Abdominal Injuries ; therapy ; Humans

Laparotomy or thoracolaparotomy is a traditional management approach for thoracoabdominal impalement injury associated with major liver and diaphragmatic injuries. We successfully treated the impalement injury with minimally invasive management. A male was brought to our trauma centre with the 15 cm long handle of the knife protruded from right lateral thoracoabdominal region. CT scan revealed that the knife blade traversed through the right costophrenic recess into segment 8 of the liver. There was an intraparenchymal haematoma and a collection of fluid in the abdominal cavity. The conservative management plan consisting of removing the impaled knife, observing, monitoring and managing complications was undertaken. A multidisciplinary approach to manage a patient with less invasive techniques yielded a good outcome. This management option may be considered as an alternative for open surgery for hemodynamically stable patients in experienced centres.
Abdominal Injuries ; therapy ; Adolescent ; Diaphragm ; injuries ; Humans ; Liver ; injuries ; Male ; Minimally Invasive Surgical Procedures ; Thoracic Injuries ; therapy ; Wounds, Penetrating ; therapy

Abdominal Injuries ; complications ; Abdominal Wall ; pathology ; Aged ; Embolization, Therapeutic ; Female ; Hematoma ; therapy ; Humans ; Liver Cirrhosis ; complications

In order to summarize the clinical diagnosis and treatment methods for 42 cases of multiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carried out in our hospital. Most cases were associated with hemopneumothorax and rib fractures (52.3%), shock (50%), multiple fractures (47.6%), and severe brain injury (26.1%). In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases (97.6%) were cured (including 40 cases receiving surgical operation and one case receiving the conservative treatment). Postoperative complications occurred in 16 cases (21 cases/times): pancreatic fistula (5 cases/times) and incisional wound infection (5 cases/times), intra-abdominal infection (3 cases/times), stress ulcer (3 cases/times), pleural effusion (3 cases/times), pulmonary infection (one case) and wound dehiscence (1 case). The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.
Abdominal Injuries/*diagnosis ; Abdominal Injuries/*therapy ; Accidents, Traffic ; Emergency Medicine/methods ; Multiple Trauma ; Pancreas/*injuries ; Retrospective Studies ; Treatment Outcome ; Wound Healing ; Wounds, Nonpenetrating/diagnosis ; Wounds, Nonpenetrating/therapy

PURPOSETo enhance the awareness of rare complications of pelvic fracture and describe the correct diagnosis and effective treatment.

METHODSA total of 188 cases of pelvic fractures were retrospectively reviewed, and four patients who suffered from four types of rare pelvic fracture complications were described, namely ureteral obstruction caused by retroperitoneal hematoma-induced abdominal compartment syndrome (ACS), bowel entrapment, external iliac artery injury, and open scrotal sac injury.

RESULTSWe demonstrated that combined measures should be employed to prevent the occurrence of ACS following major pelvic fractures. Ureteral catheter support may be a good option at an early stage when ACS occurred. Contrasted computed tomography examination and sufficient awareness are keys to a correct diagnosis of bowel entrapment following pelvic fractures. Recognition of risk factors, early diagnosis, and prompt treatment of suspected injury of the external iliac artery are keys to patient survival and to avoid limb loss. Scrotal and/or testicular injury complicated by pelvic fractures should be carefully treated to maintain normal gonad function. Additionally, establishment of a sophisticated trauma care system and multi-disciplinary coordination are important for correct diagnosis and treat- ment of rare complications in pelvic fractures.

CONCLUSIONSRare complications of pelvic fractures are difficult to diagnose and negatively impact outcome. Recognition of risk factors and sufficient awareness are essential for correct diagnosis and prompt treatment.

Adult ; Female ; Fractures, Bone ; complications ; Humans ; Iliac Artery ; injuries ; Intra-Abdominal Hypertension ; diagnosis ; therapy ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Scrotum ; injuries ; Testis ; injuries ; Tomography, X-Ray Computed

Aorta, Abdominal ; injuries ; Blood Loss, Surgical ; prevention & control ; Hemorrhage ; therapy ; Hemostasis, Surgical ; methods ; Humans ; Mesenteric Veins ; injuries ; Splenic Diseases ; therapy ; Vena Cava, Inferior ; injuries

The philosophy of abdominal injury management is currently changing from mandatory exploration to selective non-operative management (NOM). The patient with hemodynamic stability and absence of peritonitis should be managed non-operatively. NOM has an overall success rate of 80%-90%. It also can reduce the rate of non-therapeutic abdominal exploration, preserve organ function, and has been defined as the safest choice in experienced centers. However, NOM carries a risk of missed injury such as hollow organ injury, diaphragm injury, and delayed hemorrhage. Adjunct therapies such as angiography with embolization, endoscopic retrograde cholangiopancreatography with stenting, and percutaneous drainage could increase the chances of successful NOM. This article aims to describe the evolution of NOM and define its place in specific abdominal solid organ injury for the practitioner who faces this problem.
Abdominal Injuries/surgery* ; Angiography ; Humans ; Injury Severity Score ; Laparotomy ; Probability ; Retrospective Studies ; Spleen/injuries* ; Wounds, Nonpenetrating/therapy*

OBJECTIVETo improve the cure rate of patients with abdominal visceral injury complicated by craniocerebral injury.

METHODSClinical data of 176 cases of abdominal visceral injury complicated by craniocerebral injury were retrospectively analyzed.

RESULTSIn this series, 44 cases died and the mortality was 25.0. The main cause of death is abdominal visceral injury combined with shock and severe craniocerebral injury.

CONCLUSIONSIt is essential to improve the cure rate by accurate diagnosis at early stage. Abdominal paracentesis and CT should be performed promptly and dynamically. Priority should be given to the treatment of life-threatening injuries.

Abdominal Injuries ; diagnosis ; therapy ; Adolescent ; Adult ; Aged ; Child ; Craniocerebral Trauma ; diagnosis ; therapy ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; diagnosis ; therapy ; Viscera ; injuries

OBJECTIVETo investigate the approach of emergency management for severe pelvic fracture associated with injuries of adjacent viscera and evaluate the therapeutic effect.

METHODSThe data of 79 patients with severe pelvic fracture associated with injuries of adjacent viscera were retrospectively studied, and the study covered a period of 14 years.

RESULTSTo cease massive bleeding due to pelvic fracture, ligation of internal iliac arteries was performed on 33 cases, and angioembolization on 8. Of 42 patients with cystic or/and urethral injury, 35 underwent cystostomy and delayed reconstruction, and 7 received a primary realignment. All of 17 patients with injury of retroperitoneal rectum underwent diverting colostomy of the proximal end of sigmoid with presacral drainage, but 4 received primary repair without colostomy. In 22 patients with intraperitoneal colorectal injury, 19 were managed with primary repair or anastomosis while 3 received a colostomy. The overall mortality rate was 8.86% (7/79); the main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4 cases, thrombosis of right common iliac artery in 1, ARDS following chest trauma in 1, and paraplegia in 1. Except the patient with paraplegia, all of them were cured.

CONCLUSIONSPrompt diagnosis and proper treatment are the key to success. Devascularization of internal iliac arteries with external fixation cage of the pelvis, cystostomy and proximal sigmoidostomy are effective procedures in emergency treatment of the critical patients.

Abdominal Injuries ; complications ; therapy ; Adolescent ; Adult ; Aged ; Female ; Fractures, Bone ; complications ; therapy ; Hemorrhage ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies ; Treatment Outcome

Among members of the public, acupuncture has a reputation for being safe. Since 1965, many case reports of serious or even life-threatening incidents caused by acupuncture have been reported in the literature. A 55 year old male was admitted with complaints of abdominal pain after acupuncture therapy at an oriental medicine hospital. Abdominal Computerized Tomography (CT) scan showed a mass measuring 9.8 cm with active bleeding. Emergency operation was performed. He was diagnosed as ileocecal vein rupture following acupuncture. We report here on a case of an iliocecal vein rupture following acupuncture therapy and we review the relevant literature.
Abdominal Pain ; Acupuncture ; Acupuncture Therapy ; Emergencies ; Hemorrhage ; Humans ; Male ; Medicine, East Asian Traditional ; Rupture ; Vascular System Injuries ; Veins