Surgery today
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A case of transient portal venous gas in the liver following blunt abdominal trauma is described. Computed tomography (CT) demonstrated hepatic portal venous gas 4 h after the injury. An exploratory laparotomy revealed segmental necrosis of the small intestine with a rupture of the bladder. ⋯ A bacteriological examination demonstrated anaerobic bacteria from the bowel mucosa, which was most likely to produce portal venous gas. Although the present case was associated with bowel necrosis, a review of literature demonstrated that portal venous gas does not necessarily indicate bowel necrosis in trauma patients. There is another possibility that the portal venous gas was caused by a sudden increase in the intra-abdominal pressure with concomitant mucosal disruption, which thus forced intraluminal gas into the portal circulation in the blunt trauma patients.
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Over the past 20 years, it has gradually become apparent that the results of prolonged and extensive surgical procedures performed on critically injured patients are often poor, even in experienced hands. The triad of hypothermia, coagulopathy, and metabolic acidosis effectively marks the limit of the patient's ability to cope with the physiological consequences of injury, and crossing this limit will frustrate even the most technically successful repair. These observations have led to the development of a new surgical strategy that sacrifices the completeness of immediate repair in order to adequately address the combined physiological impact of trauma and surgery. ⋯ The second phase consists of secondary resuscitation in the intensive care unit, characterized by maximization of hemodynamics, correction of coagulopathy, rewarming, and complete ventilatory support. During the third phase, the intra-abdominal packing is removed and definitive repair of abdominal injuries is performed. The "damage control" concept has been shown to increase overall survival and is likely to modify the management of the critically injured patient.
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A primary abdominal aortic dissection is exceedingly rare, especially in the absence of blunt abdominal trauma. We herein report a case of aortic dissection with aneurysmal dilatation (dissecting aneurysm) of the infrarenal abdominal aorta in a 61-year-old female patient, and discuss the diagnostic and therapeutic management of this rare disorder.
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We herein describe the case of a 48-year-old man who presented to our hospital with abdominal distension and pain. Preoperative studies including abdominal ultrasonography and computed tomography failed to determine the cause of the pain. ⋯ Histologically, the tumor was diagnosed as a cystic lymphangioma. Although mesenteric lymphangiomas are rare, especially in adults, they should be considered as a possible cause of acute abdomen.
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Case Reports
Spontaneous liver hematoma and a hepatic rupture in HELLP syndrome: report of two cases.
Subcapsular liver hematomas and ruptures are unusual fatal complications of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (HS). We present two cases of a spontaneous rupture of subcapsular liver hematoma occurring in HS and review the literature on this subjects. One case demonstrated a secondary rupture of a subcapsulary liver hematoma due to HS in one patient and HS associated with preeclampsia in another. ⋯ A high index of suspicion and immediate recognition are keys to proper diagnosis and management of affected patients. The multidisciplinary approach to the management of these patients led to a remarkable decrease in the mortality rates. Less aggressive treatment is preferable to aggressive intervention such as a hepatic resection in such patients with coagulopathy.