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Exclusión pilórica en lesión duodeno-pancreática combinada: reporte de 2 casos Pyloric exclusion for traumatic duodenal and pancreatic lesions: Report of two cases  [cached]
DARWIN A I?AGUAZO S
Revista Chilena de Cirugía , 2007,
Abstract: Introducción: Las lesiones traumáticas de duodeno y páncreas constituyen una entidad quirúrgica de tratamiento difícil, especialmente, si se trata de trauma combinado. Debido a su ubicación retroperitoneal; afortunadamente, las injurias de estos órganos no son frecuentes. Objetivo: Proporcionar conocimientos actualizados sobre el diagnóstico y manejo de las lesiones duodeno-pancreáticas combinadas con énfasis en la exclusión pilórica como método de tratamiento quirúrgico. Sede: Hospital de segundo nivel de atención. Dise o: Presentación de 2 casos clínicos: caso 1: paciente varón, con trauma cerrado de abdomen; y, caso 2: paciente varón, con trauma penetrante de abdomen por arma de fuego. Resultados: Los dos pacientes fueron sometidos a una laparotomía exploradora, realizándose la exclusión pilórica, con rafia duodenal, gastrostomía, yeyunostomía; acompa ados de pancreatectomía distal en el caso 1 y colecistectomía en el caso 2. En este último, se presentó una complicación séptica: un absceso pancreático que involucró el colon transverso, tratándose mediante laparostomía y hemicolectomía derecha e ileostomía. La estancia hospitalaria fue de 33 días (caso 1) y 97 días (caso 2). Conclusiones: El presente artículo pretende comunicar una conducta para el cirujano que enfrenta este tipo de trauma, analizando la técnica de la exclusión pilórica Due to their retroperitoneal location, traumatic lesions of pancreas and duodenum are difficult to treat. Pyloric exclusion is a therapeutic alternative for these lesions. We report a 22 years old male with a blunt abdominal trauma and a 23 years old male with a gunshot abdominal wound. Both were operated, performing a pyloric exclusion, with duodenal suture, gastrostomy and jejunostomy. A distal pancreatectomy was performed in the first patient a cholecystectomy in the second. The latter had a pancreatic abscess that involved transverse colon as complication. He was treated with a laparostomy, hemicolectomy and ileostomy. Hospital stays were 33 and 97 days in each case
Primary Closure without Diversion in Management of Operative Blunt Duodenal Trauma in Children  [PDF]
Katherine Smiley,Tiffany Wright,Sean Skinner,Joseph A. Iocono,John M. Draus
ISRN Pediatrics , 2012, DOI: 10.5402/2012/298753
Abstract: Background. Operative blunt duodenal trauma is rare in pediatric patients. Management is controversial with some recommending pyloric exclusion for complex cases. We hypothesized that primary closure without diversion may be safe even in complex (Grade II-III) injuries. Methods. A retrospective review of the American College of Surgeons’ Trauma Center database for the years 2003–2011 was performed to identify operative blunt duodenal trauma at our Level 1 Pediatric Trauma Center. Inclusion criteria included ages years and duodenal injury requiring operative intervention. Duodenal hematomas not requiring intervention and other small bowel injuries were excluded. Results. A total of 3,283 hospital records were reviewed. Forty patients with operative hollow viscous injuries and seven with operative duodenal injuries were identified. The mean Injury Severity Score was 10.4, with injuries ranging from Grades I–IV and involving all duodenal segments. All injuries were closed primarily with drain placement and assessed for leakage via fluoroscopy between postoperative days 4 and 6. The average length of stay was 11 days; average time to full feeds was 7 days. No complications were encountered. Conclusion. Blunt abdominal trauma is an uncommon mechanism of pediatric duodenal injuries. Primary repair with drain placement is safe even in more complex injuries. 1. Introduction Blunt duodenal trauma remains a relatively rare diagnosis among the pediatric population, accounting for 3 to 5% of all abdominal injuries [1]. Many cases are the result of lap belt or bicycle handlebar injuries, although higher mortality rates have been reported with blunt duodenal injury secondary to nonaccidental trauma [2]. In contrast to adult duodenal traumas, of which greater than 70% are penetrating, the majority of pediatric duodenal injuries are secondary to blunt trauma [3]. Cerise and Scully emphasized that trends in duodenal trauma have demonstrated a gradual increase in severity as a greater proportion are now secondary to motor vehicle accidents, with relatively fewer children experiencing low-velocity handlebar trauma [4]. Their collected cases allowed them to describe three general mechanisms of injury to the small bowel, which include crushing the bowel between the spine and a blunt object, tangential shearing against a relatively immobile segment of bowel, and increased intraluminal pressure causing rupture of a closed bowel loop [4]. Appropriate treatment of such injuries is hampered both by potential delay in diagnosis and by the controversial nature of optimal surgical
Laparoscopic drainage of an intramural duodenal haematoma: a novel technique and review of the literature
Gregory J Nolan, Cino Bendinelli, Jon Gani
World Journal of Emergency Surgery , 2011, DOI: 10.1186/1749-7922-6-42
Abstract: Intramural Duodenal Haematoma (IDH) is uncommon and may follow high energy blunt abdominal trauma. It accounts for 2% of injuries in children in this setting [1]. It is also seen in minor abdominal injuries in thrombasthenic patients [2] and endoscopic duodenal procedures [3]. The position of the duodenum over the vertebral column and its attachment to the ligament of Treitz predisposes it to deceleration injuries. Deceleration may cause IDH due to the shearing of mucosa and submucosa which disrupts the submucosal vascular plexus [4]. Historically IDH was managed surgically [4,5]. At laparotomy the surgical options included simple haematoma evacuation, gastroenterostomy with or without pyloric exclusion, duodenoduodenostomy, duodenojejunostomy or rarely pancreatoduodenectomy, depending on the severity of injury [5,6]. The introduction and establishment of Total Parenteral Nutrition (TPN) allowed the shift toward a more conservative approach [6-12]. TPN provides the nutritional requirements while awaiting resolution of the gastric outlet obstruction caused by the IDH. Today, IDH is primarily treated non-operatively and surgery considered only if the gastric outlet obstruction is not resolved in approximately 14 days [7]. Table 1 details surgical and radiological interventions in the literature which have been used for the management of IDH in blunt abdominal trauma. In this report we describe a novel laparoscopic technique for successful drainage of an IDH and review the surgical and radiological interventions reported in the literature.An 18 year old male sustained blunt abdominal trauma after falling off a skateboard onto a tree stump. Three days after the injury, he presented to a peripheral hospital complaining of increasing left upper quadrant abdominal pain. He was transferred to a Level 1 Trauma Centre for further management. On arrival he was afebrile and haemodynamically normal. His abdomen was distended with generalised tenderness and guarding. Pathology re
Tratamento do trauma duodenal complexo: compara??o entre sutura simples e sutura associada à exclus?o pilórica e gastrojejunostomia em c?es
Pierro, André Canesso;Mantovani, Mario;Reis, Norair Salviano dos;Morandin, Rosana Celestina;Fraga, Gustavo Pereira;
Acta Cirurgica Brasileira , 2005, DOI: 10.1590/S0102-86502005000100006
Abstract: purpose: the goal of this study is to compare the results of two different procedures to complex duodenal lesion (grade iii), in an animal model. methods: twenty-four mongrel dogs, weighting 10 to 15 kg, were distributed in 4 groups of 6 animals each. all animals were submitted to a complex duodenal lesion (grade iii), with a 50% loss of its circumference. all animals were treated with a longitudinal repair, resulting a significant narrowing of the duodenal lumen. groups a and c animals were submitted solely to repair while groups b and d, also underwent pyloric exclusion and gastrojejunostomy as a protection method. groups a and b animals were sacrificed at day 7 post op, while groups c and d were sacrificed at day 14. the following parameters were studied: weight-loss, degree of duodenal stenosis, operative site, vomiting, anastomotic leak, intra-abdominal abscess formation and death. results: the results obtained with simple duodenal repair were superior to pyloric exclusion and gastrojejunostomy in that the animals lost less weight and vomited less. it was also a simpler and less traumatic procedure. there were no differences in duodenal stenosis, leak, intra-abdominal abscess incidence or death between the two treatment groups. conclusion: duodenal suture associated to pyloric exclusion and gastrojejunostomy resulted more weight-loss and more vomiting incidence; the healing process of the duodenal suture line were similar between the two treatments; both treatments resulted similar increase in the duodenal stenosis degree; there were no cases of suture dehiscence, anastomotic leak, intra-abdominal abscess or death related to the kind of treatment; all animals submitted to pyloric occlusion had it intact at the time of necropsis.
Trauma duodenal. Técnica y manejo Duodenal trauma. Technique and management
Juan A Asensio,Patrizio Petrone,Brian Kimbrell,Eric Kuncir
Revista Colombiana de Cirugía , 2006,
Abstract: Las lesiones traumáticas del duodeno son infrecuentes, representan aproximadamente el 4% de las lesiones abdominales; pero conllevan una tasa de morbi-mortalidad significativa por lo cual es primordial su reconocimiento y tratamiento precoz. El objetivo de este trabajo es presentar una descripción concisa de la perspectiva histórica y de la anatomía de este órgano. Esta última cobra especial interés a la hora de la clasificación y manejo de la lesión duodenal. Asimismo, se describen los métodos de diagnóstico al alcance en la evaluación del traumatismo duodenal y la importancia de un conocimiento amplio de las técnicas quirúrgicas más utilizadas. Por último, se realiza un análisis profundo de los rangos de morbilidad y mortalidad de estas lesiones con base en una extensa revisión de la literatura actual, y el aporte de la experiencia de los autores en el manejo de este tipo de lesiones en un Centro Urbano de Trauma Nivel I. Traumatic lesions of the duodenum are not frequent, representing around 4% of all abdominal lesions. However, they are associated with significant morbidity and mortality rates and, therefore, it becomes of utmost importance their early recognition and treatment. The aim of this paper is to present a concise historical perspective and description of the anatomy of this organ. Anatomy is important because of the need to classify these lesions in preparation for their management. We also describe the diagnostic modalities and discuss the value of an ample knowledge of the different surgical techniques that are more generally utilized. Lastly, we analyze the ranges of morbidity and mortality based upon an extensive review of the current literature, adding our experience at an Urban Trauma Center Level I.
Isolated duodenal rupture due to blunt abdominal trauma  [cached]
Celik Atilla,Altinli Ediz,Onur Ender,Sumer Aziz
Indian Journal of Critical Care Medicine , 2006,
Abstract: Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis and final out comes.
Exclusión pilórica en lesión duodeno-pancreática combinada: reporte de 2 casos
I?AGUAZO S,DARWIN A;
Revista chilena de cirugía , 2007, DOI: 10.4067/S0718-40262007000500012
Abstract: due to their retroperitoneal location, traumatic lesions of pancreas and duodenum are difficult to treat. pyloric exclusion is a therapeutic alternative for these lesions. we report a 22 years old male with a blunt abdominal trauma and a 23 years old male with a gunshot abdominal wound. both were operated, performing a pyloric exclusion, with duodenal suture, gastrostomy and jejunostomy. a distal pancreatectomy was performed in the first patient a cholecystectomy in the second. the latter had a pancreatic abscess that involved transverse colon as complication. he was treated with a laparostomy, hemicolectomy and ileostomy. hospital stays were 33 and 97 days in each case
Isolated perforation of a duodenal diverticulum following blunt abdominal trauma
Metcalfe Matthew,Rashid Tanwir,Bird Richard le
Journal of Emergencies, Trauma and Shock , 2010,
Abstract: Only 10% of duodenal diverticula are symptomatic. We present the case of a man who fell from a height of 6 ft, landing on his abdomen and presenting 4 h later with severe back pain and a rigid abdomen. At laparotomy, a perforated retroperitoneal duodenal diverticulum was found and repaired with an omental patch. No other injury was noted. Not only is this perforation unusual, but the absence of other injuries sustained during this minor blunt trauma makes this case unique. This case highlights the need for a high index of suspicion when managing patients with back or abdominal pain following minor trauma.
Trauma-Focused Dynamic Therapy Model in Treating Complex Psychological Trauma  [PDF]
Vito Zepinic
Psychology (PSYCH) , 2017, DOI: 10.4236/psych.2017.813132
Abstract: Complex psychological trauma affects all structures of the personality—one’s image of the self, images of the others, and one’s values and ideals, and leads to the sense that the personality coherence and continuity is assaulted and systematically broken down. Complex trauma, such as war-related trauma, severe brutal rape, kidnaping, terrorism, etc., overwhelms the ordinary human adaptations to life and involves the threats to life and bodily integrity, and confronts human being with the extremities of helplessness and terror, and evokes response of catastrophe. As the complex trauma is a specific traumatic experience, it requires specifically designed trauma-focused therapeutic approach which should deal with: a) the nature of the predisposing factors in complex trauma, b) the manner in which trauma experience and conditioning produce distortions in trauma victim’s personality, c) the relationship between the personality structure and trauma, d) the constituents of inner conflicts, e) meaning function and manifestations of trauma syndrome, f) the structure of the psychic apparatus, and g) the mechanisms of defences. The Dynamic Therapy model has been developed as a three-phase treatment while providing therapy for over decade to the complex PTSD patients whose condition has been an aftermath of human-designed disasters (wars, brutal rapes, assaults and serious violence). The Dynamic Therapy model emphasises that there is a complex process in interactions between different phenomenological components of the complex trauma and that there is a variety of the ways in which etiological factors can contribute to the onset of the trauma syndrome. With the patient’s complicated clinical presentations, the therapy accentuates the main principles and targets in treating complex trauma syndrome: 1) trauma symptoms reduction and stabilisation, 2) processing of traumatic memories, dissociation, and emotions, and 3) life integration after trauma processing. The model is a goal-directed phased treatment towards the restoration of a disrupted sense of self that affects the inner and the outer world of a traumatised individual.
Trauma duodenal. Técnica y manejo
Asensio,Juan A; Petrone,Patrizio; Kimbrell,Brian; Kuncir,Eric;
Revista Colombiana de Cirugía , 2006,
Abstract: traumatic lesions of the duodenum are not frequent, representing around 4% of all abdominal lesions. however, they are associated with significant morbidity and mortality rates and, therefore, it becomes of utmost importance their early recognition and treatment. the aim of this paper is to present a concise historical perspective and description of the anatomy of this organ. anatomy is important because of the need to classify these lesions in preparation for their management. we also describe the diagnostic modalities and discuss the value of an ample knowledge of the different surgical techniques that are more generally utilized. lastly, we analyze the ranges of morbidity and mortality based upon an extensive review of the current literature, adding our experience at an urban trauma center level i.
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