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PubMed1976

[Diagnostic laparocentesis in closed abdominal injury].

To improve the diagnosis of closed abdominal trauma since 1966 the authors have been widely employing laparocentesis. The results of using abdominal punctures an 260 patients are reported. The method proved to be reliable in 97.7%. The use of laparocentesis enabled the authors to reduce the number of errors by 7.3 times, to shorten the terms of establishing the diagnosis by 4 times as compared with the control group of patients (190 subjects in whom the recognition of abdominal injuries is based on common clinical symptoms).

Abdominal Injuries↗
PubMed1991

Liver lacerations--a marker of severe but sometimes subtle intra-abdominal injuries in adults.

Experience with conservative management of solid viscus injuries from abdominal trauma in children has produced the impetus for a similar management in adults. To explore the implications of such a policy, we reviewed the records of 82 patients with hepatic injuries noted at laparotomy. Indications for laparotomy were positive findings on diagnostic peritoneal lavage (DPL) or CT scan, or a history of penetrating trauma. The liver injuries were graded according to severity: grade I, 19 patients; grade II, 20 patients (low severity = LS); grade III, 14 patients; grade IV, 6 patients (high severity = HS). Twenty-three injuries were not classified by the operating surgeon. Of the 53 patients with blunt hepatic trauma, 23 (43%) had concomitant injuries that required operative intervention. Twenty-nine patients had penetrating liver injuries. Fourteen (48%) had associated injuries requiring intervention. Patients most likely to have nonoperative management, those with grade I and grade II liver injuries (LS), comprised 48 of the total. In this subgroup there were 26 (54.2%) associated injuries requiring operative intervention. Shock could not be used as a factor to differentiate patients not requiring operative intervention. Nineteen of the LS patients requiring operative intervention secondary to associated injury were never in shock. In adult trauma victims positive DPL findings secondary to minor hepatic injuries that might not require operative intervention serve as a marker for associated injuries that do require operation. The risk of nonoperative management of hepatic injuries based upon radiologic diagnosis is not the result of complications from the hepatic injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed2001

Abdominal injury and the seat-belt sign.

OBJECTIVE: To report on: 1. Prevalence of seat-belt sign in motor vehicle accident victims with abdominal injuries; 2. Prevalence of intestinal injuries in patients with seat-belt sign; and 3. Spectrum of abdominal injuries in a population with high usage of three-point restraints. METHODS: A retrospective chart review was conducted in an adult tertiary-referral hospital from January 1992 to August 1998. Patients were identified from International Classification of Disease-9 codes for abdominal wall and intra-abdominal injuries. RESULTS: The seat-belt sign was present in 60/99. The proportion of intestinal injuries in patients with and without seat-belt sign were 9/60 and 0/39, respectively (P = 0.01). In the 25 patients with intra-abdominal injuries, there were 10 hepatic, 8 splenic, 9 intestinal and 4 retroperitoneal injuries. CONCLUSION: The seat-belt sign is indicative of an increased risk of intestinal injury, which is difficult to detect with no single test providing reliable diagnosis. Other intra-abdominal and retroperitoneal injuries may also occur, which are more readily diagnosed on computed tomography scan or focused abdominal utlrasound when available, but are no more frequent in patients with the seat-belt sign than those without.

Abdominal Injuries↗
PubMed2005

The association between Chance fractures and intra-abdominal injuries revisited: a multicenter review.

The association between Chance fractures and intra-abdominal injuries is reported to be as high as 89 per cent. Because prior studies were small series or case reports, we conducted a multicenter review to learn the true association between Chance fractures and intra-abdominal injuries as well as diagnostic trends. Trauma registry data, medical records, and radiology reports from 7 trauma centers were used to characterize 79 trauma patients with Chance fractures. Initial methods of abdominal assessment were computed tomography (CT) scan (79%), clinical examination (16%), and diagnostic peritoneal lavage (DPL) (5%). Twenty-six (33%) patients had intraabdominal injuries of which hollow viscus injuries predominated (22%). Twenty patients (25%) underwent laparotomy. The presence of an abdominal wall contusion and automobile restraint use were highly predictive of intra-abdominal injury and the need for laparotomy. The association between a Chance fracture and intra-abdominal injury is not as high as previously reported. CT scan has become the primary modality to assess the abdominal cavity of patients with Chance fractures, whereas the role of DPL has diminished.

Abdominal Injuries↗
PubMed1982

Abdominal injury from sporting activities.

The frequency of abdominal injury is rising. In an analysis of 1,354 cases of closed abdominal trauma sustained during a 30-year period (1950-1979) in Skaraborg County, Sweden, a distinct increase was found in the numbers associated with sporting activities. The severity of the injuries caused by sports likewise showed an increase. The representation of injured organs was of the same order as in the total series of closed abdominal injuries. An analysis of the 136 cases of sports-associated injury is presented with regard to cause and type of the injuries, diagnosis and prognosis.

Abdominal Injuries↗
PubMed1991

Tolerance to steering wheel-induced lower abdominal injury.

Anesthetized swine were tested for biomechanical and injury responses to lower abdominal steering wheel loading. The lower abdomens of 25 subjects were impacted with a segmented steering wheel. Tests included a wide spectrum of velocities, from 1.7 to 12.4 m/s, and forced abdominal compressions of 7.0%-54.5% of the vertical thickness of the lower abdomen. Lower abdominal injuries included contusions and lacerations of varying severity and frequency in the mesentery, the small and large bowel, the spleen, and the cecum. Logistic regression correlations were performed to assess the probability of severe and greater injury with biomechanical indices such as peak velocity of deformation (Vmax), peak compression (Cmax), peak total force (Fmax), the maximum Viscous criterion (VCmax), and the product of maximum total force and maximum compression (FmaxCmax). Although Cmax, Fmax, and, to a lesser extent, FmaxCmax correlated reasonably well with the probability of severe and greater injury, the maximum Viscous criterion (VCmax) was the best correlate, establishing VCmax as the most effective predictor of an AIS greater than or equal to 4 injury risk for steering wheel loading to the lower abdomen.

Abdominal Injuries↗
PubMed1987

Randomized trial of pneumatic antishock garments in the prehospital management of penetrating abdominal injuries.

Experimental data have suggested that pneumatic external counterpressure improves outcome in intra-abdominal hemorrhage by either a tamponade effect and/or elevation in central systemic blood pressure. As a result, the empiric use of the pneumatic antishock garment (PASG) has become a standard of care, even to the point where the device has been legislated as required equipment on emergency medical rescue vehicles. However, the effect of the PASG on intra-abdominal hemorrhage has not been evaluated in randomized clinical trials. The purpose of this study was to evaluate the effect of the PASG on the survival of hypotensive patients with penetrating abdominal injuries. During a 2 1/2-year period, 201 consecutive patients presenting with penetrating anterior abdominal injuries and an initial prehospital systolic blood pressure of 90 mm Hg or less were entered into the study. All prehospital care was delivered by the same municipal emergency medical services system, and all patients subsequently were transported to the same regional trauma facility. The patients were randomized into control and pneumatic external counterpressure groups by an alternate-day assignment of PASG use. The resulting study populations (control, n = 104; PASG, n = 97) were found to be well matched for survival probability indices, prehospital response and transport times, and the volume of IV fluids received. The results demonstrated no significant difference in the survival rates of the control and PASG treatment groups (81 of 104 vs 67 of 97). From these data we conclude that, contrary to previous claims, the PASG provides no significant advantage in improving survival in the urban prehospital management of penetrating abdominal injuries.

Abdominal Injuries↗
PubMed1984

Isolated injury to the intestine from blunt abdominal injury.

Isolated injury to the intestine due to blunt abdominal trauma is an uncommon event. Since the haemodynamic disturbance which accompanies injury of the liver or spleen is absent the initial symptoms and signs may be very slight, or obscured by injuries of the abdominal wall, musculoskeletal or nervous systems. We present four cases which illustrate pitfalls in management. A high index of suspicion is essential if morbidity and mortality are to be reduced to a minimum. Abdominal radiography and peritoneal lavage are useful aids when diagnosis is in doubt.

Abdominal Injuries↗
PubMed1990

Pediatric Chance fractures: association with intra-abdominal injuries and seatbelt use.

Seven cases of Chance fractures of the spine in children are presented, with their association to intra-abdominal injuries secondary to seatbelt use. A discussion and review of the literature suggest an increasing frequency of this particular injury with a high association given the clinical sign known as the "seatbelt sign." Also reviewed is the association of intra-abdominal injuries secondary to seatbelt restraints, and particular attention is paid to the concurrence of intra-abdominal injury with Chance fractures of the spine. The unique features of the pediatric anatomy in relation to the design of the adult seat restraint as it relates to the vertebral fracture and intra-abdominal injuries are noted. A review of the literature discusses the development of a classification for this flexion-distraction type of vertebral injury, and supports our experience of the increasing frequency of these particular injuries with increasing seatbelt use.

Abdominal Injuries↗
PubMed1980

[Diagnosis and management of abdominal injuries (author's transl)].

Prognosis and mortality rate of abdominal injuries are substantially influenced by early diagnosis and thereby early definite operative treatment. Especially in cases of multiple traumata a subtle search for intraabdominal lesions in needed. 242 patients with abdominal traumata were analysed. 142 (= 58%) of them had contusions of the abdominal wall only, 83 (= 36%) had blunt and 17 (= 6%) had perforating abdominal injuries. In two-third of blunt traumata with organ lesions the operation was indicated only by clinical symptoms. The preoperative radiological examinations revealed organ lesions in 23,7% of cases. In addition to clinical and radiological examinations peritoneal lavage is an important diagnosis test of abdominal organ lesions. A laparotomy for diagnostic reasons should never be done before peritoneal lavage which can be used even in smaller hospitals.

Abdominal Injuries↗
PubMed2004

Screening for abdominal injury prior to emergent extra-abdominal trauma surgery: a prospective study.

OBJECTIVE: To prospectively evaluate the necessity of abdominal screening with computed tomography (CT) in awake and alert blunt trauma patients that require emergent extra-abdominal trauma surgery. METHODS: All blunt trauma patients admitted to a Level I trauma center that required emergent extra-abdominal trauma surgery were entered in a prospective study during the period from April 2001 to June 2003. Awake and alert blunt trauma patients (Glasgow Coma Scale [GCS] score > or =14) with a normal abdominal physical examination requiring extra-abdominal emergent surgery were entered in the study. All patients entered were greater than 14 years of age, hemodynamically stable, and underwent further abdominal evaluation with CT scan following the decision for extra-abdominal surgical intervention. Emergent extra-abdominal trauma surgery occurred within 8 hours of emergency room admission. The results of all diagnostic studies, hemodynamic values, mechanism of injury indications for extra-abdominal surgical intervention and outcome were analyzed. RESULTS: One hundred sixty-two patients were entered in the study with average age of 32 years (range: 14-81). The most common mechanism of injury was motor vehicle crash (76%). One hundred forty-three (88%) patients presented with GCS scores of 15, and 19 (12%) patients presented with GCS scores of 14. The majority of extra-abdominal emergent surgical procedures were orthopedic (88%). Two (1.2%) intra-peritoneal injuries were diagnosed in the study population. One of the injuries was a stable Grade 1 splenic injury and the other was a small bowel mesenteric hematoma. Neither of the 2 abdominal missed injury required blood transfusion or surgical intervention. CONCLUSIONS: Before emergent extra-abdominal trauma surgery, abdominal evaluation with physical examination is sufficient to identify surgically significant abdominal injury in the awake and alert blunt trauma patient. Abdominal screening with computed tomography does not impact patient outcome.

Abdominal Injuries↗
PubMed1992

Gunshot wounds of the female breast: a risk for intra-abdominal injury.

We report the results of a clinical study of female patients sustaining gunshot wounds to a breast. Thirteen homicides were reviewed by the Fulton County Medical Examiner. A prospective series of patients treated by the Grady Memorial Hospital Trauma Service included eight additional cases. Ten (48%) of the combined series of 21 patients had significant intra-abdominal injury; of these, five (24%) had injuries confined to the abdomen as a result of a missile striking a breast. A wound pattern consisting of a superior breast entrance wound, an inferior breast exit wound, and an inframammary thoracoabdominal reentry wound was noted in five patients, four of whom had intra-abdominal injuries and three only intra-abdominal injuries. Careful examination for this wound pattern should alert the clinician to the possibility of intra-abdominal injury. One should anticipate a 50% incidence of intra-abdominal injury in female patients sustaining gunshot wounds to a breast.

Abdominal Injuries↗
PubMed1998

[Concomitant intra-abdominal injuries in pelvic trauma].

A pelvic fracture combined with abdominal injury and soft tissue damage, defined as complex pelvic trauma, is an expression of severe trauma and requires specific procedures in terms of diagnosis and treatment. The clinical course and outcome of 75 patients (56 males and 19 females) with complex pelvic injuries from 1985 to 1996 are presented in this follow-up study. There were 33 (44%) Type A (stable pelvic ring fracture), 10 (13%) Type B (rotationally unstable pelvic ring fracture) and 32 (43%) Type C (rotationally and vertically unstable pelvic ring fracture). Concomitant abdominal injuries included: 14 liver lacerations (19%), 28 splenic lesions (37%), 7 ruptures of the kidney (9%), 18 ruptures of the bladder (24%), 13 urethra lesions (17%), 13 intestinal lesions (17%) and 16 ruptures of the diaphragm (21%). The mean Hannover polytrauma score was 22 points. Twelve patients (16%) died within 6 hours after associated head and/or chest injury with hemorrhage, and 3 patients (4%) died in the intensive care unit from sepsis and multiorgan failure within 2 weeks after injury. The priority of the steps taken is of utmost importance in the diagnosis and treatment of such injuries. Immediate control of hemorrhage by surgical or minimally invasive radiological techniques, stabilization of pelvic fractures and inter-disciplinary cooperation are important requirements for management and successful treatment.

Abdominal Injuries↗
PubMed1996

The use of computed tomography in blunt abdominal injuries.

A retrospective study was performed to evaluate the use of abdominopelvic computed tomography of the abdomen (CTA) in the initial evaluation of hemodynamically stable blunt trauma patients. Two hundred fifty-six of 2,047 injury admissions over a 2-year period underwent CTA. Sixty-two (24.2%) scans were positive for visceral injury. Sensitivity of CTA for patients with visceral injury was 92.4 per cent, specificity was 99.5 per cent, and overall accuracy was 97.6 per cent. Of all injuries documented by CTA or laparotomy, CTA detected 83.7 per cent. Injury-specific sensitivities were lowest in injuries of the pancreas (0%), intestinal tract (41.6%), and bladder (50%). False negative scans occurred in 1.9 per cent of patients, with no deaths or major complications attributable to delay in diagnosis. Nonoperative management was possible in 72 per cent of 57 patients with solid viscus injuries; splenic preservation was possible in 81.5 per cent of injured organs. Urine dipsticks and urinalysis performed poorly as predictors of either significant urological injury or intra-abdominal injury in general. When indications included early need for nonabdominal operation, only three of 41 scans were positive. Yield for patients scanned with obtundation as an isolated indication was diminished. Cost of CTA exceeds that of DPL, but lower procedure-related risk and lower estimated rate of nontherapeutic laparotomy leads to clinical favor of CTA in this group of patients.

Abdominal Injuries↗
PubMed1982

[Epidemiology, diagnosis, therapy and prognosis of abdominal injuries].

The low incidence rate of abdominal injuries in the GDR does not allow the single surgeon to collect extensive personal experience. Actual aspects of diagnostics, therapy and prognosis are compiled in a survey. It has to be emphasized that the definite result of treatment depends on the quality of surgico-anaesthesiological care as well as on the severity of the injury, on individual factors and conditions of the local health care system.

Abdominal Injuries↗
PubMed2003

Detection of intra-abdominal injury using diagnostic peritoneal lavage after shotgun wound to the abdomen.

BACKGROUND: The utility of diagnostic peritoneal lavage (DPL) as a diagnostic tool specifically for shotgun wound to the abdomen (SGWA) is unknown. This prospective study was undertaken to determine the sensitivity, specificity, and accuracy of DPL for the detection of intra-abdominal injuries following SGWA. METHODS: DPL was performed on all patients sustaining SGWA who lacked a clear indication for laparotomy. Patients exceeding 10,000 red blood cells (RBC)/mm were taken for exploratory laparotomy. A prospective database was kept with information on wound location, DPL result, findings upon laparotomy and outcome. RESULTS: Thirty-two DPLs were performed at our urban Level I trauma center for SGWA. Of these, 8 patients had a positive DPL. Upon laparotomy, 7 patients were found to have intra-abdominal injuries, 6 of which required surgical intervention. One patient had no peritoneal penetration or intra-abdominal injury. Of the 24 patients that had a negative DPL, 1 subsequently developed indications for laparotomy and was found to have operative injuries. For predicting intra-abdominal injuries DPL has a sensitivity, specificity and accuracy of 87.5%, 95.8% and 93.8%, respectively. CONCLUSION: For patients presenting with SGWA who do not present with indications for immediate laparotomy, DPL is a reliable indicator of intra-abdominal injury and need for operative intervention.

Abdominal Injuries↗
PubMed2004

Surgeon-directed ultrasound for trauma is a predictor of intra-abdominal injury in children.

This study investigated the efficacy of surgeon-directed focused assessment with sonography for trauma (FAST) in conjunction with physical exam (PEx) as a predictor of intra-abdominal injury in children. Injured children (ages < or = 17) presenting to a level I trauma center with abdominal trauma were evaluated in the emergency department (ED) by the trauma team of surgical attendings and residents. PEx and FAST were performed immediately upon arrival to the ED and results compared to CT, the standard exam for presence of intra-abdominal injury. Data was collected prospectively from July 1, 2000, until April 30, 2002. One hundred and twenty injured children underwent evaluation of abdominal trauma with PEx, FAST, and abdominal CT. Two patients had false-negative CT scans. Bayesian analysis was applied to the results of the remaining 118 patients. FAST compared with CT findings revealed sensitivity 70 per cent, specificity 100 per cent, positive predictive value 100 per cent, and negative predictive value 92 per cent. FAST results were combined with PEx findings such that either suggestive of intra-abdominal injury was regarded as a "positive exam." Sensitivity was 100 per cent, specificity 74 per cent, positive predictive value 53 per cent, and negative predictive value 100 per cent. Surgeon-directed FAST with consideration of PEx is a predictor of intra-abdominal injury in children.

Abdominal Injuries↗
PubMed2004

[The role of transarterial embolisation in the treatment of patients with abdominal injuries].

INTRODUCTION: The role of transarterial embolisation in patients with abdominal injuries is controversial. Some trauma centres advocate routine angiography, whereas others believe in restricted indications such as increasing haematomas or persistent/recurrent haematuria. METHOD: We prospectively studied 167 patients with blunt and penetrating abdominal trauma. We used restricted indications for angiography and embolisation. RESULTS: Eleven of 167 patients with abdominal trauma (7%) were treated with angiography and embolisation., Overall, three of 11 patients (27%) with angiography and embolisation were treated emergently and eight of them (73%) at an average of 7.3 days. There were no complications due to the embolisation procedure, and all bleeding could be stopped. CONCLUSION: Transarterial angiography and embolisation is an important and safe tool in the treatment of acute abdominal injury when used for restricted indications. We believe this should not be performed as a routine procedure, especially in unstable patients.

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