22nd European Congress of Trauma & Emergency Surgery

Chairs

Transgastric drainage of pancreatic pseudocyst after blunt abdominal trauma

Abstract text (incl. references and figure legends) Case history A 36-year-old man was admitted to the emergency department with epigastric pain after being kicked in the abdomen the day before. Clinical findings HD stable(BP 138/78mmHg,HR 80).PE:epigastric palpation-induced pain without abdominal guarding. Results Laboratory tests:leukocytosis.Elevated amylase (1032.00U/L) and lipase (1402 U/L). CT:Laceration and hematoma in pancreatic body-neck junction.Peripancreatic hematoma. MRCP:Incomplete laceration in the pancreatic body.Peripancreatic collection.Disruption vs obliteration of the main pancreatic duct in the neck-body. EUS:Complete disruption of the pancreatic duct in the body,14cm pseudocyst. Diagnosis Blunt pancreatic trauma AAST grade III Therapy and Progressions Conservative management.EUS confirmed disruption as well as a pancreatic pseudocyst, so a transgastric metal stent was placed.CT control revealed decreased collection and the patient was discharged 23 days after admission. Subsequently, a control EUS was performed and the metal stent was replaced by a plastic one.Resolution of the collection was confirmed by CT. Comments The pancreas is an uncommon organ to be injured in trauma. Although MRCP is the noninvasive imaging method of choice when evaluating for pancreatic duct injury, ERCP remains important due to its potential to direct image-guided therapy. As endoscopic techniques have improved, endoscopic stenting of isolated pancreatic duct injuries is being considered rather than surgery.Transgastric drainage is the gold standard for pseudocysts. References Petrone P,et al.Traumatismos de páncreas:manejo y revisión de la literatura.Cir Esp.2016 Björnsson B,Kullman E,Gasslander T,SandströmP.Early endoscopic treatment of blunt traumatic pancreatic injury.Scand J Gastroenterol 2015 Debi U,Kaur R,Prasad KK,Sinha SK,Sinha A,Singh K.Pancreatic trauma:a concise review.World J Gastroenterol.2013 Dec Fig1.MRCP:peripancreatic collection and disrupted duct.Fig2.EUS:transgastric stent Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Visceral trauma

Poster

A grade IV AAST/OIS liver trauma treated with ABTHERA™ device: A new therapeutic option in liver trauma?

Abstract text (incl. references and figure legends) Case history:A 17-year-old came to our Trauma Center after a motor scooter collision which hesitated in a grade IV hepatic lesion and right renal hematoma. Due to hemodynamic instability, he had been previously operated in another hospital of Damage Control Surgery (DCS) with Peri Hepatic Packing (PHP). He had been transferred to our Trauma Center for an adequate centralization. Clinical findings:He presented at the arrival a hemodynamic stability without catecholamines or inotropes, oro-tracheal intubated and sedated. Transfusion with 4 packed blood cells and 2 platelets was in progress. Investigation/Results:CT body had been performed, which referred a major hepatic laceration of 11 cm in length across the IV-V Cuinaud segments and a right renal hematoma. Diagnosis:At the relaparotomy a relevant volume of bile and blood was revealed. After the depacking an active haemorrhage was detected and a accurate surgical haemostasis and biliostasis was performed [fig.1]. The PHP was reperformed leaving the abdomen open with the ABTHERA™ device with instillation of 100 ml of saline solution per 5 minutes every 2 hours at -100 mmHg. Therapy and Progressions:After 48 hours relaparotomy was performed. The abdomen was clean and the hepatic laceration lines were almost completely joined, with no need of more invasive procedures. Follow up at 6 months with MRI revealed a substantially healed liver [fig.2]. Comments: The ABTHERA™ device has proven in this case its feasibility and usefulness in physiology restoration and an unexpected therapeutic role in hepatic healing, promoting a natural adhesion of the hepatic laceration lines. References:Predictive factors of morbidity and mortality in grade IV and V liver trauma undergoing perihepatic packing: single institution 14 years experience at European trauma centre. Injury. 2012 Sep;43(9):1347-54.Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair-single centre experience. World J Emerg Surg. 2015 Aug 1;10:34 Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Polytrauma

Peri renal packing (PRP) in post-traumatic haemorrhagic transplanted kidney: A successful extreme rescue attempt

Abstract text (incl. references and figure legends) Case history: A 51-year-old man arrived in our Trauma Center due to a motorcycle accident. He referred pelvic pain localized in right pelvic fossa and left hip pain. He underwent a right kidney transplantation in the past, due to a chronic renal failure. Clinical findings: His vital signs were not compromised. Chest x-ray and E-fast resulted negative for parenchymal injuries or pneumothorax, fluid collection around the transplanted kidney apart. Investigation/Results: He underwent a CT body scan which referred a simple fracture of the left hip bone and an active blush extravasation from the transplanted kidney in right pelvic fossa. Diagnosis: To prevent an acute renal ischaemia due to an angioembolization of the transplanted kidney, we decided to perform a mechanical haemostasis in the operatory room. Therapy and Progressions: A right para-median laparotomy has been performed. The transplanted kidney was bleeding from all the parenchyma and haemostasis was achieved thanks to Hemopatch™ and Tisseel™ [fig.1]. From the renal posterior surface bleeding was unstoppable, for this reason a PRP had been performed with 4 swabs in an extreme rescue attempt [fig. 2]. At relaparotomy 24 h later no more blood or active bleeding was detected. The patient has been discharged in 5º post-operative day, no renal failure occurred after surgery and now is in good conditions. Comments: This successful extreme rescue attempt may open a new scenario in Damage Control Surgery and Uro-Trauma and may prevent post traumatic nephrectomies in those patients who are not fit for angioembolization. References: Coccolini F. et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg. 2019 Dec 2;14:54. doi: 10.1186/s13017-019-0274-x. Malhotra MK, Malhotra S. Packing of renal fossa: useful technique for intractable bleeding after open pyelolithotomy surgery. Niger J Surg. 2012 Jan;18(1):37-9. doi: 10.4103/1117-6806.95493. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Prof. Dr.

CT severity index (CTSI) as a predictor of management in hepatic and splenic trauma: A single trauma center experience

Abstract text (incl. references and figure legends) Background: In recent years there has been an increasing focus towards non-operative management (NOM) of abdominal trauma. A modified CT severity Index (CTSI) for spleen and liver injury (AAST) has been proposed as a better diagnostic and mortality predictor for hepatic and splenic trauma, acting as a guide towards better decision-making in therapeutic management of hepato-splenic injuries. Aim: To evaluate the modified CT severity index in its accuracy of diagnosis and predictive prognosis in hepatic and splenic injuries, when considering a NOM vs OM approach. Materials and methods: A 5-year retrospective, observational study comprising of 117 admissions was conducted in patients presenting at the 1st Department Of Surgery, Clinical Emergency Hospital Targu Mures, Romania with abdominal trauma, between January 2017 and December 2021. CT results were systematically evaluated and graded based on the modified CTSI criteria for spleen and liver injury (AAST). Results: Of the total 117 cases resulting in admissions due to abdominal trauma, 71 cases were included in the study, 18(25%) were placed in hepatic Injury category, 42(59%) in splenic injury category and 11(15%) in hepatosplenic injury category. NOM was applied to 10(14%) of the cases, all with injuries below grade III, resulting in favorable prognosis and no mortality. A total of 12(17%) deaths were observed, out of which 1(8%) was in hepatic injury category, 7(58%) in splenic injury category and 4(33%) were in hepatosplenic injury category, with all grade IVA or higher injury grade. CT imaging based on the CTSI criteria for spleen and liver injury (AAST) showed a higher diagnostic accuracy and prediction of mortality in splenic injury category 90% vs. 83% in hepatic injury vs. 81% in hepatosplenic injury. Conclusions: CTSI (AAST) remains to be an important if not the main factor in determining NOM vs OM in hepatic and splenic injury.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Emergency surgery

Prof.

E-fast in unstable traumatic patients, a validation attempt to diagnose a diaphragmatic injury

Abstract text (incl. references and figure legends) Post-traumatic diaphragmatic injuries are rare occurrence thus making the diagnosis difficult, in fact, 70% of them are missed. This delay rises the mortality rates up to 30%. Current diagnostic work-up consists of chest X-ray, followed by contrast-enhanced CT scan when the patient is hemodynamically stable. The aim of our study was to validate the selective use of diaphragm-extended E-FAST in hemodynamically unstable patients. The sensibility, specificity, positive and negative prognostic value of this tool was compared to the current diagnostic modalities (chest X-ray and CT scan). From January 2018 to August 2022, 8 consecutive patients (M:F=5:3 – mean age: 53 years) affected with thoracic and abdominal blunt trauma and diaphragmatic injury were enrolled. The patients underwent a diaphragm-extended E-FAST, using a four acoustic windows on the anterior and lateral chest wall regions, a supine chest X-ray and a thoracic and abdominal CT scan. All the patients were hemodynamically stable or responder at the fluid resuscitation. The injury dimensions ranged between 7 and 20 cm. The sensibility, the specificity and the positive and negative prognostic value of the supine chest X-ray were 65%, 77%, 80% and 50%, those of the E-FAST were 68%, 80%, 83% and 60%, and, finally, those of the CT scan were 95%, 97% 90% and 98%. All patients underwent an emergency laparotomy. The diaphragmatic ruptures were closed with direct sutures (no prothesis implantation). In 2 patients (25%) a splenectomy was performed. 1 patient (12%) died in the post-surgical period for AMI. No surgery-related complications were reported. The diaphragm-extended E-FAST can be safely used as a reliable diagnostic tool in hemodynamically unstable patients who can"t be studied with CT scan, thus probably decreasing the risk of preoperative misdiagnoses.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) NO

The challenges of penetrating thoracoabdominal trauma – A case report

Abstract text (incl. references and figure legends) Introduction:Penetrating thoracoabdominal trauma is a fairly common occurrence in the ER. It is associated with potencial damage to both the abdominal and thoracic cavity. It is usualy caused by a stab wound or a gunshot. The most commonly affected abdominal organs are the bowel, liver and spleen. The involvement of the diaphragm must always be evaluated. The severity of the injury is dependent on the organs involved, the characteristics of the object, and the amount of energy transmitted. Case Report:We presente a case of a 44-years-old male with no previous medical history, taken to the ER after penetrating thoracoabdominal trauma involving a knife wound. A CT-scan was performed demontrating: "bladed weapon embedded in the left dorsolumbar transition, through the last left intercostal space with mild densification of the perirenal planes. Discrete underlying hemopneumothorax on the left and small focus that may correspond to a splenic parenchymal laceration, presumably coexisting with small hemoperitoneum." A subcostal explorative laparotomy was performed and the knife was removed under direct visualization. Diaphragm laceration was identified and primarily repaired. A grade II spleen laceration was revealed and successfully contained with compression and a surgical absorbable hemostat. Thorax drainage was performed. The postoperative period was uneventful. Conclusion:Penetrating thoracoabdominal trauma presents substantial clinical challenges as it can lead to complex and life-threating conditions, so appropriate management is of the utmost importance. When managing a patient with penetrating thoracoabdominal trauma, evaluation of the patient"s hemodynamic condition is fundamental. The high incidence of bowel and diaphragmatic involvement ultimately limits nonoperative management. Futhermore, the assessment of the diaphragm, identification of a possible laceration and its repair is essencial in the prevention of future complications, namely diaphragmatic hernias.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Blunt spleen and liver trauma complicated with biliary fistula: A case report

Abstract text (incl. references and figure legends) We report a case of a 32-year-old male that was found hypotensive and unresponsive (Glasgow Coma Scale:7) by the emergency response team, after a motorcycle crash with a lamppost. The patient was intubated on site, initiated fluid resuscitation and tranexamic acid perfusion. Upon hospital admission, the patient was in hypovolemic shock, due to intra-abdominal bleeding, confirmed by FAST Scan. The massive transfusion protocol was activated and the patient was taken to the operating room, to perform an emergency exploratory laparotomy. The findings during surgery included large hemoperitoneum, right kidney laceration with retroperitoneal hematoma and grade IV spleen and liver injury, according to the AAST classification. It was performed an emergency splenectomy, gauze-packing of the liver and hemoperitoneum evacuation. The abdomen was temporarily closed using an open abdomen negative pressure therapy system. The patient was then admitted to the intensive care unit after exclusion of other traumatic injuries. A "second look" surgery was performed two days later, with removal of the liver packing, showing no signs of active bleeding. It was performed resection of the areas of devitalized liver tissue, with pedicled omentum hepatorrhaphy. An abdominal drainage tube was placed and the abdominal wall was closed. The surgery complicated with a biliary fistula that was successfully managed with expectant treatment, without the need for surgery or endoscopic approach. We presented a case of liver and spleen injury following blunt abdominal trauma requiring emergent surgical treatment to stabilize the patient, complicated with biliary fistula, an uncommon complication of blunt liver injury. Coccolini, F., Coimbra, R., Ordonez, C. et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg 15,24(2020) Coccolini, F., Montori, G., Catena, F. et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 12,40(2017)Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Non operative management of grade IV (AAST) (WSES III) liver injury due to blunt thoracoabdominal trauma

Abstract text (incl. references and figure legends) Case history 25 year old female brought to the Emergency Department presenting blunt thoracoabdominal trauma following a horse-riding accident Clinical findings BP: 126/93 mmHg, HR: 105 bpm PE: laceration with hematoma at right costal cage. Normal abdominal exploration Results and diagnosis Laboratory tests: hypertransaminasemia with normal blood count and coagulation profile CT Scan: fifth and sixth displaced right costal fractures causing a 10 cm right hepatic intraparenchymal hematoma (figure 1). No active bleeding was demonstrated. Therapy and progressions Admission to Intensive Care Unit remaining HD stable, without requiring blood transfusions Day 10 control CT Scan: improvement of liver injuries. No associated complications Ten-month follow-up: asymptomatic with no radiologic complications Comments NOM is considered the standard of care both in blunt and penetrating liver injuries given two absolute requirements: HD stability and absence of other lesions requiring surgery We present a blunt thoracoabdominal trauma causing a major penetrating liver injury (AAST IV–WSES III) due to displaced costal fractures piercing the right hepatic lobe (figure 2) The ability to diagnose all associated injuries and to provide intensive management are paramount for the application of NOM Management of liver trauma is multidisciplinary and, when feasible, NOM should always be considered as a first option References 1. Taghavi S, Askari R. Liver Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan/2. Coccolini F, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020 Mar 30;15(1):24/3. Cimbanassi S, et al. Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: results from an International Consensus Conference. J Trauma Acute Care Surg. 2018;84(3):517–531/4. Biffl WL, Leppaniemi A. Management guidelines for penetrating abdominal trauma. World J Surg. 2015;39(6):1373–1380 Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Penetrating visceral gunshot trauma

Abstract text (incl. references and figure legends) CASE STORY A 17 year old male patient was shot twice from a long distance with hand gun. CLINICAL FINDINGS The patient arrived in A&amp;E ,from inspection the patient had three wounds which had relevant diameter to the bullet's caliper. . The patients was hemodynamically unstable with his blood pressure around 85/60 he was tachycardic and tachypnoic. INVESTIGASTION/RESULTS Immediately complete blood count was ordered and the results came back normal. A thoracoabdominal CT with intravenous infusion was done to inspect the bullets track. The CT revealed the bullet's site of entrance on the left lower hemithorax ,penetration of the spleen's parenchyma, posterior and anterior wall of the stomach and left lobe of liver. Finally the bullet found on the left anterior abdominal wall(fig1,2). DIAGNOSIS The diagnosis was penetrating abdominal gunshot wound THERAPY AND PROGRESSIONS Immediately exploratory laparotomy was done under midline incision ,big amount blood collection was found on left paracolic gutter ,the spleen was not viable so splenectomy was indicated ,the stomach"s anterior and posterior wall wounds were primarily sutured. The liver wound was packed with hemostatic gauze .Finally two penrose drainages were put in the left paracolic gutter and in Morrison"s space. The patient's postoperative period was uncomplicated and discharged on the 10th postoperative day. COMMENTS The penetrating abdominal gunshot wound is an exceptional category of open abdominal trauma because the abdominal region has vital parechymal and hollow organ in which the impact could threaten the patient's life.The inspection of site of entry and exit is of paramaount importance,moreover sometimes the patient directed to OR even without imaging studies. REFERENCES 1)Zeineddin A, Williams M, Nonez H, Nizam W, Olufajo OA, Ortega G, Haider A, Cornwell EE.Gunshot Injuries in American Trauma Centers:Analysis of the Lethality of Multiple Gunshot Wounds. Am Surg. 2021 Jan;87(1):39-44. Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) no

Blunt abdominal trauma after a MVA in patient under double antiplatelet treatment

Abstract text (incl. references and figure legends) CASE HISTORY A 54 year old male came in A&amp;E after a MVA CLINICAL FINDINGS The patient was hemodynamically unstable tachypnoic and tachycardic bruises were inspected on left iliac fossa and epigatrium .The patient was on clopidogrel and salospir treatment after two coronary artery angioplasties three months ago. INVESTIGATIONS/RESULTS Patient"s complete blood count was normal although the focused assessment with sonography in trauma revealed free fluid in abdominal cavity and in order to establish the source of bleeding abdominal CT with intravenous infusion was ordered and it revealed active exsanguination in left iliac fossa DIAGNOSIS Blunt abdominal trauma THERAPY AND PROGRESSIONS Exploratory laparotomy via a midline incision was performed measurable blood collection found on left paracolic gutter an arterial branch of a sigmoid artery was bled actively. The branch was transfixed and ligated in addition minor laceration found on cecum which primarely sutured.Two penrose drained the right and left paracolic gutter.Tintraoperative the patient eceived two units of FFP ,one unit of RBC and 2gramms of tranexamic acid.The patient followed an uncomplicated stable postoperative period and he discharged on 11th postoperative day. COMMENTS Such minor arterial branches found to exsaguinate in closed abdominal trauma could be managed by arterial embolization although in unstable patients who are under antiplatelet therapy this endovascular is very challenging ,in addition the collection of blood should be evacuated because of potential postoperative septic complications. REFERENCES 1)Ahmet K, Tongue Y. Blunt abdominal trauma: evaluation of diagnostic options and surgical outcomes. Turkish J Trauma Emerg Surg 2008;14:205-10 2)Asensio JA, Chahwan S, Hanpeter D, et al. Operative management and outcome of 302 abdominal vascular injuries. Am J Surg. 2000;180:528–33. discussion 533–4.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Liver and spleen embolization in trauma patients: Outcomes andrisk factors for therapeutic failure

Abstract text (incl. references and figure legends) Introduction: Spleen and liver are the most frequent injured solid organs in blunt abdominal trauma, almost 35-50% of patients presented injuries at these organs. Non operative management (NOM) is widely accepted in the management of these patient. In the last years angioembolization (AE) increased NOM indications through more complex injuries.The aim of this study is to analyze the efficacy and safety of AE and to identify risk factors associated with therapeutic failure. Material and Methods: Retrospective observational study based on a Level I Trauma Center prospective registry of severe trauma (1993-2022). We include all patients with hepatic and/or splenic injury who required an arteriography. We analyzed demographic data, trauma mechanism and patterns, injury severity, diagnostic and therapeutic management, and outcomes. Therapeutic failure was defined as the need of surgery or new embolization. Results: 94 met inclusion criteria: 44 (47%) with liver injuries, 35 (37%) with splenic injuries and 15 (16%) with injuries in both. 49 (52%) required an AE (26 liver/23 spleen).Almost all patients had suffered a blunt trauma (92%). Median of Shock Index (SI) at admission was 0.85 (IQR 0.77) and mean RTS 10.6 (SD 2). ISS median was 26 (IQR 16) and the NISS 27 (IQR 17). In 45 patients EA was performed as part of NOM and in 4 cases was indicated after a damage control surgery. In 5 patients (10%) NOM failed. Risk factors associated were SI on arrival &gt; 0.9, pathological abdominal examination on arrival and massive hemoperitoneum at the CT scan (p=0.017, p=0.046 and p=0.001.). 3 (6%) patients suffered AE related complications. In our sample 8 patients died, none of them due to therapeutic failure. Conclusion: AE allowed NOM in severe liver and spleen injuries, it's safe and effective. In our series, the therapeutic failure rate was 10%. Significantly associated to an IS&gt;0,9, pathological abdominal findings on arrival and massive hemoperitoneum in the CT.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) NO

Survival after suicide attempt – A pulmonary laceration caused by a penetrating thoracic gunshot, conservative treatment

Abstract text (incl. references and figure legends) Suicide is an important worldwide mortality cause. In the USA, it is a leading cause of death, specially among youth. Access to fireguns is a high risk to consider. We hereby present, a case of a man, aged 22 years old, who is admitted in the emergency room for a penetrating trauma to the chest caused by a gunshot in a suicide attempt. He presented with tachycardia, tachypnea and hypotension. Glasgow coma scale score was 14. Objetively, entry and exit wounds were found on the fourth intercostal space and below the tip of the scapule on the left side of the chest, respectively. There were no signs of external hemorrhage. Chest x-ray showed hypotransparency. FAST ultrasound confirmed the presence of moderate amount of liquid, suggesting a hemothorax. A chest tube was inserted and 900 mL of blood were drained. The CT scan showed a linear densification between the superior and inferior lobes of the left lung, a moderate volume hemothorax, and a pseudoaneurysm in the parenchyma measuring 21x12 mm in the inferior lobe. There were no signs of injury of the great vessels nor presence of intra-thoracic active hemorrhage. He was kept under surveillance during 5 days in the Thoracic Surgery ward. Re-evaluation with blood analysis and CT scan had no alterations and he was discharged after psychiatric assessment. This is a successful case of a conservative treatment after a penetrating chest trauma. However, one should be aware of its severe complications during the acute and sub-acute phases (ie. laceration of great vessels and uncontrolled hemorrhage), during which the surgeon must decide when to operate. Plus, this patient committed suicide due to gambling issues, an important cause of attempt, so attention to this problem should be given in order to prevent future cases.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No.

Idiopathic spleen rupture after laparoscopic appendectomy

Abstract text (incl. references and figure legends) Case history and clinical findings 54-years-old woman underwent a laparoscopic appendectomy for an acute appendicitis. Three days after the surgery the patient developed generalized abdominal pain and hypovolemic shock. Investigation/Results A CT-scan revealed active bleeding confined to the splenic capsule and a parenchymal laceration involving segmental arteries Diagnosis Idiopathic rupture of the spleen after appendectomy was the presumed diagnosis. Therapy and Progressions The patient underwent emergency open splenectomy. She had an uneventful post-operatory recovery and was discharged clinically improved, at the 3rd day post-op. Comments Atraumatic rupture of the spleen is a rare event, with a mortality rate of up to 12%. In 93% of the cases, this condition is related to underlying pathologic conditions like malignancy or infectious. In the remain 7% of the cases there is no identifiable cause. There are also a number of case reports that described splenic ruptures after laparoscopic surgery such as Nissen fundoplication and repair of perforated duodenal ulcer. The traction forces transmitted to the spleen at the induction of the pneumoperitoneum trough the splenic ligament or the presence of adhesions between the spleen and the colon may favour ruptures. In our case the patient had no previous surgical history, the histologic analysis revealed a normal spleen and there were no surgical manoeuvres performed in the sub-phrenic space. Furthermore, during the second intervention the presence of intra-peritoneal adhesions was ruled out. Since the rupture occurred three days after the appendectomy, it is likely that the two events are related. Idiopathic splenic ruptures are rare but should be remembered as a potential source of postoperative haemorrhage with no obvious etiology.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Partial nephrectomy in trauma patients: reality or myth?

Abstract text (incl. references and figure legends) Introduction: The kidney is the most frequently injured genitourinary organ in trauma patients. Partial nephrectomy has been described classically as a therapeutic option. Our aim was to review the use of partial nephrectomy in our practice. Our hypothesis is that this technique is almost never performed despite its continued description and teaching in trauma manuals and courses. Material and Methods: Retrospective observational study based on a Level I Trauma Center prospective registry of severe trauma (1993-2022).Demographic data, trauma mechanism, injury severity, hospital management and outcomes were analyzed with SPSS version 25. Results: We analyzed 176 patients with kidney injuries, 85.5% due to blunt trauma. Trauma mechanisms were: collisions (23%), falls from a heigh (22.5%), MVA (18.5%), run overs (13.5%), stab wounds (11.5%), fire arm injuries (2%) and bull horn injuries (1%).The Shock Index (SI) median on arrival was 0.8 (IQR0.37).The RTS mean was 10.9 (SD 1.8) and the ISS median was 22 (IQR18) and the NISS was27 (IQR18). There were 6 (3%) bilateral lesions, 74 right and 99 left. We&quot;ve found hilum lesions in 14 patients (8%), left kidney burst in 4 (2%) and 1 (0.5%) burst on right. 42% of left lesions were associated with splenic injury and 66% of right with hepatic injury. In 158 patients (88%) NOM was indicated, in 41(23%) an angiography was performed and 15 (8.5%) were embolized. This strategy succeeds in 154 patients (97%), failure was related in four cases. In 16 (9%) patients a total nephrectomy was performed, in 2 (2%) hemostatic surgical techniques were performed. There has been no partial nephrectomy in our sample. Conclusion: In our experience renal trauma NOM was effective in more than 97% of the cases.Total nephrectomy was the surgical technique performed in all unstable patients. Partial nephrectomies were not performed at all.Partial nephrectomy due to trauma seems more like a myth than a clinical reality.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) NO

Multi visceral and hand injury after an explosion of a home-made explosive presenting with massive haemorrhage shock – A case report from UMC Ljubljana

Abstract text (incl. references and figure legends) A 17-year-old patient was transported to the emergency department of the UMC Ljubljana by helicopter after a home-made explosive device exploded in his hands.He presented with a periumbilical wound with protrusion of the small bowel, amputation of several fingers of the left hand and several wounds on the chest and arms. He was oriented and talkative, GCS was 14. His first vitals at the ED were blood pressure of 95/65 mmHg, pulse 130 bpm and body temperature of 34,9°C. Pulse O2 saturation couldn&quot;t be measured. He complained of severe abdominal pain. FAST showed signs of free intraperitoneal fluid. X-rays of the pelvis and chest did not show any pathologies. A working diagnosis of a massive intraabdominal bleeding was made.He was urgently intubated, a central venous line was inserted and a protocol of massive transfusion was started.He was haemodynamically unstable, despite aggressive fluid resuscitation and vasoactive support, so prompt explorative laparotomy by an abdominal surgeon was made. One of the shrapnel transected the inferior vena cava, which was sutured by a cardiovascular surgeon. Pancreas was also completely divided by a shrapnel at the site of the pancreatic neck with subsequent injuries to the duodenum and a complete avulsion of choledochal duct, therefore a cephalic pancreaticoduodenectomy was performed. Multiple injuries to the stomach, small bowel, colon and a smaller laceration of the liver were also found. Simultaneously plastic surgeon operated on both hands, also performing functional reconstruction of left thumb remnant and palm defect coverage. Altogether he received 26 units of CE, 21 units of FFP and 24 units of thrombocytes until haemodynamic stabilisation. Postoperative CT scans of head, neck, chest and abdomen were made and showed no other important injuries.He was firstly admitted to level 1 ICU unit from which he was discharged after two days. He spent another 27 days at the ward. He was then transferred to a rehabilitation Institute.Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) NO

Hepatic infarction after transcatheter arterial embolization for blunt liver injury

Abstract text (incl. references and figure legends) Case history A 70-year-old woman with diabetes was admitted to the trauma emergency room after being injured by rolling down in the mountains. Clinical findings The initial vital sign was stable. The initial computed tomography (CT) scan showed liver laceration grade IV with active bleeding and hemoperitoneum. Investigation/Results Transarterial embolization was planned. After selective celiac and hepatic angiography, multiple ruptures and pseudoaneurysm were identified in the right hepatic artery. Embolization was performed using gelatin sponge slurry and microcoils in the right anterior hepatic artery and the right posterior hepatic artery. After the procedure, serum lactate level rose to 12.9 mmol/L. And the patients presented a confused mentality with a fever of 38.8 degrees and hypoglycemia. Diagnosis Follow-up CT showed hepatic infarct accompanied by secondary infection at the previous embolization site. Therapy and Progressions The patient underwent right hemihepatectomy due to right lobe infarction. After surgery, the patient fell into septic shock. The patient died without recovery of spontaneous circulation despite receiving cardiopulmonary resuscitation due to cardiac arrest. Comments Since the liver receives dual blood supply from the hepatic artery and portal vein, embolization can be safely performed if there is a wide parenchymal injury accompanied by arterial bleeding. In the absence of portal flow, infarction or abscess may occur after hepatic arterial embolization. It is a very rare that infarction progresses quickly within 29 hours of the procedure, even when the portal vein is intact. References Fujiwara H, Kanazawa S, Hiraki T, Mimura H, Yasui K, Akaki S, Yagi T, Naomoto Y, Tanaka N, Hiraki Y. Hepatic infarction following abdominal interventional procedures. Acta Med Okayama. 2004;58(2):97-106. Figure CT showed liver laceration (A) and embolization was performed (B). Hepatic infarction was identified on follow-up CT (C). Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.) No

Poster Session 10
Visceral trauma

Appointment

Chairs

Programme

Poster Session 10Visceral trauma

Appointment

Chairs

Programme

Poster Session 10
Visceral trauma