scholarly journals Peritoneal Breach as an Indication for Exploratory Laparotomy in Penetrating Abdominal Stab Injury: Operative Findings in Haemodynamically Stable Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Jasmina Kevric ◽  
Victor Aguirre ◽  
Kate Martin ◽  
Dinesh Varma ◽  
Mark Fitzgerald ◽  
...  
Keyword(s):  
Ct Scan ◽  
Exploratory Laparotomy ◽  
Operative Management ◽  
Organ Damage ◽  
Trauma Centre ◽  
Visceral Injury ◽  
Negative Laparotomy ◽  
Major Trauma Centre ◽  
Trauma Ct ◽  
Operative Findings

Introduction. Management of haemodynamically stable patients with penetrating abdominal injuries varies from nonoperative to operative management. The aim was to investigate whether peritoneal breach when used as an indication for exploratory laparotomy appropriately identified patients with intra-abdominal visceral injury.Methods.We conducted retrospective cohort study of all patients presenting with PAI at a major trauma centre from January 2007 to December 2011. We measured the incidence of peritoneal breach and correlated this with intra-abdominal visceral injury diagnosed at surgery.Results. 252 patients were identified with PAI. Of the included patients, 71 were managed nonoperatively and 118 operatively. The operative diagnoses included nonperitoneal-breaching injuries, intraperitoneal penetration without organ damage, or intraperitoneal injury with organ damage. The presenting trauma CT scan was reported as normal in 63%, 34%, and 2% of these groups, respectively. The total negative laparotomy/laparoscopy rate for all patients presented with PAI was 21%, almost half of whom had a normal CT scan.Conclusion. We found that peritoneal breach on its own does not necessarily always equate to intra-abdominal visceral injury. Observation with sequential examination for PAI patients with a normal CT scan may be more important than exclusion of peritoneal breach via laparoscopy.

310 Management of Anterior Penetrating Abdominal Injuries and the Role of Computerised Tomography

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Sanchez-Thompson ◽  
D Frith
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Operative Management ◽  
Trauma Centre ◽  
Abdominal Injury ◽  
Computerised Tomography ◽  
Abdominal Injuries ◽  
Number Of Patients ◽  
Major Trauma Centre ◽  
Operative Findings

Abstract Introduction Optimal management of anterior penetrating abdominal injuries (A-PAI) is an area of ongoing debate. Randomised controlled trials are missing and guidelines are based on expert opinion. The accuracy of computerised tomography (CT) is challenged, and hence diagnostic laparoscopies are still widely used. Method We retrospectively reviewed the TARN database identifying patients presenting with A-PAI to a London Major Trauma Centre between 01/19/2015-31/03/2018 and reviewed their clinical notes. Results 143 patients were identified (79% male, mean age = 30). Non-operative management (NOM) took place without complication in 15% (n = 12) of cases, despite 38% (n = 8) showing a potential peritoneal breach on CT, and 19% (n = 4) a definitive intra-abdominal injury. Of the 37% (n = 53) of patients undergoing laparoscopy, half revealed no intra-abdominal injury. When comparing CT consultant reports to intra-operative findings, the accuracy of CT in identifying peritoneal breach was calculated to be 93% and sensitivity at 95%. Negative predictive value was 62%. Conclusions We concluded that a significant number of patients have unnecessary laparoscopies, which are not without risk. CT is an excellent resource, but negative predictive value is poor. NOM with serial abdominal examination remains a valid clinical option in the stable non-peritonitic patient and in the absence of definitive viscous perforation on CT.

scholarly journals 1065 Exposing the Incidence of Ileus in Pelvic and Acetabular Fractures: A Retrospective Case Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Ward ◽  
R Ahmed ◽  
J Adedeji ◽  
J McGregor-Riley
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
High Energy ◽  
Trauma Centre ◽  
Acetabular Fractures ◽  
Retrospective Case ◽  
Visceral Injury ◽  
Bowel Surgery ◽  
Major Trauma Centre ◽  
Fracture Management

Abstract Background Paralytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury. This is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures. Method All patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data included patient demographics, injury pattern, fracture management and presence of ileus. Previous studies identified patients as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay. Results An incidence of ileus of 40.35% was observed in the 57 included patients. Ileus was three times more common in patients with a diagnosis of diabetes mellitus (p = 0.56) and 2.5 times more common in the presence of an open pelvic/acetabular fracture (p = 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p = 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors. Conclusions The authors have identified the essentiality of early risk factor identification and hope to encourage further research to create a prognostic tool.

Diagnostic Laparoscopy Reduces the Rate of Negative Laparotomy in Trauma Patients

2020 ◽  
Vol 22 (1) ◽  
pp. 47-51
Author(s):  
Debashish Bar ◽  
Masrur Akbar Khan ◽  
Sanjana Sharmin Shashi ◽  
AZM Mahfuzur Rahman ◽  
ABM Khurshid Alam ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
Exploratory Laparotomy ◽  
Operative Management ◽  
Bowel Injury ◽  
Trauma Patients ◽  
Abdominal Injuries ◽  
College Hospital ◽  
Negative Laparotomy ◽  
Intraabdominal Injuries

Background: The last century has witnessed immense evolvement of management of patients with abdominal trauma. Moreover the recent trend has shifted to selective operative management rather than exploratory laparotomy in trauma patients with suspected intraabdominal injuries and is considered more rational as well. Diagnostic laparoscopy is highly sensitive in detecting intra-abdominal injury with subsequent reduction in the rate of negative laparotomy and procedure related morbidity. Objective: The study was carried out to find the role of diagnostic laparoscopy in abdominal trauma. Methods: An observational study was carried out in the casualty block of Dhaka Medical College Hospital from 1st June 2015 to 30th March 2016. A total of 50 successive patients were assigned in this study. All of them were admitted with abdominal trauma and underwent diagnostic laparoscopy during the period of 10 months. The study was designed to find out whether laparoscopy can help in identifying intra-abdominal injuries with consequent avoidance of unnecessary operative explorations. Results: Intra-abdominal injuries other than GIT perforation were diagnosed by laparoscopy with 100% accuracy but in case of bowel injury the diagnostic accuracy was 80%. Conclusion: Diagnostic laparoscopy is the procedure of choice in doubtful intra-abdominal injuries with impressive accuracy except for bowel injury. Subsequently it reduced the need for negative laparotomies with their procedure related adverse effects. Journal of Surgical Sciences (2018) Vol. 22 (1): 47-51

scholarly journals 594 Optimising Hand Trauma Care at a Major Trauma Centre (MTC) During the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Khajuria
Keyword(s):  
Operative Management ◽  
Trauma Centre ◽  
Definitive Treatment ◽  
Face To Face ◽  
Major Trauma Centre ◽  
Treatment Centre ◽  
One Stop ◽  
The One ◽  
Non Operative Management

Abstract Introduction This study evaluates the management of hand injuries during COVID-19 following the prompt implementation of the BOA guidelines; reconfiguration of hand services and implementation of the ‘one-stop’ model. Method 285 cases OVER A 1-MONTH PERIOD were RETROSPECTIVELY reviewed to evaluate the effectiveness of managing patients using the ‘one-stop’ model and the new Urgent Treatment Centre (UTC). Results 277 patients were included in the study. During Covid-19, operative cases fell by 62%. 86.3% (239/277) of cases were managed in the UTC; 54.4% (130/239) required conservative management and 45.6% (109/239) required minor procedures (in UTC). REMOVABLE SPLINT USE was optimized through design of ‘softcasts’ for non-operative management of distal radius fractures. A patient education video: ‘softcast removal at home’ was created and in cases requiring sutures, 95.1% (39/41) were absorbable, thereby avoiding COVID-19 exposure for follow-up. Only 50.5% (140/277) of patients had formal follow-up arranged and patient information follow-up cards were developed. Conclusions The one-stop model prevents delay in definitive treatment, allows effective initial treatment, and minimizes the need for face-to-face follow up. In light of a possible second wave of COVID-19 cases, this new model should be considered for implementation by all hand’s units for the foreseeable future.

scholarly journals Trauma Audit for Intra-Abdominal Injury in Hospital Pulau Pinang

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Choon Hui Gan ◽  
Viknesh S ◽  
Wai Pheng Wong ◽  
Sahul Hamid
Keyword(s):  
Ct Scan ◽  
Chinese Population ◽  
Splenic Injury ◽  
Motor Vehicle ◽  
Operative Management ◽  
Skewed Distribution ◽  
Abdominal Injury ◽  
Negative Laparotomy ◽  
Chinese Ethnicity ◽  
Non Operative Management

Introduction: Intra-abdominal injury is one of the leading causes of morbidity and mortality in all age groups in the world. Our aim is to review the demography, incidence rates and prevalence of intra-abdominal injury in Hospital Pulau Pinang in a tertiary hospital in Northern region of Malaysia. Materials and Methods: We retrospectively reviewed medical records of patients diagnosed with intra-abdominal injury from January 2016 until December 2017 using an in-house electronic database. Traumatic renal injury was excluded. Diagnosis was confirmed via contrast-enhanced CT scan or exploratory laparotomy. Results: A total of 82 patients were diagnosed with intraabdominal injury over a period of 2 years. There is a male (75.61%) and of Chinese ethnicity (43.90%) predominance. Median age at presentation was 20 years old. The oldest patient was 94 years old and the youngest patient was 9 months old. Commonest etiology was motor vehicle accident (78.04%) followed by traumatic fall (12.19%). The commonest injury was splenic injury (50%) followed by liver injury (39.28%). The majority of patient (59.52%) was treated non-surgically, in which a grade 2 splenic injury patient underwent operation after failing a non-operative management. There were only 2 mortalities among the 34 patients in the operative group. There is a higher incidence among Chinese ethnicity due to skewed distribution of Chinese population in our studied area in relation to total Chinese population in Malaysia. We showed a reduction in negative laparotomy in stable patients with suspected intra-abdominal injury with the utilization of a CT scan. Decision for non-operative management should be tailored to individualized approach accompanied by serial assessment for optimal care. Conclusion: Blunt trauma was the most common type of intra-abdominal injury and the spleen was found to be the most common organ injured.

scholarly journals Quantifying the burden of trauma imaging on the CT scan service at a major trauma centre in South Africa

2019 ◽  
Vol 57 (2) ◽  
pp. 48-53
Author(s):  
AA Bashir ◽  
VY Kong ◽  
RD Weale ◽  
JL Bruce ◽  
GL Laing ◽  
...  
Keyword(s):  
South Africa ◽  
Ct Scan ◽  
Major Trauma ◽  
Trauma Centre ◽  
Major Trauma Centre ◽  
Trauma Imaging

scholarly journals O35 The impact of COVID-19 on access and availability of radiological imaging and surgical intervention at the east Midlands major trauma centre: an icon trauma study

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
J K Seehra ◽  
C Lewis-Lloyd ◽  
G Gida ◽  
A Adiamah ◽  
A Brooks
Keyword(s):  
Ct Scan ◽  
Major Trauma ◽  
Surgical Intervention ◽  
Ct Scanning ◽  
Fold Increase ◽  
Trauma Centre ◽  
Similar Time ◽  
Operative Care ◽  
Major Trauma Centre ◽  
The Impact

Abstract Introduction During the COVID-19 pandemic, Major Trauma services were subject to significant challenges including reduced access to Computed Tomography (CT) scanning and restrictions on operative intervention due to limited intensive care beds. This study evaluated the pandemic’s impact on access and timeliness of imaging and surgical intervention. Method This observational study compared 2 cohorts of patients admitted in a 10-week period during the COVID-19 pandemic and a similar time period in 2019. Variables included demographics, time to CT scan and to surgery and operative characteristics. Statistical comparisons were undertaken using Mann Whitney U, Fisher’s exact and Chi-squared tests. Result Of 642 patients, 405 were admitted in 2019 and 237 in 2020 representing a 41.5% absolute reduction in trauma admissions during the pandemic. There were no statistical differences (P = 0.2585) between arrival to the Emergency Department and time to CT scan across both years (median 42 minutes) or between operative approach (P = 0.728) and level of post-operative care (P = 0.788). However, there were statistical differences in time to surgery (P = 0.0193) and operative length (P = 0.0141) with a 2-fold increase in overnight operating, 31.2% increase in patients operated on < 24 hours from admission, and 42.9% reduction in surgery lasting >120 minutes during the COVID-19 pandemic. Conclusion Early robust restructuring of trauma services during the COVID-19 pandemic ensured timely access to appropriate imaging and surgery for major trauma injured patients. The higher rates of overnight surgery and shorter duration of procedure were likely explained by the increased onsite availability of suitably trained trauma surgical teams. Take-home Message COVID-19 had the potential to significantly impact Major Trauma services, however excellence in patient care was maintained by quick restructuring to staff, space and services Improvements to the Major Trauma pathway have become ingrained into daily practice and optimised for future outbreaks.

scholarly journals The use of fibrin sealant patches in the operative management of liver trauma: Experience of a UK major trauma centre

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e277
Author(s):  
J.-J. Reilly ◽  
P. MacGoey ◽  
G. Kalogeropoulos ◽  
A. Navarro ◽  
A. Brooks
Keyword(s):  
Fibrin Sealant ◽  
Major Trauma ◽  
Operative Management ◽  
Liver Trauma ◽  
Trauma Centre ◽  
Major Trauma Centre

scholarly journals P84 Optimising hand trauma care at a Major Trauma Centre (MTC) during the COVID-19 pandemic

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Apoorva Khajuria ◽  
Matthew Jones ◽  
Apoorva Khajuria
Keyword(s):  
Operative Management ◽  
Trauma Centre ◽  
Definitive Treatment ◽  
Face To Face ◽  
Major Trauma Centre ◽  
Treatment Centre ◽  
One Stop ◽  
The One ◽  
Non Operative Management

Abstract Introduction This study evaluates the management of hand injuries during COVID-19 following the prompt implementation of the BOA guidelines; reconfiguration of hand services and implementation of the ‘one-stop’ model. Methods 285 cases OVER A 1-MONTH PERIOD were RETROSPECTIVELY reviewed to evaluate the effectiveness of managing patients using the ‘one-stop’ model and the new Urgent Treatment Centre (UTC). Results 277 patients were included in the study. During Covid-19, operative cases fell by 62%. 86.3% (239/277) of cases were managed in the UTC; 54.4% (130/239) required conservative management and 45.6% (109/239) required minor procedures (in UTC). REMOVABLE SPLINT USE was optimized through design of ‘softcasts’ for non-operative management of distal radius fractures. A patient education video: ‘softcast removal at home’ was created and in cases requiring sutures, 95.1% (39/41) were absorbable, thereby avoiding COVID-19 exposure for follow-up. Only 50.5% (140/277) of patients had formal follow-up arranged and patient information follow-up cards were developed. Conclusion The one-stop model prevents delay in definitive treatment, allows effective initial treatment, and minimizes the need for face-to-face follow up. In light of a possible second wave of COVID-19 cases, this new model should be considered for implementation by all hand’s units for the foreseeable future.

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