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European Journal of Trauma and... Apr 2016This single-centre study evaluated the efficacy of damage control surgery and delayed pancreatoduodenectomy and reconstruction in patients who had combined severe...
BACKGROUND
This single-centre study evaluated the efficacy of damage control surgery and delayed pancreatoduodenectomy and reconstruction in patients who had combined severe pancreatic head and visceral venous injuries.
METHODS
Prospectively recorded data of patients who underwent an initial damage control laparotomy and a subsequent pancreatoduodenectomy for severe pancreatic injuries were evaluated to assess optimal operative sequencing.
RESULTS
During the 20-year study period, 312 patients were treated for pancreatic injuries of whom 14 underwent a pancreatoduodenectomy. Six (five men, one woman, median age 20, range 16-39 years) of the 14 patients were in extremis with exsanguinating venous bleeding and non-reconstructable AAST grade 5 pancreatoduodenal injuries and underwent a damage control laparotomy followed by delayed pancreatoduodenectomy and reconstruction when stable. During the initial DCS, the blood loss compared to the subsequent laparotomy and definitive procedure was 5456 ml, range 2318-7665 vs 1250 ml, range 850-3600 ml (p < 0.01). The mean total fluid administered in the operating room was 11,150 ml, range 8450-13,320 vs 6850 ml, range 3350-9020 ml (p < 0.01). The mean operating room time was 113 min, range 90-140 vs 335 min, range 260-395 min (p < 0.01). During the second laparotomy five patients had a pylorus-preserving pancreatoduodenectomy and one a standard Whipple resection. Four of the six patients survived. Two patients died in hospital, one of MOF and coagulopathy and the other of intra-abdominal sepsis and multi-organ failure. Median duration of intensive care was 6 days, (range 1-20 days) and median duration of hospital stay was 29 days, (range 1-94 days).
CONCLUSION
Damage control laparotomy and delayed secondary pancreatoduodenectomy is a live-saving procedure in the small cohort of patients who have dire pancreatic and vascular injuries. When used appropriately, the staged resection and reconstruction allows survival in a previously unsalvageable group of patients who have severe physiological derangement.
Topics: Abdominal Injuries; Adolescent; Adult; Blood Loss, Surgical; Blood Volume; Female; Humans; Laparotomy; Male; Pancreas; Pancreaticoduodenectomy; Retrospective Studies; South Africa; Trauma Severity Indices; Vascular System Injuries; Veins
PubMed: 26038043
DOI: 10.1007/s00068-015-0525-9 -
Revista Do Colegio Brasileiro de... Oct 2018to evaluate the epidemiological data of patients operated on due to vascular trauma at a referral hospital in Pará state, to determine the variables that increase the...
OBJECTIVE
to evaluate the epidemiological data of patients operated on due to vascular trauma at a referral hospital in Pará state, to determine the variables that increase the risk of death, and to make a comparative analysis with the results previously published by the same institution.
METHODS
an analytical retrospective study was performed through data collection from patients operated due to vascular injuries, between March 2013 and March 2017. Demographic and epidemiological data, such as the mechanism and topography of the lesion, distance between the trauma site and the hospital, and type of treatment and complications, were analyzed. Multivariate analysis and logistic regression studies were performed, to evaluate significant dependence between some variables and death occurrence.
RESULTS
two hundred and eighty eight patients with 430 lesions were studied; 92.7% were male, 49.7% were between 25 and 49 years old; 47.2% of all injuries were caused by firearm projectiles; 47.2% of the lesions were located in the upper limbs, 42.7% in the lower limbs, 8% in the cervical region, 3.1% in the thoracic region, and 0.7% in the abdominal region; 52.8% of the patients were hospitalized for seven days or less. Amputation was required in 6.9% of patients and there was mortality in 7.93% of the cases.
CONCLUSION
distances greater than 200km were associated with prolonged hospitalization and greater probability of limb amputation. Significant correlation between death occurrence and arterial injury, vascular injury in the cervical region, and vascular injury in the thoracic region was found.
Topics: Adult; Amputation, Surgical; Arteries; Brazil; Female; Health Services Accessibility; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Risk Factors; Sex Distribution; Vascular System Injuries; Veins
PubMed: 30304097
DOI: 10.1590/0100-6991e-20181844 -
Injury Jan 2015Penetrating injury may involve the major vessels in the abdomen. Injury to the abdominal inferior vena cava (IVC) is uncommon and is usually caused by gunshot wounds.... (Review)
Review
INTRODUCTION
Penetrating injury may involve the major vessels in the abdomen. Injury to the abdominal inferior vena cava (IVC) is uncommon and is usually caused by gunshot wounds. Mortality from IVC injuries is high and has changed little over time.
AIM
The aim of the study was to report a series of IVC injuries from an urban trauma unit and to compare this with reports from similar institutions.
METHOD
A retrospective review of penetrating abdominal injuries at Kalafong Hospital from 1993 to 2010 was performed. All cases of injury to the IVC were retrieved and the following data recorded: patient demographics, incident history, origin of referral, description of the IVC injury, associated injuries, operative management, hospital stay and outcome. The results were compared to those from similar institutions.
RESULTS
Twenty-seven patients with IVC injuries were treated. All were caused by gunshot wounds, and all had associated intra-abdominal injuries. The majority (56%) of injuries were infrarenal. The injury was managed most commonly by venorrhaphy and, when successful, all the patients survived. A third of patients with infrarenal injuries died, some after exploration of a stable peri-caval haematoma. Ten of the patients died (37%), half of them during surgery. These results are similar to those from similar institutions from earlier time periods.
CONCLUSIONS
This report concurs with other studies. IVC injury carries a high mortality rate and that this has not improved over several decades. Less aggressive management of some stable patients or stable injuries is proposed by the authors for possible improvement of the mortality rate.
Topics: Abdominal Injuries; Adult; Blood Transfusion; Female; Humans; Injury Severity Score; Ligation; Male; Prognosis; Retrospective Studies; South Africa; Survival Analysis; Time Factors; Trauma Centers; Urban Population; Vena Cava, Inferior; Wounds, Gunshot
PubMed: 25012841
DOI: 10.1016/j.injury.2014.06.016 -
The Journal of Trauma and Acute Care... Dec 2021
Topics: Clinical Decision-Making; Embolism; Foreign-Body Migration; Fractures, Bone; Humans; Iliac Vein; Lumbar Vertebrae; Male; Middle Aged; Pulmonary Artery; Radiography, Thoracic; Tomography, X-Ray Computed; Watchful Waiting; Wounds, Gunshot
PubMed: 34797228
DOI: 10.1097/TA.0000000000002314 -
World Journal of Surgery Mar 2022Penetrating inferior vena caval injuries remain a challenging operative entity. This study reviews our local experience with the injury over a nine-year period and... (Review)
Review
BACKGROUND
Penetrating inferior vena caval injuries remain a challenging operative entity. This study reviews our local experience with the injury over a nine-year period and attempts to contextualize it within the published literature that emanates from South Africa on the topic.
METHODS
A single-centre retrospective review of prospectively collected data was performed of all patients who underwent a laparotomy for a penetrating IVC injury. Descriptive statistics were calculated for demographics, clinical and biochemical parameters, intraoperative data, ICU admission and outcomes.
RESULTS
During the nine-year period, thirty-five patients sustained penetrating injuries to the IVC. Mechanism of injury included 25 low velocity gunshots (71%) and 10 stab wounds (29%). The anatomical location included two (6%) supra-renal, six (17%) juxta-renal and 27 (77%) infra-renal injuries. Venorrhaphy was performed in 22 cases (63%) and ligation in 13 (37%). Average ICU stay was 5.4 days. Thirteen patients died (37%), of which six (46%) died within 24 h of arrival.
CONCLUSION
Despite dramatic improvements in surgical trauma care over the last four decades, penetrating injury to the IVC carries a high mortality rate ranging from 31 to 37%. It is unlikely that further improvements can be achieved by refining operative techniques and approaches to resuscitation. Future endeavours must focus on applying the burgeoning understanding of endovascular surgery to these injuries.
Topics: Abdominal Injuries; Humans; Morbidity; Retrospective Studies; Vascular System Injuries; Vena Cava, Inferior; Wounds, Penetrating
PubMed: 35001138
DOI: 10.1007/s00268-021-06403-x -
The American Journal of Emergency... Jun 2020Patients who experience trauma, particularly thoracic trauma, may be at risk for missed cardiac injury.
BACKGROUND
Patients who experience trauma, particularly thoracic trauma, may be at risk for missed cardiac injury.
CASE REPORT
We present a case of a 36-year-old male presenting to the Emergency Department (ED) as a trauma after a high-speed motor vehicle crash. After computed tomography (CT) scans revealed a right hemopneumothorax and multiple orthopedic injuries, the patient was admitted to the trauma neuroscience intensive care unit (TNICU), where telemetry revealed ST elevations. An electrocardiogram (EKG) was performed and he was noted to have an acute anterolateral STEMI. The patient was intubated and underwent a cardiac catheterization that revealed a dissection of his left anterior descending (LAD) coronary artery and a stent was successfully placed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In cases of trauma patients who can't report the symptoms they are experiencing, or have distracting injury, there is the potential for a missed diagnosis of either significant cardiac injury and/or myocardial infarction (MI). Emergency physicians should be aware that an EKG is recommended in the ED evaluation of a trauma patient, especially those with thoracic trauma.
Topics: Accidents, Traffic; Adult; Chest Pain; Coronary Vessels; Dissection; Electrocardiography; Emergency Service, Hospital; Humans; Male; ST Elevation Myocardial Infarction; Wounds and Injuries
PubMed: 32139211
DOI: 10.1016/j.ajem.2020.02.055 -
The Journal of Hand Surgery May 2018Several technical modifications have been described to avoid complications of venous flaps. The authors describe a technical variation of the venous flap to reduce the... (Review)
Review
Several technical modifications have been described to avoid complications of venous flaps. The authors describe a technical variation of the venous flap to reduce the risk of venous congestion and the likelihood of shunting, thus increasing venous flap reliability.
Topics: Anticoagulants; Finger Injuries; Free Tissue Flaps; Graft Survival; Humans; Male; Postoperative Care; Postoperative Complications; Regional Blood Flow; Veins; Young Adult
PubMed: 29728214
DOI: 10.1016/j.jhsa.2018.02.023 -
Scientific Reports Dec 2020The dural venous sinuses play an integral role in draining venous blood from the cranial cavity. As a result of the sinuses anatomical location, they are of significant...
The dural venous sinuses play an integral role in draining venous blood from the cranial cavity. As a result of the sinuses anatomical location, they are of significant importance when evaluating the mechanopathology of traumatic brain injury (TBI). Despite the importance of the dural venous sinuses in normal neurophysiology, no mechanical analyses have been conducted on the tissues. In this study, we conduct mechanical and structural analysis on porcine dural venous sinus tissue to help elucidate the tissues' function in healthy and diseased conditions. With longitudinal elastic moduli values ranging from 33 to 58 MPa, we demonstrate that the sinuses exhibit higher mechanical stiffness than that of native dural tissue, which may be of interest to the field of TBI modelling. Furthermore, by employing histological staining and a colour deconvolution protocol, we show that the sinuses have a collagen-dominant extracellular matrix, with collagen area fractions ranging from 84 to 94%, which likely explains the tissue's large mechanical stiffness. In summary, we provide the first investigation of the dural venous sinus mechanical behaviour with accompanying structural analysis, which may aid in understanding TBI mechanopathology.
Topics: Animals; Brain Injuries, Traumatic; Cerebral Veins; Comorbidity; Cranial Sinuses; Disease Models, Animal; Dura Mater; Hematoma, Subdural, Acute; Swine; Vascular Stiffness
PubMed: 33303894
DOI: 10.1038/s41598-020-78694-4 -
World Journal of Surgery Oct 2023Traumatic inferior vena cava (IVC) injuries are uncommon, but the mortality rate remains high at 38-70%. To date, most studies on traumatic IVC injuries have evaluated...
BACKGROUND
Traumatic inferior vena cava (IVC) injuries are uncommon, but the mortality rate remains high at 38-70%. To date, most studies on traumatic IVC injuries have evaluated blunt rather than penetrating injuries. We aimed to identify the clinical features and risk factors that affect the prognosis of patients with blunt IVC injuries to improve treatment strategies for these patients.
METHODS
We retrospectively analyzed patients diagnosed with blunt IVC injury over 8 years at a single trauma center. Clinical and biochemical parameters; transfusion, surgical, and resuscitation methods; associated injuries; intensive care unit stay; and complications data were compared between survival and death groups to identify clinical features and risk factors of blunt IVC injury-related mortality.
RESULTS
Twenty-eight patients with blunt IVC injury were included during the study periods. Twenty-five (89%) patients underwent surgical treatment, and the mortality was 54%. The mortality rate according to the IVC injury location was the lowest for supra-hepatic IVC injury (25%, n = 2/8), whereas it was the highest for retrohepatic IVC injury (80%, n = 4/5). In the logistic regression analysis, Glasgow Coma Scale (GCS) (odds ratio [OR] = 0.566, 95% confidence interval [CI] [0.322-0.993], p = 0.047) and red blood cell (RBC) transfusion for 24 h (OR = 1.132, 95% CI [0.996-1.287], p = 0.058) were independent predictors for mortality.
CONCLUSIONS
Low GCS score and high-volume packed RBC transfusion requirements for 24 h were significant predictors of mortality in patients with blunt IVC injuries. Unlike IVC injuries caused by penetrating trauma, supra-hepatic IVC injuries caused by blunt trauma have a good prognosis.
Topics: Humans; Retrospective Studies; Vena Cava, Inferior; Prognosis; Risk Factors; Wounds, Penetrating; Abdominal Injuries; Wounds, Nonpenetrating
PubMed: 37423908
DOI: 10.1007/s00268-023-07110-5 -
Journal of Vascular Surgery Jun 2020Blunt abdominal aortic injury (BAAI) occurs in less than 0.1% of blunt traumas. A previous multi-institutional study found an associated mortality rate of 39%. We sought...
OBJECTIVE
Blunt abdominal aortic injury (BAAI) occurs in less than 0.1% of blunt traumas. A previous multi-institutional study found an associated mortality rate of 39%. We sought to identify risk factors for BAAI and risk factors for mortality in patients with BAAI using a large national database. We hypothesized that an Injury Severity Score of 25 or greater, and thoracic trauma would both increase the risk of mortality in patients with BAAI.
METHODS
The Trauma Quality Improvement Program (2010-2016) was queried for individuals with blunt trauma. Patients with and without BAAI were compared. Covariates were included in a multivariable logistic regression model to determine mechanisms of injury, examination findings, and concomitant injuries associated with increased risk for BAAI. An additional multivariable analysis was performed for mortality in patients with BAAI.
RESULTS
From 1,056,633 blunt trauma admissions, 1012 (0.1%) had BAAI. The most common mechanism of injury was motor vehicle accident (MVA; 57.5%). More than one-half the patients had at least one rib fracture (54.0%), or a spine fracture (53.9%), whereas 20.8% had hypotension on admission and 7.8% had a trunk abrasion. The average length of stay was 13.4 days and 24.6% required laparotomy, with 6.6% receiving an endovascular repair and 2.9% an open repair. The risk of death in those treated with endovascular vs open repair was similar (P = .28). On multivariable analysis, MVA was the mechanism associated with the highest risk of BAAI (odds ratio [OR], 4.68; 95% confidence interval [CI], 3.87-5.65; P < .001) followed by pedestrian struck (OR, 4.54; 95% CI, 3.47-5.92; P < .001). Other factors associated with BAAI included hypotension on admission (OR, 3.87; 95% CI, 3.21-4.66; P < .001), hemopneumothorax (OR, 3.67; 95% CI, 1.16-11.58; P < .001), abrasion to the trunk (OR, 1.49; 95% CI, 1.15-1.94; P = .003), and rib fracture (OR, 1.46; 95% CI, 1.25-1.70; P < .001). The overall mortality rate was 28.0%. Of the variables examined, the strongest risk factor associated with mortality in patients with BAAI was hemopneumothorax (OR, 12.49; 95% CI, 1.25-124.84; P = .03) followed by inferior vena cava (IVC) injury (OR, 12.05; 95% CI, 2.80-51.80; P < .001).
CONCLUSIONS
In the largest nationwide series to date, BAAI continues to have a high mortality rate with hemopneumothorax and IVC injury associated with the highest risk for mortality. The mechanism most strongly associated with BAAI is MVA followed by pedestrian struck. Other risk factors for BAAI include rib fracture and trunk abrasion. Providers must maintain a high suspicion of injury for BAAI when these mechanisms of injury, physical examination or imaging findings are encountered.
Topics: Abdominal Injuries; Accidents, Traffic; Adult; Aged; Aorta, Abdominal; Databases, Factual; Female; Hemopneumothorax; Humans; Incidence; Male; Middle Aged; Multiple Trauma; Pedestrians; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; United States; Vena Cava, Inferior; Wounds, Nonpenetrating; Young Adult
PubMed: 31699513
DOI: 10.1016/j.jvs.2019.07.095