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.

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.

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 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 Sternal fractures in children

2021 ◽  
Vol 9 (3) ◽  
pp. 317-325
Author(s):  
Evgeny G. Skryabin ◽  
Sergey V. Naumov ◽  
Pavel B. Zotov ◽  
Mikhail A. Akselrov
Keyword(s):  
Hospital Stay ◽  
Soft Tissues ◽  
Medical Information ◽  
The Body ◽  
Diagnostic Methods ◽  
Long Term Results ◽  
Thoracic Vertebrae ◽  
Average Hospital ◽  
Fractures In Children ◽  
Sternal Fractures

BACKGROUND: Sternal fractures are a rare nosological form of injuries in children. The injuries of the sternum often are accompanied by fractures of the long bones of the skeleton or thoracic vertebrae. Isolated fractures of the sternum in children are rarely diagnosed. The medical information on pediatric sternum injuries is limited by a small number of scientific publications. AIM: Our aim is to study the peculiarities of traumagenesis, clinic, diagnostics, treatment of sternal fractures in children. MATERIALS AND METHODS: Clinical material for the served as experience in providing traumatology assistance to 8 children who received sternal fractures. The average age of the injured children was 11.5 years. 87.5% of the victims were boys. In all patients, sternal fractures had been diagnosed along with other damage to the musculoskeletal system. During the survey, traditional diagnostic methods for emergency traumatology were used. RESULTS: The leading mechanism of injury, i.e., falling from a height of 2 meters and more were found in 62.5% of victims. In all clinical observations, fractures were localized at the level of the body of the sternum. All the children, besides sternal fractures, had uncomplicated fractures of the vertebral bodies. A total of 30 bodies of the vertebrae were compressed. Most often (in 16.75% of cases), the ThV vertebra was compressed. The reliable symptoms of sternal fractures in patients were difficult and painful breathing, local swelling of soft tissues, soreness of the sternum during palpation, and amplification of the pain in the fracture area during pressure applied on half of the chest. Compliance with the strict bed mode on the roller-reclinator under the area of the compreated vertebrae and the exclusion of the axial load on the spine was a favorable fact sufficient and led to pain disappearance in 37 days. In all cases, the sternum fractures did not require any surgery. Fractures of the bodies of the vertebrae in 7 children were also treated conservatively. The Corsets Orlett was used for immobilization, ensuring a reliable degree of fixation. The average hospital stay amounted to 16. The duration of the hospital stay was influenced by the accompanying bone-articular damage to the skeleton. The evaluation of the long-term results was performed in 4 children. The results were interpreted as good. CONCLUSIONS: When applying for emergency traumatology assistance to children with chest injury and spine, it is necessary to purposefully explore the state of the sternum.

scholarly journals Primitive Isolated Hydatid Cyst of the Spleen: Total Splenectomy Versus Spleen Saving Surgical Modalities

2020 ◽  
Author(s):  
Atef Mejri ◽  
khaoula Arfaoui ◽  
Mohamed Firas Ayadi ◽  
Badreddine Aloui ◽  
Jasser Yaakoubi
Keyword(s):  
Hydatid Cyst ◽  
Hospital Stay ◽  
Surgical Techniques ◽  
Case Series ◽  
Surgical Approaches ◽  
Average Hospital ◽  
Spleen Preserving ◽  
Operative Complications ◽  
Total Splenectomy ◽  
Post Operative Complications

Abstract BackgroundThis study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease.MethodsThis is a descriptive retrospective study carried out over a period of 7 years extended from January 2013 until December 2019 reporting eight cases of isolated primitive splenic localization of hydatid disease. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy.ResultsThe discovery of the pathology was incidental in 50% of cases, while pain in the left upper quadrant of the abdomen and renitent mass in the same quadrant revealed the pathology only in 25% and 12,5% respectively . None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay ( 9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. ConclusionsThe current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures, as the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

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.

scholarly journals Diagnostic aspects of closed abdominal injuries

2016 ◽  
Vol 97 (6) ◽  
pp. 892-897
Author(s):  
I S Malkov ◽  
V A Filippov ◽  
V N Korobkov ◽  
Kh M Khalilov ◽  
M R Tagirov ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Diagnostic Algorithm ◽  
Diagnostic Value ◽  
Diagnostic Techniques ◽  
Diagnostic Methods ◽  
Abdominal Injury ◽  
Abdominal Injuries ◽  
Surgical Department ◽  
Abdominal Organs ◽  
Radiologic Study

Aim. To study diagnostic value of various diagnostic methods for patients with closed abdominal injury, to develop a diagnostic algorithm to make a reasonable conclusion about the amount and severity of injuries of the abdomen.Methods. Various diagnostic methods used in closed abdominal injuries from 120 patients admitted to Surgical Department №2 of Kazan city clinical hospital №7 from 2007 to 2015 were analyzed. Majority of victims (65%) with closed abdominal trauma were males aged 20 to 50 years.Results. Efficiency of diagnostic program for patients with closed abdominal injury used in clinical practice was studied. In a closed abdominal trauma, injury of abdominal organs was detected in 52.5% of patients. 71.4% of those injuries were isolated and 28.6% were concomitant. According to frequency of injuries liver took the first place 15 (23.8%), followed by spleen on the second place (14; 22.2%) and kidneys (12; 19.1%) and intestine (12; 19.1%) on the third, bladder on the fourth (7; 11.1%), and pancreas on the fifth place (3; 4.8%). Importance of radiological methods and laparoscopy was demonstrated. Clinical examination and laboratory diagnostic techniques allow making a timely diagnosis in only 40% of victims. Informativity of radiologic study was 64%. The accuracy of ultrasound in damaged kidneys was 100%, that in rupture of liver was 72%, of spleen, 69%, and of the intestine (0%). Diagnostic accuracy of laparoscopy was 98.9%.Conclusion. Experience and extensive acquaintance with modern literature allowed the authors to present the algorithm of examination of patients with suspected closed abdominal trauma.

Diagnostic performance of CT and the use of GI contrast material for detection of hollow viscus injury after penetrating abdominal trauma. Experience from a level 1 Nordic trauma center

2020 ◽  
Vol 61 (10) ◽  
pp. 1309-1315
Author(s):  
Sigurveig Thorisdottir ◽  
Gudrun L Oladottir ◽  
Mari T Nummela ◽  
Seppo K Koskinen
Keyword(s):  
Abdominal Trauma ◽  
Contrast Material ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Hollow Viscus ◽  
Penetrating Abdominal Trauma ◽  
Stab Wounds ◽  
Significant Difference ◽  
Hollow Viscus Injury ◽  
Local Trauma

Background Use of gastrointestinal (GI) contrast material for computed tomography (CT) diagnosis of hollow viscus injury (HVI) after penetrating abdominal trauma is still controversial. Purpose To assess the sensitivity of CT and GI contrast material use in detecting HVI after penetrating abdominal trauma. Material and Methods Retrospective analysis (2013–2016) of patients with penetrating abdominal trauma. Data from the local trauma registry, medical records, and imaging from PACS were reviewed. CT and surgical findings were compared. Results Of 636 patients with penetrating trauma, 177 (163 men, 14 women) had abdominal trauma (mean age 34 years, age range 16–88 years): 155/177 (85%) were imaged with CT on arrival; 128/155 (83%) were stab wounds and 21/155 (14%) were gunshot wounds; 47/155 (30%) had emergent surgery after CT. Two patients were imaged using oral, rectal and i.v. contrast; 23 with rectal and i.v. contrast; and 22 with i.v. contrast only. Surgery revealed HVI in 26 patients. CT had an overall sensitivity 69.2%, specificity 90.5%, PPV 90.0%, and NPV 70.4%. CT with oral and/or rectal contrast (n = 25) had sensitivity 66.7%, specificity 71.4%, PPV 85.7%, and NPV 45.5%. CT with i.v. contrast only (n = 22) had 75% sensitivity, 100% specificity, PPV 100%, and NPV 87.5%. No statistically significant difference was found between sensitivity of CT with GI contrast material and i.v. contrast only ( P = 1). Conclusion Stab wounds were the most common cause of penetrating abdominal trauma. CT had 69.2% sensitivity and 90.5% specificity in detecting HVI. CT with GI contrast had similar sensitivity as CT with i.v. contrast only.

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