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Gastric perforation by dog bite

Bruno Martínez-Leo bruno036 at yahoo.com
Sat May 21 13:16:44 BST 2011


Dear all

We have an unusual case at our level II paediatric hospital which takes care of most major trauma paediatric patients in the city. A 3 y-o boy was accidentally involved in a street dog fight and received a bite in the epigasteoum region in the abdomen. He was brought in because omentum was out of the abdomen through the bite lesion. In laparotomy we found a gastric anterior fundus perforation, approximately 0.5 cm in diameter.

We have searched indexed literature but have found no cases. Have you ever had one case like this one? 

Thanks in advance, greetings.

Bruno Martinez-Leo, MD
Paediatric surgery resident
Mexico City

Sent from my iPhone

On 21/05/2011, at 02:44, trauma-list-request at trauma.org wrote:

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> Today's Topics:
> 
>   1. Colon Cancer post GSW (Miki)
>   2. Re: Colon Cancer post GSW (Charles Brault)
>   3. Use of Albumin in burns resuscitation (Nikahat Jahan)
>   4. Re: Use of Albumin in burns resuscitation (Richard Wigle MD FACS)
>   5. 3rd International Symposium on Critical Bleeding (ISCB2011) -
>      Sept    5-6 2011 in Copenhagen - Denmark (Jakob Stensballe)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Tue, 17 May 2011 21:53:59 +0300
> From: "Miki" <muggia at bezeqint.net>
> Subject: Colon Cancer post GSW
> To: <trauma-list at trauma.org>
> Message-ID: <20110517185418.DE4622120F9 at out8.bezeqint.net>
> Content-Type: text/plain;    charset="us-ascii"
> 
> I would like to have the opinion of the trauma members on this long surgical
> story.
> 
> 
> 
> A young man was severely injured during the 1973 conflict ("October war").
> He underwent a Rt. Hemicolectomy, partial jejunal resection and omentectomy
> with jejuno-ileostomy and ileo-transversostomy. The postoperative course was
> complicated by necrosis of the abdominal wall and a fecal fistula at the Rt.
> Flank. He was discharged 7 weeks post injury. 
> 
> 
> 
> Thirty-three (33) years later he underwent an emergent laparotomy for an
> obstructing carcinoma of the sigmoid. A subtotal colectomy was carried out
> with ileo-sigmoidostomy. This operation was complicated by severe adhesions.
> Several iatrogenic enterotomies were sutured in an attempt to save most of
> the remaining small bowel. The pathological examination revealed a mucin
> producing Adenoca. 6 cm in its maximal dimension, invading the whole colonic
> wall, into the pericolic fat. Lymph nodes were free of tumor. The
> postoperative course was complicated by an entero-cutaneous fistula that
> persisted for more than a year.
> 
> 
> 
> He was treated with chemotherapy, but the tumor recurred. This time,
> involving the abdominal wall and several loops of small bowel. The patient
> succumb during 2008, two years after the resection of the obstructing tumor.
> 
> 
> 
> The following questions rose:
> 
> 
> 
> 1.       Could there be any connection between the severe injury and the
> sigmoid cancer?
> 
> 2.       If there is such a connection, is it influenced by multiple
> transfusions and/or by the length of the remaining bowel?
> 
> 3.       Could the original injury and surgery cause a delay in diagnosis
> and treatment of the obstructing tumor?
> 
> 4.        Is there any connection between the complicated surgery for the
> obstructing tumor and its rapid progression?
> 
> 
> 
> I would appreciate your input into this case,
> 
> 
> 
> Michael Muggia, M.D.
> 
> Dept. of Surgery,
> 
> E. Wolfson Medical Center
> 
> Holon, Israel 
> 
> 
> 
> 
> 
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Tue, 17 May 2011 23:10:13 -0700 (PDT)
> From: Charles Brault <c_brault at yahoo.com>
> Subject: Re: Colon Cancer post GSW
> To: "Trauma-List \[TRAUMA.ORG\]" <trauma-list at trauma.org>
> Message-ID: <990432.27471.qm at web113510.mail.gq1.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
> 
> 
> 
> 
> 
> ________________________________
> 
> From: Miki <muggia at bezeqint.net>
> To: trauma-list at trauma.org
> Sent: Tue, May 17, 2011 7:53:59 PM
> Subject: Colon Cancer post GSW
> 
> 
> Staying on this topic :
> PROVINCE FIRST TO LICENSE MADE-IN-SASKATCHEWAN BLOOD TEST FOR COLORECTAL CANCER 
> RISK 
> 
> Detecting colorectal cancer in its early, curable, stages is the goal behind 
> Phenomenome Discoveries Inc.'s licensing of a diagnostic blood test in 
> Saskatchewan. 
> 
> Colorectal cancer is the second most commonly diagnosed cancer and the second 
> leading cause of cancer death in both men and women. Every year approximately 
> 650 people are diagnosed with colorectal cancer in this province and 250 people 
> die from the disease. 
> 
> Phenomenome Discoveries Inc.'s test measures blood levels of a novel metabolite 
> that is low in people with colorectal cancer. 
> 
> "This is an encouraging development right here in Saskatchewan that will help 
> with the early detection of cancer," Premier Brad Wall said. "This has the 
> potential to make a big difference to Saskatchewan people dealing with cancer." 
> 
> "Determining cancer risk through a blood test has the potential to strengthen 
> cancer care for Saskatchewan people, something that is a high priority for our 
> government," Health Minister Don McMorris said. 
> 
> The trial for the blood test took place over two years and involved more than 
> 5,000 patients in the Regina Qu'Appelle Health Region. The results of this 
> clinical trial indicate that the test led to the diagnosis of 87 per cent of 
> early stage cancers, making it the most sensitive blood test available for 
> colorectal cancer.
> 
> "Colorectal cancer is more than 90 per cent preventable and easily treated when 
> found in the early stages," Saskatchewan Cancer Agency Chief Executive Officer 
> Scott Livingstone said. "Finding ways to detect and prevent the disease is an 
> important aspect of our work in the fight against cancer." 
> 
> "We are pleased to be able to detect such high rates of early stage colorectal 
> cancer using a non-invasive blood test, and that Saskatchewan will be the first 
> province to license the right to use it," Phenomenome Discoveries Inc. Chief 
> Executive Officer Dr. Dayan Goodenowe said. 
> 
> Saskatchewan has made reducing colorectal cancer mortality a priority. 
> Continuing to expand screening programs that detect early stage cancer is the 
> best way to achieve this goal, allowing Saskatchewan to maintain a leadership 
> role in cancer screening. 
> 
> -30- 
> For more information, contact: 
> Tyler McMurchy
> Health
> Regina
> Phone: 306-787-4083
> Email: tyler.mcmurchy at gov.sk.ca
> Cell: 306-537-3594 
> Gladys Wasylenchuk
> Saskatchewan Cancer Agency
> Regina
> Phone: 306-791-2144
> Email: gladys.wasylenchuk at saskcancer.ca
> Cell: 306-501-7366 
> Alix Hayden
> Phenomenome Discoveries Inc.
> Saskatoon
> Phone: 306-244-8233 ex 210
> Cell: 306-229-4029 
> http://www.gov.sk.ca/news?newsId=a414e694-52c4-4f22-a644-52b3b5061dae
> ?
> 
> 
> 1.? ? ? Could there be any connection between the severe injury and the
> sigmoid cancer?
> ******************************
> 
> Do not most cancer have as it's (co)trigger an injury (Viral, bacterial, 
> chemical, traumatic )?
> 
> ------------------------------
> 
> Message: 3
> Date: Fri, 20 May 2011 23:25:40 +0530
> From: Nikahat Jahan <nikahat at gmail.com>
> Subject: Use of Albumin in burns resuscitation
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Message-ID: <BANLkTimq=3Z_chtokEiM051dTnq=PfihRA at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> Dear all
> There are several studies that recommend the use of colloids- 5% albumin in
> burn resuscitation- esp after the first 24 hrs. The original Parkland
> formula had included 5% albumin from day 2. Few other formulae like the
> Muir-Barkley formula and Modified Brooke formula include colloids.
> 
> The most recent cochrane review also concludes that *" There is no evidence
> from RCTs that resuscitation with colloids reduces the risk of death,
> compared to resuscitation with crystalloids, in patients with trauma, burns
> or following surgery. As colloids are not associated with an improvement in
> survival, and as they are more expensive than crystalloids, it is hard to
> see how their continued use in these patients can be justified outside the
> context of RCTs."*
> 
> Cochrane Database Syst Rev. <http://www.ncbi.nlm.nih.gov/pubmed/21412866> 2011
> Mar 16;3:CD000567.
> Colloids versus crystalloids for fluid resuscitation in critically ill
> patients.
> Perel P<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Perel%20P%22%5BAuthor%5D>
> , Roberts I<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roberts%20I%22%5BAuthor%5D>
> .
> 
> In view of the phenomenon of "Fluid Creep" and studies that show that
> colloids reduce it, what would be the right way to resuscitate patients with
> extensive burns- to use 5% albumin or avoid it?
> 
> -- 
> Lt Col Nikahat Jahan
> Classified Spl (Anaesthesiology)
> Indian Army
> 
> 
> ------------------------------
> 
> Message: 4
> Date: Fri, 20 May 2011 16:18:35 -0700 (PDT)
> From: Richard Wigle MD FACS <rlwigle at yahoo.com>
> Subject: Re: Use of Albumin in burns resuscitation
> To: "Trauma-List \[TRAUMA.ORG\]" <trauma-list at trauma.org>
> Message-ID: <911836.48557.qm at web111509.mail.gq1.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
> 
> The classic use of albumin in burns is on day 2 of care when the capillary leaks are supposed to have closed. The cochrane review as far as I can tell refers to colloids in initial resuscitation. For a good review of initial care see the supplement to this months J of Trauma
> 
> R Wigle? MD FACS
> LSU Shreveport
> 
> --- On Fri, 5/20/11, Nikahat Jahan <nikahat at gmail.com> wrote:
> 
> From: Nikahat Jahan <nikahat at gmail.com>
> Subject: Use of Albumin in burns resuscitation
> To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> Date: Friday, May 20, 2011, 12:55 PM
> 
> Dear all
> There are several studies that recommend the use of colloids- 5% albumin in
> burn resuscitation- esp after the first 24 hrs. The original Parkland
> formula had included 5% albumin from day 2. Few other formulae like the
> Muir-Barkley formula and Modified Brooke formula include colloids.
> 
> The most recent cochrane review also concludes that *" There is no evidence
> from RCTs that resuscitation with colloids reduces the risk of death,
> compared to resuscitation with crystalloids, in patients with trauma, burns
> or following surgery. As colloids are not associated with an improvement in
> survival, and as they are more expensive than crystalloids, it is hard to
> see how their continued use in these patients can be justified outside the
> context of RCTs."*
> 
> Cochrane Database Syst Rev. <http://www.ncbi.nlm.nih.gov/pubmed/21412866> 2011
> Mar 16;3:CD000567.
> Colloids versus crystalloids for fluid resuscitation in critically ill
> patients.
> Perel P<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Perel%20P%22%5BAuthor%5D>
> , Roberts I<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roberts%20I%22%5BAuthor%5D>
> .
> 
> In view of the phenomenon of "Fluid Creep" and studies that show that
> colloids reduce it, what would be the right way to resuscitate patients with
> extensive burns- to use 5% albumin or avoid it?
> 
> -- 
> Lt Col Nikahat Jahan
> Classified Spl (Anaesthesiology)
> Indian Army
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> Message: 5
> Date: Sat, 21 May 2011 09:44:15 +0200
> From: Jakob Stensballe <jakob.stensballe at rh.regionh.dk>
> Subject: 3rd International Symposium on Critical Bleeding (ISCB2011) -
>    Sept    5-6 2011 in Copenhagen - Denmark
> To: <trauma-list at trauma.org>
> Cc: Per Johansson <per.johansson at rh.regionh.dk>
> Message-ID:
>    <OFF40EBDDE.7DDC3630-ONC1257897.0029891A-C1257897.002A8125 at rh.dk>
> Content-Type: text/plain; charset="utf-8"
> 
> 
> (Embedded image moved to file: pic27593.jpg)
> 
> 
> Dear colleagues,
> 
> International Symposium on Critical Bleeding (ISCB) - A Multidisciplinary
> Symposium
> It is a great pleasure to invite you to back for the 3rd International
> Symposium on Critical Bleeding (http://www.iscb2011.dk) in Copenhagen,
> Denmark, on 5. -6. September 2011, at Moltkes Palace.
> 
> This meeting provides a unique forum for physicians from different
> specialties involved in the treatment of patients with critical bleedings,
> such as trauma, anaesthesiology, surgery, haematology, intensive care, and
> blood bankers to exchange experiences, knowledge and to establish personal
> relationships for creative collaborations.
> 
> Internationally renowned speaker panel
> Prof. D de Backer, Belgium, Prof. K Brohi, UK, Prof. M Cohen, USA, Dr. N
> Curry, UK, Prof. RP Dutton, USA, Prof. D Fries, Austria, Dr. T Gaarder,
> Norway, Prof. JR Hess, USA, Prof. JB Holcomb, USA, Dr. H Levy, USA, Dr. S
> Ostrowski, Denmark, Dr. A Perner, Denmark, Prof. M Rehm, Germany, Prof. H
> Sch?chl, Austria
> 
> Session topics
> - Coagulopathy of Major Trauma
> - Fluid and volume resuscitation
> - Monitoring of haemostasis ? Clinical appraisal
> - Microcirculation and the endothelium in Critical Bleeding
> - Addressing the clot ? New Data
> - Avoiding Critical Bleeding
> - Ongoing clinical studies in critical bleeding ? An update
> - How do I?..
> - Hyperfibrinolysis and Critical Bleeding
> - Future directions of research in critical bleeding
> 
> with interactive case discussions and live voting running in all sessions
> 
> Only approx 100 seats left - 280 out of 390 seats are already occupied -
> Hurry with your registration!
> 
> ISCB2011 Best Poster Award - ? 1.000 (euro) 1st prize - abstract deadline
> July 1st 2011
> We encourage delegates to submit abstracts to the ISCB2011 Best Poster
> Award, sponsored by Trygfonden.
> 
> Please visit http://www.iscb2011.dk for further info
> 
> On behalf of the organizing committee
> 
> P?r I. Johansson & Jakob Stensballe
> 
> P?r I. Johansson
> Director of Transfusion Services, MPA, DmSc, MD
> Section for Transfusion Medicine
> Capital Region Blood Bank
> Rigshospitalet, Copenhagen University Hospital
> Phone: +45 23729202
> per.johansson at rh.regionh.dk
> 
> 
> Jakob Stensballe
> MD, PhD
> Department of Trauma Anaesthesia
>    &
> Section for Transfusion Medicine
> Capital Region Blood Bank
> Rigshospitalet, Copenhagen University Hospital
> Phone: +45 27538687
> jakob.stensballe at rh.regionh.dk
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> 
> ------------------------------
> 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> End of trauma-list Digest, Vol 95, Issue 11
> *******************************************


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