Double ischemic ileal stenosis secondary to mesenteric injury after blunt abdominal trauma

The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thickening. At surgery, a double stenotic bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the two resected segments showed fibrotic and ischemic lesions within the mesentery. Ischemic intestinal stenosis from mesenteric injury should be considered in the differential diagnosis in patients suffering from intestinal occlusion with a history of blunt abdominal trauma.

The Incidence of Splenic Injury Following Blunt Abdominal Trauma (BAT), Sultan Qaboos University Hospital Experience

The aim of the study was to review traumatic splenic injury following blunt abdominal trauma (BAT), during the period from January 2009 to January 2015 at SQUH. The data for this study was retrospectively collected. It included 768 patients admitted to SQUH general surgery department following BAT. 43 patients with splenic injury were identified (34 males, 9 females). The mean age of patients with splenic injury was 36.0 years (34.4 years for males, 42.1 years for females). The most common mechanism of injury was motor vehicle collision (90.7%). Grade I, II are the most common grades of splenic injury. Non-Omani patients accounted for (51.2%) and most of them were pedestrians at the time of trauma. Ribs fracture is the most common injury associated with splenic injury. 36 (83.7%) patients were managed conservatively and 7 (16.3%) patients were splenectomized. Angioembolization was done for 11 (30.6%) patients. Despite the small population of Oman, high incidence of motor vehicle collision (MVC) increases the incidence of splenic injury among young age group.

NonOperative Management of Blunt Solid Abdominal Organ Injury in Calabar, Nigeria

Background: Over the past several years, nonoperative management has been increasingly recommended for the care of selected blunt abdominal trauma patients with solid organ injuries. Objective: To evaluate the pattern and outcome of blunt abdominal trauma using haemodynamic stability and ultrasonography in the selection of patients for nonoperative management in a facility without computed tomogram. Methods: Patients admitted with blunt abdominal trauma between February 2005 and January 2010 were prospectively studied. Haemodynamic stability and sonography formed the basis for selecting patients for nonoperative management. Results: In total, 58 patients suffered blunt abdominal trauma and 19(33%) patients were successfully managed nonoperatively suffered blunt solid abdominal organ injuries. Road traffic accidents inflicted 17(89%) patients while 2(11%) patients sustained sports injury (football). The spleen was the commonest solid organ injured 12(60%), while the liver and kidney were injured in 6(30%) and 2(10%) respectively. Associated injuries were fractured left femur recorded in 3(16%) patients and fractured rib in a patient (5%). Conclusion: Nonoperative treatment is a safe and effective method in the management of haemodynamically stable patient with blunt solid abdominal organ injury. This translated to a reduction in hospital stay, absence of the risk of blood transfusion as well as attendant morbidity and mortality associated with laparotomy. Establishment of trauma system, provision of diagnostic and monitoring facilities, good roads, and education on road safety is recommended for improved outcome.

Blunt Abdominal Trauma Leading to Pancreatic Injury in Childhood. Delay in Diagnosis Leads to Poor Outcomes—A Case Presentation

This case report illustrates the difficulty in diagnosing paediatric patients with life threatening pancreatic injuries. A high index of suspicion is essential as late diagnosis significantly affects outcomes. A 9-year-old child presented with epigastric pain following an accident on his pushbike. The patient was examined in paediatric accident and emergency (A/E) and was discharged. He returned twice more to A/E and on the third visit, 5 days after the initial incident, a CT scan was performed. This showed a classical injury to the body of the pancreas with a collection in the lesser sac. The patient was transferred to the regional hepato-pancreato-biliary unit (HPB unit) and underwent surgery. Pancreatic injuries can be difficult to detect clinically and patients may be well on initial presentation with normal observations and routine bloods. Early CT scanning confirms the diagnosis and results in early specialist referral and better outcomes.

Incidence of unexplained intra-abdominal free fluid in patients with blunt abdominal trauma

BACKGROUND: Intra-abdominal free fluid is commonly caused by injuries of solid or hollow organs in patients suffering from blunt abdominal trauma (BAT). However, it presents a diagnostic dilemma for surgeons when free fluid is unexplained, especially in stable BAT patients. This study was to analyze the incidence of such unexplained free fluid in BAT patients and its diagnostic value in abdominal organ injury. METHODS: Altogether 597 patients with BAT who had been treated at our trauma center over a 10-year period were reviewed. Stable patients with free fluid but without free air or definite organ injury on abdominal computed tomography were studied. Clinical management and operative findings were analyzed. RESULTS: Thirty-four (5.70%) of the 597 patients met the inclusion criteria: 24 (4.02%) underwent therapeutic exploratory laparotomy: bowel injuries were found in 13, hepatic rupture in 3, colon rupture in 3, duodenal rupture in 2, spleen rupture in 1, pancreas rupture in 1, and gallbladder perforation in 1. In 2 patients, laparotomy was nontherapeutic. Those with moderate or large amounts of free fluid were more likely to suffer from a hollow viscus injury and have a therapeutic procedure. The mean time of hospital stay for the delayed laparotomy group was longer than that for the emergency group (19 5.12 vs. 12 2.24 days; t=2.73, P<0.01). CONCLUSIONS: There was a positive correlation between the amount of unexplained free fluid and the determination of intra-abdominal organ injury. The proportion of BAT patients who required surgical intervention was high, particularly those with a moderate or large amount of free fluid, and most of them suffered from a hollow organ injury. Emergency laparotomy is recommended for these patients.

Isolated traumatic gallbladder injury: A case report

BACKGROUND Isolated gallbladder injury(GI)(IGI)directly induced by abdominal trauma is rare.Symptoms,indications,and imaging examinations of IGI are frequently non-specific,posing tremendous diagnostic challenges,which are simple to overlook and may have severe implications.Improving doctors'understanding of gallbladder injury(GI)facilitates early detection and decreases the likelihood of severe consequences,including death.CASE SUMMARY We report a case of IGI caused by blunt violence(after falling from three meters with the umbilicus as the stress point)and performed laparoscopic repair of the gallbladder rupture,which helps clinicians understand IGI and reduce the severe consequences of delayed diagnosis.Through extensive medical history and dynamic abdominal ultrasound evaluation,doctors can identify GI early and begin surgery,thereby decreasing the devastating repercussions of delayed diagnosis.CONCLUSION This article aims to improve clinicians'understanding of IGI and propose a method for the diagnosis and treatment of GI.

Spinal cord injury in the setting of traumatic thoracolumbar fracture is not reliably associated with increased risk of associated intra-abdominal injury following blunt trauma:An analysis of a National Trauma Registry database

Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal injury(IAI).The impact of concomitant spinal cord injury(SCI)with the risk of associated IAI has not been well clarified.The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI.Methods:A retrospective cohort study using the Israeli National Trauma Registry was conducted.Patients with thoracic,lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1,1997 to December 31,2018 were examined,comparing the incidence,severity and mortality of IAIs in patients with or without SCI.The collected variables included age,gender,mechanism of injury,incidence and severity of the concomitant IAIs and pelvic fractures,abbreviated injury scale,injury severity score,and mortality.Statistical analysis was performed using GraphPad InStat?Version 3.10,with Chi-square test for independence and two sided Fisher’s exact probability test.Results:Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures.Combined thoracic and lumbar fractures were observed in 1272 patients(7.5%),isolated thoracic fractures in 4967 patients(29.4%)and isolated lumbar fractures in 10,639 patients(63.0%).The incidence of concomitant SCI was found in 4.95%(63/1272),7.65%(380/4967)and 2.50%(266/10639)of these patients,respectively.The overall mortality was 2.5%,proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts(11.3%vs.4.6%,p<0.001).Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts(8.2%vs.3.1%,p<0.001).There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures;although isolated lumbar fractures patients with SCI were more likely to have renal(3.4%vs.1.6%,p=0.02)or bowel injuries(2.3%vs.1.0%,p=0.04)than the non-SCI counterparts.Conclusion:SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI.However,in a subset of isolated lumbar fractures,SCI patient is associated with increased risks for renal and bowel injury.

Efficacy of new scoring system for diagnosis of abdominal injury after blunt abdominal trauma in patients referred to emergency department

Purpose: The blunt abdominal trauma (BAT) is a common emergency and is significantly associated with morbidity and mortality. Our study was conducted to achieve the goal that a new scoring system could be used for the BAT patients.Methods: The statistical population of this study was 1000 patients with BAT referred to emergency department of Imam Hossein Hospital, Tehran, Iran. Sampling was carried out in a convenience non-random manner and continued to reach the required sample size. All the patients with BAT due to road traffic accidents, falls, and other direct blunt traumas such as punctures and kickbacks were included in the study. Exclusion criteria were after 3 months of pregnancy, under the age of 18, warfarin taking, no reliable medical history providing and penetrating trauma. The study questionnaire was based on BAT scoring system. The data were analyzed by SPSS V20 software. The receiver operating characteristic curve was used to analyze the effectiveness of the new scoring system in predicting the BAT patients’ outcome.Results: The mean age of the patients (n = 1000) was (35.79 ± 13.09) years. The mean score of patients was (6.29 ± 5.80). Based on this scoring system, the patients were divided into three categories. The first group was patients at low risk with score of less than 8, the second group was patients at moderate risk with score of 8-12 and the third group was patients at high risk with score of 12-24. The score of 661 (66.1%) patients were low, 109 (10.9%) were moderate and 230 (23%) had a high score. The association between hip fracture and abdominal tenderness with abdominal injury was significant (p < 0.001). Cronbach’s alpha was 0.76 showing the reliability of this questionnaire to predict the future of patients.Conclusions: The study tool has a sensitivity to predict the BAT patients’ outcome, and has a proper specificity that can be used to reduce the use of harmful modalities such as computed tomography scan.

Rare isolated extra-hepatic bile duct injury: A case report

BACKGROUND Extra-hepatic bile duct injury(EHBDI)is very rare among all blunt abdominal injuries.According to literature statistics,it only accounts for 3%-5%of abdominal injuries,most of which are combined injuries.Isolated EHBDI is more rare,with a special injury mechanism,clinical presentation and treatment strategy,so missed diagnosis easily occurs.CASE SUMMARY We report a case of unexplained abdominal effusion and jaundice following blunt abdominal trauma in our department.Of which,surgical exploration of the case was performed and a large amount of bile leakage in the abdominal cavity was found.No obvious abdominal organ damage or bile duct rupture was found.Surgery was terminated after the common bile duct indwelled with a T tube.After 2 wk,a T-tube angiography revealed the lesion in the common bile duct pancreatic segment,confirming isolated EHBDI.And 2 mo later,the T tube was pulled out with re-examined magnetic resonance cholangiopancreatography,indicating narrowing of the common bile duct injury,with no special treatment due to no clinical symptoms and no abnormality in the current follow-up.CONCLUSION This case was featured by intraoperative bile leakage and no EHBDI.This type of rare isolated EHBDI is prone to missed and delayed diagnosis due to its atypical clinical manifestations and imaging features.Surgery is still the main treatment,and the indications and principles of bile duct injury repair must be followed.

Isolated free intra-abdominal fluid on CT in blunt trauma： The continued diagnostic dilemma

Purpose： The clinical significance of isolated flee fluid （FF） without solid organ injury on computed to- mography （CT） continues to pose significant dilemma in the management of patients with blunt abdominal trauma （BAT）. Methods： We reviewed the incidence of FF and the clinical outcome amongst patients with blunt abdominal trauma in a metropolitan trauma service in South Africa. We performed a retrospective study of 121 consecutive CT scans over a period of 12 months to determine the incidence of isolated FF and the clinical outcome of patients managed in a large metropolitan trauma service, Results： Of the 121 CTs, FF was identified in 36 patients （30%）. Seven patients （6%） had isolated FF. Of the 29 patients who had free fluid and associated organ injuries, 33 organ injuries were identified. 86% （25/ 29） of all 29 patients had a single organ injury and 14% had multiple organ injuries. There were 26 solid organ injuries and 7 hollow organ injuries. The 33 organs injured were： spleen, 12; liver, 8; kidney, 5; pancreas, 2; small bowel, 4; duodenum, 1. Six （21%） patients required operative management for small bowel perforations in 4 cases and pancreatic tail injury in 2 cases. All 7 patients with isolated FF were initially observed, and 3 （43%） were eventually subjected to operative intervention. They were found to have an intra-peritoneal bladder rupture in 1 case, a non-expanding zone 3 haematoma in I case, and a negative laparotomy in 1 case. Four （5？%） patients were successfully managed without surgical interventions. Conclusions： Isolated FF is uncommon and the clinical significance remains unclear. Provided that reli- able serial physical examination can be performed by experienced surgeons, an initial non-operative approach should be considered.

闭合性腹部损伤的规范化急诊救治

目的分析闭合性腹部损伤(BAI)的临床特点和术前救治措施,规范BAI的术前救治方案。方法回顾10年间我院急诊救治1020例BAI患者的临床资料和救治结果。结果本组1020例患者中,964例行急诊手术,急诊抢救治愈904例,抢救成功率93.8%,术中、术后死亡60例。结论快速进行伤情评估,准确拟定诊疗计划,有效进行血容量维持,合理进行急诊规范化救治,能最大限度地提高BAI的救治成功率。

闭合性腹部外伤617例诊治体会

目的进一步提高闭合性腹部外伤的诊治水平。方法对我院2000-2009年间收治的闭合性腹部外伤617例诊治情况进行回顾性分析。结果手术治疗486例,保守治疗131例;治愈569例,死亡48例。结论闭合性腹部外伤多为多部位多脏器合并伤,诊断性腹腔穿刺和B超是简单可靠的诊断方法。腹部外伤的围手术期正确处理是提高救治成功率的关键措施。积极手术探查止血是最主要的治疗手段。手术治疗的原则为力求术式简单,效果确切。

超声造影鉴别单纯肝血肿与肝血肿伴活动性出血实验研究

目的探讨超声造影(CEUS)在鉴别单纯肝血肿与肝血肿伴活动性出血中的应用价值。方法新西兰大白兔15只,雄性,体质量2.5～3.5kg。经肝素化后,用自制小型撞击器撞击肝脏建立肝脏闭合性损伤模型,选10只实验动物随后用活检枪在彩色多普勒超声引导下经皮穿入肝实质损伤肝动脉,制造活动性出血。分别用二维超声及CEUS扫查15只大白兔肝脏,观察是否存在肝血肿和肝活动性出血及其位置。超声检查结束后对实验动物进行剖腹探查,并与超声诊断结果相比较。过量戊巴比妥钠处死实验动物,进行病理学检查。结果共建立肝损伤动物模型15只,其中单纯肝血肿5只,肝血肿伴活动性出血10只。二维超声检测出肝血肿9只(9/15),未发现活动性出血存在(0/10)。CEUS检测出肝血肿15只(15/15),表现为造影剂灌注缺损区,与肝实质界限清晰,造影全部过程中未见造影剂外溢现象。其中10只经CEUS证实合并存在活动性出血(10/10),活动性出血在超声造影中表现为造影剂从肝损伤区域外溢。剖腹探查结果显示肝血肿部位和大小与CEUS检查结果相符,活动性出血部位与CEUS检查结果相符。结论 CEUS是一种快速、有效的鉴别肝脏单纯血肿与血肿伴活动性出血的方法,是否存在造影剂活动性外溢现象是二者的鉴别要点。

闭合性腹部损伤致小肠破裂的诊断及治疗对策

目的:探讨闭合性腹部损伤致小肠破裂的早期诊断和治疗对策。方法:对我院1998年1月至2012年10月间收治的92例闭合性腹部损伤所致小肠破裂病人的临床资料进行回顾性分析。结果 :受伤至手术间隔时间≤8 h(A组)65例,治愈63例(96.9%),术后并发症发生率为7.7%(5例,其中2例为死亡病例);受伤至手术间隔时间>8 h(B组)27例,治愈27例(100.0%),无一例死亡,并发症发生率为33.3%(9例)。经统计学分析,两组的并发症发生率具有统计学差异(P<0.05)。除术后住院时间外,A组的手术时间、术中出血量、术后排气时间和术后下床活动时间等指标均优于B组,差异具有统计学意义(P<0.05)。结论:早期诊断和及时手术有利于闭合性腹部损伤致小肠破裂的治疗。

钝性损伤致下胸部肋骨骨折合并腹腔脏器损伤的危险因素分析

目的分析钝性损伤致下胸部肋骨骨折合并腹腔脏器损伤的危险因素和早期预测因子。方法回顾性分析2015年1月—2017年12月厦门大学附属东南医院收治的183例钝性损伤致下胸部肋骨(8~12肋)骨折患者,其中经CT影像学或剖腹探查诊断合并腹腔脏器损伤34例(腹腔脏器损伤组),无腹腔脏器损伤149例(无腹腔脏器损伤组),收集患者人口学特征(性别、年龄)、致伤原因(交通事故、高处坠落、意外跌倒、暴力击打)、肋骨骨折部位(单侧、双侧)和数目、入院时生命体征(收缩压、心率)、腹部体征、实验室指标(红细胞压积),通过单因素和多因素Logiistic回归分析合并腹腔脏器损伤的相关因素。结果本组183例钝性损伤致下胸部肋骨骨折患者中左侧肋骨骨折91例,右侧肋骨骨折79例,双侧肋骨骨折13例。本组合并腹腔脏器损伤比例为18.6%(34/183),共计发生57处脏器损伤,其中脾脏损伤27例、肝脏损伤18例、肾脏损伤6例、肾上腺损伤3例、胰腺损伤2例、十二指肠损伤1例。单因素分析发现,性别和肋骨骨折数目与合并腹腔脏器损伤无关联,而年龄(χ~2=6.349,P=0.012)、是否机动车事故(χ~2=7.133,P=0.008)、肋骨骨折部位(χ~2=11.506,P=0.001)、入院时收缩压(χ~2=18.531,P<0.001)、心率(χ~2=5.932,P=0.015)、腹部体征(χ~2=6.416,P=0.011)和红细胞压积(χ~2=6.685,P=0.010)与合并腹腔脏器损伤存在关联。多因素Logistic回归分析发现,机动车事故(OR=5.64,95%CI:2.57~11.61,P=0.008)、双侧肋骨骨折(OR=4.25,95%CI:1.63~12.87,P=0.025)、入院时红细胞压积<40%(OR=2.16,95%CI:1.98~5.29,P=0.017)是同时合并腹腔脏器损伤的独立危险因素。结论对于钝性损伤致下胸部肋骨骨折,尤其是机动车事故、双侧肋骨骨折、存在明显失血指征者,要高度警惕合并腹腔脏器损伤的可能。

闭合性腹部损伤的诊断和治疗策略

目的探讨闭合性腹部损伤的诊断和治疗策略。方法对我院90例闭合性腹部损伤患者的早期诊断和策略进行归纳总结。结果 90例患者均行腹腔穿刺,其中阳性77例(85.6%),42例行B超检查,阳性36例(85.7%),B超诊断模糊或未行B超检查者行CT检查14例,阳性12例(85.7%)。本组患者手术治疗80例,术后并发膈下血肿11例,胸腔积液5例,胆瘘4例,肝周或创面感染3例,再出血1例,均对症治愈;保守治疗10例。治愈86例,死亡4例。结论对于闭合性腹部损伤患者应尽早诊断,客观、全面分析伤情,严密、细致观察病情变化,及时合理救治,切忌过分依赖特殊检查结果 ,或存在等待的侥幸心理等,以免延误诊断,丧失最佳手术时机。

腹部闭合性损伤83例诊治体会

目的:探讨腹部闭合性损伤的早期诊断和治疗。方法:对83例腹部闭合性损伤的受伤程度、诊断方法及采取的治疗措施做回顾性分析。结果:其中75例进行了手术治疗,分别施行脏器修补、全部或部分切除,8例行非手术治疗,治愈82例,死亡1例。结论:全面分析病史资料,结合诊断性腹腔穿刺,辅助X线、B超和CT检查,是提高腹部闭合性损伤有效的诊断措施。早期应注意抗休克治疗并及时手术,后期应合理应用抗生素控制感染,预防脏器功能衰竭的发生。

一线三甲医院汶川地震7天内23例腹部闭合性损伤救治分析

目的回顾性分析德阳市人民医院23例汶川地震腹部损伤住院和死亡伤员伤情与死因,为今后完善和健全地震灾害应急预案机制和腹部损伤处置提供决策参考。方法从医院信息处系统收集震后1周内收治地震伤员的相关资料,分析伤员基本情况。资料录入采用EXCEL表格。结果我院共收治住院腹部伤员23例,占总住院伤员的1.9%;绝大部分伤员来自绵竹市,在12h内入院并得到救治。本组伤情严重、病情复杂;死亡5例,病死率21.74%;脾脏损伤采取脾切除术;切口感染2例,与围手术期未使用抗生素有关。结论建立我国地震灾害腹部脏器损伤的医疗救援应急预案,对保证救援人员配置和伤员分检、最优化手术安排、减少地震腹部伤病死率非常重要。

腹部外加压治疗腹部闭合伤腹腔出血在院外急救中的应用

目的探讨在院外急救过程中采用腹部外加压治疗腹部闭合伤腹腔出血的应用价值。方法在院外急救中将210例闭合性腹部损伤腹腔出血患者随机分成实验组和对照组，每组105例，对照组采用常规治疗，实验组在常规治疗的基础上，用充气式腹带以60—70mmHg（1mmHg=0．133kpa）的压力外加压，观察、对比两组患者的治疗效果。结果实验组与对照组相比：死亡率明显降低（10．47％：18．10％）；腹腔平均出血量减少[（1343±376）ml：（1709±403）m1]；到达院内时的休克发生率降低（60．78％：77．23％）；两组的腹腔间隔室综合征（ACS）发生率无明显差异（5．71％：3．81％）。结论在院外急救中采用适度的腹部外加压可以减少腹部闭合伤腹腔出血患者的出血量，降低休克发生率和死亡率，且不增加ACS的发生率。

腹部闭合性损伤769例临床分析

目的总结腹部脏器闭合性损伤的诊治方法,提高腹部闭合性损伤的诊疗救治水平。方法回顾性分析我院10年来769例腹部脏器闭合性损伤患者的诊治情况,总结相关的经验和教训。结果单个实质性脏器和空腔脏器损伤各占47.94%和29.58%,2个以上脏器损伤占22.48%,合并颅脑外伤和胸腹联合伤各占7.3%和4.9%。诊断性腹腔穿刺、X线、B超和CT检查的阳性率分别为92.98%、93.23%、92.79%和91.32%。接受手术治疗718例,非手术治疗51例,分别占92.91%和7.09%,手术组术中后死亡47例,占手术病例的6.55%,其中术中死亡6例,术后死亡41例,非手术组死亡9例,占非手术病例的17.65%,全组病例死亡率为7.28%。结论结合受伤情况、临床症状和检查进行综合分析是提高诊断率的关键,选择及时正确的治疗手段对提高伤者的生存率起到重要作用。