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Abdominal Trauma (abdominal + trauma)
Kinds of Abdominal Trauma Selected AbstractsThe Risk of Intra-abdominal Injuries in Pediatric Patients with Stable Blunt Abdominal Trauma and Negative Abdominal Computed TomographyACADEMIC EMERGENCY MEDICINE, Issue 5 2010Jeffrey Hom MD Abstract Objectives:, This review examines the prevalence of intra-abdominal injuries (IAI) and the negative predictive value (NPV) of an abdominal computed tomography (CT) in children who present with blunt abdominal trauma. Methods:, MEDLINE, EMBASE, and Cochrane Library databases were searched. Studies were selected if they enrolled children with blunt abdominal trauma from the emergency department (ED) with significant mechanism of injury requiring an abdominal CT. The primary outcome measure was the rate of IAI in patients with negative initial abdominal CT. The secondary outcome measure was the number of laparotomies, angiographic embolizations, or repeat abdominal CTs in those with negative initial abdominal CTs. Results:, Three studies met the inclusion criteria, comprising a total of 2,596 patients. The overall rate of IAI after a negative abdominal CT was 0.19% (95% confidence interval [CI] = 0.08% to 0.44%). The overall NPV of abdominal CT was 99.8% (95% CI = 99.6% to 99.9%). There were five patients (0.19%, 95% CI = 0.08% to 0.45%) who required additional intervention despite their initial negative CTs: one therapeutic laparotomy for bowel rupture, one diagnostic laparotomy for mesenteric hematoma and serosal tear, and three repeat abdominal CTs (one splenic and two renal injuries). None of the patients in the latter group required surgery or blood transfusion. Conclusions:, The rate of IAI after blunt abdominal trauma with negative CT in children is low. Abdominal CT has a high NPV. The review shows that it might be safe to discharge a stable child home after a negative abdominal CT. ACADEMIC EMERGENCY MEDICINE 2010; 17:469,475 © 2010 by the Society for Academic Emergency Medicine [source] Is Hospital Admission and Observation Required after a Normal Abdominal Computed Tomography Scan in Children with Blunt Abdominal Trauma?ACADEMIC EMERGENCY MEDICINE, Issue 10 2008Smita Awasthi MD Abstract Objectives:, The objective was to determine if hospital admission of children with blunt abdominal trauma for observation of possible intraabdominal injury (IAI) is necessary after a normal abdominal computed tomography (CT) scan in the emergency department (ED). Methods:, The authors conducted a prospective observational cohort study of children less than 18 years of age with blunt abdominal trauma who underwent an abdominal CT scan in the ED. Abdominal CT scans were obtained with intravenous contrast but no oral contrast. The decision to hospitalize the patient was made by the attending emergency physician (EP) with the trauma or pediatric surgery teams. An abnormal abdominal CT scan was defined by the presence of any visualized IAI or findings suggestive of possible IAI (e.g., intraperitoneal fluid without solid organ injury). Patients were followed to determine if IAI was later diagnosed and the need for acute therapeutic intervention if IAI was present. Results:, A total of 1,295 patients underwent abdominal CT, and 1,085 (84%) patients had normal abdominal CT scans in the ED and make up the study population. Seven-hundred thirty-seven (68%) were hospitalized, and 348 were discharged to home. None of the 348 patients discharged home and 2 of the 737 hospitalized patients were identified with an IAI after a normal initial abdominal CT. The IAIs in patients with normal initial CT scans included a 10-year-old with a mesenteric hematoma and serosal tear at laparotomy and a 10-year-old with a perinephric hematoma on repeat CT. Neither underwent specific therapy. The negative predictive value (NPV) of a normal abdominal CT scan for IAI was 99.8% (95% confidence interval [CI] = 99.3% to 100%). Conclusions:, Children with blunt abdominal trauma and a normal abdominal CT scan in the ED are at very low risk of having a subsequently diagnosed IAI and are very unlikely to require a therapeutic intervention. Hospitalization of children for evaluation of possible undiagnosed IAI after a normal abdominal CT scan has a low yield and is generally unnecessary. [source] The Risk of Intra-abdominal Injuries in Pediatric Patients with Stable Blunt Abdominal Trauma and Negative Abdominal Computed TomographyACADEMIC EMERGENCY MEDICINE, Issue 5 2010Jeffrey Hom MD Abstract Objectives:, This review examines the prevalence of intra-abdominal injuries (IAI) and the negative predictive value (NPV) of an abdominal computed tomography (CT) in children who present with blunt abdominal trauma. Methods:, MEDLINE, EMBASE, and Cochrane Library databases were searched. Studies were selected if they enrolled children with blunt abdominal trauma from the emergency department (ED) with significant mechanism of injury requiring an abdominal CT. The primary outcome measure was the rate of IAI in patients with negative initial abdominal CT. The secondary outcome measure was the number of laparotomies, angiographic embolizations, or repeat abdominal CTs in those with negative initial abdominal CTs. Results:, Three studies met the inclusion criteria, comprising a total of 2,596 patients. The overall rate of IAI after a negative abdominal CT was 0.19% (95% confidence interval [CI] = 0.08% to 0.44%). The overall NPV of abdominal CT was 99.8% (95% CI = 99.6% to 99.9%). There were five patients (0.19%, 95% CI = 0.08% to 0.45%) who required additional intervention despite their initial negative CTs: one therapeutic laparotomy for bowel rupture, one diagnostic laparotomy for mesenteric hematoma and serosal tear, and three repeat abdominal CTs (one splenic and two renal injuries). None of the patients in the latter group required surgery or blood transfusion. Conclusions:, The rate of IAI after blunt abdominal trauma with negative CT in children is low. Abdominal CT has a high NPV. The review shows that it might be safe to discharge a stable child home after a negative abdominal CT. ACADEMIC EMERGENCY MEDICINE 2010; 17:469,475 © 2010 by the Society for Academic Emergency Medicine [source] Fracture of the pancreas in two patients after a go-kart accidentHPB, Issue 1 2001M J Govaert Background After blunt abdominal trauma, an isolated injury to the pancreatic duct is uncommon. Physical signs and laboratory parameters are often inaccurate, and missing this diagnosis can cause serious clinical problems. Case outlines Two young women (aged 18 and 20 years) are reported who sustained isolated trauma to the pancreatic duct in go-kart accidents. Each patient sustained a fracture of the pancreas. This injury was diagnosed only after a period of clinical observation with repeated laboratory parameters, ultrasound and CT scan. Pancreatic tissue was conserved by performing a pancreaticojejunostomy. Discussion After any episode of blunt abdominal trauma, isolated injury to the pancreatic duct should be considered. Serum analysis, ultrasonography and CT scanning can be helpful in early diagnosis. Preservation of pancreatic tissue can be achieved with a good clinical outcome. [source] Successful rotational thromboelastometry-guided treatment of traumatic haemorrhage, hyperfibrinolysis and coagulopathyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010M. BRENNI Transfusion of allogeneic blood products is associated with increased morbidity and mortality. Therefore, strategies for reducing transfusion of these products during trauma management are valuable. We report a case of severe blunt abdominal trauma, successfully treated with antifibrinolytic medication and fibrinogen concentrate. Rotational thromboelastometry (ROTEM) was used to identify hyperfibrinolysis and afibrinogenaemia. In order to achieve haemostasis, over a 3-h period, the patient received a total of 1 g of tranexamic acid, 7 U of packed red blood cells, 16 g of fibrinogen concentrate (Haemocomplettan P), 3500 ml of colloids and 5500 ml of lactated Ringer's solution. Together with surgical measures, this treatment stopped the bleeding and stabilised the patient. There was no transfusion of either fresh-frozen plasma or platelets. The limited need for allogeneic blood products is of particular interest, and clinical studies of the approach used here appear to be warranted. [source] Blunt abdominal trauma in childrenJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1 2000CH Rance Abstract: Blunt abdominal trauma is the commonest cause of intra-abdominal injuries in children. The use of computerized axial tomography and non-operative management of haemoperitoneum are two significant developments in the last two decades in the management of blunt abdominal trauma in children. The concept of non-operative management was introduced in late 1979 and wherever possible remains the optimum treatment. Computerized tomography scan for paediatric abdominal trauma was first described in 1980 and remains the investigation of choice. There is no substitute, however, for a good history, astute physical examination, and strict adherence to the principles of primary and secondary survey, prompt resuscitation, vigilant monitoring and repeated evaluation. [source] Hemorrhagic bile pleuritis and peritonitis secondary to traumatic common bile duct rupture, diaphragmatic tear, and rupture of the spleen in a dogJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2008Gordon D. Peddle VMD Abstract Objective, To describe the diagnosis and successful treatment of bile pleuritis and peritonitis secondary to traumatic rupture of the common bile duct and a diaphragmatic tear in a young dog. Case Summary, A 1-year-old German Shepherd dog was referred for evaluation of vomiting and icterus 4 days after being hit by a car. Thoracic radiographs, thoracic and abdominal ultrasonographic examinations, thoraco- and abdominocentesis, and positive contrast celiogram indicated hemorrhagic pleuritis and peritonitis, left dorsal diaphragmatic tear, and rupture and infarct of the spleen. Surgical exploration of the abdomen confirmed these findings in addition to a circumferential tear of the common bile duct, leading to a diagnosis of hemorrhagic bile pleuritis and peritonitis. Aerobic and anaerobic bacterial culture of the abdominal fluid yielded no growth. Surgical correction of the traumatic injuries was achieved via common bile duct anastomosis, cholecystojejunostomy, repair of the diaphragm, and splenectomy. The dog developed postoperative signs consistent with aspiration pneumonia but was successfully treated and discharged from the hospital. Clinical signs and laboratory abnormalities resolved and the dog was alive and healthy 8 months after discharge. New or Unique Information Provided, Bile pleuritis is rare in dogs and cats and is usually associated with penetrating, not blunt, abdominal trauma. Multiple organ injury in cases of traumatic bile duct rupture is uncommon; in this dog, rupture of the common bile duct was accompanied by rupture of the diaphragm and spleen. [source] Abdominal compartment syndrome after liver transplantationLIVER TRANSPLANTATION, Issue 1 2005Alexander E. Handschin The abdominal compartment syndrome is a well-known complication after abdominal trauma and is increasingly recognized as a potential risk factor for renal failure and mortality after adult orthotopic liver transplantation (OLT). We present a case report of a young patient who presented with acute liver failure complicated by an acute pancreatitis. The patient developed an acute abdominal compartment syndrome after OLT. Transurethral measurement of intraabdominal pressure indicated an abdominal compartment syndrome associated with impaired abdominal vascular perfusion, including liver perfusion. Renal insufficiency was immediately reversed after decompressive bedside laparotomy. The abdominal compartment syndrome is a potential source of posttransplant renal insufficiency and liver necrosis in OLT. It remains, however, a rarely described complication after liver transplantation, despite the presence of significant factors that contribute to elevated intraabdominal pressure. (Liver Transpl 2005;11:98,100.) [source] Grand mal seizures: an unusual and puzzling primary presentation of ruptured hepatic hydatid cystPEDIATRIC ANESTHESIA, Issue 6 2006PHILIPPE G. MEYER MD Summary We report a case of hepatic hydatidosis where the first clinical manifestations, generalized seizures after minor head and abdominal trauma, and delayed anaphylaxis, made the primary diagnosis difficult. Severe anaphylaxis has been reported as initial presentation of quiescent hepatic hydatidosis. In endemic areas, the diagnosis must be carefully ruled out in patients experiencing abrupt anaphylactic shock of uncertain etiology. The occurrence of unexplained vascular collapse after minor abdominal trauma in a patient originating from an endemic area should prompt the diagnosis and urgent treatment should be initiated; firstly emergency management of the anaphylactic shock and later, surgical treatment of the cysts. [source] Re: Acute traumatic appendicitis following blunt abdominal traumaANZ JOURNAL OF SURGERY, Issue 7-8 2010Mohamed A. Atalla MBBS MS No abstract is available for this article. [source] Intestinal-FABP and Liver-FABP: Novel Markers for Severe Abdominal InjuryACADEMIC EMERGENCY MEDICINE, Issue 7 2010Borna Relja MSc ACADEMIC EMERGENCY MEDICINE 2010; 17:729,735 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, Fatty acid,binding proteins (FABPs) have relatively high tissue concentrations and low plasma concentrations and are released into the circulation following organ injury. We explored the utility of intestinal-(I)-FABP and liver-(L)-FABP for the diagnosis of abdominal injury in patients with multiple trauma. Methods:, This prospective study included 102 trauma patients and 30 healthy volunteers. Plasma I-FABP and L-FABP levels were measured in the emergency department (ED) by enzyme-linked immunosorbent assay (ELISA). Forty-one patients suffered from serious or severe abdominal trauma (Abbreviated Injury Score [AIS] code "ai" for abdominal injury, AISai , 3) and nine were moderately abdominally injured (AISai < 3). Fifty-two had no abdominal injury. Results:, Median I-FABP and L-FABP levels in the AISai , 3 group (516 pg/mL and 135 ng/mL, respectively) were significantly higher compared to the AISai < 3 group (154 pg/mL and 13 ng/mL, respectively) or those without abdominal injury (207 pg/mL and 21 ng/mL, respectively) or normal controls (108 pg/mL and 13 ng/mL, respectively). The cutoff to distinguish the ai , 3 is 359 pg/mL for I-FABP and 54 ng/mL for L-FABP, with 93% specificity and 75% sensitivity for I-FABP and 93% and 82% for L-FABP, respectively. Conclusions:, High I-FABP and L-FABP levels correlate with relevant severity of abdominal tissue damage in patients with multiple trauma. I-FABP and L-FABP could be useful as markers for the early detection of significant abdominal injury in acute multiple trauma and identify patients who require rapid intervention. [source] Is Hospital Admission and Observation Required after a Normal Abdominal Computed Tomography Scan in Children with Blunt Abdominal Trauma?ACADEMIC EMERGENCY MEDICINE, Issue 10 2008Smita Awasthi MD Abstract Objectives:, The objective was to determine if hospital admission of children with blunt abdominal trauma for observation of possible intraabdominal injury (IAI) is necessary after a normal abdominal computed tomography (CT) scan in the emergency department (ED). Methods:, The authors conducted a prospective observational cohort study of children less than 18 years of age with blunt abdominal trauma who underwent an abdominal CT scan in the ED. Abdominal CT scans were obtained with intravenous contrast but no oral contrast. The decision to hospitalize the patient was made by the attending emergency physician (EP) with the trauma or pediatric surgery teams. An abnormal abdominal CT scan was defined by the presence of any visualized IAI or findings suggestive of possible IAI (e.g., intraperitoneal fluid without solid organ injury). Patients were followed to determine if IAI was later diagnosed and the need for acute therapeutic intervention if IAI was present. Results:, A total of 1,295 patients underwent abdominal CT, and 1,085 (84%) patients had normal abdominal CT scans in the ED and make up the study population. Seven-hundred thirty-seven (68%) were hospitalized, and 348 were discharged to home. None of the 348 patients discharged home and 2 of the 737 hospitalized patients were identified with an IAI after a normal initial abdominal CT. The IAIs in patients with normal initial CT scans included a 10-year-old with a mesenteric hematoma and serosal tear at laparotomy and a 10-year-old with a perinephric hematoma on repeat CT. Neither underwent specific therapy. The negative predictive value (NPV) of a normal abdominal CT scan for IAI was 99.8% (95% confidence interval [CI] = 99.3% to 100%). Conclusions:, Children with blunt abdominal trauma and a normal abdominal CT scan in the ED are at very low risk of having a subsequently diagnosed IAI and are very unlikely to require a therapeutic intervention. Hospitalization of children for evaluation of possible undiagnosed IAI after a normal abdominal CT scan has a low yield and is generally unnecessary. [source] Accuracy of computed tomography in the detection of blunt bowel and mesenteric injuriesBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2005C. Elton Background: There are conflicting views on the accuracy of computed tomography (CT) findings in patients with bowel and mesenteric injuries (BMIs) following blunt abdominal trauma. The aim of the present study was to assess the accuracy of the CT report during a trauma call. Methods: Ninety-eight patients underwent preoperative abdominal spiral CT and subsequent laparotomy following blunt trauma between January 1996 and March 2001 at a level I trauma centre. The immediate results of the scans were reported by the on-call radiology registrar and written in the medical notes by the trauma team leader. Seventy of the 98 preoperative abdominal CT scans were retrieved from the radiology department and reported by two consultant radiologists with a special interest in trauma radiology. Results: The sensitivity and specificity of the 70 expert CT reports were 80 (95 per cent confidence interval (c.i.) 66 to 94) and 78 (95 per cent c.i. 65 to 90) per cent respectively for diagnosing a BMI. The sensitivity and specificity of the immediate CT reports were 93 (95 per cent c.i. 84 to 100) and 71 (95 per cent c.i. 60 to 83) per cent respectively. Conclusion: Spiral CT is highly sensitive for detecting a BMI following blunt abdominal trauma. This sensitivity is maintained when the scan is reported by a radiology registrar. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Late anastomotic leaks in pancreas transplant recipients , clinical characteristics and predisposing factorsCLINICAL TRANSPLANTATION, Issue 2 2005Dilip S Nath Abstract:, Background:, Anastomotic leaks after pancreas transplants usually occur early in the postoperative course, but may also be seen late post-transplant. We studied such leaks to determine predisposing factors, methods of management, and outcomes. Results:, Between January 1, 1994 and December 31, 2002, a total of 25 pancreas transplant recipients at our institution experienced a late leak (defined as one occurring more than 3 months post-transplant). We excluded recipients with an early leak or with a leak seen immediately after an enteric conversion. The mean recipient age was 40.3 yr; mean donor age, 31.3 yr. The category of transplant was as follows: simultaneous pancreas,kidney (n = 5, 20%), pancreas after kidney (n = 10, 40%), and pancreas transplant alone (n = 10, 40%). At the time of their leak, most recipients (n = 23, 92%) had bladder-drained pancreas grafts; only two recipients (8%) had enteric-drained grafts. The mean time from transplant to the late leak was 20.5 months (range = 3.5,74 months). A direct predisposing event or risk factor occurring in the 6 wk preceding leak diagnosis was identified in 10 (40%) of the recipients. Such events or risk factors included a biopsy-proven episode of acute rejection (n = 4, 16%), a history of blunt abdominal trauma (n = 3, 12%), a recent episode of cytomegalovirus infection (n = 2, 8%), and obstructive uropathy from acute prostatitis (n = 1, 4%). Non-operative or conservative care (Foley catheter placement with or without percutaneous abdominal drains) was the initial treatment in 14 (56%) of the recipients. Such care was successful in nine (64%) of the 14 recipients; the other five (36%) required surgical repair after failure of conservative care at a mean of 10 d after Foley catheter placement. Of the 25 recipients, 11 underwent surgery as their initial leak treatment: repair in nine and pancreatectomy because of severe peritonitis in two. After appropriate management (conservative or operative) of the initial leak, five (20%) of the 25 recipients had a recurrent leak; the mean length of time from initial leak to recurrent leak was 5.6 months. All five recipients with a recurrent leak ultimately required surgery. Conclusions:, Late anastomotic leaks are not uncommon; they may be more common with bladder-drained grafts. One-third of the recipients with a late leak had experienced some obvious preceding event that predisposed to the leak. For two-thirds of our stable recipients with bladder-drained grafts, non-operative treatment of the leak was successful. 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