Cases reported "Wounds, Nonpenetrating"

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11/30. Hepatic duct confluence injury in blunt abdominal trauma: case report and synopsis on management.

    Injuries of the extra hepatic biliary tree following blunt trauma to the abdomen are rare. We present here a case of injury to the confluence of the hepatic ducts and a brief synopsis on diagnosis and management of blunt injury to the extrahepatic biliary system.
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12/30. Traumatic pericardial rupture involved with complication by blunt chest trauma.

    A 65-year-old man who had sustained a blunt chest trauma in a traffic accident demonstrated a mass in the left hilum by chest radiography. Emergency surgery demonstrated a rupture of the left-side pericardium with herniation of the heart into the left pleural cavity along with a right ventricular rupture. The tear in the right ventricle was sutured using 4-0 polypropylene with felt and the pericardial rupture was repaired with an expanded polytetrafluoroethylene sheet. A 31-year-old man who had been crushed against a tree while skiing 5 years and 6 months earlier was diagnosed as having severe tricuspid valve regurgitation and tricuspid valve replacement was performed. Large left pericardial defect was found and repaired with an equine pericardial patch. In both cases, a bridging of phrenic nerve was found in the pericardial defect that was regarded as a traumatic rupture.
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13/30. Extraperitoneal rectal perforation without perineal wound or pelvic fracture.

    The present report describes an unusual case of rectal perforation. An 81-year-old female was struck by a truck while walking in the street, and she was sent to a local hospital where fracture of the right subtrochanteric femur was diagnosed. She was admitted, in stable condition, for planned orthopedic operation. consciousness change and respiratory distress developed 6 hours later. She was then transferred to a trauma center where extraperitoneal rectal perforation was diagnosed. Despite empirical antibiotics and surgical intervention, the patient unfortunately expired 3 days later. Unusual mechanism and incomplete physical examination were the major causes of delayed diagnosis. This case report also discusses the mechanism, classification and management of rectal perforation.
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14/30. Blunt handlebar injury of the common femoral artery: a case report.

    Bicycle handlebar-related blunt trauma to the femoral vessels with resulting arterial injury has been described previously. However, significant injury to the ileofemoral tree with underlying arterial occlusive disease in the face of handlebar-related trauma has not been reported. We present the case of an all-terrain vehicle accident with isolated injury to the common femoral artery in a patient with underlying atherosclerotic disease.
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15/30. azygos vein laceration following a vertical deceleration injury.

    A 41-year-old man presented with respiratory distress and hypotension after a 30-foot fall from a tree. Despite fluid resuscitation, the patient expired in the operating room. autopsy revealed an azygos vein laceration at the junction of the superior vena cava as the cause of death. azygos vein and superior vena caval lacerations are rare following blunt chest trauma, including vertical deceleration injury. Early suspicion of vascular injuries with aggressive fluid resuscitation and surgical intervention remain the only hope for survival from this highly lethal injury.
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16/30. Traumatic avulsion of the intrapancreatic common bile duct: case report.

    Injuries of the extra hepatic biliary tree following blunt trauma to the abdomen are rare. We present a case of avulsion of the intrapancreatic common bile duct. Very often the lesion is not identifiable until the signs of jaundice and biliary ascites occur. Intraoperative cholangiography is mandatory for the diagnosis, but the noninvasive magnetic resonance cholangiopancreatography could readily depict the injury of the extrahepatic bile duct preoperatively. When the diagnosis is late the corner stone of treatment is biliary diversion and definitive repair after complete resolution of sepsis with a choledochojejunostomy.
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17/30. Tension pneumopericardium: a case report and a review of the literature.

    pneumopericardium, or air within the pericardial sack, generally occurs after high-speed blunt deceleration injuries. Although it is generally relatively benign, in rare instances, it can become hemodynamically significant. The diagnosis is easily made on plain chest radiography. More recently, chest computed tomography has been helpful in making the diagnosis. Injury to vital structures such as the tracheobronchial tree or esophageal tears require operative fixation. However, in most instances, pneumopericardium is secondary to dissection of air through the adjacent structures to the pericardial space. The air is trapped as a one-way valve. The pneumopericardium is usually self-limited, requiring no specific therapy. In patients where there is a concomitant pneumothorax, chest tube drainage suffices. We present a case of hemodynamically significant tension pneumopericardium that occurred in association with blunt carotid injury and aortic
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18/30. role of laparoscopy in blunt liver trauma.

    Although much has been written about the role of laparoscopy in the acute setting for victims of blunt and penetrating trauma, little has been published on delayed laparoscopy relating specifically to complications of conservative management of liver trauma. There has been a shift towards managing liver trauma conservatively, with haemodynamic instability being the key indication for emergency laparotomy, rather than computed tomography findings. However, as a side-effect of more liver injuries being treated non-operatively, bile leak from a disrupted biliary tree presenting later in admission has appeared as a new problem to manage. We describe in this article three cases that have been managed by laparoscopy and drainage alone, outlining the advantages of this technique and defining a new role for delayed laparoscopy in blunt liver trauma.
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19/30. Endovascular management of acute critical ischemia secondary to blunt tibial artery injury.

    We report a case of acute limb-threatening ischemia from blunt traumatic tibial arterial disruption managed with endoluminal techniques. An otherwise healthy 37-year-old man involved in a motorcycle crash sustained a compound fracture of his right tibia and fibula. Arterial insufficiency developed after surgical reduction of the orthopedic injuries that warranted selective angiography of the involved extremity. This demonstrated complete occlusion of the infrageniculate circulation at the level of the ankle. Recanalization of the posterior tibial artery was achieved by using coronary balloon-expandable stents, thereby reestablishing in-line flow to the foot. Clinical and noninvasive surveillance at 2 years confirmed patency of the recanalized artery with the absence of any ischemic symptoms. Arterial reconstruction of the infrapopliteal arterial tree poses a formidable challenge in the setting of blunt trauma. Recent improvements in endovascular skills, endoluminal technology, and imaging capabilities have allowed percutaneous reconstruction of challenging arterial pathology. Endovascular treatment of blunt tibial injuries is an alternative to complex open reconstructions. These patients require close long-term postoperative surveillance because the durability of such a repair remains unknown.
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20/30. aneurysm of the left anterior descending coronary artery after chest trauma.

    A 28-year old man developed transmural anterior wall myocardial infarction after a car accident despite the absence of external signs of chest trauma. coronary angiography one month after the accident demonstrated an aneurysm of the left anterior descending artery. Angiography five and eleven months afterwards showed almost total regression of the aneurysm. The man remained asymptomatic with no signs of residual ischaemia one year after the accident. Blunt trauma to the chest is a well-known cause of cardiac damage including myocardial contusion, rupture of the ventricular wall, septum, papillary muscles or chordae tendineae. Myocardial infarction secondary to distinct injury to a coronary artery has only seldom been described. Visualization of a localized lesion in a coronary artery of an otherwise non-atherosclerotic coronary tree supports the traumatic origin of a myocardial infarction.
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