Degloving bowel injury following blunt abdominal trauma. Blunt abdominal trauma bat accounts for the majority 80 percent of abdominal injuries seen in the emergency department, and is responsible for substantial morbidity and mortality. Critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma january 2011 scope of application this guideline is intended for physicians working in hospitalbased emergency departments. Ct scan demonstrated gross bowel defect confirmed by emergency laparotomy figure 1. Abdominal trauma may involve penetrating or blunt injuries.
Lectures and a lunch will be monthly 3 rd wed each month at. Ct scan is the most widely used investigation in blunt abdominal trauma. Overview of abdominal trauma msd manual professional edition. Computed tomography ct of bowel and mesenteric injury. Free fluid collection in perihepatic, perisplenic and paracolic gutters arrows in. There was an 80% increase in the incidence of blunt abdominal trauma when compared with the preceding 15year experience. Shoulder tip pain kehrs sign significant abdominal injuries may present with little external evidence of trauma or a trivial pattern of injury and or mechanism. Emergency ultrasoundbased algorithms for diagnosing blunt abdominal trauma. Incidence, patterns, and factors predicting mortality of abdominal.
Identifying children at very low risk of clinically important. We report a case of a 45 years old male suffering abdominal shotgun trauma, who survived his injuries. A pictorial essay med j malaysia vol 67 no 4 august 2012 447 fig. Nem todo trauma do abdome, seja ele penetrante ou fechado, leva a lesoes internas. She was haemodynamically stable, and on abdominal examination she had nonspecific tenderness. To determine the diagnostic accuracy of focused assessment sonography for trauma fast and repeated fast in the patients with blunt abdominal trauma. Early management of severe abdominal trauma sciencedirect. In order to minimize the mortality in cases of abdominal trauma, risk factors for mortality must be identified and systematically studied. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the current east guideline. There are a wide variety of complex structures in each of these areas each with their own unique problems when injured. Abdominal injury surgeries are common in tanzania and in many parts of the world. Penetrating trauma in pregnancy is less common than blunt trauma, accounting for 9% of abdominal trauma in pregnancy in one series. Selective nonoperative management of abdominal injuries in.
Abdominal trauma can be lifethreatening because abdominal organs, especially those in the retroperitoneal space, can bleed profusely, and the space can hold a great deal of blood. Diagnosis and management of blunt abdominal trauma. Evaluation and management of blunt abdominal trauma. Lal ms associate professor department of surgery esi pgimsr new delhi 2. This study aimed to determine the relationships among the causes, characteristics, patterns and outcomes of abdominal injury patients undergoing operations at kilimanjaro christian medical centre. Jul 20, 2012 introduction trauma is the commonest cause of death in young people. Solid organs such as the spleen, liver, and kidneys are more commonly involved and associated with lower rib fractures. The approach to penetrating abdominal trauma 20120701. The pressure within the abdominal cavity, or intraabdominal pressure in a normal person is 05 mmhg. Abdominal evaluation is the challenging component of evaluating trauma. Pdf incidence, patterns, and factors predicting mortality of. Jan 01, 2012 abdominal injuries after trauma are found in 30% of older trauma patients. Solid abdominal organs, such as the liver and kidneys, bleed profusely when cut or torn, as do major blood vessels such as the aorta and vena cava. Pdf laparotomy for blunt abdominal trauma in a civilian trauma.
Common causes of abdominal injury include blunt trauma motor vehicle accidents mvas and falls, and penetrating trauma gunshot wounds gsws and stabbings. By cynthia blankreid, rn, cen, msn often involving multiple injuries, abdominal trauma can lead to hemorrhage, hypovolemic shock, and death. The management of the abdominal shotgun wounds is mainly dependent on clinical examination and clinical judgment, while requires advanced surgical skills. Computed tomography ct of bowel and mesenteric injury in. Focused abdominal sonography ultrasound for trauma fast. Cullens sign, grey turner sign and distension can be a late sign and difficult to determine. Abdominal trauma is responsible for about 10% of all deaths related to trama.
Massive haemoperitoneum from bowel and mesenteric injuries. Patients with open or penetrating abdominal trauma are usually subjected to exploratory laparotomy, however, in selected cases, many surgeons decide not to operate and keep their patients under observation since this expectant. Common abdominal organ injuries involve the liver, spleen, kidneys, intestines and vasculature. General classification on blunt and penetrating trauma helps in the diagnostic pathway and therapeutic management. Blunt abdominal trauma the royal melbourne hospital. One of the most lethal mechanisms of injury is shotgun wound and particularly the abdominal one. The nature and severity of abdominal injuries vary widely depending on the mechanism and forces involved, thus generalizations about mortality and need for operative repair tend to be misleading.
Blunt abdominal trauma occurs in 1015% of injured children, with two typical patterns. It has previously been reported that up to 10% of all abdominal injuries result from sportsrelated trauma, although this number may even be higher today as the number of participants has increased and minor injuries may go unreported. Surgical management of abdominal trauma howard b seim iii, dvm, dacvs colorado state university if you would like a copy of the illustrated version of these notes on cd and a video of this surgical procedure on dvd, go to. The objective of this study was to assess the sensitivity and specificity of fast for detecting free peritoneal fluid in children. Blunt abdominal trauma bat is frequently encountered in the form of motor vehicle crashes mvcs 75%, followed by falls and direct abdominal impact. Find out how to evaluate your patients condition and prevent further harm. Dpl or ultrasound evisceration open pelvic fracture anterior stab wound 4 gunshot wound ultrasound or ct ultrasound or dpl 2. Abdominal injuries are found in 2030% of patients with multiorgan injuries. Abdominal compartment syndrome hypercalcemia systemic vasodilation e. A, textbook of adult emergency medicine, 3rd edition pp. In abdominal trauma spleen, liver and kidney injuries are most common.
When a pediatric patient presents to the ed following blunt abdominal trauma, the abdominal examination may be unreliable due to the childs age or developmental level, or due to an associated head injury. When evaluating a patient for abdominal trauma, it is necessary to think of the abdomen as three separate areas, which consist of the peritoneal cavity, pelvis, and the retro peritoneum. Trauma surgery volume thoracic and abdominal trauma. Pdf this report looks at the group of patients who required a laparotomy for blunt torso trauma at a busy metropolitan trauma. Blunt abdominal trauma bat is a common injury in recent trauma series. Figure 1 coronal a and axial b abdominal ct shows a long segment of abnormal, thickwalled enhancing jejunum.
Fast is the investigation of choice in haemodynamically unstable patients. Pdf abdominal trauma is a major public health problem for all. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. The target audience is all those involved in the acute care of trauma and surgical patients. The majority of bat cases 75 percent are related to motor vehicle collision mvc or auto versus pedestrian accidents 2. Patterns and outcomes of patients with abdominal trauma on. Children are more susceptible than adults to serious injury secondary to blunt abdominal trauma. Sep 15, 2018 abdominal trauma is one of the most complex scenarios in emergency abdominal surgery during pregnancy. Penetrating abdominal trauma, prophylactic antibiotic use in 2012 penetrating abdominal trauma, selective nonoperative management of 2010 penetrating combined arterial and skeletal extremity trauma, management of 2002.
Being one of the referral hospitals, for trauma, we received a total figure of 6149 trauma victims out of which 500 were purely of abdominal in nature managed by the department of surgery. Penetrating injuries often result in injury to hollow organs, such as the intestines. North american journal of medical sciences march 2012 volume 4 issue. Penetrating trauma most commonly includes growing uterus and the fetus which act as a shield for maternal intra abdominal organs. The abdomen can be injured in many types of trauma. Blunt abdominal trauma algorithm 84 gsw to abdomen, flank, or low back algorithm 85 3 3 small bowel obstruction guideline 86 evaluation of genitourinary trauma 87. Various factors, including blunt trauma can lead to increased abdominal pressure or intraabdominal hypertension which is defined as sustained pressures over 12 mmhg lee, 2012. Abdominal trauma stands third next to head injury and chest injury 25% of all major trauma victims require abdominal exploration. Based on ct grading conservative treatment with monitoring of. The abdomen is one of the most commonly injured regions in trauma patients. Focused abdominal sonography for trauma in the clinical. In pediatric care, the role of focused abdominal sonography in trauma fast remains ill defined. At the royal melbourne hospital in 2016, bat accounted for 15% of all major at the royal melbourne hospital in 2016, bat accounted for 15% of all major trauma cases, of these 30% required a laparotomy and 18% required angioembolisation 2. Selective nonoperative management of blunt splenic injury.
Stab wounds cause approximately 25% of penetrating abdominal trauma, and approximately 35% of abdominal trauma injuries occur as the result of gunshot wounds 6. Journal of trauma and acute care surgery, 773, 427432. Penetrating abdominal trauma pat has the potential to be a devastating injury and ranks in the top 15 causes of death for all ages. Isolated blunt abdominal trauma bat represents about 5% of annual trauma mortality from blunt trauma. Abdominal trauma society for academic emergency medicine.
The management of blunt abdominal trauma bat is challenging. A 53yearold woman driver presented to the emergency department following a road traffic collision. Maingots abdominal operations, 12th edition, 2012, 28. Di saverio s, moore ee, tugnoli g et al 2012 non operative manage ment of liver and. Introduction abdominal trauma is regularly encountered in the emergency department one of the leading cause of death and disability identification of serious intraabdominal injuries is often challenging many injuries may. Penetrating injuries include gunshot and shrapnel injuries, impalements, and knifings. Find, read and cite all the research you need on researchgate. The signs and symptoms may include abdominal pain, tenderness, rigidity.
Role of elevated liver transaminase levels in the diagnosis. The combined traumatic insult led to severe signs of hemorrhagic shock and impaired pulmonary function. Computed tomography ct of bowel and mesenteric injury in blunt abdominal trauma. Dealing with the damage hidden in the abdomen, lifethreatening injuries can elude detection. A combined trauma model of chest and abdominal trauma with. Starting january 18, 2012, a year long lecture series on current topics in trauma acute care surgery will begin. Pdf on sep 20, 2017, alabousi a and others published blunt abdominal trauma. Pediatric emergency medicine simulation curriculum. Evaluation and management blunt abdominal injury washington. Ultrasound is regarded as the investigation of choice for early diagnostic investigations in patients with suspected blunt abdominal trauma. Evaluation of gastrointestinal injury in blunt abdominal. An eastern association for the surgery of trauma practice management guideline.