Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.
Abdominal Injuries ; complications ; Adult ; Asymptomatic Diseases ; Humans ; Male ; Spleen ; injuries ; Splenectomy ; Splenosis ; diagnosis ; etiology ; pathology ; surgery ; Thoracic Diseases ; diagnosis ; etiology ; pathology ; surgery ; Thoracic Injuries ; complications ; Thoracotomy ; Unnecessary Procedures

OBJECTIVE: To analyze the clinical characteristics of post-traumatic abortion and the relationship between trauma and abortion. METHODS: We collected and analyzed 23 cases of post-traumatic abortion encountered in the department of clinical forensic medicine, faculty of forensic medicine, China Medical University in recent years. RESULTS: All 23 post-traumatic abort inns were early abortions. Their traumata were mild and external only. Vagina bleeding and abortion occurred shortly after trauma. Most patients were older, from countryside, or unemployed. CONCLUSION The causes of abortion are complex. Post-traumatic abortion can only be diagnosed after excluding non-traumatic factors. For those cases abortion occur shortly after injuries and non-traumatic factors can not be excluded, trauma should be assessed for its role in abortions as primary, secondary or induction factors correlated with clinical symptoms and pre-
Abdominal Injuries/complications* ; Abortion, Spontaneous/etiology* ; Adult ; Brain Injuries/complications* ; Diagnosis, Differential ; Female ; Forensic Medicine ; Gestational Age ; Humans ; Pregnancy ; Retrospective Studies ; Uterine Hemorrhage/etiology* ; Young Adult

OBJECTIVETo probe 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.

RESULTSLigation of internal iliac arteries was performed in 33 cases for ceasing massive bleeding due to pelvic fracture, and angioembolization in 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 9% (7/79); The main causes were hemorrhagic shock and associated injury. The complications included urethro-rectal fistula in 4, thrombosis of right common iliac artery in 1, acute respiratory distress syndrome (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 were the key of the success. Devascularization of internal iliac arteries with external fixation cage of pelvis, cystostomy and proximal sigmoidostomy were effective procedures frequently used in the emergency treatment of the severe pelvic fracture patients.

Abdominal Injuries ; diagnosis ; etiology ; surgery ; Adolescent ; Adult ; Aged ; Colostomy ; Female ; Fractures, Bone ; complications ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies ; Urinary Diversion

We present a case of thoracic splenosis in a 42-yr-old man with a medical history of abdominal surgery for a penetration injury with an iron bar of the left abdomen and back. He had been in good condition, but a chest radiograph taken during a regular checkup showed a multinodular left pleura-based mass. Computed tomography (CT) showed that the mass was well-enhanced and homogeneous, indicating a sclerosing hemangioma. Following its removal by video-assisted thoracoscopic surgery, the mass appeared similar to a hemangioma, with marked adhesion to the left side diaphragmatic pleura and lung parenchyma. Frozen section showed that the lesion was a solid mass consisted with abundant lymphoid cells, suggesting a low grade lymphoma. On permanent section, however, the mass was found to be composed of white pulp, red pulp, a thick capsule and trabeculae and was diagnosed as ectopic splenic tissue, or thoracic splenosis. Review of the patient's history and chest CT at admission revealed that the patient had undergone a splenectomy for the penetration injury 20 yr previously.
Abdominal Injuries/complications ; Adult ; Diagnosis, Differential ; Humans ; Male ; Medical Records ; Spleen/injuries/surgery ; Splenectomy ; Splenosis/*diagnosis/etiology/radiography ; Thoracic Diseases/*diagnosis/etiology/radiography ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

OBJECTIVETo improve the diagnosis and treatment of abdominal injury.

METHODSThe clinical data of 286 patients with gastrointestinal tract laceration admitted between 2004 and 2009 to our hospital was analyzed.

RESULTSThe duration after trauma was 15 min to 2 days. Of the 286 patients eventually confirmed by laparotomy, 273 were cured, 3 showed improvement and 10 died.

CONCLUSIONAbdominal trauma in patients with gastrointestinal tract laceration, Abdominal puncture diagnosis and orthostatic abdominal X-ray are rapid and effective diagnostic methods for gastrointestinal tract laceration in patients with abdominal trauma. Laparotomy is the primary treatment measures and should be performed as early as possible.

Abdominal Injuries ; complications ; diagnosis ; surgery ; Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Intestinal Perforation ; etiology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Paracentesis is a diagnostic, therapeutic procedure performed in patients with ascites. It is generally thought to be a safe procedure and transfusion of platelet concentrate or fresh frozen plasma is not recommended before the procedure, because the incidence of clinically significant bleeding is very low. We report a case of lateral abdominal wall hematoma due to the injury of the deep circumflex iliac artery after paracentesis in patient with alcoholic liver cirrhosis who was treated with transcatheter arterial embolization.
Abdominal Wall/*blood supply ; Embolization, Therapeutic ; Hematoma/etiology/*therapy ; Humans ; Iliac Artery/injuries ; Liver Cirrhosis, Alcoholic/diagnosis ; Male ; Middle Aged ; Paracentesis/adverse effects

OBJECTIVE: To evaluate the frequency and relevance of the "sentinel clot" sign on CT for patients with traumatic intraperitoneal bladder rupture in a retrospective study. MATERIALS AND METHODS: During a recent 42-month period, 74 consecutive trauma patients (45 men, 29 women; age range, 12-84 years; mean age, 50.8 years) with gross hematuria were examined by the use of intravenous contrast-enhanced CT of the abdomen and pelvis, followed by retrograde cystography. Contrast-enhanced CT scanning was performed by using a helical CT scanner. CT images were retrospectively reviewed in consensus by two radiologists. The CT findings including the sentinel clot sign, pelvic fracture, traumatic injury to other abdominal viscera, and the degree of intraperitoneal free fluid were assessed and statistically analyzed using the two-tailed x2 test. RESULTS: Twenty of the 74 patients had intraperitoneal bladder rupture. The sentinel clot sign was seen for 16 patients (80%) with intraperitoneal bladder rupture and for four patients (7%) without intraperitoneal bladder rupture (p < 0.001). Pelvic fracture was noted in five patients (25%) with intraperitoneal bladder rupture and in 39 patients (72%) without intraperitoneal bladder rupture (p < 0.001). Intraperitoneal free fluid was found in all patients (100%) with intraperitoneal bladder rupture, irrespective of an associated intraabdominal visceral injury, whereas 19 (35%) of the 54 patients without intraperitoneal bladder rupture had intraperitoneal free fluid (p < 0.001). CONCLUSION: Detection and localization of the sentinel clot sign abutting on the bladder dome may improve the accuracy of CT in the diagnosis of traumatic intraperitoneal bladder rupture, especially when the patients present with gross hematuria.
Abdominal Injuries/diagnosis/etiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Contrast Media/administration & dosage ; Extravasation of Diagnostic and Therapeutic Materials/diagnosis/etiology ; Female ; Fractures, Bone/diagnosis/etiology ; Hematuria/etiology ; Humans ; Image Processing, Computer-Assisted ; Iohexol/diagnostic use ; Male ; Middle Aged ; Observer Variation ; Pelvic Bones/injuries/radiography ; Predictive Value of Tests ; Radiographic Image Enhancement/methods ; Reproducibility of Results ; Retrospective Studies ; Rupture/diagnosis ; Tomography, Spiral Computed/*methods ; Urinary Bladder/*injuries/*radiography ; Wounds, Nonpenetrating/complications/*diagnosis

Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
Abdominal Injuries ; complications ; Anti-Infective Agents ; therapeutic use ; Decompression, Surgical ; Digestive System Surgical Procedures ; adverse effects ; methods ; Drainage ; Duodenal Diseases ; diagnosis ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; injuries ; surgery ; Enteral Nutrition ; Humans ; Hypoproteinemia ; therapy ; Intestinal Fistula ; diagnosis ; etiology ; prevention & control ; therapy ; Ischemia ; prevention & control ; Nutritional Support ; Parenteral Nutrition ; Postoperative Complications ; prevention & control ; therapy ; Suture Techniques ; Thoracic Injuries ; complications

Therapeutic paracentesis is considered to be a relatively safe procedure and is performed commonly for the control of massive ascites in patients with liver cirrhosis. The commonest puncture site, approximately 4 or 5 cm medial of left anterior superior iliac spine, can be located across the route of the inferior epigastric artery, which is one of the sites of potential massive bleeding. In a 46-year-old woman with liver cirrhosis and refractory ascites, a huge abdominal wall hematoma developed after therapeutic paracentesis. The patient was not stabilized by conservative treatment, and inferior epigastric artery injury was confirmed on angiography. Angiographic coil embolization of the inferior epigastric artery was conducted, after which the bleeding ceased and the hematoma stopped growing. This case indicates that physicians performing paracentesis should be aware of the possibility of inferior epigastric artery injury and consider early angiographic coil embolization when a life-threatening abdominal wall hematoma develops.
Abdominal Wall ; Angiography ; Ascites/surgery ; Embolization, Therapeutic ; Epigastric Arteries/*injuries ; Female ; Hematoma/*etiology/radiography/therapy ; Humans ; Liver Cirrhosis/*diagnosis ; Middle Aged ; Paracentesis/*adverse effects ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating/complications

A 23-year-old man presented with abdominal pain after suffering blunt trauma caused by a seatbelt injury. His low platelet count of 137 × 10(9)/L was initially attributed to trauma and his underlying hypersplenism due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Despite conservative management, his platelet count remained persistently reduced even after his haemoglobin and clotting abnormalities were stabilised. After a week, follow-up imaging revealed an incidental finding of a pseudoaneurysm (measuring 9 mm × 8 mm × 10 mm) adjacent to a splenic laceration. The pseudoaneurysm was successfully closed via transcatheter glue embolisation; 20% of the spleen was also embolised. A week later, the platelet count normalised, and the patient was subsequently discharged. This case highlights the pitfalls in the detection of a delayed occurrence of splenic artery pseudoaneurysm after blunt injury via routine delayed phase computed tomography. While splenomegaly in G6PD may be a predisposing factor for injury, a low platelet count should arouse suspicion of internal haemorrhage rather than hypersplenism.
Abdominal Pain ; diagnosis ; etiology ; Accidents, Traffic ; Aneurysm, False ; diagnostic imaging ; etiology ; therapy ; Embolization, Therapeutic ; methods ; Follow-Up Studies ; Glucosephosphate Dehydrogenase Deficiency ; complications ; diagnosis ; Humans ; Injury Severity Score ; Male ; Rare Diseases ; Risk Assessment ; Seat Belts ; adverse effects ; Splenic Artery ; injuries ; Tomography, X-Ray Computed ; methods ; Treatment Outcome ; Wounds, Nonpenetrating ; complications ; diagnosis ; Young Adult