Cases reported "Abdominal Injuries"

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1/12. aortic rupture as a result of low velocity crush.

    A case of aortic disruption in a 35 year old lorry driver is described. This occurred as a result of a low velocity crushing force. Clinicians should be aware that this mechanism of injury may result in aortic disruption as well as the more commonly mentioned severe deceleration force.
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2/12. Blunt injury to the external iliac artery: a case report.

    Blunt vascular trauma is rare as compared with penetrating vascular trauma. The incidence of iliac artery injury has been reported as low as 0.4 per cent of total arterial trauma. iliac artery injury in blunt trauma is rare because of its anatomic location and protection by the pelvis. This article presents a case of external iliac artery injury secondary to blunt trauma. A deceleration-type mechanism is suggested that results in the production of an intimal flap and later vessel thrombosis. We discuss the clinical details of presentation and angiographic diagnosis as well as treatment options.
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3/12. gallbladder injuries due to blunt abdominal trauma: report on five cases and review of the literature.

    gallbladder lesions by blunt abdominal trauma are rare, due to the organ's anatomical particularities. Diagnosis is difficult, and it generally occurs during surgery. The trauma is usually associated with other lesions and is related to very serious traumas or to deceleration. Due to the scarcity of publications on this topic and to its reduced incidence, we present here a report of five patients who had suffered blunt abdominal trauma with gallbladder lesion and who were attended at the General Hospital (of the University of Sao Paulo Medical School) Emergency Service between 1986 and 1991. Furthermore, we analyze the incidence of this trauma, presence of associated lesion, treatment, morbidity and mortality of the patients, as well as a review of the literature.
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keywords = deceleration
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4/12. Seat-belt injuries in children involved in motor vehicle crashes.

    BACKGROUND: The efficacy of seat belts in reducing deaths from motor vehicle crashes is well documented. A unique association of injuries has emerged in adults and children with the use of seat belts. The "seat-belt syndrome" refers to the spectrum of injuries associated with lap-belt restraints, particularly flexion-distraction injuries to the spine (Chance fractures). methods: We describe the injuries sustained by 8 children, including 2 sets of twins, in 3 different motor vehicle crashes. RESULTS: All children were rear seat passengers wearing lap or 3-point restraints. All had abdominal lap-belt ecchymosis and multiple abdominal injuries due to the common mechanism of seat-belt compression with hyperflexion and distraction during deceleration. Five of the children had lumbar spine fractures and 4 remained permanently paraplegic. CONCLUSIONS: These incidents illustrate the need for acute awareness of the complete spectrum of intra-abdominal and spinal injuries in restrained pediatric passengers in motor vehicle crashes and for rear seat restraints that include shoulder belts with the ability to adjust them to fit smaller passengers, including older children.
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5/12. Traumatic renal artery occlusion.

    Six cases of complete occlusion of the main renal artery and one case of incomplete renal artery occlusion secondary to blunt abdominal trauma are reported, and the literature reviewed. The reported cases are analyzed as to clinical and radiographic findings, and mechanism of injury. Left renal artery occlusion occurs due to intimal fracture secondary to deceleration forces on the abdomen. Right renal artery occlusion results from direct epigastric trauma and compression of the artery against the vertebral column. An intravenous urogram with nonvisualization of the affected kidney should lead to immediate angiography. Arteriography is diagnostic, showing abrupt occlusion of the renal artery several centimeters beyond its origin, or before occlusion, an intimal flap.
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keywords = deceleration
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6/12. Injuries sustained from high velocity impact with water: an experience from the Golden Gate Bridge.

    Over 720 persons are reported to have died jumping from the Golden Gate Bridge. A review of 100 consecutive autopsies showed that, in the majority of cases, massive pulmonary contusion, pneumothorax, laceration or perforation of the heart, great vessels, or lungs by displaced ribs were the causes of immediate death. Irreparable fractures of the liver or spleen were the most common abdominal injuries. The persons fatally injured appeared to have entered the water in a horizontal position, experiencing maximal deceleration. In contrast, six survivors entered the water feet first with more gradual deceleration. These survivors remained conscious but sustained similar injuries of lesser degree; only one sustained rib fractures. Fifty per cent had fractures of the liver or spleen requiring operative therapy. Fifty per cent sustained lung contusions and subsequent pneumothoraces. Suspicion of underlying injuries to the liver, spleen, and lungs is essential during resuscitation of those who survive impact with water.
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keywords = deceleration
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7/12. Delayed perforation of the colon in blunt abdominal trauma.

    The authors describe three patients with similar clinical features and patterns of colonic injury following blunt abdominal trauma. Perforation was discovered 7 to 10 days after injury and was indicated by the clinical signs of systemic sepsis. A prominent sign of occult sepsis was post-traumatic pulmonary insufficiency. Blunt trauma to the colon was initially present but was not very impressive, consequently diagnosis was delayed. The large number of concomitant injuries and the subsequent sepsis led to a higher morbidity and mortality than in cases of penetrating injuries to the colon. The key to successful management of blunt colonic injuries is early diagnosis. awareness of the type of injury and the magnitude of the deceleration force combined with the presence of persistent ileus may lead to earlier laparotomy.
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keywords = deceleration
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8/12. Isolated perforations of the small bowel from blunt abdominal trauma. Report of two cases and review of the literature.

    On account of two recent cases, the authors present a review of the literature of small bowel isolated perforations following blunt abdominal trauma. Although these injuries are quite rare and their management relatively easy, the diagnostic approach is often hazardous and may lengthen the operative delay, worsening morbidity and mortality. The authors review the various physiopathological mechanisms (deceleration, crushing and rupture phenomena) responsible for small bowel perforations, as well as the predisposing factors. They emphasize the multiple pitfalls of the diagnosis and try, through a study of the literature, to establish systematic guidelines. The advantages and deficiencies of the various complementary investigations are discussed. The authors conclude with indications of conservative treatments and segmentary enterectomies respectively.
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keywords = deceleration
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9/12. Subadventitial rupture of the splanchnic arteries as the result of blunt abdominal trauma presenting with acute gastric dilatation.

    Two patients are reported who presented with intestinal ischaemia caused by a subadventitial rupture of the origin of the coeliac trunk and superior and inferior mesenteric arteries after blunt trauma from deceleration injury. In both cases the initial clinical examination revealed a painful abdomen without any 'peritonism'. Abdominal ultrasonographic examination showed no abnormality. Plain abdominal radiography showed gastric dilatation in both patients. In the first, the diagnosis was made by laparatomy but only after 2 days. In the second, diagnosis was made by aortography performed because of the early appearance of gastric dilatation. Both patients died as a result of extensive associated injuries and delay in diagnosis.
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keywords = deceleration
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10/12. Complete avulsion of the papilla of Vater and gastroduodenal artery due to blunt abdominal trauma: report of a case.

    A case of traumatic avulsion of the papilla of Vater and gastroduodenal artery successfully treated by pancreaticoduodenectomy is presented herein. The mechanism of this rare injury appeared to be a shearing force applied to the common bile duct and gastroduodenal artery. Thus, when the liver is driven cephalad by compression of the abdomen and by the deceleration force, the common bile duct and gastroduodenal artery are avulsed from the fixed duodenum and pancreas. The mechanism of this rare injury is postulated on the basis of operative and histological findings. Our case is thought to be the first of traumatic avulsion of the papilla of Vater and gastroduodenal artery to be reported in japan.
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