scholarly journals Blunt abdominal trauma: initial resuscitation followed by clinical and focused abdominal sonography assessment important diagnostic tools of organ injury due to restricted use of CT-scan in a tertiary care in India

2021 ◽  
Vol 9 (1) ◽  
pp. 174
Author(s):  
S. K. Sekendar Ali ◽  
Narendra Nath Mukhopadhyay ◽  
Jyotirmoy Bhattacharya ◽  
Madhusudan Chattopadhyay
Keyword(s):  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Tertiary Care ◽  
Diagnostic Tools ◽  
Solid Organ ◽  
Abdominal Sonography ◽  
Initial Resuscitation ◽  
Restricted Use

Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical ward in any hospital. It requires high level of suspicion, urgent evaluation and timely management to decrease morbidity and mortality. Objective was to evaluate the role of clinical and ultrasound assessment in early diagnosis of intra-abdominal injury following blunt abdominal trauma and follow up in patients with intraabdominal injury for detecting complications.Methods: 130 patients who presented to the emergency room were evaluated by clinical and focused abdominal sonography for trauma (FAST) and follow-up sonography was done after 6-12 hours upto 72 hours.Results: In our study, road traffic accidents (RTA) were the most common cause of blunt abdominal trauma (70.76%) with 75% patients being were males. X-ray erect abdomen and ultrasound of the abdomen were the most sensitive investigation for hollow viscous injury and solid organ injuries, respectively, with bowel (38.33%) and liver injury (26.67%) being the most common organ involved in this study. This study found sensitivity (93.7%) and specificity (98.5%) of focused abdominal ultrasonography (FAST).Conclusions: Initial resuscitation followed by clinical and ultrasonography assessment is considered the best modality in initial evaluation of blunt abdominal trauma patients as it is noninvasive, readily available, and requires minimal preparation time and also due to restricted use of modern amenities such as CT-scan in tertiary care in India.

scholarly journals Challenges in management of blunt abdominal trauma: a prospective study

2018 ◽  
Vol 5 (10) ◽  
pp. 3298
Author(s):  
Rajkumar P. N. ◽  
Kushal Kumar T. R. ◽  
Deepak G.
Keyword(s):  
Prospective Study ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Organ Injury ◽  
Solid Organ ◽  
Vehicle Accident

Background: Trauma meets the pandemic criteria, with a daily worldwide mortality as high as 16000. Abdominal trauma remains a leading cause of mortality in all age groups. Blunt abdominal trauma (BAT) mainly results from motor vehicle accident, fall from height and assaults. The commonest organ injured is the spleen, followed by the liver and small bowel. Lately, the management of BAT has changed from operative to non-operative management. This study was done to analyse the incidence, patterns, current management practiced, and challenges encountered in BAT treated operatively.Methods: This Prospective study was conducted in tertiary care centre in Bangalore during August 2015 to December 2017. 475 patients with blunt abdominal injuries who reported to emergency department were selected for the study based on following inclusion and exclusion criteria.Results: A total of 475 cases of BAT were assessed with a mean age of males and females was 32.6 and 28.3year respectively. Most patients (65%) were between 21 to 30 years of life. Most common mode of injury was motor vehicle accident (57.68%), 60% patients presented to hospital within the initial 4 hours. Abdominal CT had highest accuracy. Most common solid organ injury being spleen (26.5%). 80.84% patients were selected for SNOM and 15.62% had Failed SNOM. 28.48% patients had complications with most common complication wound infection followed by aspiration pneumonia and 7 patients had mortality.Conclusions: Initial resuscitation with thorough clinical examination with correct usage of imaging modalities with timely and proper decision making is the key of management of patients with BAT and there is a need to identify newer imaging modality/procedure which helps to determine better management scheme in all blunt trauma patients. 

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 Blunt abdominal trauma: a tertiary care experience

2018 ◽  
Vol 5 (3) ◽  
pp. 975
Author(s):  
Vikram Trehan ◽  
Sukumar S. Kumar
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Tertiary Care ◽  
Hemodynamic Instability ◽  
Morbidity And Mortality ◽  
Organ Injury ◽  
Solid Organ ◽  
Care Hospital ◽  
Management Options ◽  
Solid Organ Injury

Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical ward in any hospital. It requires high level of suspicion, urgent evaluation and timely management to decrease morbidity and mortality. Aim of present study was to find out demographic details, causes of injury, management options and treatment outcomes of BAT.Methods: Retrospective study of cases of BAT was carried out at a tertiary care hospital of India spanning five years, between June 2012 to June 2017. Authors analyzed the demographic profile of the trauma victims, etiological factors of BAT, the abdominal organs involved, the treatment modalities adopted and the final outcome.Results: There were 231 cases of BAT. Most common age group was 11 to 30 years which accounted for 42.42% of the total. The study had 181 (78.35%) males and 50 (21.64%) females. Road traffic accident was the most common cause of BAT and it accounted for 67.97%. Liver (34.20%) was the most commonly involved organ followed by spleen (22.51%), bowel (15.58%), mesentery (8.23%), kidney (7.36%), pancreaticoduodenal injuries (3.46%) and diaphragm (3.46%). 56.71% underwent non-operative management (NOM), 3.90% underwent angio-embolization and 39.39% eventually required operative treatment. Mortality occurred in 31 patients (13.41%) because of septicemia, renal failure, shock, acute coronary event or respiratory complications.Conclusions: NOM for BAT was found to be successful in haemodynamically stable patient with solid organ injury. Along with sophisticated infrastructure like ultrasound or CT Scan, close supervision with repeated examination by a treating surgeon were the sheet anchors of NOM. Angio-embolization is a feasible modality of treatment in solid organ injury and can avoid surgery in an appropriate patient. Definitive indications for laparotomy were hemodynamic instability and perforation-peritonitis. Initial hemodynamic instability, haemorrhagic shock, and associated injuries influenced morbidity and mortality in BAT. 

scholarly journals FAST as a predictor of clinical outcome in blunt abdominal trauma

2011 ◽  
Vol 15 (4) ◽  
pp. 108 ◽  
Author(s):  
Benjamin M Terry ◽  
David Blehar ◽  
Romolo Gaspari ◽  
Arthur Thomas Maydell ◽  
Fourie Abraham Bezuidenhout ◽  
...  
Keyword(s):  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Clinical Course ◽  
Free Fluid ◽  
Abdominal Sonography ◽  
Ultrasound Findings ◽  
All Cause Mortality ◽  
Trauma Triage ◽  
Operative Findings

Background. Peer-reviewed literature demonstrates increasing support for the use of focused abdominal sonography in trauma (FAST) in the setting of blunt trauma, one study demonstrating the sensitivity and specificity of FAST for the detection of free fluid to be 0.64 - 0.98 and 0.86 - 1.00, respectively, compared with abdominal CT. Utilising ultrasound in trauma triage increases efficiency and cost-effectiveness and reduces reliance on CT, compared with using CT alone. There is little evidence to support relying solely on a negative FAST and physical examination for patient management. Method. A retrospective descriptive study of 172 adult patients who received FAST for the evaluation of blunt abdominal trauma between 22 July 2007 and 21 January 2008 at Tygerberg Hospital was performed. Ultrasound findings were correlated with CT scan findings, operative findings if managed surgically, clinical outcomes whether managed surgically or conservatively, as well as postmortem findings in deceased patients. Results. FAST was negative in 147 (85.5%) patients. Twenty-four (16.3%) of these patients died from all-cause mortality, none of which was due to intra-abdominal injury. Seven patients with negative FAST underwent CT scan owing to change in clinical course, and 3 patients with negative FAST underwent laparotomy owing to change in clinical course, with positive findings in 2 patients – a bowel injury requiring resection (not seen on CT) and a diaphragmatic rupture seen on CXR. A negative FAST was shown to be an excellent predictor for the absence of significant intra-abdominal trauma. The mortality rate among 25 FAST positive patients was 24% (N=6). Only one of these patients (with a splenic rupture) was suspected to have died from abdominal pathology.

scholarly journals Comparison of positive predictive value of computed tomography versus diagnostic peritoneal lavage for diagnosis of solid organ damage in patients with blunt abdominal trauma

2019 ◽  
Vol 26 (06) ◽  
Author(s):  
Abdul Ghaffar ◽  
Saeed Mahmood ◽  
Muhammad Kareemullah ◽  
Saqib Uddin Khan ◽  
Ambreen Akram ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Peritoneal Lavage ◽  
Organ Damage ◽  
Solid Organ ◽  
Diagnostic Peritoneal Lavage

Background: Abdominal trauma can be mysterious to some practitioners. If patients are evaluated for being stable or unstable, then abdominal trauma can be easily managed. Using a combination of physical examination, eFAST Scan, DPL and CT scans, patients can be quickly and efficiently evaluated. Objectives: To determine the positive predictive value (PPV) of computed tomography and diagnostic peritoneal lavage for diagnosis of solid organ damage in patients with blunt abdominal trauma (BAT) taking surgical findings as gold standard. Study Design: Cross sectional study. Setting: Department of Surgery at Lahore General Hospital, Lahore. Period: Six months i.e. from 21.5.2016 to 20.11.2016. Materials and Methods: Data Collection: CT scan was performed with oral and intravenous contrast. DPL was done with sample assessment. Only those cases were included with positive findings in CT Scan or DPL. These patients underwent laparotomy under general anesthesia by a one standard surgical team. Results of surgical findings were compared between groups with CT scan and DPL. All the information was collected on predesigned proforma. Results: The mean age of the patients was 44.48±14.83 years. There were 66 (55%) males and 54 (45%) females in our study. In this study PPV for CT-scan group was 90.1% while PPV for group with DPL was 51.3%. Conclusion: PPV for CT Scan group was higher than that of DPL group for diagnosing solid organ damage in patients with BAT. Hence, evidence shows that CT Scan should be used as an initial investigation of choice in haemo-dynamically stable patients with BAT.

scholarly journals Role of Sonographic Imaging Findings in Evaluation of Cases Presenting with History of Blunt Abdominal Trauma in UCMS-TH

2020 ◽  
Vol 8 (02) ◽  
pp. 11-14
Author(s):  
Sanju Rawal ◽  
Sadhan Mukhi
Keyword(s):  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Cost Effective ◽  
Free Fluid ◽  
Solid Organ ◽  
Cross Sectional ◽  
History Of ◽  
Contrast Exposure ◽  
One Year

INTRODUCTION Physical examination is often unreliable. Computed tomography scan is costly, time consuming, requires injection of contrast, exposure to radiation and patient transport thereby limiting its use. With the usage of sonography, it is possible to evaluate and help in the management of patients with blunt abdominal trauma. The proposed study enables sonographic technique in assessing and accurately detecting the    presence of free fluid and to pin point the injured organ, thereby helping the clinicians and surgeons in appropriate management MATERIAL AND METHODS Our study was cross sectional conducted on UCMS-TH, Bhairahawa, Nepal. Total 150 cases with history of blunt abdominal trauma were included and scanned by GE LOGIQ6 PRO ultrasound scanner for the duration of one year. RESULTS A total of 150 patients were evaluated 121 were males and 29 were females. Free fluid was detected in total 112 cases (74.66%) out of which with most common injured solid organs were Liver and spleen in total 31 cases (20.7%) each, which were further confirmed on CT scan. CONCLUSION Ultrasonography is easy to perform, quick, cost effective and is highly sensitive in detecting free fluid and solid organ injuries however insignificant in patients with bowel or mesenteric injuries in cases of blunt abdominal trauma and demand CT scan.

scholarly journals ROLE OF FOCUSED ABDOMINAL SONOGRAPHY FOR TRAUMA IN SOLID ORGAN INJURY IN PAEDIATRIC BLUNT ABDOMINAL TRAUMA

2018 ◽  
Vol 7 (17) ◽  
pp. 2074-2077
Author(s):  
Rejum Ronya ◽  
Rajib Ray Baruah ◽  
Nirmal Bhattacharyya ◽  
Jayanta Kumar Goswami ◽  
Manoj Saha ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Abdominal Sonography

BLUNT ABDOMINAL TRAUMA WITH HAEMOPERITONEUM TREATED BY EXPLORATORY LAPAROTOMY VERSUS ONLY ABDOMINAL DRAINAGE: A PROSPECTIVE AND COMPARATIVE STUDY.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Dhawal Panchal ◽  
Firdaus Dekhaiya ◽  
Harin Tailor
Keyword(s):  
Hospital Stay ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Exploratory Laparotomy ◽  
Blunt Injury ◽  
Abdominal Drainage ◽  
Duration Of Hospital Stay ◽  
Considerable Morbidity ◽  
Injured Patients

In today’s mechanized world, Blunt Abdominal Trauma (BAT) is a common emergency which is associated with considerable morbidity and mortality. More than 75% of abdominal traumas are blunt in nature and liver and spleen are the commonest organs to be injured as a result of BAT. The aim is to analyse and compare two groups of patient of blunt abdominal trauma managed conservatively with drainage and one by exploratory laparotomy. 50 cases of blunt abdominal trauma were taken. The patient were studied  which includes age ,sex, mode of injury, initial vitals on presentation, Mortality in each group, duration of hospital stay, pre interventions and post interventions state and requirements, complications and follow up. It was observed 48% of patients were in between age group ranging from 10 to 30. Overall in terms of sex ratio, males dominated the no. of cases. RTA was most common mode of trauma. Liver and spleen was most common organ to be injured. Patients managed by laparotomy had higher mortality rate, duration of hospital stay was more, and complication were more. Early diagnosis and repeated clinical examination and use of appropriate investigation form the key in managing blunt injury abdomen patients. Keywords:  Blunt Abdominal Trauma, Haemoperitoneum , laparotomy , Abdominal Drainage.

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