Chirurgia Bucharest
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Chirurgia Bucharest · Jan 2008
Case Reports[Postoperative early enteral nutrition in a patient with polytrauma and late duodenal perforation].
We present the case of a 51 years old multiple injured female patient who was transferred from another hospital. She suffered a car accident and at admission, the diagnosis was anterior flail chest with fractured sternum, blunt abdominal trauma with IIIrd grade kidney laceration, multiple extremities fractures, ISS = 50. We performed emergency nephrectomy, surgical fixation of the flail chest and bilateral pleurostomy. ⋯ The particularities of this case are the complexity of the traumatic lesions: anterior costal flail chest, left kidney rupture, late duodenal perforation, multiple extremities fractures (APACHE II score = 34). The treatment involved internal pneumatic stabilization and surgical fixation of the flail chest, duodenal suture with pyloric exclusion and fine needle catheter jejunostomy, left nephrectomy. We consider that the use of EEN was of real help in this case and we recommend it in all polytraumatised patients and in all the cases where it can be used.
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Chirurgia Bucharest · Jan 2008
Case Reports[Non-surgical management of patients with blunt abdominal injury: the role of angiography].
We evaluated the efficacy of nonsurgical management of patients with blunt hepatic or renal injury using detailed angiographic examinations and transcatheter arterial embolization. ⋯ Our success rate for nonsurgical management of patients with blunt injury to solid abdominal organs should more extensive evaluation and use of angiography for solid abdominal organs injury and the subsequent management of solid abdominal organs injury without surgery.
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The case of a patient, victim of a car accident, with rupture of the left adrenal gland associated with splenic rupture and liver laceration is reported. Injury of the adrenal glands is most frequently caused by blunt abdominal trauma and is usually associated with injuries of other abdominal organs. Careful exploration of the upper retroperitoneal space where adrenals are located is considered necessary during laparotomy for severe blunt abdominal trauma. If adrenal lesion has been overlooked continuous hemorrhage may occur, which could be lethal if not promptly treated.