Injuries to the Stomach, Small Bowel, Colon, and Rectum

2020 ◽  
Author(s):  
Jordan A Weinberg ◽  
Timothy C. Fabian
Keyword(s):  
Small Bowel ◽  
Abdominal Trauma ◽  
Operative Management ◽  
Bowel Injury ◽  
Organ Injury ◽  
Gastric Injury ◽  
Rectal Injury ◽  
Trauma Patients ◽  
Hollow Viscus ◽  
Hollow Viscus Injury

Hollow viscus injury is most often the consequence of penetrating abdominal trauma. As a result of blunt force trauma, bowel injury occurs with relative infrequency: in one multi-institutional analysis, only 1.2% of blunt trauma admissions had an associated hollow viscus injury. The diagnosis of hollow viscus injury remains a challenge in abdominal trauma patients, and subsequent evaluation is determined by the mechanism of injury. Regardless of the specific injury mechanism, however, the principles and techniques of operative management are largely the same. This review covers determination of need for operation, and operative management. Figures show algorithms outlining the evaluation of blunt hollow organ injury in a hemodynamically stable patient with an unreliable physical examination, the treatment of truncal stab wounds, the treatment of blunt bowel and mesenteric injury, the treatment of gastric injury, the treatment of small bowel injury, the treatment of colon injury, the treatment of rectosigmoid or rectal injury, and a demonstration of presacral drainage through a curved incision midway between the anus and the tip of the coccyx. Tables list the incidence of findings suggestive of blunt mesenteric and bowel injury in true positive and false positive computed tomography  scans, and the American Association for the Surgery of Trauma organ injury scales for gastrointestinal tract and pancreas.   This review contains 8 figures, 3 tables, and 58 references Keywords: Injury, blunt, primary rectal repair, colostomy, laparotomy, trauma

scholarly journals Clinical study of hollow viscus injury in abdominal trauma

2017 ◽  
Vol 5 (1) ◽  
pp. 39
Author(s):  
Sanjay Jain ◽  
Dinkar Maske ◽  
M. C. Songra
Keyword(s):  
Small Bowel ◽  
Abdominal Trauma ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Female Gender ◽  
Bowel Injury ◽  
Solid Organ ◽  
Small Bowel Injury ◽  
Hollow Viscus

Background: Abdominal injury is leading cause of morbidity and mortality at present due to great improvement in man's lifestyle and development of industries.Methods: A total 100 cases of abdominal trauma (both blunt and penetrating) were studied in the present study in our institute for period of 18 Months.Results: Males belonging to young age group of 21-30 were most commonly affected. Road traffic accident is most common mode of injury. Abdominal pain seen in 93% of patients. Abdominal tenderness seen in 86% of patients. Plain x ray abdomen erect was sensitive in detecting hollow viscus injuries. Diagnostic peritoneal lavage is better than four quadrant aspirations. Ultrasound examination gives a clear picture of solid organ injury and free fluid. Most common injured viscera in the present study is small bowel and they were managed by simple suturing and closure of perforation and resection and anastomosis. Postoperative complications like wound infection, wound dehiscence, respiratory complications, pelvic abscess and faecal fistula were seen. The duration of stay for most of the patients in this study was between 11-20 days with mean of 15 days. Mortality in this study was 7%. Conditions such as, female gender, long interval between injury and operation, presence of shock on admission, and small bowel injury worsen the prognosis in penetrating abdominal trauma.Conclusions: Young males are most commonly affected due to road traffic accident. Conditions such as, female gender, long interval between injury and operation, presence of shock on admission, and small bowel injury worsen the prognosis in penetrating abdominal trauma.

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 90 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Shalaby ◽  
M Ibrahim ◽  
T El Faioumy ◽  
M Elmessiry
Keyword(s):  
Abdominal Trauma ◽  
Operative Management ◽  
The Other ◽  
University Hospital ◽  
Organ Injury ◽  
Low Grade ◽  
Trauma Patients ◽  
Solid Organ ◽  
Penetrating Abdominal Trauma ◽  
Non Operative Management

Abstract Aim to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient’s candidates for non-operative management. Method In this comparative study 40 abdominal stab victims (admitted to Emergency Department of Alexandria Main University Hospital) were selected during 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome. Results In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications. Conclusions Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.

Blunt Gastric Injuries

2007 ◽  
Vol 73 (9) ◽  
pp. 880-883 ◽  
Author(s):  
Didem Oncel ◽  
Darren Malinoski ◽  
Carlos Brown ◽  
Demetrios Demetriades ◽  
Ali Salim
Keyword(s):  
Small Bowel ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Injury Severity ◽  
Gastric Injury ◽  
Injury Score ◽  
Hollow Viscus ◽  
Gastric Rupture ◽  
Abbreviated Injury Score ◽  
Colon Injuries

Gastric rupture after blunt abdominal trauma is a rare injury with few reports in the literature. The purpose of this study was to review our experience with blunt gastric injuries and compare outcomes with small bowel or colon injuries. All patients with hollow viscus perforations after blunt abdominal trauma from 1992 to 2005 at our level I trauma center were reviewed. Of 35,033 blunt trauma admissions, there were 268 (0.7%) patients with a total of 319 perforating hollow viscus injuries, 25 (0.07%) of which were blunt gastric injuries. When compared with the small bowel or colon injuries, the blunt gastric injury group had a higher Injury Severity Score (22 versus 17, P = 0.04), more patients with a chest Abbreviated Injury Score greater than 2 (36% versus 12%, P < 0.01), and a shorter interval from injury to laparotomy (221 versus 366 minutes, P = 0.017). Multivariate analysis identified five independent risk factors for mortality: age older than 55 years, head Abbreviated Injury Score greater than 2, chest Abbreviated Injury Score greater than 2, the presence of hypotension on admission, and Glasgow Coma Scale 8 or less. The results of this study suggest that mortality in patients with blunt hollow viscus injuries can be attributed to concurrent head and chest injuries, but not the specific hollow viscus organ that is injured.

Diagnostic Laparoscopy Reduces the Rate of Negative Laparotomy in Trauma Patients

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

scholarly journals EP.FRI.99 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amr Shalaby ◽  
Mohammed Ibrahim ◽  
Tarek El Faioumy ◽  
Mohamed Elmessiry
Keyword(s):  
Abdominal Trauma ◽  
Vital Signs ◽  
Operative Management ◽  
The Other ◽  
Organ Injury ◽  
Low Grade ◽  
Trauma Patients ◽  
Solid Organ ◽  
Penetrating Abdominal Trauma ◽  
Non Operative Management

Abstract Aim to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient candidates for non-operative management.  Methods In this comparative study 40 abdominal stab victims (admitted to Emergency Department) were selected during a 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome.  Results In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications.  Conclusion Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission. 

A clinical study of hollow viscus injury in the cases of abdominal trauma

2019 ◽  
Vol 9 (1) ◽  
pp. 13-16
Author(s):  
Ashok F Shelake ◽  
◽  
James Joseph Nadar ◽  
Dwarka R Dhanve ◽  
◽  
...  
Keyword(s):  
Clinical Study ◽  
Abdominal Trauma ◽  
Hollow Viscus ◽  
Hollow Viscus Injury

scholarly journals Non-operative Management of Blunt abdominal trauma in a Tertiary Care Hospital of Nepal

2013 ◽  
Vol 2 (1) ◽  
pp. 38-41 ◽  
Author(s):  
P Ghimire ◽  
N Yogi ◽  
P Ghimire
Keyword(s):  
Teaching Hospital ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Operative Management ◽  
Bowel Injury ◽  
Care Hospital ◽  
Failure Group ◽  
Management Group ◽  
Clinical Instability ◽  
Non Operative Management

Background: To assess the feasibility of Non-operative management of Blunt abdominal trauma in a teaching hospital of Nepal. Methods: A prospective observational study was carried out over a period of 3 years including 52 cases of blunt abdominal trauma in a teaching hospital in western part of Nepal. Patient and trauma characteristics of the cases, different modalities of treatment and outcomes were evaluated. All the cases were divided in 3 groups: Operative group, Non-Operative Management and Non-Operative Failure group. Operative group and non-operative management group were compared using Fischer Exact Test for categorical variable and student’s “t” test for continuous variable. Results: There were 36% of cases in operative group, 61% in non-operative management group and 2% in non-operative management failure group. Non-operative management was successful in 97% of cases. Injury severity score, admission hematocrit and hemodynamic status were significantly different between non-operative management and Operative group. Non-operative management failure occurred in 1 case and was secondary to delayed hepatic hemorrhage. Conclusion: Non-operative management of Blunt abdominal trauma can be attempted with high degree of success. Hemodynamic and clinical instability rather than severity of the organ injury is the predictor of failure in non-operative management. Spleen and bowel injury are the most common organ that usually land up in operative group because of hemodynamic instability in splenic injury and peritoneal contamination in bowel injury. Close surveillance in an intensive care unit is always desirable. Nepal Journal of Medical Sciences | Volume 02 | Number 01 | Jan-Jun 2013 | Page 38-41 DOI: http://dx.doi.org/10.3126/njms.v2i1.7650

scholarly journals Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy

2019 ◽  
Vol 109 (2) ◽  
pp. 89-95 ◽  
Author(s):  
J. Kosola ◽  
T. Brinck ◽  
A. Leppäniemi ◽  
L. Handolin
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Organ Injury ◽  
General Surgeon ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Emergency Procedures ◽  
Complex Skills

Background and Aims: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. Materials and Methods: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006–2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. Results: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). Conclusion: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.

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