Splenic rupture is a common consequence of blunt abdominal trauma. Emergency splenectomy is indicated when conservative management is not effective. With better understanding of the immunologic function of the spleen,...Splenic rupture is a common consequence of blunt abdominal trauma. Emergency splenectomy is indicated when conservative management is not effective. With better understanding of the immunologic function of the spleen, surgeons have begun to perform the splenic-preserving surgery. However, it is technical challenge to perform emergency laparoscopic partial splenectomy for patient with spleen rupture. A 15-year-old male patient suffered from grade. spleen injury basing on the American association for the surgery of trauma splenic injury scale. Conservative treatment failed to success basing on the dramatically decreased hemoglobin level. During the laparoscopic exploration, we found that two individual ruptures were associated with the upper pole of spleen. An emergency laparoscopic partial splenectomy was successfully carried out. The operative time was approximate 150 min and the estimated blood loss was 200 mL. The post-operative course was uneventful and the patient was discharged on the 7th post-operative day. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.展开更多
Background: Traumatic ruptures of the diaphragm (TRD) are serious lesions that are often part of polytrauma. They pose a real diagnostic and therapeutic challenge in a disadvantaged environment such as ours. Methods: ...Background: Traumatic ruptures of the diaphragm (TRD) are serious lesions that are often part of polytrauma. They pose a real diagnostic and therapeutic challenge in a disadvantaged environment such as ours. Methods: We conducted a descriptive observational study covering a period of 11 years in 3 referral hospitals in the city of Yaoundé (Cameroon). All patients who had undergone surgery for a traumatic rupture of the diaphragm between January 1, 2011 and December 31, 2020, and whose outcome within 30 days of surgery was known were included. Results: A total of 27 patients were collected. Their mean age was 36.4 ± 19.7 years. There was a strong male predominance with 22 cases (81.5%). The TRD occurred mainly after an assault (n = 9, 33.3%), was mainly on the left side (n = 25, 92.6%) and was most often part of a polytrauma (n = 17, 62.9%). The lesions associated with TRD were mainly visceral (n = 11) and bony (n = 6). The diagnosis was made preoperatively in only 13 patients (48.1%). The average length of the diaphragmatic breach was 6.4 ± 4.5 cm and a simple suture was most often used for the repair (26 cases or 96.3%). Four osteosynthesis procedures were performed at the same time as the diaphragmatic repair. The morbidity rate was 51.9%, with surgical site infection as the main complication. Six deaths (22.2%) were recorded;septic shock was the main etiology (n = 4). Conclusion: The hospital incidence of TRD remains low in our context. These lesions remain associated with significant morbidity and mortality and require a multidisciplinary approach.展开更多
Pericardial rupture following blunt chest trauma is rare and associated with high mortality rate ranging from 30% to 64%. We review 42 cases which have been reported in the literature in last 17 years and report a cas...Pericardial rupture following blunt chest trauma is rare and associated with high mortality rate ranging from 30% to 64%. We review 42 cases which have been reported in the literature in last 17 years and report a case of our own. We have found that 83% of the cases were men with a mean age of 49 years. The most frequent cause was traffic accidents (79%). Preoperative diagnosis of traumatic rupture of the pericardium has been improved in recent 17 years, and the result is satisfactory. Early detection, timely treatment is the key. Pneumopericardium may be a valuable radiographic clue for diagnosis. The management of pericardial rupture is mainly to avoid the risk of cardiac strangulation or acute tamponade. If the injury is recognized timely, treatment is simple and effective.展开更多
BACKGROUND Previous studies reported that most of the intracranial dermoid cyst ruptures were spontaneous,and only a few were traumatic,with asymptomatic much rarer than the symptomatic ruptures.Hence,how to deal with...BACKGROUND Previous studies reported that most of the intracranial dermoid cyst ruptures were spontaneous,and only a few were traumatic,with asymptomatic much rarer than the symptomatic ruptures.Hence,how to deal with the asymptomatic traumatic rupture of intracranial dermoid cyst remains a challenge in the clinic.CASE SUMMARY A 59-year-old man was accidentally diagnosed with intracranial dermoid cyst through a cranial computed tomography(CT)scan due to a car accident.A mixed-density lesion with fat and a calcified margin was observed in the midline of the posterior fossa,accompanied with lipid droplet drifts in brain sulci,fissures,cisterns,and ventricles.After 1 wk of conservative observation,no change was observed on the updated cranial CT scan.After 2 wk of conservative observation,magnetic resonance imaging examination confirmed that the lesion was a traumatic rupture of a posterior fossa dermoid cyst with lipid droplet drifts.As the patient exhibited no adverse symptoms throughout the 2 wk,a 6-mo follow-up visit was arranged for him instead of aggressive treatment.Nonetheless,the patient did not show any abnormal neurological symptoms in the 6 mo of follow-up visits.CONCLUSION Asymptomatic traumatic rupture of intracranial dermoid cyst could be just followed or treated conservatively rather than treated aggressively.展开更多
Splenic rupture(SR)after colonoscopy is a very rare but potentially serious complication.Delayed diagnosis is common,and may increase morbidity and mortality associated.There is no clear relation between SR and diffic...Splenic rupture(SR)after colonoscopy is a very rare but potentially serious complication.Delayed diagnosis is common,and may increase morbidity and mortality associated.There is no clear relation between SR and difficult diagnostic or therapeutic procedures,but it has been suggested that loop formation and excessive torquing might be risk factors.This is a case of a65-year-old woman who underwent endoscopic submucosal dissection(ESD)for lateral spreading tumor in the descending colon,and 36 h afterwards presented symptoms and signs of severe hypotension due to SR.Standard splenectomy was completed and the patient recovered uneventfully.Colorectal ESD is usually a long and position-demanding technique,implying torquing and loop formation.To our knowledge this is the first case of SR after colorectal ESD reported in the literature.Endoscopists performing colorectal ESD in the left colon must be aware of this potential complication.展开更多
Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injur...Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insuffl ation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.展开更多
Traumatic rupture of the ascending aorta is rare. We report the case of a 23-year-old man who suffered a service accident by crushing the thorax between two tanks during army maneuvers that resulted in an adventitial ...Traumatic rupture of the ascending aorta is rare. We report the case of a 23-year-old man who suffered a service accident by crushing the thorax between two tanks during army maneuvers that resulted in an adventitial rupture of the ascending thoracic aorta extending to the Crosse. Treatment consisted of replacement of the ascending aorta with a 24 mm Hemashield straight tube and re-implantation of supra-aortic vessels at the dome of the prosthesis.展开更多
BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications d...BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications due to cyst size,location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract,vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.CASE SUMMARIES Four patients aged between 27 and 44 years(two men and two women) were admitted to our clinic with sudden abdominal pain(n = 4), hypotension(n = 3),and anaphylaxis(n = 2). Three of the perforated cysts were located in the liver,and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzymelinked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention(range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up(range: 25-80 mo).CONCLUSION Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.展开更多
Tendo Achilles ruptures are generally traumatic in origin and while bilateral tendo Achilles ruptures are a rare occurrence, most of them are associated with risk factors or pre-existing disease and generally involve ...Tendo Achilles ruptures are generally traumatic in origin and while bilateral tendo Achilles ruptures are a rare occurrence, most of them are associated with risk factors or pre-existing disease and generally involve trauma or sporting activities. Most of the cases of bilateral rupture are generally treated operatively. A spontaneous onset case of bilateral tendo achilles rupture is reported in a healthy man and its conservative (non operative) management discussed with a review of the literature.展开更多
Purpose： Traumatic diaphragmatic rupture （TDR） needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this ...Purpose： Traumatic diaphragmatic rupture （TDR） needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this study was to explore the early diagnosis and treatment of TDR. Methods： Data of 256 patients with TDR treated in our department between 1994 and 2013 were analyzed retrospectively regarding to the diagnostic methods, percentage of preoperative judgment, incidence of diaphragmatic hernia, surgical procedures and outcome, etc. Two groups were set up ac- cording to the mechanism of injury （blunt or penetrating）. Results： Of 256 patients with a mean age of 32.4 years （9-84）, 218 were male. The average ISS was 26.9 （13-66）; and shock rate was 62.9%. There were 104 blunt injuries and 152 penetrating injuries. Preoperatively diagnostic rate was 90.4% in blunt injuries and 80.3% in penetrating, respectively, P 〈 0.05. The incidence of diaphragmatic hernia was 94.2Z in blunt and 15.1% in penetrating respectively, P 〈 0.005. Thoracotomy was performed in 62 cases, laparotomy in 153, thoracotomy plus laparotomy in 29, and combined thoraco-laparotomy in 12. Overall mortality rate was 12.5% with the average ISS of 41.8; and it was 21.2% in blunt injuries and 6.6% in penetrating, respectively, P 〈 0.005. The main causes of death were hemorrhage and sepsis. Conclusions： Diagnosis of blunt TDR can be easily obtained by radiograph or helical CT scan signs of diaphragmatic hernia. For penetrating TDR without hernia, ＂offside sign＂ is helpful as initial assessment. CT scan with coronal/sagittal reconstruction is an accurate technique for diagnosis. All TDR require operation. Penetrating injury has a relatively better prognosis.展开更多
In land warfare,trenches serve as vital defensive fortifications,offering protection to soldiers while engaging in combat.However,despite their protective function,soldiers often sustain injuries within these trenches...In land warfare,trenches serve as vital defensive fortifications,offering protection to soldiers while engaging in combat.However,despite their protective function,soldiers often sustain injuries within these trenches.The lack of corresponding blast data alongside empirical injury reports presents a significant knowledge gap,particularly concerning the blast pressures propagating within trench spaces following nearby explosions.This absence hinders the correlation between blast parameters,trench geometry,and reported injury cases,limiting our understanding of blast-related risks within trenches.This paper addresses the critical aspect of blast propagation within trench systems,essential for evaluating potential blast injury risks to individuals within these structures.Through advanced computational fluid dynamics(CFD)simulations,the study comprehensively investigates blast injury risks resulting from explosions near military trenches.Employing a sophisticated computational model,the research analyzes the dynamic blast effects within trenches,considering both geometrical parameters and blast characteristics influenced by explosive weight and scaled distance.The numerical simulations yield valuable insights into the impact of these parameters on blast injury risks,particularly focusing on eardrum rupture,lung injury,and traumatic brain injury levels within the trench.The findings elucidate distinct patterns of high-risk zones,highlighting unique characteristics of internal explosions due to confinement and venting dynamics along the trench.This study underscores the significance of detailed numerical modeling in assessing blast injury risks and provides a novel knowledge base for understanding risks associated with explosives detonating near military trenches.The insights gained contribute to enhancing safety measures in both military and civilian contexts exposed to blast events near trench structures.展开更多
文摘Splenic rupture is a common consequence of blunt abdominal trauma. Emergency splenectomy is indicated when conservative management is not effective. With better understanding of the immunologic function of the spleen, surgeons have begun to perform the splenic-preserving surgery. However, it is technical challenge to perform emergency laparoscopic partial splenectomy for patient with spleen rupture. A 15-year-old male patient suffered from grade. spleen injury basing on the American association for the surgery of trauma splenic injury scale. Conservative treatment failed to success basing on the dramatically decreased hemoglobin level. During the laparoscopic exploration, we found that two individual ruptures were associated with the upper pole of spleen. An emergency laparoscopic partial splenectomy was successfully carried out. The operative time was approximate 150 min and the estimated blood loss was 200 mL. The post-operative course was uneventful and the patient was discharged on the 7th post-operative day. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
文摘Background: Traumatic ruptures of the diaphragm (TRD) are serious lesions that are often part of polytrauma. They pose a real diagnostic and therapeutic challenge in a disadvantaged environment such as ours. Methods: We conducted a descriptive observational study covering a period of 11 years in 3 referral hospitals in the city of Yaoundé (Cameroon). All patients who had undergone surgery for a traumatic rupture of the diaphragm between January 1, 2011 and December 31, 2020, and whose outcome within 30 days of surgery was known were included. Results: A total of 27 patients were collected. Their mean age was 36.4 ± 19.7 years. There was a strong male predominance with 22 cases (81.5%). The TRD occurred mainly after an assault (n = 9, 33.3%), was mainly on the left side (n = 25, 92.6%) and was most often part of a polytrauma (n = 17, 62.9%). The lesions associated with TRD were mainly visceral (n = 11) and bony (n = 6). The diagnosis was made preoperatively in only 13 patients (48.1%). The average length of the diaphragmatic breach was 6.4 ± 4.5 cm and a simple suture was most often used for the repair (26 cases or 96.3%). Four osteosynthesis procedures were performed at the same time as the diaphragmatic repair. The morbidity rate was 51.9%, with surgical site infection as the main complication. Six deaths (22.2%) were recorded;septic shock was the main etiology (n = 4). Conclusion: The hospital incidence of TRD remains low in our context. These lesions remain associated with significant morbidity and mortality and require a multidisciplinary approach.
文摘Pericardial rupture following blunt chest trauma is rare and associated with high mortality rate ranging from 30% to 64%. We review 42 cases which have been reported in the literature in last 17 years and report a case of our own. We have found that 83% of the cases were men with a mean age of 49 years. The most frequent cause was traffic accidents (79%). Preoperative diagnosis of traumatic rupture of the pericardium has been improved in recent 17 years, and the result is satisfactory. Early detection, timely treatment is the key. Pneumopericardium may be a valuable radiographic clue for diagnosis. The management of pericardial rupture is mainly to avoid the risk of cardiac strangulation or acute tamponade. If the injury is recognized timely, treatment is simple and effective.
文摘BACKGROUND Previous studies reported that most of the intracranial dermoid cyst ruptures were spontaneous,and only a few were traumatic,with asymptomatic much rarer than the symptomatic ruptures.Hence,how to deal with the asymptomatic traumatic rupture of intracranial dermoid cyst remains a challenge in the clinic.CASE SUMMARY A 59-year-old man was accidentally diagnosed with intracranial dermoid cyst through a cranial computed tomography(CT)scan due to a car accident.A mixed-density lesion with fat and a calcified margin was observed in the midline of the posterior fossa,accompanied with lipid droplet drifts in brain sulci,fissures,cisterns,and ventricles.After 1 wk of conservative observation,no change was observed on the updated cranial CT scan.After 2 wk of conservative observation,magnetic resonance imaging examination confirmed that the lesion was a traumatic rupture of a posterior fossa dermoid cyst with lipid droplet drifts.As the patient exhibited no adverse symptoms throughout the 2 wk,a 6-mo follow-up visit was arranged for him instead of aggressive treatment.Nonetheless,the patient did not show any abnormal neurological symptoms in the 6 mo of follow-up visits.CONCLUSION Asymptomatic traumatic rupture of intracranial dermoid cyst could be just followed or treated conservatively rather than treated aggressively.
文摘Splenic rupture(SR)after colonoscopy is a very rare but potentially serious complication.Delayed diagnosis is common,and may increase morbidity and mortality associated.There is no clear relation between SR and difficult diagnostic or therapeutic procedures,but it has been suggested that loop formation and excessive torquing might be risk factors.This is a case of a65-year-old woman who underwent endoscopic submucosal dissection(ESD)for lateral spreading tumor in the descending colon,and 36 h afterwards presented symptoms and signs of severe hypotension due to SR.Standard splenectomy was completed and the patient recovered uneventfully.Colorectal ESD is usually a long and position-demanding technique,implying torquing and loop formation.To our knowledge this is the first case of SR after colorectal ESD reported in the literature.Endoscopists performing colorectal ESD in the left colon must be aware of this potential complication.
文摘Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insuffl ation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.
文摘Traumatic rupture of the ascending aorta is rare. We report the case of a 23-year-old man who suffered a service accident by crushing the thorax between two tanks during army maneuvers that resulted in an adventitial rupture of the ascending thoracic aorta extending to the Crosse. Treatment consisted of replacement of the ascending aorta with a 24 mm Hemashield straight tube and re-implantation of supra-aortic vessels at the dome of the prosthesis.
文摘BACKGROUND Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons.However, some patients develop symptoms and complications due to cyst size,location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract,vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.CASE SUMMARIES Four patients aged between 27 and 44 years(two men and two women) were admitted to our clinic with sudden abdominal pain(n = 4), hypotension(n = 3),and anaphylaxis(n = 2). Three of the perforated cysts were located in the liver,and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzymelinked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention(range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up(range: 25-80 mo).CONCLUSION Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.
文摘Tendo Achilles ruptures are generally traumatic in origin and while bilateral tendo Achilles ruptures are a rare occurrence, most of them are associated with risk factors or pre-existing disease and generally involve trauma or sporting activities. Most of the cases of bilateral rupture are generally treated operatively. A spontaneous onset case of bilateral tendo achilles rupture is reported in a healthy man and its conservative (non operative) management discussed with a review of the literature.
文摘Purpose： Traumatic diaphragmatic rupture （TDR） needs early diagnosis and operation. However, the early diagnosis is usually difficult, especially in the patients without diaphragmatic hernia. The objective of this study was to explore the early diagnosis and treatment of TDR. Methods： Data of 256 patients with TDR treated in our department between 1994 and 2013 were analyzed retrospectively regarding to the diagnostic methods, percentage of preoperative judgment, incidence of diaphragmatic hernia, surgical procedures and outcome, etc. Two groups were set up ac- cording to the mechanism of injury （blunt or penetrating）. Results： Of 256 patients with a mean age of 32.4 years （9-84）, 218 were male. The average ISS was 26.9 （13-66）; and shock rate was 62.9%. There were 104 blunt injuries and 152 penetrating injuries. Preoperatively diagnostic rate was 90.4% in blunt injuries and 80.3% in penetrating, respectively, P 〈 0.05. The incidence of diaphragmatic hernia was 94.2Z in blunt and 15.1% in penetrating respectively, P 〈 0.005. Thoracotomy was performed in 62 cases, laparotomy in 153, thoracotomy plus laparotomy in 29, and combined thoraco-laparotomy in 12. Overall mortality rate was 12.5% with the average ISS of 41.8; and it was 21.2% in blunt injuries and 6.6% in penetrating, respectively, P 〈 0.005. The main causes of death were hemorrhage and sepsis. Conclusions： Diagnosis of blunt TDR can be easily obtained by radiograph or helical CT scan signs of diaphragmatic hernia. For penetrating TDR without hernia, ＂offside sign＂ is helpful as initial assessment. CT scan with coronal/sagittal reconstruction is an accurate technique for diagnosis. All TDR require operation. Penetrating injury has a relatively better prognosis.
文摘In land warfare,trenches serve as vital defensive fortifications,offering protection to soldiers while engaging in combat.However,despite their protective function,soldiers often sustain injuries within these trenches.The lack of corresponding blast data alongside empirical injury reports presents a significant knowledge gap,particularly concerning the blast pressures propagating within trench spaces following nearby explosions.This absence hinders the correlation between blast parameters,trench geometry,and reported injury cases,limiting our understanding of blast-related risks within trenches.This paper addresses the critical aspect of blast propagation within trench systems,essential for evaluating potential blast injury risks to individuals within these structures.Through advanced computational fluid dynamics(CFD)simulations,the study comprehensively investigates blast injury risks resulting from explosions near military trenches.Employing a sophisticated computational model,the research analyzes the dynamic blast effects within trenches,considering both geometrical parameters and blast characteristics influenced by explosive weight and scaled distance.The numerical simulations yield valuable insights into the impact of these parameters on blast injury risks,particularly focusing on eardrum rupture,lung injury,and traumatic brain injury levels within the trench.The findings elucidate distinct patterns of high-risk zones,highlighting unique characteristics of internal explosions due to confinement and venting dynamics along the trench.This study underscores the significance of detailed numerical modeling in assessing blast injury risks and provides a novel knowledge base for understanding risks associated with explosives detonating near military trenches.The insights gained contribute to enhancing safety measures in both military and civilian contexts exposed to blast events near trench structures.
