A Descriptive Study on the Usage of Exploratory Laparotomy for Trauma Patients

The most common cause of pneumoperitoneum in trauma patients is hollow viscus injury; however, in patients with pneumoperitoneum on imaging and normal hollow viscus during the laparotomy, other rare causes of pneumoperitoneum like intraperitoneal urinary bladder rupture should be ruled out. Urinary bladder can rupture either extraperitoneally or intraperitoneally or both. Rupture of the urinary bladder is commonly seen in patients with abdominal trauma; however, pneumoperitoneum is usually not seen in patients with traumatic bladder rupture. Intraperitoneal bladder rupture is usually due to the sudden rise in intra-abdominal pressure following abdominal or pelvic trauma. However, it is a rare cause of pneumoperitoneum and is managed by surgical repair. We present a case of blunt trauma abdomen with pneumoperitoneum due to isolated intraperitoneal bladder rupture who was managed by exploratory laparotomy and primary repair of the urinary bladder.

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Correlation between surgical site infection and obesity after exploratory laparotomy in trauma patients

QJM ◽

10.1093/qjmed/hcab097.012 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed Abdelaziz ◽

Ahmed Sabry ◽

Mohamed Fayek

Keyword(s):

Surgical Site Infection ◽

Abdominal Trauma ◽

Damage Control ◽

Exploratory Laparotomy ◽

Fascial Closure ◽

Wound Complications ◽

Trauma Patients ◽

Obese Patients ◽

Site Infection ◽

University Hospitals

Abstract Background Obesity has become a major contributor to the global burden of chronic disease and disability. Understanding the effect of obesity on the incidence of wound infections and other wound complications remains incomplete despite considerable attention to both the growing ‘‘epidemic’’ of obesity and the frequent occurrence of surgical site infection (SSI) after surgical procedures. Damage-control laparotomy specifically has been associated with a higher rate of infectious complications and a lower rate of primary fascial closure in obese patients. Aim of the work The aim of the study is to evaluate the correlation between obesity and surgical site infection (SSI) in patients undergoing exploratory laparotomy after abdominal trauma. Patients and methods A retrospective study performed on obese patients of both genders aged between 18 and 60 years old undergoing exploratory laparotomy after abdominal trauma at the surgery departments of Ain Shams University Hospitals, Al-Bank Al-Ahly Hospital, Al-Mataria Hospital and Al-Salam Hospital, Cairo, Egypt for two years (1st of January 2018 to 1st of January 2020). Patients with infected wounds, receiving antibiotic therapy at the time of injury, those with a known immunodeficiency, who died within 48 hours after injury, who had sustained burn injuries, who underwent surgery at another institution before admission to our hospital were excluded. The rate of 30-day SSI post-operatively among obese and non-obese patients were compared. Statistical analysis was also done. Results Out of 782 patients, only 480 of those patients for whom BMI data were available, 360 (75%) were males and 120 (25%) were females. Out of the 480 patients: 168 patients had BMI more than 30; 114 patients (67.8%) had SSI (P < 0.05), 312 patients had BMI less than 30; 61 patients (19.5%) had SSI. All of the included patients were fulfilling the inclusion and the exclusion criteria. On multivariate analysis, obesity was the strongest predictor of SSI (odds ratio = 1.59; 95% confidence interval, 1.32-1.91) after adjustment for sex and age. Obese patients with SSI compared with the non-obese had longer hospital stays (mean, 9.5 vs 8.1 days, respectively; P < .001) and markedly higher rates of hospital readmission (27.1% vs 6.5%, respectively; P < .001). Conclusion Obesity is considered as one of the risk factors in causing surgical site infection. Thus, this study showed the relation of BMI and obesity with surgical site infection in case of exploratory laparotomy after abdominal trauma.

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The Utility of Sonography for the Triage of Blunt Abdominal Trauma Patients to Exploratory Laparotomy

American Journal of Roentgenology ◽

10.2214/ajr.05.2100 ◽

2007 ◽

Vol 188 (2) ◽

pp. 415-421 ◽

Cited By ~ 62

Author(s):

Brett C. Lee ◽

Eleanor L. Ormsby ◽

John P. McGahan ◽

Giselle M. Melendres ◽

John R. Richards

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Exploratory Laparotomy ◽

Trauma Patients

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Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study

Prehospital and Disaster Medicine ◽

10.1017/s1049023x18000274 ◽

2018 ◽

Vol 33 (3) ◽

pp. 230-236 ◽

Cited By ~ 6

Author(s):

Felicia M. Mix ◽

Martin D. Zielinski ◽

Lucas A. Myers ◽

Kathy S. Berns ◽

Anurahda Luke ◽

...

Keyword(s):

Blood Transfusion ◽

Patient Care ◽

Blood Product ◽

Life Support ◽

Descriptive Study ◽

Blood Product Transfusion ◽

Trauma Patients ◽

Blood Products ◽

Total Patient ◽

Significant Difference

AbstractIntroductionHemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).MethodsThis was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).ResultsA total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.ConclusionsIn this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.MixFM, ZielinskiMD, MyersLA, BernsKS, LukeA, StubbsJR, ZietlowSP, JenkinsDH, SztajnkrycerMD. Prehospital blood product administration opportunities in ground transport ALS EMS – a descriptive study. Prehosp Disaster Med. 2018;33(3):230–236.

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A Six-Year Descriptive Study of Hospital-Associated Infection in Trauma Patients: Demographics, Injury Features, and Infection Patterns

Surgical Infections ◽

10.1089/sur.2005.43 ◽

2007 ◽

Vol 8 (4) ◽

pp. 463-474 ◽

Cited By ~ 17

Author(s):

Harrison M. Lazarus ◽

Jolene Fox ◽

James F. Lloyd ◽

R. Scott Evans ◽

Rouett Abouzelof ◽

...

Keyword(s):

Descriptive Study ◽

Trauma Patients

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Pola Kasus dan Penatalaksanaan Peritonitis Akut di Bangsal Bedah RSUP Dr. M. Djamil Padang

Jurnal Kesehatan Andalas ◽

10.25077/jka.v5i1.470 ◽

2016 ◽

Vol 5 (1) ◽

Author(s):

Aiwi Japanesa ◽

Asril Zahari ◽

Selfi Renita Rusjdi

Keyword(s):

Medical Records ◽

Surgical Procedure ◽

Sampling Technique ◽

Exploratory Laparotomy ◽

Descriptive Study ◽

Common Type ◽

Age Group ◽

Exclusion Criteria ◽

Common Cause ◽

Abdominal Emergency

AbstrakPeritonitis menjadi salah satu penyebab tersering akut abdomen yang merupakan suatu kegawatan abdomen. Peritonitis biasanya disertai dengan bakterisemia atau sepsis yang dapat menimbulkan kematian. Tujuan penelitian ini adalah untuk mengetahui hal-hal yang berkaitan dengan peritonitis agar dapat mencegah dan melakukan penanganan secepatnya terhadap kasus ini. Penelitian deskriptif retrospektif ini telah dilakukan dari September 2014 sampai Oktober 2014 dengan teknik total sampling. Data yang diambil merupakan kasus pasien peritonitis yang dirawat inap di Bagian Bedah RSUP Dr. M. Djamil Padang, kemudian dilakukan seleksi berdasarkan kriteria inklusi dan eksklusi sehingga didapatkan 98 data rekam medik periode 01 Januari 2013 sampai 31 Desember 2013. Prevalensi peritonitis pada laki-laki (68,4%) lebih tinggi dibandingkan perempuan (31,6%). Kelompok usia terbanyak adalah 10-19 tahun (24,5%). Peritonitis sekunder umum akibat perforasi apendiks merupakan jenis peritonitis yang terbanyak (53,1%). Sebagian besar pasien peritonitis mendapatkan tatalaksana bedah berupa laparatomi eksplorasi dan apendektomi (64,3%). Lama rawatan terbanyak pada 4-7 hari (45,9%). Frekuensi pasien peritonitis menurut kondisi keluar sebagian besar dalam keadaan hidup (85,7%). Kesimpulan yang dapat diambil dari penelitian ini adalah bahwa peritonitis dapat dipengaruhi oleh faktor usia, jenis kelamin, penyebab peritonitis, tatalaksana, lama rawatan dan kondisi saat keluar dari rumah sakit.Kata kunci: peritonitis, bedah, pola AbstractPeritonitis is one of the most common cause of acute abdomen, which is an abdominal emergency. Peritonitis is usually accompanied by bacteremia or sepsis that can cause mortality. The objective of this study was to know something that associated with peritonitis in order to prevent and to respond immediately to this case. This retrospective descriptive study was conducted from September 2014 to October 2014 using a total sampling technique. Data was taken from cases of hospitalized patients with peritonitis in Surgery Ward of RSUP Dr. M. Djamil Padang, selected by on inclusion and exclusion criteria. There were 98 medical records by the period from 1st of January 2013 to 31th of December 2013. Peritonitis prevalence in men (68,4%) was higher than women (31,6%). Most common age group is 10-19 years old (24,5%). Secondary peritonitis due to perforation of the appendix is the most common type of peritonitis (53,1%). Most patients with peritonitis get a surgical procedure of exploratory laparotomy and appendectomy (64,3%). Most hospitalization length was 4-7 days (45,9%). The frequency of peritonitis patients based on conditions when discharged from hospital is mostly alive (85,7%).Conclusion from this study is that peritonitis may be influenced by age, sex, cause of peritonitis, the surgical procedure, hospitalization, and condition when discharged from hospital.Keywords: peritonitis, surgical, pattern

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Descriptive study of all Danish patients undergoing emergency exploratory laparotomies in the period 2003–2014

Scandinavian Journal of Public Health ◽

10.1177/1403494819875271 ◽

2020 ◽

Vol 48 (3) ◽

pp. 243-249

Author(s):

Sarah A. Toftlund ◽

Ismail Gögenur ◽

Lau C. Thygesen

Keyword(s):

High Risk ◽

Exploratory Laparotomy ◽

The Elderly ◽

Descriptive Study ◽

Small Sample ◽

Logistic Regression Models ◽

Number Of Patients ◽

National Patient ◽

Study Population ◽

Small Sample Sizes

Aim: Emergency exploratory laparotomy is a high-risk procedure, but most studies are based on small sample sizes, and no nationwide studies have reported the number of patients and the mortality risk. This descriptive study reports the prevalence, incidence and 30- and 365-day mortality of all patients undergoing emergency exploratory laparotomies in Denmark from 2003 to 2014. Methods: The study population is based on the Danish National Patient Register, which includes all patient contacts with Danish hospitals, including patients undergoing emergency surgery. All patients were followed in registers on mortality. Rates and proportions were estimated using Poisson and logistic regression models. Results: The number of prevalent patients was 15,330 through the period (2003–2014) of whom 13,795 were incident patients. Prevalence increased with age and peaked at 1% for the 80- to 84-year-old age group. The overall incidence was 27 per 100,000 person-years, which strongly increased with age (87 per 100,000 person-years among men and 85 per 100,000 person-years among women). The 30-day mortality was 16.5% and the 365-day mortality was 23.1%. Both increased strongly with age and did not improve over the study period. Both 30- and 365-day mortality were higher among unmarried patients compared to married patients. Conclusions: Emergency exploratory laparotomies are common high-risk procedures especially for the elderly population. These results can be used to focus on better postoperative care to reduce the mortality.

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Diagnostic Laparoscopy Reduces the Rate of Negative Laparotomy in Trauma Patients

Journal of Surgical Sciences ◽

10.3329/jss.v22i1.44024 ◽

2020 ◽

Vol 22 (1) ◽

pp. 47-51

Author(s):

Debashish Bar ◽

Masrur Akbar Khan ◽

Sanjana Sharmin Shashi ◽

AZM Mahfuzur Rahman ◽

ABM Khurshid Alam ◽

...

Keyword(s):

Abdominal Trauma ◽

Diagnostic Laparoscopy ◽

Exploratory Laparotomy ◽

Operative Management ◽

Bowel Injury ◽

Trauma Patients ◽

Abdominal Injuries ◽

College Hospital ◽

Negative Laparotomy ◽

Intraabdominal Injuries

Background: The last century has witnessed immense evolvement of management of patients with abdominal trauma. Moreover the recent trend has shifted to selective operative management rather than exploratory laparotomy in trauma patients with suspected intraabdominal injuries and is considered more rational as well. Diagnostic laparoscopy is highly sensitive in detecting intra-abdominal injury with subsequent reduction in the rate of negative laparotomy and procedure related morbidity. Objective: The study was carried out to find the role of diagnostic laparoscopy in abdominal trauma. Methods: An observational study was carried out in the casualty block of Dhaka Medical College Hospital from 1st June 2015 to 30th March 2016. A total of 50 successive patients were assigned in this study. All of them were admitted with abdominal trauma and underwent diagnostic laparoscopy during the period of 10 months. The study was designed to find out whether laparoscopy can help in identifying intra-abdominal injuries with consequent avoidance of unnecessary operative explorations. Results: Intra-abdominal injuries other than GIT perforation were diagnosed by laparoscopy with 100% accuracy but in case of bowel injury the diagnostic accuracy was 80%. Conclusion: Diagnostic laparoscopy is the procedure of choice in doubtful intra-abdominal injuries with impressive accuracy except for bowel injury. Subsequently it reduced the need for negative laparotomies with their procedure related adverse effects. Journal of Surgical Sciences (2018) Vol. 22 (1): 47-51

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