- Abdominal Wall Closure Using Artificial Mesh for Patients with an Open Abdomen
-
Sung Whan Cha, Hong Jin Shim, Ji Young Jang, Jae Gil Lee
-
J Trauma Inj. 2012;25(4):172-177.
-
-
-
 Abstract
 PDF
- PURPOSE
After damage control surgery, abdominal wall closure may be impossible due to increased intra-abdominal pressure (IAP), and primary closure may induce abdominal compartment syndrome. The purpose of this study was to investigate changes in the IAP and the feasibility of abdominal wall closure using artificial mesh.
METHODS
From July 2010 to July 2011, 8 patients with intra-abdominal hypertension underwent abdominal wall closure using artificial mesh. Medical data such as demographics, diagnosis, operation, IAP, postoperative complications, mortality and length of hospital stays were collected and reviewed, retrospectively. One patient was excluded because of inadequate measurement of the IAP.
RESULTS
Seven patients, 4 males and 3 females, were enrolled, and the mean age was 54.1 years old. Causes of operations were six traumatic abdominal injuries and one intra-abdominal infection. The IAP was reduced from 21.9+/-6.6 mmHg before opening the abdomen to 15.1+/-7.1 mmHg after fascial closure. Fascial closure was done on 14.9+/-17.5 days after the first operation. The mean lengths of the hospital and the intensive care unit (ICU) stays were 49.6 days and 29.7 days respectively. Operations were performed 3.1+/-1.5 times in all patients. Two patients expired, and one was transferred in a moribund state. Three patients suffered from complications, such as retroperitoneal abscesses, enterocutaneous fistulas, and bleeding that was related to the negative pressure wound therapy.
CONCLUSION
After abdominal wall closure using artificial mesh, intra-abdominal pressure was well controlled, and abdominal compartment syndrome does not occur. When the abdominal wall in patients who have intra-abdominal hypertension is closed, artificial mesh may be useful for maintaining a lower abdominal pressure. However, when negative pressure wound therapy is used, the possibility of serious complications must be kept in mind.
-
Summary
- Management of Traumatic Pancreas Injury in Multiple Trauma: Single Center Experience
-
Hyuna Jang, Hong Jin Shim, Sung Whan Cha, Jae Gil Lee
-
J Korean Soc Traumatol. 2011;24(2):111-117.
-
-
-
Abstract
PDF
- PURPOSE
Pancreatic injury is rare in abdominal trauma patients (3%~12%). but it could result in significant morbidity and even mortality. Early and adequate decision making are very important in the management of patients with traumatic pancreatic injury. The purpose of this study was to assess the kinds of management and outcome through the review of our experience of pancreatic injury with multiple trauma.
METHODS
We reviewed 17 patients with traumatic pancreas injury via electronic medical records from Jan. 2002 and April. 2011. We collected demographic findings; the type, location and grade of pancreas injury, the treatment modality, and patient's outcomes, such as complications, length of hospital stay (LOS), and mortality.
RESULTS
Total 17 patients were reviewed, and man was 13 (88%). Traffic accident was the most common cause of injury. Pancreas neck was the most common injured site, and occured in 5 patients. Ductal injury was detected in 7 cases. Eleven patients were treated by surgical procedure, and in this group, 3 patients underwent the endoscopic retrograde pancreas drainage procedure coincidently. ERPD was tried in 8 patients, and failed in 2 patients. The major complications were post-traumatic fluid collection and abscess which accounted for 70% of all patients. The hospital stay was 35.9 days, and it was longer in patient with ductal injury (38.0+/-18.56 vs. 34.5+/-33.68 days). Only one patient was died due to septic shock associated with an uncontrolled retroperitoneal abscess.
CONCLUSION
Early diagnosis is the most important factor to apply the adequate treatment option and to manage the traumatic pancreas injury. Aggressive treatment should be considered in patients with a post-operative abscess.
-
Summary
|
KST
