PubMed · 8467755
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R M Seufert. 1993-04-08. [Post-traumatic splenectomy].. https://pubmed.ncbi.nlm.nih.gov/8467755/
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BACKGROUND: The pathogenesis of reduced postoperative ileus (POI) in laparoscopic gastrointestinal (GI) surgery still remains controversial. The aim of this study was to investigate the effect of surgical incision on postoperative ileus. METHODS: The effects of length, depth, and site of the incision on GI transit were compared using the geometric center of 51Cr in rats. The inhibitory mechanism of abdominal incision on GI transit also was studied. RESULTS: The findings showed that 5 cm of abdominal skin and the 5-cm back muscle incision had no significant effect on GI transit. However, the 5-cm abdominal muscle-fascia incision and a 5-cm laparotomy significantly delayed GI transit. Gastrointestinal transit after a 5-cm laparotomy was significantly delayed, as compared with that of a 1-cm laparotomy regardless whether intestinal manipulation was performed or not. Guanethidine and yohimbine, but not propranolol, significantly improved the impaired GI transit after a 5-cm laparotomy. CONCLUSIONS: The results suggest that the longer and deeper abdominal incision more profoundly inhibits GI transit. The inhibitory effect of abdominal incision is mediated via the activation of the somatosympathetic reflex and alpha-2 adrenoceptors.
Traumatic abdominal wall hernia, a rare cause of hernia, has a confusing clinical picture and requires a high index of suspicion for prompt diagnosis and management. Such hernias, if missed, can result in high morbidity and may prove fatal. Distinction from a pre-existing hernia is important as well. We report our experience in two such cases, which had presented in a span of 9 months, and submit a brief analysis of 50 reviewed cases.
BACKGROUND: We sought to determine torso injury rates and sensitivities associated with fluid-positive abdominal ultrasound, metabolic acidosis (increased base deficit and lactate), and impaired pulmonary physiology (decreased spirometric volume and PaO2/FiO2). METHODS: Level I trauma center prospective pilot and post-pilot study (2000-2001) of stable patients. Increased base deficit was < 0.0 in ethanol-negative and < or = -3.0 in ethanol-positive patients. Increased lactate was > 2.5 mmol/L in ethanol-negative and > or = 3.0 mmol/L in ethanol-positive patients. Decreased PaO2/FiO2 was < 350 and decreased spirometric volume was < 1.8 L. RESULTS: Of 215 patients, 66 (30.7%) had a torso injury (abdominal/pelvic injury n = 35 and/or thoracic injury n = 43). Glasgow Coma Scale score was 14.8 +/- 0.5 (13-15). Torso injury rates and sensitivities were: abdominal ultrasound negative and normal base deficit, lactate, PaO2/FiO2, and spirometric volume--0.0% & 0.0%; normal base deficit and normal spirometric volume--4.2% & 4.5%; chest/abdominal soft tissue injury--37.8% & 47.0%; increased lactate--39.7% & 47.0%; increased base deficit--41.3% & 75.8%; increased base deficit and/or decreased spirometric volume--43.8% & 95.5%; decreased PaO2/FiO2--48.9% & 33.3%; positive abdominal ultrasound--62.5% & 7.6%; decreased spirometric volume--73.4% & 71.2%; increased base deficit and decreased spirometric volume--82.9% & 51.5%. CONCLUSIONS: Trauma patients with normal base deficit and spirometric volume are unlikely to have a torso injury. Patients with increased base deficit or lactate, decreased spirometric volume, decreased PaO2/FiO2, or positive FAST have substantial risk for torso injury. Increased base deficit and/or decreased spirometric volume are highly sensitive for torso injury. Base deficit and spirometric volume values are readily available and increase or decrease the suspicion for torso injury.