Surgical management of abdominal trauma howard b seim iii, dvm, dacvs colorado state university if you would like a copy of the illustrated version of these notes on cd and a video of this surgical procedure on dvd, go to. The objective of this study was to assess the sensitivity and specificity of fast for detecting free peritoneal fluid in children. A combined trauma model of chest and abdominal trauma with. Blunt abdominal trauma bat is frequently encountered in the form of motor vehicle crashes mvcs 75%, followed by falls and direct abdominal impact. Evaluation and management of blunt abdominal trauma. Abdominal trauma is responsible for about 10% of all deaths related to trama. Introduction abdominal trauma is regularly encountered in the emergency department one of the leading cause of death and disability identification of serious intraabdominal injuries is often challenging many injuries may. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the current east guideline. Risk factors for mortality in blunt abdominal trauma with surgical. Penetrating trauma most commonly includes growing uterus and the fetus which act as a shield for maternal intra abdominal organs. To determine the diagnostic accuracy of focused assessment sonography for trauma fast and repeated fast in the patients with blunt abdominal trauma. There are a wide variety of complex structures in each of these areas each with their own unique problems when injured. Selective nonoperative management of blunt splenic injury.
Common abdominal organ injuries involve the liver, spleen, kidneys, intestines and vasculature. Pdf laparotomy for blunt abdominal trauma in a civilian trauma. Sep 15, 2018 abdominal trauma is one of the most complex scenarios in emergency abdominal surgery during pregnancy. Blunt abdominal trauma the royal melbourne hospital. A pictorial essay med j malaysia vol 67 no 4 august 2012 447 fig. Ct scan demonstrated gross bowel defect confirmed by emergency laparotomy figure 1. Find, read and cite all the research you need on researchgate. Diagnosis and management of blunt abdominal trauma. Penetrating abdominal trauma pat has the potential to be a devastating injury and ranks in the top 15 causes of death for all ages. The abdomen can be injured in many types of trauma.
The management of the abdominal shotgun wounds is mainly dependent on clinical examination and clinical judgment, while requires advanced surgical skills. Penetrating abdominal trauma, prophylactic antibiotic use in 2012 penetrating abdominal trauma, selective nonoperative management of 2010 penetrating combined arterial and skeletal extremity trauma, management of 2002. Di saverio s, moore ee, tugnoli g et al 2012 non operative manage ment of liver and. Dpl or ultrasound evisceration open pelvic fracture anterior stab wound 4 gunshot wound ultrasound or ct ultrasound or dpl 2. Overview of abdominal trauma msd manual professional edition. Abdominal trauma may involve penetrating or blunt injuries. A 53yearold woman driver presented to the emergency department following a road traffic collision. Ct scan is the most widely used investigation in blunt abdominal trauma. North american journal of medical sciences march 2012 volume 4 issue. Journal of trauma and acute care surgery, 773, 427432. There was an 80% increase in the incidence of blunt abdominal trauma when compared with the preceding 15year experience. The management of blunt abdominal trauma bat is challenging. Abdominal trauma society for academic emergency medicine.
Pediatric emergency medicine simulation curriculum. Focused abdominal sonography ultrasound for trauma fast. Abdominal injuries are found in 2030% of patients with multiorgan injuries. This study aimed to determine the relationships among the causes, characteristics, patterns and outcomes of abdominal injury patients undergoing operations at kilimanjaro christian medical centre. The signs and symptoms may include abdominal pain, tenderness, rigidity.
At the royal melbourne hospital in 2016, bat accounted for 15% of all major at the royal melbourne hospital in 2016, bat accounted for 15% of all major trauma cases, of these 30% required a laparotomy and 18% required angioembolisation 2. Pdf abdominal trauma is a major public health problem for all. The combined traumatic insult led to severe signs of hemorrhagic shock and impaired pulmonary function. Computed tomography ct of bowel and mesenteric injury. Equivocal abdominal exam ongoing blood loss hematuria prolonged operation for other injuries immediate operation peritonitis on exam hypotension with. Early management of severe abdominal trauma sciencedirect. The majority of bat cases 75 percent are related to motor vehicle collision mvc or auto versus pedestrian accidents 2. Abdominal trauma can be lifethreatening because abdominal organs, especially those in the retroperitoneal space, can bleed profusely, and the space can hold a great deal of blood.
Contemporary characteristics of blunt abdominal trauma in a. Nem todo trauma do abdome, seja ele penetrante ou fechado, leva a lesoes internas. The approach to penetrating abdominal trauma 20120701. Role of elevated liver transaminase levels in the diagnosis. Ultrasound is regarded as the investigation of choice for early diagnostic investigations in patients with suspected blunt abdominal trauma. By cynthia blankreid, rn, cen, msn often involving multiple injuries, abdominal trauma can lead to hemorrhage, hypovolemic shock, and death. Various factors, including blunt trauma can lead to increased abdominal pressure or intraabdominal hypertension which is defined as sustained pressures over 12 mmhg lee, 2012. Lectures and a lunch will be monthly 3 rd wed each month at. Computed tomography ct of bowel and mesenteric injury in blunt abdominal trauma. Based on ct grading conservative treatment with monitoring of. Jul 20, 2012 introduction trauma is the commonest cause of death in young people. In abdominal trauma spleen, liver and kidney injuries are most common.
Critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma january 2011 scope of application this guideline is intended for physicians working in hospitalbased emergency departments. Abdominal compartment syndrome hypercalcemia systemic vasodilation e. Emergency ultrasoundbased algorithms for diagnosing blunt abdominal trauma. Solid organs such as the spleen, liver, and kidneys are more commonly involved and associated with lower rib fractures. Abdominal trauma stands third next to head injury and chest injury 25% of all major trauma victims require abdominal exploration. Incidence, patterns, and factors predicting mortality of abdominal. Stab wounds cause approximately 25% of penetrating abdominal trauma, and approximately 35% of abdominal trauma injuries occur as the result of gunshot wounds 6. A, textbook of adult emergency medicine, 3rd edition pp.
Trauma surgery volume thoracic and abdominal trauma. Free fluid collection in perihepatic, perisplenic and paracolic gutters arrows in. The target audience is all those involved in the acute care of trauma and surgical patients. Patients with open or penetrating abdominal trauma are usually subjected to exploratory laparotomy, however, in selected cases, many surgeons decide not to operate and keep their patients under observation since this expectant. Dealing with the damage hidden in the abdomen, lifethreatening injuries can elude detection. Blunt abdominal trauma bat accounts for the majority 80 percent of abdominal injuries seen in the emergency department, and is responsible for substantial morbidity and mortality. General classification on blunt and penetrating trauma helps in the diagnostic pathway and therapeutic management. Evaluation and management blunt abdominal injury washington.
The test group comprised twentyseven patients with surgically important bbmi whose diagnoses were confirmed after surgical intervention 23 men and 4 women. Fast is the investigation of choice in haemodynamically unstable patients. Pdf this report looks at the group of patients who required a laparotomy for blunt torso trauma at a busy metropolitan trauma. Shoulder tip pain kehrs sign significant abdominal injuries may present with little external evidence of trauma or a trivial pattern of injury and or mechanism. Solid abdominal organs, such as the liver and kidneys, bleed profusely when cut or torn, as do major blood vessels such as the aorta and vena cava. Abdominal evaluation is the challenging component of evaluating trauma. Penetrating injuries often result in injury to hollow organs, such as the intestines. Abdominal injury surgeries are common in tanzania and in many parts of the world. Evaluation of gastrointestinal injury in blunt abdominal trauma fast is not reliable. The nature and severity of abdominal injuries vary widely depending on the mechanism and forces involved, thus generalizations about mortality and need for operative repair tend to be misleading. Find out how to evaluate your patients condition and prevent further harm.
Selective nonoperative management of abdominal injuries in. When a pediatric patient presents to the ed following blunt abdominal trauma, the abdominal examination may be unreliable due to the childs age or developmental level, or due to an associated head injury. Children are more susceptible than adults to serious injury secondary to blunt abdominal trauma. We report a case of a 45 years old male suffering abdominal shotgun trauma, who survived his injuries. Pdf on sep 20, 2017, alabousi a and others published blunt abdominal trauma. Being one of the referral hospitals, for trauma, we received a total figure of 6149 trauma victims out of which 500 were purely of abdominal in nature managed by the department of surgery. When evaluating a patient for abdominal trauma, it is necessary to think of the abdomen as three separate areas, which consist of the peritoneal cavity, pelvis, and the retro peritoneum.
Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. Massive haemoperitoneum from bowel and mesenteric injuries. Lal ms associate professor department of surgery esi pgimsr new delhi 2. Identifying children at very low risk of clinically important. Isolated blunt abdominal trauma bat represents about 5% of annual trauma mortality from blunt trauma. Focused abdominal sonography for trauma in the clinical. It has previously been reported that up to 10% of all abdominal injuries result from sportsrelated trauma, although this number may even be higher today as the number of participants has increased and minor injuries may go unreported. In pediatric care, the role of focused abdominal sonography in trauma fast remains ill defined. Abdominal trauma is seen quite often in the emergency department and can result from blunt or penetrating mechanisms. Blunt abdominal trauma occurs in 1015% of injured children, with two typical patterns. Penetrating injuries include gunshot and shrapnel injuries, impalements, and knifings. Figure 1 coronal a and axial b abdominal ct shows a long segment of abnormal, thickwalled enhancing jejunum.
In order to minimize the mortality in cases of abdominal trauma, risk factors for mortality must be identified and systematically studied. The abdomen is one of the most commonly injured regions in trauma patients. She was haemodynamically stable, and on abdominal examination she had nonspecific tenderness. Pdf incidence, patterns, and factors predicting mortality of. Blunt abdominal trauma bat is a common injury in recent trauma series. Starting january 18, 2012, a year long lecture series on current topics in trauma acute care surgery will begin. Common causes of abdominal injury include blunt trauma motor vehicle accidents mvas and falls, and penetrating trauma gunshot wounds gsws and stabbings. Patterns and outcomes of patients with abdominal trauma on. Maingots abdominal operations, 12th edition, 2012, 28. Degloving bowel injury following blunt abdominal trauma.
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