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PubMed1987

Abdominal injuries sustained in severe traffic accidents by seatbelt wearers.

In Finland during the period 1972-1983, there were 3,564 severe traffic accidents involving one or more victims dying within 30 days of the accident. Forty-two of the victims had been wearing a seatbelt and had an abdominal trauma as the main cause of death or as first diagnosis of injury. Small intestine and colon injuries were more common in the severely injured victims than was the case with the fatally injured ones and in these accidents the injury mechanism was always deceleration or contusion, which was in most cases caused by the seatbelt. Liver injuries seem to be the major abdominal cause of fatality, and in the fatally injured group, half of the victims sustained the fatal abdominal injury through gross crushing impact. When the direction of the impact was analyzed, all the victims seated on the receiving side of the vehicle in lateral impact collisions sustained an abdominal injury with fatal outcome. It seems that the seatbelt is less effective in protecting wearers from severe or fatal abdominal injuries in lateral impact collisions.

Abdominal Injuries↗
PubMed1986

[Epidemiology and monitoring of closed abdominal injuries].

The authors review the epidemiological and aetiopathogenetic characteristics of abdominal blunt injuries (118 cases) monitored in a homogeneous manner. The relatively young age of the patients, the diagnostic difficulties encountered and the frequent presence of associated lesions call for the rigorous application of a predetermined clinico-diagnostic protocol.

Abdominal Injuries↗
PubMed2002

Is delayed laparotomy for blunt abdominal trauma a valid quality improvement measure in the era of nonoperative management of abdominal injuries?

BACKGROUND: Review of hemodynamically stable patients who undergo laparotomy for trauma greater than 4 hours after admission is an American College of Surgeons quality improvement filter. We reviewed our recent experience with patients who underwent laparotomy for trauma greater than 4 hours after admission to evaluate the reasons for delay, and to determine whether they were because of failure of nonoperative management or other causes. METHODS: The registry at our Level I trauma center was searched from January 1998 through December 2000 for patients who required a laparotomy for trauma greater than 4 hours after admission. Of 3,369 admitted blunt trauma patients, 90 (2.7%) underwent laparotomy for trauma, of which 26 (29%) were identified as delayed laparotomies greater than 4 hours after admission. RESULTS: The most common mechanism of injury was motor vehicle crash, the mean Injury Severity Score was 18, and 65% of the patients had significant distracting injuries. Five patients had laparotomy greater than 24 hours after admission. The average time to the operating room in the remaining patients was 8.6 hours. Clinical examination (61%) findings were the most common indication for operation. Gastrointestinal (GI) tract injury was the most common injury associated with delay in laparotomy (58%). CONCLUSION: GI tract injuries are the predominant injury leading to delayed laparotomy for blunt trauma (58%). Failed nonoperative management of solid organ injuries occurred less frequently (15%). Future efforts should concentrate on earlier identification of GI tract injury. Delayed laparotomy for blunt abdominal trauma is a valid quality improvement measure.

Abdominal Injuries↗
PubMed1985

[Relaparotomy in abdominal injuries].

Relaparotomies in the postoperative period were performed in 56 out of 529 patients (10,6%) operated upon for injuries of organs of the abdominal cavity. Twenty-two of them died. In most cases relaparotomies were caused by peritonitis, intraabdominal bleedings and abscesses.

Abdominal Injuries↗
PubMed1993

Abdominal injuries in children at Muhimbili Medical Centre Dar es Salaam.

Fifty two consecutive children with abdominal trauma who were admitted and managed at the Paediatric Surgical Unit (PSU) of Muhimbili Medical Centre (MMC) between January 1987 and December 1990 were studied. There were 35 boys and 17 girls with ages ranging from 1 year to 11 years. Most of the children came from the mostly populated areas of Dar es Salaam. The commonest causes of injury were traffic accidents (57.7%), followed by falls (32.7%). All patients due to traffic motor accidents were pedestrians except two. Forty (77%) patients had blunt abdominal injuries while 12 (23%) patients had penetrating abdominal injuries. Of these patients with peritoneal penetration only two had significant vascular injury. All patients presented with specific signs of abdominal trauma. The commonest specific organ injured was the spleen followed by the liver. The mortality was 7.6%. Associated injuries were noted in 32.6% of the cases.

Abdominal Injuries↗
PubMed1975

[Emergency surgery in district hospital: massive hemorrhage after blunt abdominal injury].

In the management and prognosis of severe accident cases there are a number of conditions that occur before hospitalization which cannot be influenced, these are: no immediate medical care by a physician, delay in sending the patient to hospital, long journey time and alcoholic damage to the liver and CNS. Often, therefore, laparotomy for massive haemorrhage after abdominal injuries has to be done on a severely shocked patient with a "zero" BP. Diagnostic criteria in the evaluation of such cases are: the clinical picture, shock index, paracentesis (trial abdominal drainage) with additional laparoscopic examination and IVP. In a series of 45 laparotomies there were 25 single organ injuries; 19 multiple organ injuries and 1 negative laparotomy due to misinterpretation of the trial drainage. 22 splenectomies demonstrate the type of injury occurring in a country area. The good results of treatment despite the difficulties mentioned can, to some degree, be attributed to the technical improvement in vascular clips for large vessels. The Tantalum vascular clip offers the advantage of simple application, sure positioning and immediate arrest of haemorrhage thus reducing the shock phase; additional effects are the permanent indication of the bleeding site, the marking of anastomoses and resections and there being no foreign body reaction (pure Tantalum).

Abdominal Injuries↗
PubMed2003

Evisceration through multiple abdominal wall defects following blunt abdominal injury.

We report an unusual case of a posttraumatic evisceration of small and large bowel through 2 holes in the anterior abdominal wall after a motor vehicle accident. Prompt adequate management consists of reestablishing the perfusion of the eviscerated organ if the blood supply is compromised, performing a full laparotomy to exclude intra-abdominal organ injury and meticulous cleaning of the eviscerated organs before reducing them in the abdomen and closing the abdomen in layers.

Abdominal Injuries↗
PubMed2001

Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision.

PURPOSE: The goal of the current study was to evaluate the risk of intraabdominal injury in children who sustained spinal fractures in a motor vehicle collision (MVC). METHODS: Between 1980 and 1999, 48 patients, 24 girls and 24 boys, with a mean age of 12.8 years (range, 4 to 17) were reviewed. Twenty-nine were rear seat passengers, 12 front seat, and 7 unknown. Fifty-eight percent wore a seat belt. Thirty fractures involved the lumbar spine, 12 the thoracic, and 6 combined. Computed tomography (CT) scan, abdominal ultrasound, and peritoneal lavage were used to screen for abdominal injuries. RESULTS: Twenty-two of 48 patients had an intraabdominal injury. Eighteen (38%) required an early (<24 hours; n = 12) or delayed (n = 6) therapeutic laparotomy. Fourteen patients were rear seat passengers, 15 wore a seat belt, and 13 had an abdominal wall ecchymoses (AWE). They were 17 lumbar fractures (13 Chance) and one thoracic. The most common findings at laparotomy were hollow viscus injury (n = 12), mesenteric tear (n = 9), and solid organ injury (n = 8). Seventy-two percent of patients presenting with a lumbar fracture and AWE needed a therapeutic laparotomy. The overall survival rate was 98% with only 1 death. The mean hospital stay was 22.4 days. In this study, 38% of patients presenting with a spinal fracture required laparotomy, 68% of whom had simultaneous lumbar fracture and AWE. CONCLUSION: In light of these results, the authors propose that laparoscopy or laparotomy should be strongly considered in patients sustaining lumbar fracture and AWE after MVC. J Pediatr Surg 36:760-762.

Abdominal Injuries↗
PubMed1990

[Qualitative and quantitative puncture examination of lateral canals of the abdominal cavity in closed abdominal injury].

The diagnostic puncture of lateral canals of the abdominal cavity in patients with closed trauma of the abdomen was made in 312 patients with associated trauma. Negative results were obtained in 166 patients. Retroperitoneal hematomas were diagnosed in 66 patients, reliable in 98.5%. In 80 patients injuries of the abdominal organs were diagnosed. The volume of intraabdominal blood loss (accurate within 80.7%) was determined before operation in 31 of them with the help of puncture with +/- 200 ml error. The diagnostic significance of lateral canals was 99.7%. Complications were the involvement of the liver in 4 patients not requiring any curative measures.

Abdominal Injuries↗
PubMed2003

The incidence of recreational genitourinary and abdominal injuries in the Western New York pediatric population.

PURPOSE: We estimate the incidence of recreation related pediatric abdominal, testis and kidney injuries. MATERIALS AND METHODS: Trauma registry data at the regional pediatric trauma center for 1993 to 2000 were analyzed for recreational injuries. The data were divided into the 3 age groups of 5 to 11, 12 to 14 and 15 to 18 years. The recreation, and site and severity of injury were cross referenced. Injury incidence was calculated using United States census data. RESULTS: Of 4,921 children 34 boys and 2 girls (0.73%) had a genitourinary or abdominal injury due to recreation. Kidney injuries were the most common (44.4%), followed by spleen (36.1%) and liver (19.5%). No testicle injuries were reported. Skiing was the most common cause of injury (22.2%). Hockey, football, snowboarding, sledding and bicycling accounted for 83% of all injuries. There were no injuries related to basketball and soccer. The 12 to 14-year-old group had 50% of the injuries. Records were available for 15 kidney injuries, of which 11 were on the left side, 1 was bilateral, 3 required transfusion and 1 required nephrectomy. Injury grades were I in 2 cases, II in 5, III in 4, IV in 3 and V in 1. Kidney and spleen injury incidence due to recreation per year per million children was 6.9 and 5.6, respectively. CONCLUSIONS: Kidney injuries were more common than spleen injuries. Skiing, sledding and snowboarding accounted for more injuries than team sports. Testicle injuries were not seen and are rare. Basketball and soccer caused no injuries. Middle school-age children appear to be at greatest risk.

Abdominal Injuries↗
PubMed1983

[Capacity for activity in penetrating and blunt abdominal injuries].

In the archives of the accident hospitals available, the data of patients who had been hospitalized because of a penetrating or blunt abdominal trauma in the last two years before the surveys were evaluated. Besides the abdominal trauma, at most trivial injuries of other regions were permitted. The data which might give information on how massive the intraabdominal injury was and/or the severity of shock symptoms were taken from the patient record sheets. Afterwards, it was attempted to obtain in an interview details on the external circumstances, the course of the accident event itself and the nature of the reaction to the trauma. Finally, 32 casualties (14 with penetrating and 18 with blunt abdominal injury) were surveyed. Fundamental differences in the behavior of these two subgroups were detected and verified with statistical test techniques. Circumspect behavior after penetrating abdominal trauma was characteristic. Nevertheless, in a few cases there was loss of the ability to act even in limited penetrating injury of the abdominal wall. However, the casualties themselves had the impression of a severe stab injury and this determined the primary reaction to the trauma. A fundamentally different behavior pattern was shown by those who had suffered a blunt abdominal injury. For them, it was typical that they became unable to act immediately or within a few seconds. With regard to the significance of pain, the restriction of motor movements as well as the relation of assumed and clinically verified injury severity is dealt with in respect of the capacity to act in a comparison of the two subgroups.

Abdominal Injuries↗
PubMed1992

[The problem of the closed abdominal injury in polytrauma patients].

The histories of 66 patients with blunt abdominal trauma requiring surgery in the period from 1985 to 1989 were analysed. The patients were divided into three groups on the basis of the other injuries present. Group I, isolated blunt abdominal trauma and blunt abdominal trauma with slight concomitant injuries (18 patients, ISS 17.17 +/- 1.40); group II, blunt abdominal trauma with severe concomitant injuries but without craniocerebral trauma (23 patients, ISS 29.34 +/- 1.45); and group III, blunt abdominal trauma with severe concomitant injuries and an additional craniocerebral trauma (25 patients, ISS 31.08 +/- 1.27, GCS: 10.04 +/- 0.88). Initially, the diagnosis was made in 23 cases by means of diagnostic peritoneal lavage and in 43 cases by means of sonography. The subsequent laparotomy revealed the ultrasound findings to have been false-positive in 3 cases. No false-negative ultrasound findings were demonstrated at all. Peritoneal lavage, on the other hand, was found to have yielded false-negative and false-positive findings in 2 cases each. Counting from the time of admission, the time up to diagnosis of the intra-abdominal injury was 85 +/- 14.3 min in group I, 82 +/- 9.9 min in group II, and 86 +/- 12.9 min in group III. Thus, the presence of severe additional injuries did not lead to any significant delay in the diagnosis of blunt abdominal injury requiring surgery. The total mortality rate was 18.18% (group I, 11.1%; group II, 21.7%; group III, 20.0%). Six patients died in the acute phase and a further six patients during their stay on the intensive care ward.

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