1/34. Intrapericardial caval injury due to blunt trauma.BACKGROUND: Report of diagnosis and treatment of intrapericardial vena caval injury caused by blunt thoracic trauma, an unusual cause of cardiac tamponade. methods: A 43-year-old male motor vehicle accident victim suffered a lacerated intrapericardial inferior vena cava leading to cardiac tamponade. Positive clinical findings were hypotension and tachycardia without indication of external chest trauma. RESULTS: Abdominal computed tomography was negative, but ultrasound demonstrated cardiac tamponade and fluid in the abdomen. pericardiocentesis was performed, and nonclotted blood was aspirated. laparotomy showed intra-abdominal blood and splenic capsule avulsion. sternotomy revealed a laceration of the inferior vena cava, which was repaired. CONCLUSIONS: Signs of cardiac tamponade and a history of blunt thoracic trauma caused by deceleration injury suggests intrapericardial inferior vena cava injury. Median sternotomy is the optimal choice for caval repair.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
2/34. Immediate endovascular repair for descending thoracic aortic transection secondary to blunt trauma.PURPOSE: To report the immediate endovascular treatment of a thoracic aortic tear secondary to blunt trauma. methods AND RESULTS: A 39-year-old man was injured in a motor vehicle collision. In addition to significant trauma to the head, chest, and abdomen, there were signs of a deceleration injury to the thoracic aorta. After urgent celiotomy to repair a lacerated spleen, the thoracic aortic transection was treated intraluminally using an endograft made of Gianturco Z-stents covered with polytetrafluoroethylene. The patient recovered from his injuries, and the thoracic endograft shows no evidence of endoleak 7 months after treatment. CONCLUSIONS: Endoluminal techniques can be used successfully in the immediate repair of thoracic aortic injuries.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
3/34. Tension pneumopericardium during laparoscopy for trauma.A case involving a patient with multiple stab wounds to the thoracoabdomen is reviewed. laparoscopy was employed to determine peritoneal penetration. Hemodynamic collapse occurred secondary to tension pneumopericardium, which resulted from a 15 mm Hg pneumoperitoneum. The relevant literature is reviewed.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
4/34. Thoracolaparoscopic repair of traumatic diaphragmatic rupture.Diaphragmatic rupture may occur after blunt or penetration trauma caused by the application of a powerful external force. Diaphragmatic rupture usually is repaired via laporotomy and/or thoracotomy, depending on the associated organ injury. The case of a 49-year-old man with traumatic rupture of the left hemidiaphragm is presented. Preoperatively, diaphragmatic rupture with herniation of the stomach into the left thoracic cavity was confirmed by computed tomography scan of the thorax. Under thoracoscopic guidance, the stomach, spleen, and omentum were repositioned in the abdominal cavity, and the rupture site (10 cm) was closed by nonabsorbable suture. A subsequent laparoscopy was performed to assess the efficacy of the repair and the absence of any abdominal organ injury. The patient was discharged from hospital without any respiratory or abdominal symptoms. Our report confirms that in the case of a patient with penetration injuries to the lower chest and upper abdomen, a combined thoracoscopic and laparoscopic approach may offer both diagnostic and therapeutic benefits with reduced surgical trauma. We conclude that thoracoscopic repair of traumatic diaphragmatic rupture can be used safely when no abdominal organ injuries are found.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
5/34. Treatment of full-thickness abdominal and chest wall losses with split-thickness skin grafting.A 22-year-old man developed a large abdominal wall and sternal defect resulting from wound dehiscence. This was a sequel to two operations for gunshot wounds of the abdomen, the second one being for intraperitoneal abscess. The infected dehiscence was treated by the open method using povidoneiodine (Betadine) packs. As soon as the patient's condition permitted, split-thickness grafts were applied to the defect. One hundred percent success resulted, and convalescence of this critically ill patient was thereafter uninterrupted until discharge 31 days later. It is the authors' opinion that this method has a wider application than it is usually accredited.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
6/34. A suicidal death by explosives.A 23-year-old man committed suicide by detonating an explosive substance clutched to his abdomen. The face was singed, the hands were lacerated and the chest and the upper part of abdomen were badly mutilated. The death was due to the destruction of several vital organs. The injuries had a directional nature. Only the consideration of all the facts of the case in relation to the situation, nature, distribution and extent of wounds and the preceding medical and social history allowed a reconstruction of the circumstances.- - - - - - - - - - ranking = 2keywords = abdomen (Clic here for more details about this article) |
7/34. pneumopericardium in blunt chest trauma after high-speed motor vehicle accidents.pneumopericardium is the presence of air in the pericardial space. In adults, it may be seen in the context with severe blunt chest trauma, pneumothorax, pneumoperitoneum, or other causes of pneumomediastinum. The diagnosis is made by computed tomography scan of the thorax and abdomen that allows the additional detection of concomitant injuries. Possible causes of the pneumopericardium such as tracheobronchial or oesophageal tears have to be excluded by bronchoscopy or esophagogastroduodenoscopy. Usually, pneumopericardium is self-limiting requiring no specific therapy. However, a continuous monitoring of the electrocardiography and the blood pressure is necessary at an intermediate care unit. Tension pneumopericardium causing a life-threatening cardiac tamponade requires an immediate pericardial aspiration, the subsequent pericardial drainage via a pericardial window or emergent open subxyphoid approach to the pericardium.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
8/34. Successful late restoration of traumatic distal bronchial separation.Traumatic distal bronchial interruption is unusual. A 42-year-old male with history of blunt injury to his chest and abdomen 20 years previously presented with recurrent pneumonia of the right lung. Patient's middle and lower lobes were partially atelectatic and the right intermediate bronchus was found completely dehisced at the time of surgical exploration. A direct re-implantation of intermediate bronchus was successfully performed. At late follow-up the anastomosis had healed well without any stricture and patient remains without symptoms.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
9/34. autopsy artifact created by the Revivant AutoPulse resuscitation device.In certain cases, the evaluation and correct identification of resuscitative artifacts is critical to the correct diagnosis and determination of the cause and manner of death. Resuscitative artifacts can resemble homicidal or accidental injury and thus possibly be misinterpreted. Occasionally, new technologies and/or medical procedures will create original and/or distinctive artifacts. In 2003, the san francisco Fire Department emergency personnel began field-testing the Revivant AutoPulse, an automated chest compression device. This device is currently being used in two other counties in the san francisco Bay Area as well as regions of florida, virginia, and ohio. We present three cases of resuscitative artifact that could be potentially confused with homicidal or accidental injury. These cases illustrate resuscitative artifacts, specifically lateral chest and horizontally oriented upper abdomen cutaneous abrasions created by this automated chest compression device.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
10/34. Independent lung ventilation in the management of traumatic bronchopleural fistula.Independent lung ventilation (ILV) is a technique for managing patients with unilateral lung disease or injury who have failed conventional mechanical ventilation. A 20-year-old man sustained severe ballistic injuries to the chest and abdomen. Damage control laparotomy controlled the patient's initial hemorrhage, however, an evolving cavitary pulmonary lesion subsequently developed into a high-volume bronchopleural fistula. Progressive atelectasis of the damaged lung resulted in profound hypoxemia and hypercarbia refractory to conventional mechanical ventilation. Synchronous ILV was initiated using a double-lumen endotracheal tube and two ventilators titrated to optimize the patient's oxygenation and ventilation and minimize ventilator-induced lung injury. Intensive ILV over the next 17 days resulted in recruitment of the atelectatic right lung, resolution of the bronchopleural fistula, and significant improvement in oxygenation and pulmonary compliance. This appears to be the longest reported use of ILV for traumatic lung injury.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
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