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Cureus Jul 2021Previously, the management of gunshot wounds (GSWs) to the anterior abdomen required exploratory laparotomy; however, this was associated with a considerable number of...
Previously, the management of gunshot wounds (GSWs) to the anterior abdomen required exploratory laparotomy; however, this was associated with a considerable number of non-therapeutic surgeries. The use of non-operative management (NOM) of GSW to the abdomen is controversial, with many surgeons sceptical to accept this into their practice. The NOM of GSW to the abdomen employed in a selected group of patients has been shown to be safe and acceptable. Penetrating GSW to the thoraco-abdomen, back and lateral abdomen has been the most successful compared to the anterior penetrating wound. Most of the anterior GSWs to the abdomen are associated with viscus injury and require exploratory laparotomy. We report the case of a 58-year-old male who presented with a single GSW to the epigastrium with a contrast computed tomography scan demonstrating grade 3 liver lacerations, contusion to the right adrenal gland, with moderate free fluids in the retroperitoneum and the pelvis. The patient was haemodynamically stable and managed successfully with NOM. It is one of the safe routes of anterior penetration of GSW to the abdomen and treated with conservative management.
PubMed: 34513396
DOI: 10.7759/cureus.16789 -
Journal of Biomechanics Oct 2021Underwater explosion (UNDEX) can cause severe damage to hull structure, equipment and human. In this paper, the effect of UNDEX load, including shock wave and bubble...
Underwater explosion (UNDEX) can cause severe damage to hull structure, equipment and human. In this paper, the effect of UNDEX load, including shock wave and bubble pulsation, on seated human response was investigated. The incident pressure of non-contact UNDEX was calculated. A lumped parameter interaction model of the ship structure (single-deck and multi-deck) and seated human was created based on the Taylor's theory and its veracity was verified. The results indicated that the pelvis, which is in direct contact with the structure, is the most vulnerable part of seated human when suffered impact. The shock wave and bubble pulsation had equal destructive potential to upper torso, viscera and head. The low pass filtering feature of multi-deck configuration may magnify the human response caused by the upper deck motion. The energy carried by the low and high frequency component was the dominant factors to human injury and the broadband protection to human shock isolation design is essential.
Topics: Humans; Motion; Research Subjects; Ships; Sitting Position; Torso
PubMed: 34371474
DOI: 10.1016/j.jbiomech.2021.110666 -
Anatomical Record (Hoboken, N.J. : 2007) Oct 2021The genera Mitophis and Tetracheilostoma comprise two extant lineages of small-sized threadsnakes that exclusively inhabit several islands of the West Indies. Even...
Evolutionary treasures hidden in the West Indies: Comparative osteology and visceral morphology reveals intricate miniaturization in the insular genera Mitophis Hedges, Adalsteinsson, & Branch, 2009 and Tetracheilostoma Jan, 1861 (Leptotyphlopidae: Epictinae: Tetracheilostomina).
The genera Mitophis and Tetracheilostoma comprise two extant lineages of small-sized threadsnakes that exclusively inhabit several islands of the West Indies. Even though leptotyphlopids are known for their extremely reduced size, miniaturization has only been hypothesized to reflect insular dwarfism for the genus Tetracheilostoma. Herein, we aim to describe the comparative osteology and visceral morphology of both genera, investigating and discussing their several internal morphological simplifications and novelties. Our results indicate that these taxa exhibit several autapomorphies mostly concentrated in the dorsoposterior skull elements and maxillae, as well as in their axial skeleton and viscera. These novelties and simplifications are most likely a result of extreme miniaturization driven by the evolutionary constraints or ecological opportunities possibly imposed by the "island rule." Both Mitophis and Tetracheilostoma distinguish from all other Epictinae in lacking a dentigerous process in the maxillae, by having the prootic fused to the otooccipital, and by the lack (except in comparison to a few Epictia) of a cervical vertebrae intercentrum I. Additionally, Mitophis can be distinguished from other Epictinae by the participation of the unpaired supraoccipital in the dorsal border of the foramen magnum, by the absence of the pleurapophyses in the caudal vertebrae, by a higher number of liver segments, and by the extreme degeneration of the pelvic rudiments. Tetracheilostoma differs from other Epictinae by lacking a distinct supraoccipital, which is fused to the parietal. Thus, our results reinforce that morphological characters are extremely valuable for leptotyphlopid systematics given their extremely conserved external morphology.
Topics: Miniaturization; Osteology; Research; West Indies
PubMed: 34296825
DOI: 10.1002/ar.24716 -
Cureus Jul 2021Retroperitoneal abscesses are relatively uncommon in infants and children. They carry a high rate of morbidity due to insidious onset and pose a diagnostic challenge....
Retroperitoneal abscesses are relatively uncommon in infants and children. They carry a high rate of morbidity due to insidious onset and pose a diagnostic challenge. Here we report a case of spontaneous retroperitoneal methicillin-resistant (MRSA) infection in a two-year-old patient. The patient was successfully treated with antibiotics and surgical washout and drainage. A retroperitoneal abscess is usually found in patients with a history of osteomyelitis, seeding of post-traumatic pelvic hematomas, post radiation, or perforated hollow viscus including but not limited to: perforated appendicitis, bowel perforations due to foreign objects or malignancy, or perforated diverticulitis. Most of these conditions are usually found in the adult population. As per a recent literature search, there are no reported cases of a spontaneous retroperitoneal MRSA abscess in the pediatric population without risk factors.
PubMed: 34262825
DOI: 10.7759/cureus.16111 -
Forensic Science, Medicine, and... Dec 2021Vehicular runover of pedestrians is a commonly reported occurrence in literature. The usual presentations at autopsy are avulsion of the intra-abdominal viscera, solid...
Vehicular runover of pedestrians is a commonly reported occurrence in literature. The usual presentations at autopsy are avulsion of the intra-abdominal viscera, solid organ crushing, hemorrhage, fracture of pelvic bone and vertebra, and herniation of the abdominal contents. There are reports of many cases where the abdominal and thoracic viscera have herniated out of their respective compartment following rupture of the diaphragm. Herniation of the intestine through natural orifices or other anatomical openings of the body has also been reported. This herniation occurs following a reduction in the anteroposterior diameter and acute increase in intra-abdominal pressure, displacing the abdominal contents out of their normal position through some natural anatomical openings inside the body following the path of least resistance. We report an interesting case of vehicular runover where the intestinal coils have come out of the body at the ankle. The authors describe the plausible mechanism and the route through which the intestine could have traversed.
Topics: Abdominal Injuries; Accidents, Traffic; Ankle; Hernia; Humans; Intestines; Rupture
PubMed: 34241757
DOI: 10.1007/s12024-021-00399-5 -
Pain Apr 2022Clinical evidence indicates dorsal root ganglion (DRG) stimulation effectively reduces pain without the need to evoke paresthesia. This paresthesia-free anesthesia by...
Clinical evidence indicates dorsal root ganglion (DRG) stimulation effectively reduces pain without the need to evoke paresthesia. This paresthesia-free anesthesia by DRG stimulation can be promising to treat pain from the viscera, where paresthesia usually cannot be produced. Here, we explored the mechanisms and parameters for DRG stimulation using an ex vivo preparation with mouse distal colon and rectum (colorectum), pelvic nerve, L6 DRG, and dorsal root in continuity. We conducted single-fiber recordings from split dorsal root filaments and assessed the effect of DRG stimulation on afferent neural transmission. We determined the optimal stimulus pulse width by measuring the chronaxies of DRG stimulation to be below 216 µs, indicating spike initiation likely at attached axons rather than somata. Subkilohertz DRG stimulation significantly attenuates colorectal afferent transmission (10, 50, 100, 500, and 1000 Hz), of which 50 and 100 Hz show superior blocking effects. Synchronized spinal nerve and DRG stimulation reveals a progressive increase in conduction delay by DRG stimulation, suggesting activity-dependent slowing in blocked fibers. Afferents blocked by DRG stimulation show a greater increase in conduction delay than the unblocked counterparts. Midrange frequencies (50-500 Hz) are more efficient at blocking transmission than lower or higher frequencies. In addition, DRG stimulation at 50 and 100 Hz significantly attenuates in vivo visceromotor responses to noxious colorectal balloon distension. This reversible conduction block in C-type and Aδ-type afferents by subkilohertz DRG stimulation likely underlies the paresthesia-free anesthesia by DRG stimulation, thereby offering a promising new approach for managing chronic visceral pain.
Topics: Animals; Chronic Pain; Colorectal Neoplasms; Ganglia, Spinal; Mice; Paresthesia
PubMed: 34232925
DOI: 10.1097/j.pain.0000000000002395 -
The American Surgeon May 2023The most common cause of pneumoperitoneum in trauma patients is hollow viscus injury; however, in patients with pneumoperitoneum on imaging and normal hollow viscus...
The most common cause of pneumoperitoneum in trauma patients is hollow viscus injury; however, in patients with pneumoperitoneum on imaging and normal hollow viscus during the laparotomy, other rare causes of pneumoperitoneum like intraperitoneal urinary bladder rupture should be ruled out. Urinary bladder can rupture either extraperitoneally or intraperitoneally or both. Rupture of the urinary bladder is commonly seen in patients with abdominal trauma; however, pneumoperitoneum is usually not seen in patients with traumatic bladder rupture. Intraperitoneal bladder rupture is usually due to the sudden rise in intra-abdominal pressure following abdominal or pelvic trauma. However, it is a rare cause of pneumoperitoneum and is managed by surgical repair. We present a case of blunt trauma abdomen with pneumoperitoneum due to isolated intraperitoneal bladder rupture who was managed by exploratory laparotomy and primary repair of the urinary bladder.
Topics: Humans; Urinary Bladder; Pneumoperitoneum; Abdomen; Urinary Bladder Diseases; Abdominal Injuries; Rupture; Wounds, Nonpenetrating; Thoracic Injuries
PubMed: 34111962
DOI: 10.1177/00031348211025765 -
Case Reports in Orthopedics 2021Rotational displaced pelvic ring injuries are associated with internal injuries to both the gastrointestinal and genitourinary viscera and anatomic structures. Vaginal...
INTRODUCTION
Rotational displaced pelvic ring injuries are associated with internal injuries to both the gastrointestinal and genitourinary viscera and anatomic structures. Vaginal lacerations and open genitourinary-associated injuries are at increased risk of mortality due to sepsis. . This case presents a 65-year-old female status post-pedestrian-vehicle struck diagnosed with an open pelvic fracture with extension into the outer one-third of the vaginal wall. The patient was successfully treated with emergent surgical debridement, pelvic stabilization, and internal placement of a novel combination of metronidazole antibiotic gel and vancomycin/tobramycin Polymethyl methacrylate beads.
CONCLUSION
No evidence of infection was observed with the use of topical metronidazole-coated vancomycin/tobramycin Polymethyl methacrylate beads for contaminated open pelvic fracture injury involving the vaginal wall. Further research on antibiotic gels for use in high-risk open fractures is required.
PubMed: 34055438
DOI: 10.1155/2021/5594270 -
Journal of Laparoendoscopic & Advanced... Jul 2021Success rate of laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO) in children is comparable with open pyeloplasty. Prolonged ileus and injury to...
Success rate of laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO) in children is comparable with open pyeloplasty. Prolonged ileus and injury to adjacent viscera more often occurred in transperitoneal approach; however, longer operation time is noted in retroperitoneal approach. This study presented a hybrid retroperitoneoscopic pyeloplasty (HRP), for congenital UPJO in infants weighing <10 kg. From February 2017 to June 2020, 10 HRP procedures were performed in 9 patients by 1 surgeon. Retroperitoneal dissection of the renal pelvis and the upper third ureter was first performed, followed by extracorporeal suturing for pyeloureterostomy. Mean operative age and body weight were 4.23 ± 3.69 months and 6.18 ± 1.57 kg. Operative, CO inflation, and extracorporeal suture time were 147.9 ± 39.5, 40.6 ± 11.2, and 62.9 ± 26.1 minutes, respectively. Surgical outcome was confirmed by renal ultrasound and diuretic renogram. Postoperative follow-up duration was 15.2 ± 7.7 months. Three patients had postoperative febrile urinary tract infection and recovered after antibiotic treatment. In infants or smaller children with UPJO, the HRP procedure may be considered as an effective and minimally invasive alternative with shorter learning curve for inexperienced surgeons.
Topics: Body Weight; Female; Humans; Hydronephrosis; Ileus; Infant; Kidney; Kidney Pelvis; Learning Curve; Male; Multicystic Dysplastic Kidney; Nephrotomy; Operative Time; Postoperative Complications; Plastic Surgery Procedures; Retroperitoneal Space; Sutures; Treatment Outcome; Ultrasonography; Ureteral Obstruction; Urologic Surgical Procedures
PubMed: 34042526
DOI: 10.1089/lap.2020.0799 -
International Journal of Surgery Case... Jun 2021Post-traumatic diaphragmatic rupture is a lesion of variable severity. It is a rare and difficult to diagnose pathology, it has been found in 0.4% of all traumatized...
INTRODUCTION
Post-traumatic diaphragmatic rupture is a lesion of variable severity. It is a rare and difficult to diagnose pathology, it has been found in 0.4% of all traumatized patients and in 1.9% of blunt traumas. It can be associated with abdominal andthoracic lesions, particularly cardiac, which can be life-threatening.
MATERIALS AND METHODS
Our work is a retrospective case report with a descriptive aim concerning a patient operated for a post-traumatic diaphragmatic rupture within the department of general surgery of CHU Ibn Rochd Casablanca. This work has been reported in line with the SCARE 2020 criteria (17).
CASE PRESENTATION
A 60-year-old patient was admitted to the visceral surgical emergency department following a work accident (crushing between two carts) causing a thoraco-abdominal impact point trauma without initial loss of consciousness, nor externalized digestive hemorrhage or associated signs, but with a general condition alteration. The patient was conscious, dyspneic with a blood pressure of 100/50 mmHg and afebrile. Physical examination showed diffuse abdominal sensibility. The thoraco-abdomino-pelvic CT scan revealed the presence of a left thoracic hernia with gastric, colic and epiploic contents through a lateral defect of the left diaphragmatic dome. The decision was to directly send the patient to the operating room. Exploration found a large left diaphragmatic breach of 20 cm, a denudation of the pericardia, a medium-abundant hemoperitoneum and a hematoma of the right mesocolon. The procedure consisted of right hemicolectomy with ileocolic anastomosis, treatment of a diaphragmatic breach with a 2-silk raphia, thoracic drainage with a Joly drain, pericardial drainage with a Joly drain, pre-anastomotic drainage with 2 delbet slides, drainage of the Douglas and left subthreshold with 2 Salem catheters. The post-operative follow-up was simple.
DISCUSSION
Diaphragmatic rupture is a rare and difficult to diagnose condition. Traumatic diaphragmatic rupture (TDR) was found in 0.4% of all traumatized patients and in 1.9% of blunt trauma. Associated lesions of the spleen, liver and/or lungs were found in more than 30% of cases, with an overall mortality rate of 26.8% (1). Pericardial rupture following blunt chest trauma is rare and associated with a high mortality rate ranging from 30% to 64% (9). The physiopathology of this type of injury is not well understood, but the most accepted hypothesis describes an increase in intra-abdominal pressure due to a blunt creating a sufficiently high-pressure gradient between the chest and the abdomen to cause a diaphragmatic rupture. The common clinical symptoms of a diaphragmatic rupture are a marked respiratory distress and diffuse abdominal pain but it can be asymptomatic. Medical imaging exams visualize the ascended organs but it's more difficult to visualize the rupture itself. The chest X-ray is currently the first examination to be requested (4) and also helps in the diagnosis of injuries and diaphragm rupture (13). Surgical treatment includes the reduction of any visceral hernia, repair of the diaphragm and restoration of circulation, breathing and digestive functions. Laparotomy is generally used because of the complete exploration of the abdominal viscera, although it is easier to reduce herniated tissue and repair the diaphragm.
CONCLUSION
Diaphragmatic rupture with denudation of the heart is rare with poor prognosis and requires emergency surgery with close postoperative monitoring in the intensive care setting.
SUMMARY
Post-traumatic diaphragmatic rupture is a lesion of variable severity. It is a rare and difficult to diagnose pathology, it has been found in 0.4% of all traumatized patients and in 1.9% of blunt traumas. The lesions are more frequent in the left diaphragmatic dome compared to the right one, and exceptionally bilateral. Pericardial rupture following blunt chest trauma is rare and associated to a high mortality rate. It is often unrecognized and goes unnoticed in the acute phase. The most common clinical symptoms of diaphragmatic ruptures are respiratory distress and diffuse abdominal pain, as it can be asymptomatic. Its diagnosis is essentially radiological using CT scan, and requires emergency surgical treatment as soon as the diagnosis is suspected, in order to avoid the dreaded complications. Traumatic diaphragmatic rupture remains a diagnostic and therapeutic challenge. We report the case of a patient who presented a post-traumatic diaphragmatic rupture with pericardial damage operated in the visceral emergency department at the Ibn Rochd Hospital c in Casablanca, Morocco.
PubMed: 34029846
DOI: 10.1016/j.ijscr.2021.105970