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PubMed1982

[Rupture of the biliary tract in the liver hilum region following closed abdominal injuries. General review about 2 cases].

Two cases of traumatic rupture of the biliary tract in the liver hilum region are reported. Similar cases (27 patients) reported in the published literature are discussed and the physiopathological, pathological, and clinical characteristics described. Road accidents account for the majority of these cases of biliary tract injury, which are seen mainly in young males. Diagnosis is confirmed either during emergency laparotomy for haemoperitoneum, the presence of bile leading to cholangiography which establishes the diagnosis, or after several days from the presence of jaundice and signs of a peritoneal effusion, when urgent surgery was not required. Treatment is by direct suture or hepatojejunal anastomosis, choice being dictated by two parameters: the type of lesion and the time when it is repaired.

Adolescent↗
PubMed1993

Management of intra-abdominal organ injury following blunt abdominal trauma in children.

OBJECTIVE: To evaluate the strategy of a combined diagnostic and therapeutic approach in children with intra-abdominal organ injury following blunt abdominal trauma. DESIGN: Retrospective clinical study. SETTING: Pediatric intensive care unit of an university hospital. PATIENTS: 38 children with documented intra-abdominal injury. INTERVENTION: Initial non-surgical treatment by a team of pediatric intensivists, radiologists and surgeons. MEASUREMENTS AND RESULTS: Physical examination, oriented blood and urine tests, plain abdominal film, abdominal ultrasound (US) and computed tomography (CT) with contrast. US documented intra-abdominal fluid in 30 and initial organ lesion in 14 out of 31 patients evaluated. Abdominal CT demonstrated the precise organ lesion in 34 out of 36 patients examined with solid organ lesion. Early laparotomy was needed in 7 because of severe shock, pneumoperitoneum and ruptured diaphragm, and delayed surgery in 6 patients. All 38 patients regained a normal life. CONCLUSIONS: The stepped diagnostic approach combined with initial non-surgical treatment by a team provided accurate diagnosis and appropriate treatment. Abdominal US, by demonstrating free intra-abdominal fluid is very sensitive to detect patients with intra-abdominal organ injury, CT scan with contrast is needed to give precise information of specific organ lesions.

Abdominal Injuries↗
PubMed1996

Missed injuries in abdominal trauma.

Injuries missed at initial diagnoses or operations have the potential to cause disastrous complications in abdominal trauma patients. The aim of this retrospective study is to assess the causes and the outcomes of missed abdominal injuries. Twelve patients (2%) with missed injuries were identified among 607 abdominal trauma patients operated on from 1985 to 1993. Ten patients were male and two were female. The modes of the trauma were ten blunt injuries (83%) and two stab penetrating injuries (17%). Five cases had delayed operations because of clinical errors in the initial diagnosis. Their causative factors were obscured trauma history (two cases), radiologic misinterpretation (two cases), no reliable radiologic finding (one case), and admission to inappropriate department (one case). Missed injured organs were spleen (two cases), liver (one case), diaphragm (one case), and rectum (one case). Median delayed time was 7 days (3 to 96 days). Another seven cases of injuries were missed at the time of initial operation because of incomplete exploration. Their causative factors were surgical inexperience (two cases), severe peritoneal adhesions (one case), neglected exploration of retroperitoneal hematoma (two cases), underestimated mesocolic vascular injury (one case), and early contraction of the perforating wound with intraoperative hypotension (one case). Missed injured organs were stomach (two cases), duodenum (one case), rectum (one case), pancreas (one case), urinary bladder (one case), and rectosigmoid mesocolon (one case). Median time interval between initial and second operation was 9 days (4 to 32 days). Two patients died of complications directly related to their missed injuries. Major complication and mortality rates of missed injuries were 83 and 17%, respectively. These were significantly higher compared with those (39 and 6.3%, respectively) of detected abdominal injuries. We conclude that missed abdominal injuries can cause high mortality and morbidity, and, therefore, a systematic approach, including careful history taking, complete diagnostic procedure, complete surgical explorations, and early reoperation are mandatory for patients with multiple trauma.

Abdominal Injuries↗
PubMed2004

Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma.

BACKGROUND: Computed tomographic (CT) scanning using intravenous and oral contrast material has traditionally been advocated for the evaluation of intra-abdominal injury, including blunt bowel and mesenteric injuries (BBMIs). The necessity of oral contrast in detecting these injuries has recently been called into question. The purpose of this study was to determine the sensitivity and specificity of CT scanning without oral contrast for BBMIs. METHODS: We prospectively enrolled 500 consecutive blunt trauma patients who received CT imaging and interpretation (CT-Read1) of the abdomen from July 2000 to November 2001. All patients were imaged without oral contrast, but with intravenous contrast. CT images were reviewed within 24 hours of admission by a research radiologist (CT-Read2) blinded to CT-Read1. For study purposes, true BBMI was determined to be present if either laparotomy or autopsy identified bowel or mesenteric injury, or both CT-Read2 and the hospital discharge summary described bowel or mesenteric injury. Three-month telephone follow-up was also completed. RESULTS: CT-Read1 detected 19 of 20 bowel and mesenteric injuries. CT-Read1 missed one duodenal perforation. There were two patients with false-positive interpretations of CT-Read1 for bowel injury. The sensitivity and specificity of CT imaging for the detection of BBMIs were 95.0% and 99.6%, respectively. CONCLUSION: CT imaging of the abdomen without oral contrast for detection of BBMIs compares favorably with CT imaging using oral contrast.

Abdominal Injuries↗
PubMed2000

Operative management and outcome of 302 abdominal vascular injuries.

BACKGROUND: Abdominal vascular injuries incur high mortality rates. The purposes of this study are (1) review institutional experience, (2) determine additive effect on mortality of multiple vessel injuries, (3) determine mortality of combined arterial and venous injuries, and (4) correlate mortality with American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for abdominal vascular injury. METHODS: A retrospective 6-year study was made at an urban level I trauma center of patients with abdominal vascular injuries. Main outcome measure was survival. RESULTS: (1) There was a total of 302 patients, mean age 28, mean Injury Severity Score (ISS) 25 (range 4 to 75). Mechanism of injury was penetrating in 266 (88%), blunt in 36 (12%). Emergency Department thoracotomy was done in 43 of 302 (14%), 504 vessels were injured: arteries 238(47%), veins 266(53%). Surgical management was ligation 245, primary repair 141, prosthetic interposition grafts 24, autogenous 2. Overall mortality was 162 of 302 (54%). (2) Mortality multiple vessels injured: 1 vessel 160 (45%), 2 vessels 102 (60%), 3 vessels 33 (73%), >4 vessels 5 (100%). Mortality arterial injuries: aorta isolated (I) 78% versus combined with other arterial injuries (C) 82.4%, superior mesenteric artery (SMA) I 47.6% versus C 71.4%, iliac I 53% versus C 72.7%, renal I 37.5% versus C 66.7%. Venous injuries: inferior vena cava (IVC) isolated (I) 70% versus combined with other venous injuries (C) 77.7%, superior mesenteric vein (SMV) I 52.7% versus C 65%, IMV I 16% versus C 50%. (3) Specific mortality combined arterial and venous injuries: aorta plus IVC 93%, SMA plus SMV 43%, iliac artery plus vein 45.5%. (4) Mortality versus AAST-OIS: grade II 25%, grade III 32%, grade IV 65%, grade V 88%. CONCLUSION: Abdominal vascular injuries are highly lethal. Multiple arterial and venous injuries increase mortality. Mortality correlates with AAST-OIS for abdominal vascular injury.

Abdominal Injuries↗
PubMed1998

Management of abdominal vascular injuries.

Major abdominal vascular injuries are associated with significant morbidity and mortality. They present a formidable challenge to the most experienced surgeon. Most commonly the result of penetrating trauma, hemorrhagic shock is the usual presentation, and diagnostic maneuvers are unnecessary. Conversely, a high index of suspicion is critical in diagnosing occult injuries. This article reviews the cause, diagnosis, and treatment of major abdominal vascular injuries, with an emphasis on exposures and techniques of repair. In addition, the concepts of repair versus ligation, staged laparotomy, and the abdominal compartment syndrome are discussed.

Abdomen↗
PubMed1992

Visceral injuries.

Abdominal visceral injuries are encountered by every surgeon who deals with trauma. It is simple and useful to divide abdominal visceral injuries into those caused by penetrating mechanisms of injury and those due to blunt mechanisms. Determination of the need for operative intervention is generally easier after penetrating trauma. Gunshot wounds to the abdomen should be explored, as should stab wounds to the anterior abdomen that penetrate the fascia. A midline incision is the standard approach to abdominal visceral injuries because of its ease and versatility. Abdominal exploration should be consistent and systemic so as not to miss significant injuries. Hollow viscus injury is most common after penetrating injury, while blunt injury most often results in injury to solid viscera. Diagnostic and operative aspects of the treatment of specific visceral injuries are reviewed.

Abdominal Injuries↗
PubMedDate not supplied

[Predictive value of diagnostic tests in polytrauma patients with abdominal and craniocerebral injuries].

In a study on 1024 polytrauma patients with craniocerebral injury, abdominal injury was present in 206 (20.11%) of them. In order to identify the intraabdominal organs injury, physical examination and specific diagnostic tests will be used. Their value was calculated by means of informational indices. The main indices, sensitivity, positive predictive value and accuracy were: for physical examination = 81.06%, 90.3%, 94.72%; for peritoneal lavage = 94.17%, 95.12%, 97.94%; for abdominal computed tomography = 98.44%, 97.65% and 99.25%. As one might expect the abdominal computed tomography is the most accurate method for the diagnosis of intraabdominal organs injuries.

Abdominal Injuries↗
PubMed2000

Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children.

Defendants accused of inflicting fatal abdominal injuries to children occasionally raise the defense that the injuries were caused by cardiopulmonary resuscitation (CPR). The purpose of this study is to answer the question: Does closed chest CPR result in fatal blunt abdominal injuries that can be mistaken for homicidal assault? To that end, a retrospective study was conducted of all homicidal blunt abdominal injuries in children 10 years and younger from the Dade, Broward, and Palm Beach Medical Examiner's Offices from 1981 through 1997. These were compared to cases of children who died of natural causes during the same time period in Broward County who had CPR (control group 1) and to children who died of nonvehicular accidental blunt abdominal trauma (control group 2). Children with life-threatening head injuries were excluded. Medical examiner records, autopsy reports, documenting photographs, and clinical records were reviewed. The data analyzed included subject demographics, whether CPR was performed and by whom, and autopsy findings. Thirty-three child homicides with fatal abdominal injuries were reviewed. Twenty-four (73%) of the homicides received CPR. There was no difference in the nature and severity of injuries between the 24 children who received CPR and the 9 who did not. Three hundred and twenty-four cases of pediatric natural deaths were reviewed, all of which had CPR. No traumatic abdominal injuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal trauma related to CPR. No cases of nonvehicular accidental blunt abdominal trauma were identified during the 17-year period, although there were nonvehicular accidental fatalities due to extraabdominal injuries. The likelihood of CPR-related primary abdominal trauma in child homicides is very low.

Abdominal Injuries↗
PubMed2001

Free fluid on abdominal computed tomography without solid organ injury after blunt abdominal injury does not mandate celiotomy.

BACKGROUND: Mandatory celiotomy has been proposed for all patients with unexplained free fluid on abdominal computed tomography (CT) scanning after blunt abdominal injury. This recommendation has been based upon retrospective data and concerns over the potential morbidity from the late diagnosis of blunt intestinal injury. This study examined the rate of intestinal injury in patients with free fluid on abdominal CT after blunt abdominal trauma. METHODS: This study was a multicenter prospective series of all patients with blunt abdominal trauma admitted to four level I trauma centers over 22 months. Data were collected concurrently at the time of patient enrollment and included demographics, injury severity score, findings on CT scan, and presence or absence of blunt intestinal injury. This database was specifically queried for those patients who had free fluid without solid organ injury. RESULTS: In all, 2,299 patients were evaluated. Free fluid was present in 265. Of these, 90 patients had isolated free fluid with only 7 having a blunt intestinal injury. Conversely, 91% of patients with free fluid did not. All patients with free fluid were observed for a mean of 8 days (95% confidence interval 6.1 to 10.4, range 1 to 131). There were no missed injuries. CONCLUSIONS: Free fluid on abdominal CT scan does not mandate celiotomy. Serial observation with the possible use of other adjunctive tests is recommended.

Abdominal Injuries↗