Role of Computed Tomography in Blunt Abdominal Trauma

Introduction: Blunt abdominal trauma is one of the commonly encountered surgical emergencies. The diagnostic modality that helps in optimum management of these patients includes chest and abdominal x-rays, Focused Assessment Sonography for Trauma scan and Computed Tomography. In selected hemodynamically stable patients who are candidates for non-operative management, Contrast Enhanced Computed Tomography is not considered essential and hence avoiding its own radiation hazards and decreasing extra financial burden to the patients. Aims: To evaluate whether Contrast Enhanced Computed Tomography is necessary or not in case of blunt trauma abdomen. Methods: This is a hospital based prospective study done in the department of surgery at Nepalgunj Medical College, Kohalpur conducted from October 2020 to March 2021. The patients with blunt abdominal trauma who were hemodynamically stable at the time of presentation and those who became stable after resuscitation were included. These patient’s detailed history was taken, clinical examination done. Focused Assessment Sonography for Trauma scan was done at the time of presentation along with chest x-ray and other necessary blood investigation. Data were analyzed with Statistical Package for Social Sciences version 25 and p-value <0.05 was taken as significant. Results: Out of total 53 patients, age group between 11-20 and 21-30 years comprising of 13 patients with male: female ratio of 1.94:1 were affected more. Fall injury, being the most common mode, comprised 20 patients. The commonest organ involved was spleen seen in 17 patients (32.1%), liver in 16 patients (30.2%). In 44 (83.0%) patients, Computed Tomography scan was done only in nine patients who were also managed conservatively, except one who underwent laparoscopic evacuation of collected blood. Seventeen (32.1%) patients underwent repeat ultrasonography without any new findings. Conclusion: Patients with blunt abdominal trauma with stable hemodynamics can be managed conservatively with limited use of Contrast Enhanced Computed Tomography scan.

Isolated perforation of fourth part of Duodenum following Blunt Abdominal Trauma

Introduction: Isolated duodenal injuries are rare in blunt abdominal trauma. These present a significant challenge for management because of the associated injuries and its difficult anatomical accessibility. Case presentation: A 20years male presented to the Emergency department following a bike accident sustaining injury over face, chest and abdomen, 6hours after the incident. His vitals were unstable so he was resuscitated and admitted in Intensive Care Unit. He had generalized abdominal tenderness without rigidity. Contrast enhanced computed tomography of abdomen and pelvis was suggestive of hollow viscus perforation. He underwent exploratory laparotomy and primary repair for isolated perforation at fourth part of duodenum. He was discharged on his ninth postoperative day. Conclusion: Rare injuries following blunt abdominal trauma should be considered and early intervention is necessary.

Comparison of Blunt Abdominal Trauma Scoring System (BATSS) versus FAST in assessment of Blunt Trauma Abdomen

Trauma is the second largest cause of disease worldwide accounting for more than 16 % of global burden 1. By the next decade, the World Health Organization (WHO) estimates that trauma will be the leading cause of Years of Potential Life Lost (YPLL) amongst the world population. With advancement in infrastructure and economic prosperity, accidental trauma due to vehicular accidents has become more commonplace. A majority of victims of motor vehicular accidents present with Blunt abdominal trauma, which due to the complexity in diagnosis and management, presents with significant morbidity and mortality2. Introduced in the 1970s in Europe, point of care Ultrasonographic examination of the abdomen in trauma called as FAST (Focussed Assessment with Sonography for Trauma) has become a routine in emergency rooms worldwide 3. The Blunt Abdominal Trauma scoring system was developed to better diagnose intra-abdominal injury after blunt abdominal trauma 4. This study is aimed in comparing the findings of FAST and BATSS in predicting intra-abdominal injury accurately.

Traumatic Small Bowel Injury: A Diagnosis Challenge

Traumatic small bowel injury is rare complication following a blunt abdominal trauma. We encountered a case of small bowel injury following a motor vehicle accident that was initially missed during the first presentation due to unremarkable findings in examination. Patient re-presented five days later with bowel ischaemia and was managed accordingly. It is a challenge in diagnosing the injury due to its vague presentation. The usage of Focused Assessment with Sonography for Trauma (FAST) scan as a screening tool in Emergency Department to pick up intra-abdominal injury do have limitations especially in diagnosing small bowel perforation post blunt abdominal trauma. The early phase of small bowel injury post blunt abdominal trauma rarely produces significant free fluid during the FAST scan. It is paramount for the emergency doctors to have a high level of suspicion in high risk cases to provide early supportive treatment and early referral to surgical team. If left undiagnosed bowel ischaemia may lead to catastrophic complication affecting the patient’s morbidity and mortality. In conclusion, each case should be managed and risk stratify individually. Computed tomography abdomen is found to be more superior in detecting bowel injuries, hence, and investigation of choice compared to bedside ultrasonograpy in cases with high level of suspicaion.

Enhanced recovery after surgery protocol versus conventional care in emergency abdominal trauma surgery: a prospective, randomised, controlled study

Background: Since 1990s there has been a defined role of ERAS in elective surgeries, to optimize the peri-operative care, reducing post-operative complications and length of stay and hence, the overall costs. However, there is paucity of literature in its effectiveness in emergency trauma surgeries. The aim of the study was to investigate the feasibility and outcomes of ERAS protocol in emergency abdominal surgery in the setting of trauma.Methods: Institutional IEC approved study. A prospective randomized of 52 patients with abdominal trauma undergoing emergency laprotomy were included in the study and divided into two groups: ERP and conventional group. The ERP included early feeding, early urinary catheter removal, early mobilization/physiotherapy, early intravenous line removal and early optimal oral analgesia. The primary end-points were the length of hospital stay and secondary end-points included complication rate and re-admission rate.Results: The two groups were comparable with regards to age, gender, mechanism of injury and ISS score. Hospital stay was significantly shorter in the ERAS group: 4.67 days verses 13.36 days (p<0.001). There were 15 and 11 complications in the control and study group respectively. When graded as per the Clavien-Dindo classification there was no significant difference in the 2 groups (p=0.306).Conclusions: This study shows that early recovery programs can be successfully implemented with significant shorter hospital stays without any increase in postoperative complications in trauma patients undergoing emergency laparotomy for abdominal trauma.

Blunt abdominal trauma: initial resuscitation followed by clinical and focused abdominal sonography assessment important diagnostic tools of organ injury due to restricted use of CT-scan in a tertiary care in India

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. Objective was to evaluate the role of clinical and ultrasound assessment in early diagnosis of intra-abdominal injury following blunt abdominal trauma and follow up in patients with intraabdominal injury for detecting complications.Methods: 130 patients who presented to the emergency room were evaluated by clinical and focused abdominal sonography for trauma (FAST) and follow-up sonography was done after 6-12 hours upto 72 hours.Results: In our study, road traffic accidents (RTA) were the most common cause of blunt abdominal trauma (70.76%) with 75% patients being were males. X-ray erect abdomen and ultrasound of the abdomen were the most sensitive investigation for hollow viscous injury and solid organ injuries, respectively, with bowel (38.33%) and liver injury (26.67%) being the most common organ involved in this study. This study found sensitivity (93.7%) and specificity (98.5%) of focused abdominal ultrasonography (FAST).Conclusions: Initial resuscitation followed by clinical and ultrasonography assessment is considered the best modality in initial evaluation of blunt abdominal trauma patients as it is noninvasive, readily available, and requires minimal preparation time and also due to restricted use of modern amenities such as CT-scan in tertiary care in India.

Management of pediatric blunt abdominal trauma: تدبير رضوح البطن الكليلة عند الأطفال

Aim of study: Evaluating a non- operative treatment of pediatric blunt abdominal trauma and avoiding unnecessary surgical intervention in Tishreen University Hospital. Methods: During years (2016- 2020) a retroprospective study was conducted on 62 children who had isolated blunt abdominal trauma or associated with other injuries, most of them were managed by non- operative treatment but some required surgical management. Results: Non- operative management of pediatric blunt abdominal injuries was applied for 59 patients, three patients required a surgical procedure, the spleen was the most organ exposed to injury (40) child, followed by liver (26) child, kidney (4) and (1) pancreatic injury. Non- operative management was successful in most solid organs injuries with grades 1, 2 and 3, but it failed in 5 grade splenic injury. one out of two hollow viscus injuries required surgical intervention. There were no statistical differences between the study groups in age, gender and injury mechanism. Hospital length of stay was significantly longer in patients who underwent a laparotomy (6) days compared to other non- operative patients (3) days, one complication occurred during non- operative management as pseudocyst after pancreatic injury, (4) patient died in the non- operative group due to hemodynamic instability and associated severe cerebral injuries. Conclusion: It is safe to treat most children with blunt abdominal injuries non- operatively if monitoring is adequate with hemodynamic stability.