PubMed · 11639989
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M Thiery. 1994. [Not Available].. https://pubmed.ncbi.nlm.nih.gov/11639989/
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BACKGROUND: The purpose of this study was to determine whether laparoscopy could improve our ability to diagnose and treat perforations of the small bowel. METHODS: From 1985 to 2001, among 250 patients admitted for a blunt abdominal trauma, 195 surgical explorations were performed, comprising 42 laparoscopies. On admission, 108 patients underwent an abdominal ultrasonography (US) and 104 a computed tomography (CT). Thirty-nine patients had a blunt small bowel trauma (BSBT) that was explored and/or treated by laparoscopy (n = 15) or celiotomy (n = 24). We compared the patients who underwent emergency surgery (23) and those who were operated on after a mean delay of 51 h. RESULTS: On admission, for detecting free intraperitoneal fluid with a BSBT, the sensitivity of CT was 93.3% and specificity was 13.6%. Regarding the 23 patients who underwent emergency surgery, 8/20 had positive US and 10/15 had positive CT, whereas the 15 celiotomies and 8 laparoscopies indicated BSBT. Regarding the 16 patients who underwent delayed surgery, 9 patients underwent a celiotomy and 7 a laparoscopy; all BSBTs were diagnosed. In searching for BSBT, the sensitivity and specificity of laparoscopy were both 100%, whereas the sensitivity of CT was 83.3% and specificity was 22.2%. Twenty of 23 patients undergoing emergency surgery had bowel suture repair compared to 3/16 after delayed surgery. In contrast, a resection was necessary in 10/12 patients treated after a delay compared to 2/17 operated in emergency. Five BSBTs were sutured by laparoscopy, whereas 10 required conversion. Laparoscopy avoided celiotomy in 15 cases. There were no deaths and no enterostomy. CONCLUSION: In hemodynamically stable patients with blunt abdominal trauma, laparoscopy safely and effectively identifies small bowel injuries. Early recognition of these injuries and timely surgical treatment offer the best prognosis.
BACKGROUND: Self-inflicted abdominal stab wounds (ASWs) are uncommon. The present study aims to characterize the clinical profile of this unique group of psychiatric-surgical patients. METHODS: A retrospective review of 23 patients with intentional self-inflicted ASWs at two urban level I trauma centres during a 10-year period. RESULTS: Most patients were males (70%), ages ranging from 21 to 82 years (mean 40 years). Seventy-four percent of patients had a previous psychiatric history and prior suicide attempts were common (41%). Half of the patients had a positive admission drug or alcohol screen. Hypotension (systolic blood pressure (SBP) < 90 mmHg) was present in only two patients. Mean injury severity, revised trauma and Glasgow coma scores were 5.8, 7.7 and 14.5, respectively. The most commonly used instrument was a knife (87%). There were 1.5 external wounds per patient located primarily in the right upper quadrant (40%) and right lower quadrant (23%). These were associated with extra-abdominal wounds in 22% of cases. Local wound exploration was positive in 15 patients (65%), who all underwent laparotomy. Injured intra-abdominal or retroperitoneal organs were identified in 10 patients and included the stomach, duodenum, small bowel, colon, mesentery, inferior vena cava (IVC) and psoas muscle with a mean of 1.7 injuries per patient. Wound infection was the only post-operative complication (two patients). All eight patients with a negative local wound exploration were observed without complication. Seventy percent of patients were ultimately transferred to a psychiatric ward with a mean length of stay on the surgical service of 8 days. Only one patient died during admission due to metastatic malignant disease. CONCLUSION: Self-inflicted ASWs in suicidal patients can induce significant although most likely non-lethal abdominal and retroperitoneal injuries. This observation should guide the trauma surgeon when treating such patients.
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