BACKGROUND Most major abdominal vascular injuries are caused by penetrating injuries.A common iliac artery occlusion caused by blunt force trauma is rare,and very few cases have been reported.Because of this low incid...BACKGROUND Most major abdominal vascular injuries are caused by penetrating injuries.A common iliac artery occlusion caused by blunt force trauma is rare,and very few cases have been reported.Because of this low incidence,atypical symptoms,and frequent association with other severe injuries,the proper diagnosis tends to be missed or delayed.The gold standard for diagnosis is angiography,and treatment remains a challenge.CASE SUMMARY We report here the unusual case of a common iliac artery occlusion caused by blunt abdominal compressive trauma,with transection of the small intestine.At presentation,the patient(a 56-year-old man)complained of pain and numbness in the left lower extremity and severe pain in the whole abdomen.Physical examination showed total abdominal tenderness with evidence of peritoneal irritation.The left lower limb was pulseless and cold.Abdominal computed tomography examination revealed digestive tract perforation,and abdominal computed tomography angiography showed left common iliac artery occlusion.The patient was treated successfully by anastomosis of the intestine,percutaneous transluminal angioplasty,and stenting.The patient was followed for more than 11 mo after the operation and showed a good recovery.CONCLUSION Patients with abdominal trauma should be suspected of having major vascular injury.Individualized treatment strategies are needed for this condition.展开更多
The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thi...The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thickening. At surgery, a double stenotic bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the two resected segments showed fibrotic and ischemic lesions within the mesentery. Ischemic intestinal stenosis from mesenteric injury should be considered in the differential diagnosis in patients suffering from intestinal occlusion with a history of blunt abdominal trauma.展开更多
Objective: The aim of this study is to determine the causes, pattern, management, and outcome of jejunal-ileal rupture following blunt abdominal trauma at the teaching Hospital of Bouake. Methods: The study included 2...Objective: The aim of this study is to determine the causes, pattern, management, and outcome of jejunal-ileal rupture following blunt abdominal trauma at the teaching Hospital of Bouake. Methods: The study included 27 patients who underwent laparotomy for jejunoileal injuries from blunt abdominal trauma at the Teaching Hospital of Bouake over a period of 14 years from January 2007 to December 2020. A retrospective study was conducted and the patients were analyzed with respect to patient demographics data, cause, injury mechanisms, presentation, anatomical distribution, diagnostic methods, associated injuries, treatment and outcomes. Results: During the 14 year period from 2007 to 2020, 27 patients with blunt small bowel injuries were treated at our Teaching Hospital. That is 2.9% of all blunt abdominal trauma. Male to female ratio was 4.4:1 and the average age was 26.3 years (range: 15 and 50 years). The majority (66.7% 18 cases) were Victims of road traffic accident. Median delay between injury and arrival at hospital for these patients was 10.1 hours (range: 1 - 72 h). A single intestinal injury was present in 22 patients, while 5 patients suffered from 2 injuries. There were 32 perforations of the small intestine in 27 patients with two perforations being transection. All perforations were located on the antimesenteric border of the intestine. Out of the 32 jejuno-ileal ruptures 18 were located on the jejunum while 14 were located on the ileum. Associated intra-abdominal injuries were present in 6 patients and nineteen associated extra-abdominal injuries were present in 10 (70.4%) patients. A one-stage therapeutic strategy was performed in 20 cases (74.1%) and a two-stage strategy was performed in seven cases (25.9%). Intestinal continuity was restored 93.8 days later (range 60 and 140 days). The average length of hospital stay of the operated patients was 11.4 days. The operative morbidity was 25.9%. Conclusion: Jejuno-ileal ruptures are rare and characterized by a delay in management. An early diagnosis could improve the vital prognosis of the patients.展开更多
BACKGROUND Regular abdominal massage can be used to treat digestive symptoms such as bloating and constipation and is reported to reduce abdominal discomfort,improve digestive function,and increase the quality of life...BACKGROUND Regular abdominal massage can be used to treat digestive symptoms such as bloating and constipation and is reported to reduce abdominal discomfort,improve digestive function,and increase the quality of life,without serious adverse effects.Isolated pancreatic injury is rare,and most often occurs during severe trauma such as steering wheel impact injury.To our knowledge,pancreatic injury caused by massage has not yet been reported in the literature.CASE SUMMARY A 57-year-old woman was referred to our hospital for acute abdominal pain and transient syncope.On examination,she had low hemoglobin concentration and a high white blood cell count and neutrophil percentage.Plain computed tomography of the abdomen revealed a substantial hemorrhage in the abdominal cavity.A large amount of exudate in the pancreatic area was considered a hematoma.Preoperative diagnosis was difficult.Her hemoglobin and blood pressure did not rise even after blood.We suspected progressive bleeding in the abdominal cavity and urgently performed exploratory laparotomy.During the operation,the pancreas was confirmed to be ruptured;hence,spleen-preserving pancreatic body and tail resection were performed.A pancreatic fistula was found on the 15th d after the operation,and the patient was discharged with a drainage tube on the 24th d after active treatment.Subsequently,it was discovered that the patient had undergone a vigorous abdominal massage the day before the abdominal pain began.To our knowledge,this is the first report of isolated pancreatic injury and massive abdominal hemorrhage caused by abdominal massage.CONCLUSION Our findings indicate that any action that increases intra-abdominal pressure may cause internal organ damage.We also review similar cases reported in the literature.展开更多
目的研究乌司他丁对腹部创伤患者围术期肠粘膜屏障功能的影响。方法60例行急诊剖腹探查的腹部创伤患者随机分为两组:乌司他丁组(U组),切皮前用乌司他丁20万U溶于100m l 0.9%生理盐水中静脉注射,每24h 1次,连续3 d;对照组(C组)则以等量...目的研究乌司他丁对腹部创伤患者围术期肠粘膜屏障功能的影响。方法60例行急诊剖腹探查的腹部创伤患者随机分为两组:乌司他丁组(U组),切皮前用乌司他丁20万U溶于100m l 0.9%生理盐水中静脉注射,每24h 1次,连续3 d;对照组(C组)则以等量生理盐水作为安慰对照。分别于手术后12、24、48、72h测定两组患者尿乳果糖与甘露醇的比值(L/M)、血浆二胺氧化酶(DAO)、内毒素(ET)、肿瘤坏死因子(TNF-α)及免疫球蛋白A(IgA)。结果两组患者术后L/M、DAO、ET、TNF-α进行性升高,IgA则逐步降低;与C组比较,U组患者L/M、DAO、ET、TNF-α值于术后24h、48h、72h明显降低(P<0.05),IgA明显升高(P<0.05)。结论围术期应用乌司他丁通过改善肠道粘膜通透性对腹部创伤患者肠粘膜屏障功能具有明显保护作用,对预防创伤引起的肠道细菌内毒素移位具有重要临床意义。展开更多
文摘BACKGROUND Most major abdominal vascular injuries are caused by penetrating injuries.A common iliac artery occlusion caused by blunt force trauma is rare,and very few cases have been reported.Because of this low incidence,atypical symptoms,and frequent association with other severe injuries,the proper diagnosis tends to be missed or delayed.The gold standard for diagnosis is angiography,and treatment remains a challenge.CASE SUMMARY We report here the unusual case of a common iliac artery occlusion caused by blunt abdominal compressive trauma,with transection of the small intestine.At presentation,the patient(a 56-year-old man)complained of pain and numbness in the left lower extremity and severe pain in the whole abdomen.Physical examination showed total abdominal tenderness with evidence of peritoneal irritation.The left lower limb was pulseless and cold.Abdominal computed tomography examination revealed digestive tract perforation,and abdominal computed tomography angiography showed left common iliac artery occlusion.The patient was treated successfully by anastomosis of the intestine,percutaneous transluminal angioplasty,and stenting.The patient was followed for more than 11 mo after the operation and showed a good recovery.CONCLUSION Patients with abdominal trauma should be suspected of having major vascular injury.Individualized treatment strategies are needed for this condition.
文摘The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thickening. At surgery, a double stenotic bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the two resected segments showed fibrotic and ischemic lesions within the mesentery. Ischemic intestinal stenosis from mesenteric injury should be considered in the differential diagnosis in patients suffering from intestinal occlusion with a history of blunt abdominal trauma.
文摘Objective: The aim of this study is to determine the causes, pattern, management, and outcome of jejunal-ileal rupture following blunt abdominal trauma at the teaching Hospital of Bouake. Methods: The study included 27 patients who underwent laparotomy for jejunoileal injuries from blunt abdominal trauma at the Teaching Hospital of Bouake over a period of 14 years from January 2007 to December 2020. A retrospective study was conducted and the patients were analyzed with respect to patient demographics data, cause, injury mechanisms, presentation, anatomical distribution, diagnostic methods, associated injuries, treatment and outcomes. Results: During the 14 year period from 2007 to 2020, 27 patients with blunt small bowel injuries were treated at our Teaching Hospital. That is 2.9% of all blunt abdominal trauma. Male to female ratio was 4.4:1 and the average age was 26.3 years (range: 15 and 50 years). The majority (66.7% 18 cases) were Victims of road traffic accident. Median delay between injury and arrival at hospital for these patients was 10.1 hours (range: 1 - 72 h). A single intestinal injury was present in 22 patients, while 5 patients suffered from 2 injuries. There were 32 perforations of the small intestine in 27 patients with two perforations being transection. All perforations were located on the antimesenteric border of the intestine. Out of the 32 jejuno-ileal ruptures 18 were located on the jejunum while 14 were located on the ileum. Associated intra-abdominal injuries were present in 6 patients and nineteen associated extra-abdominal injuries were present in 10 (70.4%) patients. A one-stage therapeutic strategy was performed in 20 cases (74.1%) and a two-stage strategy was performed in seven cases (25.9%). Intestinal continuity was restored 93.8 days later (range 60 and 140 days). The average length of hospital stay of the operated patients was 11.4 days. The operative morbidity was 25.9%. Conclusion: Jejuno-ileal ruptures are rare and characterized by a delay in management. An early diagnosis could improve the vital prognosis of the patients.
文摘BACKGROUND Regular abdominal massage can be used to treat digestive symptoms such as bloating and constipation and is reported to reduce abdominal discomfort,improve digestive function,and increase the quality of life,without serious adverse effects.Isolated pancreatic injury is rare,and most often occurs during severe trauma such as steering wheel impact injury.To our knowledge,pancreatic injury caused by massage has not yet been reported in the literature.CASE SUMMARY A 57-year-old woman was referred to our hospital for acute abdominal pain and transient syncope.On examination,she had low hemoglobin concentration and a high white blood cell count and neutrophil percentage.Plain computed tomography of the abdomen revealed a substantial hemorrhage in the abdominal cavity.A large amount of exudate in the pancreatic area was considered a hematoma.Preoperative diagnosis was difficult.Her hemoglobin and blood pressure did not rise even after blood.We suspected progressive bleeding in the abdominal cavity and urgently performed exploratory laparotomy.During the operation,the pancreas was confirmed to be ruptured;hence,spleen-preserving pancreatic body and tail resection were performed.A pancreatic fistula was found on the 15th d after the operation,and the patient was discharged with a drainage tube on the 24th d after active treatment.Subsequently,it was discovered that the patient had undergone a vigorous abdominal massage the day before the abdominal pain began.To our knowledge,this is the first report of isolated pancreatic injury and massive abdominal hemorrhage caused by abdominal massage.CONCLUSION Our findings indicate that any action that increases intra-abdominal pressure may cause internal organ damage.We also review similar cases reported in the literature.
文摘目的研究乌司他丁对腹部创伤患者围术期肠粘膜屏障功能的影响。方法60例行急诊剖腹探查的腹部创伤患者随机分为两组:乌司他丁组(U组),切皮前用乌司他丁20万U溶于100m l 0.9%生理盐水中静脉注射,每24h 1次,连续3 d;对照组(C组)则以等量生理盐水作为安慰对照。分别于手术后12、24、48、72h测定两组患者尿乳果糖与甘露醇的比值(L/M)、血浆二胺氧化酶(DAO)、内毒素(ET)、肿瘤坏死因子(TNF-α)及免疫球蛋白A(IgA)。结果两组患者术后L/M、DAO、ET、TNF-α进行性升高,IgA则逐步降低;与C组比较,U组患者L/M、DAO、ET、TNF-α值于术后24h、48h、72h明显降低(P<0.05),IgA明显升高(P<0.05)。结论围术期应用乌司他丁通过改善肠道粘膜通透性对腹部创伤患者肠粘膜屏障功能具有明显保护作用,对预防创伤引起的肠道细菌内毒素移位具有重要临床意义。
