Injury of the extra-hepatic biliary tract is infrequent, occurring in approximately 3.5% of all patients with blunt and penetrating abdominal trauma. The incidence of this injury caused by blunt abdominal trauma is rare. PURPOSE--Retrospective analysis of 5069 patients with abdominal trauma treated at the Department of Surgery University of São Paulo School of Medicine over a six-year period from 1986 through 1991. METHODS--Forty five patients with gallbladder and extra-hepatic ducts injury were identified (0.89%) and divided in two groups according to the nature of trauma: 12 caused by non-penetrating injuries and 33 to penetrating injuries. Records, including operative and pathology reports, were reviewed to study the site of injury, associated intra-abdominal injuries, incidence, trauma scores, treatment, morbidity, mortality rates and correlated with the nature of the trauma. RESULTS--Overall mortality was 24.4%. The incidence was greater in patients sustaining penetrating abdominal trauma (p < 0.05). Forty of the 45 patients (88.9%) had liver lacerations, the most commonly seen injuries. The patients with blunt abdominal trauma had significant different trauma scores (p < 0.05) than those with penetrating trauma, indicating greater severity in this group of patients. CONCLUSION--There is a relation between severity of trauma and incidence of extra-hepatic biliary tract injury. However, in the penetrating trauma, the incidence of trauma is correlated with the direction of the wound and there is no relation with the severity of trauma. The greater mortality seen in the patients sustaining non-penetrating injury (p < 0.05) supports this observation.

Adolescent↗

PubMedDate not supplied

[Grynfelt's hernia. A case report and review of the literature].

Lumbar hernias are rare lesions. They involve the extrusion of visceral contents through a defect in the posterolateral abdominal wall. Only 250 a 300 cases had been reported in the literature. They occur most often in the superior lumbar triangle (Grynfelt's hernia). All lumbar hernias must be treated with surgery and the preferable surgical approach is done retroperitoneally. Primary repair, autologous tissue or prosthetic material may be used to obliterate the defect. The authors report a case of Grynfelt's hernia in which polypropylene mesch was placed pre-peritonially.

Female↗

PubMedDate not supplied

[Traumatic injuries of the pancreas: report of 65 cases].

With the aim of aiding the accurate diagnosis and treatment of patients with pancreatic injuries, we reviewed the medical records of sixty-five patients, treated for traumatic pancreatic lesions at the Department of Surgery of the University of São Paulo in the 5-year period from 1989 through 1993. Records, including operative and pathology reports, were reviewed and the location of the pancreatic injury, associated intra-abdominal injuries, type of injury, trauma scores, treatment, complications and mortality rates recorded. There were 58 male and seven female patients with a mean age of 28.3 years (range, 2-77 years). Of the 65 pancreatic injuries, 45 (69.2%) were caused by penetrating wounds and twenty by blunt trauma. The most frequent site of lesion was the head of the pancreas (38.5%). Associated injuries were found in all but five of the patients. In the 65 patients, 170 intra-abdominal injuries were found (2.6 per patient). Twenty-eight of the 65 patients (43.1%) had liver lacerations. Lacerations of major abdominal vessels (27 patients), gastric lacerations (25 patients) and colorectal lacerations (17 patients) were the next most frequent injuries. Fifteen out of twenty patients died within two days after the accident from severe concomitant injuries. Simple drainage was performed in 33 patients, distal pancreatectomy in 17 and duodenopancreatectomy in six patients. Pancreas-related complications occurred in 20 (30.7%) out of 57 patients who survived the initial operation. We concluded that the type of repair employed in our series was related to the class of injury and clinical conditions (based on trauma scores). Therefore, whenever possible, conservative management (no pancreatic resection) was employed in patients that sustained class I and II injuries and pancreatic resection in class III and IV injuries.

Abdominal Injuries↗

PubMedDate not supplied

[Mesenteric cyst].

Mesenteric cysts are rare abdominal tumors. Their incidence varies in different papers from one in 27,000 to one in 250,000 hospital admissions. Five patients with mesenteric cysts were treated at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between November 1982 and October 1992. The most common location was in the small bowel (60%). All of them were treated by surgery. One case was found incidentally. Treatment of choice is enucleation. It was realized in two cases (40%). The others had segmental bowel resection.

Abdominal Pain↗

PubMedDate not supplied

[Multicentric myxoid, metachronous and synchronous and multifocal liposarcoma: report of a case].

A case of a male patient, 66 years old, who exhibited in a period of six years many multicentric and multifocal synchronic and metachronic myxoid liposarcomas is reported. The authors made a revision of cytogenetics and DNA alterations recently identified in this type of tumor. The chromosomic alterations are represented by the translocation t(12;16) (q13;p11) and trisomy of the chromosome 8. The genic analysis revealed the presence of altered restriction fragments due to highly specific and reproducible methylation differences. In conclusion the authors suggest that the presence of the multiple tumors of this type in the same patient could be due to a common etiologic factor, not yet known, as being the initiator of this systemic illness of the fat tissue.

Abdominal Neoplasms↗

PubMedDate not supplied

[A fatal case of lower gastrointestinal hemorrhage: report of case and review of the literature].

Gastrointestinal hemorrhage continues to be a major medical problem. Even with improvements in both diagnostic and therapeutic, a significant number of patients still require surgical intervention for control of hemorrhage. When the source of persistent lower gastrointestinal hemorrhage is unknown, subtotal colectomy is a conceptually rational management choice. The authors present a case of massive lower gastrointestinal hemorrhage with unusual fatal outcome. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.

Angiography↗

PubMedDate not supplied

[Gallbladder injury in abdominal trauma: analysis of 32 cases].

Gallbladder lesion is infrequent, occurring in approximately 0.5 to 8.5% of all patients with blunt and penetrating abdominal trauma. The incidence of gallbladder injury in such cases is low. This study reviewed 32 patients with gallbladder injury due to abdominal trauma over a 6-year period to determine the complications, associated injuries, and mortality rate.

Abdominal Injuries↗

PubMedDate not supplied

[Risk factors in emergency surgery relaparotomy].

Reintervention in abdominal surgery involves the difficulty of precise indication and the limitations of surgical technics during the operation. It may bring to evidence professional errors. It presents a very high morbimortality index. In order to establish risk factors and death rate, we comparatively analysed the initial diagnoses, the number, the cause and the time of relaparotomy, the existence of associated diseases, the age and the illness severity, using APACHE-II after the first surgical intervention. During a two years period starting 1990 we retrospectively analysed charts of 40 patients submitted to relaparotomy in the Emergency Service of Hospital das Clínicas of Medicine University of São Paulo.

Abdomen, Acute↗

PubMedDate not supplied

Bilateral diaphragmatic injury diagnosed by laparoscopy.

Rupture of the diaphragm from blunt trauma is uncommon, but greatly improved prehospital care and transportation of victims has increased the frequency at which patients who sustain this injury arrive at the emergency room alive. We report a case of bilateral diaphragmatic rupture from blunt abdominal trauma in a 33-year old man. Diagnosis was established by laparoscopy after suggestive chest X-rays, liver scintigraphy, CT scan and magnetic resonance imaging. The methods used to diagnose this condition are analyzed.

Accidents, Traffic↗

PubMedDate not supplied

[Postsplenectomy gastric fistula: report of a case].

Gastric perforation following splenectomy is a rare complication occurring in less than 1% of patients and it is mainly associated with iatrogenic injury to the greater curvature of the stomach. The authors report a case of gastric fistula in a patient who underwent splenectomy for blunt abdominal trauma and discuss the main etiopathogenic and diagnostic aspects.

Abdominal Injuries↗

PubMedDate not supplied

[Conservative treatment of severe liver trauma: report of a case and review of therapeutic methods].

The emergency surgical treatment of severe hepatic traumas still carries a high mortality risk. We report a case of severe blunt trauma to the liver managed without surgery under CT guidance. This attitude requires haemodynamic stability of the patient, close monitoring in a surgical intensive care unit and repeated CT scans. Laparoscopy was used to the management of hemoperitoneum due to rupture of hematoma and diagnosis and treatment of bile leakage. Conservative treatment is a reasonable option in selected hemodynamically stable patient with severe hepatic trauma.

Adult↗