Small bowel perforation is common following blunt abdominal trauma. Intra-abdominal injury with isolated small bowel perforation however, is a rare entity and diagnosis can be ambiguous. Nonisolated small bowel perforation, which carries a higher mortality rate, will be identified early during the assessment of the patient following a blunt abdominal trauma. A case of an isolated small bowel perforation following a road traffic accident is reported. A motorcycle rider, while trying to avoid a car, lost control and skidded into a drain. Upon arrival to the Emergency Department, he was complaining of upper abdominal pain evident by abrasion and bruising of his bilateral hypochondriacs. FAST scan showed free fluid at Morrison’s pouch and a formal abdominal ultrasound confirmed minimal free fluid at Morrison’s pouch. A plain CT abdomen was done and did not show any evidence of solid organ injury but demonstrated pneumoperitoneum. In view of the persistent abdominal tenderness, open fracture of left femur, radius and ulna, and radiological findings, a laparotomy was performed which revealed an isolated 1x1cm small bowel perforation, 60cm from DJ junction with localized faecal contamination. Small bowel repair was done and patient recovered well afterward. Although challenging, due to its detrimental infectious potential, early recognition of small bowel injury is crucial. Isolated small bowel perforation, rarely without associated intra-abdominal injury, requires more investigations, delaying diagnosis to treatment period. CT abdomen has proven to be both specific and sensitive in diagnosing small bowel injuries. Even when physical examination and radiological examinations are minimal, a suspicion of small bowel perforation should be considered as delay in diagnosis eventually increases morbidity and mortality.
Introduction: Infected pseudoaneurysms among intravenous drug abusers are a serious clinical condition that carries significant morbidity and mortality. The management of such cases has been controversial on deciding the need of revascularisation following simple ligation and local debridement. In this audit, we present the results of simple ligation and local debridement of our patients with infected pseudoaneurysm. Materials and methods: We conducted a retrospective review from 2013 to 2018 on 15 of our patients who are intravenous drug abusers that underwent simple ligation and local debridement for an infected pseudoaneurysm. Results: All 15 patients underwent simple ligation and local debridement. They were all male patients, and majority of the patients were between group ages of 30-40 years old at 66.7%. The oldest patient was 63 years old. All the patients self-injected the affected site for a minimum duration of 36 months. 73% of the patients had femoral pseudoaneurysm, making it the most common affected site in our audit. The remaining patients had axillary and radial pseudoaneurysm and none of our patients had brachial pseudoaneurysms. Majority of our patients were underlying Hepatitis C at 46.7%, 2 of our patients were HIV positive and only one had Hepatitis B. The remaining 5 patients’ statuses were unknown. In accessing the complications, two patients had re-bleeding after the procedure and were eventually discharged well and were uneventful. One patient required amputation as he developed a gangrenous limb within the same admission after ligation and excision of the infected pseudoaneurysm. There were two deaths due to sepsis with multiorgan failure. 10 patients were discharged well without any complications after surgery. Conclusion: Infected pseudoaneurysms can be safely managed with simple ligation and local debridement without revascularisation as they pose acceptable complication rates.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.