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Retroperitoneal trauma

Manori Gamage, Sadeepa Weerasinghe, Mohamed Nasoor, A M P W Karunarathne, Sashi Praba Abeyrathne
Acquired hemophilia A (AHA) is a rare bleeding disorder due to acquired antibodies against coagulation factor VIII (FVIII). It is rare in children less than 16 years old, and the incidence is 0.45/million/year. An otherwise healthy, 12-year-old boy was admitted to the ward with a history of swelling of the right and left forearms, for 1 day duration. He did not have any history of trauma or bleeding disorder. He had prolonged APPTT level with very high antibody titer against factor VIII. His gene expression for factor VIII was found to be normal...
2018: Case Reports in Hematology
Kyoung Hoon Lim, Jinyoung Park
RATIONALE: Blunt injury of major visceral arteries such as celiac artery (CA) and superior mesenteric artery (SMA) are very rare but fatal, therefore, these injuries are challenging to trauma surgeons. The patient with occlusion of CA or SMA is theoretically viable by visceral collateral circulation. However, there are very rare cases in clinics. To date, there have been few reports of both CA and SMA occlusions after blunt trauma. Herein we describe our successful conservative treatment of patients with both CA and SMA occlusions...
November 2018: Medicine (Baltimore)
Nada Faris Alhassan, Saad Mohammed Alsaawy, Ibrahim Tawfiq Albabtain
INTRODUCTION: Injury to the superior mesenteric vein (SMV) is considerably rare amongst abdominal visceral vascular injuries. Multiple factors play a role in identifying such injuries, leading to the high morbidity and mortality associated. CASE PRESENTATION: We report a twenty-six-year-old male sustaining a SMV injury following a self-inflected gun shot. Initial assessment of the patient reveals hemodynamic instability and intraabdominal hemorrhage. Surgically approaching the patient was performed in two stages...
2018: International Journal of Surgery Case Reports
Petros Ioannou, George Alexakis
Retroperitoneal bleeding is a rare and difficult to diagnose condition, defined as bleeding in the retroperitoneal space without associated trauma or iatrogenic manipulation. It has been associated with hematologic diseases and malignancies and is more common in patients receiving systemic anticoagulation. A 50-year-old man on aspirin presented with abdominal pain. Physical examination revealed abdominal tenderness and a palpable mass at the left abdominal area. An abdominal CT revealed a spontaneous retroperitoneal hematoma due to bleeding of an intraparenchymal branch of the left renal artery...
2018: Case Reports in Emergency Medicine
Ye Rim Chang, Jeongseok Yun, Dong Hun Kim
The kidney is located and fixed with Gerota's fascia in the retroperitoneal space and is surrounded by a fat pad that acts as a shock absorber in the normal anatomy; however, the kidney becomes more vulnerable to external shock when it is located intraperitoneally. Bleeding from an injury may advance to hemoperitoneum and unstable hemodynamics may develop, requiring emergency surgery. Although various anatomical variations of the kidney have been reported, to our knowledge, an intraperitoneal kidney has never been reported previously except for one case in the world literature...
August 2018: Trauma Case Reports
Hiroaki Aida, Satoru Kagaya
Cardiac trauma is one of the most lethal injuries. We reported 7 patients with cardiac injuries who underwent surgical repair. They were 4 men and 3 women with a mean age of 64 years. The mechanisms of injuries were blunt trauma by traffic accident in 5 patients and penetrating trauma in 2 patients. The injured cardiac chambers were the right atrium in 2, the right ventricle in 2, the right ventricle and the ascending aorta in 1,the left atrium in 1 and the left ventricle in 1 patient. The wounds of all patients were repaired by direct suture closure...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Melissa Louise Acreman, Mahesh Sainani
A 34-year-old woman presented to hospital in shock 8 hours after a spontaneous home vaginal delivery. She is a known carrier of haemophilia A. Examination revealed a tender but firm, central and contracted uterus. There was a small second-degree perineal tear which was not actively bleeding and no other trauma or bleeding visualised in the vault or cervix. Bedside ultrasound showed a large 1 L blood clot anterior to the empty uterus. Exploratory laparotomy was performed which revealed a haematoma in the Retzius space with extension beneath the anterior serosa of the bladder, through the left broad ligament and into the retroperitoneal space...
August 29, 2018: BMJ Case Reports
Vicente Mosquera Rey, Carlota Fernández, Amer Zanabili, Jose A Del Castro, Mónica G Pandavenes, Manuel Alonso
BACKGROUND: Iliac vein injury associated with pelvic fracture due to blunt trauma is an uncommon and difficult diagnosis but a life-threatening condition which often requires an emergent management. Although open repair has been traditionally used as the treatment of choice in unstable patients, it is controversial, given the difficulty due to injured vessel exposure in patients with significant retroperitoneal hematoma as well as tamponade effect loss associated with laparotomy. We present a challenging case of iliac vein laceration successfully treated by placement of a self-expanding covered stent...
August 13, 2018: Annals of Vascular Surgery
Sarah Faloon, Hema Venkataraman, Kassiani Skordilis, Ewen A Griffiths, Neil Jl Gittoes, Zaki K Hassan-Smith, John Ayuk
A 26-year-old man presented following blunt abdominal trauma to a regional major trauma centre for emergency embolisation of a retroperitoneal bleed from a presumed renal laceration. Imaging had also revealed a large right suprarenal mass. Embolisation resulted in a hypertensive crisis raising the suspicion of a metabolically active adrenal tumour. The course was further complicated by the development of ischaemic bowel requiring emergency laparotomy. Intraoperatively he became haemodynamically unstable from an actively haemorrhaging lesion...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
Tetsuyuki Ueda, Masami Sotokawa, Akihiro Nakagaki, Kazuhiro Tani, Shingo Ohtaka, Akira Murata
We report a case of traumatic disruption of the aortic root with multisystem trauma. A 45-year-old male was suffered from multiple injuries including subarachnoid hemorrhage, lung contusion, retroperitoneal hematoma and femoral bone fracture caused by a traffic accident. He had a history of 3 cardiac surgeries including repair of atrioventricular septal defect and mitral valve replacement using a mechanical valve. Contrast-enhanced computed tomography (CT) revealed leakage of the contrast medium from the aortic root and a filling defect on the right coronary artery...
June 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Laurent Zieleskiewicz, Raphaelle Fresco, Gary Duclos, François Antonini, Calypso Mathieu, Sophie Medam, Coralie Vigne, Marion Poirier, Pierre-Hugues Roche, Pierre Bouzat, François Kerbaul, Ugo Scemama, Thierry Bège, Pascal Alexandre Thomas, Xavier Flecher, Emmanuelle Hammad, Marc Leone
BACKGROUND: Before total body computed tomography scan, an initial rapid imaging assessment should be conducted in the trauma bay. It generally includes a chest x-ray, pelvic x-ray, and an extended focused ultrasonography assessment for trauma. This initial imaging assessment has been poorly described since the increase in the use of ultrasound. Therefore, our study aimed to evaluate the diagnostic accuracy and therapeutic impact of this initial imaging work-up in severe trauma patients...
October 2018: Injury
Séverin Ramin, Margaux Hermida, Ingrid Millet, Thibault Murez, Valerie Monnin, Mazen Hamoui, Xavier Capdevila, Jonathan Charbit
BACKGROUND: The objective was to assess the predictive performance of different intravascular contrast extravasation (ICE) characteristics for need for pelvic transarterial embolization (TAE) to determine the risk factors of false positives. METHODS: A retrospective study was performed in our trauma center between 2010 and 2015. All severe trauma patients with pelvic fracture were included. Pelvic ICE characteristics on computed tomography (CT) scan were studied: arterial (aSICE), portal surface (pSICE), and extension (exSICE) anatomic relationships...
September 2018: Journal of Trauma and Acute Care Surgery
Jin Sang Kil, Mi Kyung Lee, Ki Seong Eom
Traumatic common carotid artery dissection (CCAD) is rare. To our knowledge, only 14 case reports have described traumatic CCAD previously. Here, we report a case of CCAD in a patient with severe trauma. A 50-year-old man was lying on the road after drinking alcohol when a car drove over him. Computed tomography (CT) revealed multiple rib fractures with hemopneumothorax, lung contusion, flail chest, large amount of hematoma with bladder rupture, and fractures on the C6 spinous process, sacral ala, iliac bone, and pubic ramus...
April 2018: Korean Journal of Neurotrauma
A Taylor, E Cooper, K Ham
Case summary: A 7-month-old intact male domestic shorthair cat was presented 4 h after being hit by a car. It had bilateral inguinal hernias and a mesenteric rent that were repaired surgically and a hematoma in the left retroperitoneal space. No other intra-abdominal abnormalities were identified on abdominal surgical exploration. Approximately 72 h after presentation, the cat started vomiting and developed severe abdominal discomfort. A sudden decrease in mentation and elevation of respiratory rate and effort ensued...
January 2018: JFMS Open Reports
Patrizio Petrone, Cristina Magadán Álvarez, D'Andrea Joseph, Lee Cartagena, Fahd Ali, Collin E M Brathwaite
Traumatic retroperitoneal injuries constitute a challenge for trauma surgeons. They usually occur in the context of a trauma patient with multiple associated injuries, in whom invasive procedures have an important role in the diagnosis of these injuries. The retroperitoneum is the anatomical region with the highest mortality rates, therefore early diagnosis and treatment of these lesions acquire special relevance. The aim of this study is to present current published scientific evidence regarding incidence, mechanism of injury, diagnostic methods and treatment through a review of the international literature from the last 70 years...
May 2018: Cirugía Española
Georgiana Samoila, Ian Michael Williams
INTRODUCTION: Historically, the open approach to the abdominal aorta has been transperitoneal (TP). In comparison, a retroperitoneal (RP) incision exposes the lateral wall of the suprarenal aorta for clamp application and midline structures such as the duodenum and pancreas are not encountered. Proximal clamp position for open repair of juxtarenal abdominal aortic aneurysm (JR-AAA) is suprarenal, supra-superior mesenteric, or supraceliac. While RP and TP approaches have previously been compared for physiological reasons, there are currently no randomized controlled trials comparing these methods from an anatomical perspective...
July 2018: Vascular and Endovascular Surgery
Hiroyuki Otsuka, Toshiki Sato, Keiji Sakurai, Hiromichi Aoki, Takeshi Yamagiwa, Shinichi Iizuka, Sadaki Inokuchi
Background: Recently, trauma management has been complicated owing to the introduction of damage-control strategies and interventional radiology. Here, we discuss important aspects regarding survival of patients with severe trauma. Case presentation: A 74-year-old Japanese woman experienced a traffic accident on a highway. On arrival, paramedics were unable to measure her blood pressure, and her condition deteriorated. The patient was immediately transferred to our hospital in a physician-staffed emergency helicopter, during which she was administered emergency blood transfusions...
October 2017: Trauma Case Reports
Hsiu-Wen Chang, Chia-Hao Kuei, Chin-Feng Tseng, Yi-Chou Hou, Ying-Lan Tseng
Urinoma, defined as the urine leakage beyond the urinary tract, is commonly induced by blunt trauma or urinary tract obstruction by stone, intra-abdominal malignancy, or retroperitoneal fibrosis. Spontaneous urinoma is rare and parenchymal pathologic change is rarely mentioned when urinoma is found. We present a case of a 28-year-old woman with bilateral flank pain induced by spontaneous urinoma. The lady received chronic analgesics because of migraine. After intravenous ketorolac injection, bilateral perirenal urinoma developed...
2018: Therapeutics and Clinical Risk Management
J H Wu, Y Yuan, L Q Jiang, Y Xia, Y Wang, S G Xu, P Y Zhou
Trauma with foreign objects retained within the human body has become a common surgical emergency condition. Traditional surgical methods often involve creating large incisions in soft tissue and may lead to additional complications during wound healing. We have developed a new method of removing foreign bodies from patients' abdomens by using laparoscopy with the help of a novel navigation system that provides accurate positioning. This approach is minimally invasive and simple. This is the first combination of both technologies in this field...
May 2018: Annals of the Royal College of Surgeons of England
Chuanli Zhou, Guoqing Zhang, Ripul R Panchal, Xianfeng Ren, Hongfei Xiang, Ma Xuexiao, Xiaoliang Chen, Gu Tongtong, Wang Hong, Alana D Dixson
BACKGROUND: Percutaneous endoscopic discectomy (PED) includes 2 main procedures: percutaneous endoscopic lumbar discectomy (PELD) and percutaneous endoscopic interlaminar discectomy (PEID), both of which are minimally invasive surgical procedures that effectively deal with lumbar degenerative disorders. Because of the challenging learning curve for the surgeon and the individual characteristics of each patient, preventing and avoiding complications is difficult. The most common complications, such as nucleus pulposus omission, nerve root injury, dural tear, visceral injury, nerve root induced hyperalgesia or burning-like nerve root pain, postoperative dysesthesia, posterior neck pain, and surgical site infection, are difficult to avoid; however, more focus on these issues perioperatively may be in order...
March 2018: Pain Physician
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