PubMed · 8179759
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R L Hopkins, E M Frieberg, S L Bonis. 1994. Traumatic asphyxia--curious cause and consequence.. https://doi.org/10.1016/0735-6757(94)90175-9
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OBJECTIVE: To assess the role of imaging, in particular CT, in the early detection of GI perforation. SUBJECTS AND METHODS: In a 10-year period, 43 patients with surgically confirmed GI perforation were identified from hospital records; 22 of these had preoperative CT evaluation. Medical records and radiology were retrospectively reviewed and CT studies were particularly assessed for extraluminal air, free intraperitoneal fluid, bowel wall thickening, bowel wall enhancement, and bowel dilatation. During the study period an additional 12 trauma patients were identified who had CT studies demonstrating the above findings, but who had hypovolemic shock bowel or nondisrupting bowel injury without perforation evident. RESULTS: Extraluminal air was demonstrated in 47 % of the imaged perforations. There was one false-positive extraluminal air. Perforation was confirmed in patients who had all five of the above CT findings, but this was the case for only 18 % of patients with perforation. One or more of the five specified CT findings were present in all CT studies reviewed. No false-negative CT study was performed in the study period. CONCLUSION: Separating nondisrupting bowel injury from perforation is diagnostically difficult; however, CT remains a good modality for assessing GI perforation in pediatric blunt trauma, but it cannot replace diligent and repeated clinical evaluation of all potential perforation victims.
Pancreatic injury after blunt abdominal trauma can be subtle and delayed in its onset. We present a 24-year-old man who became jaundiced 16 days after he experienced blunt trauma. He was found to have an isolated pancreatic contusion. We discuss the initial evaluation for blunt pancreatic injury, the differential diagnosis of jaundice resulting from the trauma, and, finally, three methods of treating pancreatic contusions that cause jaundice.
Many trauma centers are considering the addition of diagnostic ultrasonography to their trauma protocols. However, a diagnostic imaging application should not be used in general clinical practice until its efficacy has been demonstrated. A literature search was conducted for prospective trials on the use of ultrasound in evaluation of blunt abdominal trauma. Each study was evaluated with the use of an efficacy assessment model. Within this framework, clinical outcomes were classified according to the following efficacy assessment parameters: technical capacity, diagnostic accuracy, diagnostic effect, therapeutic effect, and patient outcome. This model also provided a systematic process for grading the quality of research methods used to obtain each outcome. Eleven trials were found that fulfilled the study criteria, and all of them concluded that ultrasound was valuable for assessment of blunt intraperitoneal trauma. Frequent methodologic flaws were detected in these studies. None of these trials determined therapeutic effect or patient outcome. The criteria for clinical efficacy were not fulfilled. Additional trials should be conducted before ultrasound is accepted as a standard diagnostic test for the evaluation of blunt abdominal trauma.