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PubMedDate not supplied

Epidemiology and surgical management of abdominal war injuries in Sarajevo: State Hospital of Sarajevo experience.

BACKGROUND: In war, abdominal injuries constitute a significant proportion of the total injuries. These injuries are associated with high mortality and their treatment poses diagnostic, surgical, and therapeutic dilemmas. This article presents the epidemiology of abdominal war injuries during the siege of Sarajevo, and briefly describes the surgical techniques and therapeutic practices used in their treatment. METHODS: A retrospective medical record review was performed of 273 war casualties with trauma to visceral and vascular structures in the abdomen inflicted during a 7.5 month period in 1992. RESULTS: Most patients underwent exploratory laparotomy. Six percent had negative laparotomies, and there were no deaths in this group. In 18.3%, injuries were limited to one organ system, while 81.7% sustained combined injuries to multiple-organ systems. The crude mortality rate was 26.0%. Mortality rate excluding deaths within 24 hours of injury was 10.3%. Injuries were caused by metal fragments from artillery shrapnel, mortar and contact mines, or hand grenades. Because of a shortage of colostomy bags, resections of the colon with primary end-to-end anastomoses rather than colostomy were performed in 72% of the cases. CONCLUSIONS: Mortality was highest in those victims with four or more injured organ systems (81.3%) or with major vascular injuries (64.7%). The primary cause of death within the first 24 hours was prolonged hemorrhagic shock.

Abdominal Injuries↗
PubMed2001

2,576 ultrasounds for blunt abdominal trauma.

BACKGROUND: Determination of intra-abdominal injury following blunt abdominal trauma (BAT) continues to be a diagnostic challenge. Ultrasound (US) has been described as a potentially useful diagnostic tool in this setting and is being used with increasing frequency in trauma centers. We determined the diagnostic capability of US in the evaluation of BAT. METHODS: A retrospective analysis of our trauma US database was performed over a 30-month period. Computed tomographic scan, diagnostic peritoneal lavage, or exploratory laparotomy confirmed the presence of intra-abdominal injury. RESULTS: During the study period, 8,197 patients were evaluated at the Ryder Trauma Center. Of this group, 2,576 (31%) had US in the evaluation of BAT. Three hundred eleven (12%) US exams were considered positive. Forty-three patients (1.7%) had a false-negative US; of this group, 10 (33%) required exploratory laparotomy. US had a sensitivity of 86%, a specificity of 98%, and an accuracy of 97% for detection of intra-abdominal injuries. Positive predictive value was 87% and negative predictive value was 98%. CONCLUSION: Emergency US is highly reliable and may replace computed tomographic scan and diagnostic peritoneal lavage as the initial diagnostic modality in the evaluation of most patients with BAT.

Abdominal Injuries↗
PubMed2004

[Shock trauma room diagnosis: initial diagnosis after blunt abdominal trauma. A review of the literature].

OBJECTIVE: Blunt abdominal trauma is most common in the polytraumatized patient and beside neurocranial trauma one major determinant of early death in these patients. Therefore, immediate recognition of an abdominal injury is of life-saving importance. METHODS: Clinical trials were systematically collected (Medline, Cochrane and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). RESULTS: Clinical examination is not reliable for evaluation of abdominal injury. Abdominal ultrasound, especially if only focusing on free fluid (FAST) is not sensitive enough. Today, CT-scan of the abdomen is the gold-standard in diagnosing abdominal injury. Diagnostic Peritoneal Lavage (DPL) has a high sensitivity but in our region only is used in exceptional cases. The patient with continuing hemodynamical instability after abdominal trauma and evidence of free intraperitonial fluid has to undergo laparotomy. CONCLUSION: After blunt abdominal trauma, initially ultrasound investigation should be performed in the emergency room. This should not only focus on free intraabdominal fluid but also on organ lesions. Regardless of the findings from ultrasound or clinical examination, the hemodynamically stable patient should undergo a CT-scan of the abdomen in order to proof or exclude an abdominal injury.

Abdominal Injuries↗
PubMed1992

Penetrating abdominal spear injuries.

Eight cases of penetrating abdominal spear injuries are presented. The type and size of the spearhead as well as its direction and severity of the impact were reflected in the degree of visceral damage. At laparotomy, retro-peritoneal haematoma (RPH) was a constant finding. Morbi-mortality was associated with early haemorrhage or later septic complications. Manipulation of intra abdominal embedded spears may require unusual surgical procedures, and no attempt to extract the weapon should be made before emergency laparotomy is carried out. Prompt first aid and hospital referral, resuscitation and facilities for the treatment and care of the critically ill patient, were important factors influencing the outcome of these cases.

Abdominal Injuries↗
PubMed2004

Blunt injury to solid abdominal organs.

Injuries to the solid abdominal viscera (spleen, liver, kidney, pancreas) are common in children sustaining trauma by blunt mechanisms. Success with nonoperative management of these injuries has led to recent extensions of this approach to the management of higher-grade more complicated injuries typically treated operatively. This review will discuss the current status of evaluation, management and outcome of children sustaining blunt injury to solid abdominal organs.

Abdominal Injuries↗
PubMedDate not supplied

Intussusception following a baby walker injury.

Serious abdominal injury as a result of a fall in a baby walker has not been previously reported. We present the case of a 13-month-old boy who developed intussusception following a fall down five stairs in a baby walker. Attempted hydrostatic reduction was unsuccessful. At operation, a bowel wall hematoma, serving as a lead point, was identified. This case adds another type of injury to the list of those previously associated with baby walker use.

Accidental Falls↗