Canadian journal of surgery. Journal canadien de chirurgie
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Abscess of the spleen is a rare entity. It may develop after generalized infection, hematologic disorders and trauma. The authors report the case of a 7-year-old boy who presented with a 2-month history of spiking fever, anorexia, fatigue and weight loss. ⋯ Although splenectomy has been advocated as the treatment of choice for splenic abscess, this patient was treated successfully with appropriate antibiotics and simple drainage, preserving the spleen. Cultures grew Staphylococcus aureus. Of all the diagnostic methods available, ultrasonography is the least invasive study that will make the diagnosis and is less expensive than some methods.
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Intestinal perforation after blunt abdominal trauma in children is rare and thus the diagnosis may be delayed. For this reason the authors reviewed their experience with 12 children to recommend a protocol for investigation that would reduce the delay in diagnosis. Of the 12 perforations, 2 were gastric, 2 duodenal, 7 jejunal and 1 colonic. ⋯ Serial films were valuable in aiding the diagnosis and are recommended, together with assessment of solid organ injury by radionuclide scanning. In this series peritoneal lavage was not used. No child died.
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Rupture of the trachea and major bronchi usually results from blunt trauma to the chest. To define the characteristics of the condition, the mechanism of injury, presentation and hospital course, the authors reviewed seven cases of tracheobronchial rupture after blunt trauma. Four were injured in a motor vehicle accident, two had a crush injury and one child had a fall from a playground swing. ⋯ Two patients died secondary to associated head injuries; one patient underwent repair of the bronchus intermedius and one patient had a lacerated membranous trachea. The possible mechanisms of injury are: rapid deceleration with forward swing of the trachea, widening of the transverse diameter of the chest, exerting traction on the carina, and a rapid rise of airway pressure on impact. Surgical intervention is recommended at an early stage to avoid loss of lung tissue.
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Immediate surgery is essential to resuscitate and save 5% to 10% of those suffering life-threatening trauma. Recently, emergency room surgery has been proposed as the procedure to follow in stabilizing such patients. Over a 3-year period, 41 moribund patients were treated by the trauma service at the Health Sciences Centre in Winnipeg. ⋯ Eighteen patients had a blood pressure of 70 mm Hg systolic or less and failed to respond to massive O positive blood transfusion; of these, 14 (77%) survived. The mix of mode of injury and injury severity scoring is important to compare results from within and between centres. The author's experience indicates that the use of a high-priority crash protocol for managing moribund patients with life-threatening traumatic injury in the main operating room provides a standard of care equal to or better than that reported for emergency room surgery.
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The long-term complications of diabetes mellitus occur despite insulin therapy. One of these complications is gangrene of an extremity which is a prime cause of morbidity and mortality in diabetic patients. ⋯ The author describes six diabetic patients with gangrene of an extremity treated at the Riverside Hospital in Ottawa to illustrate how this condition may be managed by revascularization with no amputation or with conservative amputation and debridement. Major amputation was avoided in all six patients.