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PubMed2001

[Indications for emergency surgery in thoraco-abdominal injuries].

PURPOSE OF THE STUDY: Under the conditions of an increasing number of car accidents and criminal injuries the thoracis and abdominal trauma is a source of a significant morbidity and mortality in blunt and penetrating mechanism of injury. On the basis of a group of patients operated on for blunt and penetrating injury of the chest and abdomen evaluation was made of the current indication and results of lifesaving surgery in case of these injuries. PATIENTS: The group included 68 patients requiring a lifesaving surgery for a blunt and penetrating injury of the chest and abdomen hospitalized between the beginning of 1966 and the end of April 2001. Forty-five patients sustained a blunt injury and 23 a penetrating injury. METHODS: In case of blunt injuries the indication for surgery was determined on the basis of clinical examination supplemented with a radiograph examination of the chest and spiral computer tomography. In case of penetrating stab wounds the surgery was indicated on the basis of clinical examination, in gunshot wounds by means of x-ray examination and spiral computer tomography performed in order to assess the scope of the injury of intraabdominal organs and the location of the projectile. Indicated on the basis of the examination in the blunt injury was thoracotomy in 6 cases, laporatomy in 34 cases and the combination of thoracotomy and laparotomy in 5 patients. In case of the penetrating injury thoracotomy was performed in 8 cases, laparotomy in 11 cases and the combination of thoracotomy and laparotomy in 4 patients. RESULTS: In the post-operative period 6 patients (9%) died: 3 patients with a polytrauma died from an irreversible damage caused by a protracted hemorrghagic shock, one female patient from the contusion of brain, one patient after splenectomy for an isolated injury died from cardiorespiratory failure and pneumonia, one patient with a stab wound of the left ventricle of the heart died from the heart failure by hypoxy. DISCUSSION: Indication for a lifesaving thoracotomy and laparotomy in our group of patients operated on corresponds to the overviews of surgeries in thoracoabdominal injuries presented in literature. The procedure in preoperative examination is identically limited by the stability of hemodynamics in the patient after the injury using mainly ultrasound and computer tomography of the stabilized patient. In contrast to a number of authors in our conditions we have not performed some of the intervention examinations such as diagnostic peritoneal lavage or thoracoscopy and laparoscopy. The improvement of results in patients operated on for thoracoabdominal injury is in our conditions given both by the timeliness of the operation in the availability of examination methods (US, spiral CT) and by adequate stabilization of the patient in the peroperative period at the emergency department. CONCLUSION: Priority indication for a lifesaving surgery in thoracoabdominal injuries is significant intraabdominal bleeding diagnosed on the basis of the result of the clinical examination in hemodynamically unstable patients. In a stabilized patient the lifesaving surgery is performed on the basis of the result of visualization methods (spiral computer tomography, ultrasound, angiography, endoscopy) revealing apart from significant bleeding also severe injuries of intrathoracic and intraabdominal organs. Protracted hypovolemic shock with the development of multi-organ failure or the occurrence of simultaneous severe associated injuries in polytrauma are the most frequent causes of mortality in patients operated on for thoracoabdominal injury.

Abdominal Injuries↗
PubMed1984

Abdominal injuries in children.

The problem of abdominal trauma in children is briefly reviewed to show how the etiology, diagnosis and treatment differ from those in adults. Although in many ways management is the same in both groups, certain problems more commonly affect children, and the approach to diagnosis and treatment must be adapted to their needs. The importance of frequent clinical assessment and the rather limited role of peritoneal lavage in children with abdominal trauma are stressed. Experience with splenic injuries in 63 patients treated between 1974 and 1979 is reviewed to provide guidelines for conservative management to assist surgeons who seldom treat children. Since splenectomy in pediatric patients carries a risk of overwhelming infection, distinguishing those whose spleens can be salvaged is extremely important.

Abdominal Injuries↗
PubMed1983

Changing trends with abdominal injury in seatbelt wearers.

Seatbelts were incorporated as standard equipment for automobiles constructed in North America in 1964. The first seatbelt law was made mandatory in Canada as of 1 January 1971. Between January 1976 and January 1980 38 patients involved in automobile accidents while wearing passive restraints were treated at l'Hôpital du Sacré-Coeur: 32 of these 38 patients had signs and symptoms of abdominal injury. These patients wearing passive restraints had an unusually high incidence of gastrointestinal injury in comparison to previously reported patients not wearing restraints. Twenty-seven of the 32 patients had injury to the bowel or the bowel mesentery. This different spectrum of injuries is most likely related to the altered physics of rapid deceleration caused by restraint with the lap belt and shoulder harness.

Abdominal Injuries↗
PubMed1989

Abdominal injuries associated with the use of seatbelts.

The mandatory use of seatbelts has become commonplace in Canada, and such legislation was adopted by the province of British Columbia in 1977. This has provided us with an opportunity to study the effects of seatbelt restraints on accident victims, particularly concerning abdominal injuries. Five hundred sixty-two patient charts were reviewed during a 3-year period. Documented use of seatbelts was found in 126 cases. Thirty-six of these patients underwent laparotomy and form the basis of this study. Compared with previously reported figures for blunt abdominal trauma, there was a high incidence of gastrointestinal injuries (67 percent). In addition, associated lumbar spine injuries were found in a large proportion of patients (19 percent, p less than 0.005). We found an increased risk of spinal injury in patients wearing a lap versus a three-point belt.

Abdominal Injuries↗
PubMed1989

[Diagnosis and treatment of open thoraco-abdominal injuries].

From January 1954 to December 1987, 42 cases with open thoracoabdominal injuries were surgically treated. The causes of trauma were gun shot in 11, stabbing in 28, and buffalo horn injury in 3 cases. 24 cases were complicated with shock and 29 cases had more than two thoracoabdominal organs injured. 3 patients died postoperatively, an operative mortality rate of 7.1%. The authors discussed the problems of nomenclature, diagnosis and treatment and emphasized that: (1) open wound with thoracic and abdominal cavities and diaphragm involved simultaneously should be called open thoraco-abdominal injury; (2) surgical treatment is often delayed if diagnosis depends solely on X-ray examination; (3) operative approach should be carefully selected according to circumstances.

Abdominal Injuries↗
PubMed1986

Ultrasound in abdominal injury in children.

Ultrasonography has been used as an investigation in children with abdominal signs after blunt injury. Sixteen children were examined, of whom nine had abnormal findings. Free intraperitoneal fluid was demonstrated in four cases. The injuries found are detailed and subsequent management of the patients is described. The children with normal scans settled with no sequelae. It is suggested that ultrasonography offers a valuable, non-invasive method of investigating blunt abdominal injury.

Abdominal Injuries↗