Canadian journal of surgery. Journal canadien de chirurgie
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Hemorrhoids are an extremely common affliction. The prevalence ranges from 1 in 25 to 1 in 30 individuals. There was a 20% decrease in the number of hemorrhoidectomies performed between 1978 and 1982. ⋯ Bleeding hemorrhoids can be treated by diet alone, or by injection or rubber-band ligation. Prolapsing hemorrhoids are best treated by rubber-band ligation. The relatively few patients in whom these more conservative measures fail can be considered for hemorrhoidectomy.
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Intestinal perforation after blunt abdominal trauma in children is rare and thus the diagnosis may be delayed. For this reason the authors reviewed their experience with 12 children to recommend a protocol for investigation that would reduce the delay in diagnosis. Of the 12 perforations, 2 were gastric, 2 duodenal, 7 jejunal and 1 colonic. ⋯ Serial films were valuable in aiding the diagnosis and are recommended, together with assessment of solid organ injury by radionuclide scanning. In this series peritoneal lavage was not used. No child died.
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Rupture of the trachea and major bronchi usually results from blunt trauma to the chest. To define the characteristics of the condition, the mechanism of injury, presentation and hospital course, the authors reviewed seven cases of tracheobronchial rupture after blunt trauma. Four were injured in a motor vehicle accident, two had a crush injury and one child had a fall from a playground swing. ⋯ Two patients died secondary to associated head injuries; one patient underwent repair of the bronchus intermedius and one patient had a lacerated membranous trachea. The possible mechanisms of injury are: rapid deceleration with forward swing of the trachea, widening of the transverse diameter of the chest, exerting traction on the carina, and a rapid rise of airway pressure on impact. Surgical intervention is recommended at an early stage to avoid loss of lung tissue.
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Immediate surgery is essential to resuscitate and save 5% to 10% of those suffering life-threatening trauma. Recently, emergency room surgery has been proposed as the procedure to follow in stabilizing such patients. Over a 3-year period, 41 moribund patients were treated by the trauma service at the Health Sciences Centre in Winnipeg. ⋯ Eighteen patients had a blood pressure of 70 mm Hg systolic or less and failed to respond to massive O positive blood transfusion; of these, 14 (77%) survived. The mix of mode of injury and injury severity scoring is important to compare results from within and between centres. The author's experience indicates that the use of a high-priority crash protocol for managing moribund patients with life-threatening traumatic injury in the main operating room provides a standard of care equal to or better than that reported for emergency room surgery.
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The authors reviewed and analysed the records of 75 patients with omental and bowel evisceration as a result of abdominal stab wounds to discover whether omental prolapse makes laparotomy mandatory. Major intraabdominal injuries were found in 82.7% of the total group, 82.9% in those with omental protrusion and 82.5% in patients with bowel prolapse. ⋯ Negative laparotomy did not cause important morbidity. The authors conclude that omental herniation after stab wounds of the abdomen should routinely prompt exploratory celiotomy.