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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.
Intraperitoneal Rupture of Hepatic Hydatid Cyst Following Blunt Abdominal Trauma  [cached]
Anjan Kumar Dhua,Akshay Sharma,Yogesh Kumar Sarin
APSP Journal of Case Reports , 2012,
Abstract: Peritonitis due to rupture of liver hydatid cyst secondary to blunt abdominal trauma can present with fatal consequences. Timely diagnosis and appropriate surgical management can be life saving. We report a case of ruptured liver hydatid cyst in the peritoneal cavity following trauma and its successful operative management in a preadolescent previously asymptomatic boy. Importance of detailed physical examination and early diagnosis by using appropriate radiological investigations is highlighted.
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
Blunt traumatic diaphragmatic rupture Rotura diafragmática no trauma abdominal fechado  [cached]
Antonio Carlos Nogueira,Munir Bazzi,Francisco Garcia Soriano,Haydée Jord?o
Autopsy and Case Reports , 2011,
Abstract: Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5% among patients who were victims of blunt trauma and underwent laparotomy. Clinical suspicion associated with radiological assessment contributes to early diagnosis. Isolated diaphragmatic injury has a good prognosis. Generally worse outcomes are associated with other trauma injuries. Bilateral and right diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT) scan of the chest and abdomen provides better diagnostic accuracy using the possibility of image multiplanar reconstruction. Surgical repair via laparotomy and/ or thoracotomy in the acute phase of the injury has a better outcome and avoids chronic complications of diaphragmatic hernia. The authors present the case of a young male patient, victim of blunt abdominal trauma due to motor vehicle accident with rupture of the diaphragm, spleen and kidney injuries. The diagnosis was made by computed tomography of the thorax and abdomen and was confirmed during laparotomy. A incidência de les o traumática do diafragma, relatada na literatura, varia de 0,6 a 1,2% dentre os pacientes vítimas de traumas, elevando-se para 5% nos pacientes com trauma fechado submetidos a laparotomia. A suspeita clínica associada à avalia o radiológica contribui para o diagnóstico precoce. A les o diafragmática isoladamente é de bom prognóstico. Assim, em geral, as les es associadas à rotura diafragmática s o os preditores da pior evolu o do paciente. As les es do diafragma direito e as les es bilaterais apresentam pior prognóstico. A tomografia computadorizada com multidetectores (MDCT) de tórax oferece a possibilidade de reconstru o multiplanar permitindo melhor acurácia no diagnóstico. A corre o cirúrgica por meio de laparotomia e/ou toracotomia na fase aguda do trauma apresenta boa evolu o e evita as complica es cr nicas da hérnia diafragmática. Os autores apresentam o caso de um paciente jovem do sexo masculino, vítima de trauma abdominal fechado por acidente automobilístico que apresentou rotura do diafragma, les o esplênica e renal. O diagnóstico foi feito através da tomografia computadorizada de tórax e abdome e confirmada durante laparotomia exploradora.
Partial Avulsion of Common Bile Duct and Duodenal Perforation in a Blunt Abdominal Trauma  [PDF]
Bilal Mirza,Lubna Ijaz,Shahid Iqbal,Afzal Sheikh
APSP Journal of Case Reports , 2010,
Abstract: Complete or partial avulsion of common bile duct is a very rare injury following blunt abdominal trauma in children. A 7-year old boy presented to ER following blunt abdominal trauma by a moving motorcycle. X ray abdomen revealed free air under diaphragm and CT scan showed pancreatic contusion injury. At operation anterior wall of common bile duct (CBD) along with a 2mm rim of duodenal tissue on either side of anterior wall of CBD were found avulsed from the duodenum. The avulsed portion of CBD and duodenum were reanastomosed and a tube cholecystostomy performed. The patient had an uneventful recovery.
Delayed presentation of an isolated gallbladder rupture following blunt abdominal trauma: a case report
Jonathan Bainbridge, Hossam Shaaban, Nick Kenefick, Christopher P Armstrong
Journal of Medical Case Reports , 2007, DOI: 10.1186/1752-1947-1-52
Abstract: A 65 year old lady presented through the Emergency Department with a 1 week history of blunt trauma to her abdomen. She complained of continued epigastric pain which radiated through to her back and right upper quadrant. On presentation, the patient had a low grade temperature, hypotension and mild tachycardia. Abdominal examination revealed right upper quadrant tenderness with no localised peritonism. C-reactive protein was 451. An abdominal CT showed a moderate amount of ascitic fluid in the perihepatic space. The patient underwent a laparotomy, which revealed a ruptured gallbladder with free bile. There was no evidence of any associated injuries to the surrounding organs. Partial cholecystectomy was done in view of the friable nature of the gallbladder. Post operatively, a persistent bile leak was managed successfully with endoscopic sphincterotomy and stenting.Rupture of the gallbladder due to blunt injuries to the abdomen occurs from time to time and may constitute a diagnostic challenge especially with delayed presentation. Partial cholecystectomy is a safe option in cases where friability of the wall renders formal cholecystectomy inadvisable. Endoscopic sphincterotomy and stenting is a safe and effective treatment for persistent post operative bile leaks.Blunt injuries to the gallbladder occur rarely, and the incidence of isolated damage to the gallbladder is even smaller [1-3]. The delay in presentation of the injury is not unusual. Significant morbidity or even mortality can result from delay in diagnosis, which can easily occur due to both rarity of the condition and low amplitude of symptoms. It is very important to bear in mind the possibility of such injury when confronted with a case of upper abdominal pain following blunt abdominal trauma. We report a case of delayed presentation of isolated rupture of the gallbladder following blunt trauma to the abdomen. A literature review on this subject is also provided.A 65 year old lady presented through the E
Gastrointestinal Injuries Following Blunt Abdominal Trauma In Children
LB Chirdan, AF Uba, OO Chirdan
Nigerian Journal of Clinical Practice , 2008,
Abstract: Purpose: Gastrointestinal (GI) injuries in children following blunt abdominal trauma is rare; early diagnosis and treatment is important for good outcome. The purpose of this report is to describe the management problems encountered in children with GI injuries following blunt abdominal trauma. Patients and Methods: From January 1996 June 2006, 168 children were treated at our centre for abdominal trauma. Twenty three had GI injuries, 19 were due to blunt trauma while four were due to penetrating trauma. We retrospectively reviewed the clinical data of the 19 children that had GI injuries as a result of blunt abdominal trauma to document the presentation, clinical features, diagnosis and outcome. Results: There were 19 patients, 14 were boys, and five were girls. The median age at presentation was nine years (range 1.5 15 years). Road traffic accident was responsible for injuries in 10, fall from heights in six and assault in two children. In one child the cause of injury was not recorded. Most children presented late and at presentation over 80% had abdominal signs. Diagnosis was mainly by physical examination supported by plain abdominal x-ray in 15 children. All 19 children had laparotomy. There were a total of 23 injuries. Gastric and duodenal injuries accounted for one each. Most of the injuries were in the jejunum and ileum (10 perforations, two contusions with one mesenteric haematoma and one mesenteric tear). There was one caecal perforation and six colonic injuries , one of which was associated with intraperitoneal rectal injury. Five children had other associated injuries (three splenic injuries, one renal injury, one bladder contusion associated with long bone fractures and one severe closed head injury). Treatment included segmental resection with end to end anastomosis, wedge resection with anastomosis, exteriorizations stomas, simple excision of the perforation and closure in two layers (gastric perforation). The total mortality was four (21.1%), two of them due to associated injuries. Conclusion: Gastrointestinal injuries due to blunt abdominal trauma pose a management challenge. Management based on decisions from serial clinical examinations and simple tests without recourse to advance imaging techniques may suffice.
Reconstruction of a traumatic duodenal transection with a pedicled ileal loop: a case report
Apostolos Kambaroudis, Nikolaos Antoniadis, Savvas Papadopoulos, Charalambos Spiridis, Thomas Gerasimidis
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-343
Abstract: We describe the case of a 16-year-old Caucasian boy with a blunt duodenal injury after a motor vehicle accident. On admission, the patient had stable vital signs and a normal laboratory workup. Gradually his clinical condition deteriorated and a computed tomography scan showed a retroperitoneal haematoma at the level of his duodenum. A fully circumferential rupture of the second part of his duodenum was found during laparotomy, with the intact Vater's papilla lying adjacent to the defect and a superficial laceration of the head of his pancreas. The retroperitoneal haematoma was thoroughly drained and a pedicled ileal loop was interposed between the duodenal stumps to restore the continuity of the patient's duodenum. Apart from a mild postoperative pancreatitis, the patient's postoperative course evolved with no further problems. The patient was discharged on the 22nd postoperative day in excellent condition and has remained so to date (after five years).In our case report, where the second part of the patient's duodenum was completely transected, our choices for reconstruction were limited. Important factors for the successful management of this patient were prompt surgical intervention and the accurate assessment of the nature of the duodenal and associated injuries. We believe that the technique we used was a reasonable choice because the anatomical continuity of the patient's duodenum was restored.Patients with duodenal injuries represent approximately 4% of all patients with abdominal injuries from blunt trauma, usually resulting from motor vehicle accidents, which account for 22% of all patients with duodenal injuries [1]. Due to the anatomical position of the duodenum, blunt duodenal trauma is usually associated with injuries to adjacent structures, including the pancreas, bile duct, mesenteric vessels, and inferior vena cava [1]. As the diagnosis of a patient with a blunt duodenal injury is difficult, and even though there are many laboratory tests and radiol
Laparoscopic splenectomy in a case of blunt abdominal trauma
Agarwal Narendra
Journal of Minimal Access Surgery , 2009,
Abstract: Splenic rupture is a frequent consequence of blunt abdominal trauma. Removal of the spleen (splenectomy) or alternative conservative procedures (splenorrhaphy, partial splenectomy and haemostatic collagen application) are surgical treatment options. Splenectomy was first described in 1910 by Sutherland. Laparoscopic splenectomy was first described in 1991 by Delaitre and Maignien. Since then significant improvements in instrumentation and technology such as harmonic scalpel, endovascular staplers have increased its ease of performance. Laparoscopic splenectomy for a ruptured spleen has been reported only in a few cases, in which a hand-assisted technique was used. We present the first reported case from India (to the best of our knowledge) of a successful removal of a ruptured spleen by means of a totally laparoscopic technique.
Diagnosis and Surgical Treatment of Diaphragmatic Rupture Following Blunt Abdominal Traumas
Ahmet Karamercan,Osman Kurukahvecioglu,Yildirim Imren,Tonguc Utku Yilmaz,Mustafa Sare,Bulent Aytac
Surgery Journal , 2012,
Abstract: Diaphragmatic rupture observed in trauma patients with multiple organ injuries is a rare but serious problem. The incidence rate for diaphragmatic rupture is 0.8-5% while mortality rate is between 16.6-33.3%. There are cases in the literature which diaphragmatic rupture was diagnosed years after the trauma. Symptoms related to heart or lung compression due to early or delayed displacement of the abdominal viscera into the thorax or strangulation of abdominal viscera lead the physician to diagnosis. A 75-year old female patient who presented to the emergency room with shortness of breath, abdominal pain, nausea and vomiting complaints had been in a traffic accident 20 days earlier and admitted to the hospital. Abdominal ultrasound, plain radiographs and laboratory tests after the accident had been normal and the patient was discharged after a 24 h follow-up. Patient had signs of intestinal obstruction and abnormal blood gas values and posterior-anterior chest radiograph revealed elevation of the left hemidiaphragm. Thoracic computarized tomography demonstrated elevation of the posterolateral region of the left hemidiaphragm and displacement of the subdiaphragmatic organs within the thorax, up to the level of the carina. The patient had laparotomy under emergency conditions when rupture of the diaphragm was identified and repaired transabdominally. Diaphragmatic ruptures secondary to blunt traumas can be diagnosed with its early or late symptoms. Non-specific symptoms like chest pain, dyspnea, tachypnea, shortness of breath observed in patients should raise suspicion. Early or late deterioration in blood gas analyses following blunt traumas should be assessed carefully. Diagnosis can be rapidly established with direct radiographs, thoracic computarized tomography and magnetic resonance imaging. Treatment of rupture is surgery. Generally the diaphragm is repaired by the transabdominal approach while complicated ruptures can be assessed with a lower thoracic incision. Being extra vigilant following serious blunt traumas is an important factor in establishing the diagnosis.
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