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PubMed2005

The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma.

BACKGROUND: Injuries to the pancreas following blunt abdominal trauma are rare due to its protected retroperitoneal position. Many pancreatic lesions remain unnoticed at first and only become apparent when complications arise or during treatment of other injuries. The mortality rate is between 12 and 30%, and if treatment is delayed it is as high as 60%. METHODS: Using medical records over the past 5 years, we investigated when and in what circumstances endoscopic retrograde cholangiopancreaticography (ERCP) was used in the diagnosis and treatment of pancreas injuries after blunt abdominal trauma. Penetrating injuries were not taken into consideration. RESULTS: An ERCP was performed on a total of five patients with suspected injuries to the pancreas after blunt abdominal trauma. No duct participation could be determined in three of the patients with a first degree pancreatic lesion. A 44-year-old woman sustained severe internal and external injuries after a traffic accident. Because of the nature of her injuries, pancreatic left resection with splenectomy was necessary. After the operation, a pancreatic fistula diagnosed. The ductus pancreaticus (DP) was successfully treated by stenting with the use of endoscopic retrograde pancreaticography. A 24-year old woman was kicked in the epigastrium by a horse. On the day after the incident, she complained of increasing pain in the upper abdomen, and she had elevated amylase and lipase levels. Computed tomography scan showed free fluid. Less than 48 h after the accident, ERCP was performed and a leakage in the DP in the head-body region (fourth degree) was identified. We placed a stent, and during the subsequent laparoscopy the omental bursa was flushed out and a drainage laid. After 14 days, the patient was sent home. We removed the drainage 4 weeks after the accident, and the stent after 12 weeks. CONCLUSION: The major advantage of the prompt retrograde discription of the pancreatobiliary system after an accident in which pancreas involvement is suspected is the more precise assessment of the extent of the injuries. If a stent is placed in the same session, it is possible to carry out definitive and interventional treatment.

Abdominal Injuries↗
PubMed1992

[Incisional, stab and gunshot wounds of the abdomen and thorax].

The authors give an account of the incidence and prognosis of the mentioned injuries treated during the past five years (1987-1991) at the surgical department of a district hospital in the centre of Prague. During the past two years a marked increase of these injuries was recorder. A total of 10 persons with abdominal injuries had ambulatory treatment and nine patients with injuries of the chest. During the same period 24 patients with abdominal injuries and 6 patients with chest injuries were hospitalized as well as four patients with combined abdominal and chest injuries. Nineteen ambulatory patients and 34 hospitalized patients during the five-year period are an ever increasing group of casualties who suffered injuries usually when drunk or due to violence.

Abdominal Injuries↗
PubMed1986

Splenorrhaphy in the management of splenic injury.

A retrospective study of 301 adult splenic injuries presenting to the Princess Alexandra Hospital during a 15 year period, from 1970 to 1984, was conducted. Particular attention was paid to the last 5 years during which 25% of the ruptured spleens were preserved. The details of the preserved spleens are discussed. Respiratory infections were the only complications in this same selected group of patients; the complication rate being higher in the splenectomy group (15.8%) than the splenorrhaphy group (6.25%). None of the cases of splenorrhaphy required re-operation for continued haemorrhage. Twenty-five per cent of all cases of splenic injury had associated intra-abdominal injury which, of its own nature, would require laparotomy. A policy of operative management for splenic injury in adults with major trauma is therefore proposed because of the rate of associated intra-abdominal injuries. When laparotomy is performed, splenorrhaphy should be considered because of the now widely acknowledged risks of diminished immunological competence and overwhelming sepsis in asplenic individuals.

Adolescent↗
PubMed2006

Suicide bombing attacks: Can external signs predict internal injuries?

OBJECTIVE: To report the distribution and types of injuries in victims of suicide bombing attacks and to identify external signs that would guide triage and initial management. SUMMARY BACKGROUND DATA: There is a need for information on the degree to which external injuries indicate internal injuries requiring emergency triage. METHODS: The medical charts and the trauma registry database of all patients who were admitted to the Hadassah Hospital in Jerusalem from August 2001 to August 2004 following a suicide bombing attack were reviewed and analyzed for injury characteristics, number of body areas injured, presence of blast lung injury (BLI), and need for therapeutic laparotomy. Logistic analysis was performed to identify predictors of BLI and intra-abdominal injury. RESULTS: The study population consisted of 154 patients who were injured as a result of 17 attacks. Twenty-eight patients suffered from BLI (18.2%) and 13 patients (8.4%) underwent therapeutic laparotomy. Patients with penetrating head injury and those with > or =4 body areas injured were significantly more likely to suffer from BLI (odds ratio, 3.47 and 4.12, respectively, P < 0.05). Patients with penetrating torso injury and those with > or =4 body areas injured were significantly more likely to suffer from intra-abdominal injury (odds ratio, 22.27 and 4.89, respectively, P < 0.05). CONCLUSION: Easily recognizable external signs of trauma can be used to predict the occurrence of BLI and intra-abdominal injury. The importance of these signs needs to be incorporated into triage protocols and used to direct victims to the appropriate level of care both from the scene and in the hospital.

Abdominal Injuries↗
PubMed2006

Rate and prediction of traumatic injuries detected by abdominal computed tomography scan in intubated children.

BACKGROUND: Recent concerns about the lifetime cancer risk associated computed tomography (CT) caused us to reevaluate the utility of this test in traumatized children. In addition, little is known regarding the utility of abdominal CT in children who have been emergently intubated. We sought to describe the injuries identified by abdominal CTs in intubated pediatric trauma patients and create a derivation set of predictors of intra-abdominal injury in this patient population. METHODS: A review was conducted of patients cared for at a Level I pediatric trauma center. Patients were included if they were emergently intubated after blunt trauma and had an emergent abdominal CT performed. Outcome measures included the presence of an intra-abdominal injury on CT, the need for exploratory laparotomy (ELAP), the findings of the ELAP, and death. Logistic regression was used to determine which variables were associated with an abnormal abdominal CT scan. RESULTS: In all, 118 met inclusion criteria; the median age was 7.2 years. Thirty- two patients (27.1%) were found to have at least one abdominal injury on CT scan. One ELAP was performed and 12 patients died. Of the variables analyzed, abdominal examination abnormalities and elevated liver function tests (LFTs) were significantly associated with injuries. When both were abnormal, 75% of patients (12/16) had abnormal scans (sensitivity = 71%, specificity = 92%, positive predictive value = 75%, negative predictive value = 91%). CONCLUSIONS: In this series, a significant number of intubated pediatric trauma victims had intra-abdominal injuries identified by CT scan. The presence of abnormal abdominal examination findings and elevated LFTs appear to predict an abnormal CT scan.

Abdominal Injuries↗
PubMed2003

[Diagnosis and treatment of patients with closed injury of abdominal cavity organs in combination with craniocerebral trauma].

Results of diagnosis and treatment of 114 injured persons with closed abdominal trauma, combined with craniocerebral trauma were suggested. In 34 (29.8%) observations the injury of two or more organs of peritoneal cavity was diagnosed, the parenchymatous organs trauma--in 35 (30.7%) and the hole organs trauma--in 45 (39.5%). Cerebral concussion was established in 61 (53.5%) of injured persons, cerebral contusion--in 26 (22.8%), cerebral compression on the contusion background--in 16 (14%) and subdural hematoma--in 11 (9.7%). In all the injured persons the operative intervention was performed. In 32 (28%) the blood of their own was transfused. To reduce the endogenous intoxication severity there were performed the forced diuresis, hemosorption--in 10 (8.7%), the blood ultraviolet irradiation--in 41 (35.9%), intravenous laserotherapy--in 40 (35%). After the operation 14 (12.3%) of patients died. High mortality in combined cranioabdominal trauma is caused by the injury severity, the traumatic shock and mutual burden syndrome presence.

Abdominal Injuries↗
PubMed1975

Diagnostic laparocentesis and peritoneal lavage in patients with multiple blunt injuries.

A series of 53 patients with multiple injuries and suspected abdominal trauma were analysed to determine the accuracy of diagnostic laparocentesis and peritoneal lavage. Thirty-one positive findings resulted in immediate laparotomies. Fifteen patients with an otherwise strong suspicion of intra-abdominal injury were treated conservatively with an uneventful clinical course. All three false-negative findings were in patients who has previously been subjected to laparotomy. These 3 patients were laparotomized on the basis of other diagnostic evidence. Four positive and two false-positive findings resulted in unnecessary operations. Trocar laparocentesis combined with peritoneal lavage is a quick and safe aid in the diagnosis of blunt abdominal trauma. Trauma to the urinary tract, however, should be diagnosed without laparocentesis. The test does not replace other diagnostic methods, but it may shorten the preoperative delay in complicated situations.

Abdominal Injuries↗
PubMed2004

Damage control surgery and the abdomen.

There is a complex interplay between primary injury, particularly major abdominal injury in the multi-system trauma patient, and secondary injury, which relate to patient physiology, decision making and surgical technique. Analysis of outcomes is further confounded by the variety of surgical techniques used. The challenge is to match the correct operation, for a critically injured patient, with the patient's physiology. Excellence in general surgery does not equate with excellence in trauma surgery, and a clear understanding of damage control is essential.

Abdominal Injuries↗
PubMed1984

The injured spleen: should consideration be given to conservative management?

This report is a retrospective study over a 13 year period of 267 patients who underwent splenectomy. The incidence of associated major abdominal injuries following blunt trauma in these patients was 8%. Over half of these associated injuries were diagnosed pre-operatively. Sixty-nine per cent of the patients were haemodynamically stable before operation. Patients who suffered splenic injuries whilst playing sport or who were conscious and did not have major extra-abdominal injuries or clear evidence of other intra-abdominal injury could possibly have been managed expectantly. Such a policy might have avoided splenectomy in a substantial number of cases and thus have eliminated the risk of Overwhelming Post-Splenectomy Infection (OPSI) in these patients.

Accidents, Traffic↗
PubMed1986

Splenic conservation after multiple trauma in adults.

The traditional management of splenic injuries is undergoing serious challenge. During the four year period from 1980 to 1983, 60 of 230 patients with injured spleens operated upon at the Maryland Institute for Emergency Medical Services' Shock Trauma Center have had splenic salvage. Motor vehicle accidents accounted for 57 of the 60 injuries (95 per cent). Fifty-eight patients (97 per cent) had major associated extra-abdominal injuries (average 1.9 injuries per patient) requiring additional operative procedures. Concurrent intra-abdominal injury was present in 37 patients (62 per cent). The mean operating time was 106 minutes; 98 minutes for those patients with isolated splenic injuries and 115 minutes for those with associated minor intra-abdominal injuries. The average amount of blood transfused during celiotomy was 3.5 units of packed red blood cells per patient. As familiarity and confidence with the techniques have accrued, the number of splenic preservation procedures has steadily increased from approximately 10 per cent to more than 50 per cent. Complications related to splenorrhaphy per se were few. The mortality was 10 per cent; all deaths were secondary to associated injuries. Criteria for and contraindications to splenic salvage in patients with multiple trauma are presented and discussed.

Accidents, Traffic↗
PubMed1999

[Laparoscopy with a diagnostic aim in abdominal emergencies].

In acute abdominal syndromes when a surgical exploration is required by the presence of peritoneal symptoms, laparoscopy allows to recognize the lesions and to perform simultaneously the appropriate treatment in most cases. When the surgical indication is doubtful, mainly in case of acute appendicitis, sonography or scanography may confirm the diagnosis. In case of persisting doubt, diagnostic laparoscopy is justified and laparoscopic appendicectomy seems to be the best method when another pathology is not detected by laparoscopy. In abdominal wounds, laparoscopy is useful to confirm their intraperitoneal penetration, mainly in gunshot wounds, and to recognize a diaphragmatic wound which is often isolated and unknown. Laparoscopy often fails to detect all abdominal injuries. In blunt abdominal traumas, laparoscopy is not recommended at the first step. In conclusion, laparoscopy with diagnostic intent only is rarely indicated in abdominal emergencies and its use is not worth being extended. Diagnostic value of laparoscopy is closely linked to its therapeutic interest. Laparoscopy with both diagnostic and therapeutic intent has to be developed in most abdominal emergencies.

Abdomen, Acute↗