Very early initiation of chemical venous thromboembolism prophylaxis after blunt solid organ injury is safeBackground: The optimal timing of initiating low-molecular weight heparin (LMWH) in patients who have undergone nonoperative management (NOM) of blunt solid organ injuries (SOIs) remains controversial. We describe the safety of early initiation of chemical venous thromboembolism (VTE) prophylaxis among patients undergoing NOM of blunt SOIs. Methods:We retrospectively studied severely injured adults who sustained blunt SOI without significant intracranial hemorrhage and underwent an initial NOM at a Can adian lead trauma hospital between 2010 and 2014. Safety was assessed based on failure of NOM, defined as the need for operative intervention, in patients who received early (< 48 h) or late LMWH (≥ 48 h, or early discharge [< 72 h] without LMWH). Results:We included 162 patients in our analysis. Most were men (69%), and the aver age age was 42 ± 18 years. The median injury severity score was 17, and splenic injuries were most common (97 [60%], median grade 2), followed by liver (57 [35%], median grade 2) and kidney injuries (31 [19%], median grade 1). Combined injuries were present in 14% of patients. A total of 78 (48%) patients received early LMWH, while 84 (52%) received late LMWH. The groups differed only in percent of highgrade splenic injury (14% v. 32%). Overall 2% of patients failed NOM, none after receiving LMWH. Semielective angiography was performed in 23 (14%) patients. The overall rate of con firmed VTE on imaging was 1.9%. Conclusion:Early initiation of medical thromboembolic prophylaxis appears safe in select patients with isolated SOI following blunt trauma. A prospective multicentre study is warranted. Contexte :Le moment optimal pour commencer le traitement à l'héparine de bas poids moléculaire (HBPM) chez les patients ayant subi un traumatisme fermé à un organe plein (TFOP) avec prise en charge non chirurgicale (PCNC) demeure un sujet controversé. Nous décrivons l'innocuité d'une initiation hâtive de la chimioprophy laxie de la thromboembolie veineuse (TEV) chez les patients dont le TFOP est pris en charge de façon non chirurgicale.Méthodes : Nous avons étudié rétrospectivement les cas d'adultes gravement blessés ayant subi un TFOP sans hémorragie intracrânienne importante pris en charge de façon non chirurgicale dans un hôpital canadien de premier plan spécialisé en trauma tologie entre 2010 et 2014. L'innocuité a été évaluée en fonction du taux d'échec de la PCNC, défini comme la nécessité de recourir à une intervention chirurgicale, chez des patients qui ont reçu de l'HBPM plus tôt (< 48 h) ou plus tard (≥ 48 h, ou qui ont reçu un congé précoce [< 72 h]).
We present the case of a 26 year old male who was found to have a mass in the tail of the pancreas on an ultrasound scan. The lesion was suspicious for a non-functioning pancreatic neuroendocrine tumour (PNET) and so he underwent distal pancreatectomy. Pathology revealed this to be an intrapancreatic accessory spleen (IPAS). This is a rare entity, and the literature on this subject is reviewed. A lesion in the pancreas that enhances in a manner similar to the spleen, whether the contrast is used in the setting of a Contrast Enhanced Ultrasound, a contrast enhanced CT scan, or a gadolinium enhanced MRI scan, is suggestive of IPAS. Nonetheless, the majority of these rare lesions are likely to be surgically excised rather than observed due to the similar appearance to PNET.
Introduction and importance Gallbladder contusion after blunt abdominal trauma is a rare event that presents with diagnostic challenges. There is no clear evidence supporting conservative or surgical management of gallbladder contusion injuries, especially when they present in isolation. Here, we report the first case of an isolated gallbladder contusion injury after blunt abdominal trauma resulting in hemorrhagic cholecystitis that was successfully managed non-operatively. Case presentation A 22-year-old male patient presented with a 3-day history of severe right upper quadrant pain, leukocytosis, and elevated bilirubin after suffering blunt abdominal trauma from being kicked in the abdomen during a soccer game. The patient was evaluated using computed tomography (CT), ultrasound (US), and magnetic resonance cholangiopancreatography (MRCP). His imaging findings were consistent with cholecystitis without cholelithiasis. His bloodwork and imaging were initially concerning for choledocholithiasis, but were later determined to be blood products within the common bile duct (CBD). Through conservative management, which included antibiotics, bed rest, and bowel rest, he had complete resolution of symptoms and normalization of bloodwork after four days of admission and remained symptom free at 1-year. Clinical discussion This case serves to highlight isolated gallbladder contusion as a potential outcome of blunt abdominal trauma. We re-affirm the diagnostic inconsistencies between CT and US in the work-up of cholecystitis and other biliary pathology. Furthermore, we describe the role of non-operative management in the treatment of traumatic cholecystitis, in the absence of gallstones. Conclusion Gallbladder contusion and hemorrhagic cholecystitis after blunt abdominal trauma can be managed with non-operative interventions.
Background: Self-inflicted trauma (SIT) is a public health issue ranking 4th as leading cause of death and disability in young adults. Methods: Retrospective descriptive analysis of patients admitted to a level 1 trauma centre with self-inflicted injuries, 2008-2013. Results: Over a 5-year period, 268 patients with SIT presented to our hospital, 177 (66%) male, average age 39.4 years (SD 16). The most common mechanism of injury was stabbing, (47%), followed by jumping (26.86%). Jumpers had higher ISS (22 v. 9). Seasonal variation showed summer with highest incidence (34%), winter having the lowest (17%). Patients from rural areas accounted for 28%, these were younger (30 v. 42 years, p = 0.002), had lower ISS (9 v. 14, p = 0.007), presented with more firearm injuries (18.6% vs. 2.3%). Overall, 63 (23%) patients had pre-existing psychiatric disease; these patients had longer LOS (20 v. 7 days, p = 0.002), and had jumping from height as predominant mechanism (p = 0.01). Mortality was 13.8%. Patients that died were older (42 v. 30 years, p = 0.002), had higher ISS (14 v. 9, p = 0.007), longer LOS (13.5 v. 6 days, p = 0.004), with fall being the predominant mechanism associated with mortality (p < 0.0001). Conclusion:Our study defines and characterizes the population at risk for SIT in an attempt to implement appropriate prevention strategies and improve the existing post-injury care pathway.Abdominal compartment syndrome in the child. Gilgamesh Eamer,* Ioana Bratu.
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