The role of laparoscopy in penetrating abdominal trauma: A retrospective case series from a level 1 major trauma centre

Abstract Aim The recent CODA trial concluded that appendicitis patients with confirmed faecolith are at higher risk of appendicectomy and complications than those without faecolith. A retrospective case series of patients undergoing non-operative management of appendicitis at a major trauma centre was conducted to determine the success of non-operative management, defined as lack of operative management within 30 and 90 days of diagnosis, and the impact of presence of faecolith on outcomes. Method All patients who received a working diagnosis of appendicitis over a 16-week period between March and June 2020 were identified and their electronic records interrogated for: preliminary and final diagnoses; imaging modality and result; operative or non-operative initial treatment strategy; final treatment strategy; and histopathology results where applicable. Patients who received an initial operative treatment strategy were excluded. Patients for whom appendicitis was not confirmed on either imaging or histopathology were excluded. Results 24 patients received an initial non-operative treatment strategy and were eligible for inclusion. 15 patients (62.5%) underwent successful non-operative management. The remaining 9 patients (37.5%) required operative management within 30 days. Presence of faecolith was confirmed in 9 patients (37.5%). 3 patients (33%) with presence of faecolith required operative management, while 3 patients (25%) without presence of faecolith required operative management. 1 patient with confirmed faecolith developed a large intra-abdominal abscess while undergoing a non-operative treatment strategy and subsequently required right hemicolectomy. Conclusions The majority of our eligible appendicitis patients were successfully managed non-operatively. Presence of faecolith in acute appendicitis is associated with increased risk of requiring operative management.

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Improving the care and safe movement of patients with pelvic fractures by developing a local guideline at a level 1 major trauma centre

International Journal of Surgery ◽

10.1016/j.ijsu.2016.08.391 ◽

2016 ◽

Vol 36 ◽

pp. S109

Author(s):

J. Lunn ◽

A. Clark-Morgan ◽

M. Gee ◽

P. Harnett

Keyword(s):

Major Trauma ◽

Trauma Centre ◽

Pelvic Fractures ◽

Major Trauma Centre ◽

Level 1 ◽

Local Guideline

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Development of a financially viable model for the outpatient management of mandibular fractures in a Level 1 Major Trauma Centre

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2014.07.249 ◽

2014 ◽

Vol 52 (8) ◽

pp. e125-e126

Author(s):

Jahrad Haq ◽

S Chegini ◽

K Fan ◽

C Huppa ◽

R Bentley

Keyword(s):

Major Trauma ◽

Trauma Centre ◽

Mandibular Fractures ◽

Outpatient Management ◽

Major Trauma Centre ◽

Level 1 ◽

Viable Model

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Thoracoabdominal impalement injury during pregnancy

BMJ Case Reports ◽

10.1136/bcr-2021-244463 ◽

2021 ◽

Vol 14 (8) ◽

pp. e244463

Author(s):

Charisse Anne F Aquino ◽

Maria Jesusa B Banal-Silao

Keyword(s):

Multidisciplinary Team ◽

Major Trauma ◽

Trauma Centre ◽

Emergency Laparotomy ◽

Penetrating Abdominal Trauma ◽

Penetrating Wound ◽

Primigravid Woman ◽

Thick Steel ◽

Trauma In Pregnancy

Trauma has emerged as the leading cause of death during pregnancy. Penetrating abdominal trauma in pregnancy requires a rigorous clinical evaluation to establish a complete assessment of obstetric and non-obstetric lesions. In the case of major trauma, treatment is essentially carried out in a trauma centre with a multidisciplinary team to improve maternal and fetal prognosis. This is a case of a 20-year-old primigravid woman, 33 weeks and 4 days age of gestation, who was admitted for impaled foreign body. She was brought to the emergency department for a penetrating wound of the chest and abdomen after being accidentally impaled by a metre-long, inch-thick steel rod. Emergency laparotomy, caesarean section and thoracotomy were performed. The aim of this report is to discuss the assessment, management and role of the multidisciplinary team in the management of a pregnant trauma patient.

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