Biomedical subjects
Publications and source records attributed to H Aguilera.
We report a 26 years old male that suffered a motorcycle accident resulting in a traumatic aortic rupture and splenic laceration. He was subjected to a surgical repair of the aortic lesion under complete heparinization. The splenic rupture was non operatively managed successfully.
We report a 23 years old male admitted to the hospital after a fall from a great altitude with severe trauma. During the second week of hospitalization he presented a severe nosebleed that did not respond to conventional tamponade. A selective angiography was performed and the branches of the internal maxillary artery were embolized in two occasions, stopping the bleeding. The patient was discharged from the hospital after 71 days of hospitalization.
BACKGROUND: There is a tendency towards conservative behaviours in the treatment of blunt abdominal trauma. AIM: To perform a retrospective analysis of the results of conservative management of liver and spleen trauma. PATIENTS AND METHODS: Clinical charts of 21 patients with traumatic lesions of liver or spleen that were not operated, seen between 1991 and 1996, were reviewed. Severity of trauma was assessed according to the Abbreviated injury scale of 1985 and CAT scan lesions were scored according to scale proposed by the American Association of Trauma Surgery. RESULTS: Mean age of patients was 33.4 years old and 17 were male. Twelve patients had liver trauma, that had a mean severity index of 20.1. According to abdominal CAT scan, two patients had grade II lesions, 8 had grade III lesions and 2 had grade IV lesions. Two patients required transfusions and all had a successful recovery. Nine patients had spleen trauma, with a severity score of 24.4. Three patients required transfusions and one was subjected to a splenectomy. Mean hospital stay was 17.8 days for patients with liver trauma and 16 days for patients with spleen trauma. CONCLUSIONS: Non operative management of liver and spleen trauma is feasible and safe in a selected group of patients, independent of the degree of injury and hemoperitoneum.
We report a 33 year old male admitted after a traffic accident with a painful abdomen and an open ankle fracture. An abdominal CAT scan showed a splenic laceration and free ascites. A conservative treatment was decided considering that the patient was hemodynamically stabilized. Seven days later, the patient appeared hypotense and with severe pain and was operated. During surgical intervention, a massive hemoperitoneum due to splenic bleeding from the spleen was found and a splenectomy was performed. Postoperative outcome was uneventful. The therapeutic approach to splenic traumatism ranges from splenectomy to medical treatment. The report case is an example of a complication of this later approach.
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We report a retrospective analysis of 45 patients (41 male) aged between 14 and 57 years, with a blunt liver trauma seen between 1984 and 1993. Sixty two percent had complex liver lesions and 73% extraabdominal injuries. Peritoneal lavage and abdominal ultrasound appeared as useful diagnosis tools. Five patients were not operated and had a satisfactory evolution. Among operated patients, liver lesions were corrected with simple measures in 60%, hepatotomy in 7.5% and resection in 17.5%. As additional measures, tamponade was used in 4, resuscitation thoracotomy in 4, porto caval shunt in 2 and Marimoto balloon in 1. Eighteen percent of patients died and 32% had postoperative complications.
We report three male patients in whom the diagnosis of diaphragmatic rupture was raised. Conventional X ray examination showed an unilateal bulging of the diaphragmatic dome in two and the association of basal atelectasis in the third. Magnetic resonance imaging confirmed the diagnosis of diaphragmatic rupture in all. The diaphragmatic rupture was repaired surgically in two patients and the other was managed medically.
Two patients with traumatic pancreatic pseudocyst are presented. One patient was treated with percutaneous drainage and the other was operated on to perform a cystoenterostomy. Both patients recovered successfully. Diagnosis and treatment of this condition is discussed.