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Jenny M Vidal et al RESUMENAntecedentes: La incidencia de trauma abdominal penetrante (TAP) ha aumentado en las últimas décadas como consecuencia de la violencia; convirtiéndose en un principal motivo de consulta en urgencias; su evaluación y manejo son desafiantes y evolutivos. Objetivo ratificar la seguridad del manejo no operatorio (MNO) de TAP y describir los resultados clínicos y las características de los pacientes con trauma abdominal penetrante a quienes se les ofreció MNO en un hospital nivel I. Diseño del estudio:Entre febrero y mayo 2016 se realizó un estudio cohorte prospectiva, incluye todos los pacientes con TAP ingresados a un hospital público nivel I. Se estableció protocolo MNO en pacientes hemodinámicamente estables, consistió en monitoreo hemodinámico y examen físico cada 4horas, tomografía según caso; estudio aprobado por comité ética institucional. Análisis estadístico: test chi-cuadrado o Wilcoxon según variable, significancia 0.05.Resultados: Se registró 46 pacientes, 91.30% (n = 42) hombres, mediana edad 25.6 ± 8.6años; 50% proyectil arma fuego (PAF) y 50% arma corto-punzante (ACP); laparotomía exploratoria 52.2% (n = 24), laparotomía innecesaria 2.2% (n = 1). El 47.82% (n = 22) MNO; de éstos, 77.27% (n = 17) por ACP y 22.72% (n = 5) por PAF. Mediana de TAS 90 (90-91), FC 83 (73-88), FR 19 (18-20); lugar lesión: toracoabdominal 50% (n = 11), 36.36% (n = 8) abdomen anterior, 13.64% (n = 3) abdomen posterior y flancos; 22.72% (n = 5) requirieron tomografía abdominal; 50% (n = 11) presentaron lesiones acompañantes; mediana estancia hospitalaria 2días (2-3); mortalidad y complicaciones a 1mes post-trauma 0% (n = 0). Conclusiones:El MNO del TAP es seguro respetando un protocolo estricto de selección y seguimiento; pacientes con TAP y sin compromiso hemodinámico fueron sometidos exitosamente a MNO y sin ninguna complicación a 30 días, independientemente de la región abdominal lesionada; la TAC contrastada abdominal no debe ser rutinaria. El hecho de evitar una cirugía innecesaria disminuye la morbi-mortalidad, costos hospitalarios; siempre y cuando sea hospital nivel I y cuente con cirujano de trauma y quirófano disponible.Palabras Claves: Cirugía innecesaria, Hemodinámicamente estables, Laparotomía exploratoria, Manejo no operatorio, Trauma penetrante de abdomen. ABSTRACTBackground: The incidence of penetrating abdominal trauma (PAT) has increased in recent decades as a consequence of the violence, becoming a main reason for consultations in emergency services. Its evaluation and management are defiant and evolve over time. The objective is to ratify the safety of the nonoperative management (NOM) of PAT, describe the clinical results and characteristics of patients with PAT who were offered NOM in a first-level hospital. Study design:This is a prospective cohort study conducted during February and May 2016. It includes all patients with PAT admitted to first-level public hospital. A NOM protocol was established in hemodynamically stable patients; hemodynamic monitoring and physical examin...
Thirty pneumoperitoneograms were performed postmortem and 5 were performed for diagnosis: the technique itself, the radiological anatomy of the umbilical region, and the usefulness of the procedure in diagnosis are discussed. Pneumoperitoneum may be indicated in the investigation of a bleeding Meckel's diverticulum, in the exclusion or confirmation of remnants of the omphalomesenteric duct, in chronically moist lesions of the umbilicus resistant to symptomatic treatment, in suspected cases of non-communicating urachal cysts which cannot be diagnosed by cystogram, and in the differential diagnosis of abdominal tumours related to the umbilical region.
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