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PubMed2006

Chest and abdominal injuries caused by seat belt wearing.

The authors report an original case of seat belt syndrome. Sternal fractures are common in patients with seat belt injuries. Its association with blunt bowel trauma is rarely related in the literature. Distracted injury has contributed to delay the diagnosis of intestine injury. The presence of a seat belt sign must lead to the consideration of occult injuries especially abdominal. Close observation and serial examination should be the rule.

Adult↗
PubMed1999

Penetrating abdominal injuries in children in Nigeria.

This is a report of a retrospective study of 24 children managed for penetrating abdominal injury over 10 years, and it represents 34% of all abdominal injuries in children in that period. Falls onto sharp objects within and around the home were responsible for ten of the injuries, seven were injured by animal horns and four were sporting injuries. Violence and road traffic accidents were uncommon. Most patients (67%) had evisceration of omentum or intestine, and one of these was found at laparotomy to have a jejuno-jejunal intussusception. Seven children had injury to hollow viscera. There were three deaths, one each from overwhelming sepsis, tetanus and haemorrhage.

Abdominal Injuries↗
PubMed2006

Physical examination as a reliable tool to predict intra-abdominal injuries in brain-injured children.

BACKGROUND: Brain-injured children have been thought to have an unreliable abdominal examination. This study evaluates the reliability of physical examination in the prediction of intra-abdominal injury in brain-injured children. METHODS: Pediatric patients with a traumatic brain injury or Glasgow Coma Scale (GCS) <15 and intra-abdominal organ injuries were selected. Admission data were reviewed, and findings were tabulated. RESULTS: Fifty patients had an abnormal abdominal examination. Nineteen of 71 patients with head injury and intra-abdominal organ injuries required laparotomy. These 19 patients had abdominal tenderness, distention, abrasions, and/or a positive focused abdominal sonography for trauma (FAST) scan. Seven of 19 patients had a GCS of 3. Of the 12 patients requiring surgery with GSC 4 to 14, all patients had abnormal physical examinations. CONCLUSIONS: Patients who required an operation presented with an abnormal examination and/or a positive FAST. These data suggest that examination and/or FAST may reliably identify patients with intra-abdominal organ injuries in need of an operation.

Abdominal Injuries↗
PubMed1991

[Criteria of early diagnosis of postoperative peritonitis in abdominal injuries].

The article deals with 221 relaparotomies in abdominal injuries. It was undertaken for postoperative peritonitis in 136 (61.5%) patients. It was established that signs of intoxication are the early diagnostic criteria of peritonitis which determine the indications for laparotomy in injuries to the abdomen. Signs of peritoneal irritation are less informative. The diagnosis of postoperative peritonitis can be made sufficiently objectively on the grounds of a diagnostic index suggested by the authors.

Abdominal Injuries↗
PubMed1995

Management of penetrating abdominal injuries.

One hundred and twelve patients with penetrating abdominal injuries seen at the Kingston Public Hospital, Jamaica, over a twelve month period from January 1 to December 31, 1992 were reviewed. Seventy-five (67%) patients had stab wounds and thirty-seven (33%) sustained gunshot wounds. There were 10 deaths (27%) from gunshot wounds, and seven deaths (9%) due to stab wounds. Using a protocol of selective conservatism for stab wounds, 41 (60%) were observed, 27 (40%) explored and 5 (12%) patients had negative laparotomy. The male to female ratio was 10:1 with 88% in the age group 16-35 years. A decision to perform laparotomy was based entirely on clinical diagnosis of peritonitis. In gunshot wounds a policy of mandatory laparotomy was used and is recommended.

Abdominal Injuries↗
PubMed1996

[Abdominal injuries].

Radiologic evaluation of abdominal trauma must provide a quick and accurate assessment of the lesions in order to improve the management of the patient. The technique used varies depending on the mechanism of the trauma (blunt trauma or stab wounds) and the hemodynamic status. Radiologic evaluation is usually performed in blunt trauma whereas stab wound trauma is usually explored surgically. The various techniques available are standard radiographs, ultrasonography, computed tomography and arteriography. The role of magnetic resonance imaging in the immediate evaluation is still not well defined. It appears to be a useful method in the delayed evaluation of diaphragmatic trauma. Computed tomography is the method most commonly performed in trauma patients. This technique is accurate and allows correct assessment of the lesions. The disadvantages are the radiation induced and the need for a hemodynamically stable patient. The aim of the radiologic evaluation is to provide the clinicians with an accurate description of the lesions. It can help in the management of the patient usually in association with clinical and laboratory data. It can also guide interventional procedures (drainage, embolization...). Finally, it allows radiographic follow-up when conservative treatment is performed.

Abdominal Injuries↗
PubMed1998

Survey of abdominal ultrasound and diagnostic peritoneal lavage for suspected intra-abdominal injury following blunt trauma.

Over a 3 year period all severely injured blunt trauma patients who were investigated with abdominal ultrasound examinations (AUS) or diagnostic peritoneal lavage (DPL) to exclude intra-abdominal injury were evaluated. The ultrasound examinations were performed by radiologists in 220 severely injured patients (20 of whom also had DPL). The overall sensitivity and specificity of abdominal ultrasound were 82.7% and 99.5%, respectively. The sensitivity increased to 89.1% by repeat scanning. In comparison, 72 DPLs were performed in severely injured patients; the overall sensitivity and specificity of DPL were 82.8% and 97.2%, respectively. DPL resulted in more non-therapeutic laparotomies, 9/25 (36%) compared with 3/23 (13%) with AUS. Abdominal ultrasound is now the first line investigation at this centre for evaluation of possible intra-abdominal injury in injured patients.

Abdominal Injuries↗
PubMed1990

[Abdominal injuries after blunt trauma].

We present a series of 331 patients admitted to hospital in 1980-87 with abdominal injuries after blunt trauma. The patients included 230 males and 101 females. The median age was 29 years. More than half of the patients were injured in traffic accidents. 11% were transferred to our Trauma Center from other hospitals, median five hours after the accident. A doctor-manned helicopter transported 52 patients (18%) directly to our hospital. 70% had extra-abdominal injuries as well. A minimum of 20% were intoxicated by alcohol and/or drugs. Severe injuries (AIS greater than 3) were present in 46%. 168 patients underwent laparotomy, in 56% within two hours of admission. In 27 of the 168 laparotomized patients (16%) no intraabdominal injury was encountered that needed repair.

Abdominal Injuries↗
PubMed1989

[Grading and prognosis of abdominal injuries].

The present study was carried out in order to find out the relationship between injury grading and the use of different resources and the result of the treatment in patients with intra-abdominal injuries. The injuries were graded according to two trauma scores: The Injury Severity Score and the Norwegian Injury Score. In 221 patients with intra-abdominal injuries there were good correlations between these two scores and the time of hospitalization, units of blood transfusions, need for respirator treatment and lethality.

Abdominal Injuries↗
PubMed2004

[Closed abdominal injuries: clinical analysis of 246 cases].

OBJECTIVE: To explore the approaches for early diagnosis and effective management of closed abdominal injures. METHODS: The experience in diagnosis and management of 246 cases of closed abdominal injuries was analyzed. RESULTS: Of the 246 patients treated in the past 5 years, 221 underwent exploratory laparotomy and 25 received conservative treatment. Altogether 235 patients (95.53%) were cured and 11 died (4.47%). CONCLUSION: Systemic physical examination and early diagnoses are crucial for successful management of closed abdominal injuries. Surgeons should be aware of the importance of early-stage anti-shock treatment and timely surgical management, and the indications and procedures for exploratory laparotomy should be strictly followed.

Abdominal Injuries↗
PubMedDate not supplied

Suicide attempts in HIV/AIDS patients: report of two cases presenting with penetrating abdominal injuries.

BACKGROUND: We present two patients to highlight an emerging trend of suicide attempts presenting to the surgeons with penetrating abdominal injuries found to be HIV/AIDS related. METHODS: The two patients were managed at the University of Maiduguri Teaching Hospital in the year 2003. Both patients presented as emergencies with penetrating abdominal injuries and were resuscitated followed by clinical evaluation and laparotomy. RESULTS: Both patients had visceral injuries that were repaired at laparotomy and were both confirmed HIV positive. CONCLUSION: There is an emerging trend of suicide attempts in HIV/AIDS patients and the need to determine the suicide pattern that will enable all stakeholders workout a formidable HIV/AIDS and suicide prevention programmes.

Abdominal Injuries↗
PubMed1993

'Damage control': an approach for improved survival in exsanguinating penetrating abdominal injury.

Definitive laparotomy (DL) for penetrating abdominal wounding with combined vascular and visceral injury is a difficult surgical challenge. Physiologic derangements such as dilutional coagulopathy, hypothermia, and acidosis often preclude completion of the procedure. "Damage control" (DC), defined as initial control of hemorrhage and contamination followed by intraperitoneal packing and rapid closure, allows for resuscitation to normal physiology in the intensive care unit and subsequent definitive re-exploration. The purpose of the study was to compare the damage control technique with definitive laparotomy. Over a 3 1/2-year period, 46 patients with penetrating abdominal injuries required laparotomy and urgent transfusion of greater than 10 units packed red blood cells for exsanguination. Medical records were retrospectively reviewed for degree and pattern of injury, probability of survival, actual survival, transfusion requirements for the preoperative and postoperative phases, resuscitation and operative times, lowest perioperative temperature, pH, and HCO3. No significant differences were identified between 22 DL and 24 DC patients and actual survival rates were similar (55% DC vs. 58% DL). However, in a subset of 22 patients with major vascular injury and two or more visceral injuries (maximum injury subset), otherwise similar to the overall group, survival was markedly improved in patients treated with damage control (10 of 13, 77%*) vs. DLM (1 of 9, 11%) (Fisher's exact test, * p < 0.02). In preparation for return to the operating room, DC survivors averaged 8.4 units of packed red blood cells transfused and 10.3 units fresh frozen plasma over a mean ICU stay of 31.7 hours. Resolution of coagulopathy (mean prothrombin time/partial thromboplastin time 19.5/70.4 to 13.3/34.9), normalization of acid-base balance (mean pH/HCO3 7.37/20.6 to 7.42/24.2), and core rewarming (mean 33.2 degrees C to 37.7 degrees C) were achieved. All patients had gastrointestinal procedures at reoperation (mean operative time, 4.3 hours). We conclude that damage control is a promising approach for increased survival in exsanguinating patients with major vascular and multiple visceral penetrating abdominal injuries.

Abdominal Injuries↗
PubMed1987

[Isolated injuries of the small intestine following blunt abdominal injuries].

Operations were performed on 327 patients for blunt abdominal trauma at the casualty ward of the Istanbul University Hospital, over the past three years. Isolated injuries to small intestines were recorded by laparotomy from 22 of these cases. Peritoneal lavage was applied to 18 patients. Only one patient was operated on with 24-hour delay because of false negative result of lavage. Six of the above 22 patients died (27.2 per cent) despite early surgical action. Five of these six had been admitted to the casualty ward with hypovolaemic shock as well as head and extremity injuries after a traffic accident.

Abdominal Injuries↗