PubMed · 8288362
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C G Rehm, S E Ross. 1993. Blunt traumatic flank hernia.. https://doi.org/10.1016/0020-1383(93)90320-6
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KEEP EXPLORING
The aim of the present study was to improve spleen-preserving procedures in patients undergoing laparotomy following abdominal trauma. Of a total 288 patients who underwent laparotomy for abdominal trauma in the Fourth General Surgical Department of Hardarpaşa Teaching Hospital between 1989 and 1996, 94 patients with splenic injuries were retrospectively analyzed. The mean age of these 94 patients, 69% whom were male, was 28.9 +/- 3.5 years. Traffic accidents were found to be the major cause of splenic injuries (71.3%) and diagnostic peritoneal lavage was frequently used as a diagnostic tool (58.8%). Grades IV and V splenic injuries were seen in 71 patients (75.4%), all of whom required splenectomy. Omentoplasty with partial splenectomy or omentoplasty with splenorrhaphy successfully controlled hemorrhage from the spleen in 22 patients (23.4%). The complication rate was calculated at 18.06% in this study, but no deaths occurred as a direct result of splenic injury. In conclusion, omentoplasty, partial splenectomy, and splenorrhaphy are safe and successful methods of controlling bleeding from a damaged spleen of grade III in patients without multiple injuries.
A prospective study was performed to investigate the feasibility and benefit of evaluating blunt abdominal trauma (BAT) without diagnostic peritoneal lavage (DPL) or other invasive methods. Diagnostic algorithms were designed by using ultrasonography (US) as a screening method. For unstable patients, a free fluid >/= 2 mm thickness on US images over any one of the intraperitoneal spaces (bilateral subphrenic, Morrison, and Douglas pouch) was used as an indicator for laparotomy. For stable patients, any intraabdominal free fluid detected by US was used as an indicator for further investigations. Computed tomography served as a principal complementary method. To further clarify the clinical results, the rate of nontherapeutic laparotomy (NTL) was compared with that from a previous 5-year review done before this study. During studying period of 1 year, 170 patients were consecutively enrolled. There was no delayed diagnosis, and 66 patients were found to have BAT; 17 patients were initial unstable, among whom 15 had free fluid shown by US and 13 patients had confirmed BAT. Eight of the unstable patients with free fluid on US were saved from NTL, of whom six had retroperitoneal hematoma. There was no NTL in unstable patients. Twenty-two patients underwent laparotomy. Two laparotomies done for a suspicion of bowel injury turned out to be NTL. The rate of NTL in the present study was significant lower than that in a previous review (9.1% vs. 32.2%, p = 0.025). Hence following well designed algorithms, noninvasive evaluation of BAT can proceed with safety, and NTL is minimized.
BACKGROUND: Post-traumatic hepatic artery pseudoaneurysms are rarely seen in children. MATERIALS AND METHODS: We retrospectively reviewed the radiologic studies and medical records of three patients treated at our institution and reviewed the literature. The patients (ages 5-13 years) presented immediately to 2 months after blunt (two patients) and penetrating (one patient) trauma. The hepatic pseudoaneurysms were discovered during work-up for fever (one patient), gastrointestinal bleeding and hyperbilirubinemia (one patient), or widened mediastinum (one patient) on chest radiograph. In two patients, the diagnosis was initially suspected by computed tomography (CT) examination and confirmed by angiography. In the third patient, the diagnosis was made initially by angiography. All three pseudoaneurysms were treated with transcatheter embolization. RESULTS: All three embolizations were initially technically successful. However, there was recurrence in one case, in which embolization distal to the neck of the pseudoaneurysms was not technically possible. With conservative management, however, the residual lesion demonstrated spontaneous occlusion by ultrasound (US) at 6 months. CONCLUSION: This uncommon complication of liver trauma in children can have a delayed presentation, can be clinically unsuspected, and can follow blunt or penetrating trauma. Endovascular embolotherapy is the treatment of choice.