Another source of infection are bacteria native to waste or river water, like the gram-negative bacilli, Aeromonas hydrophila and Citrobacter freundii, which are forced into the tissues with great pressures [ 3 ]. When injuries from high-pressure water jets do occur, appropriate management requires consideration of the anatomic injury, the chemical properties of the injected material, and the introduction of pathogens. The second patient, described by DeBeaux, was underwater, and wearing a thick, neoprene diving suit. Conclusion With the increased use of high-pressure water jets across many industries, there is a corresponding increase in the incidence of injuries. All highpressure water jet injuries should be treated as medical and surgical emergencies, evaluating patients for high-velocity penetrating injury, blast injury, chemical irritation, and infection. Water mixtures require irrigation, but should also be evaluated for debridement because other material can be forced into tissues with the fluid stream, like shreds of fabric from clothing or protective gear. This secondgeneration cephalosporin was selected for its coverage of anaerobic bacteria likely contaminating the peritoneum after bowel perforation. The patient in this case report required an exploratory laparotomy with irrigation. Anatomic injury Kinetic energy delivered from the high velocity of a water jet is the primary determinant of tissue disruption.
Biologic considerations Increased susceptibility to infections by uncommon pathogens is necessary to consider in treating high-pressure water jet injuries. The patient in this case report required an exploratory laparotomy with irrigation. The first patient, described by Gardner, had a non-penetrating abdominal injury. Liver lacerations, a diaphragmatic tear, and perforation of the ascending colon required surgical intervention in this patient with a blast-pattern of injury [ 13 ]. During the laparotomy, no foreign objects or necrotic tissues were identified. It is important to identify the injected substance to direct treatment. Discussion Individuals using high-pressure fluid devices must receive thorough training in the safe use of these devices and the recommended safety equipment. The two patients reviewed who did not sustain visceral injuries were wearing either PVC protective gear or a thick neoprene diving suit [ 7 , 10 ]. All other patients sustained penetrating abdominal injuries associated with a combination of bowel perforations, pancreatic transection, or liver or vascular lacerations [ 8 , 9 , 11 , 12 , 14 - 16 ]. Anatomic injury Kinetic energy delivered from the high velocity of a water jet is the primary determinant of tissue disruption. The stream penetrated the abdominal cavity, but caused only mesenteric bruising and an omental tear [ 10 ]. Water mixtures require irrigation, but should also be evaluated for debridement because other material can be forced into tissues with the fluid stream, like shreds of fabric from clothing or protective gear. These gram-negative coccobacilli commonly exist as native flora of the skin or intestines, but only cause infection in cases of extensive tissue damage or immunosuppression [ 14 ]. The water jet pierced his protective polyvinyl chloride PVC suit, and hit the abdomen at an oblique angle, scoring the abdominal wall but failing to penetrate the abdominal cavity. Costello reported a wastewater jet stream injury resulting in colon perforation in which the patient developed an infection on postoperative day 3, despite empiric treatment with cefoxitin. The water jet stream caused edema, emphysema , and deep abrasion of the abdominal wall [ 7 ]. Summary of reported high-pressure water jet injuries to the abdomen from to the present. If patients do go on to develop postoperative infectious complications, broad-spectrum antibiotics should be implemented until the specific bacteria responsible for the infection are identified. The most serious chemical damage comes from injected solvents, like paint and paint thinners, which require debridement due to extensive tissue necrosis [ 3 , 18 ]. The second patient, described by DeBeaux, was underwater, and wearing a thick, neoprene diving suit. Transection of pancreatic duct in tail of the pancreas Laparoscopy with irrigation Table 1: The most common cause of abdominal injury from one of these devices was a misdirected fluid stream from loosing grip of the hose and nozzle. Purulent drainage from the surgical incision grew Pseudomonas and Enterococcus, which were treated successfully with levofloxacin and ampicillin [ 14 ]. Tejero-Trujeque R High-pressure water jet injuries: The injected stream was fresh water; therefore irrigation was performed, but no debridement was necessary. Dispersion of kinetic energy through the neoprene diving suit may have reduced the severity of internal injury.
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