Canadian journal of surgery. Journal canadien de chirurgie
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The authors describe three patients with similar clinical features and patterns of colonic injury following blunt abdominal trauma. Perforation was discovered 7 to 10 days after injury and was indicated by the clinical signs of systemic sepsis. A prominent sign of occult sepsis was post-traumatic pulmonary insufficiency. ⋯ The large number of concomitant injuries and the subsequent sepsis led to a higher morbidity and mortality than in cases of penetrating injuries to the colon. The key to successful management of blunt colonic injuries is early diagnosis. Awareness of the type of injury and the magnitude of the deceleration force combined with the presence of persistent ileus may lead to earlier laparotomy.
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In a review of 101 patients suffering from frostbite who were admitted to hospitals in Saskatoon during 10 winters, it was found that alcohol consumption was a contributing factor in 39 patients and a motor vehicle accident or breakdown in 33 others. Sixty-six patients underwent primary treatment in Saskatoon, the other 35 were referred for management of demarcated gangrene. Two hospitalized patients died, both of causes unrelated to the frostbite. ⋯ The mainstays of treatment remain rapid rewarming and adequate delay before conservative débridement or amputation. The delay allows healing of partial-thickness injuries and demarcation of full-thickness injuries. One third of patients receiving primary care in Saskatoon required amputation.