1/63. A patient with a traumatic right diaphragmatic hernia occurring 4 years after sustaining injury--statistical observations of a delayed diaphragmatic hernia caused by uncomplicated injury in japan.We describe our experience with a patient in whom a traumatic right diaphragmatic hernia developed 4 years after sustaining injury and review cases of delayed diaphragmatic injury reported in japan. The patient was a 28-year-old man who sustained a severe contusion of the right epigastric region and fractured a right rib in a traffic accident in September 1992. In August 1996, the patient presented with shortness of breath on effort or after meals. A chest roentgenogram revealed intestinal gas in the right side of the thoracic cavity. A right diaphragmatic hernia was diagnosed on the basis of a gastrointestinal series, and the patient was operated on. The hernial orifice extended anteriorly from the central tendon in an 11:00 direction and measured 11 x 6 cm. The small intestine, right side of the colon, and liver were herniated. A total of 297 cases of blunt traumatic diaphragmatic hernia were reported in japan between 1981 and 1996, including 47 cases (left side, 32 cases; right side, 15 cases) of delayed diaphragmatic hernia, defined as occurring one month or more after injury. Diaphragmatic hernia should be considered as a possible diagnosis in patients with abnormal shadows in the thoracic region who have recently sustained injury or who have a past history of injury.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/63. Posttraumatic intestinal stenosis presenting as a perforation: report of a case.A 78-year-old woman was admitted to the hospital after falling into a ditch approximately 1 m deep and sustaining a blunt abdominal trauma with a left femur fracture. On the tenth day after admission, symptoms of a small bowel obstruction occurred. A nasogastric tube was inserted, and the symptoms thus improved. She sometimes complained of abdominal pain during the 12 months after the fall, but recovered with conservative management. The next year, she was readmitted to the hospital for a pin extraction of the left femur bone. During this admission, 15 months since her admission after her fall, she again complained of abdominal pain. abdominal pain increased with a muscular defense, and abdominal x-rays revealed free air. She was referred to our hospital with a diagnosis of perforative peritonitis, and emergency surgery was performed. Upon laparotomy, circumferential stenoses of the small bowel were recognized in the proximal segments about 40cm, 80cm, and 100cm from the ileocecal region. In addition, a perforation and prominent dilatation of the bowel segment was observed just proximal to the stenosis about 100cm from the ileocecal region. She underwent a small intestinal resection at two sites. There were no findings of an intestinal specific ulcer, such as Crohn's disease, intestinal tuberculosis, or malignancy, based on the results of a histopathological examination.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
3/63. Complete biliary avulsion from blunt compression injury.The liver is the solid organ most commonly injured as a result of blunt abdominal trauma. Complete avulsion of the common hepatic duct is a rare and devastating type of hepatobiliary trauma. Here the authors report the case of a 7-year-old child who had complete biliary disruption as a result of an abdominal crush injury that was not diagnosed correctly preoperatively. The intraoperative diagnosis and treatment of this injury is discussed.- - - - - - - - - - ranking = 1.1359727994343keywords = compression (Clic here for more details about this article) |
4/63. Ultrasound of epigastric injuries after blunt trauma.Blunt trauma to the epigastrum may result in a retroperitoneal hematoma involving the head of the pancreas and descending duodenum. Secondary effects include obstruction of the gastric outlet, obstruction of the biliary tree, and extrinsic compression of the inferior vena cava. Four patients with epigastric trauma were reviewed who had been examined by ultrasound of the abdomen. Ultrasound showed the extent of the retroperitoneal hematoma, its effect on contiguous organs, and was helpful in clinical management.- - - - - - - - - - ranking = 0.28399319985859keywords = compression (Clic here for more details about this article) |
5/63. Femorofemoral bypass, even in pregnancy--a case report.A 29-year-old pregnant woman sustained blunt, left lower abdominal trauma, with hip and pelvic fractures, and progressive dissection of an intimal flap in the left iliac artery, which manifested two days later as profound ischemia of the left leg. The patient underwent distal thromboembolectomy, fasciotomies and revascularization of the leg by femorofemoral polytetrafluoroethylene bypass. The patient recovered completely and gave normal birth three months later to a healthy child. Four years after the operation she gave uneventful birth to another child. Various considerations pertinent to this complex traumatic-vascular-gestational state are discussed.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
6/63. Blunt abdominal aortic trauma in association with thoracolumbar spine fractures.All patients with blunt abdominal aortic disruption (BAAD) in the trauma registries at the three Regional Trauma Centres were retrospectively reviewed over the last decade. From the 11465 trauma admissions ISS>16,194 sustained aortic injuries. Eight cases of BAAD were identified, six with concurrent thoracolumbar spine (TLS) fractures (mean ISS 42). patients with BAAD and TLS were subject to a detailed analysis. Clinically, three injury types were seen, hemodynamically unstable (uncontained full thickness laceration), stable symptomatic (intimal dissection with occlusion), and stable asymptomatic (contained full thickness laceration or intimal dissection without occlusion). All spinal column fractures involved a distractive mechanism, one with both distractive and translational fracture components. We propose that a distractive force, applied to the aorta lying anterior to the anterior longitudinal ligament, results in an aortic injury spectrum ranging from an intimal tear to a full thickness laceration, as a related injury. Computed tomography (CT) was an important imaging modality in the stable asymptomatic patients. All intimal dissections without occlusion were managed non-operatively. With distractive TLS fractures, BAAD needs to be considered.- - - - - - - - - - ranking = 8keywords = fracture (Clic here for more details about this article) |
7/63. Seat-belt syndrome revisited.This report describes a complex syndrome of injuries occurring in a young female who was a back seat passenger wearing a lap-belt restraint in a high-speed road traffic accident. As a consequence of the forced flexion distraction injury of her lumbar spine, she sustained a fracture-subluxation of the first lumbar vertebra in association with a jejunal perforation and extensive small intestinal mesenteric laceration. She also had a large traumatic hernia of the anterior abdominal wall, which was overlooked at primary laparotomy. This report highlights collectively the classical combination of injuries associated with the lap-belt syndrome and demonstrates the importance of carefully inspecting the anterior abdominal wall for deficiencies, because traumatic herniation may be easily overlooked.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
8/63. Management of seat-belt syndrome in children. Gravity of 2-point seat-belt.We present our experience with a management of seat-belt syndrome in three children and draw particular attention to the severity of two-point fixation seat-belt injuries after a motor vehicle accident with 5 passengers whose vehicle was struck head-on by an oncoming vehicle. The parents were sitting in front, Adeline had a 2-point lap seat-belt, the 2 other children had 3-point seat-belts. The parents both had humerus fractures. The 4-year-old brother suffered a cervical and abdominal trauma with renal and splenic contusions and intestinal perforations. Adeline suffered multiple injuries, notably to the head, spine and abdominal viscera with erosions at the site of lap-seat-belt contact. The spinal injury was an L2 angular Chance fracture associated with paraplegia on the 7th day. Operative findings included a transverse tear of the left rectus abdominus muscle, an incomplete transection of the stomach and perforation of the ileum. The injuries were ultimately fatal. Given associated abdominal pain, skin erosions at the site of seatbelt contact, spinal fracture, and rectal muscle disruption apparent on emergency laparotomy, early diagnosis is important for better prognosis.- - - - - - - - - - ranking = 3keywords = fracture (Clic here for more details about this article) |
9/63. Lap belt iliac wing fracture: a predictor of bowel injury in children.Lap belt restraints in motor vehicle collisions have been associated with a variety of injuries, mainly bowel and lumbar spine. Cephalad positioning of the belt over the intended position across the anterior superior iliac spines (which typically occurs in younger children) is thought to be responsible for the observed bowel injuries. We report two pediatric patients, both restrained by lap belts in high-speed collisions, who suffered iliac wing fractures in addition to bowel injuries. Unexplained free peritoneal fluid was the sole CT finding in one patient (a teenage girl) who had a delay in diagnosis of bowel perforation. These cases illustrate the high frequency of bowel injury in pediatric patients with iliac wing fractures associated with lap belt use.- - - - - - - - - - ranking = 6keywords = fracture (Clic here for more details about this article) |
10/63. Serial abdominal closure technique (the "SAC" procedure): a novel method for delayed closure of the abdominal wall.Abdominal compartment syndrome may occur after any elective or emergent abdominal operations that are complicated by postoperative hemorrhage or in the trauma patient who has massive fluid replacement for intra-abdominal bleeding. Once the abdomen is decompressed the type of closure varies as much as the surgeon performing the procedure. We have devised a simple, reproducible, inexpensive, and safe method to close the abdomen at the bedside. Serial abdominal closure (SAC) was performed on three patients 45, 54, and 14 years of age who had developed abdominal compartment syndrome secondary to an upper gastrointestinal bleed requiring massive transfusion, a tear of the superior mesenteric vein, and a grade 4 liver laceration respectively, all necessitating abdominal decompression. All three patients had their abdominal wounds closed at the bedside over the course of several days with our SAC technique. Subsequent postoperative course was uneventful and the abdominal wall was free of defects at one-year follow-up. SAC is an efficient, inexpensive, and easily reproducible method of managing the open abdomen. The use of SAC prevented abdominal closure-related complications such as enteric fistula and hernia formation in our three patients.- - - - - - - - - - ranking = 0.28399319985859keywords = compression (Clic here for more details about this article) |
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