scholarly journals Isolated free fluid in children with blunt abdominal trauma: Does it alters the management approach?

2018 ◽  
Vol 6 (1) ◽  
pp. 39-44
Author(s):  
Rizwan Ah. Khan ◽  
Shagufta Wahab
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Common Mechanism ◽  
Management Approach ◽  
Free Fluid ◽  
Delayed Presentation ◽  
Abdominal Ct ◽  
Visceral Injury ◽  
Male Predominance

Introduction. Isolated free fluid (IFF) on abdominal computed tomography in children with blunt abdominal trauma poses a diagnostic dilemma. The aim of this study is to present our experience of the entity and its role in management of these children. Methods. A prospective study was performed over a period of two and half years on all the children less than 14 years of age admitted to our hospital with blunt abdominal trauma and in whom the CT abdomen was done which demonstrated isolated free fluid with no sign of visceral injury. Demographic data, presenting clinical status, imaging data and management (nonoperative progress and operative findings) were collected and analyzed. Results. A total of 108 children were admitted with blunt abdominal trauma and who underwent abdominal CT during the period from July 2015 to December 2017. Isolated free fluid (IFF) was found in 26 children (24%). The mean age was 7.8 years with male predominance. Motor vehicle collisions were the most common mechanism of injury. At presentation abdominal tenderness was present in 8 of these children. Twenty two children had small IFF and 2 each had moderate and large fluid collections and the most common site being the hepatorenal pouch. One child each from moderate and large IFF group needed subsequent exploration. Conclusion. Children of blunt abdominal trauma with isolated free fluid on abdominal CT are managed conservatively. However, they need admission and repeated clinical assessment for early detection of delayed presentation of visceral injury entailing surgical intervention.

scholarly journals An experience with blunt abdominal trauma: evaluation, management and outcome

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Nikhil Mehta ◽  
Sudarshan Babu ◽  
Kumar Venugopal
Keyword(s):  
Early Diagnosis ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
World Health ◽  
Common Mechanism ◽  
World Population ◽  
Diagnosis And Management ◽  
Time Of Presentation

Blunt abdominal trauma (BAT) is a frequent emergency and is associated with significant morbidity and mortality in spite of improved recognition, diagnosis and management. Trauma is the second largest cause of disease accounting for 16% of global burden. The World Health Organization estimates that, by 2020, trauma will be the first or second leading cause of <em>years of productive life</em> <em>lost</em> for the entire world population. This study endeavors to evaluate 71 cases of BAT with stress on early diagnosis and management, increase use of non operative management, and time of presentation of patients. A retrospective analysis of 71 patients of BAT who were admitted in Kempegowda Institute of Medical Sciences hospital (KIMS, Bangalore, India) within a span of 18 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Most of the patients in our study were in the age group of 21-30 years with an M:F ratio of 3.7:1. Motor vehicle accident (53%) was the most common mechanism of injury. Spleen (53%) was the commonest organ injured and the most common surgery performed was splenectomy (30%). Most common extra abdominal injury was rib fracture in 20%. Mortality rate was 4%. Wound sepsis (13%) was the commonest complication. Initial resuscitation measures, thorough clinical examination and correct diagnosis forms the most vital part of management. 70% of splenic, liver and renal injuries can be managed conservatively where as hollow organs need laparotomy in most of the cases. The time of presentation of patients has a lot to do with outcome. Early diagnosis and prompt treatment can save many lives.

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.

scholarly journals The spectrum and outcome of blunt trauma related enteric hollow visceral injury

2018 ◽  
Vol 100 (4) ◽  
pp. 290-294 ◽  
Author(s):  
W Bekker ◽  
VY Kong ◽  
GL Laing ◽  
JL Bruce ◽  
V Manchev ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Delayed Diagnosis ◽  
Free Fluid ◽  
Visceral Injury ◽  
X Ray ◽  
Median Delay ◽  
Chest X Ray ◽  
Hollow Visceral Injury

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.

scholarly journals Management of solid organ injury in patient of blunt abdominal trauma

2021 ◽  
Vol 8 (8) ◽  
pp. 2361
Author(s):  
Aafrin S. Baldiwala ◽  
Vipul C. Lad
Keyword(s):  
Cause Of Death ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Road Traffic ◽  
Correct Diagnosis ◽  
Organ Injury ◽  
Common Mechanism ◽  
Free Fluid ◽  
Solid Organ ◽  
Initial Resuscitation

Background: In this ongoing era of 21st century, trauma is the leading cause of death in individuals between age 1 and 44. In trauma, also road traffic accidents (RTAs) are the major cause of death. Blunt abdominal trauma is a frequent emergency and is associated with significant morbidity and mortality.Methods: A prospective analysis of 50 patients of blunt abdominal trauma admitted in SMIMER hospital Surat within a span of 12 months was done. Unstable patients with initial resuscitation underwent focused assessment sonography for trauma (FAST). Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen.Results: Most of the patients in our study were in the age group of 21-45 years with M:F ratio of 4:1. RTAs (62%) was the most common mechanism of injury. Spleen (38%) was the commonest organ injured and the most common surgery performed was splenectomy. In total non-operative management (NOM) was done in 58% of cases and surgical management was done in 42% of cases.Conclusions: Appropriate patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in management of blunt abdominal trauma. To conclude, initial resuscitation measures and correct diagnosis forms the most vital part of blunt abdominal trauma management.

scholarly journals Traumatic Small Bowel Injury: A Diagnosis Challenge

2021 ◽  
Vol 16 (2) ◽  
pp. 295-300
Author(s):  
Syed Abdul Kader Mohamed Saleem ◽  
Keyword(s):  
Small Bowel ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Rare Complication ◽  
Bowel Injury ◽  
Free Fluid ◽  
Small Bowel Injury ◽  
Bowel Ischaemia ◽  
High Level

Traumatic small bowel injury is rare complication following a blunt abdominal trauma. We encountered a case of small bowel injury following a motor vehicle accident that was initially missed during the first presentation due to unremarkable findings in examination. Patient re-presented five days later with bowel ischaemia and was managed accordingly. It is a challenge in diagnosing the injury due to its vague presentation. The usage of Focused Assessment with Sonography for Trauma (FAST) scan as a screening tool in Emergency Department to pick up intra-abdominal injury do have limitations especially in diagnosing small bowel perforation post blunt abdominal trauma. The early phase of small bowel injury post blunt abdominal trauma rarely produces significant free fluid during the FAST scan. It is paramount for the emergency doctors to have a high level of suspicion in high risk cases to provide early supportive treatment and early referral to surgical team. If left undiagnosed bowel ischaemia may lead to catastrophic complication affecting the patient’s morbidity and mortality. In conclusion, each case should be managed and risk stratify individually. Computed tomography abdomen is found to be more superior in detecting bowel injuries, hence, and investigation of choice compared to bedside ultrasonograpy in cases with high level of suspicaion.

scholarly journals Case Report: Delayed Presentation of Bowel Obstruction Caused by Blunt Abdominal Trauma

2020 ◽  
Vol 4 (4) ◽  
pp. 620-622
Author(s):  
Nicholas George ◽  
Charles Baldi ◽  
James Tonascia ◽  
Siamak Moayedi
Keyword(s):  
Case Report ◽  
Bowel Obstruction ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
High Speed ◽  
Bowel Wall ◽  
Motor Vehicle ◽  
Delayed Presentation ◽  
Vehicle Collision ◽  
Post Traumatic

Introduction: Bowel obstruction is a rare but well reported complication of blunt abdominal trauma (BAT). Obstruction is most often seen acutely caused by bowel wall hematomas and chronically as a result of post-traumatic strictures. Here, we present a novel case of BAT causing a subacute obstructing bowel wall hematoma. Case Report: A healthy, 32-year-old male presented to our emergency department with three days of nausea and vomiting. Chart review revealed he had been seen two weeks prior after a high-speed motor vehicle collision. During that initial visit, the patient had a benign abdominal exam and was discharged without imaging. On this return visit, the patient was found to have a large, obstructing colonic hematoma. Conclusion: Because emergency physicians care for patients in both the acute and subacute phases of trauma, clinicians should recognize the more subtle sequelae of BAT.

scholarly journals Traumatic Gallbladder Perforation in Children – Case Report and Review

2021 ◽  
Author(s):  
Melanie Thanh Phuong Le ◽  
Jochen Herrmann ◽  
Michael Groth ◽  
Konrad Reinshagen ◽  
Michael Boettcher
Keyword(s):  
Case Report ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Recent Literature ◽  
Signs And Symptoms ◽  
Gallbladder Wall ◽  
Gallbladder Perforation ◽  
Free Fluid ◽  
Key Points ◽  
Magnetic Resonance Imaging Mri

Background Gallbladder perforation is a very rare finding in children. Clinical and radiografic presentations are often vague. Hence it is a challenging diagnosis, often missed during initial evaluation with potentially fatal consequences. The aim of this case report and review was to identify factors that might help to diagnose and manage future cases. Methods We present a case of gallbladder perforation in an 8-year-old child after blunt abdominal trauma caused by a handlebar in which imaging modalities such as ultrasound and magnetic resonance imaging (MRI) helped us to determine proper management. We identified and evaluated comparable cases for isolated traumatic gallbladder injury. A review of the recent literature was performed by online search in Pubmed and Google Scholar using “gallbladder injury in children”, “gallbladder perforation children”, “blunt abdominal trauma children” as keywords. We focused on articles exclusively in the pediatric section. The literature from the period 2000–2020 was taken into account to review the state of the art in diagnosis and management. Results and Conclusion Recent literature for gallbladder injury in pediatrics is sparse compared to the adult counterpart. Only eight published cases of isolated gallbladder injury in children were identified. Since the onset of symptoms may not develop acutely and often develops in an indistinct manner, radiografic examinations play an important role in the diagnostic progress. The authors advise caution in cases of blunt abdominal trauma especially involving handlebars, intraperitoneal free fluid, and severe abdominal pain. We advocate high suspicion of gallbladder perforation if the gallbladder wall displays discontinuation or cannot be definitively differentiated in sonografic examination. Echogenic fluid within the gallbladder should always lead to suspicion of intraluminal bleeding. Repeated clinical and imaging examinations are mandatory since the onset of signs and symptoms may be delayed. Key Points:  Citation Format

Is Hypaque Dangerous?

PEDIATRICS ◽  
1989 ◽  
Vol 83 (4) ◽  
pp. 650-650
Author(s):  
ROBERT SCHLECHTER ◽  
ABRAHAM BESSERMAN
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Ct Scanning ◽  
Ct Scans ◽  
Solid Organ ◽  
Abdominal Ct ◽  
Injured Child ◽  
Gastric Distention ◽  
Close Observation

Concerning the use of diatrizoate sodium (Hypaque) in abdominal CT scans described by Kane et al (Pediatrics 1988;82:11-15), we agree that there is certainly much to be gained from CT scanning in blunt abdominal trauma. We question the routine use of diatrizoate sodium in an injured child predisposed to gastric distention and vomiting. This is particularly dangerous when he or she is prone and restrained and close observation at the bedside is not possible. Solid organ injuries are well demonstrated without contrast, and injury to a viscus can be evaluated clinically and by routine roentgenographic procedures.

scholarly journals Delayed Presentation of Renocolic Fistula at 4 Months after Blunt Abdominal Trauma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Sang Don Lee ◽  
Tae Nam Kim ◽  
Hong Koo Ha
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Renal Injury ◽  
Delayed Presentation ◽  
Inflammatory Processes

Causes of previously reported reno-colic fistulas included primary renal and colonic pathologic states involving infectious, malignant or other inflammatory processes. However, reno-colic fistula after renal injury is extremely uncommon. We report an unusual delayed presentation of reno-colic fistula that occurred at 4 months later after blunt abdominal trauma.

EP.FRI.35 Traumatic abdominal wall hernia (TAWH) in a 16 year old boy

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Elmurtada Ahmed ◽  
Simon Shaw
Keyword(s):  
Abdominal Wall ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Abdominal Wall Defect ◽  
Rare Complication ◽  
Vital Signs ◽  
Abdominal Wall Hernia ◽  
Skin Penetration ◽  
Traumatic Abdominal Wall Hernia ◽  
Visceral Injury

Abstract Definition Traumatic abdominal wall hernia is defined as: herniation of viscera through disrupted musculature & fascia associated with forceful trauma without skin penetration & no evidence of prior hernia defect prior to trauma  Introduction There are only about 30 reported cases of TAWH due to handlebar injury, it is a rare complication of blunt abdominal trauma it involves disruption of abdominal wall muscles with bowel loops herniating through the abdominal wall defect & may be accompanied by serious or lethal complications  Case report A 16 year old boy received trauma while cycling at about: 5 miles/hour & landed in the handle-bar with his right lower abdominal wall against the handle, the patient's vital signs were stable but there was bruising in the area, the diagnosis was missed by A&E doctor, but I saw him O/E there was a positive cough impulse & the diagnosis was confirmed by US examination, his haematological & biochemical investigations were normal, patient was taken to theatre & the hernia was repaired (image 2 & 3) Conclusion our case highlights the importance of clinical examination in blunt abdominal trauma & high index of suspicion plus using US/CT as appropriate to rule out mesenteric or visceral injury 

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