scholarly journals The Role of Computed Tomography in Blunt Abdominal Trauma

2015 ◽  
Vol 53 (200) ◽  
pp. 227-230
Author(s):  
Om Bahadur Karki
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Common Mechanism

Introduction: Blunt injury trauma is regularly encountered in the emergency department. Diagnostic tools that help in optimum management of blunt abdominal trauma include; Focussed Assessment Sonography for Trauma scan, Diagnostic peritoneal lavage and Computed Tomography scan. The aim of this study is to determine the validity of CT scan as an accurate diagnostic tool and its role in management of patients with blunt abdominal trauma. Methods: A prospective analysis of 80 patients of blunt abdomen trauma who were admitted in Manipal Teaching Hospital, Pokhara, Nepal within a span of 15 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Organ injuries were graded using the Organ Injury Scale guidelines. Results: Most of the patients in our study were in the age group of 21-40 years with an M: F ratio of 2.3:1. Road traffic accident (47.5%) was the most common mechanism of injury. Spleen (27.5%) was the commonest organ injured. CT scan was superior to FAST scan and had sensitivity of 97.3% specificity 75% positive predictive value 98.6%. FAST scan had sensitivity of 78.9%, specificity 50%, positive predictive value 96% with p- value of 0.0034. 81% of patients were conservatively managed. Conclusions: In conjunction with close clinical monitoring, CT scan is reliable in the evaluation and management of blunt abdominal trauma patients. Our study also shows CT as a superior diagnostic modality compared to FAST scan. Keywords: blunt abdominal trauma; CT scan; FAST scan; road traffic accident.

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.

Educational Review of Predictive Value and Findings of Computed Tomography Scan in Diagnosing Bowel and Mesenteric Injuries after Blunt Trauma: Correlation with Trauma Surgery Findings in 163 Patients

2017 ◽  
Vol 68 (3) ◽  
pp. 276-285 ◽  
Author(s):  
Francesco Cinquantini ◽  
Gregorio Tugnoli ◽  
Alice Piccinini ◽  
Carlo Coniglio ◽  
Sergio Mannone ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Gold Standard ◽  
Clinical Management ◽  
Trauma Surgery ◽  
Trauma Patients ◽  
Increased Risk

Background and Aims Laparotomy can detect bowel and mesenteric injuries in 1.2%–5% of patients following blunt abdominal trauma. Delayed diagnosis in such cases is strongly related to increased risk of ongoing sepsis, with subsequent higher morbidity and mortality. Computed tomography (CT) scanning is the gold standard in the evaluation of blunt abdominal trauma, being accurate in the diagnosis of bowel and mesenteric injuries in case of hemodynamically stable trauma patients. Aims of the present study are to 1) review the correlation between CT signs and intraoperative findings in case of bowel and mesenteric injuries following blunt abdominal trauma, analysing the correlation between radiological features and intraoperative findings from our experience on 25 trauma patients with small bowel and mesenteric injuries (SBMI); 2) identify the diagnostic specificity of those signs found at CT with practical considerations on the following clinical management; and 3) distinguish the bowel and mesenteric injuries requiring immediate surgical intervention from those amenable to initial nonoperative management. Materials and Methods Between January 1, 2008, and May 31, 2010, 163 patients required laparotomy following blunt abdominal trauma. Among them, 25 patients presented bowel or mesenteric injuries. Data were analysed retrospectively, correlating operative surgical reports with the preoperative CT findings. Results We are presenting a pictorial review of significant and frequent findings of bowel and mesenteric lesions at CT scan, confirmed intraoperatively at laparotomy. Moreover, the predictive value of CT scan for SBMI is assessed. Conclusions Multidetector CT scan is the gold standard in the assessment of intra-abdominal blunt abdominal trauma for not only parenchymal organs injuries but also detecting SBMI; in the presence of specific signs it provides an accurate assessment of hollow viscus injuries, helping the trauma surgeons to choose the correct initial clinical management.

scholarly journals Gastric rupture following blunt abdominal trauma: a case report

2019 ◽  
Vol 6 (10) ◽  
pp. 3869
Author(s):  
Kritika Tiwari ◽  
Anuja Athale ◽  
Siddhartha K.
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Gastric Perforation ◽  
Abdominal Injuries ◽  
Concomitant Injuries ◽  
Severity Of Injury ◽  
Gastric Rupture

Gastric perforations following blunt abdominal trauma are rare, accounting for <2% of all blunt abdominal injuries. This is usually associated with other solid visceral injuries. Isolated blunt gastric ruptures are very rare. Severity of injury, timing of presentation and presentation following last meal as well as concomitant injuries are important prognostic factors. We present a patient with gastric perforation following road traffic accident.

scholarly journals Analysis And Clinical Study Of Surgical Management And Outcome Of Blunt Abdominal Trauma

2021 ◽  
Vol 23 (2) ◽  
pp. 12-21
Author(s):  
Ravi V. Satasia ◽  
Sanjay R. Chauhan ◽  
Aimanhusen M. Payala ◽  
Aarsh Panchal ◽  
Jaykumar Patel ◽  
...  
Keyword(s):  
Latent Period ◽  
Clinical Examination ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Age Group ◽  
Abdominal Injuries ◽  
The Impact

INTRODUCTION: Trauma during Road Traffic Accident is a major public health problem in all countries. It causes death, disability or both. 50% die immediately at the time of accident. 25% die in golden hour (4–6 hours) of trauma. 25% may die late during treatment period due to sepsis and complications. AIMS AND OBJECTIVES: 1)To study the impact of blunt abdominal trauma on abdominal solid organs like spleen, liver and hollow viscera like stomach and intestine along with various mode of injuries and their different type of management and their outcomes. MATERIALS AND METHODS: This is a prospective study of blunt abdominal injuries during the period from June 2019 to January 2021 in Sheth Lallubhai Gordhandas Municipal General Hospital, Ahmedabad. Number of cases studied is 60. Clinical Data of admitted patient were collected by their detail history after stabilizing the patient, clinical examination with appropriate investigations. RESULTS AND DISSCUSION: In our Study majority of the patients belonged to 21-30 years age group, followed by 31-40 years age group. 46 cases were males, with females accounting for only about 14 cases. 35 patients were operated and 25 patients were selected for non-operative management. Road traffic accident was responsible for 48% of blunt abdominal trauma cases, while fall from heights accounted for 18% of cases and blow with blunt object was responsible for 34% of injuries. Majority of the patients presented with abdominal pain (100%) and abdominal tenderness (76%). Average latent period was between 12-18 hours. Majority of patients (50%) were taken for surgery between 6-10 hours of latent period. Associated extra abdominal injuries were found in 27 cases. Apart from routine investigations, abdomen x ray was done in all patients. Ultrasound of abdomen was done in 53 cases. CT scan was done in 21 cases. CONCLUSION: Propper clinical examination and appropriate investigations helps in management of patient either operative or non-operative which leads successful treatment in these patients. Other associated injuries greatly influence the outcome in morbidity and mortality.

scholarly journals SPECTRUM AND OUTCOME OF BLUNT ABDOMINAL TRAUMA

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Mahesh Kumar Sharma ◽  
Dr. Arun Bhargava
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Traffic Accident ◽  
Traffic Accidents ◽  
Splenic Injury ◽  
Road Traffic ◽  
Age Groups ◽  
Operative Management ◽  
Fall From Height ◽  
Type Of Injury

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. So we evaluate the spectrum and outcome of blunt trauma. Methods: Hospital based prospective study conducted on 100 patients at department of general surgery. Results: Distribution according to type of injury consisted of maximum cases, 84 (84%) of road traffic accidents, 11% cases were of fall from height. Conclusions: Males were pre-dominantly affected. Road traffic accident was the most common cause of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt abdominal trauma, Liver injury, Perforation, Splenic injury

scholarly journals Role of Liver Enzymes in Patients with Blunt Abdominal Trauma to Diagnose Liver Injury

2020 ◽  
Author(s):  
Anup Shrestha ◽  
Harish Chandra Neupane ◽  
Kishor Kumar Tamrakar ◽  
Abhishek Bhattarai ◽  
Gaurav Katwal
Keyword(s):  
Liver Injury ◽  
Confidence Interval ◽  
Ct Scan ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Predictive Value ◽  
Liver Enzymes ◽  
Tertiary Center ◽  
Significant Difference

Abstract Background:The liver is the second most injured organ following blunt abdominal trauma (BAT) after spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it is not readily available in the hospital. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury.Method:The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) study from February 2019 to May 2020. During that period 96 patients with BAT presented to the emergency department(ED) of CMCTH.Results:Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (<0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89(95% Confidence Interval 0.86-0.98) and of ALT was 0.92(95% Confidence Interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7 %, a specificity of 90 %, a positive predictive value of 86.8 %, and a negative predictive value of 77.6 %. The corresponding values for ALT ≥ 80 U/l were 77.8 %, 94.1%, 92.1% and 82.8 %, respectively.ConclusionIn conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l respectively. The elevated level of AST and ALT might assist the surgeons to timely refer the suspected patients with the liver to a tertiary center and it might help the surgeons to go for conservative management for minor liver injuries in BAT preventing the exposure hazards of the CT scan.

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 Urethral injury in children: Experience in a teaching hospital in Enugu, Nigeria

2020 ◽  
Vol 29 (3) ◽  
pp. 151-155
Author(s):  
Kevin Emeka Chukwubuike ◽  
Joseph Tochukwu Enebe ◽  
Obinna Chukwuebuka Nduagubam
Keyword(s):  
Teaching Hospital ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Urethral Injury ◽  
Common Mechanism ◽  
Mechanism Of Injury ◽  
Bulbar Urethra ◽  
Urethral Trauma ◽  
Considerable Morbidity

Background: Urethral injury in children is uncommon, and its treatment is challenging. This study evaluated our experience in the management of urethral injuries in children who presented at the paediatric surgical unit of a teaching hospital in Enugu, Nigeria. Methods: The medical records of patients younger than 15 years old admitted to our centre with urethral injury from January 2008 and December 2017 were reviewed retrospectively. Results: During the period of the study, 11 cases (all male) were managed. The mean age of the patients at presentation was 11 years. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the most injured part of the urethra. All the patients had urethroplasty through the perineal approach. There was 90% success at first instance. One patient required redo urethroplasty. Conclusion: Urethral trauma is associated with considerable morbidity. Road traffic accident was the most common mechanism of injury, and the bulbar urethra was the part of the urethra most affected. Transperineal urethroplasty was an effective modality of treatment.

scholarly journals A fracture of OS trigonum: a rare case report

2020 ◽  
Vol 7 (1) ◽  
pp. 162
Author(s):  
Gnanaprakash Palaniappan ◽  
Chetan John Rasquinha ◽  
Major K. Kamalanathan
Keyword(s):  
Ct Scan ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Rare Event ◽  
Os Trigonum ◽  
Posterior Process ◽  
Lacerated Wound ◽  
Rare Case Report ◽  
Flap Cover

<p class="abstract">Fractures of os trigonum is an extremely rare event. It is one of the accessory ossicles of the foot found in about 7 % of the population. Very few cases have been reported in the literature about a fracture of the ostrigonum. We present a case of fracture of ostrigonum with associated fracture of the fibula and a large lacerated wound in the leg, in a young man sustained due to road traffic accident. The initial radiological examination with Xray ankle showed a doubtful fracture of posterior process of talus but was not clear. The diagnosis was clinched by CT scan of the ankle with 2mm cuts, which showed clearly a fracture of the os trigonum. It was treated by flap cover for the wound and plaster immobilisation for the fracture. So, any doubtful fracture near the posterior process of talus should be fully assessed radiologically with a CT scan to guide in the treatment.</p>

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