scholarly journals Intra-Abdominal Solid Organ Injury Management in Pediatrics

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
K Subrumaniam ◽  
Sakti Sakti ◽  
Nur Daliza ◽  
YW Yan
Keyword(s):  
Chest Tube ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Pediatric Population ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Organ Injury ◽  
Solid Organ ◽  
Significant Morbidity ◽  
Solid Organ Injury

Abdominal trauma is relatively uncommon in children but can leads to a significant morbidity and mortality in the pediatric population. The abdomen is the third most commonly injured anatomic region in children, after the head and the extremities. The abdomen is the most common site of initially unrecognized fatal injury in traumatized children. We are reporting a case of a child with multiple solid organ injury that was successfully treated non-operatively at our center. We presented a previously healthy 9-month-old girl, presented with fluctuating GCS secondary to motor vehicle accident with borderline hemodynamic stability. She was intubated, blood transfusion commenced and a single inotrope support started. She subsequently diagnosed with grade III liver injury, grade II splenic injury, right grade IV renal injury with large perinephric and retroperitoneal hematoma and moderate hemoperitoneum, a non-displaced left superior pubic rami fracture and cerebral edema on computed tomography (CT). She was admitted to pediatric intensive care unit (PICU). Her intra-abdominal injury injuries were successfully treated conservatively. She required a right chest tube on post trauma day 2, for right hemothorax. The chest tube was removed 3 days later following adequate drainage. She eventually was weaned off from ventilator on post trauma day 11. Feeding was commenced on day 7 of post trauma. She was discharge home well after 3 weeks post trauma with periodical follow up. Conclusion: Pediatric intra-abdominal solid organ injury is relatively uncommon, but a potential source of significant morbidity. Non-operative management is the standard of care for the majority of these injuries, which have shown successful rate more than 95%, although continued hemodynamic instability mandates operative intervention.

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 blunt trauma abdomen in a tertiary care teaching hospital: a surgical audit

2018 ◽  
Vol 5 (6) ◽  
pp. 2177
Author(s):  
Shashikumar H. B. ◽  
Madhu B. S. ◽  
Ajo Sebastian
Keyword(s):  
Blunt Trauma ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Tertiary Care ◽  
Operative Management ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Surgical Audit ◽  
Non Operative Management

Background: Blunt abdominal trauma is a common scenario in Emergency department and the common cause being road traffic accidents. With this study we present our experience with blunt trauma of abdominal solid organ injuries over a period of 12 months.Methods: A retrospective study was conducted among 45 blunt trauma of abdominal solid organ injuries who presented to the emergency room of Department of General Surgery of Mysore Medical College and Research Institute, Mysore from 1st January 17 to 31st December 2017.All date were retrieved from medical records and statistical analysis was performed using Epi info version 7.Results: Mean age of study population was 31.46 years. 78.2% of the patients were males. Thirty-three (73.3%) patients undergone non-operative management. Splenic injury was reported as the most common abdominal solid organ injury followed by liver.Conclusions: With the advent of newer investigative modalities like contrast enhanced computed tomography (CECT) abdomen, more and more cases of blunt trauma abdominal solid organ injury can be managed non-operatively with effective ICU care. High-grade injuries do not preclude non-operative 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 Serial hemoglobin monitoring in adult patients with blunt solid organ injury: less is more

2020 ◽  
Vol 5 (1) ◽  
pp. e000446 ◽  
Author(s):  
Firas Madbak ◽  
Dustin Price ◽  
David Skarupa ◽  
Brian Yorkgitis ◽  
David Ebler ◽  
...  
Keyword(s):  
Injury Severity ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Level Of Evidence ◽  
Less Is More ◽  
Urban Level ◽  
Level 1 Trauma Center

BackgroundPatients who sustain blunt solid organ injury to the liver, spleen, or kidney and are treated nonoperatively frequently undergo serial monitoring of their hemoglobin (Hb). We hypothesized that among initially hemodynamically stable patients with blunt splenic, hepatic, or renal injuries treated without an operation, scheduled monitoring of serum Hb values may be unnecessary as hemodynamic instability, not merely Hb drop, would prompt intervention.MethodsWe performed a retrospective review of patients admitted to our urban Level 1 trauma center following blunt trauma with any grade III, IV, or V liver, spleen, or kidney injury from January 1, 2016 to December 31, 2016. Patients who were hemodynamically unstable and went directly to the operating room or interventional radiology were excluded. Patients who required any urgent or unplanned operative or angiographic intervention were compared with patients who did not require an intervention. Routine demographic and outcome variables were obtained and bivariate and multivariate regression statistics were performed using Stata V.10.ResultsA total of 138 patients were included in the study. Age (39.3 vs 41.4, p=0.51), mean injury severity score (26.7 vs 22.1, p=0.12), and admission Hb (11.9 vs 12.8, p=0.06) did not differ significantly between the two groups. The number of Hb draws (9.2 vs 10, p=0.69) and the associated change in Hb (3.7 vs 3.5, p=0.71) did not differ significantly between the two groups. Only splenic grade predicted need for urgent intervention (3.5 vs 2, p<0.001). All patients who required an operative or radiologic intervention did so based on change in hemodynamics or severity of splenic grade, per our institutional protocol, and not Hb trend.DiscussionAmong patients with blunt solid organ injury, a need for emergent intervention in the form of laparotomy or angioembolization occurs within the first hours of injury. Routine scheduled Hb measurements did not change management in our cohort.Level of evidenceLevel III.

Selective non-operative management of solid organ injury following abdominal gunshot wounds

Injury ◽  
2007 ◽  
Vol 38 (9) ◽  
pp. 1084-1090 ◽  
Author(s):  
Joseph DuBose ◽  
Kenji Inaba ◽  
Pedro G.R. Teixeira ◽  
Antonio Pepe ◽  
Michael B. Dunham ◽  
...  
Keyword(s):  
Gunshot Wounds ◽  
Operative Management ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Non Operative Management ◽  
Abdominal Gunshot Wounds

scholarly journals A prospective and retrospective study on conservative management of hepatic and splenic injury following blunt abdominal trauma

2020 ◽  
Vol 7 (6) ◽  
pp. 1930
Author(s):  
Induchoodan Ponnamma Pillai Sukumaran Nair ◽  
Rajesh P. S.
Keyword(s):  
Abdominal Trauma ◽  
Conservative Management ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Road Traffic ◽  
Operative Management ◽  
Splenic Trauma ◽  
Solid Organ ◽  
Non Operative Management

Background: worldwide road traffic accidents accounts as the leading cause of death of young people. For a very long time most of the intra-abdominal injuries following blunt abdominal trauma were managed operatively. Conservative management is becoming more acceptable and effective management option for blunt abdominal trauma during the last few decades.Methods: This study was conducted in Government Medical College, Kottayam during September 2007 to December 2008. All conservatively managed blunt abdominal trauma patients during the study period were included in the study.Results: Out of 22 patients, 4 patients failed conservative management. Success rate was 81%. Most commonly injured solid organ in the study group was liver (77%). Maximum cases were of age group 10 to 20 (31.81%) years. 81% of patients were males. Motor vehicle accident was the most common cause of trauma (77%). Mean stay in intensive care unit was 4.2 days and mean hospital stay was 15.7 days. Mean systolic blood pressure was 110 mmHg ranging from 70 to 130 mmHg. 50% of patients had moderate hemoperitoneum and non-had massive hemoperitoneum.Conclusions: Non operative management is safe and effective approach in blunt spleen and liver injuries. Non operative management should be treatment of choice for all hemodynamically stable patients with blunt liver and splenic trauma.

scholarly journals Risk factors for mortality in blunt abdominal trauma with surgical approach

2015 ◽  
Vol 42 (4) ◽  
pp. 259-264 ◽  
Author(s):  
SILVANIA KLUG PIMENTEL ◽  
GUILHERME VINICIUS SAWCZYN ◽  
MELISSA MELLO MAZEPA ◽  
FELIPE GUILHERME GONÇALVES DA ROSA ◽  
ADONIS NARS ◽  
...  
Keyword(s):  
Risk Factors ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Hemodynamic Instability ◽  
The Other ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Serious Injury ◽  
Serious Injuries

ABSTRACTObjective:identify risk factors for mortality in patients who underwent laparotomy after blunt abdominal trauma.Methods:retrospective study, case-control, which were reviewed medical records of blunt trauma victims patients undergoing laparotomy, from March 2013 to January 2015, and compared the result of the deaths group with the group healed.Results:of 86 patients, 63% were healed, 36% died, and one patient was excluded from the study. Both groups had similar epidemiology and trauma mechanism, predominantly young adults males, automobilistic accident. Most cases that evolved to death had hemodynamic instability as laparotomy indication - 61% against 38% in the other group (p=0.02). The presence of solid organ injury was larger in the group of deaths - 80% versus 48% (p=0.001) and 61% of them had other associated abdominal injury compared to 25% in the other group (p=0.01). Of the patients who died 96% had other serious injuries associated (p=0.0003). Patients requiring damage control surgery had a higher mortality rate (p=0.0099). Only one of 18 patients with isolated hollow organ lesion evolved to death (p=0.0001). The mean injury score of TRISS of cured (91.70%) was significantly higher than that of deaths (46.3%) (p=0.002).Conclusion:the risk factors for mortality were hemodynamic instability as an indication for laparotomy, presence of solid organ injury, multiple intra-abdominal injuries, need for damage control surgery, serious injury association and low index of trauma score.

BET 2: Is early chemical thromboprophylaxis safe in patients with blunt trauma solid organ injury (SOI) undergoing non-operative management (NOM)?

2018 ◽  
Vol 35 (2) ◽  
pp. 127-129 ◽  
Author(s):  
Craig Ferguson ◽  
Jonathan Lewin
Keyword(s):  
Blunt Trauma ◽  
Low Molecular Weight Heparin ◽  
Operative Management ◽  
Organ Injury ◽  
Low Molecular Weight ◽  
Solid Organ ◽  
Clinical Question ◽  
Solid Organ Injury ◽  
Study Type ◽  
Non Operative Management

A short cut review was carried out to establish whether chemical thromboprophylaxis was a safe early intervention in patients with solid organ injury that is being managed non-operatively. Eight papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is inadequate evidence assessing safety of low molecular weight heparin (LMWH) within 24 hours of trauma. The current available evidence does suggest that administration of LMWH within 48 hours is safe in non-operative management of patients who have sustained solid organ injury from blunt trauma.

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