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PubMed2003

Contrast material extravasation on contrast-enhanced helical computed tomographic scan of blunt abdominal trauma: its significance on the choice, time, and outcome of treatment.

BACKGROUND: Contrast-enhanced helical computed tomographic (CT) scan of blunt abdominal trauma is valuable for detecting contrast material extravasation (CME). The aims of this study were to determine its significance and investigate factors associated with the choice, time, and outcome of management. METHODS: CT scans of 32 consecutive trauma patients who had CME were reviewed for the sources of CME, types of CME, flat inferior vena cava, and multiple abdominal injuries. The medical records were reviewed for demographics, systolic blood pressure, Injury Severity Score (ISS), choice of management, time interval between CT scan and intervention, and outcome of intervention. RESULTS: Systolic blood pressure < 100 mm Hg was the most important factor (p = 0.0064) that failed observational therapy. When proceeding to intervention treatment, patients with a flat inferior vena cava (1.6 +/- 1.1 hours) had a significantly shorter time interval between CT scan examination and intervention when compared with those with a normal cava (10.9 +/- 16.0 hours) ( p= 0.0124). The mortality rate after intervention treatment was 18.8%. High ISS, uncontained CME in the extraperitoneum, and multiple abdominal injuries were important risk factors. After adjusted for ISS and multiple abdominal injuries, the risk of dying from extraperitoneal CME remained significant when compared with intraperitoneal CME (adjusted odds ratio, 82.26; 95% confidence interval, 1.06-6,363.17). CONCLUSION: Termination of observational therapy was appropriate for trauma patients who had CME and systolic blood pressure < 100 mm Hg. The coexistence of a flat inferior vena cava and CME was associated with early intervention treatment. Despite early intervention, the mortality rate was 18.8%. High ISS and multiple abdominal injuries were important factors, but the risk of dying from uncontained extraperitoneal CME was 82 times the risk of dying from intraperitoneal CME.

Abdominal Injuries↗
PubMed1991

The epidemiology of seatbelt-associated injuries.

This study examined the frequency of spine and abdominal injuries to motor vehicle occupant crash victims, the relationship between the two types of injuries, and the association with restraint use. There were 303 motor vehicle occupants treated at a regional trauma center for spine and/or abdominal injuries over a 5-year period. Patients with Chance-type fractures of the lumbar spine were much more likely to be rear seat passengers and to be using a lap belt than were patients with other types of spinal injuries. Similarly, patients with hollow viscus injuries were more likely to be rear seat passengers and to be lap belted than were patients with injuries to the spleen, liver, pancreas, or kidneys. Nearly two thirds of the lumbar Chance-type fractures were associated with hollow viscus injuries, including six of seven children. This increased risk of Chance-type fractures and hollow viscus injuries was associated with increased use of lap-belt seat restraints in the population.

Abdominal Injuries↗
PubMed1988

Pelvic fracture associated with severe intra-abdominal gynecologic injury.

A case report of a complex pelvic fracture with associated severe intra-abdominal gynecologic injury is presented. The injury involved lacerations to the ovary, fallopian tube, and nonpregnant uterus. No previous reports of pelvic fractures with such visceral gynecologic injury have been found.

Adult↗
PubMed1993

[Liver injury in abdominal trauma. Review of the literature and personal observations].

In patients who suffered abdominal trauma, the liver is the most frequently involved organ, except the spleen. The % rises from 1520% to 30% if trauma is closed or open. Liver injury may spread from a simple parenchymal contusion to a break in vessels or biliary ducts. Life risk is related to hemorrhage. The mortality is due to: 1) extension of the injured liver surface, 2) possible damage to big vessels, 3) intra or extra abdominal associated injury in case of multiple trauma. It is important to known the kind of injury to choose the best therapy, not necessary surgical. The authors report on 15 patients with thoracoabdominal trauma and liver damage, comparing their cases with literature observations.

Abdominal Injuries↗
PubMed1982

Diagnostic peritoneal lavage.

From the preceding review, it can be seen that diagnostic peritoneal lavage is a safe, reliable means of evaluating the various acute conditions of the abdomen. Patients who have sustained, blunt trauma of the abdomen, particularly with associated injuries, are prime candidates for the procedure. Children who have sustained injuries, either suspected abdominal injuries or multiple trauma, should be included. Other groups include paraplegic patients with possible abdominal disease and patients with findings which are suggestive of an acute condition of the abdomen but an uncertain diagnosis. Relative contraindications for peritoneal lavage include a distended abdomen, a history of previous surgical procedures of the abdomen and gravid uterus. Peritoneal lavage may be performed upon these patients but with modifications of technique. Patients for whom the diagnosis is certain and those patients upon whom exploration is planned are not candidates for lavage. Peritoneal lavage has been shown to be an effective adjunct in the evaluation of the abdomen in a wide variety of conditions. Its use has decreased the rate of unnecessary laparotomy both in patients with blunt trauma to the abdomen and in those with nontraumatic, acute disease of the abdomen. It can be used to arrive at an early decision for operative and nonoperative therapy and thereby reduce morbidity and mortality in patients with abdominal disease.

Abdomen, Acute↗
PubMed1988

A perspective on the early management of abdominal trauma.

Blunt trauma in Australia is most commonly due to road accidents and is often multisystem in its effect on the body. Whereas some cases of intra-abdominal injury result in massive bleeding, and may be readily diagnosed clinically, many abdominal injuries are difficult to diagnose on initial clinical examination. Delays in treatment can result in otherwise avoidable morbidity and mortality, and the practice of diagnosis by repeated clinical examination over long periods of time is to be condemned in principle. All abdominal injuries can (and should) now be diagnosed and treatment commenced within 2-4 h of admission to hospital. Diagnostic peritoneal lavage (DPL) is the most sensitive indicator of intraperitoneal blood after trauma, and if employed early, and interpreted with a low threshold for positivity, early treatment of all intraperitoneal organ disruption can be undertaken. The best organ-imaging technique available for abdominal trauma is computerized tomography (CT) scan, but it is not as sensitive as DPL in the diagnosis of haemoperitoneum, and its accuracy in defining bowel injury is not proved. Several factors dictate the choice of DPL or CT scan in difficult trauma cases, and these include the stability of the patient, the availability of CT scan, the experience of the treating physician with either modality, the organs most at risk of injury in any case, and the decision to attempt conservative or operative management. In a small number of cases, doubt may still exist after CT and/or DPL, and an early laparotomy remains the 'gold standard' of diagnosis in such situations. In penetrating trauma, laparotomy is indicated if wound exploration shows penetration of the peritoneum.

Abdominal Injuries↗
PubMed1992

Multiple organ injuries after abdominal high energy wounding in animals and the protective effect of antioxidants.

Multiple organ injuries caused by high energy abdominal wounds were studied in 8 pigs and 24 dogs, and at the same time the protective effect of antioxidants in 14 dogs with multiple organ injuries was also studied. The experimental results showed that: 1) more than two organs (six organs at most) were wounded in each of the animals studied; 2) the injuries were characterized by hemorrhaging, tissue rupture and hematoma, and the main pathologic changes were local edema and necrosis; 3) the marked increase of lipid peroxide (LPO) levels in the vital organs indicated that multiple organ injuries could also involve the molecular level; 4) the injuries were due to the direct effect of pressure waves and ischemic reperfusion and not to shock or infection; and 5) antioxidants (vitamin E and Salvia miltiorrhiza Bge.) exhibited significant protective effects against multiple organ injuries through a free radical mechanism.

Abdominal Injuries↗
PubMed1987

Injuries to the abdominal vascular system: how much does aggressive resuscitation and prelaparotomy thoracotomy really help?

The records of 154 patients with 254 abdominal vascular injuries seen over 5 years (1980 to 1985) were reviewed. The overall mortality rate (MR) was 46%. This included 100% (5/5) for blunt injuries, 49% (59/119) for gunshot wounds, and 23% (7/30) for stab wounds. The most common venous injuries and the MRs were: inferior vena cava, 59% (33/56) and iliac veins, 65% (10/16). The most common arterial injuries and the MRs were: aorta, 68% (15/22), iliac artery, 57% (12/21), and superior mesenteric artery, 67% (8/12). Of 84 patients who presented to the emergency department (ED) with a blood pressure (BP) less than 70 mm Hg, 60 (71%) died, and of 64 patients with four or more associated injuries, 41 (64%) died. Failure to reduce the duration of shock, amount of bleeding, or severity of hypotension before surgery is highly lethal. Of the 42 patients who had shock for more than 30 minutes, 38 (90%) died. Of the 93 patients who received more than 10 U of blood in the ED and operating room (OR) 60 (64%) died. Of the 60 patients presenting to the OR with a systolic BP less than 70 mm Hg, 52 (87%) died. Prelaparotomy cross-clamping of the thoracic aorta for persistent shock is controversial. However, of the 26 patients with this procedure, 12 responded with a sustained increase in systolic BP greater than 90 with five (42%) survivors. Of the 14 no responders, none survived. Of 17 patients with persistent shock without a prelaparotomy thoracotomy, only one (6%) survived. In the high-risk group (admission systolic BP less than 70 mm Hg and four or more associated injuries), if shock was kept to less than 30 minutes and bleeding to 10 U of blood or less, the MR was reduced from 92% (24/26) to 0% (0/12). In patients presenting to the OR with a BP less than 70, a prelaparotomy cross-clamping of the aorta should be considered. In those patients not responding, prolonged surgical efforts are futile.

Abdominal Injuries↗
PubMed2003

Laparoscopy in the evaluation of penetrating thoracoabdominal trauma.

The evaluation of penetrating thoracoabdominal trauma for the presence of a diaphragmatic injury presents a diagnostic challenge to the trauma surgeon. The use of diagnostic laparoscopy (DL) in this setting was reviewed at a level-one trauma institution. Eighty patients (71 males, 9 females) with penetrating injuries to the thoracoabdominal region underwent DL to rule out injury to the diaphragm. Fifty-eight patients (72.5%) had a negative study and were spared a celiotomy. In the remaining 22 patients (27.5%), injury to the diaphragm was identified. This subset of patients underwent a mandatory celiotomy to rule out an associated intra-abdominal injury. Seventeen out of 22 (77.2%) patients had a positive exploration requiring surgical intervention, representing an associated intra-abdominal injury rate of 21.2 per cent. Intra-abdominal injuries requiring repair included small bowel, colon, spleen, liver, and stomach, in descending order. There were no missed injuries or deaths. One patient with a left diaphragmatic injury secondary to a stab wound developed a subdiaphragmatic abscess. Respiratory insufficiency secondary to atelectasis was the most common complication. Diagnostic laparoscopy is an essential and safe modality for the evaluation of diaphragmatic injuries in penetrating thoracoabdominal trauma.

Abdominal Injuries↗
PubMed2000

Characteristics of penetrating abdominal firearm injuries in children.

Penetrating injuries of the abdomen which occur primarily from gunshots and stabbing become increasingly prevalent in children. Our purpose is to assess the presentation, management and outcome of children with penetrating abdominal firearm injuries (PAFI) and to evaluate the value of Injury Severity Score (ISS) for predicting injury severity and eventual morbidity and mortality in children with PAFI. Between 1985 and 1997, 69 children < or = 15 years of age with PAFI were hospitalized at our institution. Their hospital records were reviewed retrospectively. Of the 69 children with PAFI, 53 were boys and 16 were girls. The mean age was 9.6. The causes of PAFI were explosives (44%), gunshot (39%) and shotgun injuries (17%). The most common organ injured was the small bowel followed by colon and liver respectively. Postoperative complications were seen in 12 children. The mean value of ISS was 16.8; 41 children had an ISS value of > or = 16. The value of ISS was significantly higher in children with complication than in those without complication. The children with ISS value > or = 16 were hospitalized significantly longer than those with < or = 15 of ISS. Particularly shotgun injuries were commonly associated with severe morbidity. ISS can be useful for predicting the severity of injury and the occurrence of morbidity.

Abdominal Injuries↗
PubMed2004

Futility of resuscitation criteria for the "young" old and the "old" old trauma patient: a national trauma data bank analysis.

BACKGROUND: Increasing geriatric trauma is producing disproportionate use of resources. In burn victims, age and burn extent correlate with mortality, yielding the establishment of criteria for futile resuscitation. Such criteria would be useful to trauma patients and their families in making withdrawal-of-care decisions while reducing resource use. Our objective, therefore, was to identify injury and physiologic parameters that would indicate a high probability of futile resuscitation among geriatric trauma patients. METHODS: Data pertaining to patients greater than or equal to 65 years of age within the National Trauma Databank from 1994 to 2001 were analyzed. Multivariate logistic regression-with mortality as the outcome variable and head, chest, and/or abdominal injury; base deficit; gender; comorbidities; and admission systolic blood pressure (SBP) as covariates-was performed to develop a stratification scheme providing criteria indicative of a high probability of futile resuscitation. RESULTS: There were 76,304 patients with a mean age of 79.4 years. Head, thoracic, and abdominal injury; age; gender; comorbidities; admission SBP; and base deficit were associated with mortality. Patients with severe chest and/or abdominal injury, moderate to severe head injury, admission SBP less than 90 mm Hg, and significant base deficit had mortalities approaching 100%. Older patients with modest shock and mild to moderate head injury admitted with severe chest and/or abdominal injury had a less than 5% chance of survival. CONCLUSION: Geriatric trauma patients with severe chest and/or abdominal trauma with moderate shock and mild to moderate head injury have an exceedingly low probability of survival. These data support early withdrawal of care in these individuals.

Aged↗
PubMedDate not supplied

Penetrating thoraco-abdominal war injuries.

BACKGROUND: From April 1991 till December 1995, Split University Hospital played a major role as a third échelon war hospital during the war in Croatia and Bosnia and Herzegovina. Among 2856 treated battle casualties in general, 70 patients with penetrating thoraco-abdominal war injuries were treated at the Department of Surgery. Explosive wounds were present in 38 (54%), gunshot wounds in 32 (45%) and puncture wounds in four (5.70%) patients. METHODS: The medical data from the evacuation unit, transportation, emergency department, surgical management and follow-up were obtained and analyzed. The principle of treatment of such patients is described, with particular reference to thoracophrenolaparotomy as the most efficient diagnostic-therapeutic surgical approach. RESULTS: There were considerably more explosive wounds than gunshot and puncture wounds (ratio 38/32/4). Resource utilization analysis showed a great amount of blood products (average 1.250 ml per patient), rehydrant solutions (average 3.750 ml per patient) and seven days antimicrobial chemoprophylaxis (penicillin, gentamycin, metronidazole) used. Mean time elapsed between injury and definitive surgical repair was seven hours (range, 1 to 48 hours). Recovery on discharge was recorded in 61 (80%) and lethal outcome in nine (13%) patients. CONCLUSIONS: The treatment of respiratory insufficiency and hemorrhagic shock, and prevention of infection are the basis of the management of these injuries. Treatment success depends on emergency first-aid, quick transportation, early diagnosis, resuscitation, surgical therapy and intensive care.

Abdominal Injuries↗
PubMed2003

Complete occlusion after blunt injury to the abdominal aorta.

BACKGROUND: Injury to the abdominal aorta after blunt trauma is uncommon. When this injury results in complete vessel occlusion, the presentation is dramatic. Timely intervention is essential. METHODS: After a case report, we examined all reported cases of complete occlusion after blunt injury to the abdominal aorta and reviewed the cause, presentation, and management of this injury. RESULTS: Complete vessel occlusion arises from intimal injury. The most frequent mechanism is compression from a seat belt or steering wheel during a motor vehicle crash. Patients present with absent femoral and distal pulses in association with lower extremity neuropathy. Intervention commonly involves bypass grafting of the abdominal aorta. CONCLUSION: Complete occlusion after blunt trauma to the abdominal aorta is rare. Neurologic deficits most commonly arise from peripheral nerve ischemia. Reperfusion within 6 hours confers a greater chance of limb salvage and neurologic recovery.

Aorta, Abdominal↗