Articles: trauma.
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The purpose of this study was to analyze the epidemiology and outcomes after traumatic amputation of the upper (UEA) and lower (LEA) extremities. ⋯ Traumatic limb amputation is a rare consequence of civilian trauma. Amputation is rarely the primary cause of death; however, these devastating injuries are associated with significant intensive care unit and hospital lengths of stay. Although no mortality difference was detected, when compared with patients with upper extremity amputations, patients with lower extremity amputations were more severely injured, required revision extremity surgery more often, had a higher complication rate, and more frequently required discharge to a long-term facility.
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To evaluate the pattern, demographics, circumstances behind events and patient outcome of civilian gunshot wounds (GSWs), we conducted a prospective review in a surgical department in Durban, South Africa over a period of 9 months. ⋯ This study provides evidence that the burden of GSW-related mortality and morbidity poses a substantial threat to the local public health. A national database for reporting all GSWs is recommended for proper assessment of the magnitude of the problem and to facilitate funding for research into injury prevention.
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Hemobilia is a rare cause of upper gastrointestinal bleeding. More than 50% of hemobilia cases are related to iatrogenic trauma from hepatobiliary procedures, and needle biopsy of the liver represents the most common cause. A minority of hemobilia cases are due to hepatobiliary disorders such as cholangitis, hepatobiliary cancers, choledocholithiasis, and vascular abnormalities in the liver. The classic presentation of hemobilia is the triad of right upper quadrant (biliary) pain, obstructive jaundice, and upper gastrointestinal bleeding. We report a rare case of hemobilia caused by a spontaneous hepatic cyst rupture, where our patient presented without the classical symptoms, in the absence of therapeutic or pathological coagulopathy, and in the absence of spontaneous or iatrogenic trauma. ⋯ Hemobilia is an infrequent cause of upper gastrointestinal bleeding and rarely occurs due to hepatic cyst rupture. To the best of our knowledge, this is only the second case report in the literature that describes hemobilia due to hepatic cyst rupture. However, it is the first case in the literature of hemobilia due to hepatic cyst rupture in the absence of iatrogenic or spontaneous trauma, and in the absence of a spontaneous or pathological coagulopathy.
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Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. ⋯ The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.
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Chylothorax is a rare form of pleural effusion that can be associated with both traumatic and non-traumatic causes. Thoracic duct ligation is often the treatment of choice in postsurgical patients; however the optimal treatment of this disease process after traumatic injury remains unclear 1. We present a rare case of a thoracic duct injury secondary to a blunt thoracic spine fracture and subluxation which was successfully treated non-operatively. ⋯ This unusual and complex blunt thoracic duct injury required a multidisciplinary approach. Although the spine injury required surgical fixation, successful resolution of the chyle leak was achieved without surgical intervention.