful blunt trauma to the chest, the heart can be completely avulsed and ejected from the body in human as in animals. Larger prospective and randomised studies are probably not needed to confirm these findings. Just be careful – it is possible to lose your heart to a car.

Delayed duodenal stump blow-out following total gastrectomy for cancer: Heightened awareness for the continued presence of the surgical past in the present is the key to a successful duodenal stump disruption management. A case report

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Duodenal stump disruption is not a surgical anachronism, because it still remains one of the most dreadful postgastrectomy complications.

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Postgastrectomy duodenal stump disruption poses an overwhelming therapeutic challenge.

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Historical surgical sense and familiarity with the various well established methods for the treatment of duodenal stump disruption can provide to the surgical team the ability to successfully manage this devastating complication.

INTRODUCTION

Duodenal stump disruption remains one of the most dreadful postgastrectomy complications, posing an overwhelming therapeutic challenge.

PRESENTATION OF CASE

The present report describes the extremely rare occurrence of a delayed duodenal stump disruption following total gastrectomy with Roux-en-Y esophagojejunostomy for cancer, because of mechanical obstruction of the distal jejunum resulting in increased backpressure on afferent limp and duodenal stump. Surgical management included repair of distal jejunum obstruction, mobilization and re-stapling of the duodenum at the level of its intact second part and retrograde decompressing tube duodenostomy through the proximal jejunum.

DISCUSSION

Several strategies have been proposed for the successful management post-gastrectomy duodenal stump disruption however; its treatment planning is absolutely determined by the presence or not of generalized peritonitis and hemodynamic instability with hostile abdomen. In such scenario, urgent reoperation is mandatory and the damage control principle should govern the operative treatment.

CONCLUSION

Considering that scientific data about duodenal stump disruption have virtually disappeared from the current medical literature, this report by contradicting the anachronism of this complication aims to serve as a useful reminder for gastrointestinal surgeons to be familiar with the surgical techniques that provide the ability to properly manage this dreadful postoperative complication.