Trauma to the solid abdominal organs:The missed dark box of colonoscopy

Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure.Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used,the sedatives used,but to the procedure related as well including bleeding and perforation.Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon,however,serious complications related to the procedure have been reported infrequently in the literature.Life threatening injuries to the spleen,liver,pancreas,mesentery,and urinary bladder have been reported as early as in mid-1970s.These injuries should not be overlooked by clinicians and endoscopists.Steadily increasing abdominal pain,abdominal distension,and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury.Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening.Although conservative management may help,yet they usually need interventional radiology or surgical intervention.Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively.The mechanism of abdominal organ injuries during colonoscopy is not fully understood,however many risk factors have been identified,which can be classified as-organ related,procedure related,and local abdominal factors.Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries.Left lateral position,avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.

Severe acute pancreatitis complicated with intra-abdominal infection secondary to trauma:A case report

BACKGROUND Pancreatic trauma(PT)is rare among traumatic injuries and has a low incidence,but it can still lead to severe infectious complications,resulting in a high mortality rate.Acute pancreatitis(AP)is a common complication after PT,and when combined with organ dysfunction and sepsis,it will result in a poorer prognosis.CASE SUMMARY We report a 25-year-old patient with multiple organ injuries,including the pancreas,due to abdominal trauma,who developed necrotising pancreatitis secondary to emergency caesarean section,combined with intra-abdominal infection(IAI).The patient underwent performed percutaneous drainage,pancreatic necrotic tissue debridement,and abdominal infection foci debridement on the patient.CONCLUSION We report a case of severe AP and IAI secondary to trauma.This patient was managed by a combination of conservative treatment such as antibiotic therapy and fluid support with surgery,and a better outcome was obtained.

Successful endoscopic treatment of biliary stricture following mesenteric tear caused by blunt abdominal trauma

Biliary duct injuries are frequently iatrogenic, being associated with surgery for gallbladder stones. However, blunt abdominal trauma such as a motor vehicle crash is a rare cause of extrahepatic biliary stricture. A few reports have been published on biliary strictures treated with endoscopic therapy. In the present study, we describe a suprapancreatic biliary stricture associated with mesenteric tear following road traffic accident. We performed endoscopic stent placement, which was successful in relieving the biliary stricture.

Effects of Branched-chain Amino Acids on Nutritional Metabolism and Pharmacoeconomics in Patients with Severe Abdominal Trauma

Objective:To observe the influences of branched-chain amino acids(BCAAs)on nutrition metabolism and prognosis of patients with severe abdominal trauma;at the same time,to analyze and evaluate the pharmacoeconomics of it.Methods:A total of 75 severe abdominal trauma patients were recruited from June 2016 to December 2017 and randomly divided into control group and observation group.After surgery and basic treatment,parenteral nutrition support therapy with iso-nitrogen and iso-calorie of both groups was administered.Meanwhile,an equivalent of 8.5%(18AA-Ⅱ)and 10%(20AA)compound AA injection was administrated to the control and observation groups,respectively.The nitrogen balance,serum protein level and plasma amino spectrum of the patients were observed before and after treatment.Besides,the hospital stay,survival rate,complications,adverse reactions and hospitalization costs were also compared.Results:After a 7-day course treatment,the nitrogen balance level of the two groups was significantly improved,but no significant difference was found between them.In addition,the serum protein level and plasma amino spectrum of the two groups was generally improved when compared to before treatment.Compared with the control group,the level of albumin and transferrin in the observation group was improved significantly after treatment,while no difference in plasma amino spectrum was found between the two groups.Moreover,the cost analysis showed remarkably reduced hospitalization costs in the observation group.Conclusion:To a certain degree,BCAAs could improve the nutritional metabolism and prognosis of patients with severe abdominal trauma,and have good cost-effectiveness.

Abdominal Trauma during Pregnancy with Splenic Rupture and Fetal Death in Utero at Bogodogo University Hospital: A Case Report

Splenic injury caused by abdominal trauma during pregnancy is rare. Splenic injury associated with fetal death in utero following a fall from a tree top is even rarer. The authors report a case of splenic trauma associated with fetal death in utero following a fall from the top of a tree in a 19-year-old pregnant woman at 30 weeks amenorrhoea. She was referred from a 1st level health facility for trauma that had occurred the day before admission. She was in poor general condition (WHO performance status IV) and had a cardiovascular collapse. Ultrasound was used to diagnose haemoperitoneum and fetal death in utero. A CT scan was used to diagnose splenic lesions. Treatment consisted of splenectomy and caesarean section after resuscitation.

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.

Jejuno-Ileal Ruptures after Blunt Abdominal Trauma at the Teaching Hospital of Bouake

Objective: The aim of this study is to determine the causes, pattern, management, and outcome of jejunal-ileal rupture following blunt abdominal trauma at the teaching Hospital of Bouake. Methods: The study included 27 patients who underwent laparotomy for jejunoileal injuries from blunt abdominal trauma at the Teaching Hospital of Bouake over a period of 14 years from January 2007 to December 2020. A retrospective study was conducted and the patients were analyzed with respect to patient demographics data, cause, injury mechanisms, presentation, anatomical distribution, diagnostic methods, associated injuries, treatment and outcomes. Results: During the 14 year period from 2007 to 2020, 27 patients with blunt small bowel injuries were treated at our Teaching Hospital. That is 2.9% of all blunt abdominal trauma. Male to female ratio was 4.4:1 and the average age was 26.3 years (range: 15 and 50 years). The majority (66.7% 18 cases) were Victims of road traffic accident. Median delay between injury and arrival at hospital for these patients was 10.1 hours (range: 1 - 72 h). A single intestinal injury was present in 22 patients, while 5 patients suffered from 2 injuries. There were 32 perforations of the small intestine in 27 patients with two perforations being transection. All perforations were located on the antimesenteric border of the intestine. Out of the 32 jejuno-ileal ruptures 18 were located on the jejunum while 14 were located on the ileum. Associated intra-abdominal injuries were present in 6 patients and nineteen associated extra-abdominal injuries were present in 10 (70.4%) patients. A one-stage therapeutic strategy was performed in 20 cases (74.1%) and a two-stage strategy was performed in seven cases (25.9%). Intestinal continuity was restored 93.8 days later (range 60 and 140 days). The average length of hospital stay of the operated patients was 11.4 days. The operative morbidity was 25.9%. Conclusion: Jejuno-ileal ruptures are rare and characterized by a delay in management. An early diagnosis could improve the vital prognosis of the patients.

First Reported Incidence of Delayed Secondary Abdominal Compartment Syndrome in a Trauma Patient with Scleroderma: A Case Report and Review of the Literature

Background: Scleroderma is a complex immune-mediated rheumatic disease that is characterized by fibrosis of the skin, internal organs, and vasculopathy. Extensive fibrosis, especially in the limited compartment, has been reported to induce acute compartment syndrome frequently reported involving the upper and lower extremities. Case Presentation: We present a rare case of a 54-year-old Caucasian female who underwent surgery for abdominal compartment syndrome in the setting of scleroderma. Upon arrival, at the hospital, the patient’s health status showed signs of improvement with no indicators of abdominal compartment syndrome until the tenth hospital day. A CT scan showed a new intra-abdominal fluid collection with total lower abdominal anasarca and a stable retroperitoneal hematoma. Following emergency surgery, significant bowel edema without other intra-abdominal injuries was noted. Conclusion: Secondary abdominal compartment syndrome may occur in patients with scleroderma without evidence of intra-abdominal trauma or emergent abdominal surgery. Further research is warranted to investigate the relationship between scleroderma and secondary abdominal compartment syndrome.

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.

Effect of abdominal trauma on hemorrhagic shock-induced acute lung injury in rats

TO evaluate the effects of abdominal trauma on hemorrhagic shock-induced acute lung injury in rats. METHODS： Five groups were allocated （n = 8） in the study. Group Ⅰ was taken as the control group, group Ⅱ as the hemorrhagic shock group, group Ⅲ as hemorrhagic shock ＋ laparotomy, group Ⅳ as hemorrhagic shock ＋ splenectomy and group V as splenectomy ＋ omentectomy ＋ hemorrhagic shock group. Hemorrhagic shock was induced by drawing blood and reducing mean arterial pressure （MAP） to 40 mmHg within 10 min. After a hypotensive period of 1 h, animals were resuscitated. Bronchoalveolar lavage （BAL） was performed to recover cells from the alveolar space with 40 mL of BAL fluid after resuscitation malondialdehyde （MDA） and L-γ-glutamyl-L-cysteinylglycine （GSH） levels were measured in serum, erythrocytes and lung tissue. RESULTS： Serum, erythrocyte, lung tissue MDA and GSH levels were significantly increased in hemorrhagic shock groups Ⅱ-Ⅴ （P 〈 0.05）. Lymphocyte, neutrophil and alveolar macrophage counts in BAL fluid indicated a significant difference between control and shock groups （P 〈 0.05）. CONCLUSION： The degree of trauma increases hemorrhagic shock-induced acute lung injury.

Effect of Astragalus Injection on Serious Abdominal Traumatic Patients’ Cellular Immunity

Objective： To explore the change of serious abdominal traumatic patients＇ cellular immunity and the effect of Astragalus Injection （AI） on it. Methods： Sixty-three serious abdominal traumatic patients were randomly assigned into two groups, the conventional group and the treated group, patients in the conventional group were given conventional treatment, while others in the treated group were given conventional treatment as the basis, with Al20 ml was added into 250 ml of 5% glucose solution given through intravenous dripping, and then on the first day and 14th day, their T cell activated antigens as well as that of 10 healthy subjects were monitored. Results： On the first day, in the conventional group and treated group, the levels of CD3^＋ , CD4^＋ , CD4^＋/CD8^＋ , 0D16^＋ , CD69^＋ and CD3^＋/homologous leucocytic antigen-DR （HLA-DR＋ ） were apparently lower than those in the healthy group （ P〈0.05）, while the CD8^＋ was significantly higher than that in the healthy group （P〈0.05）, and there was no significant difference between the conventional group and the treated group （P〉0.05） ; on the 14th days, the levels of CD3^＋, CD4^＋, CD4^＋/CD8^＋, CD16^＋, CD69^＋ and CD3^＋/HLA-DR^＋ of the treated group got closed to healthy subject value, and got even higher than those of conventional group （P〈0. 05）; CD8^＋ got close to that of healthy subjects, while obviously lower than that of conventional group （ P〈0. 05）. Conclusion： After serious abdominal trauma, cellular immunity lowered, auxiliary use of AI was beneficial to the restoration of cellular immunity.

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.

Relationship between abdominal trauma or surgery and mesenteric panniculitis

Mesenteric panniculitis is a rare disease characterized by chronic non-specific inflammation of mesenteric fat tissue.Several etiologic and/or associated factors have been reported in the literature so far.Although trauma or surgery is one of the potential etiologic factors for mesenteric panniculitis,to the best of our knowledge,no strong correlation has been shown in the literature until now.

Common iliac artery occlusion with small intestinal transection caused by blunt abdominal trauma: A case report and review of the literature

BACKGROUND Most major abdominal vascular injuries are caused by penetrating injuries.A common iliac artery occlusion caused by blunt force trauma is rare,and very few cases have been reported.Because of this low incidence,atypical symptoms,and frequent association with other severe injuries,the proper diagnosis tends to be missed or delayed.The gold standard for diagnosis is angiography,and treatment remains a challenge.CASE SUMMARY We report here the unusual case of a common iliac artery occlusion caused by blunt abdominal compressive trauma,with transection of the small intestine.At presentation,the patient(a 56-year-old man)complained of pain and numbness in the left lower extremity and severe pain in the whole abdomen.Physical examination showed total abdominal tenderness with evidence of peritoneal irritation.The left lower limb was pulseless and cold.Abdominal computed tomography examination revealed digestive tract perforation,and abdominal computed tomography angiography showed left common iliac artery occlusion.The patient was treated successfully by anastomosis of the intestine,percutaneous transluminal angioplasty,and stenting.The patient was followed for more than 11 mo after the operation and showed a good recovery.CONCLUSION Patients with abdominal trauma should be suspected of having major vascular injury.Individualized treatment strategies are needed for this condition.

Autopsy-Based Study of Abdominal Traffic Trauma Death after Emergency Room Arrival

We experienced the autopsy cases that the deceased was alive in emergency room on arrival. Bleeding is the leading cause of preventable death after injury. This retrospective study aimed to characterize opportunities for performance improvements identified in patients who died from traffic trauma and were considered by the quality improvement of education system. We focused the abdominal traffic trauma injury. An autopsy-based cross-sectional study was conducted. A purposive sampling technique was applied to select the study sample of 41 post-mortems of road traffic accident. 16 patients (39.0%) were abdominal trauma injury. The mean period of survival after meeting with accident was 13.5 hours, and compared abdominal trauma death was 27.4 hours longer. In road traffic accidents, the most injured abdominal organs were the liver followed by mesentery. We thought that delayed treatment was associated with immediate diagnostic imaging, and so expected to expand trauma management examination.

Child Abdominal Trauma Due to Attack of Cattles While Working on Farms in Burkina Faso

Introduction: Cattle are strong animals very often used in agriculture in rural Africa. Unpredictable in their behavior, they regularly inflict injuries to farmers, some of whom are children in rural Africa. Objective: The purpose of this study was to describe the clinical, therapeutic and evolutionary aspects of abdominal trauma caused by bovidae to children on farms in Burkina Faso. Patients and Method: This is a descriptive study covering the period from January 2014 through December 2016 and was conducted in the General Surgery Unit of the Tenkodogo Regional Hospital in Burkina Faso. It included all patients under the age of 17, victims of abdominal trauma by cattle on farms. Result: A total of 68 patients were identified, which is 3% of all patients under 17 admitted to the service during the same period. The average age of patients was 10.5 years, with a standard variation of 3.6 years. The majority (73.5%) of the patients were boys. The main lesional mechanisms found were horn strokes (88.2%). We noted 35 eviscerations without visceral perforation, 15 intestinal perforations, 6 hepatic wounds and 5 splenic wounds. In 7 cases, there were non-penetrating wounds. All patients underwent surgical intervention under anesthesia. The average length of hospital was 6 days. Two deaths were recorded, making a mortality rate of 3%. Conclusion: Abdominal traumas of the child by attack of cattle are frequent during farm works in rural Burkina Faso. The injuries are sometimes serious. Wearing protective equipment for children should be considered during farm work.

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.

Penetrating Abdominal Trauma: Experience in A Teaching Hospital, Calabar, Southern Nigeria

Background: Penetrating abdominal trauma (PAT) typically involves the violation of the abdominal cavity by a gun-shot wound (GSW) or stab wound Recently several studies have favored a more conservative approach as opposed to mandatory exploratory laparotomy. Methods: Patients admitted in the University of Calabar Teaching Hospital (UCTH), Calabar, with PAT from January 2008 to December 2010 were prospectively studied based on a questionnaire. The total number of patients with PAT was compared with total number of emergencies, traumatic injuries and abdominal trauma seen during the same period. Results: A total of 48 patients presented with abdominal trauma: PAT 29 (60%) and blunt abdominal trauma (BAT) 19 (40%). The ages of the patients (28 male, 1 female) ranged from 3 - 62 years (mean 28.1 years). Gunshot wound (GSW) 11 (38%) patients, stab wound 8 (27.6%) patients and machete cut 4 (13.8%) patients ranked first, second and third respectively as causes of PAT. The commonest organ injury was perforation of the small intestine. Four (13.8%) patients were managed conservatively while 25 (86.2%) patients had laparotomy. The duration of admission ranged from 2 - 19 days (mean 10.5 days). Morbidity [surgical site infection (SSI)] and mortality were recorded in 2 (6.9%) and 3 (10.3%) patients respectively. Conclusion: Key areas that require attention have been highlighted. Revamping the ailing economy and gainful employment for youths are paramount areas that require prompt, dedicated and sustained intervention for reduction in violent crimes.

Blunt Abdominal Trauma in a Teaching Hospital, Calabar, Nigeria

Background: Road traffic injury remains a major source of blunt abdominal trauma (BAT). Road traffic injury and other forms of trauma have become a major health problem throughout the world especially in low and middle-income countries. In a previous study (2005-2007), abdominal trauma constituted 79 (4.8%) of trauma cases;BAT, 40 (53%) and penetrating abdominal trauma (PAT), 39 (47%). Effective policies on road safety should be developed based on local research and not on adapted models. We present this study to highlight the possible effect of legislation on the ban of the use of motorcycles on blunt abdominal trauma. Methods: Patients that presented to the University of Calabar Teaching Hospital, Calabar with BAT from 2008-2010 were prospectively studied based on a questionnaire following the legislation prohibiting the use of motorcycles. Results: A total of 12,083 patients presented during the study period, trauma patients totaled 4942 (41%), of this, 48 (1%) suffered abdominal trauma: BAT 19 (40%), penetrating abdominal trauma (PAT) 29 (60%). The age range of the patients was from 5 to 48 years (mean 26.6 years) with a M:F = 5.3:1. Road traffic accident (RTA) 17 (90%) [Motorvehicle 7 (37%), motorcycles 10 (53%)] was the commonest cause of trauma. The spleen was the commonest injured organ 14 (74%). Conclusion: Road traffic injury constitutes a public health challenge and the hallmark is prevention. Legislation prohibiting the use of motorcycles may have been responsible for the reduction in BAT.

Rupture of a hepatic adenoma in a young woman after an abdominal trauma: A case report

Unlike hepatic haemorrhage following blunt abdominal trauma, spontaneous abdomen bleeding is rare, even in the presence of a hepatocellular adenoma (HA) or carcinoma. However, the diagnosis of a tumour underlying a haematoma after liver trauma is unusual, especially when it occurs more after two years after the accident. Here, we report a case of a ruptured HA due to blunt abdominal trauma. A 36-year-old woman was admitted to our hospital with sudden onset of upper abdominal pain. Her medical history revealed a blunt abdominal trauma two years prior. Initial abdominal computed tomography scan revealed a large haematoma measuring more than 16 cm in diameter in the right lobe of the liver. Magnetic resonance imaging showed haemorrhagic areas and some regions with hepatocyte hyperplasia, suggesting HA. The patient underwent right hepatic lobectomy, and a histopathological examination confirmed a diagnosis of HA. In conclusion, it is important to consider that abdominal trauma may hide old, asymptomatic and not previously detected injuries, as in the case reported.