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PubMed1982

[Pancreatic injuries. Report on 42 cases (author's transl)].

Between 1975 and 1980, 42 pancreatic injuries have been managed, they represented 9.5 per cent of abdominal injuries. Nine patients received penetrating trauma and thirty three patients sustained blunt trauma, the majority of them was a road accident. Associated and concomitant injuries of abdominal organs were present in 81 per cent of cases with the pancreatic trauma. More than 66 per cent have multiple brain, thoraco, abdominal, and bones injuries. Thirty two patients have been treated before the sixth hour. The emergency surgical treatment has been conservative in twenty six patients and a primary resection has been performed in twelve patients, (with eleven partial pancreatectomy and one pancreatoduodenectomy). But four patients died on the operating table because they have extensive injuries to several abdominal organs. Postoperative complications were present in 66 per cent of cases. They obliged the drainage of abscesses, three distal pancreatectomy and one pancreatoduodenectomy. The global mortality is 31 per cent, the secondary mortality is 21.4 per cent. The authors conclude thanks to the study of this series and of literature that the frequency of pancreatic trauma increased, and that its gravity is directly related to the number of other organs damages, missed or delayed diagnostic and to an inappropriate emergency treatment, which let necrosis and infection making their deadly evolution.

Adolescent↗

PubMed1995

Acute appendicitis: a cause of recurrent abdominal pain in pediatric trauma.

When traumatic abdominal injury and acute appendicitis occur within a short period of time, the diagnosis can be difficult and may result in a delay in treatment of the appendicitis. We report the case of a four-year-old boy with documented intraabdominal injury from a motor vehicle crash who developed appendicitis while hospitalized and recovering from his injuries.

Abdominal Injuries↗

PubMed1975

Diagnostic peritoneal lavage in blunt abdominal trauma.

Diagnostic peritoneal lavage is accurate and safe. It leads to fewer unnecessary laparotomies than if clinical examination alone is used and nearly eliminates deaths from undiagnosed abdominal injuries. Persons with clinical abdominal findings, shock, altered sensorium, and severe chest injuries after blunt trauma should undergo the procedure.

Abdominal Injuries↗

PubMed1994

Bicycle incidents in children--abdominal trauma and handlebars.

OBJECTIVES: To investigate the frequency and causes of bicycle related abdominal injuries in children and to examine the pattern of presentation. DESIGN: The study was a prospective study of bicycle related injury in children less than 15 years of age presenting to two paediatric hospitals (15 April-30 June 1992) and three general hospitals (1 August 1991-30 June 1992). RESULTS: In a series of 813 children, 41 sustained non-penetrating abdominal trauma due to a bicycle incident. In 21 cases, handlebar trauma was responsible. Ten of these children suffered life-threatening intra-abdominal injury. Handlebars with no plastic or foam covering of the metal ends were involved in all ten cases. In several of these cases, presentation to hospital was delayed and in others confirmation of the extent of injury took up to 48 hours. The length of hospital stay for those with significant intra-abdominal organ damage ranged from two to 156 days. CONCLUSIONS: Intra-abdominal trauma must be considered when dealing with children who are victims of bicycle trauma. Impact with handlebars may have occurred and some form of padded protection of handlebar ends is recommended unless their design can be suitably modified.

Abdominal Injuries↗

PubMed2004

Sonographic patterns of intraperitoneal hemorrhage associated with blunt splenic injury.

OBJECTIVE: To determine the correlation between sonographic detection of free fluid in the left upper quadrant and blunt splenic injury. METHODS: A retrospective review was conducted of all consecutive emergency blunt trauma sonograms obtained at a level I trauma center from January 1995 to January 2001. Data were collected on demographics, free fluid location, and patient outcome. Injuries were determined from computed tomography, diagnostic peritoneal lavage, laparotomy, or a combination thereof. RESULTS: A total of 4320 blunt trauma sonograms were obtained, and 596 patients (14%) had intra-abdominal injuries. The mean age was 33.7 +/- 19.1 years (range, 1-95 years), with 294 (49%) male and 302 (51%) female. There was no statistical difference between age, sex, or mechanism for all subgroups. There were 409 true-positive, 187 false-negative, 88 false-positive, and 3636 true-negative findings. Sensitivity of sonography for detecting all intra-abdominal injuries was 68%, and specificity was 97.6%; sensitivity for detecting isolated splenic injuries was 73.8%. Locations of free fluid in patients with nonsplenic injuries were compared with those in patients with splenic injuries. Isolated left upper quadrant free fluid was significantly associated with splenic injury (odds ratio = 3.0; P = .002), followed by diffuse free fluid (odds ratio = 2.1; P = .005). A subanalysis of isolated splenic injuries also revealed a significant association with left upper quadrant free fluid (odds ratio = 3.1; P = .007) and diffuse free fluid (odds ratio = 2.7; P = .0007). CONCLUSIONS: Free fluid in the left upper quadrant is significantly associated with splenic injury. This finding should triage patients more rapidly to computed tomography, angiography, embolization, and laparotomy.

Abdominal Injuries↗

PubMed1996

Complications after negative laparotomy for trauma: long-term follow-up in a health maintenance organization.

OBJECTIVE: To assess short-term and long-term complication rates after trauma laparotomy in a group of health maintenance organization (Kaiser Permanente) patients. DESIGN: Retrospective cohort study of patients belonging to Kaiser Permanente. MATERIALS AND METHODS: Eighty Kaiser patients who underwent a negative or nontherapeutic laparotomy for trauma at a Level I trauma center (University of California, Davis Medical Center (UCDMC)) between April 1989 and May 1994 were identified. Demographic data, past medical history, mechanism of injury, indications for surgery, findings at laparotomy, and short-term complications were abstracted from the UCDMC record. Long-term complications were taken from the Kaiser record. MEASUREMENTS: Long-term complications, including small bowel obstruction, hernia, and cosmesis. Short-term complications, including pneumonia, cellulitis, wound infection, prolonged ileus, and urinary tract infection. RESULTS: The single death in the early postoperative period was not related to the laparotomy. Mean follow-up was 36 +/- 2 months (median, 36 months); 86% had follow-up of at least 1 year. The incidence of short-term complications was 43% in patients with associated extra-abdominal injuries and 20% in patients without associated extra-abdominal injuries (p = 0.17). On long-term follow-up, there were no small bowel obstructions, incisional hernias, or cosmetic problems requiring correction. One patient developed a stitch abscess 6 weeks after the operation. CONCLUSIONS: The incidence of long-term complications after negative or nontherapeutic laparotomy for trauma is low.

Abdominal Injuries↗

PubMed2006

[Delayed laparotomies in blunt injuries of the abdomen: incidence rates, causes, mortality rates and hospitalization times in a group of 139 operated patients. A retrospective study].

INTRODUCTION: Employment of visualizing methods and achievements of conservative treatment methods have a major influence on the management of blunt abdominal injuries. The aim of the study is to assess incidence rates of, possibly, delayed surgeries and complications. PATIENTS AND METHODS: The authors conducted a retrospective analysis in a group of 139 operated patients. A common algorithm was followed on their admission. The following parameters were assessed in patients operated later than 24 hours following their admission (GROUP A): a cause of the delay, a mortality rate and duration of their intensive care unit (ICU) hospitalization. The parameters were compared to those of a corresponding patient group operated no later than 4 hours after their admission (GROUP B). RESULTS: The GROUP A included 17 (12.23%) patients. The delay median was 4 days (1-48). The diagnostics failed in 9 (52.94%), the conservative care failed in 8 (47.06%) subjects. The mortality rate was 29.41%. The GROUP B had significantly higher survival rates (p-value 0.0445). There was no statistically significant difference in the parameters of the ICU hospitalization duration. CONCLUSION: Diagnostic conclusions of visualizing methods, including CT scans, cannot be fully relied on in blunt abdominal injuries, mainly in cases of intestinal and diaphragmatic injuries. When a conservative treatment is indicated, the patient has to be closely monitored while sustaining an active surgical approach.

Abdominal Injuries↗

PubMed1992

Sonography in blunt abdominal trauma: a preliminary progress report.

Evaluation of blunt abdominal trauma is clinically challenging. Diagnostic peritoneal lavage (DPL) and computed tomographic (CT) scanning have become primary diagnostic modalities. We examined the efficacy and role of ultrasonographic (US) studies in the initial abdominal evaluation of blunt trauma patients. Over an 8-month period, patients whose abdominal work-up indicated the need for DPL or CT were evaluated sonographically within the first hour after admission by trauma fellows (PGY-6) with at least 1 hour of theoretical training and 1 hour of practical training. Sonograms considered positive were those showing free peritoneal fluid or organ disruption. Hard copies of the sonograms were evaluated by a staff radiologist without knowledge of the fellows' interpretations or of DPL or CT results. Based on the fellows' interpretation of the real-time sonograms, among the first 163 patients studied were 11 true-positive, 146 true-negative, one false-positive, and five false-negative results. Sixteen patients had intra-abdominal injury documented by DPL, CT, or laparotomy. Ultrasonography was 91% sensitive in detecting the presence of hemoperitoneum. Overall, ultrasonography was 69% sensitive, 99% specific, and 96% accurate in diagnosing abdominal injury. We conclude that emergency sonography on admission can serve as a valuable adjunct to the physical diagnosis of clinically significant hemoperitoneum. It is noninvasive, portable, and accurate in determining the need for further diagnostic/surgical intervention.

Abdominal Injuries↗

PubMed1979

Traumatic injuries of the abdominal aorta.

Despite immediate operation, patients with abdominal aortic injuries and profound hypovolemic shock do not respond to the usual methods of resuscitation and die soon after celiotomy, prior to control and repair of the aortic injury. The rate of aortic hemorrhage exceeds the ability to restore blood volume. Shock becomes "irreversible." In such patients tamponade of the aortic injury may be effected by the use of an external counterpressure device such as a G-suit or MAST suit. These devices, used in conjunction with transthoracic aortic occlusion, may raise blood pressure sufficiently to perfuse the sritical coronary and cerebral circulation, allowing time to correct acidosis and locate, control, and repair the aortic injury. Early aggressive therapy should result in increased survival.

Adolescent↗

PubMed1984

Aortic compressor for aortic occlusion in hemorrhagic shock.

The aortic compressor is a device that allows rapid, simple, immediately reversible occlusion of the thoracic aorta, without the aortic dissection required to use an aortic cross-clamp. We evaluated the aortic compressor in a controlled study using a canine hemorrhagic shock model. Twelve mongrel dogs were exsanguinated to a mean arterial pressure (MAP) of 47 mm Hg and maintained at that level for 20 minutes. At that point, all animals had a left lateral thoracotomy. Six study animals had the thoracic aorta occluded at the diaphragm using the compressor. Five minutes after thoracotomy, with or without occlusion, the shed blood was reinfused. Application of the aortic compressor was the only variable. Use of the aortic compressor led to an immediate and statistically significant doubling of the study animals' MAP. The increased afterload of aortic occlusion did not impair cardiac output. The cardiac index of the study animals rose slightly, while that of the control animals fell. At the same time the compressor prevented blood flow to the abdominal aorta. If the canine model can be extrapolated to human application, then the aortic compressor would be expected to enhance perfusion of the heart and brain during hemorrhagic shock, prevent further arterial blood loss from intra-abdominal injury or ruptured abdominal aortic aneurysm, and preserve already diminished cardiac output. Because the aorta does not need to be dissected out to use the compressor, there is no risk of injury to nearby vascular structures.

Animals↗

PubMed2002

Abdominal seat belt marks in the era of focused abdominal sonography for trauma.

HYPOTHESIS: Focused abdominal sonography for trauma (FAST) is an unreliable method for assessing intra-abdominal injury in patients with seat belt marks. DESIGN: Retrospective review of trauma patients with intestinal injury and seat belt marks during a 3-year period. Records were reviewed for patient demographics, FAST results, computed tomographic (CT) scan results, and operative findings. The CT scan results were considered positive if bowel wall thickening, extraluminal air, or free fluid without solid organ injury were present. SETTING: University hospital designated as a level I trauma center. PATIENTS: Twenty-three patients who required operation for intestinal or mesenteric injury and who had an abdominal seat belt mark. MAIN OUTCOME MEASURE: Sensitivity of FAST in these patients. RESULTS: All patients were evaluated using both FAST and CT scan of the abdomen and pelvis. Eighteen patients (78%) had either negative or equivocal FAST results when significant intestinal injury was present. All 23 patients had CT scan findings suggestive of bowel or mesenteric injury. Moderate-to-large free intraperitoneal fluid without solid organ injury was the most common finding (n = 21, 91%). Operative findings included small-bowel perforation (n = 18, 78%), colonic perforation (n = 7, 30%), bowel deserosalization (n = 8, 35%), and isolated mesenteric injury (n = 5, 22%). Sixteen patients (70%) had multiple intra-abdominal injuries. All patients were taken directly from the emergency department to the operating room. Seventeen percent of operative explorations (4/23) were nontherapeutic (no repairs required). CONCLUSION: This study confirms that FAST cannot reliably exclude intestinal injury in patients with seat belt marks.

Abdomen↗

PubMed2000

Blunt abdominal trauma in children: epidemiology, management, and management problems in a developing country.

Trauma is the leading cause of death in children in developed countries. In tropical Africa, it is only beginning to assume importance as infections and malnutrition are controlled. In developed countries, the availability of advanced imaging modalities has now reduced the necessity for laparotomy to less than 10% following blunt abdominal trauma (BAT) in children. This report reviews the epidemiology, management, and unnecessary laparotomies for pediatric BAT in a developing country in a retrospective review of 57 children aged 15 years or less at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria over 12 years. The average age was 9 years and the male-female ratio 3.8:1. Seventy-four percent (74%) of abdominal injuries in children were due to blunt trauma. The commonest causes of injury were road traffic accidents (RTA) (57%), 88% in pedestrians and 59% in children aged 5-9 years. Falls were the cause of trauma in 36%, 60% of them aged 10-15 years. Other causes of injury were sports in 5% and animals in 2%. Diagnosis was clinical, supported by diagnostic peritoneal lavage or paracentesis. Two patients had ultrasonography, and none had computed tomography. Fifty-three patients had a laparotomy, 2 died before surgery, 1 was managed nonoperatively, and in 1 surgery was declined. There were 34 splenic injuries, 20 treated by splenic preservation, splenectomy in 13, and non-operative in 1. Fourteen gastrointestinal injuries were treated in 12 patients. Of 9 hepatic injuries, 4 were minor and were left untreated, 3 were repaired, 1 was packed to arrest hemorrhage, and a lacerated accessory liver was excised. Four injuries to the urinary tract (bladder contusion 2, bladder rupture 1, ruptured hydronephrotic kidney 1) were treated accordingly. There were 4 retroperitoneal hematomas associated with other intra-abdominal injuries and 2 pancreatic contusions. One lacerated gallbladder was treated by cholecystectomy and a ruptured left hemidiaphragm was repaired transperitoneally. In retrospect, 27 (51%) patients could have been managed by observation (splenic injury 20, liver injury 5, bladder contusion 2) using advanced imaging modalities. One patient developed an intra-abdominal abscess following splenorrhaphy. The average hospital stay was 17 days. Mortality was 8 (14.5%) from gastric perforation (3), liver injury (2), splenic injury (1), and 2 patients died before surgery. BAT in this population results predominantly from RTA in pedestrians. Laparotomy may be avoided in 51% of cases if advanced imaging modalities are readily available.

Abdominal Injuries↗

PubMed2001

An epidemiological view of vascular trauma in Western Australia: a 5-year study.

BACKGROUND: Although Australia encounters vascular injury less frequently than countries such as the USA, the predominance of blunt trauma with associated complex injuries continues to pose problems for clinicians. The present paper reviews Royal Perth Hospital's experience of vascular trauma epidemiology. METHODS: All individuals who presented to the Royal Perth Hospital (RPH) with a vascular injury between August 1994 and January 2000 were identified from a prospective trauma database. Injuries were classified using the Abbreviated Injury Score (AIS 90 code). The five major vascular injury groups as defined by AIS 90 (neck, thorax, abdomen, upper limb and lower limb) were analysed in turn to determine which injuries were most frequent, what the common causes were, effects of alcohol and drugs, common associated injuries, investigations performed, mortality, proportion of rural vascular trauma with transfer details and lengths of hospital stay. RESULTS: During the study period, 153 patients (1% of total trauma workload) sustained 175 vascular injuries. The commonest causes of injury for each group were stabbing (neck and lower limb), motor vehicle accident (thorax and abdomen) and work machinery (upper limb). Mortality was highest for thoracic injury (14/32; 44%) followed by abdominal injury (10/29; 34%). The ratio of blunt to penetrating vascular trauma is high and is increasing, as is the ratio of truncal to extremity vascular trauma. The most common artery-vein combination injury was to the femoral vessels. CONCLUSIONS: The injury patterns emerging from the present study will hopefully help all medical personnel to recognize the potential for vascular injury in a trauma setting.

Abdominal Injuries↗

PubMed1979

[Injuries of the extrahepatic biliary tract].

We represented two injuries of extrahepatic bile ducts upon our clinics materijal within last ten years. With the first case we had isolated rupture calculus gallbladder by closed abdominal injury. Secend case had opend abdominal injury and rupture of gallbladder and common bile duct. We faund gallbladder teard off in Douglas spece. We solved both cases succesfully with cholecystectomy and in secend case we also aplied suture of common bile duct with T tube drainage.

Adolescent↗

PubMed1995

Selective use of computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma.

The purpose of this study was to attempt to identify those blunt trauma patients in whom expensive diagnostic studies such as computed tomography and diagnostic peritoneal lavage are unnecessary to exclude intra-abdominal injury. The medical records of 1096 blunt trauma patients evaluated at an urban level I trauma center were reviewed. Because of the urgent need to exclude intra-abdominal hemorrhage in patients with hypotension (blood pressure < 90 mm Hg), and the difficulty in obtaining reliable information from abdominal examination in patients with Glasgow Coma Scale scores < 11 or spinal cord injury, 140 patients meeting these criteria were reviewed but excluded from statistical analysis. Six groups of major associated injuries felt to be potential risk factors for the prediction of intra-abdominal injury were analyzed in the 956 remaining patients. Only two of these potential risk factors, namely chest injury (p = 0.0001) and gross hematuria (p = 0.0003) attained statistical significance. All of the 44 significant intra-abdominal injuries occurred in the group of 253 patients that had either an abnormal abdominal examination, one of the statistically significant risk factors, or both, for a sensitivity of 100%. Of the 703 patients with a normal abdominal examination and no risk factors, none had a significant abdominal injury, for a negative predictive value of 100%. This study suggests that patients with either an abnormal abdominal examination or one of the two statistically derived risk factors require adjunctive diagnostic evaluation with diagnostic peritoneal lavage or computed tomography scan to exclude intra-abdominal injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗

PubMed2000

The problems and characteristics of hepatic war trauma management in central Dalmatia during the 1991-1995 war in Croatia.

OBJECTIVE: War injuries to the liver treated during the 1991-1995 war in central Dalmatia, Croatia, were analyzed retrospectively. METHODS: There were 713 patients with abdominal injuries, 125 (17%) of whom were operated on for liver injuries. Mobile surgical teams operated on 91 patients (73%) in rear war hospitals (echelons II and III); only 34 patients (27%) were immediately transferred to and operated on at the Split University Hospital. RESULTS: After wounds to the small and large intestine, liver injuries were the third most common abdominal injuries. Morbidity was 63%, and reoperations were required in 20% of cases. Fourteen patients (11%) died. The highest rate of complications was observed in patients with postoperative inflammatory intra-abdominal collection, disseminated intravascular coagulation, adult respiratory distress syndrome, sepsis, or ileus. The highest mortality was found in those patients requiring a right hemihepatectomy. CONCLUSIONS: The best results were achieved in patients on whom, after hepatotomy, selective hemostasis with liver debridement was carried out.

Adolescent↗

PubMed1989

Unusually low mortality of penetrating wounds of the chest. Twelve years' experience.

Within a 12-year period ending in March 1984, 1109 patients with penetrating thoracic injuries were treated at King-Drew Medical Center located in south central Los Angeles. The average age of the patients was 28.1 years. There were 607 stab wounds and 502 gunshot wounds. Antibiotic prophylaxis was prescribed only for the 428 patients who had laparotomy, thoracotomy, and pulmonary contusion with hemoptysis. Of the 1109 patients, 105 had cardiac injuries. All patients with cardiac trauma underwent thoracotomy, and the mortality rate was 18.1%. Specifically, the mortality rate of gunshot wound of the heart 24.5% and that of stab wound of the heart, 11.5%. In contrast, of the 1004 patients without cardiac injuries, only 115 required thoracotomy and the mortality rate in this group was 0.8% (8/1004). The mortality rate was 69.6% in patients who had a thoracotomy in the emergency room but only 2.8% in patients who had a thoracotomy in the operating room within the first 24 hours after admission. In the 242 patients who had associated abdominal injuries, the mortality rate was 2.1% (5/242), as compared with 2.5% (22/867) for those who had isolated chest injuries. In the entire group, the incidence of complications was 5.1%, of which 1.8% were infectious complications. The presence of associated abdominal injuries did not influence the outcome. The mortality rate in noncardiac thoracic injuries is very low compared with that of cardiac injury. Because of the complexity of the injury, gunshot wound of the heart has the highest mortality rate.

Abdominal Injuries↗

PubMed1997

Safety and efficacy of diagnostic peritoneal lavage performed by supervised surgical and emergency medicine residents.

Diagnostic peritoneal lavage (DPL) remains an accurate diagnostic test for intra-abdominal injury. This study examined the safety and efficacy of DPL performed by supervised residents in an urban trauma centre. A retrospective chart review was carried out of a one year experience (July 1994-June 1995). Junior surgical and senior emergency medicine residents rotating on the Trauma Service performed an open DPL by protocol under the direct supervision of senior surgical residents. Standard criteria were used for diagnosis. During this study, 1349 injured patients were admitted to the Trauma Service. Of these 525 patients underwent DPL. Complete records were available on 516 patients. The average age of the patients was 33 years and injury was primarily blunt (95%). There were 72 true positives, 428 true negatives, two false positive and seven false negative DPLs; for a sensitivity of 91.1%, specificity of 99.5% and accuracy of 96.9%. Complications occurred in 12 patients (2.3%): non-diagnostic DPL-7 (1.3%); intraabdominal injury-4 (0.8%); wound complication-1 (0.2%). Seven patients underwent non-therapeutic laparotomy for a positive DPL. Thirty-four patients (6.6%) died, none from the DPL. DPL obviated the need for computed tomography scan of the abdomen and/or pelvis in 464 patients resulting in a cost saving of approximately $250,000. DPL performed by supervised junior surgical and senior emergency medicine residents is a safe and cost-effective method of evaluating patients with potential intra-abdominal injury.

Abdominal Injuries↗