1/6. 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 = 1keywords = ligament (Clic here for more details about this article) |
2/6. gallbladder injury in blunt abdominal trauma.A 36-year-old woman was admitted to the hospital for an abdominal blunt trauma. At ultrasound (US) and computed tomography (CT), a gallbladder lesion was suspected, along with a tear of the liver. The patient was submitted to a diagnostic laparoscopy. The gallbladder was partially avulsed and bile was infiltrated in the hepatoduodenal ligament. Intraoperative cholangiography and Kocher's maneuver excluded other lesions. Laparoscopic cholecystectomy was performed, but due to severe hemorrhage from the liver tear, the operation was converted to an open procedure. gallbladder lesions in blunt trauma are rare occurrences, but they are often associated with other organ injuries. US and CT scan are valuable for their diagnosis, but if a lesion is suspected, diagnostic laparoscopy is advisable in stable patients. It should be accompanied by a cystic duct cholangiography and a Kocher's maneuver to evaluate the integrity of the biliary tree. Laparoscopic cholecystectomy is generally feasible. Associated lesions require laparotomy when they are not amenable to laparoscopic treatment.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
3/6. Pediatric seatbelt injuries: unusual Chance's fracture associated with intra-abdominal lesions in a child.The authors report the case of a 7-year-old child involved in a motor vehicle accident. She sustained an unusual flexion-distraction vertebral injury. This spinal injury was related to seatbelt use and was associated with intra-abdominal lesions. The spinal lesion consisted of a posterior ligamentous disruption with widening of the posterior intervertebral space at two adjacent lumbar levels. The purpose of this case report is to describe an atypical and perhaps often unrecognized spinal lesion and to explain our approach to diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
4/6. Biliary injury after laparoscopic cholecystectomy: end-to-end anastomosis covered with umbilical vein.The management of biliary injuries after laparoscopic surgery presents a surgical challenge. We describe a promising method of biliary reconstruction with umbilical vein covering followed by end-to-end anastomosis. In the patient reported here, the umbilical vein was identified in the pedicled ligamentum teres, transected as if it were a sheet, and sutured, then covered ventrally to the anastomosed bile duct. This procedure may be a promising reinforcement of the reconstructed site which maintains the biliary integrity; however, it can be applied, only in selected situations.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
5/6. Transvaginal injury of the duodenum, diaphragm, and lung.An unusual case of transvaginal impalement is presented. At initial exploration the broad ligament and vagina were repaired. When bile drained from suction catheters reexploration revealed an injury to the duodenum and diaphragm. Wounds that penetrate the vagina may injure nonpelvic viscera. Vaginal penetrating wounds should be managed like other abdominal penetrating injuries.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
6/6. Abdomino-thoracic shooting wound with multivisceral involvement including injury of abdominal aorta in the supra-mesocolic segment.Abdomino-thoracic wounds caused by shooting are very serious as they frequently affect several organs and require extreme emergency surgery. Within traumatic abdominal vascular wounds, aortic injury in the supramesocolic segment is associated with a high mortality, 64% (2). The case reported, a 19y. old young man, suffered multiple organ injuries by shooting involving abdominal aorta, stomach, liver, diaphragm and lung. He was operated in extreme emergency. The evolution has been simple, the patient leaving the hospital 19 days after surgery. This case presents a tactical peculiarity about the access procedure to the supramesocolic abdominal aorta through the great epiploon, dividing the gastro-colic and the gastro-splenic ligaments.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |