Diagnostic aspects of closed abdominal injuries

Aim. To study diagnostic value of various diagnostic methods for patients with closed abdominal injury, to develop a diagnostic algorithm to make a reasonable conclusion about the amount and severity of injuries of the abdomen.Methods. Various diagnostic methods used in closed abdominal injuries from 120 patients admitted to Surgical Department №2 of Kazan city clinical hospital №7 from 2007 to 2015 were analyzed. Majority of victims (65%) with closed abdominal trauma were males aged 20 to 50 years.Results. Efficiency of diagnostic program for patients with closed abdominal injury used in clinical practice was studied. In a closed abdominal trauma, injury of abdominal organs was detected in 52.5% of patients. 71.4% of those injuries were isolated and 28.6% were concomitant. According to frequency of injuries liver took the first place 15 (23.8%), followed by spleen on the second place (14; 22.2%) and kidneys (12; 19.1%) and intestine (12; 19.1%) on the third, bladder on the fourth (7; 11.1%), and pancreas on the fifth place (3; 4.8%). Importance of radiological methods and laparoscopy was demonstrated. Clinical examination and laboratory diagnostic techniques allow making a timely diagnosis in only 40% of victims. Informativity of radiologic study was 64%. The accuracy of ultrasound in damaged kidneys was 100%, that in rupture of liver was 72%, of spleen, 69%, and of the intestine (0%). Diagnostic accuracy of laparoscopy was 98.9%.Conclusion. Experience and extensive acquaintance with modern literature allowed the authors to present the algorithm of examination of patients with suspected closed abdominal trauma.

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

10.36106/ijsr/9505705 ◽

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.

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Рreoperative diagnosis of parathyroid gland pathology by methods of radiological diagnostics

Diagnostic radiology and radiotherapy ◽

10.22328/2079-5343-2021-12-2-22-29 ◽

2021 ◽

Vol 12 (2) ◽

pp. 22-29

Author(s):

V. A. Pospelov

Keyword(s):

Parathyroid Gland ◽

Diagnostic Algorithm ◽

Diagnostic Techniques ◽

Diagnostic Methods ◽

Preoperative Imaging ◽

Surgical Approaches ◽

Planar Scintigraphy ◽

Diagnostic Characteristics ◽

Preoperative Diagnostic ◽

Attending Physician

Introduction. Recently, surgeons have been using minimally invasive methods to treat parathyroid gland pathology. More selective surgical approaches are based on the accuracy of preoperative diagnostic methods. Various radiological diagnostic techniques are used to visualize parathyroid gland pathology. New modalities are entering clinical practice along with long-known techniques. The attending physician should be guided by the most clinically effective and economically reasonable algorithm when choosing diagnostic algorithm. The aim of the study was to find the optimal diagnostic protocol for preoperative diagnosis of parathyroid gland pathology on the basis of available data. Conclusion. Preoperative imaging of parathyroid glands continues to evolve with changes of old techniques and appearance of new ones, though none of modalities has a clear advantage. The choice of imaging algorithm is largely based on the availability of techniques and the experience of particular diagnostic centers. Ultrasound and planar scintigraphy are well established and most widely used. The combination of these techniques remains the first line of diagnosis in preoperative imaging. However, there is no consensus on the choice between planar scintigraphy tech niques: the washout method or the subtraction method. Replacing planar scintigraphy with SPECT/CT improves the detectability of pathological masses and clarifies their topographic location. Computed tomography and MRI techniques are used as a second-line technique and have an advantage in small adenoma sizes, multiple lesions, ectopias, reoperations, and in case of ambiguous ultrasound and scintigraphy data. The significance of PET/CT in the diagnosis of thyroid pathology has not yet been defined, the data are still scarce and published studies are very heterogeneous, but due to the excellent diagnostic characteristics the method seems very promising, in particular in patients with persistent disease.

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Retrospective study of polytrauma patients’s medical records that presented abdominal trauma, comperad to abdominal trauma and extra-abdominal injuries

Acta Scientiarum Health Sciences ◽

10.4025/actascihealthsci.v43i1.56944 ◽

2021 ◽

Vol 43 ◽

pp. e56944

Author(s):

Izadora Gabriela Coutinho ◽

Thiago Henriqque Crema ◽

Bruno Felipe Viotto Petta ◽

Carlos Edmundo Rodrigues Fontes

Keyword(s):

Abdominal Trauma ◽

Medical Records ◽

Statistical Significance ◽

Abdominal Injury ◽

University Hospital ◽

Morbidity Rate ◽

Abdominal Injuries ◽

Regional University ◽

Polytrauma Patients ◽

Trauma Victims

This study sought to retrospectively assess the relationship between intra and extra-abdominal injuries in polytrauma patients undergoing laparotomy at the Regional University Hospital of Maringá between 2017 and 2018.This study was based on 111 electronic medical records from the Brazilian public health system “SUS”, admitted to the hospital due to trauma and undergoing laparotomy, comparing two groups: abdominal injury without extra-abdominal injury (WoEI) and abdominal injury with extra-abdominal injury (WiEI).A total of 111 medical records were analyzed, 57 from 2017 and 54 from 2018. Of these 111records, 43 (39%) were trauma victims with only abdominal injuries and 68 (61%) trauma victims with abdominal and extra-abdominalinjuries. Most patients were male (85%), with an average age of 33 years, ranging from 14 to 87 years. In statistical analysis, according to the T-test, there was significance (p > 0.05) between the WoEI and WiEI groups for data collected regarding death rates and hospitalization days. As for the morbidity rate and difference between genders (male and female), there was no statistical significance (p < 0.05). Polytrauma patients are exposed to greater kinetic energy, with more severe conditions and therefore required more in-hospital care.

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Diagnostic Value of sIL-2R, TNF-α and PCT for Sepsis Infection in Patients with Closed Abdominal Injury Complicated with Severe Multiple Abdominal Injuries

10.21203/rs.3.rs-618562/v1 ◽

2021 ◽

Author(s):

Anquan Shang ◽

Wei Zhang ◽

Yuzhu Dai ◽

Weiwei Wang ◽

Li-zhen He ◽

...

Keyword(s):

Diagnostic Value ◽

Abdominal Injury ◽

Sepsis Group ◽

Abdominal Injuries ◽

Infection Group ◽

Low Level ◽

Cut Point ◽

Tnf Α ◽

High Level ◽

Level Group

Abstract Objective: To evaluate the diagnostic value of soluble interleukin-2 receptor (sIL-2R), tumor necrosis factor-α (TNF-α), procalcitonin (PCT) and combined detection for sepsis infection in patients with closed abdominal injury complicated with severe multiple abdominal injuries.Patients and Methods: 140 patients with closed abdominal injury complicated with severe multiple abdominal injuries who were diagnosed and treated in 2015 to 2020, were divided into sepsis group (n = 70), and infection group (n = 70).Results: The levels of sIL-2R, TNF-α and PCT in sepsis group were higher than those in infection group (P < 0.05). ROC curve showed that the AUC values of sIL-2R, TNF-α, PCT and sIL-2R+TNF-a+PCT were 0.827, 0.781, 0.821 and 0.846, respectively, which were higher than those of WBC, CRP, SAA, and IL-6. AUC of the three combined tests was higher than that of TNF-α, and the difference was statistically significant (P < 0.05). There was no significant difference in AUC between sIL-2R and TNF-α, sIL-2R and PCT, TNF-α and PCT, three combined tests and sIL-2R, three combined tests and PCT (P > 0.05). When the median was used as the cut point, the corrected sIL-2R, TNF-α, PCT high level group was not better than the low level group in the risk of sepsis (P >0.05). When the four groups were classified by using quantile as cut point, the OR risk values of the high level of TNF-α and PCT (Q4) and the low level of PCT (Q1) after correction were 7.991 and 21.76, respectively, with statistical significance (P < 0.05).Conclusions: The detection of sIL-2R, TNF-α and PCT has a good value in the diagnosis for sepsis infection in patients with closed abdominal injury complicated with severe multiple abdominal injuries. The high concentrations of PCT and TNF-α can be used as predictors of septic infection risk.

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Abdominal Trauma and Complications

10.2310/7ccsp.8174 ◽

2019 ◽

Author(s):

Alia Aunchman ◽

Ajai K Malhotra

Keyword(s):

Abdominal Trauma ◽

Damage Control ◽

Abdominal Injury ◽

Morbidity And Mortality ◽

Lower Grade ◽

Solid Organ ◽

Abdominal Injuries ◽

Hollow Viscus ◽

Contrast Enhanced Ct ◽

Operative Exploration

The abdomen, including pelvis, is injured in 10 to 15% of significantly injured patients: 80% by blunt and 20% by penetrating mechanisms. Abdominal injuries can be subtle and hence missed. The majority of injuries, if detected early, can be treated, and hence, delay in diagnosis or underappreciation of the severity of intra-abdominal injury is responsible for significant preventable morbidity and even mortality. The initial management is the same as any trauma patient, with the greatest threats to life addressed first. If the patient is in shock and the source is intra-abdominal, urgent laparotomy is indicated along with damage control resuscitation. If the patient remains in shock in the operating room, abbreviated damage control laparotomy should be pursued. In stable patients with penetrating mechanism, if the penetration extends into the peritoneal cavity, operative exploration to identify and address any injury is the safest approach; however, more selective approaches are increasingly being pursued. In stable patients with blunt mechanism, a thorough evaluation, usually including IV contrast-enhanced CT (CECT) is pursued to diagnose, and equally importantly, exclude intra-abdominal injury. High-quality IV CECT has a very high negative predictive value for intra-abdominal injuries. In stable patients, injuries to spleen, liver, and kidney, irrespective of grade, are managed nonoperatively with or without angioembolization. Lower-grade pancreatic injuries are managed nonoperatively or with drainage, whereas higher-grade injuries (involving major ducts) usually require resection. Majority of gastrointestinal hollow viscus injuries are managed with repair, resection with anastomosis or diversion. Delays as short as 8 hours in definitive management of such injuries increase morbidity and mortality. Intra and retro peritoneal genitourinary injuries are repaired and extraperitoneal ones are managed without surgery. Retroperitoneal hematomas are managed based on mechanism, stability, and location. Abdominal trauma is associated with a host of complications that need to be detected early and managed appropriately to prevent delayed morbidity and mortality. This review contains 5 figures, 6 tables, and 60 references. Key Words: abdomen, complications, damage control, diaphragm, hollow viscus, trauma, solid organ, retroperitoneum

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Diagnosis and treatment of non-allergic rhinitis

Russian otorhinolaryngology ◽

10.18692/1810-4800-2020-4-27-33 ◽

2020 ◽

Vol 19 (4) ◽

pp. 27-33

Author(s):

M. A. Zavaliy ◽

◽

T. A. Krylova ◽

A. N. Orel ◽

A. G. Balabantsev ◽

...

Keyword(s):

Allergic Rhinitis ◽

Diagnostic Algorithm ◽

The United States ◽

Diagnostic Value ◽

Evidence Base ◽

Convincing Evidence ◽

Diagnostic Methods ◽

Chronic Rhinitis ◽

Icd 10 ◽

Non Allergic Rhinitis

There is considerable disagreement in the views on the problem of rhinitis, which concerns classification issues, as well as the role and place of various treatment methods. There are no official statistics on non-allergic rhinitis in Russia yet, due to the absence of certain types of rhinitis in the ICD-10. The prevalence of non-allergic rhinitis is one third of the prevalence of allergic rhinitis, involving, for example, in the United States about 7% of the population. Against the background of a convincing evidence base and well-structured international reference documents for allergic rhinitis, other forms of rhinitis, especially non-allergic rhinitis, remain almost “white” spots in medicine, and this leads to numerous errors in the therapeutic approach to this disease. The purpose of this scientific study was to justify the conduct of pathogenic therapy of patients with chronic non-allergic rhinitis by using the differential diagnostic algorithm to establish the etiology of chronic rhinitis. The article formulates a treatment and diagnostic algorithm based on summation of the examination results of 1040 patients with chronic rhinitis. The prevalence and comorbidity of non-allergic rhinitis was determined, the diagnostic value for patients with pseudo-allergic rhinitis of various diagnostic methods (nasocytogramma, prik-test with allergens, biochemical markers of various types of pseudo-allergic rhinitis) was analyzed, and treatment approaches are systematized.

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Abdominal tuberculosis

Infusion & Chemotherapy ◽

10.32902/2663-0338-2021-1-37-44 ◽

2021 ◽

pp. 37-44

Author(s):

O.D. Nikolaeva

Keyword(s):

Lymph Nodes ◽

High Sensitivity ◽

Abdominal Tuberculosis ◽

Diagnostic Value ◽

Diagnostic Methods ◽

Mesenteric Lymph Nodes ◽

Ileocecal Region ◽

Infected People ◽

Mesenteric Lymph ◽

Abdominal Organs

ABSTRACT. The problem of detecting and diagnosing abdominal tuberculosis (TB) remains difficult. Recently in Ukraine there has been an increase in extrapulmonary TB, including abdominal TB. In modern conditions, this localization of TB is a manifestation of a generalized process in HIV-infected people. The most commonly diagnosed lesions of the lymphatic system and the peritoneum. The liver and spleen in abdominal TB is affected in every third case (32.3 %). In most patients, TB of the abdominal organs develops as a result of lymph-hematogenous dissemination from the primary focus, progresses through contact from the mesenteric lymph nodes to the peritoneum and intestines. According to statistics, TB of the mesenteric lymph nodes is most often diagnosed (70 %), the ileocecal region and the peritoneum are affected in 12 % of cases. The clinical picture of abdominal TB is polymorphic, there are no pathognomonic symptoms, therefore, the diagnosis of damage to the abdominal organs is the most difficult in the field of phthisiology. Diagnostic methods that are used: X-ray examination of the small intestine with a contrast agent, irrigoscopy, ultrasonography, computed tomography (CT), laparoscopy and laparotomy with sampling of material for morphological and bacteriological researches. The diagnostic value of CT with bolus enhancement is quite high: sensitivity is 95 %, specificity is 67.5 %. Given the difficulty of confirming the diagnosis of TB, in the case when the diagnosis is not confirmed culturally or histologically, and there is a reasonable suspicion of a specific lesion, which is based on clinical, endoscopic and radiological data, it is recommended to prescribe empirical treatment. Most patients respond positively to anti-TB treatment within 2 weeks. A clinical case of abdominal TB in an HIV-infected patient is described in this article.

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Laparotomy Due to War-Related Penetrating Abdominal Trauma in Civilians: Experience From Syria 2011-2017

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.77 ◽

2020 ◽

pp. 1-9

Author(s):

Bayan Alsaid ◽

Maryam Alhimyar ◽

Ahmad Alnweilaty ◽

Ehab Alhasan ◽

Zein Al Abidin Shalhoum ◽

...

Keyword(s):

Abdominal Trauma ◽

Penetrating Trauma ◽

Exploratory Laparotomy ◽

Abdominal Injuries ◽

Penetrating Abdominal Trauma ◽

Abdominal Organs ◽

Negative Laparotomy ◽

Organ Systems ◽

Multiple Injured ◽

The Impact

ABSTRACT Objectives: Penetrating abdominal trauma is one of the injuries that could affect civilians in wartime. This retrospective study investigates the commonly injured abdominal organs, and the impact of multiple injured organs on mortality. Methods: We reviewed the operating room (OR) logs of patients who presented to the surgical emergency department (SED) at Al-Mouwasat University Hospital with war-related abdominal penetrating trauma requiring exploratory laparotomy between April 1, 2011 and December 31, 2017. Results: Of 7826 patients with traumatic injuries, 898 patients (11.5%) required exploratory laparotomy. Of all patients who had an exploratory laparotomy (n = 898), 58 patients (6.5%) died in the perioperative period. Regarding complete laparotomies (n = 873 patients), small intestines, large intestines, and liver were the most commonly affected organs (36.4%, 33%, 22.9%, respectively). A total of 92 patients (10.2%) had negative laparotomy in which all the abdominal organs were not injured. The perioperative mortality rate (POMR) increased when more organs/organ systems were injured per patient reaching a peak at 3 organs/organ systems injuries with a POMR of 8.3%. POMR was highest in patients with musculoskeletal injuries (18.2%), followed by vascular injuries (11.8%), and liver injuries (7%). Conclusions: The management of civilians’ abdominal injuries remains a challenge for general and trauma surgeons, especially the civilian trauma team. The number and type of injured organs and their correlation with mortality should be considered during surgical management of penetrating abdominal injuries.

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Analytical revisit to basics helps reduce unnecessary CT scan in children with abdominal trauma: A single institution experience

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors6254-62 ◽

2018 ◽

Vol 6 (2) ◽

pp. 54-62

Author(s):

Rizwan A. Khan ◽

Mohd Hazique ◽

Shagufta Wahab

Keyword(s):

Ct Scan ◽

Abdominal Trauma ◽

Clinical Laboratory ◽

Final Diagnosis ◽

Abdominal Injury ◽

Free Fluid ◽

Abdominal Injuries ◽

Blunt Abdominal Injury ◽

Line Imaging ◽

Sensitive Parameters

Introduction. CT scan is regarded as the investigation choice for accurate depiction of blunt abdominal injuries in children and is considered as an inevitable tool in the armamentarium of the clinician before deciding for conservative management of these children. However over dependence on CT scan puts the patient to many disadvantages. The aim of this study to devise stratification criteria for the children with blunt abdominal injury and advise CT scan to the children only who really require it. Material and methods. All the children with blunt abdominal injury were studied prospectively over a period of two years. These children underwent clinical, biochemical and ultrasonographic assessment at presentation followed by CT abdomen. Efficacy of predefined clinical, biochemical and ultrasonographic parameters was compared with CT scan to triage the children with intra abdominal injury. Results. A total of 84 children were registered in the study based on final diagnosis of presence or absence of intra abdominal injury the children were divided in two groups. These groups were then compared for various clinical, laboratory and ultrasonographic parameters to predict intra abdominal injury. The children having isolated abdominal injury, tenderness, raised AST, ALT and amylase and free fluid on ultrasonography were found to have more chances of intrabdominal injury (p < 0.001). These parameters were the most sensitive parameters to predict intra abdominal injury and the cumulative sensitivity of these parameters was 99.7%. The CT abdomen was negative in 74.7% of the patients. Conclusion. Due to high negative rate of CT abdomen in children with abdominal trauma, its use as first line imaging investigation is questionable in all the children with abdominal trauma. We suggest that by utilizing clinical, biochemical and ultrasonographic parameters, the children at risk of intra abdominal injuries can identified with almost 100% accuracy mandating the use of CT scan only in these children.

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Diagnostic Value of sIL-2R, TNF-α and PCT for Sepsis Infection in Patients With Closed Abdominal Injury Complicated With Severe Multiple Abdominal Injuries

Frontiers in Immunology ◽

10.3389/fimmu.2021.741268 ◽

2021 ◽

Vol 12 ◽

Author(s):

Guang-hua Zhai ◽

Wei Zhang ◽

Ze Xiang ◽

Li-Zhen He ◽

Wei-wei Wang ◽

...

Keyword(s):

Roc Curve ◽

Diagnostic Value ◽

Abdominal Injury ◽

Sepsis Group ◽

Abdominal Injuries ◽

Infection Group ◽

Low Level ◽

Cut Point ◽

Tnf Α ◽

Level Group

ObjectiveWe aimed to evaluate the diagnostic value of soluble interleukin-2 receptor (sIL-2R), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and combined detection for sepsis infection in patients with closed abdominal injury complicated with severe multiple abdominal injuries.Patients and MethodsOne hundred forty patients with closed abdominal injury complicated with severe multiple abdominal injuries who were diagnosed and treated from 2015 to 2020 were divided into a sepsis group (n = 70) and an infection group (n = 70).ResultsThe levels of sIL-2R, TNF-α, and PCT in the sepsis group were higher than those in the infection group (p < 0.05). The receiver operating characteristic (ROC) curve showed that the areas under the ROC curve (AUCs) of sIL-2R, TNF-α, PCT and sIL-2R+TNF-a+PCT were 0.827, 0.781, 0.821, and 0.846, respectively, which were higher than those of white blood cells (WBC, 0.712), C-reactive protein (CRP, 0.766), serum amyloid A (SAA, 0.666), and IL-6 (0.735). The AUC of the three combined tests was higher than that of TNF-α, and the difference was statistically significant (p < 0.05). There was no significant difference in the AUCs of sIL-2R and TNF-α, sIL-2R and PCT, TNF-α and PCT, the three combined tests and sIL-2R, and the three combined tests and PCT (p > 0.05). When the median was used as the cut point, the corrected sIL-2R, TNF-α, and PCT of the high-level group were not better than those of the low-level group (p > 0.05). When the four groups were classified by using quantile as the cut point, the OR risk values of high levels of TNF-α and PCT (Q4) and the low level of PCT (Q1) after correction were 7.991 and 21.76, respectively, with statistical significance (p < 0.05).ConclusionsThe detection of sIL-2R, TNF-α, and PCT has good value in the diagnosis of sepsis infection in patients with closed abdominal injury complicated with severe multiple abdominal injuries. The high concentrations of PCT and TNF-α can be used as predictors of the risk of septic infection.

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