Introduction Intussusception in pediatric cases are predominantly idiopathic, while intussusception in adult cases are predominantly associated with a lesion. The differential diagnosis for the lesion includes Meckel's diverticulum, lipoma, adenoma, and metastatic disease. Presentation of case We report a case of intussusception in which the lead point was the site of a jejunorrhaphy for a jejunal perforation secondary to blunt abdominal trauma. The intussusception presented as a postoperative bowel obstruction requiring a re-laparotomy and a segmental bowel resection. The postoperative course after the re-laparotomy was unremarkable. Discussion Postoperative intussusception with a bowel anastomosis acting as the lead point is a rare but described complication of anastomotic procedures. Our report is the first in the trauma literature to describe an intussusception led by a jejunorrhaphy rather than a circumferential suture or stapled anastomosis. While rare, this complication is a critical constituent in the differential diagnosis of bowel obstruction after laparotomy for trauma. Currently, no standardized technique or prophylactic maneuver exists to prevent intussusception after an intestinal repair.
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Introduction Approximately 300 000 hip fractures occur annually in the USA in patients >65 years old. Early intervention is key in reducing morbidity and mortality. Our institution implemented a collaborative hip fracture protocol, streamlining existing processes to reduce time to OR (TTO) and hospital length of stay (LOS). Our aim was to determine if this protocol improved these outcomes. Study Design We conducted a retrospective cohort study using our level-1 trauma center’s trauma registry, comparing outcomes for patients >60 years old with isolated hip fractures pre-and post-hip protocol implementation in May 2018. Our primary outcomes were TTO and in-hospital mortality. Secondary outcomes included LOS and postoperative complications. Univariate analysis was done using chi-square and T-test. Results We identified 176 patients with isolated hip fractures: 69 post- and 107 pre-protocol. Comparing post- to pre-protocol, TTO decreased by 18hrs (39 vs 57h; P = .013) and patients had fewer postoperative complications (9 vs 23%; P = .016) despite post-protocol patients being more likely to have diabetes (42 vs 27%, P < .05), elevated BMI (22 vs 25; P < .001), and to be current smokers (9 vs 2%; P < .05). LOS and in-hospital mortality also decreased (11 vs 20d; P = .312, 4.3 vs 7.5%; P = .402). Post-protocol patients were more likely to go to the OR within 24hrs of presentation (39 vs 16%; P < .001) and to go straight from ED to OR (32 vs 4%; P < .001). Conclusion TTO, LOS, and postoperative complications for isolated hip fracture patients were lower post-protocol. Though not all statistically significant, this trend indicates that the protocol was helpful in improving hip fracture outcomes but may require further improvement and institution-wide education.
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