Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers

Introduction An American College of Surgeons (ACS) Level-I (L-I) pediatric trauma center demonstrated successful laparoscopy without conversion to laparotomy in ∼65% of trauma cases. Prior reports have demonstrated differences in outcomes based on ACS level of trauma center. We sought to compare laparoscopy use for blunt abdominal trauma at L-I compared to Level-II (L-II) centers. Methods The Pediatric Trauma Quality Improvement Program was queried (2014-2016) for patients ≤16 years old who underwent any abdominal surgery. Bivariate analyses comparing patients undergoing abdominal surgery at ACS L-I and L-II centers were performed. Results 970 patients underwent abdominal surgery with 14% using laparoscopy. Level-I centers had an increased rate of laparoscopy (15.6% vs 9.7%, P = .019 ); however they had a lower mean Injury Severity Score (16.2 vs 18.5, P = .002) compared to L-II centers. Level-I and L-II centers had similar length of stay ventilator days, and SSIs (all P > .05). Conclusion While use of laparoscopy for pediatric trauma remains low, there was increased use at L-I compared to L-II centers with no difference in LOS or SSIs. Future studies are needed to elucidate which pediatric trauma patients benefit from laparoscopic surgery.

Do you think of gangrenous gallbladder following blunt trauma abdomen? a rare case report

Isolated gangrenous gallbladder secondary to blunt trauma abdomen (BTA) is the rarest entity comes with great challenge due to low incidence. Gallbladder injury was reported to be between 1.9%-2.1% of all abdominal trauma, out of it, gall bladder rupture seen in <1%. Till date only one case report has been published. Clinical presentation of gallbladder injury is variable, resulting in a delay in diagnosis and treatment. This case report describes a significant mechanism of blunt force injury resulting in an isolated gangrenous gallbladder as it is a relatively well-protected organ; consequently, its gangrenous following blunt abdominal injury is rare and usually associated with other visceral injuries. Almost all gallbladder injuries following blunt trauma are associated with other significant intra-abdominal injuries and in the setting of acute trauma. We recommend an open procedure to facilitate a detailed exploration to exclude associated injuries. We report a case of a healthy 23years old adult male who sustained isolated gangrenous gallbladder following BTA who sustained injury following fall from riding a two wheeler motor cycle. We recommend an open cholecystectomy procedure to facilitate a detailed exploration to exclude associated injuries and has a good outcome.

Unusual Post-Traumatic Under-Serosa Rupture of the Gallbladder

Gallbladder lesions due to blunt abdominal injury are rare, being found in only about 2% of patients who undergo laparotomy for abdominal trauma. It is commonly associated with other concomitant visceral injuries. It is challenging to make an early diagnosis. We report the case of a 35-year-old woman victim of a public road accident who underwent laparotomic cholecystectomy. Acute post traumatic cholecystitis was suspected based on clinical and radiologic data. Perioperative findings showed no ascites, but a distended gallbladder. Its serosa was intact. After its removal, we opened the gallbladder, we discovered a rupture of the mucosa and bile trapped between the mucosa and the serosa of the gallbladder. The postoperative course was simple.

Isolated gallbladder perforation in paediatric blunt abdominal injury: A case report and review of literature

Gallbladder injury in blunt abdominal trauma is rare, around 2% of all abdominal traumas. Vague symptoms and inconclusive imaging make it an elusive diagnosis, more so in children. Only 30 pediatric cases have been reported worldwide till date. We report a case of a 7yrs old boy presenting 2 weeks after a road accident with a gallbladder rupture which was eventually discovered on a diagnostic laparoscopy. This is the second such case being reported from India. The injury is most often identified at exploration and although cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ. The classification system of Losanoff and Kjossev has merit in guiding treatment. The various presentations, mechanisms and modes of injury have been highlighted along with the clinical and imaging findings. Despite the developments in modern radiology, identifying gallbladder perforation has always been difficult because of the rarity of the condition. In a child with blunt abdominal trauma and intra-abdominal free fluid without any solid organ injury, a diagnostic peritoneal tap may be helpful. Based on the current evidence, we advocate a low threshold for performing a diagnostic laparoscopy in all such cases.

Traumatic J-Pouch Perforation following a Blunt Abdominal Injury

A 46-year-old male was admitted to the trauma department after a motor vehicle accident. He presented with severe abdominal pain and a distended abdomen with peritonitis. His past surgical history included total proctocolectomy with ileal J-pouch anal anastomosis for ulcerative colitis 20 years previously. Computed tomography showed free peritoneal air and fluid in the abdomen mandating an exploratory laparotomy. A perforation at the ileal J-pouch blind end was found. Primary closure with diverting loop ileostomy was performed. The patient had an uneventful recovery and underwent closure of the ileostomy two months later. The case and management are discussed after reviewing the literature.

ANALYSIS OF BLUNT ABDOMINAL TRAUMA CASES AT TERTIARY CARE HOSPITAL BIKANER (RAJASTHAN)

Background: In view of increasing number of vehicles and consequently road traffic accidents, this dissertation has been chosen to study the cases of blunt abdominal trauma with reference to the patients presenting at P.B.M. hospital, attached to S.P. Medical College, Bikaner. Methods: Prospective hospital-based study was conducted on all the patients of blunt abdominal injury admitted in the department of surgery, S.P. Medical College and P.B.M. Hospital, Bikaner. Results: Majority of the patients presented with abdominal pain (86%) and abdominal tenderness (81%). Conclusion: We concluded that young Males are predominantly affected. Road traffic accident forms the most common mode of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt trauma, Age, Sex

Hepatic Trauma Interventions

The liver is the second most commonly involved solid organ (after spleen) to be injured in blunt abdominal trauma, but liver injury is the most common cause of death in such trauma. In patients with significant blunt abdominal injury, the liver is involved approximately 35 to 45% of the time. Its large size also makes it a vulnerable organ, commonly injured in penetrating trauma. Other than its position and size, the liver is surrounded by fragile parenchyma and its location under the diaphragm makes it vulnerable to shear forces during deceleration injuries. The liver is also a vascular organ made of large, thin-walled vessels with high blood flow. In severe hepatic trauma, hemorrhage is a common complication and uncontrolled bleeding is usually fatal. In fact, in patients with severe abdominal trauma, liver injury is the primary cause of death. This article reviews the clinical presentation of patients with liver injury, the grading system for such injuries that is most frequently used, and management of the patient with liver trauma.

Oxygenated salt enteral solution in the treatment of a child with pancreonekrosis

Objective. This article describes the first experience of using an oxygenated salt intestinal solution (SIS) in the complex intensive care of functional intestinal failure (FIF) developed due to pancreonecrosis in a child aged 10 years 11 months after a blunt abdominal injury and burdened with concomitant alimentary factor. Complex treatment was aimed to eliminate increasing endotoxicosis, pain syndrome, suspected secondary ischemia of the affected organs of the pancreaticoduodenal zone, restoration of motor and barrier functions of the intestine. In this connection, adjustments were made to the early enteral nutrition and enteral correction method using an oxygenated salt enteral solution (with a description of the oxygenation method), which allowed for 12 h to eliminate intestinal paresis, with the production of stool. According to the intestinal lavage method, repeated use of SIR-RA led to the significant persistent improvement in the patients condition and a decrease in inflammatory markers, which subsequently allowed the transition to adequate enteral nutrition. The patient was subsequently transferred to a specialized surgical Department and discharged from the hospital, and recovered with no signs of endocrine pancreatic insufficiency. Positive treatment results of a patient with pancreonecrosis complicated by FIF were made possible by improving intensive therapy tactics using an oxygenated salt enteral solution. The scheme of gradual enteral correction developed and used by us is an essential component of complex therapy of pancreonecrosis and functional intestinal insufficiency. The use of an oxygenated salt enteral solution helps to restore the main functions of the gastrointestinal tract.