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PubMed2001

Blunt thoraco-abdominal injury.

Recent advances in blunt thoraco-abdominal trauma management include improvements in imaging, particularly in trauma bay ultrasound. Indications for non-operative management have expanded for solid organ and aortic injury. The physiology of abdominal compartment syndrome continues to be defined, with resulting improvements in care.

Journal Article↗
PubMed1975

Penetrating abdominal injuries in children and adolescents.

One hundred thirty-two children and adolescents with penetrating abdominal trauma have been reported. Eighty-two of these patients had intraperitoneal injuries. Five of the injured patients died, and 35 suffered complications. Patterns of organ injuries were found to be similar to a previously studied adult series. Satisfactory results were obtained by simple management of specific injuries. Ninety-five per cent of the injured patients and 80% of uninjured patients could be accurately identified at initial physical examination. Selective observation of penetrating abdominal injuries can be safely employed in children and adolescents.

Abdominal Injuries↗
PubMed1987

A second-look procedure in major blunt abdominal injuries.

A case is presented in which blunt abdominal trauma ultimately caused necrosis of portions of the small bowel in a patient. The bowel, which had been identified at the first operation as viable, was upon re-exploration 24 hours later, found to be necrotic. Consideration for a "second-look procedure" is made in cases of major blunt small bowel injury with systemic compromise.

Abdominal Injuries↗
PubMed1995

Trans-scrotal intra-abdominal injuries: two case reports.

Penetrating injury to the scrotum is uncommon. Usually not serious in itself it may be associated with other more serious conditions. A 15-year-old boy was involved in a tobogganing accident, and a shard of wood penetrated the left scrotum, the anterior abdominal wall and the rectus sheath one-third of the way from umbilicus to xiphisternum. There was also a liver laceration. Removal of the piece of wood and closure of the wounds with drainage resulted in successful recovery. A 45-year-old man, sustained a penetrating straddle-type injury from a broom handle. The handle penetrated Dartos fascia but there was no testicular injury. It also perforated the rectus sheath 6 cm inferior to the costal margin, and both anterior and posterior gastric walls. The tract of the handle extended along the base of the transverse mesocolon and posterior to the pancreas. The perforations were debrided and repaired. The patient received a 5-day course of broad-spectrum antibiotics and recovered fully. As a result of their experience with these two patients the authors recommend that when there is penetration of Dartos fascia, the testicle and cord should be inspected, lavage and débridement should be carried out, and any foreign bodies should be removed and the injuries repaired. Antibiotics should be given perioperatively. In all cases the entire tract should be explored to its terminus to search for other injuries. Even upper abdominal injuries can occur with penetrating scrotal injuries.

Abdominal Injuries↗
PubMed1999

Zone I retroperitoneal hematoma identified by computed tomography scan as an indicator of significant abdominal injury.

OBJECTIVE: All zone I retroperitoneal hematomas (Z1RPHs) identified at laparotomy for blunt trauma traditionally require exploration. The purpose of this study was to correlate patient outcome after blunt abdominal trauma with the presence of Z1RPH diagnosed on admission computed tomography (CT) scan. METHODS: This is a retrospective review of patients with blunt trauma who were admitted to a Level 1 trauma center and who underwent CT scan during a 40-month period. All scans with a traumatic injury were reviewed to identify and grade Z1RPH as mild, moderate, or severe. Patients requiring operative treatment were compared with those who were observed. Statistical analysis was performed with Student's t test and chi-square test, with P < .05 considered significant. RESULTS: Eighty-five (15.5%) of the CT scans were positive for Z1RPH. None of the 50 patients with a mild Z1RPH had their treatment altered. Of the 29 patients with a moderate or severe Z1RPH, 8 required celiotomy. The patients requiring celiotomy had significant elevations of solid viscus score (SVS) (4.9 +/- 1.6 versus 1.8 +/- 0.3), abdominal Abbreviated Injury Scale (3.8 +/- 0.3 versus 2.6 +/- 0.3), and transfusion requirements (13 +/- 4 versus 2 +/- 1). All patients (N = 4) with an SVS >4 required operative treatment. Seventy-two percent of patients with more than 1 intra-abdominal injury required abdominal exploration. CONCLUSIONS: The presence of a moderate or severe Z1RPH and more than 1 intra-abdominal injury or an SVS >4 on admission CT scan is an important radiographic finding. This injury pattern should be considered a contraindication for nonoperative treatment of the associated solid organ injury.

Abdominal Injuries↗