Six adult loggerhead turtles were found stranded and were rescued near Sicily within a period of 12 months. Macroscopically apparent lesions of the shell were present. After thorough physical examination, ketamine-dexmedetomidine-atipamezole induction and tracheal tube insertion all six patients underwent computed tomographic examination under inhalant anaesthesia with isoflurane. A vertebral lesion at the level of the 3 rd thoracic-lumbar vertebra with vertebral lamina and the vertebral body being involved without compression of the spinal cord, a vertebral lesion at the level of the 7 th thoracic-lumbar vertebra and a vertebral lesion at the level of the 8 th thoracic-lumbar vertebra were recorded in the first female. Loss of the shell near the left carapace-plastron bridge, with massive haemorrhage and compression of organs were present in the second female. The remaining four turtles had only superficial lesions with no involvement of bones and organs of the coelom. Computed tomography was proved to be a valuable non-invasive method for clinical examination of stranded sea turtles.

Introduction Use of a urinary catheter balloon tamponade (UCBT) in controlling traumatic hemorrhage is a frequently employed but infrequently described technique. We aim to discuss the experience of balloon tamponade as a bridge to definitive hemorrhage control in the operating room. Methods This is retrospective review at a single institution from January 2008 to December 2018. We identified patients with active bleeding from penetrating torso trauma in whom UCBT was used to tamponade bleeding. We used revised trauma score (RTS), injury severity score (ISS), and new trauma and injury severity score (TRISS) to quantify injury severity. All surviving patients required definitively hemorrhage control in the operating room. Primary endpoint was mortality at 24 hours and 30 days. Results Twenty-nine patients were managed with UCBT. Nine had hemorrhage controlled in the trauma bay, including 4 with neck trauma and 5 with cardiac trauma. Twenty patients had hemorrhage controlled in the operating room, including 15 with cardiac trauma and 5 with intra-abdominal hemorrhage. Mean RTS, ISS, and TRISS in this population were: 5.93, 19.31, and 83.78, respectively. Of the 9 patients treated in the trauma bay, 1 (11.1%) died in the first 24 hours and 2 died in the first 30 days (22.2%). Of the 20 patients treated in the operating room, 0 (0%) patients died in the first 24 hours and 3 died in the first 30 days (15.0%). Conclusion UCBT is an effective tool that can be used to stabilize and bridge an actively bleeding patient to definitive hemorrhage control in the operating room.

InTRODUCCIOnLos traumatismos del recto extraperitoneal (TRE) constituyen afección poco frecuente en la práctica civil, representan sólo del 3% al 5% de todos los traumatismos y heridas abdominales 1,2,31 y se destacan por la elevada morbimortalidad que presentan si no son diagnosticadas y tratadas precoz y adecuadamente. Se destacan también por la evolución histórica en las normativas de su tratamiento quirúrgico, las cuales han sido dictadas en gran parte por las experiencias ganadas en los tiempos de guerra. Así, en la Segunda Guerra Mundial la mortalidad vigente en ese momento de 50% fue disminuida a 30% después que los cirujanos generales del ejercito norteamericano indicaran colostomía en forma sistemática para todas las lesiones colorrectales 32. Posteriormente en el conflicto de Vietnam se asistió a una disminución de la mortalidad del 30 al 14% y de la morbilidad del 72 al 10%, lo cual fue atribuido al agregado del lavado rectal distal y del drenaje presacro, además de optimización de los cuidados perioperatorios. ABCDDV/581Barillaro G, Gatica S, Escudero E, Jimenez L, Martini M. Morbimortalidaded del traumatismo de recto extraperitoneal. ABCD Arq Bras Cir Dig 2008;21(1):6-11 RESUMEn -Introduccion -Los traumatismos del recto extraperitoneal representan el 3% al 5% de todos los traumatismos y heridas abdominales y se destacan por la elevada morbimortalidad que presentan si no son diagnosticados y tratados precoz y adecuadamente. En la actualidad existe falta de consenso con respecto al óptimo manejo quirúrgico en el medio civil. Objetivo -Relatar la experiencia en el tratamiento evaluando aquellos factores que influyeron en la morbimortalidad. Metodos -Estudo retrospectivo descriptivo onde se revisaron los prontuarios de todos los pacientes operados por traumatismo recto extraperitoneal, entre enero de 1998 y diciembre de 2007. Las variables índice de trauma abdominal, intervalo entre trauma y cirugía y tipo de cirugía inicial fueron relacionadas con las complicaciones infecciosas y mortalidad. Resultados -Se evaluaron 13 pacientes, 5 por herida de arma de fuego, 5 por autoempalamiento y 3 por trauma cerrado. El índice de trauma abdominal promedio en infectados y fallecidos fue superior a 25. El 61% de los pacientes(8) fueron operados antes de las 8 horas. La tasa de infección fue del 61,5% y el 90% de los pacientes infectados requirieron nuevas cirugías. La mortalidad de la serie fue de 38,5% (5 pacientes). En los pacientes intervenidos después de las 8 horas se registró un 80% de infección perirrectal y un 80% de mortalidad independientemente del tipo de cirugía realizada. Conclusiones -El retraso en el tratamiento mayor 8hs y el índice de trauma abdominal mayor 25 fueron los principales factores asociados a infección perirrectal y mortalidad en esta serie. La ausencia de drenaje presacro y de lavado rectal distal se asoció a mayor incidencia de infección perirrectal. DESCRITORES -Traumatismo rectal. Recto extraperitoneal. Cirugía rectal.Las bases para las cirugías de estas lesiones san: colostomía a ca...

Conditions requiring emergency surgery and trauma care are still common in emergency systems and require immediate evaluation and timely resolution even during a pandemic as is currently happening with COVID-19, a scenario that threatens to affect their capacity to provide care5,8. In these cases, certain measures must be taken for the special care of health care workers and their patients, who are often admitted in critical condition and require an immediate surgical intervention that does not allow for any delay. For this purpose, an algorithm should be developed with recommendations which include a checklist to guide surgeons working in emergency and trauma systems about the issues to consider for the appropriate management and treatment of these conditions and for preparation of perioperative environments during the COVID-19 pandemic. The ultimate goal is to maintain adequate care with the necessary and required protection in each case5,8,11, raising awareness of the importance of preserving capacity to respond to these conditions that routinely occur in our community.

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