PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “ABDOMINAL INJURIES”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,351 records · Page 75Linked to original sources
PubMed1990

Blunt intestinal injury. Keys to diagnosis and management.

Fifty-six patients with blunt intestinal injury seen during 39 months were reviewed for keys to diagnosis and treatment. Motor vehicle accidents were involved in 80% of the cases and seat/lap belts were in use 69% of the time. Blunt intestinal injury was the only abdominal injury in 70% of the cases. There were 42 perforations and 20 devascularizations; multiple injuries were common (27%). Abdominal tenderness was present on admission in 43 of 44 patients in whom a reliable examination was possible. Peritoneal lavage was positive in 13 (93%) of 14 patients. Computed tomography was falsely negative in three of four instances in which it was used. Perforations were most common in the upper and lower ends of the small bowel and in the sigmoid colon; devascularizations were most common in the distal ileum and sigmoid colon. Resection/anastomosis was performed in 38% of small-bowel perforations and in all small-bowel devascularizations. Resection/diversion was required in most colonic perforations (five of six patients) and devascularizations (four of six patients). There were five deaths (9%), none due to intestinal injury. There were seven complications related to intestinal injury. Diagnostic delay occurred in two patients; both had resultant morbidity. Blunt intestinal injury is associated with physical findings in conscious patients. Peritoneal lavage should be used when tenderness cannot be evaluated. Timely operative intervention minimizes morbidity and hospital stay.

Abdominal Injuries↗
PubMed2006

The use of routine laboratory studies as screening tools in pediatric abdominal trauma.

BACKGROUND: Standard laboratory panels were shown to play an important role in the evaluation of pediatric blunt abdominal trauma before the routine use of computed tomography (CT) scan. Recently, only a few relatively limited studies have evaluated the use of these "trauma panels." OBJECTIVE: To evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of routine "trauma panels" for evaluating intra-abdominal injury in pediatric blunt trauma patients. METHOD: We undertook a retrospective medical record review of all children with potential major blunt abdominal trauma who entered the Children's Hospital (Boston, MA) trauma registry from July 1996 to August 1999. Routine laboratory tests during those years included sodium, glucose, white blood cell count, hematocrit, platelets, prothrombin time, activated partial thromboplastin time, aspartate aminotransferase (AST), alanine aminotransferase, amylase, lipase, and urinalysis. Individual findings were considered abnormal if they fell out of the laboratory's respective reference range. We determined sensitivity, specificity, PPV, NPV, and the 95% confidence interval for each test, using abdominal pathology identified by CT scan as the gold standard. RESULTS: Three hundred eighty-two patients were included. Of that, 68% were men. Median age was 115 months (intraquartile range, 60-159 months). In total, 241 of the patients (63%) had an abdominal CT scan performed, 83 of which (33%) had abnormal findings. Abnormal values for glucose, AST, urinalysis, and white blood cell count were the most frequently observed abnormalities (67%, 47%, 43%, and 43%, respectively). Among the 83 patients with abdominal pathology, glucose and AST had the highest sensitivity (75% and 63%, respectively). Lipase had the highest PPV at 75%, and AST had the highest negative predictive at 71%. No routine laboratory test had excellent sensitivity, specificity, PPV, and NPV. CONCLUSIONS: Routine "trauma panels" should not be obtained as a screening tool in children with blunt trauma being evaluated for intra-abdominal injury.

Abdominal Injuries↗
PubMed1984

[Injuries to abdominal vessels after surgery of disk herniation].

Four cases of major vascular injury after disc surgery have been treated by the authors. In two instances the symptoms were those of an intra peritoneal haemorrhage after injury to the aorta or to the common iliac artery. These two cases were treated by resection-anastomosis of the vessel. In the two other cases, a fistula developed between the common iliac artery and the inferior vena cava or between the common iliac artery and the common iliac vein. Both lesions were also repaired two days and 10 days after disc surgery. A review of the literature has shown that these lesions are more frequent after surgery at L4-L5 level than at L5-S1 level. They are more frequent after repeated operation. They should be looked for when a fall in blood pressure is noted at the end of the surgical procedure. The published mortality is about 80 p. 100 in vessel division and 10 p. 100 after arterio venus fistula. The earlier the diagnosis is made, the higher is the proportion of healing.

Adult↗
PubMed2006

N-acetylcysteine for the prevention of kidney injury in abdominal aortic surgery: a randomized, double-blind, placebo-controlled trial.

In this prospective, randomized, placebo-controlled, double-blind trial we studied the effects of IV N-acetylcysteine for prevention of renal injury in patients undergoing abdominal aortic surgery. Seventy patients without previously documented renal dysfunction were randomly allocated to receive either N-acetylcysteine (150 mg/kg mixed in 250 mL of 5% dextrose infused in 20 min, followed by an infusion of 150 mg/kg in 250 mL of 5% dextrose over 24 h) or placebo. The infusion was started after the induction of anesthesia. The primary outcome measure was renal injury as measured by the increases in urinary N-acetyl-beta-d-glucosaminidase (NAG)/creatinine ratio (indicator of renal tubular injury) and urinary albumin/creatinine ratio (indicator of glomerular injury). Renal function was assessed by measuring plasma creatinine and serum cystatin C concentrations. The urinary NAG/creatinine ratio increased significantly from baseline to before crossclamp and remained increased on day 5 in both groups. The urinary albumin/creatinine ratio increased significantly from baseline to 6 h after declamping in the N-acetylcysteine group. However, the changes in the NAG/creatinine ratio and the albumin/creatinine ratio were not significantly different between the two groups. Plasma creatinine and serum cystatin C values remained unchanged during the study period in both groups. In conclusion, N-acetylcysteine did not offer any significant protection from renal injury during elective aortic operation in patients with normal preoperative renal function, and some degree of tubular injury seems to occur before aortic crossclamp.

Acetylcysteine↗
PubMed1990

The value of alkaline phosphatase in peritoneal lavage.

The accuracy of peritoneal lavage for diagnosis of intra-abdominal injury in trauma is limited by its relative lack of sensitivity for hollow viscus injury. Peritoneal lavage in the dog indicates that alkaline phosphatase is an early marker of intestinal injury. If these results were confirmed in human patients, alkaline phosphatase determination would improve lavage sensitivity for hollow viscus injuries. A study was conducted to determine the usefulness of alkaline phosphatase in lavage in human beings. Alkaline phosphatase was measured in all trauma lavage samples sent for laboratory assay during a one-year period. Two hundred ninety-two lavages were performed: 25 were positive by laboratory criteria, and 66 were grossly positive. There were 13 intestinal injuries--nine were grossly positive, and four were diagnosed by laboratory results. Three of these four patients with intestinal injuries had elevated lavage alkaline phosphatase. All three (lavaged from 30 minutes to two hours after injury) also had elevated white blood cells or bile in the lavage fluid. The remaining intestinal injury was diagnosed by lavage bile but had no elevation of alkaline phosphatase (lavaged 15 minutes after injury). Two patients with elevated alkaline phosphatase in otherwise negative lavages were observed for at least five days; neither demonstrated any evidence of intra-abdominal injury. We conclude that alkaline phosphatase is no better than traditional determinants of intestinal injury in peritoneal lavage. In no patient was alkaline phosphatase helpful in diagnosing a hollow viscus injury, and its use would have prompted two unnecessary laparotomies. These data do not support the use of lavage alkaline phosphatase to identify hollow viscus injuries.

Abdominal Injuries↗
PubMed1988

Management of major tracheobronchial ruptures in patients with multiple system trauma.

Major tracheobronchial injury presents special problems in the context of multiple system trauma. A 14-year review of a clinical experience revealed eight patients who had operative repair of major bronchial or intrathoracic tracheal injuries. The diagnosis was suspected by subcutaneous emphysema, and especially by persistent pneumothorax or a significant air leak. Bronchoscopy confirmed the diagnosis in all patients before thoracotomy. All eight patients had multiple system injuries. All five with abdominal injuries were hypotensive at admission and underwent celiotomy before thoracotomy. The decision to perform thoracotomy or celiotomy first in patients with major tracheobronchial injuries and concomitant abdominal trauma must be individualized. If both injuries are recognized simultaneously and the patient is hemodynamically unstable but has adequate oxygenation and ventilation, the celiotomy can be performed first. On the contrary, if oxygenation and ventilation are the most threatening problems in a hemodynamically stable patient despite evidence of hemoperitoneum, the bronchial repair should have priority.

Adolescent↗
PubMed1991

Enterocutaneous fistulas following laparotomy for trauma.

Enterocutaneous fistulas (ECF) are recognized complications of various bowel diseases. Trauma is reported as a rare cause of ECF. ECF following laparotomy for abdominal injury was studied in 15 patients to determine whether traditional principles of management for ECF are applicable in posttraumatic ECF. Thirty-three per cent of patients with posttraumatic ECF spontaneously healed fistulas with appropriate nutritional support without operative intervention. Sixty-six per cent of patients required operative intervention, either because of associated sepsis or failure to spontaneously heal. Five patients had fistulas originate from areas of bowel not injured in the initial injury. This study suggests traditional principles of management for ECF are applicable in ECF following laparotomy for abdominal injury and result in a spontaneous closure of fistulas in one-third of patients. In addition, sepsis is the main indication for early aggressive operative treatment of these fistulas.

Abdominal Injuries↗
PubMed1992

[Patterns of injuries: a guideline for evaluation of multiple injuries?].

By means of 468 patients with polytrauma the pattern of injuries were analysed. Separated into body regions the combinations of injuries to skeleton/thorax and skeleton/thorax/abdomen were found most often. A high lethality was evaluated for the combination of skeletal and abdominal injuries. 362 patients of the examined collective survived, 106 patients died. Among the deceased patients with head-injuries intracranial bleeding could be seen much more than in the group of survivors. Patients who died had also more ruptures of liver and other gastrointestinal injuries. Concerning the skeletal patterns of injuries they surprisingly had more fractures of shoulder, forearm and lower leg than the survivor-group. The statistic demonstrates clearly that in pattern of head or abdominal injuries the single diagnosis determines the rate of lethality. This correlation could not be seen in skeletal injuries. The pattern of injuries cannot be used as a guideline for the assessment of therapy of the severe trauma patient.

Abdominal Injuries↗
PubMedDate not supplied

[Classification of complications of combined injuries of abdominal organs and long tubular bones in traffic accidents].

The outcomes of treatment of 386 victims with abdominal trauma and fractures of the long tubular bones were studied. The authors systematized the typical complications developing after the trauma, both on the part of the injured organs of the abdominal cavity and true pelvis and the fractures of the long tubular bones. This allowed the developed complications to be divided according to time into early, late, and sequelae of trauma. The early complications of injuries to the organs of the abdomen and true pelvis are as follows: suppuration of postoperative wounds, postoperative wound dehiscence with or without eventration, recurrent intracavitary hemorrhage, progressing local peritonitis, incompetence of anastomoses, intestinal obstruction, abdominal abscesses and infiltrates, abscesses and infiltrates in the true pelvis, intestinal paresis, large hematomas, phlegmons of the anterior abdominal wall. The late complications are: sluggish wounds of the anterior abdominal wall, formation of ligature fistulas, postoperative ventral hernias, suppuration of intraorganic and interstitial hematomas, subclinical forms of sepsis and sepsis, thrombophlebitic complications, chronic venous insufficiency, persistent wounds, and other complications. The sequelae of injury to the organs of the abdominal cavity and true pelvis are: intestinal fistulas, functional intestinal disorders, gastric disease, the dumping syndrome, cicatricial changes of the anterior abdominal wall, posttraumatic disease, venous insufficiency, pneumosclerosis, chronic pneumonia, pulmonary emphysema, chronic vascular insufficiency, etc. The early complications in fractures of long tubular bones in the group of studied patients: suppuration of osteomuscular wounds, recurrent displacement of bone fragments, bone necrosis in open type IIIC, IIID fractures, gangrene of the limb consequent upon crushing of skin and subcutaneous tissue, subluxations, secondary subluxations of limbs.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed2005

Computed tomography without oral contrast solution for blunt diaphragmatic injuries in abdominal trauma.

OBJECTIVE: The aim of this study was to estimate the sensitivity, specificity, and positive predictive value (PPV) of computed tomography (CT) without oral contrast for diaphragm injuries (DIs) in blunt abdominal trauma. METHODS: We prospectively enrolled 500 consecutive "trauma-one" patients who received CT imaging and interpretation (CT-Read1) of the abdomen within 45 minutes of their arrival from July 2000 to December 2001. All patients were imaged without oral contrast but with intravenous contrast. Computed tomographic images were reviewed within 24 hours of admission by research radiologists (CT-Read2) blinded to CT-Read1. True DIs were determined hierarchically by either laparotomy or autopsy. RESULTS: There were 9 patients with laparotomy or autopsy-proven blunt DIs; 8 of these injuries involved the left hemidiaphragm. The CT-Read1 correctly detected only 6 of 9 blunt DIs, thus missing 3 DIs. One of these involved the right hemidiaphragm, whereas the other 2 were left sided. There were no false-positive findings with CT-Read1 for blunt DI. The sensitivity and specificity of CT imaging with respect to DI were 66.7% (95% CI, 29.9%-92.5%) and 100% (95% CI, 99.2%-100%), respectively. The PPV for the test was 1.00 (95% CI, 0.65-1.00). CONCLUSION: Although the low number of blunt DIs in this study limits its general applicability, CT imaging of the diaphragm without oral contrast appears to perform within the range of reported imaging techniques using oral contrast. Still, CT scanning appears to have an unsatisfactorily low sensitivity to be reliably used in eliminating the diagnosis of blunt DI.

Adult↗
PubMed1992

Computed tomography imaging of abdominal trauma in children.

The authors discuss the role of computed tomography (CT) in the evaluation of children following blunt abdominal trauma. Appropriate techniques for scanning children are described, as well as clinical indications that place children at high risk and low risk for abdominal injury. Examples of both solid organ and bowel injuries are shown, with special emphasis on the correlation of CT appearance and clinical outcomes. The authors conclude that CT is an effective tool for the diagnosis of abdominal injury in the pediatric patient, and that the clinical impact of CT appears to be changing with the increasing use of nonoperative therapy for solid organ injury.

Abdominal Injuries↗
PubMed1987

Blunt injury of the neck of the pancreas: a report of nine patients.

Nine patients with injury of the neck of the pancreas following blunt abdominal injury are reported. Eight were sustained in road traffic accidents and only two victims had used seatbelts. Serious associated injuries were present in four patients and the pancreatic injury was missed in two patients. The diagnosis of this injury was made at laparotomy in six, while one patient had the diagnosis confirmed at endoscopic retrograde pancreatography (ERP). The neck of the pancreas was the site of injury in all nine cases. Pancreatic drainage (3), suture repair (1) and distal resection with splenectomy (2) were the operative procedures performed. Pseudocyst of the pancreas (2), pancreatic fistulas (2), pancreatitis (1) and ascites (1), which necessitated a further laparotomy, accounted for postoperative morbidity. There was one postoperative death from haemorrhage due to stress ulceration. This study emphasizes that the neck of the pancreas is at special risk following blunt abdominal injury.

Accidents, Traffic↗
PubMed2005

Frequency and severity of injuries in correlation with the height of fall.

The main aim of this study was to examine the correlation between the height of fall and the frequency, extensiveness, and type of injuries of certain body regions and organs. The specific objective was to determine characteristic injuries of the analyzed body regions in relation to the certain height of fall. The study included 660 cases of fatal falls from height (469 males and 191 females). Results support the hypothesis that the frequency and extent of the injured body regions and organs are related to the fall height. Head injuries are characteristic of the falls from heights up to 7 m and beyond 30 m. Brain injuries in high falls from heights beyond 30 m show an absence of contre coup contusions and macroscopically evident intracranial bleeding. The extensiveness of chest injuries is significantly statistically associated with fall height. In cases of high falls, the frequency of abdominal injuries is not significantly statistically related to the height of fall. Liver injuries are the most common abdominal injury and the critical height of fall at which the liver injury occurs is 15 m. Injuries of liver and spleen are concomitant in high falls from heights beyond 24 m, irrespective of the manner of impact. The height of fall over 15 m appears to be a reasonable boundary height beyond which the injuries of two or three body regions are generally associated.

Accidental Falls↗
PubMed2001

Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study.

BACKGROUND: Focused Assessment with Sonography for Trauma (FAST) is rapidly establishing its place in the evaluation of blunt abdominal trauma. However, no prospective study specifically evaluates its role in penetrating abdominal trauma. METHODS: Data were collected prospectively in 75 consecutive stable patients with penetrating trauma to the abdomen, flank, or back, from December 1998 to June 1999. Those with an obvious need for emergent laparotomy were excluded. FAST was performed as the initial diagnostic study on all patients. Wound location, type of weapon, and findings of diagnostic peritoneal lavage, triple-contrast computed tomographic scan, or laparotomy were recorded. The presence of peritoneal blood was noted. Data were analyzed using the chi(2) test. RESULTS: Of the 75 patients, there were 32 stab and 43 gunshot wounds. There were 66 male patients and 9 female patients; the mean age was 30 years; 41 had proven abdominal injury and 34 had no injury; and 21 patients had a positive FAST. Nineteen had peritoneal blood and injuries requiring repair at the time of laparotomy. There were two false-positive studies. Fifty-four patients had a negative FAST. In 32 patients, this was a true-negative study. Thirteen patients had a false-negative FAST and had peritoneal blood and significant injury on further evaluation. Nine patients had a negative FAST and no peritoneal blood but still had abdominal injuries requiring operative repair, including liver (four), small bowel (four), diaphragm (three), colon (three), and stomach (one). The overall sensitivity of FAST was 46% and the specificity was 94%. The positive predictive value was 90%, and the negative predictive value was 60%. CONCLUSION: FAST can be a useful initial diagnostic study after penetrating abdominal trauma. A positive FAST is a strong predictor of injury, and patients should proceed directly to laparotomy. If negative, additional diagnostic studies should be performed to rule out occult injury.

Abdominal Injuries↗
PubMedDate not supplied

Detecting blunt pancreatic injuries.

Pancreatic injury after blunt abdominal trauma is exceedingly uncommon, occurring in less than 5% of major abdominal injuries. When blunt pancreatic injury does occur, however, it is notoriously difficult to identify. The use of serum amylase has been advocated in the diagnosis of such injury, yet it is neither sensitive nor specific. Computed tomography has become widely accepted in the evaluation of hemodynamically stable patients after blunt abdominal trauma, although it is clearly not a sensitive modality for the detection of pancreatic injury. In fact, numerous examples of normal CT scans with missed pancreatic injury have been documented. However, careful attention to CT technique and awareness of the CT manifestations of pancreatic injury may facilitate the diagnosis of pancreatic injury. Additionally, important information about the pancreatic duct can be obtained with the use of MRI-pancreatography or endoscopic retrograde pancreatography. Accurate, timely identification of major pancreatic ductal injury is imperative because delay in diagnosis and associated vascular injuries are largely responsible for the high morbidity and mortality associated with blunt pancreatic trauma. Blunt pancreatic trauma can be managed successfully by means of both operative and selective approaches.

Algorithms↗
PubMed1999

Urban free falls and patterns of renal injury: a 20-year experience with 396 cases.

OBJECTIVE: To determine the distribution and stage of renal injuries from free falls and to determine the appropriate methods for their evaluation and management. MATERIALS AND METHODS: We reviewed the records of 423 patients with renal injuries after a fall from height. Twenty-seven patients did not survive their injuries and were removed from the study. RESULTS: Based on the American Association for the Surgery of Trauma grading scale, 372 of the renal injuries (94%) were grade 1, whereas 24 injuries (6%) were grade 2 to 4. None of the injuries was grade 5. Of the patients with grade 2 to 4 renal injuries, nine patients had grade 2, three patients had grade 3, nine patients had grade 4, and one patients had a forniceal rupture, as well as two patients with ureteropelvic junction disruptions (one bilateral), four with segmental vascular injuries, and two with hilar vessel injuries. Mean height of free fall was 23.1 feet (range, 10-60 feet) and mean Injury Severity Score was 20.6. Neither the degree of renal injury nor the Injury Severity Score statistically correlated to the height of the free fall. Patients with grade 2 to 4 were more likely than patients with grade 1 renal injuries to be in shock and to have intra-abdominal injuries, gross hematuria, and higher Injury Severity Score(33%, 34%, 62%, 24.6 vs. 6%, 9%, 14%, 20.1, respectively). The degree of hematuria and the grade of renal injury, however, did not correlate. Grade 2 to 4 renal injuries had microscopic hematuria and no shock in 8.3% (2 of 24 patients) and no hematuria in 20.8% (5 of 24 patients). Thus, standard selection criteria for renal imaging of blunt trauma, namely gross hematuria or microhematuria and shock would have missed 7 or 29% of our grade 2 to 4 renal injuries, or 1.8% of all grade 1 to 4. Half of the patients with grade 2 to 4 renal injuries had associated multiple-system injuries, and half had flank ecchymosis or tenderness. Of the patients with grade 2 to 4 injuries, 9 patients (37%) underwent surgical exploration and repair of injury. All renal units were preserved and underwent successful reconstruction. Six of the nine patients initially were explored because of associated intra-abdominal injuries. No major urological sequelae were noted postoperatively or in follow-up of all renal injuries. CONCLUSION: The height of the free fall cannot reliably predict the degree of the resulting renal injury. Despite the absence of hematuria or shock, vertical deceleration injuries, in particular those associated with multiple-system injuries and/or physical signs of potential renal injury (e.g., flank ecchymosis), demand renal imaging. After a fall from height, the ureteropelvic junction and renal vasculature should also be imaged for potential injury.

Accidental Falls↗