Hemorrhagic Shock Caused by Mesenteric Injury - Ski Pediatric Blunt Abdominal Trauma case report (original) (raw)
Related papers
Presentation of blunt small intestinal and mesenteric injuries
Annals of The Royal College of Surgeons of England
patients with blunt small bowel and mesenteric injuries were treated at two trauma centres. The majority (52 cases) were victims of motor vehicle accidents, and 54% of them wore seat belts at the time of the accident. There were 22 small bowel injuries (17 full-thickness and 5 seromuscular) and 42 mesenteric injuries (7 with and 35 without a devascularised bowel segment). Shock on admission was present in 34% of the patients and generalised abdominal tendemess in 75%. Diagnostic peritoneal lavage was positive for blood in 25 out of 36 cases in which it was performed (69%), and positive for bowel content in 4/6 patients (67%) with fullthickness bowel perforations or transactions. Emergency room ultrasound was positive for blood in 13/25 cases (52%), and CT scan in 7/17 (41%). It is concluded that blunt small bowel and mesenteric injuries including patients with perforated or ischaemic bowel are difficult to diagnose using currently available diagnostic tools, and require a low threshold for exploration based on clinical suspicion in order to reduce the complications following delayed treatment of these injuries.
Missed mesenteric injury in blunt abdominal trauma: A potentially lethal error
International Journal of Case Reports and Images, 2013
Introduction: Mesenteric injury following blunt abdominal trauma is uncommon. Delay in diagnosis is unfortunately common due to its subtle clinical presentation and is associated with significant morbidity and mortality. Case Report: We present a case of a 35yearold male who was discharged home with a missed mesenteric injury. The initial computed tomography scan of the abdomen and pelvis was normal. He represented acutely with small bowel infarction. Conclusion: Although computed tomography is the current gold standard of investigation, a very small proportion of injuries that require surgical intervention will invariably be missed. This case highlights several pitfalls in evaluation of these patients. Clinicians must always be vigilant of such injury despite normal radiological studies. A sufficient period of observation post injury should be considered in circumstances where the possibility of mesenteric injury is increased. Such circumstances include lack of seat belt usage, highspeed impact and deceleration injury.
Europe PMC (PubMed Central), 2016
Introduction: Equine related sports are very popular. In this present study patients, hurt by horses or during riding, were analysed, to gain knowledge of injury patterns, mechanisms, circumstances and to identify groups of risk. Material and methods: 667 patients injured by horses since 2006, were analysed regarding epidemiology, initial fettle, based on GCS and the injury severity, based on the ISS. All injuries were categorized, based on AO classifications, treatment duration and information about intensive care. To obtain information about the accident, patients were surveyed. Results: Average age was 25 (std.dev. 6 years) and 90 % were female. 72 % were injured while riding, with an average ISS of 5.7. 33 % suffered from injuries of the upper extremity. 51 % were contusions, mostly affecting hands and shoulder, followed by fractures with 41 %. 48 % of the upperarm fractures occured distal and were simple without joint involvement. 70 % of the forearm fractures occured distal, involving the wrist in 30 % of the cases. 68 % of the patients wore a helmet. Accidents at courtyards had an average ISS of 10. The average ISS in riding halls was 5.7 and 6.6 on outside courts. 35 % of the accidents occured during jumping. While handling the horse 79 % wore no protection. Conclusion: Riders jumping in riding halls bear the highest risk of getting injured. Handling and riding injuries are equally severe, although fewer persons wear protection when handling their horse. Therefore wearing protection at all time is mandatory. Riders need to be well trained in falling techniques in order to prevent injuries of the upper extremity.
Blunt abdominal trauma in children: Risks of nonoperative treatment
Journal of Pediatric Surgery, 1997
This retrospective study includes 203 children who had intraabdominal injuries after blunt trauma, mainly bicycle accidents and falls. Of 145 patients with splenic injury, seven underwent surgery. There was a 100% splenic salvage rate. Twenty-nine children had hepatic injury and four underwent laparotomy. One patient who was initially treated conservatively had a complicated clinical course with rebleeding that led to two laparotomies. Three of 10 pancreatic injuries were operated on; one of them 4 weeks after the trauma because of a pseudocyst. Nineteen patients had gastrointestinal tract injuries. Of seven intramural hematomas, five were treated nonoperatively. Twelve patients had gastrointestinal perforations. Seven underwent laparotomy without delay. Three patients underwent surgery 24 hours after admission because of severe abdominal rigidity or pneumoperitoneum. There was one case of severe in-hospital delay in which splenic and hepatic injuries were thought to account for the physical findings. At laparotomy 36 hours after admission, a jejunal rupture and necrosis of the transverse colon were found. Nonoperative management of blunt abdominal trauma has been very successful regarding splenic ruptures. Conservative management of hepatic injuries is more hazardous, and treatment of pancreatic injuries is a matter of controversy. Gastrointestinal-tract perforations are difficult to diagnose and important to bear in mind while keeping a conservative attitude toward abdominal trauma.
Abdominal injuries in children: an analysis of 348 cases
Injury-international Journal of The Care of The Injured, 1985
Three hundred and forty-eight children from Skaraborg County, Sweden, admitted to hospital with abdominal injuries over a 30-year period (1951–1980), have been analysed and compared with all patients with abdominal injury (1407) admitted to hospital from the same area during the same period. The number of children admitted in the second half of the period was greater than during the first but the proportion of children compared with adults was considerably reduced. During the period abdominal injuries due to car accidents increased in adults but not in children. The most frequent cause of abdominal injury in children was a bicycle accident. Abdominal injury due to sport also increased over the period. Mortality decreased, with no deaths in the past 10 years, compared with 8·6 per cent mortality in the first 10 years of the period.
2016
– Background- Mesenteric thrombosis related to trauma is an uncommon entity and has poor prognosis when have low flow and hemorrhagic shock. It usually presents with a challenging diagnosis and high mortality rates, despite appropriate treatment. Case report – Patient with blunt trauma was admitted and initial treatment, complementary exams showed ribs and humerus fractures. Computerized tomography showed aerial distension in small bowels along with gastric stasis and hidropneumothorax. The patient had hypotension during clinical observation and cardiopulmonary arrest, responding to reanimation. Taken to surgery for damage control, it was found extensive necrosis of right colon, which was excised and performed primary anastomosis. He was admitted in the intensive care unit, evolving with oliguria, miosis, convulsion, and pulseless electric activity, dying three days after hospital admission. Conclusion- Although uncommon, mesenteric ischemia with venous thrombosis might be secondary...
A big mesenteric rupture after blunt abdominal trauma: a case report and literature review
International Journal of Surgery Case Reports
INTRODUCTION: A blunt abdominal trauma especially in organs less commonly injured (such as small bowel and mesentery injury), are difficult to diagnose. PRESENTATION OF CASE: We report a case of a blunt abdominal trauma, in a 43 year old male presented in the Emergency Department after a truck vehicle accident. He sustained a chest injury, a pelvic fracture and diffuse abdominal tenderness. The patient had tachycardia (120 pulses/min) and normal blood pressure (120/90 mm Hg). The computed tomography (CT) showed only free fluid. We placed two chest tubes (due to pneumothorax and hemothorax at both sides) and the patient went to the operating room (OP). An external pelvic osteosynthesis was performed first and then we did an exploratory laparotomy, which revealed a big mesenteric rupture. Finally, an enterectomy (circa 2 m) with a fist stage side to side anastomosis was performed. DISCUSSION: Mesentery and bowel injury constitutes 3-5% of blunt abdominal injuries. The main diagnostic challenge is to identify lesions that require surgery. Diagnostic delay over 8 h can lead to high morbidity and mortality rates. Laparotomy is the standard of care in hemodynamically unstable patients. CONCLUSION: In polytrauma cases with abdominal pain and unclear CT findings the decision to proceed with exploratory laparotomy is better than a conservative treatment, because any surgical delay can lead to severe complications.
Blunt Abdominal Trauma in Children
Annals of Surgery, 1972
Blunt abdominal trauma remains the commonest cause of abdominal injury in children. Data collected prospectively by the National Trauma Registry in USA from 1985 to 1991 showed 86% of the abdominal injuries were secondary to blunt abdominal trauma. 1 In Britain and Australia, the percentage of blunt abdominal trauma is higher because knife and gunshot injuries are less common. In the above-mentioned series from USA mortality associated with blunt injuries was 9%. Liver, spleen, and kidney injuries each occurred in about 30% of cases, and the gastrointestinal tract was injured in about 15%. Significant progress has been made in the past two decades in imaging children with blunt abdominal trauma and understanding its pathophysiology, leading to a sharp decline in the laparotomy rate. The salient features in the management of blunt abdominal trauma in children are discussed in this article.