Multiple Stab Research Articles

Enhancing trauma evaluation: Comparative analysis of post-mortem computed tomography and autopsy findings in abdominal stab wounds.

In cases of traumatic deaths, accurate assessment of injuries is essential for both legal and medical purposes. This case report compares the findings of post-mortem computed tomography with conventional autopsy methods in assessing abdominal stab wounds. A 34-year-old woman with multiple stab wounds in the abdomen underwent post-mortem examination, including computed tomography imaging. Computed tomography revealed specific breaches in the skin's continuity and internal injuries, including perforation of the stomach. A conventional autopsy confirmed the presence of multiple stab wounds and associated injuries to internal structures. However, additional injuries to major blood vessels, such as the abdominal aorta and inferior vena cava, were only detected during manual exploration of the peritoneal cavity. This case highlights the complementary roles of post-mortem computed tomography and conventional autopsy in evaluating traumatic injuries. While computed tomography imaging offers non-invasive visualisation of injuries, manual examination remains essential for identifying certain injuries, particularly those affecting major blood vessels. The integration of computed tomography imaging with traditional autopsy methods enhances the accuracy and reliability of forensic assessments in cases of traumatic deaths, particularly in complex cases involving multiple injuries. Understanding the strengths and limitations of these techniques is crucial for improving forensic investigations and ultimately enhancing medico-legal outcomes.

Comparison of Efficacy of Decompressive Craniectomy By Multiple Dural Stabs Versus Open Dural Flap For The Evacuation of Acute Subdural Hematoma

Comparison of Efficacy of Decompressive Craniectomy By Multiple Dural Stabs Versus Open Dural Flap For The Evacuation of Acute Subdural Hematoma

A safe and effective winged peripheral intravenous cannula for use in clinical practice.

Vascular access continues to be a key factor for the reliable and safe delivery of intravenous (IV) therapy to patients in any healthcare setting. Clinical guidelines advocate for the right vascular access device selection, in order to reduce avoidable complications, eg multiple stabs, phlebitis, thrombophlebitis, insertion site infection, and blood stream infection, while improving efficiency and reducing costs. Peripheral intravenous catheters or cannulas (PIVCs) remain widely used for gaining vascular access in all clinical settings, with both adults and children, because they provide a relatively cheap and simple way to provide blood sampling and the prompt administration of IV medications. Although safe and easy to insert, PIVCs present with associated risks that can be costly to the organisation. The case studies included with this article introduce Nipro's Safetouch Cath Winged with Injection Port as a new cost-effective choice of PIVC, which is now available from NHS Supply Chain.

Suicide by sharp force associated with major self-mutilation and self-cannibalism.

Self-stabbing and self-cutting represents an uncommon method of suicide. We present a case of a 30-year-old man who was found dead in the forest. The body was naked and showed multiple cut and stab wounds on different parts of the body (face, neck, chest, abdomen, and extremities). A single-edged kitchen knife was found approximately 20m from the body. Parts of both ears, the fifth toe of the right foot, and the scrotum were cut off. At the autopsy, two of the severed body parts-the toe and the part of the left ear-were found in the stomach. The cause of death was asphyxiation due to blood aspiration resulting from a cut throat injury. A police investigation uncovered a history of substance abuse and two previous suicidal attempts using a knife. Upon complex analysis of all the evidence, the manner of death was ruled a suicide, which was preceded by actions of major self-mutilation and self-cannibalism, both considered rare behavioral patterns.

Clinical case of long-term mechanical circulatory support in a patient with biventricular heart failure after cardiac stab wound

Cardiac injury remains one of the most complex conditions in emergency surgery. Only 6% of patients with penetrating heart wounds manage to be delivered to the operating room for surgery, and the mortality rate is still extremely high. Unfortunately, such emergency interventions are often performed in institutions lacking the ability to provide the full range of reconstructive techniques, resulting in suboptimal correction and a high risk of developing postoperative complications. This paper describes a clinical case of successful repair of multiple stab wounds to the heart with concomitant anterior descending artery injury followed by severe heart failure requiring biventricular mechanical circulatory support.

Coronary-coronary bypass grafting in a child with a stab wound of the anterior interventricular artery

Highlights. A successful case of surgical treatment of a child with a stab wound of the heart and damaged anterior interventricular artery is presented.Abstract. A girl aged 5 years and 9 months was admitted to the hospital in extremely severe condition with multiple stab wounds to the chest and left shoulder and massive bleeding. The child was immediately taken to the operating room due to hemorrhagic shock and injury localized in the anatomical area directly affecting heart function. The wound in the projection of the interventricular sulcus was repaired with one U-shaped suture, hemodynamics was stabilized by inotropic agents. In the postoperative period, heart failure developed due to akinesia of the apical segments, anterior, lateral and anterolateral walls, and reduced ejection fraction. An emergency coronary angiography revealed an occlusion of the anterior interventricular artery (AIV). Emergency repeated surgical intervention was performed. We diagnosed complete intersection of AIV with thrombosis in the proximal and distal segments. Surgical treatment of the coronary stumps enabled satisfactory antegrade and retrograde blood flow. End-to-end coronary-coronary bypass grafting with AIV grafting was performed on the beating heart. The postoperative period was uneventful. Active lifestyle, absence of complaints, and AIV being opaque, including autogenous graft, were reported in the long-term follow up. The presented case proves that effective diagnostic protocol, echocardiography data and appropriate choice of surgical technique led to a positive outcome.

Multiple stab incision technique to prevent postoperative acute compartment syndrome of leg in proximal and segmental fracture tibia and fibula: a prospective study

<p>The objective is to study the effectiveness of Multiple stab incision technique in preventing acute compartment syndrome (ACS) in proximal and segmental fractures of both bones (Tibia and fibula) in leg. This study is prospective done<strong> </strong>at K. S. Hospital Koppal, Karnataka spanning for a period of one year (April 2020 to April 2021). A total of 20 patients of both genders aged 20-60 years were included in the study. Multiple stab incision technique was performed in patients after fixation of Tibia by either closed nailing or MIPPO plating. This procedure was done under spinal anesthesia. Multiple stab incision technique significantly decreased the chances of post-op ACS in proximal and segmental fractures of both bones (tibia and fibula) in leg. Multiple stab incision technique is help full in preventing developing compartment syndrome.</p><p><strong> </strong></p><h2> </h2>

Coronary Sinus Injury in a Multisystem Thoracoabdominal Cut/Stab Wound

We report a case of successful treatment of a patient with multiple stab and cut wounds of chest and abdomen which resulted in the injuries of venous coronary sinus and abdominal organs. Surgical wound revision in the antishock unit, priorities of surgical accesses (thoracotomy and laparotomy) allowed timely cure the injury. A key feature of our case report is a coronary sinus trauma. Coronary sinus suturing in a closed heart surgery is technically difficult. It has the potential hazard due to the proximity of coronary arteries, stricture and thrombosis of the coronary sinus after suturing. Extracorporeal circulation and cardioplegia ensure reliable hemostasis and intact patency of the coronary sinus. Clinical case of suturing coronary sinus injury in a closed heart surgery proves the reasonable use of autopericardial strengthening strips and local hemostatic made of regenerated cellulose.

Age-related injury patterns resulting from knife violence in an urban population.

Interpersonal violence involving knives is a major public health problem. The majority of patients are young people in urban areas, but little is known about age-specific patterns of injury and recent trends in injury characteristics. We performed a retrospective cohort study of all patients presenting to an urban major trauma centre with stab injuries resulting from assault between 2012 and 2018. A total of 3583 patients were included. Young people (age under 25) were more likely to have sustained multiple stab wounds compared to older people (43% vs 35%, p < 0.001) and had significantly higher rates of stab injuries involving the lower limbs, groin and buttocks. The annual number of injuries increased steadily during the study period in patients aged under 25 (r2 = 0.82, p = 0.005) and those over 25 (r2 = 0.95, p < 0.001). Over time, limb and junctional injuries accounted for an increasing proportion of stab wounds in young people, overtaking torso injuries as most common pattern of injury by the end of the study period. These findings illustrate the influence of age on injury patterns resulting from knife violence, and support the expansion of outreach initiatives promoting bystander-delivered haemorrhage control of extremity wounds.

Delayed Horner's Syndrome After Multiple Penetrating Stab Injury of the Neck.

Horner's syndrome is characterized by a triad of symptoms (ipsilateral miosis, ptosis, and anhidrosis) with damage of the sympathetic nervous system. The condition may be congenital or acquired from traumatic conditions including cardiovascular surgery. Horner's syndrome can be also caused by neck trauma especially when cervical vital structures such as blood vessels, the aerodigestive tract, and nerves are disrupted. This report describes a 16-year-old woman with delayed Horner's syndrome who initially presented with internal jugular vein injury caused by multiple penetrating stab injury to the neck. To the best of our knowledge, this is the first reported case of Horner's syndrome resulting from neck trauma of which symptoms were presented after a couple of weeks after initial trauma. Understanding this rare clinical course may help surgeons pay attention to not only early hospital course but also long-term complications of patients with neck trauma.

A False-positive Diatom Test in a Non-drowned Victim of Multiple Stab Wounds

For the diagnosis of drowning in immersed bodies, the diatom test has been controversial due to false-negative and false-positive results. Causes of false positive results include antemortem penetration of diatoms, and postmortem contamination during the submersion or the diatom preparation process. Herein, we report a false-positive case in a 30-year-old woman who died from homicidal multiple stab wounds and was thrown into a shallow farm waterway approximately 10 days after her death. In addition, a discussion on the false-positive diatom test results in immersed bodies with penetrating wounds is provided.

Evaluation of Efficacy of Endovenous Radio Frequency Ablation for Varicose Veins in Industrial Workers—A Prospective Study

AbstractIntroduction The disease of varicose veins is a common vascular condition affecting one out of five in world population. Although conventional surgical treatments were considered the gold standard, they were fraught with many complications. Endovenous thermal interventions like endovenous radio frequency ablation (RFA) have largely superseded traditional surgery as the gold standard treatment as it is minimally invasive. Our initial experience with this treatment modality is presented along with the review of literature.Aim Our aim was to evaluate the efficacy, safety, clinical outcomes, and health economic benefits of endovenous RFA for varicose veins in our setup.Materials and Methods It was a prospective observational study conducted by the Department of General surgery at ESIC Medical College and Hospital, Hyderabad, India, from September 2020 to February 2021. Thirty consecutive patients with primary varicose veins were evaluated by detailed history, clinical examination, and venous Doppler study of the lower limbs. The procedure was performed under spinal anesthesia and Doppler ultrasound guidance using the ClosureFast (Medtronic) radio frequency segmental ablation system. Additionally, multiple stab phlebectomies were performed to deal with tributary varices in required cases. Various intraoperative (length of vein ablated and operative time) and postoperative (complications and return to work) variables were studied. Postoperative follow-up at 1,8,24 weeks was done clinically and using Doppler ultrasound to look for the recanalization of vein. The collected data were entered in Microsoft Excel spreadsheet and analyzed using descriptive statistics.Results The mean (standard deviation) age of patients was 39.1 (8.7) years. Ten patients had C2 disease, six C3, eleven C4, and three had C6 disease. The mean postoperative visual analog scale score on day 1 was 1.4. Mean return to normal activity time was 1.3 days. Average return to work time was 2.1 days. The post-procedure total occlusion rate at 24 weeks follow-up was 96%.Conclusion Endovenous RFA is a safe and effective minimally invasive modality for treating lower limb varicose veins, providing health economic benefits to patients.

A Rare Encounter Compartment Syndrome after High Saphenous Vein Ligation and Multiple Stab Avulsion Surgery

A Rare Encounter Compartment Syndrome after High Saphenous Vein Ligation and Multiple Stab Avulsion Surgery

Arteriovenous Fistula Is Protective in Stab Wounds Involving Major Vessels

<h3>Introduction and Objective</h3> Stab wounds to the neck resulting in major vascular injuries occur in 40% of patients. These are usually associated with significant blood loss and frequently fatal. We describe a patient with multiple stab wounds to neck resulting in almost complete transection of the right common carotid artery (CCA) with a large pseudoaneurysm and an associated internal jugular (IJ) injury, resulting in a "protective" arterio-venous (AV) fistula. Protective AV fistulae are uncommonly described in the literature. We believe this to be a novel description of a CCA transection with associated "protective" AV fistula. <h3>Case Report</h3> A middle-aged male presented to our Level I trauma center after suffering three 1 cm stab wounds to the right side of his neck. The patient arrived via ambulance. The emergency medical services crew provided basic field care including applying supplemental oxygen and covering wounds with dry gauze. Upon arrival, the patient was verbal with a Glasgow Coma Scale score of 15. Heart rate was 122 and blood pressure was 139/91. On initial examination, a large, pulsatile hematoma with a palpable thrill was noted underlying a laceration to the lateral aspect of zone two. A second and third laceration were noted without associated swelling in zone one and zone three, respectively. Minimal external bleeding was noted from all stab wounds. Computed tomography angiography was obtained en-route to the operating room and demonstrated a right CCA injury with a large pseudoaneurysm and AV fistula decompressing into the right internal jugular (IJV) vein. On operative exploration, the right CCA was found to be greater than 90% transected with the proximal and distal ends connected by small amount of bridging adventitia. The right IJV was found to have an approximately 70% wall transection and the vagus nerve was totally transected. The CCA and IJV were repaired in a primary end-to-end fashion. The vagus nerve was also repaired. The patient had an uneventful postoperative course and was discharged home on hospital day three. On follow-up visit after 6 weeks patient was doing well with no neurovascular deficit. <h3>Discussion</h3> Penetrating injuries of the neck involving major vessels are associated with high morbidity and mortality. A traumatic AV fistula can provide a protective effect by decompressing the injured arterial structure and prevent massive blood loss and airway compression. Protective AV fistulae have been uncommonly described, and to our knowledge, this is the first case involving a >90% carotid transection with associated "protective" AV fistula ultimately allowing life-saving operative repair.

EP.FRI.42 REBOA associated iatrogenic AV fistula

Abstract Aim To discuss a rarely reported complication of Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a trauma patient with exsanguating haemorrhage. Case description A 15 year old male sustained was brought in as a cod Red, following multiple stab injuries to his Rt thigh. A REBOA was inserted via the contralateral Femoral artery on the scene to control the bleeding. Once proximal and distal control was obtained on the Right leg, the REBOA was deflated and removed. The right leg needed an interposition vein graft and ligation of femoral vein. The patient had received 12 units of transfusion. Post-operative CT-angiogram demonstrated an AV fistula between the Left Profunda femoris artery and Common femoral vein on the side of REBOA insertion. A Duplex scan showed flows of 2600ml/min on duplex and AVF diameter of 2.6mm. It was decided to wait for spontaneously closure as patient underwent rehab. At 6 weeks the AVF flow had reduced to 460ml/min however further expectant management did not lead to spontaneous closure of the AVF and he underwent surgical tie off during his next school holidays 6 months later. Conclusion AV fistula formation as a complication of REBOA insertion has not been reported in paediatric population. It highlights the need for a CT angio after surgical stabilisation. These post traumatic AVFs may need surgical repair if it does not spontaneously close in 3-6 month time.

TP5.2.2 Office based endovascular radiofrequency ablation (OBEVRFA) as a standalone procedure for varicose veins

Abstract Aims The aim of this study was to identify the number of patients that required a secondary procedure for persistence/ recurrence of symptoms within 3 years of the index (OBEVRFA) procedure. Method Retrospective analysis of data collected prospectively for patients booked to have OBEVRFA in the period January 2017- January 2018 was accessed from electronic patient records. Their clinic follow letters, scans and any secondary procedures done were documented on an excel sheet. Results A total of 303 patients, were booked for an OBEVRFA of which 17 (5.6%) patients did not attend the procedure. 39 (12.8%) patients were cancelled on the day of the procedure. 247 patients (M:F 1:1.5), underwent OBEVRFA. 53 patients (21.8%), had residual veins or were symptomatic &amp; were followed up beyond their 3 month period. 24 patients had a duplex scan which showed complete recanalization in 4, a reflux in non-treated secondary vein (Like Anterior thigh vein or duplicated Long saphenous vein) and a new perforator incompetence in others. 40 (16.1%) patients eventually underwent secondary procedures, 8 underwent classical High flush ligation and stripping with multiple stab avulsions (MSA) , 7 had a redo OBEVRFA, 3 had a redo RFA with MSA under GA, others had MSA alone and 1 had successful sclerotherapy. 3 patients were not keen for a secondary procedure. Conclusion OBEVRFA alone provides complete symptomatic relief in over 80% of patients with only 16% needing a secondary procedure. For symptomatic varicose veins from truncal reflux OBEVRFA should be the first line treatment on NHS.

TRIOGENESIS OF EXTREME HETERO-AGGRESSIVE BEHAVIOUR IN PSYCHIATRIC FORENSIC EXPERT PRACTICE

An individual's behavior can be defined as a set of complex reactions of the body to internal and external stimuli. Case description: We present a case of a young adult student who, under the circumstances of an anomic environment, causes a female person multiple stab wounds to the cervical region. The patient has an addiction to virtual reality, personal psychiatric history of a depressive disorder, emotional and anxious behavioral disorders, as he was a regular cannabis user. The young man was attending an event where he was consuming alcohol and banned substances (Ecstasy), whose effect combined with antidepressants creates a virtual reality in which the individual has a particular mental state, having the impression that bystanders want to hurt him. Under the impulse of this state, the individual uses a bladed weapon and causes multiple wounds to the victim. The patient is examined in the psychiatric forensic examination commission to determine the discernment at the time of the act of violence and for recommendations regarding safety measures. Conclusion: The approach of hetero-aggression behaviour is based on three categories of causal factors, in a triune concept that implies the consequence of the interaction of the existential environment, with the personality structure of the young individual and with the circumstantial factors that precipitate the act.

WHERE IS THE AIR? THE CASE OF A NON-ISOLATING AIR LEAK IN A 19-YEAR-OLD THORACIC STAB WOUND PATIENT

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: Unidirectional bronchoscopically deployed endobronchial valves have been are indicated for emphysematous disease as an alternative to lung volume reduction surgery. These valves have found a second indication in the treatment of bronchopleural fistulas. CASE PRESENTATION: A 19 year-old male presented with multiple stab wounds after a homicide attempt. The patient had a series of intra-thoracic surgeries including partial wedge resection of the left upper lobe, removal of impaled knife from thoracic vertebra, several orthopedic procedures, and an esophageal repair. The two left sided large bore chest tubes placed intraoperatively had persistent air leaks on post-operative day 6 (image 1). We attempted a bronchoscopic balloon occlusion of the airway to isolate a suspected bronchopleural fistula with the intent to place a unidirectional endobronchial valve. However, balloon occlusion of the left upper lobe and then the left lower lobe did not result in an appreciable decrease in air leak. The entire left mainstem bronchus was then occluded without a decrease air leak (image 2). As such no valve could be deployed and the procedure was aborted. Careful consideration was given to the alternative sources of intra-thoracic air including fistulation from the esophagus or mediastinum. We considered abdominal free air crossing the diaphragm and even free air crossing the contralateral hemithorax. After these had been carefully ruled out with contrast studies and imaging, the patient was scheduled for video-assisted thoracic surgery (VATS) with wedge resection. On the morning of surgery, we noted that the patient's chest tubes were leaking around the insertion site. Furthermore there was fluid bubbling around the insertion site suggesting that the site itself was the origin of the patient's intrathoracic air. Both chest tubes were then removed and replaced with a small-bore pigtail chest tube resulting in complete resolution of air leak (image 3). DISCUSSION: The technique for placing unidirectional endobronchial valves for a bronchopleural fistula first involves isolating the source of the air leak. Segments of the affected lung are occluded using a sizing balloon starting proximally. When the segment where the bronchopleural fistula originates is occluded, the air leak will diminish indicating a decrease in airflow distally. A unidirectional endobronchial valve can then be deployed resulting in occlusion of the diseased airway, distal atelectasis, and a resolution of the bronchopleural fistula. This algorithmic approach will identify the diseased segment unless there is significant collateralization of airways, in which case a VATS is indicated. Our case highlights how alternative sources of air leak should be entertained prior to more aggressive surgical intervention. CONCLUSIONS: The patient's VATS was canceled and he has made a full recovery. REFERENCE #1: Mahajan AK, Khandhar SJ. Bronchoscopic valves for prolonged air leak: current status and technique. J Thorac Dis. 2017;9(Suppl 2):S110-S115. doi:10.21037/jtd.2016.12.63 REFERENCE #2: Travaline JM, McKenna RJ, Jr, De Giacomo T, et al. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest 2009;136:355-60. 10.1378/chest.08-2389 REFERENCE #3: Reed MF, Gilbert CR, Taylor MD, et al. Endobronchial Valves for Challenging Air Leaks. Ann Thorac Surg 2015;100:1181-6. 10.1016/j.athoracsur.2015.04.104 DISCLOSURES: No relevant relationships by Jonathan Xian, source=Web Response

Tratamento intervencionista e cirúrgico híbrido de lesões cardíacas traumáticas complexas por arma branca

Penetrating injuries to the heart are usually devastating and few patients survive the initial trauma. The most frequent penetrating injuries are caused by projectile injuries and less commonly by melee weapons. Most of these injuries involve chamber free walls and a small percentage can affect the interventricular septum. We report a case in which an emergency surgical procedure was successful in controlling cardiac tamponade, and repairing a right ventricular laceration caused by multiple stab wounds. Subsequently, a successful interventional occlusion of a large interventricular septal defect, associated with significantly augmented pulmonary flow was performed.

Use of REBOA in the universe of magical realism: a real-world review

While reading the novella “Chronicle of a Death Foretold” by the Colombian Nobel Laureate Gabriel García-Marquez, we were surprised to realize that the injuries sustained by the main character could have been successfully treated had he received modern trauma care in which REBOA may have been considered. This is a discussion of Mr. Nasar's murder to explore whether he could have been saved by deploying REBOA as a surgical adjunct to bleeding control and resuscitation. In reading García-Marquez's novel we noted the events that unfolded at the time of Santiago Nasar's murder. To contextualize the claim that Mr. Nasar could have survived, had his injuries been treated with REBOA, we explored and illustrated what could have done differently and why. On the day of his death, Mr. Nasar sustained multiple penetrating stab wounds. Although he received multiple stab wounds to his torso, the book describes seven potentially fatal injuries, resulting in hollow viscus, solid viscus, and major vascular injuries. We provided a practical description of the clinical and surgical management algorithm we would have followed in Mr. Nasar's case. This algorithm included the REBOA deployment for hemorrhage control and resuscitation. The use of REBOA as part of the surgical procedures performed could have saved Mr. Nasar's life. Based on our current knowledge about REBOA in trauma surgery, we claim that its use, coupled with appropriate surgical care for hemorrhage control, could have saved Santiago Nasar's life, and thus prevent a death foretold.