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Hamdi M, Hammoud KJ, Issa MY, Assad A. A Novel Case of Cervical Lipoma Arising From Surgical Incision. Ear Nose Throat J 2024:1455613241249085. [PMID: 38654496 DOI: 10.1177/01455613241249085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Lipoma is a benign mesenchymal tumor primarily found in subcutaneous fat. Post-traumatic lipoma (PTL) sporadically associates with blunt of penetrating trauma, but the exact mechanism remains not fully understood. This article unveils a rare case of a 32-year-old male presenting with a cervical lipoma at a previous surgical incision, an unprecedented occurrence. The patient incidentally detected the mass and underwent complete excision, with pathology confirming the diagnosis. The etiology of PTL remains speculative, with proposed mechanisms postulating inflammatory chemokines inducing preadipocyte differentiation and acute trauma causing septal rupture, allowing lipoma formation. Notably, the prior use of blade in our patient's surgical procedure aligns with this hypothesis. The varied nature of trauma encompasses acute, blunt, and penetrating injuries. This case represents the second instance attributed to penetrating trauma and the first occurrence at a surgical incision site.
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Affiliation(s)
- Mohammad Hamdi
- Department of Otolaryngology-Head and Neck Surgery, Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Kinana Jamal Hammoud
- Department of Otolaryngology-Head and Neck Surgery, Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | - Mohammad Yasin Issa
- Department of Otolaryngology-Head and Neck Surgery, Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Asef Assad
- Department of Otolaryngology-Head and Neck Surgery, Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
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Silver E, Nahmias J, Lekawa M, Inaba K, Schellenberg M, De Virgilio C, Grigorian A. Immediate Operative Trauma Assessment Score: A Simple and Reliable Predictor of Mortality in Trauma Patients Undergoing Urgent/Emergent Surgery. Am Surg 2024:31348241248784. [PMID: 38641872 DOI: 10.1177/00031348241248784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Objective: Many current trauma mortality prediction tools are either too intricate or rely on data not readily available during a trauma patient's initial evaluation. Moreover, none are tailored to those necessitating urgent or emergent surgery. Our objective was to design a practical, user-friendly scoring tool using immediately available variables, and then compare its efficacy to the widely-known Revised Trauma Score (RTS). Methods: The adult 2017-2021 Trauma Quality Improvement Program (TQIP) database was queried to identify patients ≥18 years old undergoing any urgent/emergent operation (direct from Emergency Department to operating room). Patients were divided into derivation and validation groups. A three-step methodology was used. First, multiple logistic regression models were created to determine risk of death using only variables available upon arrival. Second, the weighted average and relative impact of each independent predictor was used to derive an easily calculated Immediate Operative Trauma Assessment Score (IOTAS). We then validated IOTAS using AUROC and compared it to RTS. Results: From 249 208 patients in the derivation-set, 14 635 (5.9%) died. Age ≥65, Glasgow Coma Scale score <9, hypotension (SBP <90 mmHg), and tachycardia (>120/min) on arrival were identified as independent predictors for mortality. Using these, the IOTAS was structured, offering scores between 0-8. The AUROC for this was .88. A clear escalation in mortality was observed across scores: from 4.4% at score 1 to 60.5% at score 8. For the validation set (250 182 patients; mortality rate 5.8%), the AUROC remained consistent at .87, surpassing RTS's AUROC of .83. Conclusion: IOTAS is a novel, accurate, and now validated tool that is intuitive and efficient in predicting mortality for trauma patients requiring urgent or emergent surgeries. It outperforms RTS, and thereby may help guide clinicians when determining the best course of action in patient management as well as counseling patients and their families.
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Affiliation(s)
| | | | | | - Kenji Inaba
- University of Southern California, Los Angeles, CA, USA
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Jama T, Lefering R, Lauronen J, Handolin L. Factors affecting physicians' decision to start prehospital blood product transfusion in blunt trauma patients: A cohort study of Helsinki Trauma Registry. Transfusion 2024. [PMID: 38511866 DOI: 10.1111/trf.17791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Prehospital blood transfusions are increasing as a treatment for bleeding trauma patients at risk for exsanguination. Triggers for starting transfusion in the field are less studied. We analyzed the factors affecting the decision of physicians to start prehospital blood product transfusion (PHBT) in blunt adult trauma patients. STUDY DESIGN AND METHODS Data of all adult blunt trauma patients from the Helsinki Trauma Registry between March 2016 and July 2021 were retrospectively analyzed. Univariate analysis for the identification of predictive factors and multivariate regression analysis for their importance as predictive factors for the initiation of PHBT were applied. RESULTS There were 1652 patients registered in the database. A total of 556 of them were treated by a physician-level prehospital emergency care unit, of which by transfusion-capable unit in 394 patients. PHBT (red blood cells and/or plasma) was started in 19.8% of the patients. We identified three statistically highly important clinical triggers for starting PHBT: high crystalloid volume need, shock index ≥0.9, and need for prehospital pleural decompression. DISCUSSION PHBT in blunt adult trauma patients is initiated in ~20% of the patients in Southern Finland. High crystalloid volume need, shock index ≥0.9 and prehospital pleural decompression are associated with the initiation of PHBT, probably reflecting patients at high risk for bleeding.
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Affiliation(s)
- Timo Jama
- Wellbeing Services County of Päijät-Häme, Lahti, Finland
- University of Helsinki, Helsinki, Finland
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Jouni Lauronen
- University of Helsinki, Helsinki, Finland
- Finnish Red Cross Blood Service, Vantaa, Finland
| | - Lauri Handolin
- University of Helsinki, Helsinki, Finland
- Helsinki University Hospital Trauma Unit, Helsinki, Finland
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Dagestani H, Alomar S, Alfraidy D, Twier KI, Alramahi G. Isolated Blowout Distal Esophageal Injury From Blunt Thoraco-Abdominal Trauma Following Airbag Deployment in an Unrestrained Driver: A Case Report. Cureus 2024; 16:e53718. [PMID: 38455768 PMCID: PMC10919379 DOI: 10.7759/cureus.53718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Esophageal perforation from blunt trauma is rare. It is more frequently encountered in a penetrative mechanism where the cervical esophagus is most commonly injured. Blunt esophageal injury is challenging to diagnose with nonspecific findings clinically and radiologically within trauma settings. The main factors contributing to difficulty in early recognition are its scarce occurrence combined with nonspecific manifestations clinically on patient examination and radiologically on usual trauma computed tomography with intravenous contrast. We report a case of a 15-year-old young man who sustained an isolated distal blowout esophageal perforation as a result of blunt thoraco-abdominal trauma. Despite early primary surgical repair, a leak developed later on, which was managed with stent placement. The leak and associated sepsis were resolved, with an overall status improvement and no subsequent complications. We report an unusual presentation of esophageal perforation from blunt trauma, which was promptly diagnosed and managed with multiple modalities. This case highlights the importance of early recognition and management of esophageal injury and, furthermore, the role of multiple diagnostic and therapeutic modalities that lead to a successful outcome.
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Affiliation(s)
- Hatoon Dagestani
- Department of Surgery, King Saud University Medical City, Riyadh, SAU
| | - Sahar Alomar
- Department of Trauma Surgery, King Saud University Medical City, Riyadh, SAU
| | - Doaa Alfraidy
- Department of Surgery, King Saud University Medical City, Riyadh, SAU
| | - Khaled I Twier
- Department of Trauma Surgery, King Saud University Medical City, Riyadh, SAU
| | - Ghassan Alramahi
- Department of Trauma Surgery, King Saud University Medical City, Riyadh, SAU
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Michalopoulos GD, Pennington Z, Bambakidis P, Alexander AY, Lakomkin N, Charalampous C, Sammak SE, Hassett LC, Graepel S, Meyer FB, Bydon M. Traumatic vertebral artery injury: Denver grade, bilaterality, and stroke risk. A systematic review and meta-analysis. J Neurosurg 2024; 140:522-536. [PMID: 37548568 DOI: 10.3171/2023.5.jns222818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/23/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Vertebral artery injury (VAI), a complication of blunt trauma, may cause posterior circulation stroke. An association of disease severity, classified in Denver grades, with stroke risk has not been shown. Using a literature-based analysis, the authors estimated the incidence of VAI following blunt trauma with the aim to investigate the impact of Denver grade and bilateral VAI on stroke occurrence. METHODS A systematic review of the literature on VAI following blunt trauma was conducted, and data on its incidence, the severity per Denver grade, and stroke occurrence were collected. The incidence of VAI and stroke occurrence were analyzed cumulatively and between Denver grades. A meta-analysis with random-effects models was performed. RESULTS Fifty-six studies including 2563 patients were identified. The overall incidence of VAI was 0.49% among blunt trauma cases and 14.5% among patients screened via any type of angiography. The incidence rates of bilateral VAI and concurrent carotid injury among all VAIs were 12.3% and 19.2%, respectively. VAI severity by Denver grade was as follows: grade I, 23.4%; grade II, 28.2%; grade III, 5.8%; grade IV, 42.1%; and grade V, 0.5%. The overall stroke risk was 5.32%, differing significantly among lesions of different Denver grades (p = 0.02). Grade III and IV lesions had the highest stroke prevalence (9.8% and 10.9% respectively), while strokes occurred significantly less frequently in patients with grade I and II lesions (1.9% and 3.0%, respectively). Denver grade V cases were too rare for meaningful analysis. Bilateral VAI was associated with a 33.2% stroke prevalence. The association between Denver grade and stroke occurrence persisted in a sensitivity subanalysis including only unilateral cases (p = 0.03). CONCLUSIONS VAI complicates a small yet nontrivial fraction of blunt trauma cases, with Denver grade IV lesions being the most common. This is the first study to document a significantly higher stroke prevalence among grade III and IV VAIs compared with grade I and II VAIs independently from bilaterality. Bilateral VAIs carry a significantly higher stroke rate.
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Affiliation(s)
- Giorgos D Michalopoulos
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Zach Pennington
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Peter Bambakidis
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - A Yohan Alexander
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 3University of Minnesota Medical School, Minneapolis, Minnesota
| | - Nikita Lakomkin
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | - Sally El Sammak
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 4Department of Neurology, Emory University, Atlanta, Georgia; and
| | | | - Stephen Graepel
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Fredric B Meyer
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- 1Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
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Correia G, Mendes Santos P, Campos JP, Camelo Barbosa N, Carvalho L. Acute Compartment Syndrome of the Thigh After Contusion in a Football Player. Cureus 2024; 16:e53617. [PMID: 38449983 PMCID: PMC10916738 DOI: 10.7759/cureus.53617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 03/08/2024] Open
Abstract
Acute compartment syndrome of the thigh is an exceptionally uncommon condition that can have severe consequences if not promptly and effectively treated. A 19-year-old man presented to our emergency department with severe and progressive pain in his left thigh after sustaining a direct trauma during a football game 24 hours prior. Compartment pressure was assessed, confirming the diagnosis of compartment syndrome arising from a sizable intramuscular hematoma without detection of any other contributing factors. Fasciotomy incisions were closed using the shoelace technique with excellent functional results. This case highlights the importance of high suspicion and intra-compartmental pressure measurement to diagnose this condition accurately.
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Affiliation(s)
| | - Pedro Mendes Santos
- Orthopedics and Traumatology, Unidade Local de Saúde de Matosinhos, Matosinhos, PRT
| | - João Pedro Campos
- Orthopedics and Traumatology, Unidade Local de Saúde de Matosinhos, Matosinhos, PRT
| | - Nuno Camelo Barbosa
- Orthopedics and Traumatology, Unidade Local de Saúde de Matosinhos, Matosinhos, PRT
| | - Luís Carvalho
- Orthopedics and Traumatology, Unidade Local de Saúde de Matosinhos, Matosinhos, PRT
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Lukies M, Clements W. Splenic artery embolisation for splenic injury during colonoscopy: A systematic review. United European Gastroenterol J 2024; 12:44-55. [PMID: 38047383 PMCID: PMC10859723 DOI: 10.1002/ueg2.12498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/21/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Splenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low-grade injuries or with splenectomy for high-grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes of published cases of splenic injury due to colonoscopy treated with splenic artery embolisation. METHODS A systematic review was performed of published articles concerning splenic injury during colonoscopy treated primarily with splenic artery embolisation, splenectomy, or splenorrhaphy from 1977 to 2022. Datapoints included demographics, past surgical history, indication for colonoscopy, delay to diagnosis, treatment, grade of injury, splenic artery embolisation location, splenic preservation (salvage), and mortality. RESULTS The 30 patients treated with splenic artery embolisation were of mean age 65 (SD 9) years and 67% female, with 83% avoiding splenectomy and 6.7% mortality. Splenic artery embolisation was proximal to the splenic hilum in 81%. The 163 patients treated with splenectomy were of mean age 65 (SD 11) years and 66% female, with 5.5% mortality. Three patients treated with splenorrhaphy of median age 60 (range 59-70) years all avoided splenectomy with no mortality. There was no difference in mortality between splenic artery embolisation and splenectomy cohorts (p = 0.81). CONCLUSIONS Splenic artery embolisation is an effective treatment option in splenic injury due to colonoscopy. Given the known benefits of splenic salvage compared to splenectomy, including preserved immune function against encapsulated organisms, low cost, and shorter hospital length of stay, embolisation should be incorporated into treatment pathways for splenic injury due to colonoscopy in suitable patients.
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Affiliation(s)
- Matthew Lukies
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
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Muzyka L, Bradford JM, Teixeira PG, DuBose J, Cardenas TCP, Bach M, Ali S, Robert M, Brown CVR. Trends in prehospital cervical collar utilization in trauma patients: Closer, but not there yet. Acad Emerg Med 2024; 31:36-41. [PMID: 37828864 DOI: 10.1111/acem.14822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE This study aims to assess the change in cervical spine (C-spine) immobilization frequency in trauma patients over time. We hypothesize that the frequency of unnecessary C-spine immobilization has decreased. METHODS A retrospective chart review of adult trauma patients transported to our American College of Surgeons-verified Level I trauma center from January 1, 2014, to December 31, 2021, was performed. Emergency medical services documentation was manually reviewed to record prehospital physiology and the application of a prehospital cervical collar (c-collar). C-spine injuries were defined as cervical vertebral fractures and/or spinal cord injuries. Univariate and year-by-year trend analyses were used to assess changes in C-spine injury and immobilization frequency. RESULTS Among 2906 patients meeting inclusion criteria, 12% sustained C-spine injuries, while 88% did not. Patients with C-spine injuries were more likely to experience blunt trauma (95% vs. 68%, p < 0.001), were older (46 years vs. 41 years, p < 0.001), and had higher Injury Severity Scores (31 vs. 18, p < 0.001). They also exhibited lower initial systolic blood pressures (108 mm Hg vs. 119 mm Hg, p < 0.001), lower heart rates (92 beats/min vs. 97 beats/min, p < 0.05), and lower Glasgow Coma Scale scores (9 vs. 11, p < 0.001). In blunt trauma, c-collars were applied to 83% of patients with C-spine injuries and 75% without; for penetrating trauma, c-collars were applied to 50% of patients with C-spine injuries and only 8% without. Among penetrating trauma patients with C-spine injury, all patients either arrived quadriplegic or did not require emergent neurosurgical intervention. The proportion of patients receiving a c-collar decreased in both blunt and penetrating traumas from 2014 to 2021 (blunt-82% in 2014 to 68% in 2021; penetrating-24% in 2014 to 6% in 2021). CONCLUSIONS Unnecessary C-spine stabilization has decreased from 2014 to 2021. However, c-collars are still being applied to patients who do not need them, both in blunt and in penetrating trauma cases, while not being applied to patients who would benefit from them.
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Affiliation(s)
- Logan Muzyka
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - James M Bradford
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Pedro G Teixeira
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Joseph DuBose
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Tatiana C P Cardenas
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Michelle Bach
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Sadia Ali
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Michelle Robert
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Carlos V R Brown
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
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Kong I, Riddell LW, Kohler JM, Nguyen MC, Carraro MN. Atypical Presentation and Diagnosis of Multiple Myeloma: A Case Report. Cureus 2024; 16:e51870. [PMID: 38327916 PMCID: PMC10849065 DOI: 10.7759/cureus.51870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
Chronic neck pain is a common, seemingly benign condition that typically does not warrant an urgent workup, in contrast to acute onset neck pain. Vertebral artery dissection (VAD) is a relatively rare presentation of acute onset neck pain and often presents in the context of blunt trauma. Due to the risk of subsequent clot formation and stroke, patients who present with symptoms suggestive of VAD must be promptly screened, most often first with computed tomography angiography (CTA) followed by magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA) for further evaluation. We present a case of a 69-year-old male with a history of chronic neck pain who was seen in the emergency department due to acute, severe neck pain with initial CTA imaging that suggested left VAD. However, follow-up MRI of his cervical spine identified that what seemed to be a left VAD was instead multiple myeloma. This case demonstrates the utility of using multiple imaging modalities, including CT, CTA, MRI, and MRA, in diagnosing an atypical presentation of multiple myeloma and the consequences of physician implicit biases that are often involved when treating patients with chronic pain.
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Affiliation(s)
- Iris Kong
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Luke W Riddell
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Jacquelyn M Kohler
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Michael C Nguyen
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Michelle N Carraro
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
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Chan SY, Huang JF, Cheng CT, Hsu CP, Liao CH, Fu CY. Low-molecular-weight heparin is associated with lower venous thromboembolism events than factor Xa inhibitors in patients with severe blunt trauma: a cohort study from the Trauma Quality Improvement Program. Int J Surg 2024; 110:280-286. [PMID: 37738013 PMCID: PMC10793782 DOI: 10.1097/js9.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common complication of major trauma. Pharmacological VTE prophylactics are widely used, and low-molecular-weight heparin (LMWH) is recommended. Factor Xa inhibitors are increasingly being used for VTE prophylaxis in both medical and surgical patients. Evidence comparing LMWH and factor Xa inhibitors as VTE prophylactics for severe blunt trauma is lacking. This study aims to compare the efficacy and safety of factor Xa inhibitors and LMHW in VTE prophylaxis. MATERIALS AND METHODS Patients with severe blunt trauma who received LMWH or a factor Xa inhibitor for VTE prophylaxis in the Trauma Quality Improvement Program between 2017 and 2019 were included. The comparison was performed after using propensity score matching. The outcomes included mortality and incidence of DVT, PE, post-prophylactics haemorrhage control procedures and length of stay. RESULTS After 2:1 propensity score matching, 1128 patients ( n =752, LMHW group; n =376, factor Xa inhibitor group) were included in the analysis. Patients in the LMWH group had fewer VTE events than those in the factor Xa inhibitor group (DVT, 3.7% vs. 7.2%, P =0.013; PE, 0.4% vs. 3.2%, P <0.001). VTE risk was higher in the factor Xa group (DVT: odds ratio, 1.97; 95% CI, 1.12-3.44; P =0.018 and PE: odds ratio, 9.65; 95% CI, 2.91-44.12; P =0.001). The mortality rate was higher in the LMWH group; however, there was no significant difference (4.0% vs. 1.9%; P =0.075). The difference in the risk of undergoing haemorrhage control surgery after VTE prophylaxis between both groups was insignificant (0.3% vs. 0.0%; P =0.333). CONCLUSIONS LMWH was associated with a lower risk of VTE than factor Xa inhibitors in patients with severe blunt trauma. The mortality rate was higher in the LMWH group; however, there was no statistically significant difference observed.
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Affiliation(s)
- Sheng-Yu Chan
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Huang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Chang Gung University, Taoyuan, Taiwan
| | - Chih-Po Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Chang Gung University, Taoyuan, Taiwan
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Wasfie T, Hardy R, Naisan M, Hella J, Barber K, Yapchai R, Memar S, Megaly M, Shapiro B. Value of Thoracic CT in Blunt Trauma Patients With High Glasgow Coma Scale and Low Injury Severity Scale. Am Surg 2023; 89:5678-5681. [PMID: 37118989 DOI: 10.1177/00031348231173423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To determine the value of ordering a routine chest CT (CCT) in patients with blunt trauma presenting to the emergency department with a high GCS and low ISS, we retrospectively collected patient data including CT scan results, when physical examination and initial chest X-ray were normal in the trauma bay area. METHODS A retrospective data collection of 901 consecutive blunt trauma patients seen in the ED between 2017 and 2019 was analyzed. Data included physical examination, age, gender, current use of anticoagulation therapy, comorbid conditions, as well as the result of radiologic images, hospital length of stay, surgical intervention, and mortality. The patients were divided into two groups: group one (patients with negative physical examination; chest x-ray and CT) and group 2 (negative physical examination, positive or negative chest x-ray, and positive CT). Statistical analysis was performed using student's t-test and chi-square test. RESULTS Of the 901 patients there were 489 (54%) males and 412 (46%) females with a mean age of 56 years. There were 461 patients who had a physical examination, chest x-ray, abdominal and CCT done. Group one included 442 (96%) patients, with negative physical examination, negative chest X-ray and CT scan. In group 2, 19 (4%) patients who had positive CT and or chest x-ray. Both groups were similar in GCS and ISS. Of the 19 patients, sixteen patients had a positive CCT, and thirteen of those had a positive chest x-ray. In the three patients who had negative physical examination and chest x-ray, the CT findings included one with a nondisplaced 10th rib fracture and two patients with osteoporotic compression fractures of dorsal vertebrae. The rate of both chest x-ray and CCT being positive among a group of screened patients was 16% (3/19) and the rate of a negative chest x-ray but positive CT was 16% (3/19). The odds ratio between the two outcomes was one. CONCLUSION In blunt trauma patients presenting to the ED with a high GCS and low ISS score, when initial physical examination and chest x-ray are negative, routine CCT is of little value.
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Affiliation(s)
- Tarik Wasfie
- Department of Trauma and General Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Rachel Hardy
- Department of Trauma and General Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | | | - Jennifer Hella
- Department of Academic Research, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Kimberly Barber
- Department of Academic Research, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Raquel Yapchai
- Department of Trauma and General Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Shayan Memar
- Kirkville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Maher Megaly
- College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Brian Shapiro
- Department of Trauma and General Surgery, Ascension Genesys Hospital, Grand Blanc, MI, USA
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12
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Chen S, Ma G, Zhang P, Kang Q. Isolated traumatic supraclinoid internal carotid artery dissection diagnosed by high-resolution vessel wall MRI. Br J Neurosurg 2023; 37:1801-1804. [PMID: 34585640 DOI: 10.1080/02688697.2021.1919861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 04/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Isolated traumatic supraclinoid internal carotid artery (ICA) dissection is a rare complication of blunt craniomaxillofacial trauma, and differentiation from atherosclerosis is the key factor for confirming the diagnosis. CASE DESCRIPTION A 53-year-old man was admitted because of blunt trauma to his head and face. His primary manifestations were disability of abduction of the left eye on day 2, recurrent epistaxis and a blowing murmur in the left ear on day 4. Neurological physical examination showed bilateral normal pupil diameter, a corrected visual acuity of 0.6 in the right eye and 0.3 in the left eye, and loss of abduction of the left eye. Craniofacial computed tomography scans revealed multiple craniomaxillofacial fractures mainly including a LeFort III injury of the left maxilla, fractures of the left ramus of the mandible, fractures of the left orbital apex, fractures of the sellar turcica, etc. Brain magnetic resonance (MR) findings showed multifocal lacunar infarcts in the left hemisphere. Cerebral angiography demonstrated severe intraluminal stenosis of the left supraclinoid ICA, which was highly suspicious of arterial dissection. A high-resolution vessel wall MR imaging performed on day 7 showed proximal intramural subacute haemorrhage and two distal intimal flaps at the injured region, both of which facilitated the exclusion of atherosclerosis and thus, confirmation of isolated arterial dissection. The patient underwent treatment with endovascular stent placement and antiplatelet agents two weeks later and had no ictus of symptomatic stroke during the next half-year duration. CONCLUSIONS HR vw-MRI is able to assist in the diagnosis of isolated traumatic supraclinoid dissection complicated with underlying atherosclerosis.
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Affiliation(s)
- Shanwen Chen
- Department of Neurosurgery, The Hospital of Shunyi District, Beijing, China
| | - Gengping Ma
- Department of Neurosurgery, The Hospital of Shunyi District, Beijing, China
| | - Peng Zhang
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijng, China
| | - Quanli Kang
- Department of Neurosurgery, The Hospital of Shunyi District, Beijing, China
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13
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Ramachandran S, Chavan K, Padhi TR, Takkar B, Karande S, Kelgaonkar A, Panda KG, Padhy SK. Central retinal artery occlusion following pediatric blunt ocular trauma. Indian J Ophthalmol 2023; 71:3626-3632. [PMID: 37991294 PMCID: PMC10788753 DOI: 10.4103/ijo.ijo_3337_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND To analyze the clinical profile, presentation, possible pathophysiology, and outcomes of central retinal artery occlusion (CRAO) following blunt trauma in pediatric subjects. METHODOLOGY The medical charts of subjects aged 18 years or less with a diagnosis of CRAO following blunt ocular trauma were analyzed retrospectively for demography, details of the trauma, ocular findings, additional imaging reports if any, and final outcome. A Medline search was done (key words like central retinal artery occlusion, blunt trauma, children, pediatric subjects, and adolescents) to gather information available in the literature on the subject. RESULTS A total of 11 patients (11 eyes), mean age of 14.3 ± 3.4 years, and 100% male preponderance, with an average time duration from trauma to presentation to the hospital of 8.1 days were included. Visual acuity ranged from no light perception (four eyes) to finger count at a 1 m distance. Intraocular pressure was raised in three patients, of which two were suffering from sickle cell disease. In two eyes, the CRAO coexisted with optic nerve avulsion and the cilioretinal artery was spared. Disk pallor was seen in six eyes as early as 12 days from the trauma. None of the cases revealed any bony fracture in the CT scan. CONCLUSION CRAO was observed to be an important primary or contributory cause of visual loss in children following blunt trauma, reflex vasospasm being the most common etiology. Early onset disk pallor could suggest an underlying vascular compromise of both retinal and optic disk circulation in addition to direct disk damage.
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Affiliation(s)
- Sivaranjan Ramachandran
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Kasturi Chavan
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Tapas R Padhi
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Brijesh Takkar
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayali Karande
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Anup Kelgaonkar
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Krushna G Panda
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Srikanta K Padhy
- Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India
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14
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Srisukho S, Chandacham K, Tongsong T. Complete transverse transection of the normal-sized non-pregnant uterus associated with wearing a safety belt in abdominal blunt trauma: Narrative review and case study. Int J Gynaecol Obstet 2023. [PMID: 37927124 DOI: 10.1002/ijgo.15227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/23/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
This review and case study illustrates a patient with a complete transverse transection of a non-pregnant uterus caused by blunt trauma associated with wearing a safety belt. The 31-year-old patient, who had a previous cesarean section, presented with impending hypovolemic shock caused by intra-abdominal hemorrhage secondary to blunt trauma while wearing a safety belt. On physical examination, a transverse straight line of ecchymosis along the line of a fastened safety belt was noted without any other external injury. The operative findings revealed a complete transverse transection which had cut through the lower part of the non-pathological, normal-sized uterus with active bleeding and mild injury to the small bowel without active bleeding. Total hysterectomy and simple closure of the small bowel were performed with successful outcomes. We hypothesize that transection was caused by the enormous pressure produced by blunt trauma transmitted through the abdomen by the fastened safety belt and the weakness of the uterine wall caused by the previous low transverse cesarean section which facilitated the separation and extension to the entire wall. In conclusion, this case study provides the following learning points: (1) Enormous forces produced by a fixed fastened safety belt during a car accident can cause complete transverse transection of a normal-sized, non-pathological uterus, leading to life-threatening intra-abdominal hemorrhage. (2) A previous cesarean section may potentiate the transection, especially when the uterus is repositioned above the pelvic brim. (3) The gynecologic condition should also be included in the differential diagnoses in cases of intra-abdominal hemorrhage. If highly suspected, gynecologists should be notified for early recognition and avoidance of delayed actions.
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Affiliation(s)
- Sasivimol Srisukho
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kamtone Chandacham
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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15
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Albalawi N, Alhazmi M, ALqahtani A, Aloboudi A, Mesawa A, Alotaibi N, Babiker A. Appendicitis Post Fall in the Pediatric Population: A Case Report. Cureus 2023; 15:e49603. [PMID: 38161912 PMCID: PMC10755133 DOI: 10.7759/cureus.49603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
The appendix is a small, finger-sized tubular pouch that extends from your large intestine. Regardless, the physiology of the appendix is still unclear. There are several factors that cause appendicitis, such as infection, underlying tumor, constipation, and trauma. Symptoms of right lower quadrant abdominal pain, nausea, anorexia, and fever, as well as physical signs such as rebound tenderness and McBurney point/sign, are typical of non-traumatic acute appendicitis. On the other hand, a thorough history and physical examination are paramount for an accurate diagnosis of acute traumatic appendicitis. If the history and physical examination are inconclusive, further evaluation with ultrasonography or computed tomography (CT) is advised. Upon reaching an accurate diagnosis, the course of treatment involves an appendectomy and intravenous antibiotics. This case describes a patient who suffered blunt traumatic abdominal injury from a fall resulting in acute appendicitis. For pediatric patients who complain of abdominal pain and present to the emergency department (ED), appendicitis should be on the differential diagnosis list, even if the patient's symptoms started after blunt abdominal trauma. Due to the rarity of appendicitis after trauma, rapid identification necessitates a high index of suspicion.
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Affiliation(s)
- Nouf Albalawi
- Pediatric Emergency Medicine, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Mishal Alhazmi
- Pediatric Emergency Medicine, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Abduallah ALqahtani
- Pediatric Emergency Medicine, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Abdullah Aloboudi
- Pediatric Radiology, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Alanoud Mesawa
- Pediatric Emergency Medicine, King Abdullah Specialized Children's Hospital, Riyadh, SAU
| | - Naif Alotaibi
- Emergency Medicine, King Abdulaziz Medical City, Riyadh, SAU
| | - Amel Babiker
- Pediatric Emergency Medicine, King Abdullah Specialized Children's Hospital, Riyadh, SAU
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16
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Sharma A, Khanna R, Meena RN, Mishra SP, Khanna S. A Case Series on Acute Mesenteric Ischemia (AMI) Leading to Intestinal Gangrene Following Blunt Trauma to the Abdomen. Cureus 2023; 15:e49092. [PMID: 38125260 PMCID: PMC10731625 DOI: 10.7759/cureus.49092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
The term "acute mesenteric ischemia" (AMI) refers to a set of conditions where the blood supply to various segments of the small intestine is cut off, causing ischemia and subsequent inflammatory changes that might result in bowel gangrene. Estimates place the incidence between 0.09% and 0.2% of all acute surgical hospitalizations. Early diagnosis is essential, despite the entity being a rare cause of abdominal discomfort, because if left untreated, mortality is 50%. Herein, we present a case series of three patients with bowel ischemia following blunt abdominal trauma.
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Affiliation(s)
- Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Rahul Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Ram Niwas Meena
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Shashi Prakash Mishra
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Seema Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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17
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Hogarty J, Jassal K, Ravintharan N, Adhami M, Yeung M, Clements W, Fitzgerald M, Mathew JK. Twenty-year perspective on blunt traumatic diaphragmatic injury in level 1 trauma centre: Early versus delayed diagnosis injury patterns and outcomes. Emerg Med Australas 2023; 35:842-848. [PMID: 37308166 DOI: 10.1111/1742-6723.14255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/25/2023] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Blunt traumatic diaphragmatic injury (TDI) is typically associated with severe trauma and concomitant injuries. It is a diagnostic challenge in the setting of blunt trauma and can be easily overlooked especially in the acute phase often dominated by concurrent injuries. METHODS A retrospective review was conducted of patients with blunt-TDI identified from a level 1 trauma registry. Variables associated with early versus delayed diagnosis as well as non-survivor and survivor groups were collected to examine factors associated with delayed diagnosis. RESULTS A total of 155 patients were included (mean age 46 ± 20, 60.6% male). Diagnosis was made <24 h in 126 (81.3%), and >24 h in 29 (18.7%). Of the delayed diagnosis group, 14 (48%) were diagnosed >7 days. Overall, 27 (21.4%) patients had a diagnostic initial CXR and 64 (50.8%) had a diagnostic initial CT. Fifty-eight (37.4%) patients were diagnosed intraoperatively. Of the delayed diagnosis group, 22 (75.9%) had no initial signs on CXR or CT, 15 (52%) of this group had persistent pleural-effusions/elevated-hemidiaphragm leading to further investigation and diagnosis. No significant difference in survival was observed between early and delayed diagnoses, no clinically significant injury patterns to predict delayed diagnoses were noted. CONCLUSION The diagnosis of TDI is challenging. Without frank signs of herniation of abdominal contents on CXR or CT, the diagnosis is often not made on initial imaging. In patients with the evidence of blunt traumatic injury in the lower-chest/upper-abdomen, a high degree of clinical suspicion should be held and follow-up CXRs/CTs arranged.
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Affiliation(s)
- Joseph Hogarty
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Karishma Jassal
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | - Meei Yeung
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
| | - Warren Clements
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
| | - Joseph K Mathew
- Alfred Health Trauma Service, Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Alfred Hospital, Melbourne, Victoria, Australia
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18
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Saleem H, Liu YJ, Ellenby MI, Sarhan M. Non-Anastomotic Axillofemoral Bypass Disruption After Blunt Trauma Treated by Endovascular Approach. Vasc Endovascular Surg 2023; 57:801-805. [PMID: 37105178 DOI: 10.1177/15385744231173188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Disruption in the non-anastomotic section of an axillofemoral bypass is a rare occurrence. In this report, we consider a patient who presented with a pseudoaneurysm in the non-anastomotic section of his axillofemoral bypass due to blunt trauma to the chest after a fall. Clinical presentation, management, treatment, and complications related to our case are discussed.
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Affiliation(s)
- Hamzah Saleem
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Yuen-Joyce Liu
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Martin I Ellenby
- Department of Vascular Surgery, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Mohammad Sarhan
- Department of Vascular Surgery, Advocate Christ Medical Center, Oak Lawn, IL, USA
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19
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Al-Aieb A, Abdelrahman H, Rizoli S, El-Menyar A, Nabir S, Kloub A, Al-Thani H. Isolated free intraperitoneal fluid in young male after blunt abdominal sport trauma: two case reports from the World Cup 2022. J Surg Case Rep 2023; 2023:rjad561. [PMID: 37846415 PMCID: PMC10576987 DOI: 10.1093/jscr/rjad561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023] Open
Abstract
The presence of isolated intraperitoneal free fluid (IFIPF) indicates the presence of mesenteric, organ, or bowel injury, which necessitates surgical exploration. The advances in computerized tomographic scanning (CT scan) allow even smaller amounts of IFIPF being detected. However, the clinical significance of IFIPF following blunt abdominal trauma remains not well-studied. Moreover, IFIPF is an unexpected condition in healthy male in the absence of mesenteric or organ injury on abdominal imaging. Herein, we presented two cases with IFIPF detected by CT scan in two healthy football male players during the World Cup 2022. The two players were managed conservatively and rejoined safely their football team during the same competition.
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Affiliation(s)
- Abubaker Al-Aieb
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, P.O. Box 3050, Doha 24144, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, P.O. Box 3050, Doha 24144, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, P.O. Box 3050, Doha 24144, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, P.O. Box 24144. Doha, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Ahmad Kloub
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, P.O. Box 3050, Doha 24144, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, P.O. Box 3050, Doha 24144, Qatar
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20
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Javid M, Ilangovan AK, Selvaraj S, Ganapathy R, Prasad S. Beyond the Breaking Point: A Unique Case Report of a Penile Fracture With a Distal Urethral Injury. Cureus 2023; 15:e46268. [PMID: 37908947 PMCID: PMC10615226 DOI: 10.7759/cureus.46268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
A penile fracture is a rare urological emergency, often resulting from blunt trauma to the erect penis. This case report describes a 30-year-old male who presented with penile swelling during sexual intercourse, raising suspicion of a penile fracture. The patient underwent surgical exploration, revealing a rent in the tunica albuginea and an additional laceration in the corpus spongiosum with the Foley catheter exposed. The lacerations were closed using Vicryl sutures over a Foley catheter. The patient experienced an uneventful postoperative course, and follow-up assessments showed satisfactory healing of the urethra. This case underlines the need for clinicians to consider the possibility of urethral involvement in cases of penile fracture, as timely surgical intervention can prevent long-term sequelae such as erectile dysfunction and urethral strictures. By sharing this case, we hope to further emphasize the need for vigilance and swift action when faced with potential penile fractures in clinical practice.
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Affiliation(s)
- Mohamed Javid
- Urology, Chengalpattu Medical College, Chengalpattu, IND
| | | | | | | | - Srikala Prasad
- Urology, Chengalpattu Medical College, Chengalpattu, IND
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21
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Shariati MM, Same M. Traumatic rosette cataract. Clin Case Rep 2023; 11:e7834. [PMID: 37636876 PMCID: PMC10448125 DOI: 10.1002/ccr3.7834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023] Open
Abstract
One of the clinical presentations of traumatic cataracts is a rosette-shaped posterior capsular opacity. The severity of vision loss, the patient's age, and the cornea, macula, and optic nerve states are major determinants of the therapeutic approach.
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Affiliation(s)
| | - Mohammadreza Same
- Eye Research CenterMashhad University of Medical SciencesMashhadIran
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22
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Gumbs S, Ausqui G, Orach T, Ramcharan A, Donaldson B. An Unusual Case of Cecal Perforation: Accidental Ingestion of a Tooth in an Elderly Trauma Patient. Cureus 2023; 15:e45467. [PMID: 37859879 PMCID: PMC10583788 DOI: 10.7759/cureus.45467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Foreign body ingestion is a common occurrence in the United States, with the majority passing asymptomatically. In cases where complications occur, such as intestinal perforation, it may present as an acute abdomen with diagnostic challenges regarding the etiology. A 70-year-old male was brought to the emergency department (ED) after he jumped from the second floor of a burning building, sustaining 10% second-degree burns to his forearms. He was intubated for concerns of inhalational injury and resuscitated. His intensive care unit (ICU) course included the management of respiratory failure, sepsis, and acute kidney injury. On hospital day 28, imaging showed moderate pneumoperitoneum with ascites. He was taken for abdominal exploration, during which it was noted that there was gross fecal contamination and a 1 cm cecal perforation. After resection of the ileocecum, it was left in discontinuity due to hemodynamic instability and contamination. He was brought for a second-look laparotomy in 48 hours, and an incisor tooth was found in the right pelvis, and an ileocolic (ileum-ascending colon) anastomosis was performed. His post-operative course was complicated by an anastomotic leak and an intra-abdominal collection. Despite attempts at source control with percutaneous drainage, the patient remained septic with a poor prognosis. Goals of care were discussed, and the decision was made to de-escalate care. Although there is literature on foreign body ingestion resulting in intestinal perforation, there is a paucity of literature highlighting the importance of dental exams in elderly trauma patients, the incidence of perforation due to tooth ingestion, and maintaining a high index of suspicion for an acute abdomen in unusual presentations of sepsis.
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Affiliation(s)
- Shamon Gumbs
- Department of Surgery, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA
| | - Gonzalo Ausqui
- Department of Surgery, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA
| | - Tonny Orach
- Department of Surgery, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA
| | - Alexius Ramcharan
- Department of Surgery, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA
| | - Brian Donaldson
- Department of Surgery, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA
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23
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Park IH, Kim CW, Choi YU, Kang TW, Lim J, Byun CS. Occult pneumothorax in patients with blunt chest trauma: key findings on supine chest radiography. J Thorac Dis 2023; 15:4379-4386. [PMID: 37691659 PMCID: PMC10482646 DOI: 10.21037/jtd-23-541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/21/2023] [Indexed: 09/12/2023]
Abstract
Background In patients with multiple trauma, a supine chest radiography [chest X-ray (CXR)] is preferred over a erect CXR. However, this method has limitations in detecting post-traumatic pneumothorax. The use of chest computed tomography (CT) to detect traumatic pneumothorax is well known. However, pneumothorax that is not detected before a chest CT scan is known as an occult pneumothorax (OP), and it can cause serious complications in the patient. This study sought to evaluate the frequency and risk factors for OP in trauma patients. Methods Patients who suffered thoracic trauma at the Level 1 Regional Trauma Center of Wonju Severance Christian Hospital between 2015 and 2022 were included in this study. All patients were at least 18 years old. The study reviewed all patients' supine CXR and chest CT images and classified them into five radiographic diagnoses: pneumothorax, rib fracture, subcutaneous emphysema, lung contusion, and pneumomediastinum. Results The study included 1,284 patients, all with diagnoses of pneumothorax, rib fracture, subcutaneous emphysema, lung contusion, and pneumomediastinum following supine CXR and chest CT. The patient's average age was 58.3±15.2 years. Pneumothorax diagnosis on supine CXR had the lowest accuracy, at 46.7%, and the lowest sensitivity, at 12.7%. In univariate analysis, rib fracture, lung contusion, and subcutaneous emphysema on supine CXR were all found to be statistically significant regarding traumatic OP. In multivariate analysis, the risk factors for OP were lung contusion [odds ratio (OR), 1.440; 95% confidence interval (CI): 1.115-1.860; P=0.005] and subcutaneous emphysema (OR, 25.883; 95% CI: 13.155-50.928; P<0.001) on supine CXR. Conclusions The lung contusion and subcutaneous emphysema in supine CXR of trauma patients indicate the presence of OP. Therefore, if chest CT cannot be performed immediately due to unstable vital signs or other circumstances, recognizing the above radiological findings of traumatic pneumothorax may be necessary.
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Affiliation(s)
- Il Hwan Park
- Department of Cardiovascular and Thoracic Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chang Wan Kim
- Department of Cardiovascular and Thoracic Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Un Choi
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Tae Wook Kang
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - JiHye Lim
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chun Sung Byun
- Department of Cardiovascular and Thoracic Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Meaigel MA, Haider MA, Touloumis Z. Right Diaphragmatic Rupture: A Case Report of a Rare Surgical Trauma Emergency. Cureus 2023; 15:e42828. [PMID: 37664347 PMCID: PMC10471833 DOI: 10.7759/cureus.42828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Diaphragmatic injuries, particularly on the right side, are a rare yet challenging clinical scenario, especially when associated with other injuries. We present the case of a 38-year-old male patient who sustained a fall from a significant height, resulting in blunt abdominal trauma, chest injuries, right-side diaphragmatic injury, a grade 4 liver injury, and fractures of the right ribs, right femur, and pelvis. The patient also suffered a lung laceration with hemopneumothorax. The clinical team managed these injuries through a video-assisted thoracoscopy, laparotomy, and primary repair of the diaphragmatic rupture. The postoperative course was complicated by a low-output bile leak and infection of the orthopedic surgical wound, but these were effectively managed, and the patient showed a steady recovery. This case underscores the complexity of managing traumatic injuries that span multiple body regions and systems, requiring a coordinated, multidisciplinary approach. It also highlights the critical role of timely intervention and appropriate surgical strategies in the successful recovery of patients from complex traumas.
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Goel N, D’ Souza Z, Tripathi A, Dey A, Sen A, Majumdar B, Thounaojam S, Roy R, Saurabh K. Concomitant paracentral acute middle maculopathy and acute macular neuroretinopathy in eyes post- blunt trauma. Indian J Ophthalmol 2023; 71:2789-2795. [PMID: 37417122 PMCID: PMC10491048 DOI: 10.4103/ijo.ijo_254_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/02/2023] [Accepted: 05/03/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To analyze the imaging characteristics and the clinical course of patients showing concomitant paracentral acute middle maculopathy (PAMM) and acute macular neuroretinopathy (AMN) post-blunt trauma. Methods PAMM and AMN lesions post-blunt trauma diagnosed on enhanced depth imaging optical coherence tomography (EDI-OCT) were recruited for the study. Results : Thirteen eyes of 13 individuals with a history of blunt trauma were included in the study, of whom 11 (85%) were males. Mean age of the patients was 33.62 (range 16-67) years. Mean visual acuity at presentation and the last visit was 1.67 log of minimum angle of resolution (logMAR) and 0.82 logMAR, respectively. Mean interval between trauma and imaging was 5.08 (range 1-15) days. All patients had unilateral involvement, with the right eye being involved in 10 patients (77%). All patients had concomitant PAMM and AMN lesions. Conclusion : Presence of coincident PAMM and AMN suggests a common pathophysiologic etiology, but the description of concomitant PAMM and AMN in the setting of blunt trauma to eye is hitherto unreported. Identifying AMN in a setting of PAMM requires meticulous examination of the OCT and OCTA images. It can be a cause of suboptimal visual recovery in such eyes.
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Affiliation(s)
- Nikita Goel
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Zubin D’ Souza
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Abhishek Tripathi
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Amrita Dey
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Ahana Sen
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Bristi Majumdar
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Sanatombi Thounaojam
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Rupak Roy
- Department of VitreoRetina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M. Bypass, Kolkata, West Bengal, India
| | - Kumar Saurabh
- Department of VitreoRetina, BB Eye Foundation VIP, Shree Tower, RAA – 36, II, VIP Road, Raghunathpur, Rajarhat, Kolkata, West Bengal, India
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Hefny AF, Al Qemzi AD, Hefny MA, Almarzooqi GA, Al Afari HST, Elbery AI. Acute Traumatic Lumbar Hernia: Report of Two Cases. J Emerg Trauma Shock 2023; 16:127-129. [PMID: 38025498 PMCID: PMC10661568 DOI: 10.4103/jets.jets_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 12/01/2023] Open
Abstract
Acute traumatic lumbar hernia (ATLH) is rare in blunt trauma and can be overlooked due to the presence of multiple injuries following the trauma incidence. ATLH is usually found at the time of radiological examination or during surgical exploration. Awareness of the clinicians about the possibility of ATLH can enhance early diagnosis and reduce the occurrence of serious complications including bowel obstruction and strangulation. Herein, we present two cases of ATLH in which one of them was treated conservatively in the acute stage and the other patient was treated surgically. Conservative management can be adopted in the acute stage with the delayed repair of the hernia after resolving the muscles' contusion. However, early operative intervention is essential if conservative management failed or in the event of acute deterioration of the patient's condition.
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Affiliation(s)
- Ashraf F. Hefny
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University and Al Rahba Hospital, United Arab Emirates
| | - Ayesha D. Al Qemzi
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Mohamed A. Hefny
- Department of Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ghaya A. Almarzooqi
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
| | | | - Adel I Elbery
- Department of Radiology, Tawam Hospital, Al Ain, United Arab Emirates
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27
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Shirakabe K, Kanzaki M. Isolated Superior Mesenteric Artery Dissection following Blunt Trauma: A Case Report. Surg J (N Y) 2023; 9:e89-e91. [PMID: 37434872 PMCID: PMC10332908 DOI: 10.1055/s-0043-1770955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/26/2023] [Indexed: 07/13/2023] Open
Abstract
Isolated superior mesenteric artery dissection (ISMAD) is rare, with symptoms ranging from asymptomatic to acute intestinal ischemia. Risk factors for ISMAD include hypertension, atherosclerosis, abnormal elastic fibers, and pregnancy. In the present case, blunt trauma, which has not been previously reported, was suggested as a risk factor. A 46-year-old man was brought to the emergency room after he was found unconscious after a motor vehicle collision. At presentation, he had no abdominal symptoms; however, on the fourth day of admission, he presented with severe abdominal pain and vomiting. A contrast-enhanced computed tomography scan revealed an ISMAD with associated intestinal ischemia and necrosis; hence, emergency surgery was performed. Herein, we report a case of ISMAD caused by blunt abdominal trauma.
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Affiliation(s)
- Katsudai Shirakabe
- Tokyo Bay Urayasu Ichikawa. Department of General Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-City, Chiba, Japan
| | - Masaki Kanzaki
- Department of General Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu-City, Chiba, Japan
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28
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Kefeli I, Utine CA, Kaya M, Kaynak S. Optical Coherence Tomography Angiography Imaging of Foveal Atrophy Secondary to Commotio Retinae in a Pediatric Patient. Beyoglu Eye J 2023; 8:128-133. [PMID: 37521885 PMCID: PMC10375211 DOI: 10.14744/bej.2023.38233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/05/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
Optical coherence tomography-angiography (OCTA) is a fast, reliable, and non-invasive technique for the diagnosis and follow-up of patients with commotio retinae (CR). Severity of the damage to the retinal and choroidal microvasculature in OCTA imaging and the visual prognosis are directly related to the severity of trauma. There are a few published reports on OCTA in CR that shows alterations of the retinal or superficial choroidal vessels and choriocapillary plexus. OCTA imaging seems to be predictive for visual prognosis. Herein, we present a 6-year-old boy, who had blunt trauma to the right eye with a stick during outdoor playing with visual acuity reduction to 0.1 following resolution of the Berlin's edema. In our case, OCTA revealed damage to the outer layers of the retinae and choriocapillaris and resulting in permanent vision loss. OCTA is a non-invasive, rapid, and safe imaging technique that qualitatively and quantitatively analyzes blood flow from the superficial capillary plexus to the choriocapillaris, which can be predictive in the visual prognosis.
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Affiliation(s)
- Işıl Kefeli
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Türkiye
| | - Canan Aslı Utine
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Türkiye
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29
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Schwarze E, Chang DD, Cleary CJ, Rakitin I. Spontaneous resolution of traumatic bronchial tear after thoracic crush injury. J Surg Case Rep 2023; 2023:rjac627. [PMID: 37016700 PMCID: PMC10066814 DOI: 10.1093/jscr/rjac627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/20/2022] [Indexed: 04/04/2023] Open
Abstract
Traumatic bronchial tears are rare life-threatening injuries. Here, we report a 28-year old male who presented after sustaining a crush injury to his thoracic cavity, resulting in a spiral left mainstem bronchial tear secondary to high intraluminal pressure. While preparing for surgery, a preoperative bronchoscopy found that the bronchial tear had re-approximated and effectively sealed the laceration. No operative intervention was performed and the patient subsequently underwent a full recovery. While most bronchial tears undergo surgical intervention, our report describes the successful management of a bronchial tear injury with a non-operative approach and supportive care.
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Affiliation(s)
- Erik Schwarze
- Correspondence address. Henry Ford Hospital Main Campus, 2799 W. Grand Blvd., CFP-127, Detroit, MI 48202, USA. Tel: +1-313-916-3056; Fax: +1-313-916-5811; E-mail:
| | - Donald D Chang
- Department of General Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Corbin J Cleary
- Department of Thoracic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Ilya Rakitin
- Department of Surgery, Division of Acute Care Surgery, Henry Ford Hospital, Detroit, MI, USA
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30
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Amelia T. Collings, Manzur Farazi, Kyle J. Van Arendonk, Mary E. Fallat, Peter C. Minneci, Thomas T. Sato, K. Elizabeth Speck, Samir Gadepalli, Katherine J. Deans, Richard A. Falcone, David S. Foley, Jason D. Fraser, Martin S. Keller, Meera Kotagal, Matthew P. Landman, Charles M. Leys, Troy Markel, Nathan Rubalcava, Shawn D. St. Peter, Katherine T. Flynn-O’Brien, Midwest Pediatric Surgery Consortium. Evaluating the regional differences in pediatric injury patterns during the COVID-19 pandemic. J Surg Res 2023. [PMID: 37086597 PMCID: PMC10033255 DOI: 10.1016/j.jss.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/18/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
Background Reports of pediatric injury patterns during the COVID-19 pandemic are conflicting and lack the granularity to explore differences across regions. We hypothesized there would be considerable variation in injury patterns across Pediatric Trauma Centers (PTCs) in the United States. Materials and Methods A multicenter, retrospective study evaluating patients <18-years-old with traumatic injuries meeting National Trauma Data Bank criteria was performed. Patients injured after Stay-at-Home Orders through September 2020 (“COVID” cohort) were compared to “Historical” controls from an averaged period of equivalent dates in 2016–2019. Differences in injury type, intent, and mechanism were explored at the site level. Results 47,385 pediatric trauma patients were included. Overall trauma volume increased during the COVID cohort compared to the Historical (COVID 7,068 patients vs. Historical 5,891 patients); however, some sites demonstrated a decrease in overall trauma of 25% while others had an increase over 33%. Bicycle injuries increased at every site, with a range in percent change from 24% to 135% increase. Although the greatest net increase was due to blunt injuries, there was a greater relative increase in penetrating injuries at 7/9 sites, with a range in percent change from 110% increase to a 69% decrease. Conclusions There was considerable discrepancy in pediatric injury patterns at the individual site level, perhaps suggesting a variable impact of the specific sociopolitical climate and pandemic policies of each catchment area. Investigation of the unique response of the community during times of stress at PTCs is warranted to be better prepared for future environmental stressors.
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31
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Lathrop SL, Wiest PW, Andrews SW, Elifritz J, Price JP, Mlady GW, Zumwalt RE, Gerrard CY, Poland VL, Nolte KB. Can computed tomography replace or supplement autopsy? J Forensic Sci 2023; 68:524-535. [PMID: 36752321 DOI: 10.1111/1556-4029.15217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/09/2023]
Abstract
Postmortem computed tomography (PMCT) has been integrated into the practice of many forensic pathologists. To evaluate the utility of PMCT in supplementing and/or supplanting medicolegal autopsy, we conducted a prospective double-blind comparison of abnormal findings reported by the autopsy pathologist with those reported by a radiologist reviewing the PMCT. We reviewed 890 cases: 167 with blunt force injury (BFI), 63 with pediatric trauma (under 5 years), 203 firearm injuries, and 457 drug poisoning deaths. Autopsy and radiology reports were coded using the Abbreviated Injury Scale and abnormal findings and cause of death (COD) were compared for congruence in consensus conferences with novel pathologists and radiologists. Overall sensitivity for recognizing abnormal findings was 71% for PMCT and 74.6% for autopsy. Sensitivities for PMCT/autopsy were 74%/73.1% for BFI, 61.5%/71.4% for pediatric trauma, 84.9%/83.7% for firearm injuries, and 56.5%/66.4% for drug poisoning deaths. COD assigned by reviewing PMCT/autopsy was correct in 88%/95.8% of BFI cases, 99%/99.5% of firearm fatalities, 82.5%/98.5% of pediatric trauma deaths, and 84%/100% of drug poisoning deaths of individuals younger than 50. Both autopsy and PMCT were imperfect in recognizing injuries. However, both methods identified the most important findings and are sufficient to establish COD in cases of BFI, pediatric trauma, firearm injuries and drug poisoning in individuals younger than 50. Ideally, all forensic pathologists would have access to a CT scanner and a consulting radiologist. This would allow a flexible approach that meets the diagnostic needs of each case and best serves decedents' families and other stakeholders.
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Affiliation(s)
- Sarah L Lathrop
- Office of the Medical Investigator, Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Philip W Wiest
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Sam W Andrews
- Tarrant County Medical Examiner Office, Fort Worth, Texas, USA
| | - Jamie Elifritz
- Office of the Medical Investigator, Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA.,Department of Radiology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Gary W Mlady
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Ross E Zumwalt
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Chandra Y Gerrard
- Radiology Informatics/Information Technology, University of New Mexico Hospitals, Albuquerque, New Mexico, USA
| | - Valerie L Poland
- Office of the Medical Investigator, Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kurt B Nolte
- Office of the Medical Investigator, Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA.,Department of Radiology, University of New Mexico, Albuquerque, New Mexico, USA
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Yazici H, Verdiyev O. Laparoscopic Approach to Severe Liver Injury in a Patient With Blunt Abdominal Trauma. Cureus 2023; 15:e36568. [PMID: 37095823 PMCID: PMC10122191 DOI: 10.7759/cureus.36568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
With laparoscopic surgery becoming more popular in surgical practice, laparoscopic approaches in trauma patients have increased. Non-operative management is the standard treatment algorithm in patients with blunt abdominal trauma who are hemodynamically stable and have sustained a liver injury. However, laparoscopy is a safe and feasible method for exploration, irrigation, and treatment if a surgical intervention is needed in this group. In this study, we aimed to present a case of liver injury in blunt abdominal trauma and its management laparoscopically. A 22-year-old male was admitted to the Marmara University Hospital's Emergency Unit of a tertiary center following a truck accident. The patient was hemodynamically stable at admission. CT scan showed a grade IV liver laceration with hemoperitoneum. The patient was transferred to the observation room. After three hours, the patient's hemoglobin value decreased from 14.6 g/dl to 8.4 g/dl, and the mean arterial blood pressure decreased to 60 mmHg. The patient's heart rate increased to 125, and peritonitis was evident on the abdominal examination. Emergent laparoscopy was performed on the patient. Grade IV liver laceration with no active bleeding was observed. After peritoneal irrigation, surgery was terminated. With the developments in minimally invasive procedures, laparoscopic approaches were used more frequently in trauma patients. In the referral and experienced centers, laparoscopy could be an appropriate way to avoid unnecessary laparotomies.
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Affiliation(s)
- Hilmi Yazici
- General Surgery, Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, İstanbul, TUR
| | - Orkhan Verdiyev
- General Surgery, Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Istanbul, TUR
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Alexopoulou-Prounia L, Kakkos SK, Mystakidi V, Ntouvas I, Kraniotis P, Sintou E. Vascular handlebar syndrome with blunt injury of common femoral artery. VASA 2023; 52:86-96. [PMID: 36698255 DOI: 10.1024/0301-1526/a001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Vascular handlebar syndrome with blunt injury of the common femoral artery is a rare vascular trauma mechanism, with high possibility of being missed or delayed. We present two cases of vascular handlebar syndrome treated in our hospital and a systematic review of the literature using MEDLINE and SCOPUS databases. Literature review identified 20 similar cases. The median age of patients was 18 years, and in vast majority males in gender. In most cases, the common femoral artery injury was an intimal flap and lumen occlusion with intramural thrombosis followed by transection and intimal injury without occlusion or thrombosis. The median time between injury and diagnosis/treatment was half an hour. Clinical presentation ranged from asymptomatic to acute limb ischemia. The grade of acute ischemia was mostly Rutherford class I (n=14), while acute IIa (n=4), chronic ischemia (n=3), and no ischemia (n=1) were also noticed. The correct diagnosis was revealed by clinical examination only (n=1), or by the combination of clinical and imaging techniques including computed tomography angiography (n=7) and duplex ultrasonography (n=4) or both (n=10). Management of the handlebar trauma syndrome injuries was surgical in most cases. Outcome was favorable in all patients. Vascular handlebar syndrome is extremely rare and high suspicion is required for early diagnosis and definitive treatment, as the early management is effective and crucial for averting the devastating consequences. An individualized approach to the vascular trauma patient is to be applied with considerations taken to the age of the patient, the mechanism of the injury, the anatomy of the lesion, and symptomatology of the case.
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Affiliation(s)
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Vasiliki Mystakidi
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Ioannis Ntouvas
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Pantelis Kraniotis
- Department of Radiology, University of Patras Medical School, Patras, Greece
| | - Eleni Sintou
- Department of Anesthesiology, University of Patras Medical School, Patras, Greece
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Wasfie T, White H, Casey T, Hella J, Barber K, Shapiro B. The Impact of Alcohol Level on Elderly Trauma Patients Presenting to the Emergency Department. Am Surg 2023:31348231157909. [PMID: 36803071 DOI: 10.1177/00031348231157909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Alcohol is a chemical substance that alters cognitive ability and judgment. We looked at our elderly patients that arrived at the Emergency Department (ED) following trauma and evaluated the factors that may influence outcome. Retrospective analysis of patients seen in ED with positive alcohol was performed. Statistical analysis was performed to identify the confounding factors for outcomes. Records collected on 449 patients with a mean age of 42 ± 16.9 years. There were 314 males (70%) and 135 females (30%). Average GCS was 14, and average ISS was 7.0. Mean alcohol level was 176 g/dL ± 91.6. There were 48 patients aged 65 years and older with significantly higher hospital stay (4.1 and 2.8 days, P = .019) and ICU stay (2.4 and 1.2 days, P = .003) compared to the 64 and younger group. Elderly trauma patients had a higher mortality and length of stay due to a higher number of comorbidities.
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Affiliation(s)
- Tarik Wasfie
- Department of Surgery, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Hutton White
- Department of Surgery, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Taylor Casey
- 3078Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Jennifer Hella
- Department of Academic Research, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Kimberly Barber
- Department of Academic Research, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
| | - Brian Shapiro
- Department of Surgery, 3577Ascension Genesys Hospital, Grand Blanc, MI, USA
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Kawakami K, Oyama Y, Watanabe Y, Motoi H, Odaka M, Shiga K, Ito S. Delayed internal carotid artery occlusion and paralysis after oral trauma. Pediatr Int 2023; 65:e15594. [PMID: 37515346 DOI: 10.1111/ped.15594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Kento Kawakami
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshitaka Oyama
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshihiro Watanabe
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hirotaka Motoi
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Mao Odaka
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kentaro Shiga
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Yamashita T, Asai K, Ochiai H, Kanai T, Matsubayashi Y, Tanaka K, Hashimoto T. Connected simultaneous rupture of the diaphragm and pericardium via congenitally fused site due to blunt trauma. Gen Thorac Cardiovasc Surg Cases 2023. [PMCID: PMC9891893 DOI: 10.1186/s44215-022-00018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background In severe blunt trauma, multiple organ injuries are often observed. Patients with a ruptured diaphragm and pericardium are referred to as having pericardio-diaphragmatic rupture. However, few studies have reported a narrowly defined case of connected rupture of the diaphragm and pericardium via their congenitally fused site along with an abdominal visceral herniation and cardiac luxation into the thoracic cavity. Case presentation A 78-year-old man presented to our hospital with left chest pain caused by a traffic accident. Contrast-enhanced computed tomography revealed a left diaphragmatic rupture and an intestinal herniation into the thoracic cavity. Surgical repair of the diaphragm was performed, and pericardial rupture was noted during surgery. It was considered that the laceration had spread via the congenitally fused site of the diaphragm and pericardium. The diaphragm was sutured, but the pericardium was left open because the laceration was large and the risk of cardiac incarceration was thought to be low. One year after the operation, no recurrence of diaphragmatic hernia was observed and any circulatory symptoms were not occurred. Conclusions In cases of diaphragmatic laceration extending to the fused site of the pericardium, connected pericardial rupture should also be considered. It would be challenging to detect without intraoperative findings, and it is desirable to observe both the thoracic and abdominal cavities.
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Affiliation(s)
- Takashi Yamashita
- grid.413553.50000 0004 1772 534XGeneral Thoracic Surgery, Hamamatsu Medical Center, 328, Tomitsuka, Nakaku, Hamamatsu, Shizuoka 432-8580 Japan
| | - Katsuyuki Asai
- grid.413553.50000 0004 1772 534XGeneral Thoracic Surgery, Hamamatsu Medical Center, 328, Tomitsuka, Nakaku, Hamamatsu, Shizuoka 432-8580 Japan
| | - Hideto Ochiai
- grid.413553.50000 0004 1772 534XGastroenterological Surgery, Hamamatsu Medical Center, 328, Tomitsuka, Nakaku, Hamamatsu, Shizuoka 432-8580 Japan
| | - Toshikazu Kanai
- grid.413553.50000 0004 1772 534XGastroenterological Surgery, Hamamatsu Medical Center, 328, Tomitsuka, Nakaku, Hamamatsu, Shizuoka 432-8580 Japan
| | - Yuta Matsubayashi
- grid.413553.50000 0004 1772 534XGeneral Thoracic Surgery, Hamamatsu Medical Center, 328, Tomitsuka, Nakaku, Hamamatsu, Shizuoka 432-8580 Japan
| | - Keizo Tanaka
- grid.413553.50000 0004 1772 534XCardiovascular Surgery, Hamamatsu Medical Center, 328, Tomitsuka, Nakaku, Hamamatsu, Shizuoka 432-8580 Japan
| | - Takashi Hashimoto
- grid.413553.50000 0004 1772 534XCardiovascular Surgery, Hamamatsu Medical Center, 328, Tomitsuka, Nakaku, Hamamatsu, Shizuoka 432-8580 Japan
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Pinchuk PV, Kuzmina VA, Leonov SV, Sukhareva MA. [Historical aspects, current state and problematic issues of forensic medical examination of a gunshot blunt trauma]. Sud Med Ekspert 2023; 66:39-42. [PMID: 36719312 DOI: 10.17116/sudmed20236601139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The data of the world literature characterizing the forensic aspects of blunt trauma are generalized and systematized. The issues related to the morphology of damage caused after overcoming an obstacle made of various materials by a bullet, the trajectory of a firearm projectile after overcoming an obstacle, the deformation of a bullet, the transfer of fragments of an obstacle by a bullet, the determination of the distance to the target located behind the damaged barrier, the study of the strength properties of individual human armor protection, the nature of the release of particles of an obstacle. The current state of forensic medical examination of blunt trauma is considered, problems and promising directions of their solution are identified. The importance of using knowledge in the field of theoretical mechanics of deformed solid bodies and high-speed impact interaction of solid bodies is noted.
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Affiliation(s)
- P V Pinchuk
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia.,Main State Center for Forensic and Criminalistic Examinations of the Ministry of Defense of Russia, Moscow, Russia
| | - V A Kuzmina
- Main State Center for Forensic and Criminalistic Examinations of the Ministry of Defense of Russia, Moscow, Russia
| | - S V Leonov
- Main State Center for Forensic and Criminalistic Examinations of the Ministry of Defense of Russia, Moscow, Russia.,A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - M A Sukhareva
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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38
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Gunarathne KPDJK, Kaushalya PDJ, Halpegamage NW. A delayed presentation of a traumatic isolated duodenal injury. SAGE Open Med Case Rep 2023; 11:2050313X231169848. [PMID: 37151739 PMCID: PMC10154991 DOI: 10.1177/2050313x231169848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Blunt injury to the abdomen resulting in isolated duodenal injury is rare in surgical practice. Due to the insidious onset of symptoms and the vague non-specific nature of the clinical presentation, these injuries can be easily missed even in experienced hands. Contrary to Europe or developed countries, assaults to the abdomen using hands, fists, and feet in home-based violence is common in third-world countries. These patients have the habit of hiding the assault part of the history to avoid litigations to 'known' people. A high level of suspicion, a continuous revisiting of the history, and timely damage control surgery can improve the outcomes of such patients.
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Affiliation(s)
- KPD Janitha Kaushalya Gunarathne
- National Hospital Colombo, Colombo, Sri
Lanka
- KPD Janitha Kaushalya Gunarathne, National Hospital
Colombo, Colombo 0800, Western Province, Sri Lanka.
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39
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Poirier M, Stillion JR, Boysen SR. Markers of tissue perfusion and their relation to mortality in dogs with blunt trauma. J Vet Emerg Crit Care (San Antonio) 2023; 33:16-21. [PMID: 36286596 DOI: 10.1111/vec.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/06/2021] [Accepted: 11/12/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate admission Animal Trauma Triage (ATT) score, shock index (SI), and markers of perfusion, including base excess (BE), plasma lactate, and lactate clearance in dogs with blunt trauma. DESIGN Prospective observational clinical study from 2013 to 2015. SETTING Private veterinary referral and emergency center. ANIMALS Forty-four client-owned dogs hospitalized following blunt trauma. INTERVENTION Within 1 hour of presentation and prior to fluid administration an initial hematocrit, total plasma protein, blood glucose, plasma lactate, blood gas, and electrolytes were obtained for analysis. Plasma lactate concentrations were also measured 4 and 8 hours following initial measurement, and a 4-hour lactate clearance was calculated if patients had an increased admission plasma lactate. ATT score and SI were calculated for each patient based on admission data. Outcome was defined as survival to hospital discharge. MEASUREMENTS AND MAIN RESULTS Twenty-nine dogs survived, 14 were euthanized, and 1 died. Nonsurviving dogs had a lower mean pH (7.28 ± 0.03 vs 7.36 ± 0.01, P = 0.006), lower median HCO3 (15.7 vs 18.8 mmol/L, P = 0.004), lower median admission BE (-11.0 vs -7.0 mmol/L, P = 0.004), and higher median admission lactate (3.1 vs 2.4 mmol/L, P = 0.036) than those who survived. Median ATT was significantly higher in nonsurvivors (5 vsF 2, P < 0.001). The SI was not significantly different between survivors and nonsurvivors (P = 0.41). There was no difference in median 4-hour lactate (P = 0.34), median 8-hour lactate (P = 0.19), or 4-hour lactate clearance (P = 0.83) in survivors compared to nonsurvivors. No other statistically significant differences were noted between groups. CONCLUSION Dogs hospitalized following blunt trauma with a lower admission pH, HCO3 , and BE and a higher admission plasma lactate were less likely to survive to hospital discharge. Median ATT score was also significantly higher in nonsurvivors. Although lactate clearance was not predictive of survival, the sample size was small, and additional studies with a larger study population are warranted.
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Affiliation(s)
- Maude Poirier
- Western Veterinary Specialty and Emergency Centre, Calgary, Alberta, Canada
| | | | - Søren R Boysen
- Department of Veterinary Clinical and Diagnostic Sciences, College of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
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40
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Shen T, Fang H, Tang T, Tang H, Hu X, Zhu F. Case report: Delayed cardiac rupture with congenital absence of pericardium after blunt trauma. Front Cardiovasc Med 2022; 9:1079670. [PMID: 36606282 PMCID: PMC9808968 DOI: 10.3389/fcvm.2022.1079670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
A 66 years old male was admitted to our hospital after a serious car accident. The patient presented with severe shock after admission. After the examination, the patient was diagnosed with hemopneumothorax and myocardial contusion, accompanied by spleen rupture. After emergency surgery and a series of symptomatic treatments, the patient's condition gradually stabilized. One week later, the patient suddenly presented with severe shock. Massive hemothorax was found on the left side of the chest. Surgical exploration revealed cardiac rupture and accidental absence of congenital pericardium. According to the literature review, congenital absence of pericardium (CAP) is relatively rare. Although there are certain imaging features, the clinical diagnosis is very difficult. However, this patient did not show the characteristics in the literature and had some other atypical features. The role of CAP in the occurrence and development of the patient's heart injury and rupture is worthy of discussion. What we learned from this case is that we should look for potential risks in the telltale signs of a patient's condition.
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41
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Soomro FH, Hassan A, Nazir I, Azam S, Yasmin A. Intra-thoracic Symptomatic Gallstones in a Right-Sided Post-traumatic Diaphragmatic Hernia: A Case Report. Cureus 2022; 14:e32824. [PMID: 36699800 PMCID: PMC9870184 DOI: 10.7759/cureus.32824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Herniation of abdominal contents through the diaphragm into the thoracic cavity can occur after blunt abdominal injury, resulting in a permanently acquired diaphragmatic hernia. Their clinical presentation is varied and non-specific, which can go unnoticed for a long duration. A 27-year-old male presented with right upper quadrant pain and right-sided pleuritic chest pain for the past 20 days. His past medical history included high-impact blunt trauma a few years back. His workup revealed a right-sided diaphragmatic hernia through which the gallbladder had herniated into the thoracic cavity, along with liver and hepatic flexure of the colon. The gallbladder contained gallstones which were the cause of his symptoms. The patient was managed successfully with a laparotomy and repair of the diaphragmatic hernia and cholecystectomy. After blunt abdominal trauma, right-sided diaphragmatic injury is less common because most of the trauma is absorbed by the liver, providing a protective effect. The sign and symptoms of acquired diaphragmatic hernia lack sensitivity and specificity, due to which many cases remain undiagnosed and are incidentally picked up on chest auscultation where bowel sounds are audible in the chest, and breath sounds on the affected side are absent, whereas patients have complaints of respiratory difficulty and recurrent pneumonia. Chest and abdominal imagining in the form of chest X-rays and abdominal ultrasound can help diagnose. The case we present was a unique presentation of acquired right-sided diaphragmatic hernia resulting in herniation of the gallbladder in the right-sided chest and leading to acute cholecystitis. The treatment modality is surgical repair of the diaphragm. Any patient presenting with unusual symptoms of pneumonia or abdominal pain should be investigated, especially patients with a history of blunt abdominal trauma.
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Affiliation(s)
- Faiza H Soomro
- General Surgery, The Dudley Group NHS Foundation Trust, Dudley, GBR.,Hepatobiliary and Pancreatic (HPB) Surgery, King's College Hospital, London, GBR
| | - Afnan Hassan
- Internal Medicine, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Izza Nazir
- General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Sufyan Azam
- Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
| | - Amber Yasmin
- Medicine and Surgery, Sheikh Zayed Hospital Lahore, Lahore, PAK
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42
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Temperley HC, McDonnell JM, O'Sullivan NJ, Waters C, Cunniffe G, Darwish S, Butler JS. The Incidence, Characteristics and Outcomes of Vertebral Artery Injury Associated with Cervical Spine Trauma: A Systematic Review. Global Spine J 2022; 13:1134-1152. [PMID: 36341773 DOI: 10.1177/21925682221137823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES Vertebral Artery Injury (VAI) is a potentially serious complication of cervical spine fractures. As many patients can be asymptomatic at the time of injury, the identification and diagnosis of VAI can often prove difficult. Due to the high rates of morbidity and mortality associated with VAI, high clinical suspicion is paramount. The purpose of this review is to elucidate incidence, diagnosis, treatment and outcomes of VAI associated with cervical spine injuries. METHODS A systematic search of electronic databases was performed using 'PUBMED', 'EMBASE','Medline (OVID)', and 'Web of Science, for articles pertaining to traumatic cervical fractures with associated VAI. RESULTS 24 studies were included in this systematic review. Data was included from 48 744 patients. In regards to the demographics of the focus groups that highlighted information on VAI, the mean average age was 46.6 (32.1-62.6). 75.1% (169/225) were male and 24.9% (56/225) were female. Overall incidence of VAI was 596/11 479 (5.19%). 190/420 (45.2%) of patients with VAI had fractures involving the transverse foramina. The right vertebral artery was the most commonly injured 114/234 (48.7%). V3 was the most common section injured (16/36 (44.4%)). Grade I was the most common (103/218 (47.2%)) injury noted. Collective acute hospital mortality rate was 32/226 (14.2%), ranging from 0-26.2% across studies. CONCLUSION VAI secondary to cervical spine trauma has a notable incidence and high associated mortality rates. The current available literature is limited by a low quality of evidence. In order to optimise diagnostic protocols and treatment strategies, in addition to reducing mortality rates associated with VAI, robust quantitative and qualitative studies are needed.
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Affiliation(s)
| | - Jake M McDonnell
- 8881The Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Gráinne Cunniffe
- 8881The Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Joseph S Butler
- 8881The Mater Misericordiae University Hospital, Dublin, Ireland
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Abstract
PURPOSE To discuss the mechanism of injury and characterize the clinical features of ocular trauma associated with elastic cord exercise equipment band injuries in a consecutive series of patients seen at a single vitreoretinal surgery practice. METHODS We performed a retrospective review of all patients who were treated for blunt trauma from 2013 to 2020 at a single vitreoretinal practice. RESULTS Thirteen eyes from 11 patients met the inclusion criteria of possessing ocular trauma secondary to recoil from exercise bands. Presenting visual acuity ranged from 20/16 to HM (median: 20/32). The most frequently observed anterior segment pathologies were traumatic iritis (54%) and angle recession (31%). The most common posterior segment findings were vitreous hemorrhage (54%) and peripheral commotio retinae (54%). Three eyes (23%) required surgical intervention. Follow-up intervals ranged from 0 to 10 months (median: 1.75 months). Visual acuity at last examination ranged from 20/13 to 20/400 (median: 20/40). CONCLUSION A wide spectrum of serious ocular injuries requiring medical and surgical intervention can result from this form of blunt ocular trauma. The frequency of this event would be decreased by the use of sports goggles and careful inspection of equipment for wear and over use.
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Lee JS, Kim SH, Lee JY, Ye JB, Sul YH, Seok J, Yoon SY, Kim HR, Choi JH, Kim Y. Intestinal obstruction caused by small bowel entrapment within a lumbar fracture: A case report. Medicine (Baltimore) 2022; 101:e31273. [PMID: 36281106 PMCID: PMC9592479 DOI: 10.1097/md.0000000000031273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Intestinal obstruction associated with traumatic vertebral fracture is extremely rare. We report a case of obstructive small bowel injury caused by entrapment of the small intestine at the fracture site of the 5th lumbar vertebra due to trauma. CASE PRESENTATION A 55-year-old man fell from a height of 4 m and visited the emergency room of a local hospital with complain of back pain. During the examination, a 5th lumbar vertebral body fracture and left psoas muscle hematoma were observed, and the patient was admitted to the neurosurgery department for conservative treatment. The patient received conservative treatment for 2 days, but new symptoms of intestinal obstruction and fever occurred. A neurosurgeon at the hospital suspected duodenal perforation and transferred the patient to the regional trauma center for treatment. Our medical staff reviewed the patient's symptoms and imaging data and decided to perform an emergency operation because of small bowel entrapment in the 5th lumbar vertebrae fracture and perforation of the small intestine. We found that the small bowel, approximately 160 cm below the ligament of Treitz, was incarcerated at the 5th lumbar vertebral fracture site. After careful manual reduction of the entrapment of the small intestine, a small bowel resection of 25 cm, including the injury site, was performed with anastomosis. CONCLUSION If symptoms of intestinal obstruction are observed in patients with traumatic spinal injury, medical staff must consider the exceedingly rare possibility of bowel entrapment.
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Affiliation(s)
- Jin Suk Lee
- Trauma Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Se Heon Kim
- Trauma Surgery, Chungbuk National University Hospital, Cheongju, South Korea
- *Correspondence: Se Heon Kim, Department of Trauma Surgery, Chungbuk National University Hospital, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju 28644, South Korea (e-mail: )
| | - Jin Young Lee
- Trauma Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Jin Bong Ye
- Trauma Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Young Hoon Sul
- Trauma Surgery, Chungbuk National University Hospital, Cheongju, South Korea
- Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Junepill Seok
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Su Young Yoon
- Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Hong Rye Kim
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, South Korea
| | - Jung Hee Choi
- Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju, South Korea
| | - Yook Kim
- Department of Radiology, Chungbuk National University Hospital, Cheongju, South Korea
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45
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Wong J, Peng C, Shakerian R, Knowles B, Thomson B, Read DJ. An algorithm for the management of traumatic abdominal wall hernia based on a 9-year review. ANZ J Surg 2022; 92:2648-2654. [PMID: 36047464 PMCID: PMC9826009 DOI: 10.1111/ans.18017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Traumatic abdominal wall hernia (TAWH) is a rare consequence of blunt abdominal trauma, usually in the setting of multitrauma, with little consensus or guidelines for management. We present a case series of patients with traumatic herniae over a 9-year period and a suggested management algorithm. METHOD Retrospective review of all patients with TAWH from 1st January 2011 to 31st December 2019 at a Level 1 adult Major Trauma Centre. Clinical presentation, surgical intervention and complications and recurrence were analysed. RESULTS Forty-seven patients were found to have TAWH, 0.5% of all major trauma admissions. Thirty (63.8%) were repaired, 12 acutely, 11 semi-acute and 7 delayed. All but 1 (fall>3 m) were transport associated, with a median Injury Severity Score (ISS) of 29. Follow-up data for operative cases were available for all but one (97%). Seven (23.3%) cases had a recurrence, more common in the acute repair group (33.3%) compared to semi-acute (18.2%), and elective group (14.3%). CONCLUSION TAWH is a rare but potentially serious consequence of blunt abdominal trauma. This series has favoured earlier repair for anterior TAWH, or all those undergoing a laparotomy for other reasons, and elective repair for lumbar or lateral TAWH that do not require a laparotomy for other conditions. We present our preferred algorithm for management, accepting that there are many available strategies in this heterogeneous group of injuries. Loss of follow up and recurrence are a concern, and clinicians are encouraged to develop processes to ensure that TAWH are not a 'forgotten hernia'.
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Affiliation(s)
- Jessica Wong
- The Trauma ServiceThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Calvin Peng
- The Trauma ServiceThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Rose Shakerian
- The Trauma ServiceThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Brett Knowles
- The Trauma ServiceThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Ben Thomson
- The Trauma ServiceThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - David J. Read
- The Trauma ServiceThe Royal Melbourne HospitalMelbourneVictoriaAustralia
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Muacevic A, Adler JR. A High Level of Fibrinogen Degradation Product on Arrival as the Only Clue Suggesting Deterioration in a Blunt Trauma Patient. Cureus 2022; 14:e30914. [PMID: 36465765 PMCID: PMC9710564 DOI: 10.7759/cureus.30914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 01/25/2023] Open
Abstract
We report the case of an 89-year-old woman who was struck by a car while walking and fell to the ground. She had hypertension, dyslipidemia, and cerebral infarction requiring medication. She was transported to a nearby acute critical care center. Upon arrival, her vital signs were stable. A physical examination showed right facial and hip contusion, right shoulder tenderness, a right elbow contusional lacerated wound, and bilateral knee abrasion wounds. She vomited when her face moved. Radiological studies showed a right proximal humerus fracture and a right minor ischial fracture. Her injury severity score (ISS) was 5 points, and her probability of surviving was 97.8%. However, a blood test revealed an extremely high fibrinogen degradation product (FDP) level (573.3 μg/mL). Because of this elevated FDP value and her inability to walk due to vomiting on motion, she remained in the emergency room (ER) for monitoring. At five hours from arrival, she became comatose, and hypotension and bradycardia (30 beats per minute) were noted followed by cardiac arrest. She underwent advanced cardiac life support and obtained spontaneous circulation. Repeated blood tests showed hyperkalemia, anemia, and hypoglycemia. She immediately underwent infusion of glucose and insulin and continuous infusion of catecholamine. Repeated whole-body CT scans revealed only increased hematomas where the fractures and contusions existed. She was admitted to the ICU. Her post-admission course was quite eventful. She required transfusion until the fourth hospital day to control circulation and anemia and underwent transfusion of 28 units of red blood cells, 30 units of platelets, and four units of fresh-frozen plasma in total. After her circulation and respiratory function had stabilized, she was extubated. However, her condition became complicated with the deterioration of her knee wounds and gall bladder inflammation in the ward. All complications were treated by non-operative management. She was transferred to another hospital for rehabilitation on day 70. This report discusses our experience with a blunt trauma patient in whom a high FDP level on arrival was the only clue indicating the deterioration of her condition. Such patients need close observation with hospitalization.
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Suzuki K, Yoshida H, Esumi R, Ieki Y, Yamamoto A, Ohi M, Kaneko T, Imai H. Esophageal Perforation Accompanying Mediastinitis in Blunt Trauma in a Patient with Thoracic Osteophytes. Intern Med 2022; 61:2601-2605. [PMID: 35135923 PMCID: PMC9492484 DOI: 10.2169/internalmedicine.8930-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We herein report a 61-year-old man who sustained injury after a 2-m fall and developed mediastinitis. He presented to another hospital two days after the fall and was transferred to our hospital four days after the fall with a fever and dysphagia. Computed tomography revealed osteophytes on the second and third thoracic vertebrae and free air in the mediastinum, indicating esophageal perforation. Emergent surgery was performed. Intraoperatively, a longitudinal esophageal tear was identified. We stress the importance of being aware of the possibility of osteophyte-related esophageal perforation in patients with a history of a fall. A delayed diagnosis affects the prognosis.
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Affiliation(s)
- Kei Suzuki
- Emergency and Critical Care Center, Mie University Hospital, Japan
- Department of Infectious Diseases, Mie University Hospital, Japan
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Japan
| | - Haruna Yoshida
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Ryo Esumi
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Yohei Ieki
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Akira Yamamoto
- Department of Gastrointestinal and Pediatric Surgery, Mie University Hospital, Japan
| | - Masaki Ohi
- Department of Gastrointestinal and Pediatric Surgery, Mie University Hospital, Japan
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Japan
| | - Hiroshi Imai
- Emergency and Critical Care Center, Mie University Hospital, Japan
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48
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Ghosh S, Kazi FN, Sharma JVP. Extrahepatic Bile Duct Injury Caused by Blunt Abdomen Trauma: A Case Report. Cureus 2022; 14:e25662. [PMID: 35686195 PMCID: PMC9170451 DOI: 10.7759/cureus.25662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/16/2022] Open
Abstract
Traumatic injuries to the extra-hepatic biliary tract are uncommon and may be suspected intraoperatively by the presence of bile-stained fluid in the subhepatic area. We present a case of injury to the common bile duct in a polytrauma patient. The initial CT scan did not suggest biliary injury. However, intraoperatively, bile-stained fluid in the subhepatic space raised suspicion of bile duct injury. This was confirmed postoperatively in the development of a biliary fistula after the primary laparotomy. The patient was treated by endoscopic biliary stenting with complete resolution of the fistula.
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Affiliation(s)
- Shaurav Ghosh
- General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Farah Naaz Kazi
- Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - J V Pranav Sharma
- General Surgery, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
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49
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Schellenberg M, Gallegos H, Owattanapanich N, Wong MD, Bardes JM, Joos E, Vogt KN, Inaba K. Complications Following Temporary Bilateral Internal Iliac Artery Ligation for Pelvic Hemorrhage Control in Trauma. Am Surg 2022; 88:2475-2479. [PMID: 35537815 DOI: 10.1177/00031348221101509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Temporary bilateral internal iliac artery ligation (TBIIAL) is an option for surgical control of pelvic hemorrhage after trauma. Concerns persist that complications, particularly gluteal necrosis, following TBIIAL should preclude its use, despite a lack of formal research on TBIIAL complications. This study aimed to define complications following TBIIAL for emergent control of traumatic pelvic bleeding.Study Design: Patients undergoing TBIIAL after blunt trauma (2008-2020) at our level 1 trauma center were included without exclusions. Demographics, clinical/injury data, and outcomes were collected. Descriptive statistics summarized study variables. Multivariable analysis of factors independently associated with mortality after TBIIAL was performed.Results: In total, 77 patients undergoing emergent TBIIAL after blunt trauma were identified. Median age was 46 [IQR 29-63] years. Most patients (n = 70, 91%) were severely injured (ISS ≥16), with 43% undergoing resuscitative thoracotomy prior to TBIIAL. No local complications (gluteal necrosis, iatrogenic injury, fascial dehiscence, surgical site infection) after TBIIAL occurred over the 13-year study period. In the first 28 days after injury, median hospital-, ICU-, and ventilator-free days were 0. Mortality was 70% (n = 54). On multivariable analysis, older age was the only variable independently associated with in-hospital mortality (OR 1.081, P = .028).Conclusion: Zero cases of gluteal necrosis, iatrogenic injury to surrounding structures, or surgical site infection/fascial dehiscence of the exploratory laparotomy occurred over the study period. High concern for gluteal necrosis after TBIIAL in severely injured trauma patients is unfounded and should not prevent a surgeon from obtaining prompt pelvic hemorrhage control with this technique among patients in extremis.
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Affiliation(s)
- Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Hannah Gallegos
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Natthida Owattanapanich
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Monica D Wong
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - James M Bardes
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Emilie Joos
- Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kelly N Vogt
- Department of Surgery, London Health Sciences Center, University of Western Ontario, London, ON, Canada
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
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Samanta R, Jayaraj S, Sood G, Agrawal A. Post-traumatic posterior giant retinal tear and macular hole associated retinal detachment. Indian J Ophthalmol 2022; 70:1869. [PMID: 35502118 PMCID: PMC9332946 DOI: 10.4103/ijo.ijo_1017_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma occurs most commonly at the equatorial region or anterior to the equator. GRT posterior to the equator is rare. Purpose: To demonstrate the successful management of a post-traumatic posterior GRT and full-thickness macular hole (MH) associated retinal detachment (RD). Synposis: A 21-year-old-male presented with sudden diminution of vision in the right eye (RE) following blunt-trauma with cricket ball. RE vision at presentation was hand movement close to face. Anterior segment of RE revealed pupillary sphincter tear, posterior synechiae and posterior subcapsular cataract (PSC). RE fundus revealed a posterior-GRT, full thickness MH, mild vitreous haemorrhage and rhegmatogenous RD. He was managed with pars plana vitrectomy, encircling scleral band, perfluorocarbon liquid-assisted flattening of GRT, internal limiting membrane peeling, and endotamponade. Post-operatively the retina was attached, MH was closed and the patient achieved an ambulatory vision of 1/60. Highlights: This video demonstrates the successful management of a posterior-GRT and MH associated RD. Removal of adherent hyaloid from the long anterior flap of posterior GRT, peeling of ILM from temporal narrow mobile strip of retina (which has a risk of radial extension of GRT edges) and manoeuvring in suboptimally dilated pupil are illustrated in this video. Video Link: https://youtu.be/p04-_t0Wuuc
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Affiliation(s)
- Ramanuj Samanta
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sreeram Jayaraj
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Gitanjli Sood
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ajai Agrawal
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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