[Abdominal injury associated with inguinal hernia and orthopedic truss].
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Abdominal Injuries↗
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Predictors of mortality in patients with traumatic diaphragmatic rupture and associated thoracic and/or abdominal injuries.
This is a retrospective review of 731 patients sustaining diaphragmatic trauma over a 22 year period (1980-2002) at an urban level I trauma center. Patients had an average injury severity score (ISS) of 22 +/- 12. The mortality rate (MR) was 23 per cent (168/731). There were a total of 460 left-sided diaphragmatic injuries (L-TDR), 263 right-sided diaphragmatic injuries (R-TDR), and 8 bilateral diaphragmatic injuries (B-TDR). There were no significant differences in mortality with L-TDR versus R-TDR. Shotgun wounds had the highest MR (42%) (P = 0.0028). Emergency thoracotomies were performed in 31 per cent (225) with a 62 per cent (140) MR. Bilateral thoracotomies had a significantly higher MR of 85 per cent (33/39) compared to the 58 per cent (107/186) for unilateral thoracotomies (P = 0.0028). Multivariate analysis revealed the most significant independent predictors of mortality to be the revised trauma score, transfusion of pRBCs > 10 units, and need for thoracotomy (P < 0.0001). The infection rate was 41 per cent. Multivariate analysis revealed blunt trauma, blood transfusions, ISS, and pancreatic injury as the most significant independent predictors of infection (P < 0.001). The initial physiologic presentation of the patient and the severity of hemorrhagic shock are the primary determinants for survival. Prompt identification of associated injuries with rapid control of bleeding is paramount to survival.
Abdominal Injuries↗
[Analysis of fatal outcomes in severe nonpenetrating thoracic and abdominal injuries].
Experience of treatment of 1147 injured persons with severe closed thoracoabdominal trauma (SCTT) in acute period was summarized. Analysis of causes of the injured persons deaths was conducted, irreversible states in SCTT were determined. Lethality had constituted 33.4%.
Abdominal Injuries↗
[Open abdominal injuries in the Ivory Coast. A retrospective study of a series of 652 cases].
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Abdomen, Acute↗
[Closed abdominal injuries in patients with multiple injuries. Diagnostic considerations on 74 cases].
A diagnostic assessment was made of 74 cases of non-penetrating abdominal wounds observed over the previous 5 years. Laparoscopy performed in 49 polytraumatised patients made a decisive contribution to accurate, early diagnosis, with an indication for emergency surgery in 35 cases (32 visceral lesions and 3 retroperitoneal haematoma), whereas it was clear from the negative finding that surgery was not required in the remaining 14. It is felt that all additional radiological and instrumental diagnostic should be employed, and that careful clinical examination and repeated inspection, preferably by the same surgeon, are important in cases of multiple injury, since the situation may become dramatically worse in the space of a few hours.
Abdominal Injuries↗
[Cranio-abdominal injury].
Cranioabdominal trauma (CAT) is one of the most severe forms of combined injury, in which the mortality rises up to 80%. Four principle factors in diagnosis and treatment of CAT are noted. The absence or noncomplete volume of the aid provided in the before hospitalization period causes unsatisfactory result of treatment in 30% of injured persons. Instrumental methods of investigation play the main role in CAT diagnosis. The informativity of laparocentesis in the closed abdominal trauma constitutes 98%. Operative intervention is performed under the support of antishock intensive therapy. When an urgent operation conduction is necessary it is performed by two teams of surgeons.
Abdominal Injuries↗
[Ureteral rupture after blunt abdominal injury].
Two male and one female patients, between the ages of four and 25 years, involved in road traffic accidents, sustained isolated ruptures of the right proximal ureter in addition to severe injuries to the skull and extremities. The typical urographic finding of an absent ureter was seen only once. In one incomplete rupture of the ureter from a solitary kidney, the ureter filled with contrast and there was no dilatation of the renal pelvis and in another case, the appearance of the ureter was simulated by a peri-ureteric contrast leak. Ultrasound examinations following abdominal trauma should be directed at finding peri-renal fluid; this should be followed by an urogram in order to recognize ureteric rupture at an early stage, when there may be few symptoms.
Abdominal Injuries↗
[Instrumental method of examination in diagnosis of closed abdominal injury].
70 instrumental investigations were performed (18 laparoscopies and 52 laparocenteses) in closed traumas of the abdomen. Both methods are believed to be of a great diagnostic precision, making 96%. A hazard of damaging internal organs during the investigation seems to be rather exaggerated. The characteristics of both methods are described comparatively.
Abdominal Injuries↗
[Express method of determining blood in the abdominal cavity in closed abdominal injuries].
The article describes an express-method of determining intraabdominal bleeding with the help of a benzidine test based on the ability of the hemine group of hemoglobin to catalyze the reaction of benzidine oxidation with hydrogen peroxide.
Abdominal Injuries↗
[Judgement of prognosis in multiple trauma of patients with blunt abdominal injuries based on different useful trauma scores].
The use of trauma indices for characterisation of polytraumatized patients concerning prognoses is being discussed for nearly 30 years. In the seventies a couple of trauma indices were developed. Some of them are in use all over the world. In the Department for Trauma surgery in the General Hospital of Salzburg three of the common trauma scores were analysed and compared with one another: Injury Severity Score (Baker), Polytraumascore of the University Clinic of Hannover, Trauma index (Schreinlechner and Eber). As a rule most studies presently published are based on the Injury Severity Score. In a retrospective analysis of 62 polytraumatized patients we could show that the Trauma index of Schreinlechner and Eber is more practicable for classification of polytrauma because it shows a good correlation of score, fatality and prognoses.
Abdominal Injuries↗
Priorities in the management of multiple trauma: intracranial versus intra-abdominal injury.
UNLABELLED: Setting priorities in the management of patients with suspected injuries to both the head and the abdomen is difficult and depends on the likelihood of different injuries. Eight hundred trauma patients were retrospectively reviewed to determine the likelihood of a surgically correctable cerebral injury. All 800 patients, at the time of initial evaluation, were thought to have potentially correctable injuries to both the head and the abdomen. Of these, 52 had a head injury requiring craniotomy; 40 required a therapeutic celiotomy. Only three patients required both craniotomy and therapeutic celiotomy. There were more cases of delay in therapeutic celiotomy because of negative results of computed tomographic (CT) scanning of the head (13 cases) than there were delays in craniotomy because of nontherapeutic celiotomy (four cases). Need for craniotomy, based on emergency department evaluation, was indicated by the presence of lateralizing neurologic signs. Low Glasgow Coma Scale score, anisocoria, fixed/dilated pupils, loss of consciousness, facial or scalp injuries, and age were of no independent value in predicting the need for craniotomy. CONCLUSIONS: Patients with surgically correctable injuries of both the head and the abdomen are rare. In stable patients with altered mental status and potential injuries to both the head and the abdomen, the abdomen is best evaluated first by diagnostic paracentesis. If paracentesis does not return gross blood, CT scanning of the head should be done.(ABSTRACT TRUNCATED AT 250 WORDS)
Abdominal Injuries↗
[Additional intra-abdominal injuries in multiple-traumatized patients with pelvic fractures. Difficulties in diagnosis and therapy].
Between 1.1. 1987 to 31.12. 1988 178 polytraumatized patients were treated with 62 patients demonstrating pelvic fractures. In 58% of patients injured by rapid falls pelvic fractures were diagnosed compared to only 25% of all patients with traffic accidents. 22% of all polytraumatized patients suffered from intraabdominal injuries, with raise to 47% in patients with pelvic fractures. To avoid unnecessary laparotomies caused by questionable positive lavage ultrasonography is recommended because of its high accuracy and lack of any diagnostic morbidity. 27 of 29 patients with intraabdominal injuries underwent laparotomy. One patient with an isolated kidney rupture was treated conservatively and one patient died before operation. The most common intraabdominal lesion was rupture of liver in 52% and splenic injury in 10 patients. Lesions of the intestine were diagnosed in 11 patients mostly in combination with parenchymal injuries. Concerning the therapeutical approach a conservative treatment is recommended in order to shorten time of operation in concern of the progressively increasing retroperitoneal hematoma. The overall mortality rate was 36%. Most common cause was direct injury of CNS in 14 patients of whom 6 patients suffocated during the first 24 hours. Unstable dislocated pelvic fractures were primary stabilized by external fixator which may help to avoid further progressive retroperitoneal hematoma.
Abdominal Injuries↗
Blunt abdominal injury in the pregnant patient: detection with US.
PURPOSE: To determine the accuracy of ultrasonography (US) for the detection of blunt intraabdominal injury in pregnant patients and to compare differences between pregnant and nonpregnant patients of childbearing age. MATERIALS AND METHODS: A retrospective review of results of all consecutive emergency blunt trauma US examinations performed at a level I trauma center from January 1995 to June 2002 was conducted. Data on demographics, free fluid location, and patient outcome were collected. Injuries were determined on the basis of results of computed tomography and/or laparotomy. The Student t test was used to detect differences between continuous variables, and chi(2) analysis was used to evaluate differences between proportions. RESULTS: A total of 2319 US examinations for blunt trauma were performed in girls and women between the ages of 10 and 50 years. There were 328 pregnant patients, 23 of whom had intraabdominal injury. The mean age of the pregnant patients was 24.7 years +/- 6.1 (standard deviation) (age range, 14-42 years). In pregnant patients, the sensitivity of US was 61% (14 of 23 patients), the specificity was 94.4% (288 of 305 patients), and the accuracy was 92.1% (302 of 328 patients). Pregnant patients were significantly more likely to have sustained injuries from assault (odds ratio: 2.6, P < .001). The most common pattern of free fluid accumulation detected at US in pregnant patients was that of fluid in the left and right upper quadrants and pelvis (n = 4, 29%); the second most common pattern was one of isolated pelvic fluid (n = 3, 21%). CONCLUSION: For detection of intraabdominal injury, US was less sensitive in pregnant patients than in nonpregnant patients but was highly specific in both subgroups. The sensitivity of US was highest in pregnant patients during the first trimester.
Abdominal Injuries↗
[Relaparotomy for postoperative mechanical intestinal obstruction in abdominal injuries].
The article analyzes an experience with the treatment of 41 patients with traumas of the abdomen who were subjected to relaparotomy for acute mechanical intestinal obstruction. A comparative estimation of early diagnostic symptoms allowing determination of indications for relaparotomy in postoperative acute mechanical intestinal obstruction was made. Medical errors responsible for relaparotomies and causes of death after it are analyzed.
Abdominal Injuries↗
[Clinical course, diagnosis and treatment of thoraco-abdominal injuries].
High incidence of diagnostic errors in thoracoabdominal wounds is due to the critical state of the patients, insufficient clinical examination and underestimation of localization of the wound hole. Errors in diagnosis result in the incorrect sequence of surgical procedures, time loss during the arrest of bleeding, use of traumatic operative accesses.
Abdominal Injuries↗
[A table method for the evaluation of the severity and prognosis of the outcome of treatment of closed abdominal injuries].
A unified method for early prognosis of severity and results of the treatment of closed trauma of the abdomen has been developed and introduced into clinical practice. The method is based on the quantitative estimation of seven most important features characterizing the patient's state. It helps to find an adequate method of treatment and determine prognosis of more than 90% of the patients.
Abdominal Injuries↗
[Thrombosis of the renal pedicle in a closed abdominal injury].
A case of traumatic thrombosis of renal vascular pedicule in a 15 years old patient is presented. The different diagnostic and therapeutic problems which were seen are discussed. Special emphasis is made on the necessity of an early diagnosis for the revascularization techniques to be effective, or the nephrectomy is otherwise indicated.
Abdominal Injuries↗
[Endogenous intoxication in chest and abdominal injuries].
Results of clinico-laboratory examinations of the endogenic intoxication in patients with injuries of the chest and abdomen are presented. Correlative relationships of the endogenic intoxication parameters and their association with the degree and character of injuries were established, the clinical informative value and prognostic significance of certain laboratory tests were determined. A conclusion is made on the necessity of a correction of endogenic intoxication in complex treatment of these patients.
Abdominal Injuries↗