Helvetica chirurgica acta
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Helvetica chirurgica acta · Jun 1993
Case Reports[Hemorrhage from pseudocysts caused by pseudoaneurysms in chronic pancreatitis. Diagnosis and management].
Bleeding pseudocysts respectively pseudoaneurysms represents a seldom complication of chronic pancreatitis in owing to erosion of pancreatic or peripancreatic arteries. The potential rupture into neighbouring organs or in the peritoneal cavity is accompanied with paramount life-threatening risks. During the last years we observed 3 patients with acute intestinal bleeding caused by pseudocysts converted to pseudoaneurysms. ⋯ With management of these patients with hemorrhagic complications of pancreatic pseudocysts we acquired the following findings: 1. Patients with known chronic pancreatitis and abdominal tumor, especially when accompanied by epigastric pain and anemia, are highly suspicious for pancreatic pseudoaneurysms. 2. The color-doppler ultrasound is the best diagnostic tool, since this investigation can establish the pseudoaneurysm and identify the source.
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Helvetica chirurgica acta · Jun 1993
[The significance of computerized tomography for conservative treatment of liver trauma].
Increasing experience with early radiological evaluation by ultrasound (US) and computed tomography (CT) of patients with abdominal trauma is leading to more frequent use of conservative treatment in patients with severe liver injuries. In a retrospective study with predominant use of peritoneal lavage only 3 out of 100 patients with liver injuries were treated non-surgically. In a consecutive prospectively evaluated series of 75 patients with early use of US and CT, 30 patients in stable circulatory conditions were treated non-surgically. ⋯ Although a precise anatomical classification of the liver injury degree seems difficult, the predictive value of computed tomography for non-surgical treatment was good. Use of iv-contrast is mandatory. We conclude that in experienced hands computed tomography allows precise evaluation of liver injuries for adequate treatment, provided careful follow-up (intensive care unit, CT, angiography) ensues to avoid complications.
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Helvetica chirurgica acta · Jun 1993
[Combined fractures of the femoral neck with femoral shaft fractures].
Ipsilateral fractures of the femoral neck and shaft presents diagnostic difficulties and complex choices as to treatment. The surgeon is often faced with a multiply-injured patient with an obvious fracture of the femoral shaft. The accompanying femoral neck fracture can be overlooked (20-50%). ⋯ ISS < 25: Interlocking nailing for the shaft fracture and supplementary screws for the neck fracture, 2. ISS > 25: Plating for the shaft fracture and screwing for the neck fracture. The aseptic necrosis of the femoral head is not frequent.
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Helvetica chirurgica acta · Jun 1993
[Lesions of the small intestine and colon in blunt injuries of the abdomen].
Between 1976 and 1991, we observed lesions of the small bowel or colon in 39 patients having sustained blunt abdominal trauma. 70% of the patients presented with concomitant injuries. Except for 3 cases, all the patients presented with abdominal pain on admission. All the patients were operated on. ⋯ Due to the lack of specific laboratory or X-ray test, we suggest a high index of suspicion for bowel lesions in blunt abdominal trauma, especially in unconscious patients. Close observation is mandatory. Indication for laparotomy must not be delayed if any doubt exists regarding the integrity of hollow viscus.