Abdominal Cavity Research Articles

Double-sided gastric perforation after a motorcycle accident in Korea: A case report

BACKGROUND Motorcycle accidents often result in abdominal trauma in patients seeking emergency care. Injuries to the hollow viscera, including the duodenum, jejunum, urinary bladder, and colorectum, are relatively common. In contrast, owing to the protective function of the anterior rib cage, gastric rupture is exceptionally rare, with an incidence of < 1.7%. Gastric rupture typically occurs in the anterior wall and rarely presents as multiple ruptures. This report describes an unusual case of multiple gastric ruptures resulting from blunt trauma. CASE SUMMARY A 21-year-old man, who was involved in a motorcycle collision at 70 km/hour after consuming a large meal, presented with hypotension. Physical examination revealed abdominal tenderness. Laboratory test results indicated elevated amylase, lipase, and liver enzyme levels. Computed tomography showed pneumoperitoneum, hemoperitoneum, and gastric wall discontinuation, suggesting gastric perforation alongside pancreatic, splenic, and hepatic injuries. Angiographic embolization was performed because of active contrast leakage in the left gastric and right gastroepiploic arteries. Emergency laparotomy revealed substantial blood loss, hematoma, and gastric contents scattered throughout the abdominal cavity. Two 10 cm gastric perforations in the anterior and posterior walls were identified, as well as severe liver damage, splenic injury, and pancreatic contusion. Surgical interventions included primary closure of the gastric wall, splenectomy, and partial hepatectomy. After temporary abdominal closure, the patient underwent a second surgery without further bleeding. The gastric repair site was resected and reinforced for optimal tissue healing. CONCLUSION Gastric rupture following blunt trauma is fatal. However, patients without severe complications can recover through surgical interventions and postoperative care.

Sepsis and high-density lipoproteins: Pathophysiology and potential new therapeutic targets.

Sepsis and high-density lipoproteins: Pathophysiology and potential new therapeutic targets.

Comparison of fentanyl-induced brain oxygen responses following intravenous and intraperitoneal injections in rats.

Comparison of fentanyl-induced brain oxygen responses following intravenous and intraperitoneal injections in rats.

Mitomycin C in HIPEC: A proposal to use abdominal cavity volume for drug dosage

Mitomycin C in HIPEC: A proposal to use abdominal cavity volume for drug dosage

Design and Control of the Manipulator of Magnetic Surgical Forceps with Cable Transmission

Magnetically actuated medical robots have attracted growing research interest because magnetic force can transmit power in a non-contact manner to fix magnetic surgical instruments onto the inner wall of the abdominal cavity. In this paper, we present magnetic and cable-driven surgical forceps with cable transmission. The design achieves significant diameter reduction in the manipulator by separating the power sources (micro-motors) from the manipulator through cable transmission, consequently improving surgical maneuverability. The manipulator adopting cable transmission mechanism has the problem of joint motion coupling. Additionally, due to the compact space within the magnetic surgical forceps, it is difficult to install pre-tightening or decoupling mechanisms. To address these technical challenges, we designed a pair of miniature pre-tensioning buckles for connecting and pre-tensioning the driving cables. A mathematical model was established to characterize the length changes of the coupled joint-driving cables with the angles of moving joints and was integrated into the control program of the manipulator. Joint motion decoupling was achieved through real-time compensation of the length changes of the coupled joint-driving cables. The decoupling and control effects of the manipulator have been verified experimentally. While one joint moves, the angle changes of the coupled joints are within 2°.

Cognitive impairment after major surgical operations

To study the characteristics of cognitive impairment after extensive surgical operations of various profiles, to develop tactics of cerebroprotection, as well as personalized prevention of cognitive impairment (CI). The study included 277 patients who underwent elective extensive cardiac surgery (coronary bypass surgery, prosthetics of the aortic heart valve) and oncological (for malignant neoplasms of the thoracic or abdominal cavities) profile. All patients underwent a comprehensive clinical, laboratory, and instrumental examination (including neuropsychological testing using the MoCA, FAB scales) in the preoperative and intraoperative periods, as well as 10 days after surgery. Deferred CI after cardiac surgery was diagnosed in 30-36% of patients, and after oncological surgery in 31% of patients. The incidence of acute clinical types of postoperative cerebral dysfunction also had no statistically significant differences: perioperative stroke (2-4% and 2%), symptomatic delirium of the early postoperative period (14-17% and 11%, respectively). Postoperative brain dysfunction was diagnosed after 44% of cardiac surgeries and 34% of oncosurgical operations. Risk factors for deferred CI after coronary bypass surgery: age over 65 years; stenotic atherosclerosis of the brachiocephalic arteries. During aortic valve replacement, the risk factors for deferred CI are: total cholesterol >5.1 mmol/L; very low-density lipoproteins >1.2 mmol/L; low-density lipoproteins >3.2 mmol/L; platelet count<220×109/L; hematocrit<28%. In oncosurgery, the risk factors for delayed CI are: age >70 years, lack of work in the specialty; Charlson's index comorbidity score >5 points; ASA physical status >Class III; MoCA test scores<20 points. Most of the risk factors for deferred cognitive impairment are preoperative, which allows ahead additional assessment of the possibility of modifying the surgical technique and accompanying therapy, as well as designing of personalized tactics of cerebroprotection and prevention of cognitive impairment.

Evaluation of the Safety and Efficacy of Chitosan-Based Hemostatic Sponges in a Chronic Large-Animal Model

Background: The development of agents aimed at achieving hemostasis in parenchymal organ bleeding remains one of the current challenges in medicine. Chitosan-based sponges are considered a promising approach to achieving effective hemostasis. The safety of these products was previously demonstrated in a 60-day experiment in rats. AIM: To evaluate the efficacy and safety of chitosan-based hemostatic sponge samples in a standardized liver trauma model in pigs during a long-term experiment. MATERIALS AND METHODS: The study was conducted in three same-sex pigs. A standardized model of intraperitoneal bleeding was created using laparoscopic access, followed by the application of a chitosan-based hemostatic sponge, which was left in the abdominal cavity for the entire duration of the experiment. The animals were observed for 60 days, during which general condition, body weight, and complete blood count were monitored. On day 30, repeat laparoscopy was performed to visually inspect the trauma site. At the end of the observation period, the animals were euthanized. RESULTS: The hemostatic sponge provided complete hemostasis of parenchymal bleeding, with no recurrence of bleeding. No behavioral abnormalities were observed in animals throughout the entire experiment. Blood parameters remained within reference ranges. On day 30, repeat laparoscopy revealed adhesion formation and encapsulation of the hemostatic sponge in the peritoneal cavity. Histological examination of liver tissue on day 60 revealed an increased number of inflammatory cells at the site of contact with the hemostatic sponge. Maturation of granulomatous connective tissue in the liver was also observed, suggesting active wound healing. CONCLUSION: The developed chitosan-based hemostatic sponge demonstrated both efficacy and biocompatibility, which allow it to remain in the abdominal cavity throughout medical evacuation. However, subsequent removal is recommended to prevent adhesion formation and potential peritoneal inflammation.

EMBRYOTOPOGRAPHIC FEATURES OF THE ILEOCECAL SEGMENT

This is what ensured the formation of the definitive state of the intestines, which guarantees gradual, portioned, cyclical, unilateral, phased entry of the food lump into the corresponding intestinal segments. One of the key locking mechanisms, and at the same time a massive reflexogenic field, which provides the specified properties of the intestine is the ileocecal sphincter- valve apparatus represented by the Bauhinia valve and the iliac papilla. This locking apparatus is closely morphofunctionally connected with adjacent structures, parts of which it is: the cecum, the ascending colon, the terminal segment of the ileum, the appendix. Purpose – to study the spatiotemporal embryotopographic features of the formation of the ileocecal segment of a person. Material and methods. The study was conducted on 20 specimens of human embryos using of methods of histological and morphological research (morphometry, microscopy) and statistical analysis. Results. The article describes the laying of the ileocecal segment of the intestine, which is formed at the end of the embryonic period in two stages: first, at the 5th week of prenatal development, the rudiment of the terminal ileum and the initial part of the colon appears, and then, at the 6th week, the rudiment of the cecum. It has been established that in embryos of 4.5 mm PCL the primary intestine has a thickness of 96.0±6.0 μm, located slightly ventral to the chord between the gastric fold and the cloaca. In 5-week-old embryos (5.5-8.0 mm PCL) significant changes in the topography of the primary intestine occur – it lengthens and bulges in the sagittal plane, which leads to the appearance of a U-shaped loop that protrudes into the abdominal stalk, forming a «physiological umbilical hernia». In embryos of the 6th week of the development (8.5-13.0 mm PCL) further changes in the topographic and anatomical relationships of the intestinal fold are observed. The cranial knee of the intestinal loop increases in length and forms 2-3 loops, some of which are located in the «physiological umbilical hernia», and the other in the abdominal cavity. At the beginning of the pre-fetal period (7th week of development, specimens 14.0-20.0 mm PCL) the total length of the expanded section of the intestine reaches 4800±40 μm, the width at the site of the lateral protrusion is 1800±30 μm. Between the junction of the small and large intestines, the lateral protrusion has a coneshaped shape with an expansion at the apex. Conclusions. The ileocecal segment of the intestine is laid at the end of the embryonic period in two stages: first, at the 5th week of prenatal development, the rudiment of the terminal ileum and the initial part of the colon appears, and then, at the 6th week, the rudiment of the cecum. The separation of the rudiment of the vermiform appendix from the cecum begins at the 7th week.

The Avian Model as a Versatile and Cost-Effective Tool for Surgical Training Across Specialties

Abstract Background Five years after its 2019 validation, the avian tissue model for neonatal minimal access surgery (MAS) training was reassessed to evaluate its sustained effectiveness and realism. Unlike the original study, this evaluation included participants from pediatric and other surgical specialties. Aims The study aimed to reassess the model’s realism and effectiveness for neonatal MAS training and explore its potential for broader applications in surgical training. Methods The study occurred during two events: an international MAS Skills Lab in August 2024 and a national MAS Skills Lab in September 2024. Twenty-six participants (16 females, 10 males) took part, including 17 pediatric surgeons and 9 from other specialties. Using 3 mm MAS instruments on fresh chicken cadavers with balloon trocars, participants performed laparoscopic exercises such as adhesiolysis, cholecystectomy, and intestinal anastomosis. Feedback on the model was gathered via a 5-point Likert scale (MiSSES). Results Participants had varied experience levels: 23% had performed over 100 MAS cases, 15.4% between 50–100 cases, and 61.5% fewer than 50 cases. The model’s perceived realism averaged 4.05 ± 0.10. Scores for specific features included 3.66 ± 0.09 for the abdominal wall, 3.85 ± 0.10 for the abdominal cavity, and 4.86 ± 0.09 for tissue dissection. Participants rated the model highly for improving laparoscopic knowledge (4.3 ± 0.90) and skills development (4.77 ± 0.07). Satisfaction scores highlighted its effectiveness in addressing challenges like trocar placement (3.64 ± 0.12), pneumoperitoneum (3.5 ± 0.10), and confined-space suturing (4.99 ± 0.08). Overall satisfaction with the model was rated at 4.9 ± 0.09. Conclusion The avian tissue model remains an effective and realistic tool for neonatal MAS training, reaffirming the findings of the 2019 study. Positive outcomes across multiple disciplines demonstrate its versatility, highlighting its potential as a valuable training tool extending beyond pediatric surgery to other specialties.

Object Detection in Laparoscopic Surgery: A Comparative Study of Deep Learning Models on a Custom Endometriosis Dataset.

Background: Laparoscopic surgery for endometriosis presents unique challenges due to the complexity of and variability in lesion appearances within the abdominal cavity. This study investigates the application of deep learning models for object detection in laparoscopic videos, aiming to assist surgeons in accurately identifying and localizing endometriosis lesions and related anatomical structures. A custom dataset was curated, comprising of 199 video sequences and 205,725 frames. Of these, 17,560 frames were meticulously annotated by medical professionals. The dataset includes object detection annotations for 10 object classes relevant to endometriosis, alongside segmentation masks for some classes. Methods: To address the object detection task, we evaluated the performance of two deep learning models-FasterRCNN and YOLOv9-under both stratified and non-stratified training scenarios. Results: The experimental results demonstrated that stratified training significantly reduced the risk of data leakage and improved model generalization. The best-performing FasterRCNN object detection model achieved a high average test precision of 0.9811 ± 0.0084, recall of 0.7083 ± 0.0807, and mAP50 (mean average precision at 50% overlap) of 0.8185 ± 0.0562 across all presented classes. Despite these successes, the study also highlights the challenges posed by the weak annotations and class imbalances in the dataset, which impacted overall model performances. Conclusions: In conclusion, this study provides valuable insights into the application of deep learning for enhancing laparoscopic surgical precision in endometriosis treatment. The findings underscore the importance of robust dataset curation and advanced training strategies in developing reliable AI-assisted tools for surgical interventions. The latter could potentially improve the guidance of surgical interventions and prevent blind spots occurring in difficult to reach abdominal regions. Future work will focus on refining the dataset and exploring more sophisticated model architectures to further improve detection accuracy.

Therapeutic effect of hUC-MSCs from different transplantation routes on acute liver failure in rats

ObjectiveAcute liver failure (ALF) is a rare yet serious clinical syndrome. Recent studies have indicated that stem cells can effectively treat this condition. However, the optimal route for stem cell transplantation in the treatment of ALF remains unclear. This study aims to investigate the most effective transplantation route for stem cell therapy in ALF.MethodsHuman umbilical cord mesenchymal stem cells (hUC-MSCs) expressing both luciferase and green fluorescent protein were generated using a lentiviral vector. The hUC-MSCs were transplanted via the tail vein, portal vein, and abdominal cavity. The survival and distribution of the transplanted hUC-MSCs in rats were assessed through in vivo imaging and immunofluorescence. Furthermore, the therapeutic effects of hUC-MSCs transplanted via different routes on ALF were compared.ResultsThe survival time of hUC-MSCs transplanted via the tail vein and portal vein was shorter compared to those transplanted intraperitoneally. The distribution of hUC-MSCs varied by transplantation route: those injected via the tail vein and portal vein were primarily found in the lungs and liver, respectively, while intraperitoneally transplanted hUC-MSCs predominantly localized in the abdominal cavity. In ALF rats, hUC-MSCs transplanted via the tail vein and portal vein improved survival rates, enhanced liver pathology, and reduced levels of inflammatory cytokines in liver tissue. In contrast, abdominal transplantation of hUC-MSCs showed no significant therapeutic effect.ConclusionhUC-MSCs transplanted via the tail vein and portal vein exhibited similar therapeutic effects on ALF; however, abdominal transplantation of hUC-MSCs showed no significant effect.

KEVS: enhancing segmentation of visceral adipose tissue in pre-cystectomy CT with Gaussian kernel density estimation.

The distribution of visceral adipose tissue (VAT) in cystectomy patients is indicative of the incidence of postoperative complications. Existing VAT segmentation methods for computed tomography (CT) employing intensity thresholding have limitations relating to inter-observer variability. Moreover, the difficulty in creating ground-truth masks limits the development of deep learning (DL) models for this task. This paper introduces a novel method for VAT prediction in pre-cystectomy CT, which is fully automated and does not require ground-truth VAT masks for training, overcoming aforementioned limitations. We introduce the kernel density-enhanced VAT segmentator (KEVS), combining a DL semantic segmentation model, for multi-body feature prediction, with Gaussian kernel density estimation analysis of predicted subcutaneous adipose tissue to achieve accurate scan-specific predictions of VAT in the abdominal cavity. Uniquely for a DL pipeline, KEVS does not require ground-truth VAT masks. We verify the ability of KEVS to accurately segment abdominal organs in unseen CT data and compare KEVS VAT segmentation predictions to existing state-of-the-art (SOTA) approaches in a dataset of 20 pre-cystectomy CT scans, collected from University College London Hospital (UCLH-Cyst), with expert ground-truth annotations. KEVS presents a and improvement in Dice coefficient over the second best DL and thresholding-based VAT segmentation techniques respectively when evaluated on UCLH-Cyst. This research introduces KEVS, an automated, SOTA method for the prediction of VAT in pre-cystectomy CT which eliminates inter-observer variability and is trained entirely on open-source CT datasets which do not contain ground-truth VAT masks.

Professor Vasily Parmenovich Obraztsov — a surgeon who became an outstanding therapist and founder of the school of internal medicine at Kiev university (on the 175th anniversary of his birth)

Vasily Parmenovich Obraztsov (1851–1920) was an outstanding Russian physician (pathologist, surgeon, and therapist). He graduated from the Imperial Medical and Surgical Academy in St. Petersburg in 1875. For 25 years (from 1893 to 1918), he was a professor at Vladimir University in Kyiv and head of the Department of Special Pathology and Therapy, and from 1903 to 1918, he also served as the director of the university clinic of internal diseases. Professor Obraztsov introduced several methods for examining patients: deep sliding (methodical) palpation of the abdominal organs, direct auscultation of the heart (which allows for the recognition of gallop rhythm and the third heart sound), and direct percussion with one finger on the organs of the chest and abdominal cavity. In 1910, he diagnosed myocardial infarction. He was the chairman of the Kyiv Physical-Medical Society, the Kyiv Society of Physicians, and founded a school of internal diseases.

Extended Hematological Parameters and Short-Term Mortality in Sepsis Patients: A Retrospective Study.

Background/Objectives: Sepsis has a high mortality rate, with septic shock exceeding 50%. The most common score for diagnosis and prognosis in sepsis is the Sepsis-related Organ Failure Assessment (SOFA). This study aimed to identify hematological parameters for the prediction of intensive care unit (ICU) mortality. Methods: This study collected demographic and clinical data from sepsis patients, including age, sex, infection site, length of stay, the SOFA, and ICU mortality. The standard laboratory panel included, among others, complete blood count with differential and reticulocyte panel. Intergroup differences were analyzed using Student's t-test, Mann-Whitney U test, Pearson's χ2, and Fisher's test where applicable. The AUROC was used for evaluating the predictive value of hematological parameters. Multiple logistic regression was performed to exclude the impact of potential confounding factors. Results: This study analyzed data from 190 sepsis patients hospitalized in the ICU, excluding patients with other conditions significantly affecting mortality. The median age was 65.0 (IQR 51.0-71.0) years. The sexes were almost perfectly balanced. The sites of infection were mostly the abdominal cavity, lungs, and urinary tract. The short-term mortality rate was 30%, with higher SOFA scores and significant differences in leukocyte, platelet, and erythrocyte parameters between survivors and non-survivors. The percentage of nucleated red blood cells (NRBCs) showed the highest AUROC. Conclusions: The only reliable hematological parameter for predicting ICU mortality in sepsis patients may be the percentage of NRBCs. The presence of NRBCs in a blood smear is linked to a worse prognosis.

Investigation of the morphofunctional status of macrophages in abdominal adhesions in rats and on exposure to oxidized dextran

Abdominal adhesions result from the organization of fibrinous exudate and subsequent fibrosis, attributed to the low phagocytic activity of macrophages associated with their M1 phenotype. Oxidized dextran (OD) can limit the development of fibrosis by exerting a stimulating effect on phagocytosis.The aim of the study is to investigate the morphofunctional status of macrophages during the formation of abdominal adhesions in an experimental model and under exposure to OD.Material and methods. In male Wistar rats (n = 30), the adhesive process in the abdominal cavity was simulated. The animals were divided into 3 groups: group 1 – control, with adhesions in the abdominal cavity; group 2 rats were injected once with 2 ml of OD 5 % aqueous solution; the 3rd group consisted of intact animals. The rats were removed from the experiment on the 7th and 21st days. Histological immunohistochemical (Il-10, IFNγ, Il-1, TNFα, TGF-β) and electron microscopic study of abdominal adhesions, morphometry of structures were performed.Results and discussion. Macrophages in adhesions of group 1 and 2 rats were larger, compared to those in intact animals. On days 7 and 21 macrophages in group 2 rats were 19 % and 2.5 times larger, respectively, compared to group 1 animals, contained in the cytoplasm a greater number of phagosomes, phagolysosomes and rough endoplasmic reticulum, by the 21st day nuclear-to-cytoplasmic ratio was shifted towards the cytoplasm. The expression of IFNγ in the infiltrates of adhesions in group 2 rats increased 3,2-fold, indicating greater phagocytotic activity of macrophages. The expression of IL-10 and TGFβ on the 7th and 21st days was represented in a larger number of macrophages of group 2 than group 1 rats (2.7 and 4.1 times, respectively), but IL-1 and TNFα ‒ in a smaller number (4.6 and 3.2 times, respectively), which corresponded to the phenotypic characteristics of M2 macrophages.Conclusions. The population of macrophages in inflammatory infiltrates of abdominal adhesions is heterogeneous, there are signs of M1 and M2 type. Under the influence of OD, the phagocytic activity of M2 type macrophages increases, preventing the formation of adhesions.

The Many Faces of the Angry Peritoneum.

The peritoneum is a thin membrane that lines the abdominal cavity and covers the abdominal organs. It serves as a conduit for the spread of various pathological processes, including gas and fluid collections, inflammation, infections, and neoplastic conditions. Peritoneal carcinomatosis is the most common and well-known pathology involving the peritoneum, typically resulting from the dissemination of gastrointestinal and pelvic malignancies. However, numerous benign and malignant peritoneal diseases can mimic the imaging appearance of peritoneal carcinomatosis. The aim of this review is to revisit the anatomy of peritoneal compartments and elucidate the patterns of peritoneal disease spread. Emphasis is placed on identifying the distinctive imaging features of both neoplastic and non-neoplastic peritoneal diseases that differ from peritoneal carcinomatosis.

The mystery of the "air-dried chaplain" solved: the life and "afterlife" of an unusual human mummy from eighteenth century Austria.

The multidisciplinary study of the well preserved cadaver of the so-called "air-dried chaplain" from the church crypt of St. Thomas am Blasenstein (Upper Austria) not only solved the "mystery" of the excellent preservation of the trunk of this unusual mummified human body, but also provided circumstantial information about this historic individual, his life and disease history, and conclusion of his cause of death. The mummy of a 35-45 year old male, radiocarbon dated to the period 1730-1780 CE is most likely that of the local aristocratic parish vicar Franz Xaver Sidler von Rosenegg who had been temporarily delegated to St. Thomas parish from his mother monastery of Waldhausen im Strudengau (Upper Austria). He had a high-quality diet based on terrestrial animal products, showed no signs of major physical work load, was most likely a pipe smoker and suffered from chronic active pulmonary tuberculosis with peripheral and central (hilar) calcifications (primary tuberculous complex) and a right lower lobe cavity with focal heterotopic ossification and potential active inflammation. This latter may have caused acute pulmonary hemorrhage which may have been the cause of death. Most surprisingly, we detected, in the otherwise completely intact abdominal (and pelvic) cavity, extensive packing with foreign material which was identified as a mixture of wood chips, fragmented twigs, large amounts of fabric of various types including elaborate embroidered linen, and even pieces of silk. Furthermore, this embalming method seems to have included high level zinc-ion solution impregnation (most likely zinc-chloride with small amounts of arsenic) and the addition of copper. The packing was inserted into the abdominal body cavity through the rectum. It led to an excellent state of conservation of the trunk, while the face (and skull) and peripheral extremities were less well preserved.

Average Dose Rate is the Major Temporal Beam Structure Parameter for Preserving Murine Intestines with Pulsed Electron FLASH-RT.

Average Dose Rate is the Major Temporal Beam Structure Parameter for Preserving Murine Intestines with Pulsed Electron FLASH-RT.

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Procedure, Complications and Nursing Care

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a minimally invasive surgical cancer treatment procedure. It is a treatment method in which aerosolized chemotherapy drugs administered into the abdominal cavity with the help of trocars are aimed at acting directly on cancer cells. This method aims to maximize the effect on cancer cells and reduce systemic toxicity. The PIPAC treatment has advantages and disadvantages. Therefore, the operating room nurse has many tasks. The PIPAC procedure can cause various symptoms. The most common symptoms related to the surgical procedure are abdominal pain, bleeding, deep vein thrombosis, intestinal obstruction, and ascites. Allergies, loss of taste, nausea, and vomiting can occur due to the effect of chemotherapy drugs on the stomach and intestines, while irritation of the intestines can lead to diarrhea. The impact of symptoms can affect the patient's quality of life and compliance with treatment. Therefore, appropriate precautions should be taken before and after the PIPAC procedure. Nurses should monitor symptoms and guide patients to contact their surgeon if necessary. The patient should be informed about what to do if they experience symptoms, and medications should be administered by nurses if necessary. It is important to provide psychosocial support to patients. In conclusion, procedure-related symptoms should be managed effectively in patients undergoing PIPAC procedures, and operating room nurses play an important role in this regard.

AFAST in Veterinary Emergency Medicine: Technique, Applications and Diagnostic Relevance

The Abdominal Focused Assessment with Sonography for Trauma (AFAST) is a rapid, point-of-care ultrasound technique increasingly utilized in veterinary emergency medicine. Adapted from human medical practices, AFAST is designed to detect free fluid within the abdominal cavity, particularly in trauma patients or those presenting with acute clinical deterioration. Its application enhances the clinician’s ability to assess internal injury swiftly, supporting critical decision-making during initial triage and ongoing patient monitoring. The AFAST protocol involves four standardized sonographic views—diaphragmatic-hepatic, splenorenal, cystocolic and hepatorenal—each offering targeted evaluation of dependent regions where effusion tends to accumulate. The Abdominal Fluid Scoring (AFS) system, based on the presence and quantity of anechoic fluid at these sites, provides a semi-quantitative assessment of intra-abdominal hemorrhage or effusion. The technique has demonstrated high diagnostic sensitivity and specificity, comparable to more advanced imaging modalities, while offering speed, repeatability and non-invasiveness advantages. Beyond trauma, AFAST is valuable in identifying non-traumatic conditions such as hemoperitoneum, pericardial and pleural effusion, ruptured organs and acute anaphylactic reactions. Although its diagnostic utility in cases of penetrating trauma remains under investigation, AFAST remains a reliable adjunctive tool in emergency settings. Due to its simplicity, portability and diagnostic accuracy, AFAST has become an essential component of emergency care protocols in veterinary practice. With continued validation and clinical application, it holds considerable promise for improving outcomes in critically ill animals and optimizing the use of diagnostic resources in emergency and critical care settings.