Visceral Trauma Research Articles

Status quo of operative training in emergency surgery in Germany – results of a survey

BackgroundEmergencies and emergency surgeries are a central part of everyday surgical care in Germany. However, it is unclear how emergency surgery is practically trained in clinics on a daily basis and what training concept is underlying. Therefore, the aim of this survey study was to capture the status quo of emergency surgical training of German general and visceral surgeons.MethodsThe members of the German Society for General and Visceral Surgery were surveyed online (n = 5281). The questionnaire included demographic data and expertise in surgery and assistance in emergency surgery regarding common emergency surgical operations. In addition, further training measures in emergency surgery and their support by employers were queried.ResultsOnly complete questionnaires (n = 184, response rate 3.5%) were included in the analysis. Most participants were in training (n = 69; 38%), followed by senior physicians (n = 52; 29%), specialists (n = 31; 17%) and chief physicians (n = 30; 17%). 64% of the participants were employed at university hospitals or maximum care hospitals. Regarding further training opportunities, in-clinic shock room training was most frequently used. Outside of their own clinic, the ATLS course was most frequently mentioned. Operations for cholecystitis and appendicitis as well as emergency stoma procedures are the most common emergency procedures. There was a strong difference in the frequency of operated cases depending on the level of training. For operations to treat acute abdominal traumas (hemostasis of liver and spleen, packing) as well as outside of visceral surgery, only low competence was reported. Over 90% of survey participants consider emergency surgery to be an indispensable core competence. Neither in the old (76%) nor in the new training regulations (47%) is emergency surgery adequately represented according to the participants’ assessment. There was a significantly lower prevalence of the “sub-steps concept” in emergency surgery at 38% compared to elective surgery (44%). Important elements of imparting skills in emergency surgery are simulation and courses as well as operative sub-steps, according to the majority of survey participants.ConclusionThe results show that general and visceral surgeons in Germany are introduced to emergency surgery too little structured during further training and at specialist level. The survey participants had, as expected, hardly any experience in emergency surgery outside of visceral surgery but surprisingly also little experience in visceral surgical trauma care. There is a need to discuss the future organization of emergency surgical training. Adequate simulation structures and extracurricular courses could contribute to an improvement in this respect.

Traumatismo renal secundario a accidente en patinete eléctrico

Introduction: the e-scooter has become a common transportation method which use has been rising in the last few years. Most lesions reported secondary to e-scooter accidents are traumatic brain injury (TBI), bone fractures and in a lower percentage abdominal visceral trauma. Methods: retrospective review of renal traumatisms cases secondary to e-scooter accidents presented to the emergency room (ER) of the Hospital Universitari Doctor Peset in Valencia, Spain since December 2021 to December 2022. A literature review on PubMed database was performed to investigate injuries caused by electric scooter use. Results: a total of five patients were included with a mean age of 34 years, being one woman and four men. A contrasted abdominopelvic computerized tomography (CT) scan was performed in all cases as a diagnosis method. The American Association for the Surgery of Trauma (AAST) renal injury scale was used to classify each case and determine the correct treatment. As a result, one case of AAST grade I, one case of AAST grade III, two cases of AAST grade IV and one AAST grade V were obtained; three of which were managed conservatively and two required invasive procedures. Conclusions: the rising use of the e-scooter as a transportation method has become a new cause and mechanism of renal traumatism to have in mind in polytraumatized patients in this context.

Single-Stage Surgical Treatment of Acute Type A Aortic Dissection and Blunt Abdominal Trauma: A Case Report.

A 53-year-old man suddenly developed chest and back pain while driving, resulting in an accident. Computed tomography revealed acute type A aortic dissection with malperfusion of the left lower extremity, retroperitoneal extravasation, hematoma in the anterior mediastinum, and ascites in the rectovesical pouch. Exploratory laparotomy before aortic repair revealed intestinal perforation and retroperitoneal bleeding, which were repaired, and an ascending aortic replacement was performed. Visceral trauma with active bleeding should be treated with priority, even if the need for systemic heparinization accompanies acute type A aortic dissection during surgery for aortic dissection.

Outcome of Laparostomy as a Treatment Measure for Abdominal Compartment Syndrome: A Retrospective Study

Introduction Abdominal compartment syndrome is a life-threatening condition that affects critically ill patients. When pressures inside a fixed cavity of the body increases, ischemia, muscle injury, and organ failure can result. Aim To assess the benefits and outcomes of laparostomy for abdominal compartment syndrome. Methods This retrospective study included patients who underwent a laparostomy procedure as a treatment measure for abdominal compartment syndrome, secondary to different etiologies such as sepsis and major abdominal visceral trauma. Results Although there are a few complications such as incisional hernia in the future following a laparostomy, the mortality rate following the procedure is less than < 10%, thus ensuring a good prognosis for patients who present with acute surgical emergencies. It could also be further noted that an early closure by 7 to 14 days had definite beneficial outcomes as compared with delayed closure of more than 14 days. It prevented most long-term complications such as entero-atmospheric fistula formation or granuloma formation, the outcomes of which were further aided by the use of a transparent custom-made polypropylene mesh. Conclusion Laparostomy is the gold standard treatment for abdominal compartment syndrome. The use of a custom-made polypropylene mesh has proven to have the least complications in the follow-up period. Incisional hernias are the most common complications documented, followed by entero-atmospheric fistula.

25, 50 & 75 years ago.

25, 50 & 75 years ago.

Prophylactic hypogastric arterial ligation before cesarean hysterectomy for controlling complications in pregnant women with placenta adherent abnormality: A randomized controlled clinical trial.

Placenta adherent abnormality (PAA) is abnormal attachment of the placenta to the myometrium. This abnormal placenta binding has severe clinical consequences for the mother and the fetus. We investigated the outcomes of hypogastric arterial ligation (HAL) before hysterectomy compared to hysterectomy alone in pregnant women with PAA. In this randomized controlled clinical trial, 70 patients were randomly allocated to HAL along with hysterectomy and hysterectomy alone groups (35 in each Group). The total amount of intraoperative blood loss, the need for intraoperative blood products transfusion, frequency of deep vein thrombosis, duration of surgery, duration of hospitalization, and visceral trauma were compared between 2 Groups. Finally, 64 patients completed the study protocol with mean age of 33.84 ± 4.25 years. The study groups were comparable in terms of basic baseline demographic and clinical characteristics. Visceral trauma was less frequently occurred in HAL group compared to hysterectomy alone (0% vs. 15.6%; P = 0.02). Intraoperative blood loss (1525 ± 536.41 cc vs. 2075 ± 889.36 cc; P = 0.001) and were significantly lower in HAL group compared to hysterectomy alone. Duration of operation (179.06 ± 36.28 vs. 197.66 ± 39.47; P = 0.05) and hospitalization (4.97 ± 2.20 vs. 6.10 ± 2.39; P = 0.03) also were significantly lower in HAL group. Our findings suggest that prophylactic HAL has a protective effect on the reduction of blood loss and less visceral trauma in pregnant women with PAA.

Blunt Trauma Leading to Anterior Abdominal Wall Hernia

Traumatic abdominal wall hernia (TAWH) has a reported incidence of around 1%. It is defined as herniation of intra-abdominal organs following trauma without skin penetration. High-energy trauma is often associated with intra-abdominal injury. Treatment options vary from non-operative management to surgical repair either open or laparoscopic. We present a case of a middle-aged male who presented with a history of rickshaw roll over injury. On examination, there was tender abdominal swelling with abrasions. Computerized Tomography (CT) scan confirmed the diagnosis of TAWH and free fluid in abdomen. Emergency exploratory laparotomy was performed. Mesenteric tears were repaired and primary restoration of abdominal wall was done. The patient was discharged on a fourth post-operative day without any complications. Management of TAWH should be tailored according to individual patient presentation. Midline exploratory laparotomy with the primary hernial repair is an operative intervention of choice for those with high-energy injury as there is an increased chance of accompanying visceral trauma. Keywords: Laparotomy; Trauma; Hernia.

Knowledge of Nursing Staff on Postoperative Pain: The Case of the Laquintinie Hospital in Douala, Cameroon

Background and objective: Pain is a major concern in the surgical environment, but its management remains insufficient due to several factors related to the nursing staff, the organization of the structure or the patient himself. The objective of this study was to assess the knowledge of the nursing staff on postoperative pain at the Laquintinie Hospital in Douala. Methodology: This was a cross-sectional study carried out at the Laquintinie Hospital in Douala from September to December 2018. Participants were consecutively selected among members of nursing staff in charge of operated patients in the visceral surgery, trauma surgery, surgical reanimation, gynaecology and obstetrics services. Socio-professional data and data related to knowledge of postoperative pain were collected from this personnel using a pre-tested semi-structured questionnaire. Results: With regard to knowledge of postoperative pain, the proportion of correct answers to the knowledge questions was 61.4%. This proportion varied significantly with the specific training received on pain and the specialization of the nursing staff (p < 0.001). Conclusion: The results of the study reveal knowledge in this population that deserves to be improved with a view to better management of patients undergoing surgery.

Impact of containment following COVID -19 on hospitalization activities in the pediatric surgical emergencies department, children’s hospital of Rabat

The Covid-19 pandemic has put stress on the healthcare system with a major impact on access to healthcare. The aim is to study the impact of containment on the hospitalization of children in the pediatric surgical emergency department, Children’s Hospital of Rabat. Material and methods: A retrospective study was carried out of children admitted at the Pediatric Surgical Emergencies Department (PSE), over a period of 6 months. The data were entered and analyzed by statistical software Jamovi 1.6.23. A chi-square test was used to compare the variables between the two periods: before and during containment. Results: We identified 579 children hospitalized during the first semester of 2020. The median age was 5 years [1-10] with predominance of boys (66.1%). Admission diagnosis are represented by abdominal emergencies (36.8%), head trauma (22.6%). Burns represent only 5,7%. These diagnosis were divided into visceral surgical emergencies (42%), trauma emergencies (48%) and non-urgent pathologies (10%). Surgery was done in 45.6%. Visceral and trauma emergencies were equivalent before and during the containment. On the other hand, there was a slight increase for visceral emergencies (57% Vs 43%) while the number of scheduled patients fell from 94.3% before containment to 5,7% during the containment.

Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: abdominal, hepatobiliary, and gastrointestinal conditions

BackgroundMedical 3D printing has demonstrated value in anatomic models for abdominal, hepatobiliary, and gastrointestinal conditions. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness criteria for abdominal, hepatobiliary, and gastrointestinal 3D printing indications.MethodsA literature search was conducted to identify all relevant articles using 3D printing technology associated with a number of abdominal pathologic processes. Each included study was graded according to published guidelines.ResultsEvidence-based appropriateness guidelines are provided for the following areas: intra-hepatic masses, hilar cholangiocarcinoma, biliary stenosis, biliary stones, gallbladder pathology, pancreatic cancer, pancreatitis, splenic disease, gastric pathology, small bowel pathology, colorectal cancer, perianal fistula, visceral trauma, hernia, abdominal sarcoma, abdominal wall masses, and intra-abdominal fluid collections.ConclusionThis document provides initial appropriate use criteria for medical 3D printing in abdominal, hepatobiliary, and gastrointestinal conditions.

Ultrasound-Guided Access in a Malrotated Kidney: Optimally Safe and Effective.

Background: Management of renal calculi in a patient with kidney malrotation can be difficult because of complexity and alteration of collecting system anatomy. Pyelolithotomy, whether open, laparoscopic, or robotic, has been shown to be an effective method of stone removal in this patient population; however, it is not always ideal because of its invasiveness and increased morbidity. Ideally, a percutaneous approach may be less invasive, and if feasible, it can optimize patient safety and stone-free status. Case Presentation: Here we present a case of a 68-year-old Caucasian female who presented with 2.7 cm stone in the renal pelvis of a severely malrotated left kidney, which was managed using a combination of fluoroscopy and ultrasound (US)-guided percutaneous nephrolithotomy. Conclusion: US-guided access properly delineates the anatomic complexities of a severely malrotated kidney and permits safe percutaneous management of large stones. This is because fluoroscopic guidance alone may lead to inadvertent adjacent visceral organ trauma and increased risk of parenchymal and intrarenal vascular injury.

Operating Site Infections at Friendship Hospital Sino Guinean of Kipe

The aim of this study was to make our contribution to improving the quality of care for patients operated on at the Sino-Guinean Friendship Hospital. Introduction: The surgical site infections (ISO) are defined as infections occurring within 30 days after surgery (or up to a year after surgery in patients receiving implants) and affecting the incision or deep tissue site operative. Methodology: This study is a prospective, cross, a one time year from 1st January to 31 December 2018 inclusive: The study involved 73 patients carriers of surgical site infections during the study period in visceral trauma surgery and neurosurgery departments of the kipe sino- guinean friendship hospital. The administrative procedure and patient confidentiality were respected. We had done the encoding. Results: We had noted 33 cases of infection of the operating site in the trauma department, 19 cases in the neurosurgery department and 21 cases in the visceral surgery department. Smoking was found in 22 patients, obesity in 7 patients., alcoholism in 6 patients, HIV in 5 patients, diabetes in 4 patients and no history in 23 patients. The infection occurred between 1 to 7 days in 52 cases, 7 14 day in 20 cases and higher has 14 days in 1 case. The dressings were soiled in one hundred percent of our patients who developed surgical site infections. Conclusion: Infections of the operating site constitute a serious complication and feared by surgeons because it ruins the success of the surgical act.

82 Detecting Abdominal Visceral Injury in Cases of Suspected Physical Abuse

Abdominal visceral injury is an uncommon but serious form of physical abuse. Most cases of abusive visceral injury are clinically occult and are at risk of going undiagnosed. Current recommendations suggest screening children with suspicious injuries for occult visceral trauma by measuring serum hepatic transaminases and pancreatic enzymes (primarily lipase) and ordering a CT scan of the abdomen for children with an AST or ALT ≥ 80 mmol/L, a lipase ≥ 100 mmol/L or clinical signs of intra-abdominal injury. This approach was proposed to the Child Maltreatment pediatricians at the 2015 Canadian Symposium on Advanced Practices in Child Maltreatment and was informally adopted by several Canadian Child Maltreatment programs. To review our group’s experience with employing the recommended approach to detecting inflicted visceral injury. A retrospective review of the group’s experience with this approach was completed by the Visceral Trauma Working Group for the October 2018 Symposium. Anonymized data from three centres for the period from January 2016-July 2018 was available for review. In two centres, data on patients who had screening transaminases/lipase and/or abdominal visceral injury was reviewed. In one centre a prospectively collected clinical database was reviewed. 200 children had transaminase +/- lipase measurements. Nine (4.5%) had an AST or ALT ≥ 80 mmol/L. None had a lipase ≥ 100 mmol/L. Ten children had an abdominal CT scan because of elevated transaminases and/or clinical signs/symptoms of blunt torso trauma. Five of the 10 patients had an abdominal visceral injury. No intestinal injuries were identified. Only one child had a visceral injury detected purely as a result of screening blood tests. Physical abuse was suspected as the cause of the visceral injury in 4 of the 5 cases and in all 4, the child was ≤ 5 years of age. Data on suspicious injuries present in screened children was available from one centre. One of 5 children with visceral injury had abdominal bruising and none had chest bruising or greater than 10 suspicious bruises. Following the currently recommended approach in this small group of children resulted in the detection of visceral injury in only one child who did not have other evidence of blunt torso trauma. Given the low incidence of clinically occult visceral injury in this population, a larger study is needed to determine the importance of age, clinical factors and clinically evident injuries when a decision to screen for possible inflicted abdominal visceral injury is being made.

Man With Left Upper Quadrant Pain

A 59-year-old man presented to the emergency department with sudden-onset, sharp, left upper quadrant abdominal pain radiating to the back, and diaphoresis. He had poorly controlled hypertension, with chronic type B abdominal aortic dissection beginning 1 year earlier and coexisting alcoholic liver cirrhosis. On physical examination, the patient was conscious, with a pulse rate of 80 beats/min and blood pressure of 136/85 mm Hg, and he was afebrile. Tenderness was noted over the left upper quadrant on palpation. Point-of-care ultrasonography of the abdomen was performed (Figure 1 and Video) and the diagnosis was confirmed by contrast-enhanced computed tomography (CT) (Figure 2) and maximum intensity projection (a CT image reconstruction) (Figure 3).Figure 2Contrast-enhanced CT confirming isolated splenic artery dissection (white arrow) and evacuated hematoma around the pancreas. Chronic aortic dissection was also noted (arrowhead).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3An intimal flap in the splenic artery, sparing the celiac trunk (arrow), was found on maximum-intensity-projection reconstructed image of contrast-enhanced CT. In addition, previous abdominal aortic dissection with atherosclerosis (arrowhead) was noted.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Isolated splenic artery dissection. After the patient was admitted to the vascular surgery department, abdominal pain improved, with labetalol to control blood pressure. He was asymptomatic at discharge 5 days later and on follow-up 1 month later. Visceral artery disease should be considered an uncommon cause of left upper quadrant pain; splenic artery dissection is a rare but potentially deadly consequence.1Merrell S.W. Gloviczki P. Splenic artery dissection: a case report and review of the literature.J Vasc Surg. 1992; 15: 221-225Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Splenic artery dissection should be considered in a patient with previous visceral artery disease, trauma, pregnancy, or connective tissue disorders.2Desinan L. Scott C.A. Piai I. et al.Sudden death due to spontaneous rupture in splenic artery atypical dissection with features of vasculitis: case report and review of the literature.Forensic Sci Int. 2010; 200 (e1-5)Google Scholar In patients presenting with sudden left upper quadrant pain, point-of-care ultrasonography of the abdomen is a good screening tool for vascular lesions. Treatment of splenic artery dissection depends on the symptoms, and surgery is indicated if symptoms progress.3Jung S.C. Lee W. Park E.A. et al.Spontaneous dissection of the splanchnic arteries: CT findings, treatment, and outcome.AJR Am J Roentgenol. 2013; 200: 219-225Crossref PubMed Scopus (35) Google Scholar, 4Nahas R. Pain T. Goulden P. A rare cause of epigastric pain in a middle-aged man.BMJ Case Rep. 2013; https://doi.org/10.1136/bcr-2013-009605Crossref Scopus (4) Google Scholar eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI4MzljNDgzNDI5YzcxYTk0MzRjYTYzOTRiYmY2YmYxZSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc3NzIwMTc2fQ.R9VXm-UMWBo33NCsKvgIuU5S8P4_TesAwFZG28rviE6ItKdrYtk9fSRI-tCvc3QROc9qI8OXIRs1n_2ZoNAkryNgNvNJi8n0KpkfFF7F-7OU-iaisyZDtBozgiBwwXHPUMcaNtNpte4l1MvooodQmjhP2QixrJekeUKQ39784EOgA26t36F4FqDSuPhfyh66pJz8oMJk4A5bMpY8uCGeUQlh89Rd2R5_xFgHQnH_uZqPKAyXGxuUt9t68p04UGXvE8RHr6MuF58Snut8yP0HhBZgjBXokulyly0_vdqkECp6q4ySk-DsshdBxkHukfpErZXwEJQLi0e29nwZ-KKSsg Download .mp4 (4.1 MB) Help with .mp4 files VideoPoint-of-care ultrasonography of the epigastrium, showing an intimal flap in the splenic artery (visible at 00:00 to 00:03 and again at 00:10 to 00:15) and heterogeneous density around the pancreas, implying extravasation or necrotizing pancreatitis. Chronic aortic dissection can be identified clearly at 00:05 to 00:09.

Teaching Courses in the Management of Visceral Trauma

Several changes introduced in the management of trauma during the last two decades have considerably decreased the practical exposure to bleeding trauma patients by residents and young surgeons. Hemorrhage still represents the second cause of death from trauma worldwide, and the surgical maneuvers required for its control must be learned and practised in specific courses. These courses address the “second hour” of trauma, beyond ATLS©, and also emphasize the decision-making process, communication among team members, and discussion of clinical scenarios. The significant progress made in simulation technologies and virtual reality systems have yet to replace living tissue models to train surgeons in the rapid control of active bleeding, although that replacement is probably not far away.

Young surgeons' challenges at the start of their clinical residency: a semi-qualitative study.

IntroductionAccording to German regulations on licensing to practice medicine, the aim of undergraduate medical training is to produce a scientifically and practically trained physician who is able to work independently. More precisely, medical training has to impart the required knowledge and skills in diagnostics, therapy, health promotion, prevention, and rehabilitation. From the young residents’ point of view, this aim is not achieved, and they do not feel prepared to be a doctor. However, the literature on this subject relies mostly on data based on surveys, and there is a lack of deep analysis of the specific details of the topic. The aim of this study was to analyze in depth how junior doctors in their first and second years felt about their preparation for clinical practice as a doctor from their undergraduate training, as well as which teaching formats and factors influence their preparedness.MethodsThis semi-qualitative study is based on recorded interviews conducted using a structured interview manual. This serves to limit the subject matter of the interview and to target the topics. The study participants were 35 residents of general and visceral surgery, trauma surgery, and urology in their first and second years of medical specialty training. The number of participants was defined by the concept of saturation of the content. Basic data regarding age and the location and length of study were collected using a questionnaire. The audio recordings were transcribed word by word and analyzed with structured qualitative content analysis techniques.ResultsOnly 43% (n=15) of the 35 participating residents stated they were sufficiently prepared to be a doctor from undergraduate medical training, and 22.9% stated that they were not prepared for their work as a resident (8/35). However, 34.3% of the residents stated that undergraduate medical training did prepare them for some of the parts they were expected to master in daily clinical practice, but not other parts. Most of the participants described their first weeks as doctors as particularly stressful and exhausting. As major hurdles during their daily clinical work, participants described knowledge gaps regarding organizational and administrative pathways (71%), deficits in linking knowledge to clinical reasoning (71%), decision making (54%), and therapy planning (51%). Most participants stated that the practical placements during the semester, the clinical clerkships, and the last year internship were most effective as preparation for clinical residency. To be better prepared for clinical practice, participants suggested providing a clearer structure and that the course subjects bear better relations to each other. Nearly all participants proposed increasing patient encounters directly from the beginning of medical training as a longitudinal approach.DiscussionEven though we were able to demonstrate an increase in residents’ preparedness, 57% of the study participants still felt unprepared for their job to some extent. One might argue that starting a new profession will always result in a feeling of being unprepared to some extent. However, this unpreparedness can increase the risk for patients’ well being due to medical errors, which actually represents the third leading cause of death in the US after malignant tumors and cardiovascular diseases. Structured on-the-job adjustment, structured qualification training, and guided professional training are becoming increasingly important for future doctors as selection criteria for career choice and choice of employer. Thus, the surgical disciplines that are struggling with new young residents have to improve their concepts.

Terrorist attack in Nice – The experience of general surgeons

After the attacks in Paris, France was again struck by terrorism in the city of Nice during the night of July 14, 2016. At 22:33 in the evening, a 19-ton truck drove into the crowd of holiday celebrators. The attack resulted in 458 wounded and 86 deaths. The purpose of this study was to describe the management of patients with abdominal trauma admitted alive in our institution, in the context of a massive influx of victims. We performed a retrospective analysis of the management of adults with abdominal trauma arising from the terrorist attack in Nice. Among the 182 victims admitted to our trauma center, eleven patients presented with abdominal trauma. The median age was 44 years [14-63] and the median Injury Severity Score (ISS) was 34 [9-59]. Eight patients underwent urgent surgical treatment in the operating room including six for abdominal trauma. These patients were treated according to the principles of surgical damage control, albeit without the need for temporary abdominal closure or packing. Three patients could have had their lesions managed non-operatively had they been admitted outside this surge episode, which saturated the technical means of the receiving hospital. The terrorist attack that victimized the citizens of Nice resulted in the second largest number of dead of any attack on French soil. A large number of patients were admitted to the city's only center for adult trauma care. The management of these patients posed diagnostic, therapeutic and logistical problems. Increased use of pre-hospital pelvic restraint belts may help to reduce vehicular trauma. We do not feel that non-operative management of abdominal lesions can be envisaged in the context of a mass influx of victims. We recommend surgical hemostasis for patients with secondary hemorrhagic risk from visceral trauma in the context of a massive influx of victims.

The management of pancreatic injuries

Pancreatic injuries are relatively uncommon, but considerable morbidity and mortality may result if associated vascular and duodenal injuries are present or if the extent of the injury is underestimated and appropriate intervention is delayed. Optimal management includes the need for early diagnosis and accurate definition of the site and extent of injury. Prognosis is influenced by the cause and complexity of the pancreatic injury, the amount of blood lost, duration of shock, the rapidity of resuscitation and the quality and appropriateness of surgical intervention. Early mortality results from uncontrolled or major bleeding due to associated injuries while late mortality is generally a consequence of infection or multiple organ failure. Initial management of pancreatic trauma is similar to that of any patient with a severe abdominal injury. Stable patients with a suspected pancreatic injury should have non-invasive imaging including a CT scan or MRI. Urgent laparotomy is required in patients with evidence of major intraperitoneal bleeding, associated visceral trauma, or peritonitis. Operative intervention is guided by the integrity of the main pancreatic duct. External drainage is adequate for parenchymal injuries with an intact duct, while duct injuries of the neck, body and tail require a distal pancreatectomy. Pancreatic head injuries are more complex. If the duodenum is reparable and the ampulla is intact, external drainage suffices. Rarely, complex injuries may require a pancreatoduodenectomy after damage control surgery if the patient has multiple injuries and is unstable. Postoperative pancreatic complications including fistula and pseudocysts are common but can usually be treated endoscopically.

Use of a self-adherent parietal traction mesh to close laparostomy (with video)

The increase of damage control surgery in visceral trauma as in other emergency situations (mesenteric ischemia, peritonitis) may require leaving the abdomen open, i.e. laparostomy at the end of the procedure. This approach can prevent or treat an abdominal compartment syndrome, which is associated with high morbidity and mortality. In cases of open abdomen, the use of a negative pressure system by vacuum-assisted closure (VAC) is the preferred technique to isolate and cover the abdominal contents.

Visceral Trauma Fellowships in Johannesburg

Die Forderung durch das Stipendium der Deutschen Gesellschaft fur Unfallchirurgie bezog sich auf einen Aufenthalt in der Trauma Unit des Chris Hani Baragwanath Academic Hospital, einem der Lehrkrankenhauser der University of the Witwatersrand in Johannesburg, Sudafrika. Das Chris Hani Baragwanath Academic Hospital – kurz „Bara“ genannt – liegt im Sudwesten von Johannesburg im Stadtteil Soweto, einem Township mit schatzungsweise 3.5 Millionen Einwohnern.