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[Secondary perforation of the colon in a patient with blast injury of the abdomen--case report].

The patient was admitted to the M.M.A. for correction of defects of both hands seven days after injury caused by explosion. Acute abdomen developed on the same day of admission and laparotomy was performed immediately. Perforations of the cecum and distal part of the sigmoid were found. Based on the data about the time and type of injury sustained it has been concluded that secondary perforations of the colon after blast abdominal injury were present.

Abdominal Injuries↗
PubMed1991

Role of diagnostic techniques in the initial evaluation of stab wounds to the anterior abdomen, back, and flank.

Despite the widespread availability of firearms, stab wounds to the abdomen, back, and flank continue to account for a significant number of injuries. The proper sequencing of diagnostic modalities in this patient group is constantly undergoing change. We report our experience with these injuries and present a new algorithm for the use of currently available diagnostic procedures. In 1987, 162 patients were seen, 103 with anterior abdominal wounds and 59 with back and flank wounds. Patients with shock, peritonitis, and evisceration were resuscitated and explored. The remainder of the cohort underwent tap and lavage, and patients with a negative study were observed. Patients with back and flank wounds underwent contrast enhanced computerized tomographic enemas (CECTE). Seventeen patients underwent immediate exploration and 108 of the 162 patients were spared exploration. Fifty-four patients were explored with six negative laparotomies. Of the 126 taps and lavages, the false positive rate was zero, and only one patient had a false negative study. Of the 47 CECTE studies, only three were interpreted as an indication for angiography which proved negative, and all patients were safely observed. The overall mortality was 4.3%, including three patients without vital signs on admission and four who expired intraoperatively due to irreversible shock. We concluded that this algorithm can be safely applied to patients with these injuries with a high degree of specificity and sensitivity.

Abdominal Injuries↗
PubMed1991

Assessment of the use of disposable skin staplers in bowel anastomoses to reduce laparotomy time in penetrating ballistic injury to the abdomen.

Laparotomy and anastomosis of the small bowel after penetrating injury to the abdomen is a lengthy procedure. This paper describes the use of skin staplers for bowel anastomosis and presents the results of a short series of experiments upon dead pigs to compare the staple technique with conventional handsewn anastomosis. The time taken to perform each small bowel anastomosis, the integrity of the anastomosis and the skill required were assessed. The staple technique was considerably faster (mean construction time: 5.4 min, range 4-6 min) than the handsewn technique (mean construction time: 12 min, range 10-14 min), at least halving the anastomosis time (Kolmogorov two-sample test P = 0.05). In addition, the stapled anastomosis had a higher intraluminal failure pressure (mean failure pressure: 65 cmH2O, 6.37 kPa, range 30-70 cmH2O) than the handsewn anastomosis (mean failure pressure: 38.6 cmH2O, 3.78 kPa, range 10-70 cmH2O).

Abdominal Injuries↗
PubMed1991

[Optimization of the techniques for studying the upper abdomen with magnetic resonance. II. Changes in the intrinsic contrast].

Magnetic Resonance imaging of the upper abdomen was performed on more than 300 patients. The aim of the study was to determine the influence of spin-echo parameters on intrinsic image contrast. Different TR (ranging 260 to 2000 ms) and TE (ranging 20 to 120 ms) values were employed in two patients with a hepatic metastases and in a healthy volunteer with a hepatic cyst. The highest liver-to-lesion contrast was observed when the shortest TR and TE values (260 and 20 ms, respectively) were used, while the lesions appeared isointense with the surrounding parenchyma with TR 800 ms. In T2-weighted images TR 2000 ms allowed the complete recovery of longitudinal magnetization, giving a contrast relative only to the T2 of the lesion.

Humans↗
PubMed1990

Abdominal wall reconstruction after open management of the septic abdomen.

The increasing popularity of open management of the septic abdomen has generated a challenge that the surgeon is forced to face more frequently. The typical presentation is that of a patient with a full-thickness abdominal wall defect occurring after a protracted, severe illness. The various methods of reconstruction of the abdominal wall are reviewed and evaluated. The reconstruction should only be attempted once intra-abdominal sepsis is controlled, re-exploration of the peritoneal cavity is no longer necessary and organ support is discontinued. Although various methods of reconstruction are described, the recommended technique consists of either medial advancement of the rectus abdominis muscle or direct application of split-thickness skin grafts. Mid-line abdominal defects may also be repaired with tensor fasciae latae or rectus femoris flaps.

Abdominal Muscles↗
PubMed1990

[Problems with definitive abdominal closure using "zipper" and after "left open abdomen"].

There are many problems associated with definitive closure of "left open abdomen" and abdominal zip. If the assumption can be made that after an operation multiple lavages will be necessary, we recommend a transverse laparotomy because there is much less retraction of the abdominal wall than with longitudinal laparotomy. Definitive closure with split-skin is inadequate as the missing elasticity especially with underlying small intestine loops leads to tearing, besides the mechanical properties of a thiersch as replacement for the abdominal wall is bad. Should the intra-abdominal infection have affected the abdominal wall itself, the implantation of an abdominal zip is useless as it tears away in a short time. Primary laparostoma is then the therapy of choice. The earlier definitive closure is planned, the easier this can be done. Prognosis does not depend on the way of temporary closure but on underlying pathology and on the possibility of resolving problems in adequate time.

Abdominal Muscles↗
PubMed1990

Computed tomography of abdomen (CTA) in management of blunt abdominal trauma.

We reviewed our initial 2-year experience utilizing CT of the abdomen (CTA) in the management of blunt abdominal trauma. Thirty-four of 176 patients (19%) admitted with this diagnosis during 1987-88 underwent CTA as part of their initial evaluation. All patients were hemodynamically stable. Of the 34 CTA's, 15 were negative and the remaining 19 showed positive findings. When the CTA was negative, it was correct in 14 of 15 cases (93%). One case of a perforated jejunum was missed. Of the 19 positive CTA's, 12 cases were treated by observation. The CTA diagnosed a variety of intra- and extraperitoneal injuries which were successfully managed nonoperatively. It, however, missed findings in two cases. Seven of 19 positive CTA cases underwent laparotomy. CTA missed findings in four of these cases. These errors may have been related to the quality of the CTA technique which was subsequently assessed to be suboptimal. When positive, CTA was correct in 13 of 19 cases (68%). The overall accuracy rate was 79% (27 of 34). Subsequent review of the CT scans, however, improved the accuracy rate to 88% (30 of 34). CTA was found to be a valuable adjunct to clinical monitoring in the management of blunt abdominal trauma. However, if the utilization of CTA does not include appropriate patient selection, standardized CTA technique, and accurate radiologic interpretation, there is a significant potential for serious error.

Abdominal Injuries↗
PubMed1990

[Does sonographic evidence of blood in the abdomen following blunt abdominal trauma present an indication for surgery in every case?].

In a comparative study based on the diagnosis of blunt abdominal trauma, the accuracy of ultrasound (US) proved inferior, with 82-91%, to that of diagnostic peritoneal lavage, with 97-100%. The sensitivity of US, i.e. the proportion of patients with blood in the abdomen who had an abnormal test result (positive sonography) was 94%. The reasons for this may be either patient-related (severe obesity, intestinal gas superposition) or examiner-related (differing previous experience). The specificity for correct elimination of abdominal lesions was 100%. When no intra-abdominal liquid was present none appeared in the US picture; however, 3-13% of cases where intra-abdominal liquid was present this was not revealed by US. If only a small amount of intra-abdominal liquid is demonstrated after blunt trauma, the adoption of a wait-and-see attitude is justified. In intensive care conditions US can be repeated several times if necessary. In this study US showed deterioration in these circumstances in 25%, and in 21% it must be expected that an operation will be necessary.

Abdominal Injuries↗
PubMed1990

[Role of CT and ultrasonography in acute blunt trauma of the abdomen].

From March 1985 to April 1989, one hundred thirty-one patients were examined using computed tomography (CT) and/or ultrasonography (US) in the evaluation of acute blunt trauma of the abdomen (CT and US in 36 patients, CT in 25 US in 70). Twenty-three out of the 131 cases (17.6%) showed positive findings of abdominal trauma on CT and/or US. Sixteen of the 23 patients with positive findings underwent therapeutic laparotomy, while all of the other 108 patients with negative findings were successfully managed conservatively. This fact suggests that one of the roles of CT and/or US is to pick up patients with negative findings who do not have any laparotomy. Free fluid collection was demonstrated in all of the 23 patients with positive findings in: all 22 on CT (100%), and 13 of 14 on US (92.9%). In all of the 23 patients but one with an injured mesenterium, injured organ was demonstrated by CT and/or US in: 21 of 22 by CT (95.5%), and 11 of 14 by US (78.6%). In one of the 11 patients, not an immediate US but a follow-up on the next day revealed an injured organ. In 6 out of the 12 patients who underwent both plain and contrast enhancement (CE), CT, CE-CT demonstrated the injured organ more clearly than plain CT. US with sector probe was also useful for demonstrating the injured lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1990

[Comparison of computerized tomography and pathologic-anatomic findings of the abdomen in HIV infection].

In a retrospective study the results of abdominal computed tomography (CT) from 48 patients, who died of the complications of HIV infection, were compared with those obtained at autopsy. The CT diagnosis was confirmed at autopsy in 39 cases (81.3%). In nine patients CT results did not correlate with the postmortal findings. This was caused by lack of cooperation, cachexia and the time between the last CT study and the death of the patients. Nevertheless, CT with its standardised imaging planes is an important method for diagnosing and monitoring HIV-related diseases of the abdomen.

Adult↗
PubMed1990

Trauma to the lower abdomen.

Various aspects of trauma to the lower abdomen are discussed. The initial assessment, including appropriate diagnostic tests, are outlined. Principles of management of specific injuries and indications for operation are discussed.

Abdominal Injuries↗
PubMed1989

Ultrasound measurement of foetal head to abdomen circumference ratio in pregnant Nigerians.

The ratio of foetal head to abdomen circumference ratio has been established in 242 foetuses scanned between 16 weeks and 40 weeks of gestation. The ratio was observed to fall gradually from 1.30 at 16 weeks to 1 at 30-32 weeks, and more slowly thereafter to 0.95 at term. The value of this ratio in differentiating between symmetrical and asymmetrical growth-retarded foetuses and in the management of such pregnancies is discussed.

Female↗
PubMed1989

[Perforation of the small intestine as a sequela of blunt injuries of the abdomen during a 12-year period].

The paper presents 44 cases of small intestine perforation caused by blunt abdominal trauma in a period of 12 years. 34 patients were men and 10 were women. The patients were aged from 10 to 82 years which gives an average age of 39 years. The average incidence of cases was 4 per year. In 23 patients associated injuries were diagnosed, namely: 5 spleen ruptures, 3 liver ruptures, 5 colon perforations, 1 pancreas injury and 1 kidney injury. Associated injuries in which the dominant syndrome was intraabdominal hemorrhage presented no diagnostical difficulties seeing that the results of punction or abdomen lavage indicated immediate laparotomy. In patients with isolated injury of the small intestine and clinical signs of peritonitis laparotomy was treated with a two layer suture in 32 patients; in 12 patients resection with T-T or L-L anastomosis was made. Associated injuries were treated in the same act. Of 44 patients treated in our Clinic 37 were treated successfully, while 7 died.

Abdominal Injuries↗
PubMed1989

Magnetic resonance imaging of the abdomen and pelvis. Council on Scientific Affairs.

Magnetic resonance imaging (MRI) of the abdomen presents greater inherent difficulties than other anatomic regions. However, new techniques now allow imaging comparable in quality to computed tomography (CT). Magnetic resonance imaging offers the advantages of greater tissue contrast, multiplanar imaging, and lack of ionizing radiation or risk of toxic reactions from iodinated contrast media. Its use remains limited by high cost, limited availability, lack of a bowel contrast agent, and long imaging time, which some patients cannot tolerate. In many areas of abdominal imaging, MRI is now comparable to CT, but because of the greater availability and lesser cost, CT remains the procedure of choice. Magnetic resonance imaging is more accurate for staging neoplasms of the liver, adrenal glands, kidneys, bladder, prostate, uterus, and cervix and may aid in diagnosis of hepatic, adrenal, and uterine masses. In selected patients, especially those in whom CT is inconclusive or those who cannot tolerate iodinated contrast material, MRI can provide valuable information. Development of faster scanning techniques and MRI contrast agents and wider availability will probably increase the usefulness of abdominal MRI. At this time, MRI complements other abdominal imaging procedures. In a small number of patients, however, it can provide unique information in a virtually risk-free manner.

Abdominal Neoplasms↗
PubMed1989

[Cystic lymphangiomas of the abdomen. CT and US findings].

Cystic lymphangiomas of the abdomen are an uncommon kind of hamartoma. Their diagnosis is often difficult and calls for an accurate differential diagnosis of this disease and such lesions as cystic pancreatic neoplasms, pseudocysts, hematomas, abscesses and urinomas. Eight cases of abdominal lymphangioma are reported, in patients ranging 35 to 68 years; all lesions were uni/multilocular containing serous fluid. Lymphangiomas were located in the retroperitoneal space (3 cases), in the mesenteric bed (3 cases), close to the left lumbar ureter (1 case), and on the left colon wall (1 case); the symptoms were little characteristic, mostly due to pressure on the adjacent organs. Both CT and US were able to detect and evaluate the lesions; in particular, CT provided also with exact topography. A small lymphangioma in the left colon was revealed only by barium enema. In 2 huge retroperitoneal lymphangiomas the diagnostic evaluation was improved by the use of CT-guided fine-needle biopsy; in patients with mesenteric lesions angiography was employed, also for surgical planning. Lymphography was never performed because CT and US proved the best diagnostic procedures. All patients underwent surgery, whose results confirmed the previous diagnosis, but for the patient with para-ureteral location the surgeon thought nephrectomy necessary.

Abdominal Neoplasms↗
PubMed1989

[Late sequelae of appendectomy with special reference to adhesions in the lower abdomen, chronic abdominal pain and sterility].

Analyzing the medical history and operation protocols of 2,465 female patients undergoing pelviscopy for different reasons we found that 1,743 patients (71%) reported a previous appendectomy in their anamnesis. 657 patients presented adhesions after previous appendectomy. In 41.5% these adhesions were located in the middle right abdomen. In comparison to a collective of 308 patients without adhesions there were no correlations between the occurrence of adhesions post appendectomy and chronic lower abdominal pain. In conclusion it is to point out that laparotomy--especially appendectomy--correlates in 70% with postoperative adhesions. These adhesions correlate in 30% of cases with chronic abdominal pains and in 40 to 50% we were able to prove periovarian and peritubal adhesions in cases of sterility. In order to prevent unnecessary appendectomy or other unnecessary laparotomies with later formation of adhesion it is very important to use laparoscopy in all questionable cases.

Abdominal Pain↗
PubMed1985

Applications of ultrasound in the neonatal abdomen.

In this article, the uses of real-time sonography relative to evaluation of the neonatal abdomen are presented. Included are some of the more recent applications that, to a great extent, have evolved because of the ease with which portable real-time examination of the fragile or compromised infant can be accomplished.

Adrenal Gland Diseases↗