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PubMed1998

[Gunshot and blast injuries to the abdomen. The problems of mechanogenesis and of diagnostic and treatment procedures based on the experience of delivering surgical care to the wounded during the war in Afghanistan (1980-1989)].

The work is bases on an analysis of treatment of 2687 wounded in the abdomen. There are two main groups of factors in mechanogenesis of military injuries of the abdomen: ballistic parameters of gunshot shells and additional injuring factors of mine-explosive ammunition. Bullet wounds prevailed (60.2%), lethality from penetrating abdominal injuries was 31.4%. Laparotomies were performed in 10.7% of the patients on the basis of absolute symptoms of penetrating wounds of the abdomen, in 74.1%--on the basis of analytical signs and in 15.2%--due to results of abdominal paracentesis. The following questions are discussed: the adequacy of the access, reinfusion of the blood accumulated in the abdominal cavity, surgical treatment for gunshot peritonitis, errors in treatment of wounded with abdominal injuries, application of new methods of treatment. Surgical features of traumatic disease and its treatment in wounded with gunshot abdominal injuries are described.

Abdomen↗
PubMed2001

The routine use of sonography in penetrating torso injury is beneficial.

BACKGROUND: Torso sonography (focused assessment with sonography for trauma [FAST]) has been added to our protocols for the evaluation of penetrating torso injury. The purpose of this study was to evaluate our recent experience and determine whether the use of FAST is beneficial. METHODS: From January 1999 to January 2000, patients with penetrating torso injury and no clinical indication for surgery were evaluated by sonography with a selective use of other investigations. FAST consisted of sonographic views of the peritoneum and/or pericardium to determine the presence or absence of fluid. RESULTS: During the study period, there were 238 victims of penetrating injury assessed by our trauma service, and sonography was performed in 72 (30%) patients as per our protocols. There were 31 stab, 37 gunshot/shotgun and, and 4 puncture wounds. Thirty-eight patients had peritoneal views, 6 patients had pericardial views, and 28 patients had both pericardial and peritoneal views obtained. Thirteen of 66 patients had free fluid in the peritoneal cavity and 12 of the 13 patients had a therapeutic laparotomy. No peritoneal fluid was seen in 53 of 66 patients, of whom 6 had abdominal injuries, 5 requiring surgery for diaphragm or bowel injuries. The sensitivity of FAST alone for abdominal injury was 67%, specificity was 98%, positive predictive value was 92%, and negative predictive value was 89%. Pericardial fluid was seen in 3 of 34 patients; one had a heart wound and two had negative pericardial windows. All 31 patients without pericardial fluid recovered without surgery. CONCLUSION: The routine use of sonography in penetrating torso injury is beneficial. The detection of pericardial or peritoneal fluid is clinically useful. However, a negative FAST examination does not exclude abdominal injury, such as a diaphragm or hollow viscus wound, and further investigation or close follow-up is required.

Abdominal Injuries↗
PubMed1987

Diagnostic peritoneal lavage in the management of blunt abdominal trauma: a reassessment.

In order to reassess the value of diagnostic peritoneal lavage (DPL) in patients with blunt abdominal trauma, we conducted a prospective study over a 15-month period involving 138 patients. There were 29 (28.3%) patients with positive DPL and 103 (71.7%) with negative DPL in this series. Of the 29 patients with positive DPL, 28 (96.5%) were found to have significant intra-abdominal injuries; 27 by exploratory laparotomy and in one case at autopsy. One patient with a grossly positive DPL had a negative exploratory laparotomy (3.4% false positive rate). All 109 patients with negative DPL were admitted. In only one case a significant intra-abdominal injury was demonstrated (0.9% false negative rate). The overall mortality in this series was 11.6% and there were no complications related to the DPL. Our results suggest that DPL is indeed an accurate indicator of significant intra-abdominal injuries in patients with blunt abdominal trauma.

Abdominal Injuries↗
PubMed2001

Factors influencing pediatric injury in side impact collisions.

BACKGROUND: Side impact collisions pose a great risk to children in crashes, but information about the injury mechanisms is limited. METHODS: This study involves a case series of children in side impact collisions who were identified through Partners for Child Passenger Safety, a large, child-focused crash surveillance system. The aim of the current study was to use in-depth crash investigations to identify injury mechanisms to children in side impact collisions. RESULTS: Ninety-three children in 55 side impact crashes were studied. Twenty-three percent (n = 22) of the children received an Abbreviated Injury Scale (AIS) score > or = 2 (clinically significant) injury. In these 22 children, head (40%), extremity (23%), and abdominal injuries (21%) were the most common significant injuries. Cases that illustrate body region-specific injury mechanisms are discussed. CONCLUSION: The cases revealed that serious injuries, particularly head injuries, occur even in minor crashes, and efforts should be made to make the interiors of vehicles more child occupant friendly. Lower extremity and abdominal injuries occurred because of contact with the intruding door. Design of vehicles to minimize crush should mitigate the occurrence and severity of these injuries.

Abbreviated Injury Scale↗
PubMed2004

[Abdominal wound injuries: diagnosis and treatment. Report of 79 cases].

INTRODUCTION: - Traditionally, penetrating abdominal wounds justify routine laparotomy. However, this policy can be adapted to mechanism of injury (stab or firearm) and accuracy of imaging procedures if they eliminate visceral injury thus allowing close follow up. PATIENTS AND METHODS: Retrospective study of 79 patients (May 1995-May 2002) with a penetrating abdominal wound: (47 (59%) stab wounds and 32 (41 %) firearm wounds). Correlation between imaging and surgical findings, treatment, post-operative course were studied. RESULTS: Sixty-eight patients were operated on from the outset, and 11 underwent close follow-up. Of the 11 patients who had follow-up, (9 after stab wound and 2 after firearm wound), two had to be operated (1 in each group). Correlation between imaging and surgical findings was good in 34 (72%) patients after stab wound and in 21 (80%) after firearm wound; the mean number of visceral injuries was 1 and 3 respectively. Six patients (8%) died (mortality: 2% and 16% respectively), 12 (15%) had postoperative complications. CONCLUSION: Penetrating abdominal stab wounds can be treated by close follow-up if imaging excludes visceral injury. Firearm wounds still justify routine laparotomy due to both multiplicity of visceral injuries and bad prognosis.

Abdominal Injuries↗
PubMed1985

Abdominal trauma.

Abdominal injuries are an important cause of morbidity and mortality. In the face of more obvious traumatic lesions, life-threatening intra-abdominal injuries may be initially overlooked. Plain abdominal and chest radiographs may prove diagnostic for specific injuries. However, normal or equivocal studies should not exclude the diagnosis of significant abdominal trauma. In patients who are clinically stable in whom there is suspicion of abdominal injury, additional imaging procedures should be undertaken for more definitive evaluation. At this time, computed tomography is the examination of choice for the assessment of the liver, spleen, and kidneys. In all cases, direct consultation with the radiologist should lead to the most expeditious plan for evaluation of the traumatized patient.

Abdominal Injuries↗
PubMed1986

Patterns of injury in motor vehicle trauma.

One hundred and sixty victims of motor vehicle accidents presenting to Auckland Hospital were evaluated to determine patterns of injury, overall injury severity, and outcome. Motor vehicle occupants comprised 51% of the group, pedestrians 28% and motorcyclists 21%. Mortality was 7.4%, 20% and 2.9% respectively for these three groups. The mean injury severity score was 19. Head and external injuries were common, each occurring in over 60% of all patients. In motorcyclists however, head injuries were less common (47%) (p less than 0.05) and facial injuries occurred in only 9% compared to 23% (p = ns) of the other two injury groups. Overall, severe chest or abdominal injury was present in only 16% of patients but these injuries occurred in 58% of those patients with severe head injury and extremity fractures (p less than 0.001). In motor vehicle occupants the combination of severe head injury and lower extremity fracture was associated with severe chest or abdominal injury in 8/9 patients. The patterns of injury identified here may be helpful in triaging patients to appropriate care facilities.

Accidents, Traffic↗
PubMed1984

Peritoneal lavage in blunt abdominal trauma.

Peritoneal lavage is a safe and relatively simple procedure that can eliminate delay in diagnosing significant intra-abdominal injury after blunt abdominal trauma. Serious complications from the procedure are quite uncommon. The use of an "open" technique minimizes the risk of false-positive results. The technique does not uncover retroperitoneal injuries.

Abdominal Injuries↗
PubMed1992

Unspecified injuries on death certificates: a source of bias in injury research.

Protective gear (for example, helmets and bulletproof vests) shields certain body regions from damaging energy. Failure to specify on death certificates the body region and nature of fatal injuries compromises the utility of mortality data for epidemiologic or prevention research. Of fatally injured California motorcyclists, 41% had no specific injuries listed on their death certificates in 1988. To examine the implications of this problem, the authors abstracted 186 coroner's or medical examiner's reports from four California counties with over 60% nonspecific injuries and one county with few such injuries. These data were merged with computerized death certificate files and with the Fatal Accident Reporting System. Among the 99 cases with nonspecific injury codes, 68% had head injuries, 63% had chest injuries, 58% had abdominal injuries, and 58% had extremity injuries. Reporting sensitivity in the four problem counties varied from 36% for head injury to less than 5% for abdominal, spinal, and extremity injury. The association between head injury and failure to wear a helmet was statistically significant using the coroner's diagnoses (p = 0.02), but not using death certificate diagnoses (p = 0.17). The value of mortality data to injury researchers would be enhanced by better reporting of the nature of injury on death certificates.

Accidents, Traffic↗
PubMed2002

[Impact of blood loss on lipid peroxidation and on the antioxidative system in victims with isolated injury to the chest and abdomen].

The paper deals with the impact of the volume of blood loss on the time course of changes in the parameters of lipid peroxidation (LPO) and the antioxidative system (AOS) in the sera of 22 and 31 victims with isolated chest and abdominal injuries, respectively, on days 1, 3, 7, and 14 days after injury. All the victims were found to have enhanced LPO processes and altered AOS. The severity of disorders in the LPO-AOS system depends on the size of blood loss, the disorders manifest themselves to a greater extent with over 2-liter brisk bleeding and enhance on days 7 and 14 after injury. In mild blood loss equal to as low as 1.0 liters, there was a mobilization of AOS components, such as (-tocopherol and ceruloplasmin, to the blood bed in the victims with both isolated chest and abdominal injury. AOS failure remaining during all periods of the study was detected in victims with abdominal organs and over 2-liter blood loss. Disorders in the LPO-AOS system were pronounced in abdominal injury. Multimodality treatment in victims with isolated injury of the chest and abdomen does not normalize impaired LPO processes and AOS, which makes it necessary to include into antioxidative therapy for brisk bleeding.

Abdominal Injuries↗
PubMed1979

Indications and use of abdominal angiography in trauma.

A series of 148 angiographic examinations in patients with blunt abdominal trauma have been reviewed. The major indications for arteriography were: (1) manifestations of shock in conjunction with clinical signs of abdominal injury; (2) the necessity for differentiation of multiple abdominal injuries; and (3) clinical signs of delayed rupture. Few false positive or false negative results were noted. The typical angiographic findings are discussed.

Abdominal Injuries↗
PubMed2001

War abdominal trauma: usefulness of Penetrating Abdominal Trauma Index, Injury Severity Score, and number of injured abdominal organs as predictive factors.

OBJECTIVE: To analyze predictive factors for developing complications or lethal outcome in war abdominal trauma. DESIGN: Retrospective study. METHODS: We analyzed 93 cases of war penetrating abdominal trauma treated at the General Hospital Karlovac, Croatia. The following potential predictor variables were analyzed: age, sex, type of wound, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), and number of injured abdominal organs (NIAO). RESULTS: A total of 10.8% of wounded patients died and 25.8% developed complications. The overall average number of injured intra-abdominal organs was 2.0; in the group of patients with complications, the average was 3.0, and in the group of deceased patients, the average was 3.5. The most frequently injured organs were the small and large bowels. The significant predictors of developing complications as well as death outcome were the PATI, the ISS, and the NIAO. The best diagnostic efficiency (79.57%) for predicting complications was with the NIAO, whereas the best model for the prediction of death outcome combined all three variables (Z = -13.0776 + 0.1561 x PATI + 0.281 x ISS - 0.5234 x NIAO), with diagnostic efficiency of 92.47%. CONCLUSION: These models may be used as important prognostic factors in war abdominal injuries.

Abdominal Injuries↗
PubMed1994

Early definitive abdominal evaluation in the triage of unconscious normotensive blunt trauma patients.

The need for simultaneous diagnosis and treatment of life-threatening intracranial mass lesions and intra-abdominal injury results in controversy over the appropriate triage of unconscious blunt trauma patients with stable vital signs. To aid in early decisions for these patients, a retrospective analysis of 290 patients with Glasgow Coma Scale (GCS) scores < or = 8 and systolic blood pressures (SBP) > 90 mm Hg was undertaken. The hypothesis of this study was that life-threatening abdominal injury frequently occurs in these patients and injuries cannot be consistently identified from vital signs alone. Data were analyzed for injury mechanism, SBP, heart rate (HR), Injury Severity Score (ISS), Revised Trauma Score (RTS), Abbreviated Injury Scale score for the abdomen and brain (A-AIS, CNS-AIS), and the need for emergent laparotomy. Patients with concurrent injuries were more likely to come from motor vehicle crashes than falls (p < 0.001). Although severe abdominal injuries (A-AIS > or = 3) were frequently identified based on SBP and HR, the use of clinical signs alone resulted in more missed injuries than did using the results diagnostic peritoneal lavage (DPL). This study suggests that all unconscious normotensive blunt trauma patients undergo immediate DPL to prevent missing life-threatening injuries.

Abdominal Injuries↗