RESUMO
Pancreatic trauma is a rare but potentially lethal entity which requires a high level of clinical suspicion. Early diagnosis and assessment of the integrity of the pancreatic duct are essential since ductal injury is a crucial predictor of morbimortality. Overall mortality is 19%, which can rise to 30% in cases of ductal injury. The diagnostic and therapeutic approach is multidisciplinary and guided by a surgeon, imaging specialist and ICU physician. Laboratory analysis shows that pancreatic enzymes are frequently elevated, which is a low specificity finding. In hemodynamically stable patients, the posttraumatic condition of the pancreas is firstly evaluated by the multidetector computed tomography. Moreover, in case of suspicion of ductal injury, more sensitive studies such as Endoscopic Retrograde Cholangiopancreatography or cholangioresonance are needed. This narrative review aims to analyze the etiopathogenesis and pathophysiology of pancreatic trauma and discuss its diagnosis and treatment. Also, the most clinically relevant complications will be summarized.
Assuntos
Traumatismos Abdominais , Pancreatopatias , Humanos , Pâncreas/diagnóstico por imagem , Pâncreas/lesões , Pâncreas/patologia , Colangiopancreatografia Retrógrada Endoscópica , Ductos Pancreáticos/lesões , Pancreatopatias/complicações , Traumatismos Abdominais/complicações , Traumatismos Abdominais/patologia , Traumatismos Abdominais/cirurgiaRESUMO
OBJECTIVE: to evaluate the epidemiological profile of deaths due to abdominal trauma at the Forensic Medicine Institute of Belo Horizonte, MG - Brazil. METHODS: we conducted a retrospective study of the reports of deaths due to abdominal trauma autopsied from 2006 to 2011. RESULTS: we analyzed 1.888 necropsy reports related to abdominal trauma. Penetrating trauma was more common than blunt one and gunshot wounds were more prevalent than stab wounds. Most of the individuals were male, brown-skinned, single and occupationally active. The median age was 34 years. The abdominal organs most injured in the penetrating trauma were the liver and the intestines, and in blunt trauma, the liver and the spleen. Homicide was the most prevalent circumstance of death, followed by traffic accidents, and almost half of the cases were referred to the Forensic Medicine Institute by a health unit. The blood alcohol test was positive in a third of the necropsies where it was performed. Cocaine and marijuana were the most commonly found substances in toxicology studies. CONCLUSION: in this sample. there was a predominance of penetrating abdominal trauma in young, brown and single men, the liver being the most injured organ.
Assuntos
Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/patologia , Adulto , Autopsia , Causas de Morte , Feminino , Medicina Legal , Humanos , Masculino , Estudos RetrospectivosRESUMO
ABSTRACT Objective: to evaluate the epidemiological profile of deaths due to abdominal trauma at the Forensic Medicine Institute of Belo Horizonte, MG - Brazil. Methods: we conducted a retrospective study of the reports of deaths due to abdominal trauma autopsied from 2006 to 2011. Results: we analyzed 1.888 necropsy reports related to abdominal trauma. Penetrating trauma was more common than blunt one and gunshot wounds were more prevalent than stab wounds. Most of the individuals were male, brown-skinned, single and occupationally active. The median age was 34 years. The abdominal organs most injured in the penetrating trauma were the liver and the intestines, and in blunt trauma, the liver and the spleen. Homicide was the most prevalent circumstance of death, followed by traffic accidents, and almost half of the cases were referred to the Forensic Medicine Institute by a health unit. The blood alcohol test was positive in a third of the necropsies where it was performed. Cocaine and marijuana were the most commonly found substances in toxicology studies. Conclusion: in this sample. there was a predominance of penetrating abdominal trauma in young, brown and single men, the liver being the most injured organ.
RESUMO Objetivo: avaliar o perfil epidemiológico dos óbitos por trauma abdominal no Instituto Médico Legal de Belo Horizonte. Métodos: estudo retrospectivo dos laudos de óbitos relacionados a trauma abdominal necropsiados no período de 2006 a 2011. Resultados: foram analisados 1888 laudos necroscópicos de trauma abdominal. O trauma penetrante foi mais comum que o contuso, e o decorrente de projéteis de arma de fogo mais prevalente que o relacionado a armas brancas. A maioria dos indivíduos era do sexo masculino, morena, solteira e ativa do ponto de vista ocupacional. A média etária foi de 34 anos. O homicídio foi a circunstância do óbito mais prevalente, seguido dos acidentes de trânsito, e quase a metade dos casos foi recebida no Instituto Médico Legal proveniente de uma unidade saúde. Os órgãos abdominais mais lesados no trauma penetrante foram o fígado e os intestinos, e no trauma contuso foram o fígado e o baço. A pesquisa de alcoolemia foi positiva em um terço das necropsias onde foi realizada. Cocaína e maconha foram as substâncias mais encontradas nos exames toxicológicos. Conclusão: nesta amostra houve predominância do trauma abdominal penetrante, em homens jovens, morenos e solteiros, sendo o fígado o órgão mais lesado.
Assuntos
Humanos , Masculino , Feminino , Adulto , Traumatismos Abdominais/mortalidade , Autopsia , Estudos Retrospectivos , Causas de Morte , Medicina Legal , Traumatismos Abdominais/patologiaRESUMO
Describir la utilidad y demostrar la seguridad del Robot Da Vinci®, en la cirugía general abdominal. Estudio realizado en el Hospital de Clínicas Caracas, Caracas-Venezuela. Estudio descriptivo, retrospectivo realizado entre junio 2006 y julio 2010, en pacientes que ameritaron cirugía abdominal y que fueron operados con el robot Da Vinci® (Intuitive Surgical, Sunnyvale, CA). Se incluyeron 61 pacientes, predominando el género femenino (82%), en edades comprendidas entre 21-80 años, que acudieron a la consulta y/o emergencia y que, accedieron a realizarse el abordaje laparoscópico asistido por el robot Da Vinci®. Entre las patologías mayormente operadas se encuentran: litiasis vesicular o colecistitis aguda y la hernia hiatal con reflujo gastroesofágico. Tuvimos 8% de complicaciones (entre mayores y menores). La cirugía abdominal laparoscópica asistida por robot, recupera la visión y la habilidad perdida con la cirugía laparoscópica convencional. En nuestra serie observamos no sólo los beneficios que el robot le brinda al cirujano, sino los que esta técnica le ofrece al paciente. La cirugía robótica ha probado ser de gran utilidad y segura.
To demostrate the safety and describe the benefits in abdominal general surgery. Study performed at the Hospital de Clínicas Caracas, Caracas-Venezuela. Retrospective study performed between 2006-2010 in patients who underwent abdominal surgery with the Da Vinci® robot (Intuitive Surgical, Sunnyvale, CA). Sixty one patients were included, 82% females, between 21-80 years. Elective and/or emergency abdominal surgery was performed after they agree to have the laparoscopic approach assited by the Da Vinci® robot. Gastroesophageal reflux disease with or withouth hiatal hernia, cholecistectomy were the frecuent pathologies. Minor and/or major complications where 8%. Laparoscopic approach with the Da Vinci® System, regains the tridimentional visión and the intuitive hand movements lost with the conventional laparoscopic approach. In our series robotic surgery is safe and brings benefits to the surgeon and the patients.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Análise Custo-Benefício/métodos , Laparoscopia/métodos , Robótica/métodos , Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/patologia , Acalasia Esofágica/complicações , Diverticulite/complicaçõesRESUMO
Demostrar el beneficio del inicio enteral posterior a anastomosis gastrointestinales, comparado con el manejo tradicional. Estudio realizado en el Hospital General del Sur Dr. Pedro Iturbe, Maracaibo. Se realizó un estudio prospectivo, descriptivo y transversal, basado en el análisis de los pacientes sometidos a anastomosis gastrointestinales durante el período comprendido entre septiembre 2008 y marzo 2009, con diagnóstico de trauma abdominal penetrante, neoplasias, restitución del tránsito intestinal y obstrucción intestinal. Se evaluaron las variables edad, sexo antecedentes, diagnóstico de ingreso, tipo de intervención quirúrgica, anastomosis realizada, tiempo de estancia hospitalaria, aparición de íleo postoperatorio, tolerancia a la dieta (náuseas y/o vómitos), dehiscencia de anastomosis, complicaciones infecciosas y mortalidad. Se evaluó un total de 51 pacientes; 27 casos y 24 controles, edad promedio de 42,7±21 años y 33,3±10,5 años respectivamente. La mayoría presentó antecedentes de importancia: quirúrgicos 29,4% respiratorios 13,7%, cardiovasculares 9,8%. El diagnóstico de ingreso más frecuente fue herida por arma de fuego en 41,2% pacientes, herida por arma de blanca, restitución de transito neoplasias 15,7% cada uno. Complicaciones postoperatorias 16,7% de los controles presentó íleo postoperatorio mientras ninguno de los casos presentó esta complicación. Sólo 7,4% de los casos presentó dehiscencia total o parcial de la anastomosis realizada, comparado con 16,7% de dehiscencias en el grupo control. Complicaciones infecciosas abscesos intraabdominales en los casos 3,7%, en contraste con los controles 50%, infecciones de herida 25% casos, mientras el segundo 18,5%, entre otras. El tiempo de estancia hospitalaria fue de 4,7±1,8 días (3-10) para el grupo de los casos, en oposición a 10,2±6,3 días (5-24) en el grupo control. No hubo muertes en los pacientes estudiados. El inicio de dieta enteral precoz, es beneficioso para todo paciente...
To demostrate the benefit of early enteral feeding in patients with gastrointestinal anastomosis, comparing with traditional management. Study done in Hospital General de Sur Dr. Pedro Iturbe, Maracaibo. This is a prospective, descriptive and transversal in patients submitted to gastrointestinal anastomosis in the period between September 2008 and March 2009 with diagnosis of penetrating abdominal trauma, cancer, restoration of intestinal continuity and intestinal obstruction. There were evaluated age, gender, initial diagnosis, surgical procedure, hospital stay, postoperative ileus, complications and mortality. There were evaluated 51 patients, 27 cases and 24 control. Mean age 42,7±21 years and 33,3±10,5, years respectively. Diagnosis were gunshort wounds 41,2%, stab wounds, restoration of intestinal continuity and cancer 15,7% each. In control group there was a 16,7% of postoperative ileus and none in case group. There was a 7,4% of anastomotic leak-age in case group vs 16,7% in control group. Intraabdominal abscess was 3,7% in case group vs 50% in control group. Hospital stay 4,7±1,8 days in case group and 10,2±6,3 days in control group. No mortality in this study. Early enteral feeding has benefit in all patients submitted to gastrointestinal anastomosis, reduces complications, hospital stay and mortality. The gastrointestinal phisiology is not altered and improves cicatrization.
Assuntos
Humanos , Masculino , Adulto , Feminino , Anastomose Cirúrgica/métodos , Ferimentos por Arma de Fogo/etiologia , Nutrição Enteral/métodos , Trato Gastrointestinal/lesões , Obstrução Intestinal/etiologia , Traumatismos Abdominais/patologiaRESUMO
Evaluar la posibilidad de empiema en el trauma tóraco-abdominal con lesión de viscera hueca y diafragma. Estudio retrospectivo, descriptivo y transversal, realizado en un período comprendido entre los años 2002 y 2008. De un total de 304 pacientes ingresados con el diagnóstico de trauma tóraco-abdominal, se estudiaron 40 historias clínicas de aquellos que presentaron lesión de diafragma, en las cuales se evaluó el tratamiento efectivo a la lesión toracica y su seguimiento. Hubo 39 pacientes del sexo masculino (97,5 por ciento) y 1 femenino (2,5 por ciento), con edades comprendidas entre 13 y 60 años (promedio 27,9 años). El mecanismo de lesión más frecuente fue las heridas por arma de fuego con 33 casos (82,5 por ciento); arma blanca con 6 (15 por ciento) y trauma cerrado con 1 caso (2,5 por ciento). En todos los pacientes se dejo un drenaje torácico a través de una toracotomía mínima. En 3 de ellos (7,5 por ciento) se realizó la exploración del tórax a través de una toracotomía. Se reportaron 3 casos de empiema, todos en el grupo de toracotomía mínima como manejo de la lesión torácica. Lesiones de viscera hueca, inestabilidad hemodinámica y un ATI > 30 fueron los factores de riesgo más frecuentes asociados a la formación del empiema. En un trauma tóraco-abdominal con lesión de diafragma y viscera hueca, la contaminación del tórax es posible, por lo que sólo un drenaje torácico podría ser insuficiente para una adecuada limpieza de la cavidad pleural.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Empiema Pleural/patologia , Ferimentos por Arma de Fogo/patologia , Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/patologia , Traumatismos Torácicos/etiologia , Diafragma/lesões , Trato Gastrointestinal/lesões , Vísceras/lesõesRESUMO
El tumor desmoide es una neoplasia rara de tejidos blandos que se desarrolla a partir de músculo, tejido conectivo, fascia y aponeurois. Se presenta esporádicamente y más frecuentemente en mujeres. El caso que se presenta concierne a paciente femenina de 27 años que fue sometida a escisión radical de una gran masa que infiltraba músculo recto abdominal, diagnosticada como tumor desmoide. Aunque tiene características benignas, es de naturaleza infiltrativa y se comporta como una masa localmente agresiva, la cual puede invadir estructuras adyacentes haciendo que la resección quirúrgica sea difícil. El único tratamiento viable es la cirugía amplia dejando bordes sanos, esto causa gran defecto de pared y por tanto serios problemas en la reconstrucción. Además, la tasa de recurrencias locales varía y depende de la edad del paciente, localización y los márgenes de resección.
Desmoid tumor is quite rare soft tissues neoplasm that develops from muscle connective tissue, fasciae and aponeuroses. This neoplasm occurs in sporadic and more frequent in women than men. The presented case report refers to young female (27 years old), who underwent the radical excision of a large desmoid tumour infiltrating the right rectus muscle of the abdomen. Although desmoid is classified pathologically as a benign tumour, its infiltrative nature leads to a locally aggressive mass, which can invade surrounding structures and organs making surgical resection difficult. The only radical treatment for her was the surgical resection carried out far from the tumour borders into the healthy tissues. This resection causes wide muscle-fascial defects determining serious reconstructive problems. Futhermore, overall local recurrence rates vary and depend on patients age, tumour location and margins at resection.
Assuntos
Humanos , Adulto , Feminino , Células do Tecido Conjuntivo/patologia , Fibromatose Agressiva/cirurgia , Fibromatose Agressiva/patologia , Neoplasias de Tecidos Moles/patologia , Oncologia , Traumatismos Abdominais/patologiaRESUMO
Hepatic trauma occurs in approximately 5% of all admissions in emergency rooms. The anatomic location and the size of the liver make the organ even more susceptible to trauma and frequently in penetrating injuries. The American Association for the Surgery of Trauma established a detailed classification system that provides for uniform comparisons of hepatic injury. Diagnosis of hepatic injury can be sometimes easy; however the use diagnostic modalities as diagnostic peritoneal lavage, ultrasound and computed tomography allow faster and more accurate diagnosis. Nonoperative management of the hemodynamically stable patient with blunt injury has become the standard of care in most trauma centers. Few penetrating abdominal lesions allow conservative management; exceptions can be some penetrating wounds to right upper abdominal quadrant. Operative treatment of minor liver injuries requires no fixation or can only be managed with eletrocautery or little sutures. Major liver injuries continue, despite technical advances, a challenge to surgeons. Many procedures can be done as direct repair, debridement associated to resections, or even in more severe lesions, packing. This constitutes a damage control which can allow time to recovery of patient and decreasing mortality shortly after trauma.
Assuntos
Fígado/lesões , Ferimentos não Penetrantes/patologia , Ferimentos Penetrantes/patologia , Traumatismos Abdominais/patologia , Traumatismos Abdominais/terapia , Humanos , Escala de Gravidade do Ferimento , Fígado/patologia , Ferimentos não Penetrantes/classificação , Ferimentos não Penetrantes/terapia , Ferimentos Penetrantes/classificação , Ferimentos Penetrantes/terapiaRESUMO
Conservative management of solid abdominal organ injuries has been increasing and challenging trauma surgeons. This case report describes a successful non-operative management of a grade V renal lesion associated to a grade III hepatic lesion. Such lesions have not been described in conjunction in the revised literature.