Trauma to the Abdomen and Pelvis

2018 ◽  
Author(s):  
Zahir Basrai ◽  
Timothy Jang ◽  
Manuel Celedon
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Peritoneal Lavage ◽  
Penetrating Trauma ◽  
Balloon Occlusion ◽  
Organ Injury ◽  
Abdominal Organs ◽  
Fast Exam ◽  
Definitive Management ◽  
Endovascular Balloon Occlusion

Abdominal trauma accounts for approximately 12% of all trauma. The evaluation of abdominal trauma is difficult as the patient may have concomitant distracting injuries or alteration of mental status. As a result, a systematic approach to abdominal trauma is needed to ensure that life threatening injuries are not missed. The evaluation and management of abdominal trauma is directed by the Western and Eastern Trauma Association guidelines. Trauma to the abdomen is divided into two main categories, penetrating and blunt. The initial steps in management of both types are determined by the hemodynamic stability of the patient. Unstable patients with either pattern of injury are emergently taken to the operating room (OR) for exploration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is being used at select trauma centers in unstable patients with abdominal trauma that are unresponsive to standard trauma resuscitation. For hemodynamically stable patient with penetrating trauma, recent data on selective non-operative management has shown promising outcomes. Patients with tenuous hemodynamics and blunt abdominal trauma are resuscitated with blood transfusions while being worked up by a Focused Assessment with Sonography for Trauma (FAST) exam or deep peritoneal lavage (DPL). If the patient stabilizes further work up with labs and imaging is performed. Patients that remain tenuous should be taken to the OR. Hemodynamically stable patients with blunt trauma and evidence of peritonitis on exam can be evaluated with labs and imaging to assess for organ injury. Non- tender patients can be evaluated with labs and serial abdominal exams. The American Association for the Surgery of Trauma (AAST) organ injury scales are used to guide the definitive management of patients with intraabdominal injury. The Young-Burgess Classification System can be used to characterize pelvic fractures and to guide stabilization and definitive management. Tables demonstrate the AAST Injury Scales for the different abdominal organs. Images demonstrate the FAST exam and CT findings for different abdominal organs.   This review contains 14 figures, 6 tables and 48 references Key Words: Abdominal Trauma, Penetrating Trauma, Blunt Trauma, FAST exam, Liver Trauma, Splenic Trauma, Intestinal Trauma, Pancreatic Trauma, Diaphragmatic Trauma, Aortic Trauma, Pelvic Fracture, Deep peritoneal lavage, DPL, Focused Assessment with Sonography for Trauma, REBOA, Resuscitative Endovascular Balloon Occlusion of the Aorta

Trauma to the Abdomen and Pelvis

2018 ◽  
Author(s):  
Zahir Basrai ◽  
Timothy Jang ◽  
Manuel Celedon
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Peritoneal Lavage ◽  
Penetrating Trauma ◽  
Balloon Occlusion ◽  
Organ Injury ◽  
Abdominal Organs ◽  
Fast Exam ◽  
Definitive Management ◽  
Endovascular Balloon Occlusion

Abdominal trauma accounts for approximately 12% of all trauma. The evaluation of abdominal trauma is difficult as the patient may have concomitant distracting injuries or alteration of mental status. As a result, a systematic approach to abdominal trauma is needed to ensure that life threatening injuries are not missed. The evaluation and management of abdominal trauma is directed by the Western and Eastern Trauma Association guidelines. Trauma to the abdomen is divided into two main categories, penetrating and blunt. The initial steps in management of both types are determined by the hemodynamic stability of the patient. Unstable patients with either pattern of injury are emergently taken to the operating room (OR) for exploration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is being used at select trauma centers in unstable patients with abdominal trauma that are unresponsive to standard trauma resuscitation. For hemodynamically stable patient with penetrating trauma, recent data on selective non-operative management has shown promising outcomes. Patients with tenuous hemodynamics and blunt abdominal trauma are resuscitated with blood transfusions while being worked up by a Focused Assessment with Sonography for Trauma (FAST) exam or deep peritoneal lavage (DPL). If the patient stabilizes further work up with labs and imaging is performed. Patients that remain tenuous should be taken to the OR. Hemodynamically stable patients with blunt trauma and evidence of peritonitis on exam can be evaluated with labs and imaging to assess for organ injury. Non- tender patients can be evaluated with labs and serial abdominal exams. The American Association for the Surgery of Trauma (AAST) organ injury scales are used to guide the definitive management of patients with intraabdominal injury. The Young-Burgess Classification System can be used to characterize pelvic fractures and to guide stabilization and definitive management. Tables demonstrate the AAST Injury Scales for the different abdominal organs. Images demonstrate the FAST exam and CT findings for different abdominal organs.   This review contains 14 figures, 6 tables and 48 references Key Words: Abdominal Trauma, Penetrating Trauma, Blunt Trauma, FAST exam, Liver Trauma, Splenic Trauma, Intestinal Trauma, Pancreatic Trauma, Diaphragmatic Trauma, Aortic Trauma, Pelvic Fracture, Deep peritoneal lavage, DPL, Focused Assessment with Sonography for Trauma, REBOA, Resuscitative Endovascular Balloon Occlusion of the Aorta

scholarly journals Distal organ inflammation and injury after resuscitative endovascular balloon occlusion of the aorta in a porcine model of severe hemorrhagic shock

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242450
Author(s):  
Yansong Li ◽  
Michael A. Dubick ◽  
Zhangsheng Yang ◽  
Johnny L. Barr ◽  
Brandon J. Gremmer ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Positive Control ◽  
Balloon Occlusion ◽  
Organ Injury ◽  
Trauma Patients ◽  
Total Blood ◽  
Shed Blood ◽  
Endovascular Balloon Occlusion

Background and objective Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) has emerged as a potential life-saving maneuver for the management of non-compressible torso hemorrhage in trauma patients. Complete REBOA (cREBOA) is inherently associated with the burden of ischemia reperfusion injury (IRI) and organ dysfunction. However, the distal organ inflammation and its association with organ injury have been little investigated. This study was conducted to assess these adverse effects of cREBOA following massive hemorrhage in swine. Methods Spontaneously breathing and consciously sedated Sinclair pigs were subjected to exponential hemorrhage of 65% total blood volume over 60 minutes. Animals were randomized into 3 groups (n = 7): (1) Positive control (PC) received immediate transfusion of shed blood after hemorrhage, (2) 30min-cREBOA (A30) received Zone 1 cREBOA for 30 minutes, and (3) 60min-cREBOA (A60) given Zone 1 cREBOA for 60 minutes. The A30 and A60 groups were followed by resuscitation with shed blood post-cREBOA and observed for 4h. Metabolic and hemodynamic effects, coagulation parameters, inflammatory and end organ consequences were monitored and assessed. Results Compared with 30min-cREBOA, 60min-cREBOA resulted in (1) increased IL-6, TNF-α, and IL-1β in distal organs (kidney, jejunum, and liver) (p < 0.05) and decreased reduced glutathione in kidney and liver (p < 0.05), (2) leukopenia, neutropenia, and coagulopathy (p < 0.05), (3) blood pressure decline (p < 0.05), (4) metabolic acidosis and hyperkalemia (p < 0.05), and (5) histological injury of kidney and jejunum (p < 0.05) as well as higher levels of creatinine, AST, and ALT (p < 0.05). Conclusion 30min-cREBOA seems to be a feasible and effective adjunct in supporting central perfusion during severe hemorrhage. However, prolonged cREBOA (60min) adverse effects such as distal organ inflammation and injury must be taken into serious consideration.

scholarly journals The role of laparoscopy in patients with abdominal trauma

2019 ◽  
Vol 7 (5) ◽  
pp. 1853
Author(s):  
Pranav K. Sharma ◽  
Gaurav Gupta
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Case Reports ◽  
Operating Time ◽  
Penetrating Trauma ◽  
Exploratory Laparotomy ◽  
Therapeutic Interventions ◽  
Trauma Patients ◽  
Diagnostic Dilemma ◽  
Therapeutic Laparoscopy

Background: Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted.Methods: All adult patients who presented with abdominal trauma laparoscopic surgery was considered in patients who were deemed fit for the same in the Department of General Surgery, MMIMSR, Mullana, Ambala during a period of 18 months starting from January 1st 2015 to June 30th 2016. Data was analysed using descriptive statistics.Results: A total of 53 patients with either blunt or penetrating abdominal trauma that required surgery were included in the study. Exploratory laparotomy was performed in 45 patients (84.91%) and laparoscopy was performed in 8 patients (15.09%). Overall mesenteric injury (45.28%) was the most common intra-abdominal injury noted. The most common organ involved in blunt trauma was the spleen (68.97%). The mean operating time of laparoscopy was lesser by 57 minutes as compared to exploratory laparotomy. The use of laparoscopy avoided negative and non-therapeutic laparotomy in 2 patients (25%). Therapeutic laparoscopy was performed in 3 patients with repair of bowel and mesenteric injuries. There was no documented procedure‑related morbidity and mortality.Conclusions: The positive outcomes from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal trauma patients.

Resuscitative endovascular balloon occlusion of the aorta for pelvic blunt trauma and life-threatening hemorrhage

2018 ◽  
Vol 84 (3) ◽  
pp. 449-453 ◽  
Author(s):  
Audrey Pieper ◽  
Frédéric Thony ◽  
Julien Brun ◽  
Mathieu Rodière ◽  
Bastien Boussat ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Balloon Occlusion ◽  
Life Threatening ◽  
Endovascular Balloon Occlusion

The usefulness of resuscitative endovascular balloon occlusion of the aorta in detecting the source of a hemorrhage due to abdominal blunt trauma

2016 ◽  
Vol 34 (10) ◽  
pp. 2057.e1-2057.e3 ◽  
Author(s):  
Naoya Matsumoto ◽  
Osanori Sogabe ◽  
Osamu Yoshida ◽  
Izuru Endo ◽  
Sumiharu Yamamoto ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Balloon Occlusion ◽  
Abdominal Blunt Trauma ◽  
Endovascular Balloon Occlusion

Isolated Blunt Duodenal Trauma: Simple Repair, Low Mortality

2015 ◽  
Vol 81 (10) ◽  
pp. 961-964 ◽  
Author(s):  
Stefano Siboni ◽  
Elizabeth Benjamin ◽  
Tobias Haltmeier ◽  
Kenji Inaba ◽  
Demetrios Demetriades
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Primary Repair ◽  
Data Bank ◽  
Hospital Length Of Stay ◽  
Organ Injury ◽  
Low Grade ◽  
Trauma Patients ◽  
National Trauma ◽  
National Trauma Data Bank

Optimal surgical management of traumatic duodenal injury (DI) remains controversial. The National Trauma Data Bank was queried for all blunt trauma patients with DI. Patients with isolated injury were identified by excluding chest and head Abbreviated Injury Score > 3 and non-duodenal intra-abdominal Organ Injury Scale ≥ 3. Demographics, OIS, and operative intervention were collected. Outcomes included mortality and hospital length of stay (HLOS). During the study period, 3,456,098 blunt trauma patients were entered into the National Trauma Data Bank, 388,137 of which had abdominal trauma. Overall, 1.0 per cent patients with abdominal trauma had DI with isolated DI in only 0.6 per cent (n = 2220). The majority of isolated DI was low grade with only 158 patients sustaining severe injury and overall mortality was 5.2 per cent. Overall 743 patients were operated, of which 353 (47.5%) patients underwent duodenal operation, 280 (37.7%) had primary repair (PR), and 68 (9.2%) had gastroenterostomy (GE). Patients with PR had similar mortality to those with GE (6.6% vs 4.5%, P = 0.777); however, HLOS was shorter (median 11 days, vs 18 days, P < 0.001). In only OIS 4 and 5 injuries, PR was also associated with shorter HLOS ( P = 0.004) and similar mortality ( P = 1.000) when compared with GE. Isolated DI after blunt abdominal trauma is rare. In severe injuries, PR is associated with a shorter HLOS without effecting mortality when compared with GE.

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