Hollow Visceral Injury in Blunt Trauma

Introduction This audit focused on patients who sustained enteric injury following blunt abdominal trauma. Methods Our prospectively maintained electronic registry was interrogated retrospectively, and all patients who had sustained blunt abdominal trauma between December 2011 and January 2016 were identified. Results Overall, 2,045 patients had sustained blunt abdominal trauma during the period under review. Seventy per cent were male. The median age was 28 years. Sixty patients (2.9%) sustained a small bowel injury (SBI). Thirty-five of these were peritonitic on presentation. All patients with a SBI had a chest x-ray and free air was present in seven. In 18 patients with a SBI, computed tomography (CT) was performed, which revealed isolated free fluid in 12 and free intraperitoneal air in 5. In five cases, the CT was normal. A total of 32 patients (1.5%) sustained blunt duodenal trauma (BDT). All patients with BDT had a chest x-ray on presentation. Free intraperitoneal air was not present in any. CT was performed on 17 patients with BDT. This revealed isolated free fluid or retroperitoneal air in 12. The median delay between injury and presentation for these enteric injures was 15.5 hours (interquartile range [IQR]: 8–25 hours) while between presentation at hospital and operation, the median delay was 6 hours (IQR: 3–13 hours). Conclusions Blunt trauma related enteric hollow visceral injury remains associated with delayed diagnosis and significant morbidity. It can be caused by a disparate array of mechanisms and is difficult to diagnose even with modern imaging strategies.

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Predicting hollow visceral injury in the pediatric blunt trauma patient with solid visceral injury

Journal of Pediatric Surgery ◽

10.1053/jpsu.2000.9301 ◽

2000 ◽

Vol 35 (9) ◽

pp. 1300-1303 ◽

Cited By ~ 30

Author(s):

Michael L. Nance ◽

Martin S. Keller ◽

Perry W. Stafford

Keyword(s):

Trauma Patient ◽

Blunt Trauma ◽

Visceral Injury ◽

Blunt Trauma Patient ◽

Hollow Visceral Injury

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A report of three cases and review of the literature on rectal disruption following abdominal seatbelt trauma

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0050 ◽

2016 ◽

Vol 98 (2) ◽

pp. 86-90

Author(s):

J El Kafsi ◽

R Kraus ◽

R Guy

Keyword(s):

Abdominal Wall ◽

Blunt Trauma ◽

Multidisciplinary Approach ◽

Abdominal Wall Reconstruction ◽

Spine Injury ◽

Rectal Injury ◽

Emergency Laparotomy ◽

Abdominal Compression ◽

Visceral Injury ◽

Hollow Visceral Injury

Seatbelt associated blunt trauma to the rectum is a rare but well recognised injury. The exact mechanism of hollow visceral injury in blunt trauma is unclear. Stress and shear waves generated by abdominal compression may in part account for injury to gas containing structures. A ‘seatbelt sign’ (linear ecchymosis across the abdomen in the distribution of the lap belt) should raise the suspicion of hollow visceral injuries and can be more severe with disruption of the abdominal wall musculature. Three consecutive cases of rectal injury following blunt abdominal trauma, requiring emergency laparotomy and resection, are described. Lumbar spine injury occurred in one case and in the other two cases, there was injury to the iliac wing of the pelvis; all three cases sustained significant abdominal wall contusion or muscle disruption. Abdominal wall reconstruction and closure posed a particular challenge, requiring a multidisciplinary approach. The literature on this topic is reviewed and potential mechanisms of injury are discussed.

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AN ANALYSIS ON HOLLOW VISCERAL INJURY AND ITS MANAGEMENT FOLLOWING BLUNT TRAUMA ABDOMEN AT A TERTIARY HEALTHCARE CENTRE

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2017/961 ◽

2017 ◽

Vol 4 (82) ◽

pp. 4821-4824

Author(s):

Niranjan Sahoo ◽

Ravi Teja P ◽

Abinash Kumar Panda ◽

Sanjeeb Kumar Pradhan ◽

Nrushing Charan Dash ◽

...

Keyword(s):

Blunt Trauma ◽

Visceral Injury ◽

Healthcare Centre ◽

Tertiary Healthcare ◽

Hollow Visceral Injury

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ALKALINE PHOSPHATASE LEVELS IN DIAGNOSTIC PERITONEAL LAVAGE FLUID AS A PREDICTOR OF HOLLOW VISCERAL INJURY

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-199306000-00014 ◽

1993 ◽

Vol 34 (6) ◽

pp. 829-833 ◽

Cited By ~ 30

Author(s):

Jonathan H. Jaffin ◽

M. Gage Ochsner ◽

Frederic J. Cole ◽

Grace S. Rozycki ◽

Mary Kass ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Peritoneal Lavage ◽

Lavage Fluid ◽

Diagnostic Peritoneal Lavage ◽

Visceral Injury ◽

Peritoneal Lavage Fluid ◽

Hollow Visceral Injury

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Diagnostic Peritoneal Lavage for Diagnosing Blunt Hollow Visceral Injury: The Accuracy of Two Different Criteria and Their Combination

Surgery Today ◽

10.1007/s00595-005-3065-9 ◽

2005 ◽

Vol 35 (11) ◽

pp. 935-939 ◽

Cited By ~ 8

Author(s):

Tomoi Sato ◽

Yasuo Hirose ◽

Hideki Saito ◽

Mutsuo Yamamoto ◽

Norio Katayanagi ◽

...

Keyword(s):

Peritoneal Lavage ◽

Diagnostic Peritoneal Lavage ◽

Visceral Injury ◽

Hollow Visceral Injury

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Complex Perineal Injuries in Blunt Trauma Patients: The Value of a Damage Control Approach

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1122 ◽

2015 ◽

Vol 4 (2) ◽

pp. 87-95 ◽

Cited By ~ 1

Author(s):

Newton Djin Mori ◽

Frederico José Ribeiro Teixeira Jr ◽

Sérgio Dias do Couto Netto ◽

Francisco Salles Collet e Silva ◽

Belchor Fontes ◽

...

Keyword(s):

Blunt Trauma ◽

Saline Solution ◽

Bone Fractures ◽

Damage Control ◽

Treatment Protocol ◽

Perineal Wound ◽

Trauma Patients ◽

Visceral Injury ◽

Control Approach ◽

Perineal Injuries

ABSTRACT Purpose In a previous work, we presented a protocol for the management of patients with complex pelviperineal injuries (CPI) resulting from blunt trauma. This treatment protocol included: early hemorrhage control, surgical debridement of devitalized tissue, selective loop transverse colostomy according to the location of the perineal wound, distal colonic irrigation with saline solution, pulsatile saline solution irrigation of the perineal wound, maintenance of the perineal wound open, management of bone fractures and visceral injuries, surgical revisions at intervals of 24 to 48 hours, presumptive antibiotic therapy, early nutritional support, and definitive repair of wound defect and visceral injuries after infection control and metabolic recovery. In order to determine whether the evolution of the authors's protocol for the assessment and management of patients with CPI is associated with improved patient outcome we conduct this review. Materials and methods The medical records of 42 patients with CPI resulting from blunt trauma admitted in the level I trauma center at the HC-USPSM, were reviewed. Demographic data, mechanism of trauma, revised trauma score (RTS) and injury severity score (ISS), classification of perineal injuries, associated systemic trauma, infection complications and mortality rates (overall, early and late) were collected. Results The early mortality was 19% and the late mortality was 17%. The overall mortality was 36%. Patients who died had higher average ISS (average ISS = 45) comparing to patients who survived (average ISS = 25) with significant statistical difference (p < 0.05). Damage control principles applied to CPI was the standard of care and a selective approach to perform fecal stream diversion were used. Conclusion The results of this study showed that the use of this protocol was effective and reinforced the importance of the priority in early control of hemorrhage, early fecal diversion in selected cases, multiple surgical perineal revisions, and avoidance of complex visceral injury repair at the first surgical intervention. How to cite this article Teixeira Jr FJR, do Couto Netto SD, Collete e Silva FS, Mori ND, Fontes B, Poggetti RS, Birolini D, Bernini CO, Utiyama EM. Complex Perineal Injuries in Blunt Trauma Patients: The Value of a Damage Control Approach. Panam J Trauma Crit Care Emerg Surg 2015;4(2):87-95.

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Splenectomy for Trauma Increases the Rate of Early Postoperative Infections

The American Surgeon ◽

10.1177/000313480607201024 ◽

2006 ◽

Vol 72 (10) ◽

pp. 947-950 ◽

Cited By ~ 9

Author(s):

James Wiseman ◽

Carlos V.R. Brown ◽

Janie Weng ◽

Ali Salim ◽

Peter Rhee ◽

...

Keyword(s):

Urinary Tract ◽

Injury Severity ◽

Infectious Complications ◽

Multiple Infections ◽

Trauma Patients ◽

Postoperative Infections ◽

Visceral Injury ◽

Tract Infections ◽

Hollow Visceral Injury ◽

Injury Outcomes

Little is known what effect splenectomy for trauma has on early postoperative infectious complications. Our aim was to determine if splenectomy increases early postoperative infections in trauma patients undergoing laparotomy. We reviewed all trauma patients undergoing splenectomy from June 2002 through December 2004. Each splenectomy patient was matched to a unique trauma patient who underwent laparotomy without splenectomy based on age, gender, mechanism of injury, injury severity score, and presence of colon or other hollow visceral injury. Outcomes included infectious complications including pneumonia, urinary tract infection, bacteremia, and intra-abdominal abscess, as well as mortality. There were 98 splenectomy patients and 98 controls. The splenectomy patients had more overall infectious complications (45% vs 30%, P = 0.04) trended toward more urinary tract infections (12% vs 5%, P = 0.12), and more often had pneumonia (30% vs 14%, P = 0.02). Additionally, more splenectomy patients developed multiple infections (20% vs 7%, P = 0.01). There was no difference in mortality (11% vs 8%, P = 0.63). Splenectomy is associated with an increase in infectious complications after laparotomy for trauma. More specifically, splenectomy patients more often develop pneumonia and multiple infections. This increase in infections is not associated with increased mortality.

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