Abdominal crush injury in the Sichuan earthquake evaluated by multidetector computed tomography

AIM: To investigate the features of abdominal crush injuries resulting from an earthquake using multidetector computed tomography (MDCT). METHODS: Fifty-one survivors with abdominal crush injuries due to the 2008 Sichuan earthquake underwent emergency non-enhanced scans with 16-row MDCT. Data were reviewed focusing on anatomic regions including lumbar vertebrae, abdominal wall soft tissue, retroperitoneum and intraperitoneal space; and types of traumatic lesions. RESULTS: Fractures of lumbar vertebrae and abdominal wall soft tissue injuries were more common than retro- and intraperitoneal injuries (P < 0.05). With regard to the 49 lumbar vertebral fractures in 24 patients, these occurred predominantly in the transverse process (P < 0.05), and 66.67% of patients (16/24) had fractures of multiple vertebrae, predominantly two vertebrae in 62.5% of patients (10/16), mainly in L1-3 vertebrae in 81.63% of the vertebrae (40/49). Retroperitoneal injuries occurred more frequently than intraperitoneal injuries (P < 0.05), and renal and liver injuries were most often seen in the retroperitoneum and in the intraperitoneal space, respectively (all P < 0.05). CONCLUSION: Transverse process fractures in two vertebrae among L1-3 vertebrae, injury of abdominal wall soft tissue, and renal injury might be features of earthquake-related crush abdominal injury.

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.

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.

New scoring system for intra-abdominal injury diagno- sis after blunt trauma

Objective： An accurate scoring system for intra-abdominal injury （IAI） based on clinical manifesta- tion and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is de- signed to provide a new scoring system for a better diagno- sis of IAI after blunt trauma. Methods： This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma （BAT） admitted to the emergency department （ED） of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient＇s history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi- square test and logistic regression were done. Factors with significant relationship with CT scan were imported in multi- variate regression models, where a coefficient （13） was given based on the contribution of each of them. Scoring systemwas developed based on the obtained total [3 of each factor. Results： Altogether 261 patients （80.1% male） were enrolled （48 cases of IAI）. A 24-point blunt abdominal trauma scoring system （BATSS） was developed. Patients were di- vided into three groups including low （score〈8）, moderate （8≤score〈12） and high risk （score≥ 12）. In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans （specificity 100%）. Conversely, all high risk patients had positive CT-scan findings （sensitivity 100%）. The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS （sensitivity=99.3%）. Conclusion： The present scoring system furnishes a high precision and reproducible diagnostic tool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.

Analysis of closed abdominal injury in pregnant women

Objective: To explore the characteristics of closed abdominal injury in pregnancy women and its treatment.Methods: The clinical data of 37 pregnancy patients with closed abdominal injury treated in our hospital from June 1993 to June 2003 were collected and analyzed.Results: All the 37 patients were treated with operation. Among them 2 early pregnancy patients with intestinal rupture and 1 patient with retroperitoneal hematoma were treated under laparoscope; in other 34 pregnancy patients laparotomy was performed. Of the 34 patients 8 used cesarean section because premature separation of placenta and enlarged womb interrupted the management of intra-abdominal organ injury. In the 37 patients 33 ( 89.1%) were cured, 4 ( 10.8%) die, postoperative complication rate was 16.2% (6/37). Two patients ( 5.4%) suffered from abdominal cavity infection, 3 ( 8.1%) from pulmonary infection, and 1 ( 2.7%) had multi-organ failure.Conclusions: For pregnancy patients with closed abdominal injury, besides obsteric diseases intra-abdominal injury should be given much attention. Accurate diagnosis and timely treatment can gain the time to save the life of both mother and fetus.

Thoracic spinal trauma associated with closed thoraco-abdominal injury

Objective: To explore the management of thoracic spinal trauma (TST) associated with closed thoraco abdominal injuries (CTAI). Methods: A retrospective study was made on 259 patients with TST admitted to our department as an emergency treatment from January 1996 to June 2001. We summarized the clinical features of TST associated with CTAI. Results: Among 259 patients with thoracic spinal trauma, 112 were associated with CTAI. Traffic accident was the most common cause. The force causing upper TST was more violent than that causing the lower. Pulmonary complications were the leading cause of death in this group. Surgery could not improve neurological function for completely paraplegic patients. Conclusions: The reason that upper TST has the tendency to be associated with CTAI is its special anatomical feature. Routine ultrasonic examination can avoid misdiagnosis of latent closed abdominal injuries associated with spinal injury. The presence of potential injuries, especially CTAI, should be considered when deciding whether or not to perform surgery early.

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.

Heterotopic mesenteric ossification caused by trauma:A case report

BACKGROUND Heterotopic mesenteric ossification(HMO)is a clinically rare condition characterized by the formation of bone tissue in the mesentery.The worldwide reporting of such cases is limited to just over 70 instances in the medical literature.The etiology of HMO remains unclear,but the disease is possibly induced by mechanical trauma,ischemia,or intra-left lower quadrant abdominal infection,leading to the differentiation of mesenchymal stem cells into osteoblasts.Here,we present a rare case of HMO that occurred in a 34-year-old male,who presented with left lower quadrant abdominal pain.CASE SUMMARY We report the case of a 34-year-old male patient who presented with left lower abdominal pain following trauma to the left lower abdomen.He subsequently underwent surgical treatment,and the postoperative pathological diagnosis was HMO.CONCLUSION We believe that although there is limited literature and research on HMO,when patients with a history of trauma or surgery to the left lower abdomen present with corresponding imaging findings,clinicians should be vigilant in distinguishing this condition and promptly selecting appropriate diagnostic and therapeutic interventions.

Interventional treatment experience in multiple injury with major abdominal or pelvic injuries： 160 cases analysis

Purpose： To observe the therapeutic effect of interventional embolization and haemorrhage control in multiple trauma patients with a major abdominal or pelvic injury. Methods： Data of 160 multiple trauma patients with a major abdominal or pelvic injury were retro- spectively analyzed. They were admitted into the Department of Emergency of the First Affiliated Hospital of Zunyi Medical College from October 2013 to April 2016. Eighty-seven patients who received emergent intervention for embolization and haemorrhage control were set as group A, including 72 males and 15 females, with an average age of （39.32 ±14.0） years. Patients underwent emergent intervention for embolization and hemostasis. The other 73 patients who received traditional surgeries were set as group B, including 62 males and 11 females, with an average age of （38.48 ± 13.12） years. The time from admission to emergency intervention, the time of interventional embolization, transfusion during hospitalization, length of stay and prognosis were observed. The whole treatment and prognosis were compared between group A and group B. Results： In group A, the average time from admission to intervention exploration was （132.05 ± 86.80） min, the average operation time was （149 ± 49.69） min, the average hospitalization time was （18.37±4.71 ） days, the average amount of RBC transfusion during hospitalization was （Z2 ± 4.33） units, and the mortality was 4.60% （4 patients died）. The corresponding data in group B were respectively （138.95± 82.49） min, （183 ± 52.39） min, （22.72 ± 6.63） days, （12.23 ± 5.43） units, and 9.59% （7 cases died）. There was no statistical difference in the time from admission to operation between the two groups （p 〉 0.05）, but there was statistical difference in operation time, RBC transfusion, hospitalization time, prognosis, and mortality between the two groups （all p 〈 0.05）. Conclusion： The emergent intervention for embolization and haemorrhage control of multiple trauma patients with a major abdominal or pelvic injury and visceral organ haemorrhage has the advantages of less trauma, shorter operation time, shorter hospital stay, less blood transfusion in comparison to the traditional emergency surgeries.

Clinical diagnosis and treatment of abdominal visceral injury complicated by craniocerebral injury

Objective ： To improve the cure rate of patients with abdominal visceral injury complicated by craniocerebral injury. Methods： Clinical data of 176 cases of abdominal visceral injury complicated by craniocerebral injury were retrospectively analyzed. Results： In this series, 44 cases died and the mortality was 25.0%. The main cause of death is abdominal visceral injury combined with shock and severe craniocerebral injury. Conclusions： It is essential to improve the cure rate by accurate diagnosis at early stage. Abdominal paracentesis and CT should be performed promptly and dynamically. Priority should be given to the treatment of life-threatening injuries.

Unusual management of thoracoabdominal impalement injury to the right hemiliver and diaphragm

Laparotomy or thoracolaparotomy is a traditional management approach for thoracoabdominal im- palement injury associated with major liver and diaphrag- matic injuries. We successfully treated the impalement in- jury with minimally invasive management. A male was brought to our trauma centre with the 15 cm long handle of the knife protruded from right lateral thoracoabdominal region. CT scan revealed that the knife blade traversed through the right costophrenic recess into segment 8 of the liver. There was an intraparenchymal haematoma and a col- lection of fluid in the abdominal cavity. The conservativemanagement plan consisting of removing the impaled knife, observing, monitoring and managing complications was undertaken. A multidisciplinary approach to manage a pa- tient with less invasive techniques yielded a good outcome. This management option may be considered as an alterna- tive for open surgery for hemodynamically stable patients in experienced centres.

Clinical diagnosis and surgical treatment of pancreatic and/or duodenal injuries

Objective: To investigate the points of the clinical diagnosis and surgical treatment for pancreatic and/or duodenal injuries. Methods: Clinical data of 30 patients who suffered from pancreatic and/or duodenal injuries were reviewed. Results: There were 29 cases who received surgical management. Of the 30 cases, 22 cases were cured, seven cases died, and postoperative complications occurred in 16 cases. The cure rate was 73.3%. Conclusion: Pancreatic and/or duodenal injuries are severe abdominal injuries and difficult to treat. The mortality and complication rate are high. The keys to successful treatments for pancreatic and/or duodenal injuries are early diagnosis, careful exploration and proper operational management.

Non-operative management for abdominal solidorgan injuries: A literature review

The philosophy of abdominal injury management is currently changing from mandatory exploration to selective non-operative management (NOM). The patient with hemodynamic stability and absence of peritonitis should be managed non-operatively. NOM has an overall success rate of 80%—90%. It also can reduce the rate of non-therapeutic abdominal exploration, preserve organ function, and has been defined as the safest choice in experienced centers. However, NOM carries a risk of missed injury such as hollow organ injury, diaphragm injury, and delayed hemorrhage. Adjunct therapies such as angiography with embolization, endoscopic retrograde cholangiopancreatography with stenting, and percutaneous drainage could increase the chances of successful NOM. This article aims to describe the evolution of NOM and define its place in specific abdominal solid organ injury for the practitioner who faces this problem.

Polytrauma with thoracic and/or abdominal injuries: experience in 1 540 cases

Objective ：To investigate the early diagnosis and treatment of polytrauma patients with thoracic and/or abdominal injuries. Methods： The data of all polytrauma patients with thoracic and/or abdominal injuries during the past 10 years were studied retrospectively. Results： In the present study, there were 1 540 polytrauma patients, accounting for 65.0% of all 2 368 trauma patients. Of these patients, 62.4% were in shock state on admission. The operative rates were 15.0% （181/1 206） and 79.9% （ 612/766 ） in patients with thoracic and abdominal injury （ P 〈 0.01 ）, 5.2 % （39/758） and 31.7% （142/448） in patients with blunt and penetrating chest trauma （P〈0.01）, and 72.4% （359/496） and 93.7 % （253/270） in patients with blunt and penetrating abdominal injuries （P〈0.01）, respectively. To deal with abdominal injury, angioembolization was performed in 43 cases, with 42 cured. The overall mortality rate was 6.2%. And in the blunt and penetrating subgroups, the mortalities were 7.9 % （75/950） and 3.6 % （21/590）, respectively （P〈0.01）. Most patients died from exsanguination. Conclusions： The first ＂golden hour＂ after trauma should be grasped, since the treatment in this hour can determine greatly whether the critically-injured victim could survive. Prompt diagnosis and proper treatment contribute more greatly to the survival of the victim than the severity of injury.

Effects of CO2 pneumoperitoneum on blood flow vol-ume of abdominal organs of rabbits with controlled hem-orrhagic shock and liver impact injuries

Objective: To investigate the effects of CO2 pneumo-peritoneum on blood flow volume of abdominal organs of rabbits with controlled hemorrhagic shock model and liver impact injuries.Methods: After controlled hemorrhagic shock and liver impact injuries, the rabbit model was established. Eighteen rabbits subjected to hemorrhagic shock and liver impact inju-ries were divided into 3 groups randomly according to the volume of lost blood: light hemorrhagic shock (blood loss volume was 10%, 6 ml/kg), moderate hemorrhagic shock (20%, 12 ml/kg) and severe hemorrhagic shock (40%, 22 ml/kg). Intraabdominal pressures of CO2 pneumoperitoneum was 10 mmHg. Color-labeled microspheres were used to mea-sure the blood flow volume of the liver, kidney and stomach before pneumoperitoneum at 30 minutes and 2 hours after pneumoperitoneum and 30 minutes after deflation. And the mortality and hepatic traumatic condition of rabbits were recorded.Results: Of the 18 rabbits, there were 9 with liver impact injuries at Grade Ⅰ, 8 at Grade Ⅱ and Ⅰ at Grade Ⅲ (according to AIS-2005). The mortality rate in light hemorrhagic shock group was 33.33%, and that in moderate or severe hemor-rhagic shock group was 100% within 30 minutes and 2 hours after pneumoperitoneum, respectively. The blood flow vol-ume in the organs detected decreased at 30 minutes under pneumoperitoneum in light and moderate hemorrhagic shock groups. At the same time, the blood flow volume of the liver in moderate hemorrhagic shock group decreased more sig-nificantly than that in light hemorrhagic shock group.Conclusions: The blood flow volume of abdominal organs in rabbits is decreased obviously under CO2 pneumoperitoneum, with fairly high mortality rate. It is be-lieved that CO2 pneumoperitoneum should cautiously be used in abdominal injury accompanied with hemorrhagic shock, especially under non-resuscitation conditions.

Management of multiple trauma with mainly thoracic and abdominal injuries： a report of 1166 cases

Objective： To discuss the diagnosis and treatment of multiple trauma with mainly thoracic and abdominal injuries. Methods： A retrospective analysis was performed on data of multiple trauma cases with mainly thoracic and/or abdominal injuries. Results： Of 1166 cases, 72.3% were found with shock. The operation rates of thoracic and abdominal injuries were 14.8% （119/804） and 83.5% （710/850） respectively （ x^2=780.683, P 〈0.01）. The operation rates of blunt and penetrating thoracic injuries was 6.8% （42/617） and 40.6% （76/187） respectively （ x^2=131.701, P〈0.01）. The operation rates of blunt and penetrating abdominal injuries were 77.1% （434/563） and 96.1% （276/287） respectively （ x^2=50.302, P〈0.01）. The operation rates of blunt thoracio-abdominal injuries were 6.8% （42/617） in thoracic region and 77.1% （434/563） in abdomen respectively （x^2=544.043, P〈0.01 ）. Among the cases of abdominal injuries, 41 received arteriography embolism, with the efficacy of 95.1% （39/41）. Total mortality rate was 6.1%. The mortality rates of blunt and penetrating injuries were 7.3% （62/854） and 2.9% （9/312） （ x^2=6.51, P〈0.005）. The deaths were mainly due to large volume of blood loss. Conclusions： When both thoracic and abdominal injuries exist, laparotomy is frequently required rather than thoracotomy. Laparotomy is seldomly used for blunt thoracic injuries, but usually used for penetrating thoracic and abdominal injuries. Mortality rate of penetrating thoracic and abdominal injuries is markedly lower than that of blunt injuries. Surgical operation is still important for those patients with penetrating thoracic or abdominal injuries.

Accuracy of the AAST organ injury scale for CT evaluation of traumatic liver and spleen injuries

Objective： Detection of abdominal in- jury is a very important component in trauma management, so a precise assessment of liver and spleen injuries includ- ing their severity degree is necessary. There is a good case to believe that in emergency situations the radiologists＇ performance may profit from a systematic approach using established scoring systems. Score systems as the organ injury scale （OIS） drawn up by the American Association for the Surgery of Trauma are a valuable guidance for objec- tive trauma assessment. Aim of this study was to evaluate retrospectively whether a structured approach using the OIS may help improve trauma assessment. Methods： Fifty-three patients, 38 male and 15 female who underwent CT and laparotomy after abdominal trauma were included in this study. The laparotomy was performed by experienced surgeons with a minimum experience of 6 years. While the original CT reports were written by differ- ent radiologists with a minimum experience of 3 years, and then a radiologist with experience of 4 years reviewed the same original CT pictures, resulting in the structured report. Both the original and structured CT results on liver and spleen injuries were transferred into OIS grades. Finally, the initial and structured CT results were compared with theintraoperative findings gathered from the surgery report. Results： Regarding the original CT report we found a mean divergence of 0.68±0.8 （r=-0.45） to the OIS finding in the surgery report for liver injuries （0.69±1.17 for spleen injuries; r=-0.69）. In comparison with the structured approach, where we detected a divergence of 0.8±0.68; r=-0.63 （0.47±0.77 for spleen injuries; r=0.91）, there was no significant difference. However we detected a lower rate of over-diag- nosis in structured approaches. Conclusion： Our study shows that a structured ap- proach to triage abdominal trauma using an imaging check- list does not lead to a significantly higher detection rate, but a nonsignificant trend to reduce the rate of over- diagnoses, thus being more precise in grading the severity grade. Concerning the bias by retrospective study design, further prospective investigations are needed to evaluate the impact of trauma scores on the workflow in emergency department procedure as structured reporting systems are a valuable guidance in other radiological disciplines.

Analysis of high risk factors related to acute respiratory distress syndrome following severe thoracoabdominal injuries

Objective: To investigate the high risk factors related to acute respiratory distress syndrome ( ARDS ) following serious thoracoabdominal injuries.Methods: The clinical data of 282 patients with serious thoracoabdominal injuries were retrospectively studied. Univariate and Cox multivariate regression analysis were used to determine the risk factors related to ARDS following serious thoracoabdominal injuries.Results: The incidence of ARDS was 31.9% (90/282) in patients with serious thoracoabdominal injuries.The mortality caused by ARDS was 37.8% (34/90). The univariate analysis and multivariate analysis demonstrated that the clinical conditions such as elder age, shock,dyspnea, abnormal arterial blood gas, hemopneumothorax,pulmonary contusion, flail chest, coexisting pulmonary diseases, multiple abdominal injury and high ISS score were the independent high risk factors related to ARDS.Conclusion: There are many high risk factors related to ARDS following severe thoracoabdominal injuries, which should be detected early and treated timely to decrease the incidence and mortality of ARDS.

Increased incidence of adrenal gland injury in blunt ab- dominal trauma： a computed tomography-based study from Pakistan

Objective： To determine the frequency of adrenal injuries in patients presenting with blunt abdomi- nal trauma by computed tomography （CT）. Methods： During a 6 month period from January 1, 2011 to June 30, 2011, 82 emergency CT examinations were performed in the setting of major abdominal trauma and ret- rospectively reviewed for adrenal gland injuries. Results： A total of 7 patients were identified as having adrenal gland injuries （6 males and 1 female）. Two patients had isolated adrenal gland injuries. In the other 5 patients with nonisolated injuries, injuries to the liver （1 case）, spleen （1 case）, retroperitoneum （2 cases） and mesentery （4 cases） were identified. Overall 24 cases with liver injuries （29 %）, 11cases with splenic injuries （13%）, 54 cases with mesenteric injuries （65%）, 14 cases （17%） with retroperitoneal injuries and 9 cases with renal injuries were identified. Conclusion： Adrenal gland injury is identified in 7 patients （11.7%） out of a total of 82 patients who underwent CT after major abdominal trauma. Most of these cases were nonisolated injuries. Our experience indicates that adrenal injury resulting from trauma is more common than suggested by other reports. The rise in incidence of adrenal injuries could be attributed to the mode of injury.