Non-penetrating abdominal trauma: With special reference to lesions of the duodenum and pancreas

Abstract

1. 1. A series of sixty-seven cases of non-penetrating trauma of the abdomen has been reviewed with over-all mortality of 19.4 per cent. 2. 2. Occurrence of subcutaneous abdominal trauma is relatively rare in hospital admissions. Injury to the liver, spleen, kidney and the fixed solid viscera are most common. 3. 3. The high mortality lies in the frequency of multiple concomitant injuries not only intra-abdominal but also those of the head, chest and diaphragm and pelvis. Lesions of the liver, spleen, stomach and diaphragm show the highest mortality. 4. 4. There were thirty-four operative and thirty-three non-operative cases. The non-operative cases were largely those of mild trauma, contusion of the kidney, those in extremis and those with delayed or concealed hemorrhage in the multiple-injured. 5. 5. Nine of the eighteen cases of splenic rupture were associated with multiple injuries; four survived splenectomy. All patients in whom splenic laceration was the only trauma recovered following splenectomy. 6. 6. A case of retroperitoneal complete rupture of the duodenum between the second and third portions is reported. The diagnosis was aided by gas outlining the psoas muscle shadow, demonstrated in flat abdominal x-ray. Likewise, retroperitoneal crepitation lateral to a peculiar gray-black hematoma in mesentery of the ascending colon was present. For full exposure of ruptured segments not only mobilization of the ascending colon and duodenum, but also division of lateral margin of the gastrocolic omen-turn was required. 7. 7. The reported characteristics of retroperitoneal duodenal rupture are reviewed. 8. 8. The relatively high incidence of pancreatic lesions in this series is noteworthy. These consisted of a case of complete rupture of the pancreas with rupture of stomach and duodenum, a simple contusion of the head of the pancreas complicated by secondary suppuration of gallbladder and atonic obstruction of duodenum, and two cases of mild pancreatic trauma followed with the development of pseudocysts. 9. 9. The high mortality of pancreatic lesions with concomitant major trauma is discussed. 10. 10. The complications of pancreatic injury are reviewed, particularly pseudocyst and fistula, and their treatment described. For pseudocyst resection with partial pancreatectomy, cyst gastrostomy or cyst enterostomy is the treatment of choice.