BACKGROUND: Isolated injury to the superior mesenteric vein (SMV) caused by blunt abdominal trauma is rare but often lethal, especially in pediatric patients. Due to the low incidence of SMV injuries, there are no universal guidelines for its diagnosis and treatment. The diagnosis is made using either computed tomography (CT) or intraoperative exploration. Primary vascular repair is recommended. CASE REPORT: A 10-year-old girl was transferred to a trauma center after a high-energy motor vehicle collision. Under the diagnosis of acute abdomen with hemoperitoneum, the patient underwent urgent laparotomy, 34 min after admission to the hospital. A complete laceration of the SMV trunk was observed. Definitive vascular repair of the transected SMV was performed. An interposition graft from the internal jugular vein was used with a good postoperative course. CONCLUSION: This case report demonstrates that definitive vascular repair of the SMV reduces the risk of intestinal ischemia and should be performed in cases where ligation presents a real threat to small bowel viability. In cases of severe SMV injury, the internal jugular vein is a high-quality and easily accessible graft.
- Klíčová slova
- Pediatric patient, definitive vascular repair, internal jugular vein, trauma of the superior mesenteric vein,
- MeSH
- dítě MeSH
- dopravní nehody MeSH
- lacerace * chirurgie etiologie MeSH
- laparotomie metody MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- poranění břicha * komplikace chirurgie diagnóza MeSH
- poranění cév * chirurgie etiologie diagnóza MeSH
- tupá poranění * komplikace chirurgie diagnóza MeSH
- vena mesenterica * zranění chirurgie diagnostické zobrazování MeSH
- výkony cévní chirurgie metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY: The aim of this study is to describe injury patterns, characteristics, treatment modalities and functional outcomes after punching related injuries. MATERIAL AND METHODS: Retrospective data of cases admitted to emergency department following punch injury between January 1, 2012, and December 31, 2022. was collected. Patient's demographic data, the dominant and injured upper extremity side, punched object, a time of patient admission were recorded. Smoking habit and blood ethanol level were documented. Trauma mechanism, diagnosis (1: dermabrasions: skin, 2: lacerations: neurovascular structures or tendons and 3: osseous pathologies), treatment modalities were analyzed. Outcomes were assessed using the DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand) at the last follow-up. RESULTS: A total of 1052 patients (male=968 (92%), female=84 (8%)) with mean age 24.6 ± 7.2 included this study. Six hundred and twenty-one (59%) patients punched a solid object and 675 (64%) had osseous pathology. The most commonly fractured bone, injured tendon, injured nerve, and injured artery were 5th metacarpal, extensor digitorum communis (EDC), ulnar nerve, and ulnar artery, respectively. The majority of the patients, (73%) were smokers while 15% of the patients had high level of blood ethanol concentration on admission (82±12.3 mg/100 ml). A comparison between smokers and non-smokers did not reveal any significant differences (p=0.425) in terms of diagnosis whereas 74% of alcoholic patients admitted with lacerations which was statistically significant (p=0.023). Injuries of 321 (30.5%) patients required surgery in the operating room, while 711(67.5 %) patients received interventions in the emergency room setting. The average DASH score differed between subgroups, with significantly higher scores in patients with laceration type injuries (7.2 SD), indicating more disability (p=0.001) DISCUSSION. The study reveales a high prevalence of hand injuries among individuals aged 18 to 40, with the dominant hand being most affected, primarily due to physical violence and self-harming behaviors. Primary contributing factors to this pattern are the escalated incidents of physical violence and self-harming behaviors arising from an inability to manage anger impulses. Punching solid objects, especially during late afternoon and evening periods often associated with alcohol use, was a common cause, resulting in metacarpal fractures being the most reported injury. Multiple tendon and nerve injuries were frequent, highlighting the severity and complexity of these traumas, often necessitating surgical intervention. CONCLUSIONS: These findings highlight the several key aspects, including demographic characteristics of the patient population, common causes and types of injuries observed, and the association between alcohol use as well as the specific injury profiles. Satisfactory results can be achieved with both conservative and surgical treatment for punch injuries. KEY WORDS: punching, fisting, boxing injuries, laceration, blood ethanol level.
- MeSH
- dospělí MeSH
- fraktury kostí terapie diagnóza MeSH
- lacerace * etiologie diagnóza terapie MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- poranění šlachy diagnóza terapie chirurgie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- incidence MeSH
- lacerace etiologie chirurgie MeSH
- lidé MeSH
- perineum * zranění chirurgie MeSH
- pooperační komplikace * etiologie epidemiologie MeSH
- prospektivní studie MeSH
- retence moči * etiologie epidemiologie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- dopisy MeSH
- komentáře MeSH
- Geografické názvy
- Uganda epidemiologie MeSH
OBJECTIVE: Evaluation of maternal and neonatal outcomes in operative vaginal deliveries in prospective study analysis. DESIGN: Prospective case-control study analysis. SETTING: Prospective analysis of 292 operative vaginal deliveries (VEX, forceps) for the period June 2016 - August 2017 from overall 6056 vaginal deliveries. Type and frequency of maternal and neonatal trauma occurence was observed in connection with using vacuum-assisted delivery and forceps delivery, mainly the cephalohematomas and their complications. Collected data were statistically analysed. RESULTS: In the reported period from overall 6056 deliveries there were 216 vacuumextractions (3.6%) and 72 forceps deliveries (1.2%) performed. Both methods were used in four patients (VEX and forceps). The most frequent trauma in newborns were cephalohematomas. Remarkable cephalohematoma, requiring further observation has occured in 40 newborns (18.5%) after vacuum-assisted delivery and in 5 newborns (6.9%), (p = 0,017) after forceps delivery. Consequential punction of cephalohematoma occured only after vacuumextraction delivery and in 6 newborns (15.0 %). The third degree perineal rupture occured after vacuumextraction in 20 patients (9.3%) and after forceps delivery in 12 patients (16.7%), (p = 0,091). The fourth degree perineal rupture occured only after vacuumextraction and in 1 case (0.5%). CONCLUSION: The vacuumextraction compared with forceps is more likely to be associated with the statistically significant incidence of cephalohematomas and their further treatment. Forceps deliveries compared with vacuumextraction are more likely to be associated with the maternal perineal trauma, but the diference was not statistically significant.
- Klíčová slova
- cephalohematoma, forceps delivery, maternal trauma, neonatal trauma, vacuum-assisted delivery,
- MeSH
- hematom etiologie MeSH
- lacerace etiologie MeSH
- lidé MeSH
- novorozenec MeSH
- porodní poranění novorozence etiologie MeSH
- porodnické kleště škodlivé účinky MeSH
- prospektivní studie MeSH
- studie případů a kontrol MeSH
- těhotenství MeSH
- vakuová extrakce porodnická škodlivé účinky MeSH
- vedení porodu metody MeSH
- výsledek těhotenství MeSH
- ženské pohlavní orgány zranění MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The objectives of this study were to explore the course of labor and the risk of obstetric anal sphincter injury at the first vaginal birth after cesarean section (fVBAC) in comparison to primiparous vaginal birth (PVB) in women without epidural analgesia and to assess if laboring before the previous cesarean affected these outcomes. METHODS: All fVBACs without epidural analgesia and the subsequent PVBs (controls) between 2012 and 2016 were included in this retrospective cohort study. Data were collected from health records and included maternal demographics, gestational age, and labor details (duration of 1st and 2nd stages, labor induction or augmentation, birthweight, operative vaginal birth, estimated blood loss, extent of childbirth trauma) in both groups as well as cervical dilation at the time of previous cesarean in the fVBAC group. Wilcoxon and Chi-square tests were used for data analyses. RESULTS: The study comprised 510 women; 255 fVBACs and 255 controls. The majority of fVBACs were after a pre-labor cesarean section - 177 (69.4%). There was a statistically significant difference in the recorded duration of first stage between the fVBACs and controls (289 vs. 347 min respectively, p < .001). Women were less likely to have an intact perineum in the fVBAC group (29.8 vs. 43.1%, p < 0.01), however, there was no statistically significant difference in anal sphincter injury rates between both groups (2.3 vs. 1.9%, p = 0.76). The groups differed in rates of cervical tears requiring suturing (21.2 vs. 12.9%, p = 0.01). On further subgroup analysis, the duration of first stage of labor was shorter in women who previously had a caesarean section late in labor (≥ 8 cm cervical dilatation) compared to a pre-labor cesarean section, however, there were no differences in other outcomes. CONCLUSION: Compared to primiparous women having a vaginal birth, women having their first vaginal birth after a cesarean section have a shorter 1st stage of labor (particularly if the cesarean was performed in advanced labor), a higher risk of sustaining cervical lacerations and perineal trauma. However, there was no difference in the risk of sustaining obstetric anal sphincter injuries between the study groups.
- Klíčová slova
- Cervical laceration, Childbirth trauma, OASI, Perineal tear, Vaginal birth after cesarean,
- MeSH
- anální kanál zranění MeSH
- časové faktory MeSH
- cervix uteri zranění MeSH
- císařský řez * MeSH
- dospělí MeSH
- lacerace etiologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- perineum zranění MeSH
- první doba porodní * MeSH
- retrospektivní studie MeSH
- těhotenství MeSH
- vaginální porod po císařském řezu škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Tracheobronchial rupture after tracheal intubation has been infrequently reported. Successful diagnosis often requires a high level of suspicion. A laceration of the distal membranous trachea usually has been repaired through a right thoracotomy.
