The American surgeon
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The American surgeon · Jun 1993
The role of sigmoidoscopy in the management of gunshot wounds to the buttocks.
The charts of all patients (n = 70) admitted over 26 months after sustaining a gunshot wound to the buttocks were reviewed to assess the role of physical examination, routine radiologic studies, and sigmoidoscopy in the evaluation of these patients. There were 68 men and 2 women. Sixteen patients underwent sigmoidoscopy, which demonstrated a rectal injury in 7. ⋯ All patients with gross blood on rectal examination (n = 5) and blood at the urethral meatus (n = 2) had visceral injuries. One patient underwent celiotomy for an injury at 15 cm that was noted on sigmoidoscopy performed because the bullet trajectory was in proximity to the rectum. Sigmoidoscopy can be performed selectively in patients sustaining a gunshot wound to the buttocks when the proximity of the wound to the rectum is in doubt.
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The American surgeon · Jun 1993
The utility of color flow Doppler examination in penetrating extremity arterial trauma.
Recent reports from our institution have demonstrated the safety of nonoperative management of minimal arterial injuries. The purpose of this pilot study was to evaluate whether color flow Doppler (CFD) examination could detect minimal arterial injuries caused by penetrating extremity trauma. Twelve patients with minimal arterial injuries identified by arteriography were treated nonoperatively. ⋯ These findings suggest the possibility that color Doppler sonography may be able to sequentially monitor these lesions to determine if they resolve or progress. If progression is documented they may require surgical correction. Further prospective studies must be performed to assess whether color flow Doppler examination can supplant arteriography in patients at low or intermediate risk for arterial injury following penetrating arterial trauma.
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Forty-eight cases of penetrating cardiac trauma seen at the Medical University of South Carolina between 1979 and the present were reviewed retrospectively. Age, race, sex, Champion trauma score, cardiac chamber injured, associated injuries, weapon, circumstances, and means of transport were recorded and analyzed to define predictors of mortality. Overall mortality was 56 per cent. ⋯ Sex, race, the chamber injured, weapon, circumstances, and mode of transport were not significantly different between survivors and nonsurvivors. Survival did not change significantly during the study period. Mortality compares favorably with that of other series.
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Spinal cord trauma frequently results from high energy vehicular accidents which produce multisystem trauma. Because of the priorities of resuscitation, other injuries may escape early diagnosis. This study was undertaken to examine the extent and implications of "missed injuries" associated with spinal trauma. ⋯ Missed spinal injuries included: fractures of C5-6 (2), C4 (1), T7 (1), and L1 presenting as a progressive deficit (1). Nonspinal injuries were: pneumothorax (3), hemopneumothorax (1), paralyzed hemidiaphragm (1), and renal contusion (1). Prolonged hospital stay and/or the need for additional surgery were the most common sequelae of delayed diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Jun 1993
Exposure of buttock burn wounds to stool in scald-abused infants and children: stool-staining of eschar and burn wound sepsis.
Between July 1, 1987 and June 30, 1990, 30 consecutive deliberately scalded children with buttock involvement were prospectively studied. Mean age was 22.5 months. Mean burn size was 18.1 per cent TBSA (total body surface area). ⋯ Four (13.3%) patients with a mean burn size of 32.3 per cent TBSA, diarrhea, and burns involving the buttock, perineum, and external genitalia died of burn wound sepsis, three of whom had deep stool staining of their burn wound and Gram-positive bacteremia. Buttock burn wounds should be examined carefully and frequently for the presence of deep stool staining, an ominous predictor of burn wound sepsis and death. Such wounds, if present, should be emergently excised.