scholarly journals Hollow viscus injury due to blunt abdominal trauma

2017 ◽  
Vol 4 (3) ◽  
pp. 861 ◽  
Author(s):  
Surya Ramachandra Varma Gunturi ◽  
Venu Madhav Thumma ◽  
Jagan Mohan Reddy Bathalapalli ◽  
Nava Kishore Kunduru ◽  
Kamal Kishore Bishnoi ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Close Monitoring ◽  
Medical Sciences ◽  
Hollow Viscus ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Hollow Viscus Injury ◽  
Time Of Presentation

Background: Management of hollow viscus injury (HVI) due to blunt abdominal trauma (BAT) is a challenge to the clinicians even in the era of advanced imaging and enhanced critical care. Repeated clinical examination with appropriate imaging with multidisciplinary teamwork is the key for timely intervention in equivocal cases for successful outcomes. Aim of the study was to present our experience over last 4½ years.Methods: This is a retrospective study of prospectively collected data of patients treated at surgical gastroenterology department, Nizam’s Institute of Medical Sciences, Hyderabad, India over a period of 4½ years (2012-2016).Results: A total of 126 BAT Patients were treated in our unit as inpatients during the last 4½ years. Out of 126, twenty patients (15.87%) with HVI in whom surgical intervention was done formed the study group. Contrast enhanced CT Scan abdomen and chest was done in stable patients (13/20), in rest of the patients (7/20) the decision to operate was taken more on clinical grounds along with X-ray abdomen and USG abdomen features. 12 (60%) had jejunal and ileal injuries, 5 (25%) patients had colonic injuries (sigmoid 4, caecum 1). One (5%) patient had extra peritoneal rectal perforation with ascending retroperitoneal fascitis and 2 (10%) had duodenal injury. Two (10%)patients required relaparotomy. We had mortality in 3 (15%) patients and 17 (85%) patients had complete recovery.Conclusions: Hollow viscus injury should be suspected in all cases of blunt abdominal trauma. In equivocal cases careful repeat clinical examinations with close monitoring and repeat imaging is highly essential to prevent delay in intervention. Type of procedure is based on time of presentation, degree of contamination, associated injuries and general condition of the patient.

scholarly journals The value of non-contrast-enhanced CT in blunt abdominal trauma

1989 ◽  
Vol 152 (1) ◽  
pp. 41-48 ◽  
Author(s):  
J Kelly ◽  
V Raptopoulos ◽  
A Davidoff ◽  
R Waite ◽  
P Norton
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

scholarly journals Evaluating the role of liver enzymes as predictors of severity of liver injury in patients with blunt abdominal trauma

2017 ◽  
Vol 5 (6) ◽  
pp. 2462
Author(s):  
Preetha Prasad ◽  
Abhijith Acharya ◽  
Gopi Ellikunnel Vithon ◽  
Girish N. M. Kumar
Keyword(s):  
Liver Injury ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Liver Enzymes ◽  
Liver Trauma ◽  
Organ Injury ◽  
Contrast Enhanced Ct ◽  
Hepatic Transaminases ◽  
Contrast Enhanced ◽  
Enhanced Ct

Background: Liver is the 2nd most common organ affected in patients with blunt abdominal trauma (BAT). Computed tomography (CT) is the gold standard in the initial evaluation of the hemodynamically stable patient with suspected liver trauma. However, a challenge exists in centers devoid of CT scan, where an elevation in hepatic transaminases may provide guidance for the emergency physician in seeking further imaging and/or surgical consultation.Methods: In patients with suspected BAT blood samples were taken for estimation of liver enzymes (AST and ALT). All patients underwent contrast enhanced CT of the abdomen. Hemodynamically unstable patients were taken up for laparotomy and the findings were recorded. Based on imaging / surgery patients were subdivided into 2 groups (with and without liver injury). Liver injuries were graded according to organ injury scale by American Association of Surgery for Trauma.Results: ALT>100 units had 100% sensitivity and specificity improved to 83.78%. The mean level of ALT in patients without liver injury was around 64. This increased to 142 in grade 1 and upto 780 units in grade 4 injury. The same rising trend was seen when AST was evaluated against grade of Liver injury. This was statistically significant (p<0.01).Conclusions: ALT is the better of the transaminases in predicting liver injury. The rise in transaminases is directly proportional to grade of liver injury.

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

Horseshoe Kidney Blunt Trauma With Double Laceration: Endovascular Management

2020 ◽  
Vol 54 (7) ◽  
pp. 643-645
Author(s):  
Enrico Boninsegna ◽  
Emilio Simonini ◽  
Stefano Crosara ◽  
Carlo Sozzi ◽  
Stefano Colopi
Keyword(s):  
Abdominal Trauma ◽  
Horseshoe Kidney ◽  
Left Common Iliac Artery ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Arterial Hemorrhage ◽  
Endovascular Approach ◽  
Perinephric Hematoma ◽  
Enhanced Computed Tomography

A 78-year-old male patient was admitted to our hospital after abdominal trauma. Contrast-enhanced computed tomography (CT) scan demonstrated a horseshoe kidney with a perinephric hematoma and evidence of arterial hemorrhage. An anomalous renal arterial anatomy was noted as well, with a renal artery originating from the left common iliac artery. He was successfully treated via an endovascular approach. Varying forms of vascularization may complicate angiographic treatment of patients with abdominal trauma in a setting of kidney anomalies. Obtaining and evaluating contrast-enhanced CT angiography can identify anomalous vessels and can be invaluable when deciding on the most appropriate interventional approach.

scholarly journals Contemporary characteristics of blunt abdominal trauma in a regional series from the UK

2017 ◽  
Vol 99 (1) ◽  
pp. 82-87 ◽  
Author(s):  
R Pande ◽  
A Saratzis ◽  
J Winter Beatty ◽  
C Doran ◽  
R Kirby ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Major Trauma ◽  
Clinical Results ◽  
Hollow Viscus ◽  
West Midlands ◽  
Hollow Viscus Injury ◽  
Laparotomy Group ◽  
The Uk ◽  
Type Of Injury

INTRODUCTION Blunt abdominal trauma (BAT) is a common injury in recent trauma series. The characteristics of patients with BAT have changed following the reconfiguration of UK trauma services. The aim of this study was to build a new profile for BAT patients undergoing immediate or delayed laparotomy. METHODS All 5,401 consecutive adults presenting with major trauma between April 2012 and April 2014 in the 3 major trauma centres in the West Midlands were analysed to identify all patients with BAT. A total of 2,793 patients with a mechanism of injury or symptomatology consistent with BAT were identified (52%). Outcomes were analysed using local electronic clinical results systems and notes. RESULTS Of the 2,793 patients, 179 (6.4%) had a mesenteric or hollow viscus injury, 168 (6.0%) had a hepatobiliary injury, 149 (5.4%) had a splenic injury and 46 (1.6%) had a vascular injury. Overall, 103 patients (3.7%) underwent an early (<12 hours) laparotomy while 30 (1.1%) underwent a delayed (>12 hours) laparotomy. Twenty (66.7%) of those undergoing a delayed laparotomy had a hollow viscus injury. In total, 170 deaths occurred among the BAT patients (6.1%). In the early laparotomy group, 53 patients died (51.5%) whereas in the delayed laparotomy group, 6 patients died (20.0%). CONCLUSIONS This series has attempted to provide the characteristics of patients with BAT in a large contemporary UK cohort. BAT was found to be a common type of injury. Early and delayed laparotomy occurred in 3.7% and 1.1% of these patients respectively, mostly because of hollow viscus injury in both cases. Outcomes were comparable with those in the international literature from regions with mature trauma services.

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