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24th European Congress of Trauma & Emergency Surgery 

The eposters will be accessible during the entire congress.

Laparoscopic cholecystectomy for traumatic gallbladder laceration

Visceral trauma

Emergency surgery

Case history: 30-year-old female with history of drug abuse presents to the ER with head and abdominal trauma following a bicycle accident. Patient was initially amnesic and could not give a detailed history. Clinical Findings: Normocardic, normotensive, with intense abdominal pain in the lower quadrants with no guarding and negative FAST. After analgesia, patient was significantly better and fell asleep with serial abdominal examinations being unremarkable. 24h after initial presentation, patient was still hemodynamically stable, but growing epigastric ecchymosis and sustained abdominal pain warranted a formal abdominal ultrasound and CT scan. Results: US – V segment hepatic laceration and hemoperitoneum. CT – IV-V segment hepatic laceration from surface to hilum (60 cm) with no vascular lesion and no blush but apparent gallbladder laceration, hemoperitoneum more pronounced in the upper quadrantes. Diagnosis: AAST III liver laceration with concomitant gallbladder laceration, with no hemodynamic instability. Therapy and Progressions: Exploratory laparoscopy was proposed with low threshold for conversion if active hemorrhage was identified and packing was needed. Intra-operatively only bile and blood clots were aspirated with no active hemorrhage identified. Simple cholecystectomy was performed, hemostatic gauze was placed on the liver laceration and hemostasis revision was performed with low pressure insufflation. Peri-hepatic drain was left. Patient was discharged at 7th post-operative day with no complications but lost to follow-up, but with no other related emergency visits to date. Comments: Exploratory laparoscopy is safe and effective on selected patients, especially hemodynamic patients, although a lower threshold for conversion is advised. Intoxicated patients can present added difficulty with disproportionate clinical findings and challenging diagnosis.Fig1 - CT scan; Fig2 - Intra-opNo

ePoster (self-study)

Management of severe blunt liver injury by applying the damage control surgery and staged hepatectomy

Trauma and Emergency surgery | Miscellaneous

Case history A 36-year-old female presented to our emergency department due to blunt abdominal trauma injury cause by car accident.Clinical findingsThe patient was in hypovolemic shock with the blood pressure of 90/60 mmHg, weak peripheral pulses at the rate of 110 per minute.Investigation/ResultsFocused Assessment with Sonography for Trauma(FAST) was positive for free fluid in perihepatic area. Abdomianl CT findings showed liver parenchymal laceration in multiple segmentsDiagnosisAAST Grade IV liver injuryTherapy and ProgressionsEmergency operation was performed. Necrosectomy and hepatic bleeding control was performed with perihepatic packing and placed temporary abdominal closure dressing. The second-look laparotomy performed 36 h after the first operation. Lt hepatectomy and packing removal was performed. The postoperative course was uneventful. Damage control sugery and staged hepatectomy is safely performed.CommentsThe liver is the organ most commonly injured in blunt abdominal trauma. Current operative management is packing, damage control, and early utilization of interventional radiology for angiography and embolization. Liver resection is thought to have minimal role in the management of hepatic injury. In high grade liver injuries, Staged liver resection makes possible to effectively control bleeding, remove necrotic tissue and prevent complications as bile leak. Patient selection and decision making by operative findings should be carefully considered by experienced trama and liver surgeons.ReferencesManagement of blunt hepatic trauma. Letoublon C, Amariutei A, Taton N, Lacaze L, Abba J, Risse O, Arvieux C. J Visc Surg. 2016 Aug;153(4 Suppl):33-43. PMID: 27519150No

Epidemiological analysis of the COVID-19 pandemic: Impacts on traffic accidents and trauma in Brazil

Research

INTRODUCTION: In Brazil, traffic accidents cause an average of 40,000 deaths per year, placing the country in 5th place worldwide in traffic-related deaths. During the COVID-19 pandemic, the changes caused by social distancing measures affected the epidemiology of trauma, including traffic accidents. The public health guidance to limit outdoor activities led to a decrease in urban mobility, changing the patterns of traffic incidents. OBJECTIVES: Analyze the impact of the COVID-19 pandemic on the incidence of traffic accidents in Brazil, focusing on their different types, and comparing to the pre-pandemic period. MATERIALS AND METHODS: Analytical approach to the epidemiology of traffic accidents and trauma during the COVID-19 pandemic, specifically in 2020, using the DATASUS platform. RESULTS: The number of hospitalizations in Brazil due to traffic accidents was 193,935 in 2020, 198,896 in 2019, and 191,094 in 2018. For injured motorcyclists, there were 103,869 hospitalizations in 2020, compared to 103,549 in 2019 and 96,871 in 2018. In bus-related accidents, there were 196 records in 2020, 286 in 2019, and 332 in 2018, indicating a reduction of 31.5% and 40.9%, respectively. DISCUSSION: It was observed that traffic accidents remained high in 2020, mainly related to motorcycles. The study by Silva et al., which evaluated accidents in a Brazilian hospital, showed that most of them involved motorcycles, which may be related to the increase in home delivery services, in addition to the excessive demand that may have resulted in exhausting work, leading to distractions in traffic. CONCLUSION: Therefore, it was possible to assess that, from 2019 to 2020, during the pandemic, there was an increase in the number of hospitalizations due to motorcycle accidents, and on the other hand, there was a decrease in hospitalizations caused by bus accidents. REFERENCES: Ministry of Health. DATASUS (TABNET). 2024. Available at: https://datasus.saude.gov.br/informacoes-de-saude-tabnet/.No

Conservative treatment of a complicated traumatic pulmonary pseudocyst: A case report

Case history, clinical findings, and investigations: A man in his twenties was admitted to our hospital after a tractor rollover. At admission, he was respiratory and hemodynamically stable. A CT scan revealed multiple rib fractures on the right side, a lung contusion, a traumatic pulmonary pseudocyst in the lower lobe of the right lung, and an occult pneumothorax on the right side.Diagnosis: multiple rib fractures, traumatic pulmonary pseudocyst on the right side, occult pneumothorax on the right sideTherapy and progressions: Chest drainage was proposed to the patient to treat traumatic pneumothorax, and he subsequently developed pleural effusion, but he was reluctant and finally chose rather conservative treatment. On repeated chest radiographs two months after the injury, we noticed pleural effusion and traumatic pseudocyst regression, without any signs of pneumothorax progression.Comments: Traumatic pulmonary pseudocysts are rarely seen after blunt chest trauma. They are usually seen in the lower pulmonary lobes in younger patients. These lesions are generally self-limiting and do not require any specific surgical treatment. Complications like hemothorax, pneumothorax, and cavitary infections are indications for surgical procedures like chest drainage, surgical debridement, or resections. Complicated traumatic pulmonary pseudocyst could also be a self-limiting condition in some stable, young patients. Close monitoring and evaluation of patients conservatively treated is highly recommended.References: 1.Asamura H, J, Detterbeck F, Goldstraw P, Lerut A, Thomas P, Treasure T, et al. ESTS textbook of Thoracic Surgery: Vol.2. Cracow: Medycyna Praktyczna, 2015: 879–935No

Prof.

Retroperitoneal abscesses resulting from foreign bodies following penetrating trauma to the perineum

Case history/ An 18-year-old male fell onto a wooden stick, resulting in a perineal laceration. Clinical findings/ Upon admission, the patient was hemodynamically stable. The physical examination revealed a two-centimeter pararectal laceration affecting the anal sphincter with proximal extension. Investigation/Results/ The CT scan of the pelvis showed pneumoretroperitoneum. No additional injuries were noted on imaging, with no significant decrease in hemoglobin. Diagnosis/ The patient was rushed to the Operating Theatre with suspected perforation of the rectum. Therapy and Progressions/ Intraoperatively, reconstruction of the anal sphincter was performed, while exploration did not show definite signs of perforation. The bipolar sigmoidostomy was created. The patient was readmitted a week after the discharge due to a high fever. A CT scan identified a retroperitoneal abscess (Figure 1.,2.). The patient underwent exploratory laparotomy for abscess drainage and the evacuation of a foreign body—a piece of fabric. A few days later, the patient developed signs of ileus and acute abdomen. Hematoma, necrosis, and another foreign body—human hair— were found at the left colic flexure during surgery. A left hemicolectomy with unipolar transversostomy was performed. Months later, he returned to restore intestinal continuity through an end-to-end transverse-sigmoid anastomosis. The patient is currently doing well and remains asymptomatic. Comments/ While the perineal injury did not lead to immediate intestinal perforation, it facilitated the entry of foreign bodies, resulting in recurrent retroperitoneal abscesses, intestinal injury, and multiple surgical interventions. References/ McMahon KR, Balasubramanya R. Intestinal Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls; 2024 Jan. Figure legends/ Figure 1.,2. CT of the abdomen and pelvis. The frontal (Figure 1.) and sagittal (Figure 2.) planes of the CT scan show a retroperitoneal abscess 10x9x17 centimeters.No.

Home-run hit to the chest: Trauma-induced lad occlusion triggers ventricular fibrillation in a young male

A 36-year old male fell on his chest during a baseball game. The prehospital clinical evaluation was reassuring, with normal vital parameters. The patient had a normal ECG was transported to the nearest emergency department. Ten minutes after admission he had a cardiac arrest with ventricular fibrillation for which he was resuscitated following the advanced life support algorithm, including repeated defibrillations. The patient regained return of spontaneous circulation after 15 minutes and remained hemodynamically stable. The patient was transferred to our hospital as the ECG now indicated an anterior wall myocardial infarction (figure 1), while a transthoracic echocardiography (TTE) showed moderate hypokinesis of the left ventricle. After exclusion of post-traumatic lesions by CT angiography, a coronary angiography was performed. This diagnosed an occlusion of the left anterior descending artery, for which a coronary stent was placed (figure 2).The patient was admitted to the intensive care and dual antiplatelet therapy was initiated. A repeat TTE showed a left ventricular ejection fraction of 48% with mild global hypokinesia at discharge. Blunt impact to the chest can cause cardiac injuries, such as coronary artery dissection (1). We suspect an intramural hematoma, as the angiography showed no characteristic findings of a dissection (2). An acute coronary syndrome with cardiac arrest after low impact chest trauma should raise suspicion for traumatic coronary occlusion.Figure 1: STEMIFigure 2: Blocked LAD & Open LAD with stentReferencesChan, E. L., Malik, J. S., & Gomez, C. (2021). Management of Acute Coronary Syndrome Following Blunt Chest Trauma: A Case Report. Bulletin of emergency and trauma, 9(3),Saw J. (2014). Coronary angiogram classification of spontaneous coronary artery dissection. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 84(7),No conflicts of interest.Spelling & grammar check with chatGPt.

Emergency department recuscitative thoracotomy

BACKROUND: Emergency Department Thoracotomy (EDRT) after traumatic Cardio-pulmonary Arrest (CPR) can be used to salvage select critically injured patients. Indications of this surgical procedure are widely debated and changed during last decades. Methods: We evaluated case series of all the adult trauma patients admitted to Nicosia Trauma Center in Cyprus for 12 month period – and patients needed thoracotomy after blunt or penetrating trauma Results: During the study period , 274 patients attended the trauma center who met the TTA ( Team Trauma Activation) criteria , totally 11 patients needed thoracotomy ( 4%)- blunt trauma ( 7) and penetrating ( 4) Following emergency thoracotomy, Mortality for blunt trauma was 14% and for penetrating 25%. Conclusions: It is critical to identify the patient population who will benefit from EDT. Resuscitative efforts should not be abandoned prematurely in the potentially salvageable patient but field assessment of salvage ability is unreliable References : 18NO

Pancreatic trauma during a game of football

Polytrauma

Case history - Pancreatic trauma is a rare entity, but a potentially lethal one. The diagnosis is often difficult due to its location in the retroperitoneal cavity and conventional imaging may miss subtle findings. Most injuries are low grade and seldom manifest alone. Post-traumatic pancreatitis might not manifest until several hours after the initial trauma, which can delay the diagnosis and potentially lead to complications (e.g. infection).Clinical findings - We present a case of a 18-year-old male, without known diseases. He presented to the emergency room with epigastric pain and vomiting, which developed 8 hours after a blunt abdominal trauma whilst playing football. He was hemodynamically stable.Investigation/Results - Blood work revealed an elevated lipase and amylase and an abdominal CT scan demonstrated pancreatic oedema and a small haematoma of the body of the pancreas,without duct injury.Diagnosis - Post-traumatic pancreatitis and pancreatic lesion (grade I according to the AAST score) after blunt abdominal trauma.Therapy and Progressions - Conservative treatment with fluids and analgesia was started and the patient was admitted to the surgical ward. Initially with difficult pain control, however with progressive clinical and blood work improvement. A control CT scan showed a small peri-pancreatic collection (diameter of 1 cm) with no signs of complication. The patient was discharged 9 days after admission. At follow-up, he remained asymptomatic and with normalized CT scan and blood work.Comments - Post-traumatic pancreatitis and pancreatic injury can be difficult diagnosis to achieve and only belatedly recognized when complications develop. A high degree of suspicion is essential and a CT scan should be performed to assess organ damage and guide the necessary treatment.References - Sharbidre, K.G., Galgano, S.J. & Morgan, D.E. Traumatic pancreatitis. Abdom Radiol45, 1265–1276 (2020). https://doi.org/10.1007/s00261-019-02241-7No

Management of splenic trauma at Aintree university hospital: An audit

IntroductionThe spleen is the most common organ to be damaged in blunt trauma injuries, resulting in haemorrhage and life-threatening haemodynamic instability. Our study aimed to evaluate the management of traumatic splenic injury at a major trauma centre against current international guidelines, and identify areas of good practice and areas for improvement.MethodsData was obtained from an existing data set of trauma patients presenting to AUH between 2018-2022. Patients with splenic injury confirmed on CT scan were included. Electronic notes and scanned notes were reviewed for data collection and analysis. Standards included:1) 80% of patients received CT/FAST scan2) 100% of patients receiving correct grading of their splenic injury according to American Association for Surgery of Trauma (AAST) guidelines.3) 100% of patients received correct treatment based upon the World Society of Emergency Surgery (WSES) guidelines.Results115 patients were included, 73% (n=84) males and 27% (n=31) females with a median age of 46.3. All patients underwent CT scan. Of these patients, 73% (n=84) received an AAST grading, of whom 93% (n=78) were graded correctly. Management comprised of either non-operative management (NOM) or operative management (OM). 63%, (n=73) had NOM in the form of conservative management and/or interventional radiological embolization, 37% (n=42) underwent OM. 5% ( n= 6 ) failed conservative management and required surgery. 37% ( n=43 ) were managed correctly according to WSES guidelines. Correct management was undetermined in 27% (n=31) due to lack of AAST grading. When graded according to WSES, patients with WSES III and IV had a lower adherence to correct management (40% and 43% respectively) versus WSES I and II.ConclusionAll patients received the gold standard investigation (CT). However not all patients were graded and managed correctly. This highlights the need to balance application of clinical experience versus adherence to guidelines. No conflicts of interest

ePoster presentation

Resuscitation thoracotomy – Knowing the rules of the game and when to quit

Aim and background: In recent decades, the indications to perform a resuscitation thoracotomy reported in the literature have varied from very vague to very specific, being the penetrating mechanism by piercing object the most accepted indication for presenting the most favorable survival (>15%). Case description: We present the case of a 47 year-old man who entered the emergency area after suffering penetrating trauma in the left hemithorax. During the evaluation and resuscitation maneuvers he presented sudden cardiac arrest, for which resuscitation thoracotomy was performed. During the thoracotomy, myocardial injury of partial thickness in the left ventricle with active bleeding was observed, for which cardiorrhaphy was performed. The patient was discharge from the hospital 15 days after the traumatic event. Conclusion: Resuscitation Thoracotomy involves the mobilization of human resources and equipment with an impact on the cost-benefit of the care of patients with severe polytrauma; for this reason the feasibility of offering a resuscitation thoracotomy in a trauma center is considered a quality indicator in some countries. The Europe experience with trauma victims with blunt mechanism and more liberal criteria for the performance of resuscitation thoracotomy has allowed to increase the survival of more patients; on the other hand, the use of these criteria in conjunction with training in simulators - as a gap of opportunity- it will allow to increase the effectiveness of the personal to carry out this maneuver.No.

ePoster session (self-study)
Visceral trauma (self-study)

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Programm

ePoster session (self-study)Visceral trauma (self-study)

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ePoster session (self-study)
Visceral trauma (self-study)