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PubMed1997

[Strategy and outcome in bowel injuries after blunt abdominal trauma].

In this retrospective trial, we examined 215 patients with bowel lesions following abdominal injuries. We analyzed the diagnostic procedures, the time to diagnosis, the subsequent surgical therapy, and complications. The diagnosis of bowel lesions remains a diagnostic challenge. All apparative diagnostic procedures (sonography, CT-scan, lavage, laparoscopy, X-ray) fail to diagnose bowel lesions. In our trial, most patients showed clinical signs of peritonitis leading to diagnosis. Ultrasonographically guided puncture was important, if clinical signs remained unclear. This study underlines the importance of repeated clinical examination for early diagnosis and treatment of bowel injury.

Abdominal Injuries↗
PubMed2007

Outcomes of management in stable children with intra-abdominal free fluid without solid organ injury after blunt abdominal injury.

BACKGROUND: The optimal management of hemodynamically stable children without solid-organ injury and with intra-abdominal free fluid on computed tomographic (CT) scan is highly debatable. The possibility of hollow viscus injury in this setting has led many to propose mandatory exploration. We think that stable children with intra-abdominal fluid without solid organ injury can be managed nonoperatively. METHODS: The charts of all children less than 18 years of age who had an abdominopelvic CT scan after a blunt abdominal trauma between January 2001 and July 2004 were queried. Patient demographics, mechanism of injury, vital signs, physical examination, laboratory data, CT findings, and outcomes of management were reviewed. RESULTS: There were 37 pediatric patients identified during the study period who met the selection criteria. Twenty were boys and 17 were girls. Thirty-one patients had a small amount of fluid and six had a moderate amount of fluid. The most common mechanism of injury was motor vehicle crash (MVC). Thirty-one patients were successfully managed nonoperatively. Six patients received an exploratory laparotomy. Intraoperative findings included mesenteric injuries with or without ischemic bowel. There were no cases of hollow viscus perforation. CONCLUSIONS: Nonoperative management of stable patients with small amounts of free fluid in the absence of significant abdominal findings is appropriate in the pediatric population. Increasing amounts of tenderness elicited on physical examination correlates well with the presence of more than a small amount of fluid. The presence of seat belt sign and more than a small amount of fluid may be associated with an increased likelihood of operative intervention.

Abdominal Injuries↗
PubMed1989

[Acute surgical diseases and injuries of the abdominal organs in mentally ill patients].

The work analyses the results of treatment of acute surgical diseases and traumas of the abdominal organs in 84 patients 18 to 81 years of age suffering from various mental disorders. Schizophrenia was encountered in 47 patients, the manic-depressive syndrome in 16, epilepsy in 8, reactive psychosis in 8, and senile psychosis in 5 patients. Among 66 patients who were admitted for suspected acute surgical disease of the abdominal organs, in 54 the diagnosis was confirmed. Operation was conducted on 59 of them. Eighteen patients had an abdominal trauma. Fourteen patients were operated on for closed (2) and open (12) abdominal injury. All in all 73 patients were treated by operation. Eight patients died. The causes of death were peritonitis and intoxication (4), thromboembolism of the pulmonary artery (1), acute cardiovascular insufficiency (2), and pulmonary edema (1). The peculiarities of the diagnosis and postoperative management of these patients are discussed.

Abdominal Injuries↗
PubMed1999

Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma.

PURPOSE: To determine, at screening ultrasonography, the prevalence, severity, and clinical outcome of clinically important abdominal visceral injuries, without associated hemoperitoneum, that result from blunt abdominal trauma. MATERIALS AND METHODS: Computed tomography (CT) was performed at admission in 466 patients with visceral injury. A retrospective review was performed of findings from surgery and contrast material-enhanced spiral and conventional CT performed to verify abdominal visceral injuries in 467 (4%) of 11,188 patients with blunt trauma. These patients were admitted to a level 1 trauma center over 33 months to determine the presence of hemoperitoneum and to identify the grade of injury. Medical records of patients with abdominal visceral injury without hemoperitoneum were reviewed for the management required and for results of focused abdominal sonography for trauma (FAST). RESULTS: A total of 575 abdominal visceral injuries were identified at CT and/or surgery. Findings of CT at admission (n = 156) and of surgery (n = 1) revealed no evidence of hemoperitoneum in 157 (34%) patients with abdominal visceral injury; 26 (17%) of whom also had negative FAST studies. Abdominal visceral injuries diagnosed in patients without hemoperitoneum included 57 (27%) of 210 splenic injuries, 71 (34%) of 206 hepatic injuries, 30 (48%) of 63 renal injuries, four (11%) of 35 mesenteric injuries, and two (29%) of seven pancreatic injuries. Surgical and/or angiographic intervention was required in 26 (17%) patients without hemoperitoneum. CONCLUSION: Reliance on the presence of hemoperitoneum as the sole indicator of abdominal visceral injury limits the value of FAST as a screening diagnostic modality for patients who sustain blunt abdominal trauma.

Abdominal Injuries↗
PubMedDate not supplied

A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury.

Abdominal Compartment Syndrome (ACS) has multiple causes, and decompressive laparotomy has been the most frequent modality to prevent worsening cardiovascular, respiratory, and renal function. This pilot study evaluated the utility of percutaneous drainage (PD) of peritoneal fluid compared with decompressive laparotomy in burn patients. A 26-month review was conducted. Nine of 13 (69%) study patients developed intra-abdominal hypertension (IAH) that progressed to abdominal compartment syndrome in 4 (31%). All were treated with PD using a diagnostic peritoneal lavage catheter. Peritoneal fluid analysis revealed a sterile plasma ultrafiltrate with electrolyte and other chemistries reflecting patient serum levels. Five patients underwent PD successfully, and their IAH did not progress to ACS. Four patients with greater than 80% TBSA and severe inhalation injury did not respond to PD and required decompressive laparotomy. There was no evidence of bowel edema, ischemia, or necrosis. All patients requiring decompressive laparotomies died either from sepsis or respiratory failure. Percutaneous decompression is a safe and effective method of decreasing IAH and preventing ACS in patients with less than 80% TBSA thermal injury.

Abdomen↗
PubMedDate not supplied

Difference in the outcome of patients managed with isolated renal injury and co-existent abdominal organ injury.

BACKGROUND: Involvement of associated intra-abdominal organs like spleen; pancreas, bowel and liver with renal injuries have a higher rate of open operative management. This is often done to avert the potential of peri-renal infection and subsequent risk of secondary hemorrhage of the injured kidney after intra-abdominal surgery. With this background we reviewed our experience to see if operative intervention for co-existing injuries to intra-abdominal organs increase the rate of nephrectomy for grade II-IV renal injuries. METHODS: In the period between January 1990 and December 2000, we identified 50 patients managed in this hospital with evidence of external injury resulting in renal trauma. Patients were divided into two groups; i) Patients with isolated renal injury (group A) and ii) renal injury associated with solid abdominal organ injury (group B). The two groups were compared. The severity of renal injury was classified by using the renal injury scale (I-V), which was published by the Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.). RESULTS: Sixty percent patients had associated organ involvement. Penetrating injuries were responsible for 47% patients in-group B compared to only 5% in group A (p < 0.001). CT was the predominant radiological investigation in both groups. Spleen was the commonest intra-abdominal organ involved (70%). Mean grade of injury in group-A was 2.2 compared to 2.7 in group B. Operative management was done in 20% patients in group A compared to 29% in group B. Nephrectomy in both groups were performed only for grade V injuries. CONCLUSIONS: Exploration does not increase the rate of nephrectomy; in group B grade II-IV injuries when explored were all reconstructed. Penetrating injuries are more likely to cause associated organ injuries (p < 0.001). Spleen is the commonest organ involved.

Abdominal Injuries↗
PubMed2002

Injury patterns associated with mortality following motorcycle crashes.

All patients involved in motorcycle crashes admitted to various hospitals in the Yorkshire region of UK between January 1993 and December 1999 were retrospectively reviewed to identify the factors that are likely to predict a reduced survival. Of the 1239 patients requiring hospital admission, 74 died. The probability of reduced survival was estimated by a logistic regression model using independent variables such as head injury, thoracic trauma, abdominal injury, spinal injury and pelvic fracture and a compound variable of pelvic fracture combined with a long bone fracture. The odds ratio for head injury was 0.349, chest injury 0.39, abdominal injury 0.42, and the compound variable (pelvis plus a long bone fracture) 0.576. The mean injury severity score (ISS) in the fatal group was 35.96 compared to 12.2 in the group that survived (P<0.01). There was a significant difference in the Glasgow coma scale (GCS) between patients wearing a helmet and those that did not wear any protective headgear (P=0.0007). Head injury followed by chest and abdominal trauma were found to predict a reduced survival rate. Use of helmets should continue to be compulsory. Chest and abdominal injuries should be diagnosed and treated early to reduce mortality.

Abdominal Injuries↗
PubMed1985

Abdominal vascular injuries.

Treatment of major abdominal vascular injuries is a challenge. Since 1973, 93 patients have been treated at our institution for 147 abdominal vascular injuries. The majority of these injuries (67%) resulted from penetrating trauma in young men between 21 and 30 years of age. Upon admission 72% of the patients were in shock. Injured most frequently were the iliac vessels (36%) and the inferior vena cava (20%). Suture repair with preservation of function was possible in 61%; ligation of the damaged vessel was necessary in 24 cases (26%). Overall mortality was 29%. Military anti-shock (MAS) trousers were used in the management of ten patients who had an average admission systolic blood pressure of 52 mm Hg; 50% survived. In six cases of refractory hypotension or cardiac arrest, thoracotomy was done in the emergency room; mortality in this group was 100%. For some abdominal vascular injuries, ER thoracotomy has a very limited application. The key factors for increasing the survival rate in patients with major abdominal vascular injuries include rapid stabilization, reversal of hypotension (especially by the use of MAS trousers), and prevention of coagulopathy, combined with prompt surgical exploration and thoracotomy when indicated.

Abdomen↗
PubMed1987

Biomechanics of liver injury by steering wheel loading.

Abdominal injury induced by steering wheel contact at a velocity of 32 km/hr was investigated using anesthetized swine as the surrogate on a Hyge sled. The lower rim of the wheel was positioned 5 cm below the xyphoid. By varying wheel stiffness, wheel orientation, and column angle, resultant abdominal injury ranged from fatal or critical to minor or none. Wheel stiffness was found to be the primary determinant of abdominal injury severity. The mechanism of abdominal injury was identified to be the rim impacting the abdomen and exceeding a combined velocity and compression sensitive tolerance limit. Abdominal injury occurred within the initial 15 ms of wheel contact before whole body movement of the surrogate of column compression, which were initiated by hub contact with the thorax. The severity of abdominal injury correlated with the peak viscous response which can be represented by the product of the instantaneous velocity of abdominal deformation and abdominal compression. It did not correlate with spinal acceleration.

Abdominal Injuries↗
PubMed2007

Traumatic abdominal aortic injury treated by endovascular stent placement.

Traumatic injury of the abdominal aorta is rare and potentially lethal. The authors present the case of a restrained passenger who was involved in a high-speed, head-on motor vehicle accident. On arrival in the emergency department, the patient complained of abdominal pain, was tachycardic and had a large ecchymoses on his right flank and lower abdominal wall. Computed tomography (CT) angiography (CTA) of the abdomen revealed a degloving injury to the abdominal wall, small bowel injury, and a distal abdominal aortic injury with a small amount of retroperitoneal hemorrhage. The patient underwent surgical repair of bowel injuries and the anterior abdominal wall. Because of risk of peritoneal soiling, open repair of the aorta was not attempted. The interventional radiology and vascular surgery services performed an endovascular repair of the aortic injury using a bifurcated endograft.

Abdominal Injuries↗
PubMed1998

Seat belt injury presenting as bilateral abdominal wall herniations in a child.

The constellation of abdominal injuries caused by seat belts in automobile accidents usually consists of intraabdominal solid organ and hollow viscus injuries. We present a two-and-one-half-year-old patient with an unusual constellation of seat belt injuries that presented as bilateral abdominal herniations. We feel that an abdominal hernia caused by a seat belt injury should alert the clinician to the probability of other severe intraabdominal injuries. The uniqueness of this case is compounded by the way in which the seat belt was misused.

Abdominal Injuries↗
PubMed2000

Blunt trauma in intoxicated patients: is computed tomography of the abdomen always necessary?

BACKGROUND: Physical examination to detect abdominal injuries has been considered unreliable in alcohol-intoxicated trauma patients. Computed tomography (CT) plays the primary role in these abdominal evaluations. METHODS: We reviewed medical records of all blunt trauma patients admitted to our trauma service from January 1, 1992, to March 31, 1998. Study patients had a blood alcohol level > or =80 mg/dL, Glasgow Coma Scale (GCS) score of 15, and unremarkable abdominal examination. RESULTS: Of 324 patients studied, 317 (98%) had CT scans negative for abdominal injury. Abdominal injuries were identified in 7 patients (2%), with only 2 (0.6%) requiring abdominal exploration. A significant association was found between major chest injury and abdominal injury. CONCLUSION: The incidence of abdominal injury in intoxicated, hemodynamically stable, blunt trauma patients with a normal abdominal examination and normal mentation is low. Physical examination and attention to clinical risk factors allow accurate abdominal evaluation without CT.

Abdominal Injuries↗
PubMed1994

[Experience of the surgical service and surgeons at the 1st Surgical Clinical Center in Belgrade in the primary care of abdominal war injuries 1991-1992].

During the recent (1991/92) war on the territory of the former Yugoslavia, 12 of our surgeons participated in the treating of war abdominal injuries, on 8 localities with the various characteristics of combat. Treating all injuries, with adequate evidence and documentation, the general experience of all participants of our team was that abdominal injuries range from 0-12% depending on the the intensity of combat, with the mean percentage of 5.43% while combined injuries approximate 50% with the most common injuries of extremities (24%). The number of laparotomies was 65. The most common cause of abdominal injuries were bullets (75%) except in the localities with heavy combat where the explosive and bullet woundings were equally observed. The blast injuries were recorded in 3%. The most common injured organs were large (29.5%), small intestine (23.46%) liver, stomach and spleen subsequently. The severity of injury and mortality depends mostly of the number of injured organs, and multiorgan lesions were systematically observed (1.89 of injured organs SD 0.96). The total hospital mortality was 6.15% (4 cases: 2 "in tabula" and 2 later) due to multiorgan injuries with severe shock and bleeding. To achieve better results, early transportation to a place where operation could be made is necessary, with the effective first aid and good organisation of the initial management and triage. The diagnosis must be fast and effective, decision quick and the operation must deal with all the injuries primary, by the most safe surgical procedure, with the exposition of external wound.

Abdominal Injuries↗
PubMed2004

Performance of abdominal ultrasonography in blunt trauma patients with out-of-hospital or emergency department hypotension.

STUDY OBJECTIVES: We determine the test performance of abdominal ultrasonography for detecting hemoperitoneum in blunt trauma patients with out-of-hospital or emergency department (ED) hypotension. METHODS: We reviewed the medical records of all blunt trauma patients hospitalized at a Level I trauma center. Patients were included if they were older than 6 years and had out-of-hospital or ED hypotension (systolic blood pressure < or =90 mm Hg) and underwent ED ultrasonography. The initial interpretation of the abdominal ultrasonography was recorded, including the presence or absence of intraperitoneal fluid and the specific location of such fluid. Presence or absence of intra-abdominal injury was determined by abdominal computed tomography scan, laparotomy, or clinical follow-up. RESULTS: Four hundred forty-seven patients with a mean age of 36.0+/-17.5 years were enrolled. One hundred forty-eight (33%) patients had intra-abdominal injuries, and 116 (78%) of these patients had hemoperitoneum. Abdominal ultrasonography had the following test performance for detecting patients with intra-abdominal injury and hemoperitoneum: sensitivity 92/116 (79%; 95% confidence interval [CI] 71% to 86%), specificity 316/331 (95%; 95% CI 93% to 97%), positive predictive value 92/107 (86%; 95% CI 78% to 92%), and negative predictive value 316/340 (93%; 95% CI 90% to 95%). The positive likelihood ratio was 15.8, and the negative likelihood ratio was 0.22. One hundred five (91%) of the 116 patients with intra-abdominal injuries and hemoperitoneum underwent a therapeutic laparotomy. Abdominal ultrasonography demonstrated intraperitoneal fluid in 87 (sensitivity 83%; 95% CI 74% to 90%) of these 105 patients. CONCLUSION: Of patients with out-of-hospital or ED hypotension, abdominal ultrasonography identifies most patients with hemoperitoneum and intra-abdominal injuries. Hypotensive patients with negative abdominal ultrasonography results, however, must be further evaluated for sources of their hypotension, including additional abdominal evaluation, once they are hemodynamically stabilized.

Abdominal Injuries↗
PubMed1984

Pancreatic injury associated with interposed abdominal compressions in pediatric cardiopulmonary resuscitation.

A case in which conventional CPR was augmented with interposed abdominal compressions on a child is reported. Animal studies and electrical models of this new form of CPR have demonstrated improved hemodynamics without instance of intra-abdominal injury. In this case, intraperitoneal visceral injury was noticed in the form of blood within the stomach and small intestine and parenchymal hemorrhage within the pancreas. Similar pancreatic injury has not been reported with conventional pediatric CPR, and caution may have to be exercised if this form of CPR with interposed abdominal compressions is to be used on children.

Abdominal Injuries↗
PubMed2002

Traumatic injuries: imaging of abdominal and pelvic injuries.

The availability of new imaging modalities has altered the diagnostic approach to patients with abdominal and pelvic trauma. Computed tomography and ultrasound have largely replaced diagnostic peritoneal lavage. Ultrasound is used in most trauma centers as the initial imaging technique for the detection of hemoperitoneum and helps to determine the need for emergency laparotomy. Computed tomography allows for an accurate diagnosis of a wide range of traumatic abdominal and pelvic conditions. The speed of single-detector helical and multi-detector row CT (MDCT) permits a rapid CT examination of the seriously ill patient in the emergency room. In particular, the technology of MDCT permits multiple, sequential CT scans to be quickly obtained in the same patient, which is a great advance in the rapid assessment of the multiple-injured patient. The evolving concepts in trauma care promoting non-operative management of liver and splenic injuries creates the need for follow-up cross-sectional imaging studies in these patients. Computed tomography and, less frequently, MR or ultrasound, are used for this purpose.

Abdominal Injuries↗