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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Pediatric surgery international 16 (2000), S. 35-39 
    ISSN: 1437-9813
    Keywords: Key words Pancreatic trauma ; Duodenal trauma ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1437-9813
    Keywords: Piglet model ; Intestinal ischemia ; Bacterial translocation ; Disaccharidase activities
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Intestinal ischemia was created after a limited laparotomy by ligation of the terminal mesenteric vessels in the last 10 cm of distal ileum in 2-day-old piglets. Five groups (each n = 15) were studied: 1 (unoperated control group, killed on day 4), 2 (sham control with laparotomy, killed on day 4), 3 (ischemia, killed on day 4), 4 (ischemia, killed on day 9), and 5 (unoperated control on day 9, not killed). All animals in groups 1, 2 and 5 survived. Two animals in group 3 and 1 in group 4 died (peritonitis and distal ileal perforation). In animals killed on day 9, less weight gain was observed in group 4 compared to the unoperated controls. Macroscopically, no alteration was found at laparotomy in the animals in group 1, whereas in group 2, 1 animal showed beginning peritonitis and another some degree of peritoneal adhesions in group 3, 1 piglet had an intestinal perforation and 4 had intestinal distention above the ischemic loop. In group 4, 7 animals had dilatation of the upper loops, 4 a complete stricture, and 3 peritonitis with complete necrosis of the distal ileum. Microscopic examination revealed severe lesions of the ischemic area in groups 3 and 4 and mild lesions of the upper loop. The kidney was contaminated by translocation of gram-positive cocci in 36% of cases in group 2. Germ carriage for staphylococci was estimated at 80% in the terminal ileum of animals in group 3 versus 8.3% in group 2. In groups 3 and 4, the translocation rate was 30% in the kidney and 40% in the liver. Low disaccharidase activities were found in ischemic areas in groups 3 and 4, with no difference in activity in the upper loops.
    Type of Medium: Electronic Resource
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