Cases reported "Wounds, Penetrating"

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1/13. Isolated chylothorax after penetrating trauma.

    A case is presented with a left traumatic chylothorax, secondary to penetrating thoracic trauma, treated by conservative therapy. With this clinical report and the review of the literature, it is concluded that conservative management should be initially performed as alternative to surgical approach.
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2/13. Free toe pulp transfer for digital reconstruction after high-pressure injection injury.

    We report two cases of high-pressure injection injuries to the fingertip in which free toe pulp flaps were used to resurface the palmar surface of the finger following extensive wound debridement. There was good return of sensibility and, because of the high durability of the donor skin, both patients regained good functional use of the injured digits and returned to heavy manual work. There was minimal associated morbidity of the donor sites. The free toe pulp flap represents an excellent alternative for resurfacing the digit with a large residual skin defect after high-pressure injection injury.
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3/13. Hypopharyngeal perforation during laparoscopic Roux-en-Y gastric bypass.

    Laparoscopic Roux-en-Y gastric bypass was recently introduced as an alternative surgical treatment for morbid obesity.The technique involves placement of a 21-mm anvil transorally down to the gastric pouch for creation of the gastroenterostomy anastomosis using an EEA stapler placed transabdominally. Esophageal injury is a theoretical concern with transoral manipulation of the anvil. The authors present a case of hypopharyngeal perforation after an attempted transoral insertion of an EEA anvil. The perforation was treated with neck exploration and drainage. We discuss the mechanism of injury and alternative method for placement of the gastric anvil.
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4/13. Thoracoscopic retrieval of metal rods after penetrating chest injury: case report.

    thoracoscopy has been used for both diagnostic and therapeutic purposes. Its use in the trauma field is rapidly increasing. Here, we present a case of chest trauma that was successfully treated using the thoracoscopic approach. A 43-year-old male patient was brought to our emergency room with a severe right chest wall-penetrating metal-rod injury, which had occurred after falling from a height. The chest X-ray showed an upper right lung lobe injury. Video-assisted thoracoscopic surgery (VATS) was performed for diagnosis of any other associated injury and for management of the penetrating injury. The prognosis was good. We believe that minimal thoracoscopic surgery is an alternative way that provides a more rapid diagnosis, and a less-invasive and safe operation for acute chest trauma patients.
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5/13. Laparoscopic nephrectomy and autotransplantation for severe iatrogenic ureteral injuries.

    OBJECTIVES: To evaluate the efficacy of laparoscopic nephrectomy with autotransplantation in cases of severe proximal ureteral damage. Many patients with complex proximal ureteral injuries have good functional renal parenchyma and wish to salvage their kidney. Autotransplantation is a viable alternative to nephrectomy in these frustrating situations. methods: Two patients, aged 32 and 36 years, underwent laparoscopic nephrectomy and autotransplantation for treatment of severe proximal ureteral injuries. The injuries included a ureteropelvic junction avulsion and a proximal ureteral avulsion, respectively. Both patients had good functional renal parenchyma. A transperitoneal laparoscopic approach was used, and the kidney was removed by way of a Gibson incision. RESULTS: The procedures were successful, with immediate return of renal function in both patients. A pyeloureterostomy to the native distal ipsilateral ureter was required in one and a direct ureterovesical anastomosis was performed in the other. In the 2 patients, the warm ischemia time was 4.5 and 4 minutes, the transplant operative time 175 and 150 minutes, and the estimated blood loss 150 and 75 mL, respectively. No intraoperative complications occurred. At follow-up, the kidneys were functional, and the patients had returned to their normal activity. CONCLUSIONS: Laparoscopic nephrectomy with autotransplantation is an excellent alternative to nephrectomy or bowel interposition in patients with proximal ureteral loss, irrespective of the contralateral renal function. This procedure is associated with acceptable morbidity and preserves the renal function. This approach is desirable in those patients who have had complications from other surgical procedures and are otherwise facing the loss of a normally functioning kidney.
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6/13. Late cardiac perforation following transcatheter atrial septal defect closure.

    Transcatheter closure of secundum atrial septal defect (ASD) has become an alternative to surgery. We present a patient with hemodynamic collapse secondary to cardiac perforation occurring 6-months after the placement of an Amplatzer Septal Occluder and discuss the utilization/complications of this device.
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7/13. Thoracic packing for uncontrolled bleeding in penetrating thoracic injuries.

    We present a series of three patients who suffered penetrating thoracic injury, and in whom thoracic packing was used as a life-saving procedure. survival among these patients paralleled the severity and extent of the original injuries. Restriction of cardiac filling and lung expansion are potential deterrents from using this technique; however, its use seems to be a valid adjunct, especially in the setting of chest wall bleeding coming from the intercostal arteries. Damage control surgery in pentrating thoracic trauma, including thoracic packing, is a sound alternative when uncontrollable bleeding, hypothermia and coagulopathy compromises the survival of a patient.
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8/13. A rare complication of atrial septal occluders: diagnosis by transthoracic echocardiography.

    Atrial septal defect transcatheter occlusion techniques have become a reliable alternative to surgical procedures. Possible complications can derive from unfavorable anatomy of the defect and over-dimensioning of the device. We describe the first case ever reported of anterior mitral leaflet perforation caused by an atrial septal occluder. The diagnosis was performed by conventional echocardiography and 3 dimensions helped for a more accurate anatomic definition. device removal, atrial septal defect closure, and repair of the mitral tear were then successfully performed.
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9/13. Late-onset congestive heart failure with multiple carotid-jugular fistulae and pseudoaneurysm after penetration injury.

    Trauma-acquired multiple arteriovenous fistulae with late-onset congestive heart failure has not been documented. We describe a 29-year-old man who presented with progressive congestive heart failure 25 years after a penetrating trauma to the left side of the neck. The neck duplex showed a large shunt between the carotid artery and internal jugular vein. Arteriography showed three high-flow arteriovenous fistulae between these two vessels. magnetic resonance angiography (MRA) showed a carotid pseudoaneurysm originating from three different loci of the carotid artery with a large aneurysm-venous communication between the pseudoaneurysm and the internal jugular vein. Reconstruction of contrast MRA showed three different arteriovenous fistulae, leading to the decision to perform aneurysmectomy, carotid artery repair and jugular vein patch angioplasty. The favorable outcome of this case illustrates that surgery is a reasonable alternative when an endovascular approach is not feasible in patients with trauma-acquired arteriovenous fistulae.
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10/13. Endovascular embolization of iatrogenic vertebral artery injury during anterior cervical spine surgery: report of two cases and review of the literature.

    STUDY DESIGN: Case description. OBJECTIVES: To report 2 cases of vertebral artery injury (VAI) during anterior cervical decompression surgery and review the pertinent medical literature. SUMMARY OF BACKGROUND DATA: The incidence of VAI during an anterior surgical approach to the cervical spine is rare but potentially lethal. The spine surgeon should be aware of the detailed surgical anatomy and be prepared to manage an inadvertent injury to the vertebral artery. methods: In the first case presented, infection was the cause of VAI. During aggressive irrigation and pus drainage, massive bleeding was encountered. For the second case, the vertebral artery was injured during decompression of cervical spondylosis while drilling the neural foramen. Intraoperative direct packing with hemostatic agents provided effective control of hemorrhage. RESULTS: Ten days after surgery, sudden neck swelling and mental deterioration occurred because of rebleeding from a pseudoaneurysm in the first case. In the second case, a pseudoaneurysm was detected by angiography, obtained 4 days after surgery. Both pseudoaneurysms were successfully occluded by an endovascular technique without any neurologic sequelae. CONCLUSIONS: In case of bleeding control by hemostatic packing, there remains a risk of delayed hemorrhage from pseudoaneurysm. Postoperative vertebral angiography is helpful to avoid life-threatening complications. Endovascular treatment can be a good alternative in the treatment of VAI.
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