ectes-2025-eposter2-67e3feaeba922792958446.jpg

ectes-2024-eposter-logo-67e3feaf078cb246155060.svg

ectes-2025-eposter-1-67ee376d6199e315368845.jpg

24th European Congress of Trauma & Emergency Surgery 

The eposters will be accessible during the entire congress.

PD Dr. med.

Prof. Dr.

PD Dr.

Dr. med.

Prof. Dr. med.

A novel assessment tool for detecting injuries of the lower extremities in trauma bay patients: The "Straight-Leg-Evaluation-Trauma-Test" (SILENT)

Polytrauma

Skeletal trauma and sports medicine

IntroductionRapid and precise assessment of relevant injuries is essential in the initial treatment of severely injured patients in the trauma bay. We present a concise novel technique for the rapid and safe evaluation of a novel test for detecting shaft fractures of the lower extremityMethodsFirst, the test was assessed in a cadaver study. Cadavers had different types of injuries (femoral shaft, tibial shaft, both fractures) and one served as control. Examiners were blinded to the injuries and performed their routine test and the novel test.In a second step this novel test was introduced in the clinical setting. Treating trauma surgeons applied the test in all consecutive patients in the trauma bay and documented their results. These clinical results were then compared with the radiographic assessment.In a final step a survey has been performed that included all trauma surgeons who had some experience with the novel test assessing reliability, safety, and recommendations.ResultsThe cadaver study yielded a positive predictive value of 0.97 (95% CI 0.93 to 0.99) with highest sensitivity and specificity for detecting tibia shaft fractures. In the clinical setting, the overall sensitivity for the SILENT was 5% (95%CI 64 to 84%), and overall specificity was 99% (95%CI 97 to 100%). Highest sensitivity was for detection of tibia fractures (93%, 95%CI 77 to 99%). Sensitivity of SILENT was higher in the unconscious patient (96%, 95%CI 78 to 100%) with a near 100% specificity.The survey yielded comparable safety with increased standardization of the assessment procedure when compared with the conventional testing.ConclusionThe SILENT appears to be a rapid, safe and secure alternative to conventional testing. Radiographic evaluation based on positive SILENT is highly recommended.No

ePoster (self-study)

Knife housed in abdomen. Absolute indication of surgery?

Visceral trauma

Case History2 cases of self-inflicted stab injuries to the abdomen, the weapon being kept in the abdomen56-year-old male, drinker and with psychiatric history82-year-old female patient with multiple medical historyClinical findings1.He is hemodynamically stable. Globular abdomen, diffusely painful, without peritonism and a large knife that crosses the abdomen from right to left tangentially, observing the handle and the tip2.She is hemodynamically stable. Knife stuck in the left flank and immobilized with multiple swabs. Tender abdomen, painful, without peritonismInvestigation/resultsBoth are hemodynamically stable, they only have the described stab injury and the weapon continues to be lodged in the cavity.DiagnosisPatients injured by a stab in which the damaging instrument continues to be housed at the time of arrival at the hospital must go to OR. This instrument must be removed under direct vision, previously having vascular controlTherapy and progressions1.Laparotomy. The path of the knife is subcutaneous at its beginning and end. However, in the middle part, the patient has an abdominal hernia, entering the cavity at that level. There are no vascular or intestinal lesions. After removing the knife, a wall repair is carried out with Rives-type mesh2.Laparotomy. The path of the knife from the left flank to the lesser sac. Small bleeding from omentum, without intestinal lesionsCommentsThe urgent surgical indication for the removal of the damaging instrument is clear, with vascular control under direct vision prior to its removal. Both cases underwent surgical intervention, although neither of them had significant injuriesReferences:Shih HK, et al. Elderly Patient With Abdominal Stab Wound. SJ.Ann Emerg Med. 2021 May;77(5):547-559Mock K, et al. Are Self-Inflicted Stab Wounds Less Severe Than Assaults? Analysis of Injury and Severity by Intent. PJ.J Surg Res. 2021 May;261:33-38No

Eye-catching injury, the enemy of a protocolized trauma management

Case history:44-yo man brought to the ER after being run over by a tractor.The patient was and transferred by helicopter.Pre-hospital care time:120 min.Clinical findings: A/B:Airway protected by endotracheal tube.Normal breath sounds bilateral.SpO2 100%, FiO2 100%. C:BP 99/60 without VAD, HR 84bpm.Peripheral pulses present and symmetric.Delayed capillary refill. D:CSG 3/15 (sedated).Reactive isochoric pupils. E:36ºC.Bowel evisceration through groin and left scrotum with three perforations.Right leg shortened and externally rotated.Investigation/results:Chest X-Rays normal.E-FAST -.Pelvic X-Rays:Unstable fracture. CT scan:Evisceration of small bowel through the inguinal canal (probable pre-existent inguinal hernia).Unstable pelvic fracture. Displaced fracture of the right femoral diaphysis.No signs of active bleeding.Therapy and progressions:Emergency surgery:External fixation and closure of the pelvis and external fixation of the right femur was performed by orthopedic surgeons.Concurrently, intense washing of the eviscerated bowel and resection of the perforated segments was performed.Subsequently, the intestinal package was reintroduced into the cavity through the inguinal defect.After completion of the bone fixation, abdominal cavity was opened and examined, without any new findings.A single anastomosis was performed and the scrotum was primary closed after removal of devitalized skin.The inguinal hernia was not repaired.Follow up:The patient progressively recovered in the ICU. Definitive pelvic and femoral fixation was performed 7 days after the first surgery.He developed a right tight abscess and a laparotomy wound infection that were drained 18 days after arrival.Definitive hernioplasty was performed 30 days after arrival.Comments:Traumatic injuries can be very spectacular.It is important not to be distracted by their eye-catching nature and to always perform a standardized managementof the polytraumatized patient in order to obtain the best results.No

The relevance of a good organization of the trauma team in the management of multiple trauma victims in a level II hospital

Trauma and Emergency surgery | Miscellaneous

CASE HISTORY: We present 3 polytrauma patients, victims of a car crash, admitted simultaneously to the ER of a level II trauma hospital.CLINICAL FINDINGS: After the alert of trauma arrival, the team had 20 minutes to organize and start the primary survey that found 3 hemodynamically stable patients:P.1: 35y man, GCS 13 with abdominal pain and limbs deformities;P.2: 56y woman, GCS 15 with abdominal and dorsal pain;P.3: 66y man, GCS 15 with worsening respiratory failure and open fractures of lower limbs.INVESTIGATION: After initial resuscitation, due to suspicion of polytrauma, all patients went to the CT scan, starting by P.2.DIAGNOSIS: P.2: maxillofacial trauma, vertebral fractures and hemoperitoneum;P.1: a small subarachnoid haemorrhage, hemoperitoneum and a femur fracture;P.3: thoracic trauma with pulmonary contusion.THERAPY: Due to sudden instability, P.2 was immediately taken to the OR and submitted to an exploratory laparotomy that found mesenteric disruption and bowel injury. She was admitted to the ICU for ongoing support.P.3 was stabilized in the ER, needing non-invasive mechanical ventilation, and admitted to the ICU with intervention of Orthopedics on the next day.P.1 was submitted to an exploratory laparotomy with mesenteric disruption and bowel perforation. On the next day he was transferred to a level I trauma centre for neurosurgery intervention due to neurologic deterioration.COMMENTS: These cases alert to the importance of a well organized trauma team with the roles of each element clearly defined in the management of multiple trauma victims, mainly in a hospital with limited resources. It"s essential to have an adequate primary survey, according to the principles of ATLS, to assess all lesions and establish priorities.In level III or II hospitals it"s also important to define the need of transference to level I trauma centres when there aren"t sufficient resources, like the case of P.1.REFERENCE: P. Goode, ETC The team approach, 4th editionNo

Cost analysis of emergency care for motorcycle accident victims in the emergency unit

Motorcycle accidents have significantly increased in recent years, leading to higher public expenditures. Most patients require multidisciplinary care in emergency services, necessitating urgent surgeries and intensive treatment. This study aims to estimate the treatment costs of motorcycle accident patients in a public hospital's emergency unit in São Paulo. This is a prospective, observational, exploratory, and descriptive study. The Research Ethics Committee waived project approval since it does not involve human subjects, focusing only on resource utilization data. From December 2023 to June 2024, ten patients who suffered motorcycle accidents were monitored in the Emergency Unit of the Hospital de Clínicas at Unicamp. Various procedures were conducted based on individual needs, and a table was created detailing each patient"s clinical case and materials used. Limitations included the exclusion of costs for cleaning, utilities, hospitality supplies, and blood products. The average total cost for treating all ten patients was $20,490.60. These findings will aid in managing care for motorcycle accident patients, promoting efficient use of physical, human, and material resources. The project aligns with enhancing quality of life in healthcare, particularly in urgent and emergency care services.ReferencesSantiago, MLO et al. Mortalidade e anos de vida ajustados por incapacidade de motociclistas na América Latina e Caribe. 2023. Available from: https://iris.paho.org/handle/10665.2/57369World Health Organization (WHO). Brasilia Declaration. Proceedings of the Second Global High-level Conference on Road Safety. Brasília: ONU; 2015. Available from: https://cdn.who.int/media/docs/default-source/documents/un-road-safety-collaboration/brasilia_declaration_en.pdfMachado, SM et al. Lesões e padrão das vítimas de acidentes de trânsito com motocicletas. Available from: https://revistas.pucsp.br/index.php/RFCMS/article/view/52392/39972Conflicts of Interest: The authors of this work declare that they have no financial, personal, or professional interests that could influence the research. Funding: This work was funded by the Institutional Program for Scientific Initiation Scholarships (PIBIC), which is linked to the funding agency of the National Council for Scientific and Technological Development (CNPq). Data and Transparency: This research project was developed in collaboration with students and advisors from the Trauma League of the Faculty of Medical Sciences (FCM) of Unicamp. The Ethics Committee on Research issued a statement exempting this study from approval under CAAE: 64883022.2.0000.5404 and opinion 5.827.634. The data from this work will be made available upon request and approval from the authors.

Prof.

Caution slow down, pedestrian trauma

Pedestrian accidents are a significant global concern and can have severe consequences for those involved often result in serious injuries and fatalities1. Large cities tend to have higher rates of pedestrian trauma due to increased traffic and pedestrian activity and are implementing safety measures and public awareness campaigns2.Pedestrian accidents can result in a variety of trauma: head injuries ranging from concussions to severe traumatic brain injuries; spinal cord injuries with devastating consequences, leading to long-term disabilities; orthopaedic fractures or liver, spleen, lungs trauma that may not be immediately apparent but can be life-threatening.Our aim is to conduct a retrospective observational cohort study of road trauma pedestrians admitted to our institution from January 2019 to today, within 24 h of involvement in vehicle collision. The study will analyse data including Injury Severity Score calculated from ICD-9-CM codes, mortality rate, length of hospitalization, and need for intensive care support of patients divided by sex, age, blood alcohol levels, place, and time of the accident, and need for centralization. Results can lead to campaigns to educate both drivers and pedestrians about safety measures, implementing better crosswalks and pedestrian signals, enforcing speed limits in specific high-risk areas, raising awareness for both distracted drivers and pedestrians to stay alert and aware of their surrounding while walking.Pedestrian trauma need multidisciplinary approach and standardized protocol of severe trauma"s centralization offering specialized medical services that smaller hospitals might not provide, such as advanced trauma care, specialized surgeries, and high-level diagnostics.1.Widodo, A. F. et al. Walking against traffic and pedestrian injuries in the United Kingdom: new insights. BMC Public Health (2023)2.Tiwari, G. Progress in pedestrian safety research. Int. J. Inj. Contr. Saf. Promot (2020)NO

Hindfoot nailing for trauma

Today, for intramedullary nailing of the tibia a thin nail is usually inserted from the knee at the proximal tibia and driven distally to stabilize the fracture. We inserted a nail from the calcaneus in one hundred trauma patients during a ten-year period. Follow up of these patients is three years. Most outpatients were able to weight bear after a month. The hindfoot nail can be removed after one year with return of some subtalar motion in appropriate cases. Hindfoot nailing is a useful option for polytrauma patients to restore their ambulatory status expeditiously.No.

Unusual blunt diaphragmatic rupture: A case report

Case history52 year-old man taken to the emergency room after a thoracic and abdominal blunt trauma in a high speed frontal collisionClinical findingsThe patient arrives with a laryngeal mask to the hospital with a SatO2: 80%. The patient is intubated in the emergency room. BP: 130/80 mmHg and HR: 134 bpm. GCS 7Results- Eco-FAST: Left anterior pneumothorax, with no intraabdominal free fluid- Blood test: Ethanol < 3 mg/dl, Hemoglobin 14.5 g/dL (12.0 - 17.0)- CT Scan: left diaphragmatic rupture, with left pneumothorax and pneumoperitoneum. Mesenteric hematoma. Bilateral rib and sternal manubrium fractures. Complex fracture of the left hemipelvis.DiagnosisLeft diaphragmatic rupture grade IVTherapy and ProgressionsIn the emergency room a chest tube was placedAn urgent laparotomy was carried out. We found the gastric fundus and the spleen in the thoracic cavity through a left diaphragmatic rupture (15cm)We reduce the herniated stomach and spleen and the diaphragmatic rupture was closed with PDOÒ.The patient was discharged after 40 days to his hospital of reference, with no signs of hernia recurrence.Comments Diaphragmatic injury is uncommon (less than 1%) with blunt mechanisms accounting for 35% of these. . The blunt trauma is also associated with other injuries, including lung (48%), thoracic aorta (2,8%), bladder (5,9%) and spleen (44%) 1,2.Grade I-III could be repair with simple suture. Grade IV and V sould need a mesh repair2What"s remarkable about the case at hand was that, considering the size of the diaphragmatic defect (Grade IV), a primary repair was performed with very good results.References Mallory Williams. Recognition and management of diaphragmatic injury in adults. Up to dateCharles E. Lucas and Anna M. Ledgerwood. Diaphragmatic Injury. Current Therapy of Trauma and Surgical Critical Care, 329-339.e1Figure 1 : CT scanleft diaphragmatic ruptureFigure 2: left diaphragmatic rupture (15cm) NO

Laparoscopic management of delayed blunt small bowel perforation and splenic laceration

The diagnosis and management of small bowel perforation in blunt abdominal trauma can be difficult.We present the case of a man with spleen"s hematoma following blunt abdominal truma.After conservatively management,there was a deterioration in abdominal pain.A CT scan revealed free air and fluid in the peritoneal cavity.Emergency laparoscopy revealed hemoperitoneum,purulent abdominal effusion,spillage bowel content and allowed hemostasis of the spleen's laceration and resection of the perforated bowel.This case emphasizes the importance of considering small bowel perforation in blunt abdominal trauma.Early recognition and prompt intervention are paramount for improving outcomes.NO

Decision making saves lives in trauma. Seven surgeries in 34 hours: Is this what trauma surgery is all about ?

Case Report A 29-year-old male was dropped outside ED with alleged history of RTC, was taken back home by friends while bleeding. A homemade Tourniquet was applied at home to stop the bleeding during which time he collapsed became unresponsive so rushed by family to hospital. In rhesus, patient had no respiratory effort, no central pulse, GCS 3 with no signs of life. HOTT protocol started, intubated and bilateral chest thoracostomy done which revealed left pneumothorax. A large wound on the left proximal femur wrapped in clothes and two tourniquets (long shoelaces) soaked in bright red blood was noted. Despite intubation, bilateral thoracotomies and initiation of resuscitative measures no output was noted, so a decision for a clam shell taken which revealed an empty heart and a flat aorta with feeble heart contraction. Internal cardiac compressions started and manual compression on the thoracic aorta applied. Resuscitation with shock packs, fluids continued. Increased cardiac contractility with SBP of 70 mm of hg achieved in 5 minutes. The chest cavity was packed and a PAN scan done which revealed abrupt cut off in the left SFA with absent distal flow. He was transferred to theatre for surgery with continuous resuscitation. He underwent 7 surgeries in the next 34 hours which included two thoracotomies, three laparotomies, an interposition graft and amputation. In addition he had severe ischemic liver injury with deranged LFT"s with coagulopathy which was managed conservatively requiring support with dialysis and TPN. Underwent further surgery for closure of amputation stump and VATS for empyema left side of chest and discharged after 53 days in hospital. Comments The timing of definitive surgery in multiple injured patients remains a topic of debate, and multiple concepts have been described. Early recognition of injuries and management in trauma surgery is important and depends on injury patterns and physiological patient responses.No

Precision and stability: Loop X 3D navigation in unstable pelvic fracture repair after severe camel-riding trauma

This case study highlights a multidisciplinary approach to complex pelvic fractures, showcasing the use of Loop X 3D navigation for precision and stability in surgical fixation. By examining a patient"s journey from initial trauma to definitive treatment, we demonstrate how advanced imaging and navigation improve surgical accuracy and outcomes in unstable pelvic fractures (UPF).Patient PresentationA 45-year-old female suffered severe trauma from a fall off a running camel, presenting with complex pelvic fractures, including displaced right pubic rami, a comminuted sacral fracture, TBI, and rib fractures.The patient was intubated, sedated, and stabilized with a pelvic binder. Imaging confirmed severe pelvic and cranial injuries. An external fixator was applied due to hemodynamic instability, with ICP monitoring and neuroprotective measures for TBI management.Loop X 3D Navigation After hemodybilization in the UCI, ORIF was done with Loop X 3D with navigation and fluoroscopy- insertion of 2 right S1 screws 7.3x 140mm and 6.5 mm x 75mm with a washer - left 6.5 mm x 75 mm screw. Real-time 3D imaging guided optimal fixation points, enabling accurate alignment with minimal soft tissue and neurovascular risk. Loop X navigation provided stable fixation, reduced fluoroscopy reliance, minimized radiation exposure for surgeons and enhanced procedural precision.Postoperative and Long-Term OutcomesPrecise fixation with Loop X supported rapid recovery, avoiding revision surgery and promoting healing. Neuro-monitoring confirmed ICP stability, while orthopedic evaluations showed successful pelvic alignment and consolidation, aiding rehabilitation.ConclusionThis case demonstrates the impact of Loop X 3D navigation in managing complex pelvic fractures, enhancing accuracy and safety in challenging cases. Supported by precise navigation, multidisciplinary care underscores Loop X"s role in advancing trauma orthopedic standards.None

Role of transplantation in post-traumatic severe liver injury. Case report and review of literature

Case History: We report a case of a 34-year-old male patient with major gunshot trauma to the neck and chest- abdomen. Clinical findings, Investigations: He was transferred at the emergency department on arrest and resuscitative thoracotomy was performed. After restoring blood flow, an emergency laparotomy was carried out. We identified grade V splenic laceration, left kidney rupture, grade III liver injury on section VII, and retroperitoneal haematoma. We performed splenectomy, Lt nephrectomy, and packing. The abdomen was left open with VAC.. Therapy- Progressions: The patient was transferred to the ICU. On second-look laparotomy ischemia of right colon was found, and right colectomy was performed. Due to sanguineous drainage, he was transferred to the OR again, where severe liver injury was identified, and liver packing was carried out. CT angiography showed active extravasation from right hepatic artery. Angiography with pseudoaneurysm of right hepatic artery and embolization was performed. Progressive liver failure with hyperbilirubinemia. ERCP was performed without evidence of dilatation. At the ICU, he became septic, with high needs for vasoconstrictors. The patient passed away on day 40.Comments: Despite the damage control approaches to achieve hemodynamic stability in patients with severe liver injury, some develop hypovolemic shock, acute liver failure, and death. Hepatic vessels thrombosis, sepsis, major hepatic resections are associated with the progression toward irreversible liver failure. Liver transplantation has a limited role in specific liver trauma cases, when initial therapeutic options fail. As a trauma centre that has not been firmly established for an extended period, we have limited experience with this particular issue. This patient’s case has prompted us to investigate further and explore additional avenues of research. Better collaboration with liver transplant specialists is essential for optimizing patient outcomes.Legend: Photos 1. Post traumatic ischemic liver with cavitation 2. Angioembolization radiopaque material of right hepatic artery on day 7.The authors declare no conflicts of interest.

Three strikes in the chest: The hidden dangers of pneumothorax, pneumomediastinum and subcutaneous emphysema

INTRODUCTION:Thoracic trauma is among the primary causes of morbidity and mortality. When trauma significantly impacts the thoracic area,it can lead to critical complications, including pneumothorax, pneumomediastinum and extensive subcutaneous emphysema.Timely management, precise diagnostic imaging and appropriate treatment are essential for successful outcomes.However, in polytrauma patients, the presentation of symptoms and the complexity of the overall clinical picture may complicate the prioritization of interventions.C.C.: This case involves a 65-year-old male patient who presented to the ED with dyspnea and chest pain. 48 hours earlier, the patient had been evaluated for a loss of consciousness and left-sided flank pain after a fall and discharged with a diagnosis of syncope and a left-sided 7th rib fracture.However, upon further examination in the ED, CAT scan revealed the presence of a left-sided pneumothorax, pneumomediastinum, and extensive subcutaneous emphysema.Immediate intervention involved the placement of a chest drain to decompress the pneumothorax, which enabled a rapid stabilization of the patient"s respiratory function; the patient was admitted to the ICU for 24 hours to receive NIV and progressively weaned off oxygen therapy.On the 6day, after radiological confirmation of resolution, the chest drain was successfully removed.CONCLUSIONS: Thoracic trauma presenting with complications demands prompt treatment tailored to the injury's severity.The literature highlights that these complications may either share an underlying etiology or act as confounding factors.Evidence further indicates that chest drainage remains a cornerstone procedure in managing traumatic cases complicated by pulmonary collapse as it helps mitigate the risk of associated complications.A well-coordinated approach is vital in these cases as rapid intervention can significantly enhance patient recovery trajectories and reduce the likelihood of recurrent or worsening symptoms.No

Traumatic diaphragm injuries: 10-year experience at a tertiary hospital in Madrid

Traumatic diaphragm injuries are an uncommon finding and present a significant diagnostic challenge.This study reviewed cases of traumatic diaphragmatic hernia at a tertiary hospital in Madrid from January 2014 to November 2024.Eight patients were identified, primarily from motor vehicle accidents (3) and penetrating injuries (3), with 63% having left diaphragm injuries. Urgent treatment was performed in three cases, while two patients were managed conservatively, and two were diagnosed late and treated surgically via thoracic approach.The challenge in managing traumatic diaphragmatic hernias lies in their diagnostic difficulty and the impact of associated injuries on patient prognosis.Figure 1: On the left, coronal CT slice of a patient with a late diagnosis of right post-traumatic diaphragmatic hernia. On the right, photo of the hernial defect.Abdellatif, W., et al., (2020). Unravelling the Mysteries of Traumatic Diaphragmatic Injury: An Up-to-Date Review. Canadian Association Of Radiologists Journal, 71(3), 313-321.Candelas, D. A. D., et al., (2019). Hernia diafragmática complicada. Cirugía Española, 98(4), 238.Cardoso, L. F., et al, (2017). Análise retrospectiva de 103 casos de lesão diafragmática operados em um centro de trauma. Revista Do Colégio Brasileiro de Cirurgiões, 44(3), 245-251.Giuffrida, M., Perrone, G., Abu-Zidan, F. et al., (2023). Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper. WSES, 18(1).Lim, B., et al., (2016). Traumatic diaphragmatic injuries: a retrospective review of a 12-year experience at a tertiary trauma centre. Singapore Medical Journal, 58(10), 595-600.Mahamid, A., et al., (2016). Blunt traumatic diaphragmatic injury: A diagnostic enigma with potential surgical pitfalls. The American Journal Of Emergency Medicine, 35(2), 214-217.Taş, İ., & Yiğit, E. (2023). Analysis of traumatic acute diaphragmatic injuries. Singapore Medical Journal.NOINTRODUCTIONTraumatic diaphragmatic hernia is defined as a discontinuity in the diaphragm, either in the membranous or muscular parts, or at one of its insertions, resulting from closed blunt trauma, such as high-energy motor vehicle accidents, or secondary to penetrating injuries.Its severity lies in the lack of continuity in the diaphragm, which predisposes to herniation of intra-abdominal contents into the thorax, potentially causing strangulation and ischemia of abdominal viscera, respiratory failure, compression of the vena cava, and circulatory collapse (Lim et al., 2016).The prevalence of diaphragmatic injuries in the literature is variable, likely due to the significant diagnostic challenge they pose during the acute trauma episode and their rarity. Upon finding a traumatic diaphragmatic injury, urgent correction of the defect is recommended, traditionally using non-absorbable sutures. However, often the patient's prognosis is clouded by associated concomitant injuries (Cardoso et al., 2017). The aim of this study was to review all cases of traumatic diaphragmatic hernia at a busy tertiary hospital in the Community of Madrid: injury mechanism, radiological findings, and management.MATERIALS AND METHODSA retrospective search for patients diagnosed with traumatic diaphragmatic hernia, both acute and chronic, was conducted at La Paz University Hospital, a tertiary center in the Community of Madrid, from January 2014 to November 2024.RESULTSA total of 8 patients were found, 7 men and 1 woman. Regarding injury mechanisms, 3 patients presented diaphragmatic rupture due to motor vehicle accidents, 3 suffered thoraco-abdominal injuries from stab wounds, 1 patient sustained a goring injury, and 1 patient experienced a ground-level fall. In terms of lateralization, left diaphragmatic involvement was most frequent (63%), making the stomach the most herniated organ into the thoracic cavity.Regarding concomitant injuries, 5 patients presented pneumothorax, bilateral in two cases; 3 patients had rib fractures, 2 spleen injuries (one required splenectomy and the other embolization), 2 liver injuries, 3 pelvic fractures, one stomach perforation, one subarachnoid hemorrhage, and one injury to major mediastinal vessels.It should be noted that in two patients, the diagnosis of traumatic hernia was delayed. One case involved a motorbike accident, where the hernia was an incidental finding in a follow-up CT scan, with a right hemidiaphragm injury and herniation of the left liver lobe and transverse colon into the thorax. In the other case, the patient had a ground-level fall, with left hernia and stomach herniation diagnosed two years later after presenting dyspnea on moderate exertion.The average ISS (Injury Severity Score) obtained was 24. One patient died due to hemorrhagic shock secondary to injury to major vessels.For hospital management, conservative management was decided for two patients, both young males approximately 33 years old who sustained stab wounds, one to the right hemidiaphragm and the other to the left. None of the patients were evaluated by a general surgeon during the acute phase of the trauma. The patient with left diaphragmatic injury is awaiting surgery.Four patients underwent urgent surgery. In three of them, a laparotomy was performed with repair of the hernial defect, and in one patient, the approach was thoracic.In the elective cases, the approach was thoracic: one patient underwent herniorrhaphy via thoracotomy, while the other had a hernioplasty with a biological mesh through VATS (Video-Assisted Thoracic Surgery).DISCUSSIONTraumatic diaphragmatic hernia is an uncommon injury but can have severe consequences for patient life. It is described as a defect of continuity in the diaphragm or at one of its insertions, which favors or predisposes to herniation of intra-abdominal contents into the thoracic cavity (Giuffrida et al., 2023). Within the injury mechanisms, it occurs in 1-5% of patients who have suffered a traffic accident (primarily blunt injuries) and in 10-15% of victims of penetrating thoraco-abdominal injuries (Abdellatif et al., 2020).Blunt injuries result from a sudden increase in intra-abdominal pressure during a collision or motor vehicle impact, causing tears and shear injuries in the diaphragm. The resulting injuries are extensive continuity defects (5-15 cm), more common on the left side and posterolateral. Penetrating injuries, such as those from stab wounds, present variable and random trajectories and usually show a smaller defect (1-2 cm). Consequently, they may go unnoticed in up to one-third of patients (Abdellatif et al., 2020).The severity of diaphragm injury lies in the herniation of intra-abdominal contents into the thoracic cavity, which can lead to incarceration, strangulation, or perforation of intra-abdominal viscera, or cause cardiorespiratory symptoms such as dyspnea or circulatory collapse.Despite the potential risk, 12-63% of traumatic diaphragmatic hernias go unnoticed during the acute phase of trauma (especially on the right side due to the protective barrier of the liver) due to their rarity, nonspecific symptoms, inconclusive radiological findings, or diagnostic difficulty. Approximately 80% of patients with traumatic diaphragmatic hernia who are not diagnosed during the acute episode will present symptoms around 3 years later; however, it is possible for the injury to go unnoticed for many years (Taş & Yiğit, 2023).It is noteworthy that mortality in polytraumatized patients with traumatic diaphragmatic hernia is primarily due to other associated injuries, from major vessel injuries with hemorrhagic shock to severe traumatic brain injury. However, if the patient presents with a complication secondary to the hernia, such as strangulation of an abdominal viscera, mortality ranges from 60% to 66% (Candelas et al., 2019).Traumatic diaphragm injuries are associated with up to 90% rib fractures and intrathoracic injuries such as lung laceration, pneumothorax, or hemothorax. Between 80% and 90% of patients present concomitant intra-abdominal injuries (Mahamid et al., 2016).CONCLUSIONSTraumatic diaphragmatic hernia is an uncommon pathology in polytraumatized patients that often goes unnoticed during the acute episode of trauma. It is important to suspect it in cases of thoraco-abdominal trauma.Its diagnosis presents a challenge, due both to its rarity and nonspecific symptoms or inconclusive radiological findings.Undiagnosed traumatic diaphragm involvement can have serious consequences for the patient, such as herniation and strangulation of abdominal viscera into the thoracic cavity.Surgical consultation is mandatory.

Traumatic abdominal wall hernia (TAWH): Case report and review of the literature

CASE HISTORY A 28 year old obese drunk male without significant past medical history was admitted to the emergency department with severe polytrauma after a high-speed frontal car collision. CLINICAL FINDINGS Low consciousness with TA 70/40 mmHg and HR 115 bpm. RESULTS - Analysis → CK 3747 U/L, Leukocytes 26.6 x10E3/microL, Ethanol 114 mg/dL, Lactate (art) 2.2 mmol/L. - Head CT scan → subdural hematoma with subarachnoid hemorrhage. - Abdominal and pelvic CT scan → retroperitoneal hematoma with dissection of the right common iliac artery and an infraumbilical 4 cm disruption of the abdominal wall with a small bowel herniation. DIAGNOSIS Severe polytrauma with TAWH. THERAPY AND PROGRESSIONS After a 2-week stay in the ICU being evaluated by Neurosurgery, Vascular Surgery, General Surgery and Orthopedic Surgery, the patient ends in brain death and is surgically assessed as a potential liver donor, which is finally dismissed. COMMENTS A traumatic abdominal wall hernia is most frequently seen in children after a blunt bicycle or motorbike handlebar trauma because of shear stress forces during a sudden deceleration, especially in regions of anatomic weakness such as the inguinal region or the lower abdomen lateral to the rectus muscle. The diagnosis is usually reached after a thorough clinical examination, although a CT scan is the gold-standard diagnostic test in these cases not only to rule out intra-abdominal injuries (60% of cases), but also to define the anatomy of the disrupted abdominal wall layers and differentiate a hernia from a hematoma. Although there is no standardized management plan for TAWH, a prompt surgical open repair in layers via midline exploratory laparotomy is usually preferred due to the risk of incarceration and/or strangulation and to rule out intra-abdominal injuries. REFERENCES Hamidian Jahromi A, Skweres J, Sangster G, Johnson L, Samra N. What we know about management of traumatic abdominal wall hernia: review of the literature and case report. Int Surg. 2015 Feb;100(2):233-9. Theodorou CM, Stokes SC, Beres AL. Traumatic Abdominal Wall Hernia in Children: A Systematic Review. J Surg Res. 2021 Jun;262:181-189.NO

ePoster session (self-study)
Polytrauma (self-study)

Termin

Thema

Beschreibung

Programm

ePoster session (self-study)Polytrauma (self-study)

Termin

Thema

Beschreibung

Programm

ePoster session (self-study)
Polytrauma (self-study)