Cases reported "Abdominal Injuries"

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1/10. 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.
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2/10. jaundice as a sign of delayed gall-bladder perforation following blunt abdominal trauma.

    A case of delayed rupture of the gall-bladder following blund abdominal trauma is presented. A discussion of the aetiology, clinical and biochemical manifestations, and prognosis of this condition follows.
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3/10. renal artery dissection after blunt abdominal trauma: a rare cause of acute cortical necrosis.

    renal artery injury is an uncommon complication of blunt abdominal trauma. We present a case of a 19-year-old man who developed acute cortical necrosis in a congenital single kidney after a motorcycle accident. On initial presentation, he had signs of splenic injury and required immediate laparotomy and splenectomy. His renal function deteriorated, and he became dialysis dependent. Computed tomography followed by percutaneous angiography showed a dissection of a single renal artery causing the formation of a large pseudoaneurysm. A second angiogram showed an increase in the size of the pseudoaneurysm. We performed a laparotomy and attempted in situ vein graft repair of the renal artery. A wedge biopsy specimen taken at laparotomy revealed acute cortical necrosis, and plain radiographs showed cortical calcification. renal artery dissection and pseudoaneurysm formation are rare events after blunt trauma. Iatrogenic damage is the most common cause of pseudoaneurysm. Traumatic pseudoaneurysms have a poor prognosis without prompt surgical intervention. Renal arterial damage may occur after blunt trauma, and early imaging and intervention are essential to salvage renal function.
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4/10. Sonographic diagnosis of traumatic gallbladder rupture.

    gallbladder injuries after blunt abdominal trauma are rare and often follow a vague and insidious clinical course. Consequently, gallbladder injuries commonly go undiagnosed until exploratory laparotomy. early diagnosis is essential, because trauma to the gallbladder is typically treated surgically, and delay in treatment can result in considerable mortality and morbidity. With sonography emerging as a first-line modality for evaluation of intra-abdominal trauma, sonographers may wish to become more familiar with the appearance of gallbladder injury on sonography to facilitate earlier diagnosis and to improve treatment and prognosis. We report a case of gallbladder perforation after blunt abdominal trauma diagnosed on the basis of computed tomography (CT) and sonography.
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5/10. Urgent Whipple resection for solid pseudopapillary tumor of the pancreas.

    We report a 14-year-old boy who was urgently transferred to our institution after a blunt abdominal trauma. CT scan and repeated ultrasound examinations revealed a subhepatic mass, which slowly increased in size. Imaging features were not specific enough to permit a precise diagnosis. Because of the positive peritoneal signs and increased signs of circulatory instability, the decision was made to perform an urgent explorative laparotomy. The exploration revealed that the large haematoma-like bleeding mass was a tumor arising from the head of the pancreas, which ruptured on the surface. We performed a curative R0 Whipple resection. histology of the resected specimen revealed a solid pseudopapillary tumor of the pancreas, an extremely rare tumor predominantly occurring in young and middle-aged women. It has a favorable prognosis if resected radically. The boy is well 30 months after the operation. To our knowledge, there are only two other descriptions of pancreatic solid pseudopapillary tumor in boys treated urgently by Whipple resection because of acute presentation after blunt abdominal trauma.
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6/10. Acute presentation of a solid pseudopapillary tumor of the pancreas.

    We report a case of acute presentation of a solid pseudopapillary tumor of the pancreas in a young boy who had suffered a blunt abdominal trauma. Urgently performed CT examination and repeated ultrasound revealed a subhepatic mass, which gradually increased in size, but the imaging features were not specific enough to permit a precise diagnosis. Because signs of peritoneal irritation and increased circulatory instability gradually developed within the hours of observation, the decision was made to perform an urgent exploratory laparotomy. The exploration revealed a hematoperitoneum and a large hematoma-like subhepatic bleeding mass. Further exploration showed that this mass was a tumor arising from the head of the pancreas, which had ruptured on the surface. A curative pancreatoduodenectomy was performed. Pathohistological examination of the resected specimen revealed a solid pseudopapillary tumor of the pancreas, an extremely rare tumor predominantly occurring in adolescent girls and in young adult women. It has a favorable prognosis if resected radically. The boy in our report is feeling well 36 months after the operation.
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7/10. Management of electrical injuries of the abdomen.

    High voltage electrical burns may involve intra-abdominal viscera with or without an abdominal wound. The risk of such an involvement is much higher when a wound is present. Depending upon the amount of heat produced vapourization of tissues may occur. If it includes part of the peritoneum, visceral damage is revealed immediately. If it does not occur to that extent, necrosed tissues remain in continuity and visceral involvement remains concealed until slough separates. The prognosis is related to early diagnosis of the associated visceral injury. It is recommended that the debridement should be undertaken at 2-3 days postburn. laparotomy is indicated if part of the peritoneum is also debrided. Reconstruction of the abdominal wall may be a formidable task. Among the options available, pedicled muscle and musculocutaneous flaps seem to be ideally suited for the purpose.
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8/10. Solid and papillary epithelial neoplasm of the pancreas presenting as a traumatic cyst. Case report.

    A 16-year-old girl presented with a left-sided abdominal mass following blunt trauma. Clinically and ultrasonographically a pseudocyst of the pancreas was suspected. Computed tomography demonstrated a moderately vascularized tumour mass in the pancreatic tail, with a central cystic space. Distal pancreatectomy was subsequently performed. Histologic examination revealed a solid and papillary epithelial neoplasm of the pancreas. This is a well-defined clinicopathologic entity, mostly found in young women. Histologic evidence of aggressive behaviour is sometimes seen, and was found in the present case. The prognosis after surgical removal is good, however, which emphasizes the importance of recognizing this rare tumour.
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9/10. Biliary peritonitis following blunt abdominal trauma in children. Report of a case.

    Bile peritonitis, following blunt abdomen injury to the biliary tract, is not a very common condition. The clinical features, however, are typical, the treatment is delayed due to the quiescent interval between the symptoms. The operative treatment is simple draining of the area of perforation and the site of the collection of bile. A catheter in the gallbladder is helpful in assessing the stoppage of the leak and the restoration of biliary drainage. The prompt surgical treatment on diagnosis has good prognosis.
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10/10. Post-traumatic costochondritis caused by candida albicans. Aetiology, diagnosis and treatment.

    Candida costochondritis is a rare disease of complex aetiology. Pathogenetic factors range from postoperative and posttraumatic complications to haematogenous dissemination in intravenous drug addicts. In addition to clinical examination, possible diagnostic procedures include scintiscan and magnetic resonance imaging. The treatment of choice is extensive debridement and resection of the structures affected by the inflammatory process. The long-term prognosis is good.
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