Diagnostic performance of CT and the use of GI contrast material for detection of hollow viscus injury after penetrating abdominal trauma. Experience from a level 1 Nordic trauma center

2020 ◽  
Vol 61 (10) ◽  
pp. 1309-1315
Author(s):  
Sigurveig Thorisdottir ◽  
Gudrun L Oladottir ◽  
Mari T Nummela ◽  
Seppo K Koskinen
Keyword(s):  
Abdominal Trauma ◽  
Contrast Material ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Hollow Viscus ◽  
Penetrating Abdominal Trauma ◽  
Stab Wounds ◽  
Significant Difference ◽  
Hollow Viscus Injury ◽  
Local Trauma

Background Use of gastrointestinal (GI) contrast material for computed tomography (CT) diagnosis of hollow viscus injury (HVI) after penetrating abdominal trauma is still controversial. Purpose To assess the sensitivity of CT and GI contrast material use in detecting HVI after penetrating abdominal trauma. Material and Methods Retrospective analysis (2013–2016) of patients with penetrating abdominal trauma. Data from the local trauma registry, medical records, and imaging from PACS were reviewed. CT and surgical findings were compared. Results Of 636 patients with penetrating trauma, 177 (163 men, 14 women) had abdominal trauma (mean age 34 years, age range 16–88 years): 155/177 (85%) were imaged with CT on arrival; 128/155 (83%) were stab wounds and 21/155 (14%) were gunshot wounds; 47/155 (30%) had emergent surgery after CT. Two patients were imaged using oral, rectal and i.v. contrast; 23 with rectal and i.v. contrast; and 22 with i.v. contrast only. Surgery revealed HVI in 26 patients. CT had an overall sensitivity 69.2%, specificity 90.5%, PPV 90.0%, and NPV 70.4%. CT with oral and/or rectal contrast (n = 25) had sensitivity 66.7%, specificity 71.4%, PPV 85.7%, and NPV 45.5%. CT with i.v. contrast only (n = 22) had 75% sensitivity, 100% specificity, PPV 100%, and NPV 87.5%. No statistically significant difference was found between sensitivity of CT with GI contrast material and i.v. contrast only ( P = 1). Conclusion Stab wounds were the most common cause of penetrating abdominal trauma. CT had 69.2% sensitivity and 90.5% specificity in detecting HVI. CT with GI contrast had similar sensitivity as CT with i.v. contrast only.

scholarly journals Conservative management of penetrating abdominal trauma (stab wound)

2019 ◽  
Vol 6 (8) ◽  
pp. 2686
Author(s):  
Magdy Ahmed Loulah ◽  
Asem Fayed Mostafa ◽  
Osama Soliman El-Balky ◽  
Abdel-Rahman Mohamed Mohamed Mohamed El-Meligi
Keyword(s):  
Conservative Management ◽  
Penetrating Trauma ◽  
Hollow Viscus ◽  
Penetrating Abdominal Trauma ◽  
Stab Wounds ◽  
A Prospective Study ◽  
Abdominal Stab Wounds ◽  
Abdominal Penetration ◽  
Initial Classification

Background: The aim of the study is to study the reliability of selective conservative management of the penetrating stab abdominal wounds. Trauma is one of the most important reasons of mortality. The mechanism that underlies the penetrating trauma relates to the mode of injury. The early diagnosis of hollow viscus injuries is difficult and a delay in the diagnosis of such injuries may be associated with increased morbidity and mortality. Focused assessment with sonography for trauma (FAST) is an effective for screening and initial classification of stable patients and confirmed by CT scan. The management of stable patients was either surgical exploration or selective non-operative interference with the optimal management of patients is yet to be fully elucidated for abdominal stab wounds (ASW).Methods: A prospective study of 40 patients with penetrating abdominal stab wounds between June 2017 and February 2018, at Damanhour Medical National Institute.Results: The mean age of our patients was 51.9±13.3 years with predominance of males and without predominance of any side to be affected and non-significant deviation from the normal values of hemodynamic signs. The presence of air under diaphragm in X-ray films signify abdominal penetration and ultrasonographic examination (FAST) document the diagnosis and help in following up of cases. Most of hemodynamically stable patients passed conservatively with a little rate of laparotomy.Conclusions: We concluded that there is still a role for conservative management in managing stable cases of penetrating stab abdominal wound. 

scholarly journals Deaths from abdominal trauma: analysis of 1888 forensic autopsies

2017 ◽  
Vol 44 (6) ◽  
pp. 582-595 ◽  
Author(s):  
POLYANNA HELENA COELHO BORDONI ◽  
DANIELA MAGALHÃES MOREIRA DOS SANTOS ◽  
JAÍSA SANTANA TEIXEIRA ◽  
LEONARDO SANTOS BORDONI
Keyword(s):  
Abdominal Trauma ◽  
Forensic Medicine ◽  
Traffic Accidents ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Blood Alcohol ◽  
Penetrating Abdominal Trauma ◽  
Abdominal Organs ◽  
Belo Horizonte ◽  
Epidemiological Profile

ABSTRACT Objective: to evaluate the epidemiological profile of deaths due to abdominal trauma at the Forensic Medicine Institute of Belo Horizonte, MG - Brazil. Methods: we conducted a retrospective study of the reports of deaths due to abdominal trauma autopsied from 2006 to 2011. Results: we analyzed 1.888 necropsy reports related to abdominal trauma. Penetrating trauma was more common than blunt one and gunshot wounds were more prevalent than stab wounds. Most of the individuals were male, brown-skinned, single and occupationally active. The median age was 34 years. The abdominal organs most injured in the penetrating trauma were the liver and the intestines, and in blunt trauma, the liver and the spleen. Homicide was the most prevalent circumstance of death, followed by traffic accidents, and almost half of the cases were referred to the Forensic Medicine Institute by a health unit. The blood alcohol test was positive in a third of the necropsies where it was performed. Cocaine and marijuana were the most commonly found substances in toxicology studies. Conclusion: in this sample. there was a predominance of penetrating abdominal trauma in young, brown and single men, the liver being the most injured organ.

A clinical study of hollow viscus injury in the cases of abdominal trauma

2019 ◽  
Vol 9 (1) ◽  
pp. 13-16
Author(s):  
Ashok F Shelake ◽  
◽  
James Joseph Nadar ◽  
Dwarka R Dhanve ◽  
◽  
...  
Keyword(s):  
Clinical Study ◽  
Abdominal Trauma ◽  
Hollow Viscus ◽  
Hollow Viscus Injury

A CLINICAL STUDY OF PENETRATING ABDOMINAL TRAUMA WITH SPECIAL REFERENCE TO ITS MANAGEMENT : AN INDIAN SCENARIO

2021 ◽  
pp. 1-3
Author(s):  
Saumya Singh ◽  
Anindya Halder ◽  
Niru Das
Keyword(s):  
Data Collection ◽  
Hospital Stay ◽  
Abdominal Trauma ◽  
Surgical Techniques ◽  
Penetrating Trauma ◽  
Diagnostic Methods ◽  
Gunshot Injury ◽  
Abdominal Injuries ◽  
Average Hospital ◽  
Penetrating Abdominal Trauma

Introduction: The incidence of penetrating abdominal injuries has been on the rise. The common availability of rearms, the lack of proper law, armed conicts, civil violence and road trafc accidents are the major causes of penetrating abdominal injuries. As patient with penetrating abdominal trauma are at risk of harbouring life threatening injuries, early diagnosis and timely intervention is the most important steps to reduce its morbidity as well as mortality. Recently due to improvement of the present healthcare system, the outcome of these injuries is improving. Materials And Methods: A descriptive observational study was carried out on 60 cases of penetrating abdominal injuries. A predesigned pretested schedule was used for data collection. Interview of the study subject and evaluation of all clinical reports was done to obtain the history, clinical ndings, management, complications, mortality and follow up. Before data collection, informed consent was obtained from each and every study subjects. Results: The overall incidence of penetrating abdominal trauma was found to be 2.30% of the total admission of 6217 patients in the department of surgery. The most common cause of penetrating abdominal injury found in this study is stab injury by sharp objects which is followed by gunshot injury. The commonest age group affected was 20 to 30 years which comprises about 41.67%. In this study we found a male preponderance in cases of penetrating injury to the abdomen. In most of the cases the mode is homicidal stab or gunshot injury followed by accidental injuries. Pain, abdominal distension and bleeding from the wound are the main presenting symptom. After initial evaluation with USG (FAST),CTscan abdomen is the most valuable investigation so far. In this series, it is found that the small intestine is the most commonly involved viscera followed by colon, omentum, mesentery and liver respectively. Most common complications after operative intervention was wound infection. The average hospital stay was 6 to 15 days. It has been observed that the post-operative complications, associated injuries and multiple organ injuries are the cause of increased hospital stay. Conclusion: Penetrating trauma can be serious because it can damage internal organs and presents a risk of shock and infection. In the present year, due to overall improvement in the communication and transportation, better monitoring systems and resuscitative measures, improvised diagnostic methods, better availability of blood and blood products, better medications and more skilful surgical techniques, the outcomes of these injuries are improving.

Dual-Energy CT: A Paradigm Shift in Acute Traumatic Abdomen

2020 ◽  
Vol 71 (3) ◽  
pp. 371-387 ◽  
Author(s):  
Saira Hamid ◽  
Savvas Nicolaou ◽  
Faisal Khosa ◽  
Gordon Andrews ◽  
Nicolas Murray ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Trauma ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Vascular Injuries ◽  
Intravenous Contrast ◽  
Penetrating Abdominal Trauma ◽  
Portable Ultrasound

Abdominal trauma, one of the leading causes of death under the age of 45, can be broadly classified into blunt and penetrating trauma, based on the mechanism of injury. Blunt abdominal trauma usually results from motor vehicle collisions, fall from heights, assaults, and sports and is more common than penetrating abdominal trauma, which is usually seen in firearm injuries and stab wounds. In both blunt and penetrating abdominal trauma, an optimized imaging approach is mandatory to exclude life-threatening injuries. Easy availability of the portable ultrasound in the emergency department and trauma bay makes it one of the most commonly used screening imaging modalities in the abdominal trauma, especially to exclude hemoperitoneum. Evaluation of the visceral and vascular injuries in a hemodynamically stable patient, however, warrants intravenous contrast-enhanced multidetector computed tomography scan. Dual-energy computed tomography with its postprocessing applications such as iodine selective imaging and virtual monoenergetic imaging can reliably depict the conspicuity of traumatic solid and hollow visceral and vascular injuries.

scholarly journals Isolated free fluid on computed tomography for blunt abdominal trauma

2019 ◽  
Vol 101 (8) ◽  
pp. 552-557
Author(s):  
W Bekker ◽  
MTD Smith ◽  
VY Kong ◽  
JL Bruce ◽  
G Laing ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Splenic Injury ◽  
Operative Management ◽  
Bladder Injury ◽  
Free Fluid ◽  
Abdominal Ct ◽  
Hollow Viscus ◽  
Hollow Viscus Injury ◽  
Non Operative Management

Introduction The clinical significance of isolated free fluid on abdominal computed tomography (CT) in patients with blunt abdominal trauma is unclear. This audit reviews our unit’s experience with isolated free fluid and attempts to refine our clinical algorithms for the assessment of patients with blunt abdominal trauma. Materials and methods All patients who sustained blunt abdominal trauma between December 2012 and December 2017 who were subjected to multidetector CT of the abdomen as part of their initial investigation were included in this study. Results During the five-year period under review, a total of 1066 patients underwent abdominal CT following blunt poly trauma. A total of 84 (7.9%) patients died. There were 148 (14%) patients with CT finding of isolated free fluid. Of these, 128 (67%) were selected for non-operative management, which included a period of serial abdominal examinations. In this non-operative group, five patients failed their abdominal observations and underwent laparotomy. Findings in these five cases were negative (1), non-therapeutic (1), splenic injury (1), Pancreatic and splenic injury (1) and bladder injury (1). Thirteen patients (10%) died, none of whom had surgery. The causes of death were exsanguination from a major traumatic lower limb injury (1), multiple organ failure (1), traumatic brain injury (10) and spinal cord injury (1). The remaining 20 patients underwent laparotomy. The indications were failed non-operative management (5), abdominal distension (1) and suspicion of a missed hollow viscus injury (14). In this group there were 11 therapeutic and 6 non-therapeutic surgeries and three negative laparotomies. For the 15 patients selected for operative management, the findings were as follows: hollow viscus injury (3), mesenteric bleeds (2), splenic and pancreatic injury (1), liver and bladder injury (1), splenic and bladder injury (1), non-therapeutic (4), negative (3). The finding of isolated free fluid on CT is 98% sensitive and 96% specific for true isolated free fluid (chi square 331.598; P = 0.000). This finding predicts successful non-operative management with a positive predictive value of 93% and a negative predictive value of 96%. Discussion In patients with blunt abdominal trauma, the finding of isolated free fluid on abdominal CT alone is no longer an indication for laparotomy. Other clinical factors must be taken into account when deciding on the need for laparotomy, such as haemodynamic status, clinical abdominal findings and the ability to reliably assess the abdomen. In the absence of a clinical indication for urgent laparotomy, patients with isolated free fluid may be observed.

Solid Viscus Injury Predicts Major Hollow Viscus Injury in Blunt Abdominal Trauma

1997 ◽  
Vol 43 (4) ◽  
pp. 618-623 ◽  
Author(s):  
Michael L. Nance ◽  
Gerald W. Peden ◽  
Michael B. Shapiro ◽  
Donald R. Kauder ◽  
Michael F. Rotondo ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Hollow Viscus ◽  
Hollow Viscus Injury

scholarly journals Laparoscopy and Penetrating Abdominal Trauma: A Systematic Review

2019 ◽  
Vol 4 (7) ◽  
pp. 217-231
Author(s):  
Bráulio Filgueira Magalhães ◽  
Pedro De Sousa Leite ◽  
Pedro Hugo Bezerra Maia Filho ◽  
George Wallisson Severo de Sá ◽  
Whallyson Pinheiro Mascarenhas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Abdominal Trauma ◽  
Retrieval System ◽  
Penetrating Trauma ◽  
Laparoscopic Approach ◽  
Final Analysis ◽  
Penetrating Abdominal Trauma ◽  
Penetrating Wound ◽  
Definition Of

This article aims to evaluate the effectiveness and use of laparoscopy in penetrating abdominal trauma, thus providing a better definition of the role of laparoscopic approach in patients with PAD.  A systematic review was performed by searching indexed articles in the Virtual Health Library and the Medical Literature Analysis and Retrieval System Online database (MEDLINE / PubMed), in which analysis after final analysis included 07 articles.  In this study we identified seven articles that evaluated the use and contributions of the laparoscopic approach in patients with TAP, in which it was identified that the use as a diagnostic approach is widely used due to its benefits and safety.  Regarding its therapeutic approach it was determined that in the largest of the studies there is indication, usefulness, reliability and accuracy of its use, however, for better results is essential experience of the surgical team in laparoscopic technique.Keywords: Abdominal trauma;  Laparoscopy and Penetrating Trauma;  Abdominal injury;  Laparoscopy;  Penetrating wound.

scholarly journals Role of Diagnostic Laparoscopy in Penetrating Abdominal Trauma

2021 ◽  
Vol 15 (10) ◽  
pp. 3514-3516
Author(s):  
Fatima Abbasi ◽  
Muhammad Khurram Zia ◽  
Farhan Siddique ◽  
Ali Adnan ◽  
Hina Tahseen
Keyword(s):  
Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
Bowel Perforation ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Penetrating Abdominal Trauma ◽  
Missed Injury ◽  
Operative Findings ◽  
Intraabdominal Injury

Background and Objective: Trauma remains the major cause of mortality and disability among young people across the world with penetrating trauma being a very common cause. Traditionally, penetrating abdominal trauma was managed with exploration. But now with the advent of minimally access surgery and advancements in laparoscopic expertise, more patients can be managed with minimally invasive methods. This approach can save many unnecessary laparotomies and large midline incisions. The role of laparoscopy in blunt abdominal trauma is well established. The aim of this study was to evaluate the role of diagnostic laparoscopy in penetrating abdominal injuries. Methods: All the penetrating abdominal trauma patients presenting to the emergency department of Rawal Medical and Dental hospital from January 2019 till December 2020 for a period of 2years (a total of 102 patients) and who were hemodynamically stable, between the ages of 20 to 50 years of either gender were included in the study. All these patients had equivocal abdominal findings with no signs to suggest serious intraabdominal injury. These patients were prepared as standard for general anesthesia and diagnostic laparoscopy was performed. A predesigned performa was used for entering the patients’ details and operative findings. All patients gave written informed consent in urdu. Main outcome measures were the conversion rate, missed injuries leading to reexploration. Results: 85%of the patients were males with only 15% females. Mean age of the population was 38.7 years .Conversion to open was required in only 6.12 % of the cases .Laparoscopy alone was sufficient for all other patients. In about 36% of the patients no intraabdominal injury was found. In rest 58% patients the surgeons were able to repair the injuries laparoscopically.18 patients had minor liver injury,10 patients had minor hemoperitoneum<100 ml without any significant injury and 2 patients had single small bowel perforation which was repaired laparoscopically and cavity was irrigated. No patient had post operative complications of peritonitis due to missed injury or bleeding leading to re exploration. Conclusion: Laparoscopy is a very effective procedure to deal with penetrating abdominal trauma patients who are stable and with equivocal abdominal findings without increasing risk of missed injury with minimal rates of conversion to open laparotomy if patients are selected vigilantly. Keywords: Penetrating, Diagnostic Laparoscopy, Abdominal Trauma

Injuries to the Stomach, Small Bowel, Colon, and Rectum

2020 ◽  
Author(s):  
Jordan A Weinberg ◽  
Timothy C. Fabian
Keyword(s):  
Small Bowel ◽  
Abdominal Trauma ◽  
Operative Management ◽  
Bowel Injury ◽  
Organ Injury ◽  
Gastric Injury ◽  
Rectal Injury ◽  
Trauma Patients ◽  
Hollow Viscus ◽  
Hollow Viscus Injury

Hollow viscus injury is most often the consequence of penetrating abdominal trauma. As a result of blunt force trauma, bowel injury occurs with relative infrequency: in one multi-institutional analysis, only 1.2% of blunt trauma admissions had an associated hollow viscus injury. The diagnosis of hollow viscus injury remains a challenge in abdominal trauma patients, and subsequent evaluation is determined by the mechanism of injury. Regardless of the specific injury mechanism, however, the principles and techniques of operative management are largely the same. This review covers determination of need for operation, and operative management. Figures show algorithms outlining the evaluation of blunt hollow organ injury in a hemodynamically stable patient with an unreliable physical examination, the treatment of truncal stab wounds, the treatment of blunt bowel and mesenteric injury, the treatment of gastric injury, the treatment of small bowel injury, the treatment of colon injury, the treatment of rectosigmoid or rectal injury, and a demonstration of presacral drainage through a curved incision midway between the anus and the tip of the coccyx. Tables list the incidence of findings suggestive of blunt mesenteric and bowel injury in true positive and false positive computed tomography  scans, and the American Association for the Surgery of Trauma organ injury scales for gastrointestinal tract and pancreas.   This review contains 8 figures, 3 tables, and 58 references Keywords: Injury, blunt, primary rectal repair, colostomy, laparotomy, trauma

Sign in / Sign up

Export Citation Format

Share Document