Laparotomy Due to War-Related Penetrating Abdominal Trauma in Civilians: Experience From Syria 2011-2017

2020 ◽  
pp. 1-9
Author(s):  
Bayan Alsaid ◽  
Maryam Alhimyar ◽  
Ahmad Alnweilaty ◽  
Ehab Alhasan ◽  
Zein Al Abidin Shalhoum ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Penetrating Trauma ◽  
Exploratory Laparotomy ◽  
Abdominal Injuries ◽  
Penetrating Abdominal Trauma ◽  
Abdominal Organs ◽  
Negative Laparotomy ◽  
Organ Systems ◽  
Multiple Injured ◽  
The Impact

ABSTRACT Objectives: Penetrating abdominal trauma is one of the injuries that could affect civilians in wartime. This retrospective study investigates the commonly injured abdominal organs, and the impact of multiple injured organs on mortality. Methods: We reviewed the operating room (OR) logs of patients who presented to the surgical emergency department (SED) at Al-Mouwasat University Hospital with war-related abdominal penetrating trauma requiring exploratory laparotomy between April 1, 2011 and December 31, 2017. Results: Of 7826 patients with traumatic injuries, 898 patients (11.5%) required exploratory laparotomy. Of all patients who had an exploratory laparotomy (n = 898), 58 patients (6.5%) died in the perioperative period. Regarding complete laparotomies (n = 873 patients), small intestines, large intestines, and liver were the most commonly affected organs (36.4%, 33%, 22.9%, respectively). A total of 92 patients (10.2%) had negative laparotomy in which all the abdominal organs were not injured. The perioperative mortality rate (POMR) increased when more organs/organ systems were injured per patient reaching a peak at 3 organs/organ systems injuries with a POMR of 8.3%. POMR was highest in patients with musculoskeletal injuries (18.2%), followed by vascular injuries (11.8%), and liver injuries (7%). Conclusions: The management of civilians’ abdominal injuries remains a challenge for general and trauma surgeons, especially the civilian trauma team. The number and type of injured organs and their correlation with mortality should be considered during surgical management of penetrating abdominal injuries.

A CLINICAL STUDY OF PENETRATING ABDOMINAL TRAUMA WITH SPECIAL REFERENCE TO ITS MANAGEMENT : AN INDIAN SCENARIO

2021 ◽  
pp. 1-3
Author(s):  
Saumya Singh ◽  
Anindya Halder ◽  
Niru Das
Keyword(s):  
Data Collection ◽  
Hospital Stay ◽  
Abdominal Trauma ◽  
Surgical Techniques ◽  
Penetrating Trauma ◽  
Diagnostic Methods ◽  
Gunshot Injury ◽  
Abdominal Injuries ◽  
Average Hospital ◽  
Penetrating Abdominal Trauma

Introduction: The incidence of penetrating abdominal injuries has been on the rise. The common availability of rearms, the lack of proper law, armed conicts, civil violence and road trafc accidents are the major causes of penetrating abdominal injuries. As patient with penetrating abdominal trauma are at risk of harbouring life threatening injuries, early diagnosis and timely intervention is the most important steps to reduce its morbidity as well as mortality. Recently due to improvement of the present healthcare system, the outcome of these injuries is improving. Materials And Methods: A descriptive observational study was carried out on 60 cases of penetrating abdominal injuries. A predesigned pretested schedule was used for data collection. Interview of the study subject and evaluation of all clinical reports was done to obtain the history, clinical ndings, management, complications, mortality and follow up. Before data collection, informed consent was obtained from each and every study subjects. Results: The overall incidence of penetrating abdominal trauma was found to be 2.30% of the total admission of 6217 patients in the department of surgery. The most common cause of penetrating abdominal injury found in this study is stab injury by sharp objects which is followed by gunshot injury. The commonest age group affected was 20 to 30 years which comprises about 41.67%. In this study we found a male preponderance in cases of penetrating injury to the abdomen. In most of the cases the mode is homicidal stab or gunshot injury followed by accidental injuries. Pain, abdominal distension and bleeding from the wound are the main presenting symptom. After initial evaluation with USG (FAST),CTscan abdomen is the most valuable investigation so far. In this series, it is found that the small intestine is the most commonly involved viscera followed by colon, omentum, mesentery and liver respectively. Most common complications after operative intervention was wound infection. The average hospital stay was 6 to 15 days. It has been observed that the post-operative complications, associated injuries and multiple organ injuries are the cause of increased hospital stay. Conclusion: Penetrating trauma can be serious because it can damage internal organs and presents a risk of shock and infection. In the present year, due to overall improvement in the communication and transportation, better monitoring systems and resuscitative measures, improvised diagnostic methods, better availability of blood and blood products, better medications and more skilful surgical techniques, the outcomes of these injuries are improving.

Diagnostic Laparoscopy Reduces the Rate of Negative Laparotomy in Trauma Patients

2020 ◽  
Vol 22 (1) ◽  
pp. 47-51
Author(s):  
Debashish Bar ◽  
Masrur Akbar Khan ◽  
Sanjana Sharmin Shashi ◽  
AZM Mahfuzur Rahman ◽  
ABM Khurshid Alam ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
Exploratory Laparotomy ◽  
Operative Management ◽  
Bowel Injury ◽  
Trauma Patients ◽  
Abdominal Injuries ◽  
College Hospital ◽  
Negative Laparotomy ◽  
Intraabdominal Injuries

Background: The last century has witnessed immense evolvement of management of patients with abdominal trauma. Moreover the recent trend has shifted to selective operative management rather than exploratory laparotomy in trauma patients with suspected intraabdominal injuries and is considered more rational as well. Diagnostic laparoscopy is highly sensitive in detecting intra-abdominal injury with subsequent reduction in the rate of negative laparotomy and procedure related morbidity. Objective: The study was carried out to find the role of diagnostic laparoscopy in abdominal trauma. Methods: An observational study was carried out in the casualty block of Dhaka Medical College Hospital from 1st June 2015 to 30th March 2016. A total of 50 successive patients were assigned in this study. All of them were admitted with abdominal trauma and underwent diagnostic laparoscopy during the period of 10 months. The study was designed to find out whether laparoscopy can help in identifying intra-abdominal injuries with consequent avoidance of unnecessary operative explorations. Results: Intra-abdominal injuries other than GIT perforation were diagnosed by laparoscopy with 100% accuracy but in case of bowel injury the diagnostic accuracy was 80%. Conclusion: Diagnostic laparoscopy is the procedure of choice in doubtful intra-abdominal injuries with impressive accuracy except for bowel injury. Subsequently it reduced the need for negative laparotomies with their procedure related adverse effects. Journal of Surgical Sciences (2018) Vol. 22 (1): 47-51

scholarly journals Deaths from abdominal trauma: analysis of 1888 forensic autopsies

2017 ◽  
Vol 44 (6) ◽  
pp. 582-595 ◽  
Author(s):  
POLYANNA HELENA COELHO BORDONI ◽  
DANIELA MAGALHÃES MOREIRA DOS SANTOS ◽  
JAÍSA SANTANA TEIXEIRA ◽  
LEONARDO SANTOS BORDONI
Keyword(s):  
Abdominal Trauma ◽  
Forensic Medicine ◽  
Traffic Accidents ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Blood Alcohol ◽  
Penetrating Abdominal Trauma ◽  
Abdominal Organs ◽  
Belo Horizonte ◽  
Epidemiological Profile

ABSTRACT Objective: to evaluate the epidemiological profile of deaths due to abdominal trauma at the Forensic Medicine Institute of Belo Horizonte, MG - Brazil. Methods: we conducted a retrospective study of the reports of deaths due to abdominal trauma autopsied from 2006 to 2011. Results: we analyzed 1.888 necropsy reports related to abdominal trauma. Penetrating trauma was more common than blunt one and gunshot wounds were more prevalent than stab wounds. Most of the individuals were male, brown-skinned, single and occupationally active. The median age was 34 years. The abdominal organs most injured in the penetrating trauma were the liver and the intestines, and in blunt trauma, the liver and the spleen. Homicide was the most prevalent circumstance of death, followed by traffic accidents, and almost half of the cases were referred to the Forensic Medicine Institute by a health unit. The blood alcohol test was positive in a third of the necropsies where it was performed. Cocaine and marijuana were the most commonly found substances in toxicology studies. Conclusion: in this sample. there was a predominance of penetrating abdominal trauma in young, brown and single men, the liver being the most injured organ.

Trauma to the Abdomen and Pelvis

2018 ◽  
Author(s):  
Zahir Basrai ◽  
Timothy Jang ◽  
Manuel Celedon
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Peritoneal Lavage ◽  
Penetrating Trauma ◽  
Balloon Occlusion ◽  
Organ Injury ◽  
Abdominal Organs ◽  
Fast Exam ◽  
Definitive Management ◽  
Endovascular Balloon Occlusion

Abdominal trauma accounts for approximately 12% of all trauma. The evaluation of abdominal trauma is difficult as the patient may have concomitant distracting injuries or alteration of mental status. As a result, a systematic approach to abdominal trauma is needed to ensure that life threatening injuries are not missed. The evaluation and management of abdominal trauma is directed by the Western and Eastern Trauma Association guidelines. Trauma to the abdomen is divided into two main categories, penetrating and blunt. The initial steps in management of both types are determined by the hemodynamic stability of the patient. Unstable patients with either pattern of injury are emergently taken to the operating room (OR) for exploration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is being used at select trauma centers in unstable patients with abdominal trauma that are unresponsive to standard trauma resuscitation. For hemodynamically stable patient with penetrating trauma, recent data on selective non-operative management has shown promising outcomes. Patients with tenuous hemodynamics and blunt abdominal trauma are resuscitated with blood transfusions while being worked up by a Focused Assessment with Sonography for Trauma (FAST) exam or deep peritoneal lavage (DPL). If the patient stabilizes further work up with labs and imaging is performed. Patients that remain tenuous should be taken to the OR. Hemodynamically stable patients with blunt trauma and evidence of peritonitis on exam can be evaluated with labs and imaging to assess for organ injury. Non- tender patients can be evaluated with labs and serial abdominal exams. The American Association for the Surgery of Trauma (AAST) organ injury scales are used to guide the definitive management of patients with intraabdominal injury. The Young-Burgess Classification System can be used to characterize pelvic fractures and to guide stabilization and definitive management. Tables demonstrate the AAST Injury Scales for the different abdominal organs. Images demonstrate the FAST exam and CT findings for different abdominal organs.   This review contains 14 figures, 6 tables and 48 references Key Words: Abdominal Trauma, Penetrating Trauma, Blunt Trauma, FAST exam, Liver Trauma, Splenic Trauma, Intestinal Trauma, Pancreatic Trauma, Diaphragmatic Trauma, Aortic Trauma, Pelvic Fracture, Deep peritoneal lavage, DPL, Focused Assessment with Sonography for Trauma, REBOA, Resuscitative Endovascular Balloon Occlusion of the Aorta

Dual-Energy CT: A Paradigm Shift in Acute Traumatic Abdomen

2020 ◽  
Vol 71 (3) ◽  
pp. 371-387 ◽  
Author(s):  
Saira Hamid ◽  
Savvas Nicolaou ◽  
Faisal Khosa ◽  
Gordon Andrews ◽  
Nicolas Murray ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Trauma ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Vascular Injuries ◽  
Intravenous Contrast ◽  
Penetrating Abdominal Trauma ◽  
Portable Ultrasound

Abdominal trauma, one of the leading causes of death under the age of 45, can be broadly classified into blunt and penetrating trauma, based on the mechanism of injury. Blunt abdominal trauma usually results from motor vehicle collisions, fall from heights, assaults, and sports and is more common than penetrating abdominal trauma, which is usually seen in firearm injuries and stab wounds. In both blunt and penetrating abdominal trauma, an optimized imaging approach is mandatory to exclude life-threatening injuries. Easy availability of the portable ultrasound in the emergency department and trauma bay makes it one of the most commonly used screening imaging modalities in the abdominal trauma, especially to exclude hemoperitoneum. Evaluation of the visceral and vascular injuries in a hemodynamically stable patient, however, warrants intravenous contrast-enhanced multidetector computed tomography scan. Dual-energy computed tomography with its postprocessing applications such as iodine selective imaging and virtual monoenergetic imaging can reliably depict the conspicuity of traumatic solid and hollow visceral and vascular injuries.

scholarly journals Laparoscopic Bullet Removal in a Penetrating Abdominal Gunshot

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Christos Stefanou ◽  
Nicolaos Zikos ◽  
George Pappas-Gogos ◽  
Spyridon Koulas ◽  
Ioannis Tsimoyiannis
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Exploratory Laparotomy ◽  
Stable Patient ◽  
Imaging Studies ◽  
Abdominal Injuries ◽  
Penetrating Abdominal Trauma ◽  
Entry Wound ◽  
Accepted Practice ◽  
Lower Abdominal Wall

Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. We report a case of a lower anterior abdominal gunshot patient treated laparoscopically. A 32-year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall. The patient had no symptoms or obvious bleeding and was vitally stable. On examination we identified 1 cm diameter entry wound at the left lower abdominal wall. The imaging studies showed the bullet in the peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera. We decided to remove the bullet laparoscopically. Twenty-four hours after the intervention the patient was discharged. The decision for managing gunshot patients should be based on clinical and diagnostic findings. Anterior abdominal injuries in a stable patient without other health problems can be managed laparoscopically.

scholarly journals Laparoscopy and Penetrating Abdominal Trauma: A Systematic Review

2019 ◽  
Vol 4 (7) ◽  
pp. 217-231
Author(s):  
Bráulio Filgueira Magalhães ◽  
Pedro De Sousa Leite ◽  
Pedro Hugo Bezerra Maia Filho ◽  
George Wallisson Severo de Sá ◽  
Whallyson Pinheiro Mascarenhas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Abdominal Trauma ◽  
Retrieval System ◽  
Penetrating Trauma ◽  
Laparoscopic Approach ◽  
Final Analysis ◽  
Penetrating Abdominal Trauma ◽  
Penetrating Wound ◽  
Definition Of

This article aims to evaluate the effectiveness and use of laparoscopy in penetrating abdominal trauma, thus providing a better definition of the role of laparoscopic approach in patients with PAD.  A systematic review was performed by searching indexed articles in the Virtual Health Library and the Medical Literature Analysis and Retrieval System Online database (MEDLINE / PubMed), in which analysis after final analysis included 07 articles.  In this study we identified seven articles that evaluated the use and contributions of the laparoscopic approach in patients with TAP, in which it was identified that the use as a diagnostic approach is widely used due to its benefits and safety.  Regarding its therapeutic approach it was determined that in the largest of the studies there is indication, usefulness, reliability and accuracy of its use, however, for better results is essential experience of the surgical team in laparoscopic technique.Keywords: Abdominal trauma;  Laparoscopy and Penetrating Trauma;  Abdominal injury;  Laparoscopy;  Penetrating wound.

scholarly journals Role of Diagnostic Laparoscopy in Penetrating Abdominal Trauma

2021 ◽  
Vol 15 (10) ◽  
pp. 3514-3516
Author(s):  
Fatima Abbasi ◽  
Muhammad Khurram Zia ◽  
Farhan Siddique ◽  
Ali Adnan ◽  
Hina Tahseen
Keyword(s):  
Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
Bowel Perforation ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Penetrating Abdominal Trauma ◽  
Missed Injury ◽  
Operative Findings ◽  
Intraabdominal Injury

Background and Objective: Trauma remains the major cause of mortality and disability among young people across the world with penetrating trauma being a very common cause. Traditionally, penetrating abdominal trauma was managed with exploration. But now with the advent of minimally access surgery and advancements in laparoscopic expertise, more patients can be managed with minimally invasive methods. This approach can save many unnecessary laparotomies and large midline incisions. The role of laparoscopy in blunt abdominal trauma is well established. The aim of this study was to evaluate the role of diagnostic laparoscopy in penetrating abdominal injuries. Methods: All the penetrating abdominal trauma patients presenting to the emergency department of Rawal Medical and Dental hospital from January 2019 till December 2020 for a period of 2years (a total of 102 patients) and who were hemodynamically stable, between the ages of 20 to 50 years of either gender were included in the study. All these patients had equivocal abdominal findings with no signs to suggest serious intraabdominal injury. These patients were prepared as standard for general anesthesia and diagnostic laparoscopy was performed. A predesigned performa was used for entering the patients’ details and operative findings. All patients gave written informed consent in urdu. Main outcome measures were the conversion rate, missed injuries leading to reexploration. Results: 85%of the patients were males with only 15% females. Mean age of the population was 38.7 years .Conversion to open was required in only 6.12 % of the cases .Laparoscopy alone was sufficient for all other patients. In about 36% of the patients no intraabdominal injury was found. In rest 58% patients the surgeons were able to repair the injuries laparoscopically.18 patients had minor liver injury,10 patients had minor hemoperitoneum<100 ml without any significant injury and 2 patients had single small bowel perforation which was repaired laparoscopically and cavity was irrigated. No patient had post operative complications of peritonitis due to missed injury or bleeding leading to re exploration. Conclusion: Laparoscopy is a very effective procedure to deal with penetrating abdominal trauma patients who are stable and with equivocal abdominal findings without increasing risk of missed injury with minimal rates of conversion to open laparotomy if patients are selected vigilantly. Keywords: Penetrating, Diagnostic Laparoscopy, Abdominal Trauma

scholarly journals Traumatic Implantation: A Novel Aetiology in the Development of Peritoneal Mesothelioma

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Nicola Humphrys ◽  
Amy Downing ◽  
Luke Evans ◽  
Martin Sinclair
Keyword(s):  
Case Report ◽  
Peritoneal Cavity ◽  
Abdominal Trauma ◽  
Penetrating Trauma ◽  
Peritoneal Mesothelioma ◽  
Penetrating Abdominal Trauma ◽  
Abdominal Malignancy ◽  
Long Term Consequences

Peritoneal mesothelioma is a rare intra-abdominal malignancy. Its aetiology has been thought to be due to either inhalation or ingestion of asbestos particles. We present a case of peritoneal mesothelioma developing as a result of a novel third route and the inoculation of fibres into the peritoneal cavity by penetrating trauma and direct transport. This case report highlights the important long term consequences of penetrating abdominal trauma and the need for vigilance in undertaking peritoneal toilet.

scholarly journals Leucocytosis in penetrating trauma (abdominal and thoracic/osseous): a transversal study in Juarez, México

2015 ◽  
Vol 15 (2) ◽  
pp. 220-225
Author(s):  
Juan de Dios Díaz-Rosales ◽  
Lenin Enríquez-Domínguez ◽  
Balthazar Aguayo-Muñoz ◽  
Beatriz Díaz-Torres
Keyword(s):  
Abdominal Trauma ◽  
Blood Cells ◽  
White Blood Cells ◽  
Penetrating Trauma ◽  
Human Anatomy ◽  
Thoracic Injury ◽  
Trauma Patients ◽  
Penetrating Abdominal Trauma ◽  
Major Injury ◽  
Transversal Study

Introduction: The abdominal trauma is an important cause of morbility and mortality, abdomen is the 3th zone of human anatomy more affected by traumatism that require surgery and hospitalization. Evaluation of penetrating abdominal trauma aims to identify patients that requires surgical treatment. Objective: The objective of this study was to compare white blood cells levels in patients with penetrating abdominal trauma isolated and associated with osseous and/or thoracic injury. Patients and methods:  A transversal study comparing two groups of abdominal penetrating trauma patients; penetrating abdominal trauma isolated versus penetrating abdominal trauma associated with osseous and or thoracic injury. We examined the level of white blood cells as a factor associated with major injury. Results: Our study showed a difference in mean of white blood cells count between the two groups that was statistically significant (p=0.01). A positive relationship between penetrating abdominal trauma associated with osseous and or thoracic injury was found. Conclusion: A significant elevation in white blood cells count in penetrating abdominal trauma associated with osseous and or thoracic injury is observed in comparison with penetrating abdominal trauma isolated.

Sign in / Sign up

Export Citation Format

Share Document