PurposeThe epidemiology of pediatric trauma is different in different parts of the world. Some researchers suggest falls as the most common mechanism, whereas others report road traffic accidents (RTAs) as the most common cause. The aim of this study is to find out the leading cause of pediatric admissions in Trauma Surgery in New Delhi, India.MethodsInpatient data from January 2012 to September 2014 was searched retrospectively in Jai Prakash Narayan Apex Trauma Centre Trauma Registry. All patients aged 18 years or less on index presentation admitted to surgical ward/ICU or later taken transfer by the Department of Trauma Surgery were included. Data were retrieved in predesigned proformas. Information thus compiled was coded in unique alphanumeric codes for each variable and subjected to statistical analysis using SPSS version 21.ResultsWe had 300 patients over a 33 month period. Among them, 236 (78.6%) were males and 64 (21.3%) females. Overall the predominant cause was RTAs in 132 (43%) patients. On subgroup analysis of up to 12 years age group (n = 147), the most common cause was found to be RTAs again. However, falls showed an incremental upward trend (36.05% in up to 12 age group versus 27% overall), catching up with RTAs (44.89%). Pediatric Trauma Score (PTS) ranged from 0 to 12 with a mean of 8.12 ± 2.022. 223 (74.33%) patients experienced trauma limited to one anatomic region only, whereas 77 (25.66%) patients suffered polytrauma. 288 patients were discharged to home care. Overall, 12 patients expired in the cohort. Median hospital stay was 6 days (range 1–182).ConclusionPediatric trauma is becoming a cause of increasing concern, especially in the developing countries. The leading cause of admissions in Trauma Surgery is RTAs (43%) as compared to falls from height (27%); however, falls from height are showing an increasing trend as we move to younger age groups. Enhancing road safety alone may not be a lasting solution for prevention of pediatric trauma and local injury patterns must be taken into account when formulating policies to address this unique challenge.

Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially life-threatening hemorrhage but also need profound surgical expertise in management. Development of collateral circulation in neck is well known; however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of penetrating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient presented with no neurological or motor deficits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.

The Wound Care Surveillance Program has been a very effective strategy for the prevention and management of pressure ulcers. Stage two ulcers were the most common in our setup. Braden scoring, traditionally used to screen these ulcers, can be used as a predictive and prognostic tool to predict healing of pressure ulcers. Poor healing is expected in higher staged ulcers and patients with spinal injury and major solid organ injury and those who need a tracheostomy. Home-based care is not up to mark in our society and accounts for most of the cases in the follow-up.

Blunt traumatic injuries to the superior gluteal artery are rare in clinic. A majority of injuries present as aneurysms following penetrating trauma, fracture pelvis or posterior dislocation of the hip joint. We reported a rare case of superior gluteal artery pseudoaneurysm following blunt trauma presenting as large expanding right gluteal hematoma without any bony injury. The gluteal hematoma was suspected clinically, confirmed by ultrasound and the arterial injury was diagnosed by CT angiography that revealed a large right gluteal hematoma with a focal contrast leakage forming a pseudoaneurysm within the hematoma. Pseudoaneurysm arose from the superior gluteal branch of right internal iliac artery, which was successfully angioembolized. The patient was discharged on day 4 of hospitalization with resolving gluteal hematoma. This report highlighted the importance of considering an arterial injury following blunt trauma to the buttocks with subsequent painful swelling. Acknowledgment of this rare injury pattern was necessary to facilitate rapid diagnosis and appropriate treatment.

Aneurysm of gastroduodenal artery (GDA) is rare. Most reported cases are due to pancreatitis and atherosclerosis; however, those following pancreatic trauma have not been reported. We encountered GDA aneurysm in a patient of blunt abdominal trauma, who had pancreatic contusion and retroduodenal air on contrast enhanced computed tomography of abdomen. Emergency laparotomy for suspected duodenal injury revealed duodenal wall and pancreatic head contusion, mild hemoperitoneum and no evidence of duodenal perforation. In the postoperative period, the patient developed upper gastrointestinal hemorrhage on day 5. Repeat imaging revealed GDA aneurysm, which was managed successfully by angioembolization. This case highlights, one, delayed presentation of GDA aneurysm after blunt pancreatic trauma and two, its successful management using endovascular technique.

Cases after laparoscopic cholecystectomy were collected from Darbhanga Medical College and Hospital. A series of 200 cholecystectomized cases operated over a period of 5 years have studied. Follow-up of cases were made by personal interview and examination either at the hospitals or the residence, information collected from the relatives and by correspondence. Patient details, symptoms, clinical findings, investigations, and laboratory reports were noted. Hemogram, total counts, serum biliribin, and alkaline phosphatase were noted. Gastric analysis, upper gastrointestinal endoscopy (UGIE), ultrasound findings, intraoperative, and

Perigraft seroma presenting as discharging sinus and spontaneous exteriorization of vascular graft are rare complication of vascular injury repair with polytetrafluoroethylene (PTFE) grafts. We hereby report a case of young boy who presented with discharging sinuses and vascular graft coming out from one of the sinuses following vascular repair of femoral artery with PTFE graft after a follow-up of six months but the limb was salvaged. On evaluation PTFE graft was found to be thrombosed and collaterals were formed for distal perfusion. Because of persistent discharging sinuses, PTFE graft was removed and femoral artery was ligated proximal and distal to the graft. This case highlights an unusual complication of PTFE grafts that is commonly used in vascular surgery and also highlights the fact that these graft buy time for gradual collaterals formation for distal perfusion and hence when thrombosed and complicated can be safely removed.

Sleeve gastrectomy is one of the most commonly performed procedure for treatment of morbid obesity. The surgery evolved from two step procedure of biliopancreatic bypass/duodenal switch. The procedure is safe and associated with symptoms of gastroesophageal reflux, food intolerance and vomiting. These symptoms are attributed to the improper sleeve position and deformity, due to the loss of natural attachments of the stomach. We here by present a case with morbid obesity in which we did sleeve gastrectomy with sleeve fixation. Post operatively patient had benefit from complications which are previously attributed due to sleeve rotation .Our patient was 51 year old male with the history of morbid obesity since 10 years with the BMI of 44.20 . Patient has the history of Smoking, hypertension, Obstructive sleep apnea, Diabetes Mellitus with renal failure. After preoperative workup and anaesthetic check up patient was taken up for surgery and sleeve gastrectomy procedure with sleeve fixation was done. Gastrograffin study done on post op day 1 was normal and Patient was started orally liquids on day 1 and discharged on day 2. On follow up patient was doing fine, lost 36 kg weight in 8 months. There was no problem of gastroesophageal reflux, heart burn, food intolerance and vomiting. Aim -To devise the gastric sleeve fixation for the laparoscopic sleeve gastrectomy. Technique -The gastric tube is fixed along the new greater curvature with the gastrocolic omentum using the PDS 3-0 in continuous fashion. The interrupted suture is used to fix at the lower part of the tube with the transverse mesocolon near the lower edge of pancreas. Conclusion -the gastric fixation stratergy is safe and easy. It can reduce the problems arising from the improper gastric tube position, reducing the incidence of food intolerance and gastroesophageal disease.