S Afr J Surg
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Review Case Reports
Misdiagnosis of diaphragmatic rupture in a trauma setting.
Distinguishing diaphragmatic eventration from rupture in the trauma setting can be a considerable challenge. We present a case involving a man suffering from chest pain and with a raised left hemidiaphragm on the chest radiograph after a motor vehicle injury. A review of the literature discusses the use of imaging modalities and subsequent surgical diagnostic procedures in the face of uncertainty.
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Review Case Reports
Situs inversus abdominalis and duodenal atresia: a case report and review of the literature.
Fewer than 20 patients born with situs inversus and duodenal atresia have been reported in the literature. We present a patient with this condition. A newborn baby presented shortly after birth with persistent bilious vomiting. ⋯ Duodenal obstruction in the presence of situs inversus has been described, including obstruction due to a web, stenosis, pre-duodenal portal vein and complete atresia. The patient presented in this paper had a duodenal web in the second part of the duodenum. Before undertaking surgery it is important to establish the presence of associated gastrointestinal and cardiac abnormalities.
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At the turn of the century, a significant advance in the rapidly expanding field of rotational thrombelastography (ROTEG), known at present as thrombelastometry or ROTEM analysis, was developed at the Ludwig-Maximillian University in Munich. The measuring unit is operated by a laptop computer. ⋯ It also provides a useful guide in the choice of an appropriate therapeutic option in the bleeding patient, reducing costs by avoiding administration of costly component therapy such as fresh-frozen plasma, cryoprecipitate, platelet concentrates or antifibrinolytic agents. As well as being useful in monitoring anticoagulant therapy and the use of pharmacological agents, ROTEM is a valuable research tool in the field of hypercoagulability, fibrinolysis, factor XIII activity and the ultimate phases of the blood coagulation process.
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Major injuries of the pancreas are uncommon, but may result in considerable morbidity and mortality because of the magnitude of associated vascular and duodenal injuries or underestimation of the extent of the pancreatic injury. Prognosis is influenced by the cause and complexity of the pancreatic injury, the amount of blood lost, duration of shock, speed of resuscitation and quality and nature of surgical intervention. Early mortality usually results from uncontrolled or massive bleeding due to associated vascular and adjacent organ injuries. ⋯ Unstable patients may require initial damage control before later definitive surgery. Successful treatment of complex injuries of the head of the pancreas depends largely on initial correct assessment and appropriate treatment. The management of these severe proximal pancreatic injuries remains one of the most difficult challenges in abdominal trauma surgery, and optimal results are most likely to be obtained by an experienced multidisciplinary team.