[Characteristics of an abdominal injury combined with lesions of the locomotor apparatus in children].
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We report the case of a young girl with diffuse peritoneal carcinomatosis due to pseudopapillary and solid tumor of the pancreas. Fourteen months before the diagnosis and treatment of the tumor, an abdominal trauma occurred. Initial treatment was tumor and visible peritoneal carcinomatosis resection. Eight months later, relapse of peritoneal carcinomatosis occurred and the patient was reoperated. All macroscopic lesions were removed. Thirty-seven months after first laparotomy, the patient was well but abdominal ultrasound led to suspicion of hepatic metastasis. Among 17 published cases of metastatic pseudopapillary and solid tumor of the pancreas (including 6 cases with peritoneal carcinomatosis), trauma was described in 11 cases (including 3 cases with peritoneal carcinomatosis). Pseudopapillary and solid tumor of the pancreas may spread outside the pancreas, particularly in peritoneal cavity. Metastatic spread may be promoted by trauma, including tumor biopsies which should never be performed.
An experience with treatment of 138 patients with penetrating punctured-incised wounds of the abdominal cavity has shown advantages of laparoscopy in diagnostics of the character of injuries of internals. Laparoscopy used in cases with difficult diagnosis allowed to give up operative interventions in 53.8% of patients. High diagnostic value and relative safety of laparoscopy make it possible to widely use this method in wounds of the abdomen.
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CD8 knockout mice depleted of natural killer (NK) cells by treatment with anti-asialoGM1 (CD8KO/alphaAsGM1 mice) are resistant to injury caused by cecal ligation and puncture (CLP). However, CLP-induced injury is complex. Potential sources of injury include bacterial dissemination, cecal ischemia, and translocation of bacterial toxins. We treated wild-type and CD8KO/alphaAsGM1 mice with imipenem after CLP to decrease bacterial dissemination. Additional mice were subjected to cecal ligation without puncture of the cecal wall or cecal ligation and removal of cecal contents. Imipenem treatment decreased bacterial counts by at least two orders of magnitude. However, all wild-type mice, whether treated with saline or imipenem, died by 42 h after CLP and exhibited significant hypothermia, metabolic acidosis, and high plasma cytokine concentrations. Wild-type mice subjected to cecal ligation without puncture also died, despite very low bacterial counts in blood, but wild-type mice subjected to cecal ligation and washout of cecal contents survived. In CD8KO/alphaAsGM1 mice subjected to CLP, imipenem treatment increased survival from 50% to 100%. After cecal ligation without puncture, long-term survival was 80-90% in CD8KO/alphaAsGM1 mice. Hypothermia, metabolic acidosis, and cytokine production were attenuated in CD8KO/alphaAsGM1 mice compared with wild-type controls. These results indicate that bacterial dissemination is not a major source of injury in wild-type mice after CLP, but the presence of gut flora in the cecal lumen is required for induction of systemic inflammation after cecal injury. CD8KO/alphaAsGM1 mice are resistant to the systemic manifestations of cecal injury.
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Acute post-traumatic pancreatitis in unusual, accounting for no more than 1% of all cases of acute pancreatitis. The authors describe a case of acute pancreatitis in a patient who had a closed abdominal trauma during a football match. The recommended procedures for ensuring early diagnoses are described. Prognosis and management is dependent upon pathology and extension of lesions. Hemorrhagic and necrotic pancreatitis carries a poor prognosis, especially when diagnosis is delayed.
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Importance of laparoscopy (LS) in diagnosis of intraabdominal catastrophe in patients with combined trauma (CT) is determined. Based on analysis of treatment results in 1,118 patients with CT it was revealed that real LS requirement does not exceed 10%, and it may influence negatively trauma outcome. Low diagnostic value of this method was revealed: sensitivity 98.4%, specificity 51%, accuracy 69.2%. It is concluded that LS is not a method of choice in diagnosis of intraabdominal injuries in patients with CT.
During the years of 1969 to 1982, 361 patients with blunt abdominal trauma were treated at the General Surgical Hospital of the University of Giessen. 46 out of these patients (12,7%) had also a fracture of the pelvis. The mortality was high with 43,5% (20 patients), however, all these patients had multiple injuries. In most cases hemorrhagic complications were responsible for death. Peritoneal lavage is an important diagnostic measure. In case of injuries to inner organs, generally several organs are concerned. Therapeutic methods should be time-sparing because of the great risks involved in these injuries. Retroperitoneal hemorrhages allow only seldom a vessel reconstruction. Angiographic localization with subsequent vessel embolization should be tried.