அதிர்ச்சி மற்றும் சிகிச்சை இதழ்

Background: Bile leaks are a well recognised complication following liver trauma, however the incidence is rare, and literature is limited. The aims of this study were to identify incidence, risk factors, diagnosis, and management of bile leaks from a large cohort of liver trauma patients.

Methods: All patients with liver trauma over a 15-year period at a trauma centre were retrospectively reviewed using data from a prospective trauma registry. Clinical records, radiology, and laboratory data were reviewed. A comparative analysis compared patients with bile leaks to liver injury grade matched controls.

Results: From this cohort of 473 patients with liver trauma, 31 (6.6%) had a bile leak. High grade injury was a risk factor, occurring in 30% of these patients, as well as parenchymal damage extending into the porta-hepatis. Serum bilirubin levels over 40 μmol/L were predictive of a bile leak. Endoscopic biliary decompression with a transampullary stent was the most common management technique. Surgical management associated with high bile drainage volumes.

Conclusion: Bile leak as sequelae of liver trauma occurs in high grade injuries. Serum bilirubin levels over 40 μmol/L are predictive of bile leak. Most cases are managed with endoscopic decompression; however, high volume drainage is associated with definitive surgical management.

Most injuries to thoracic great vessels are caused by penetrating trauma but can occur after blunt trauma as well. Combined injury of azygous vein and descending thoracic aorta is rare. A 56 year-old woman suffered a motor vehicle accident. Computed Tomography (CT) revealed rupture of the azygous vein with bilateral serial rib fractures. The azygous vein was suture ligated. Repeat CT showed new intramural hematoma of the descending aorta causing compression of the celiac trunc. A Terumo Relay® aortic stent was implanted transfemorally. Early repeat CT can detect additional vascular injuries after major thoracic trauma and allows for combined open and endovascular management of such injuries.

Women are more likely than men to experience symptoms of several psychiatric problems, such as nightmares and sleeplessness, after experiencing traumatic stress. After finishing cognitive behavioural therapy for posttraumatic stress disorder (PTSD), people with the disease frequently continue to have sleep problems. Women who have experienced trauma may benefit from imagery rehearsal therapy, cognitive behavioural therapy for insomnia, or a combination of these approaches to manage their sleeplessness and nightmares. The use of proposing in combination with other psychotropic drugs or psychotherapy may be an effective way to help traumatised women with their nightmares.