Abdominal Trauma Research Articles

Abdominal wound closure in the presence of sepsis: our experience with the use of subcutaneous drain.

Patients requiring surgery for secondary peritonitis demonstrate a significantly increased risk for incisional surgical site infection. This study aimed to evaluate the efficacy of subcutaneous wound drain post-laparotomy for contaminated surgical wounds. This was a prospective comparative hospital-based study. Patients who had surgery for secondary peritonitis in Irrua Specialist Teaching Hospital were studied. Fifty patients aged 16 years and above who presented with secondary peritonitis. Patients who met the inclusion criteria were randomized into two equal groups. Group A had a suction drain placed in the subcutaneous space after laparotomy while Group B did not. Development of incisional surgical site infection, wound dehiscence, and duration of post-operative hospital stay. The incidence of incisional surgical site infection was significantly less in Group A (20%) than in Group B (68%). There was no case of wound dehiscence in Group A as against 3 (12%) in Group B. The difference was not statistically significant. The mean duration of hospital stay was significantly less with subcutaneous suction drain (8.96+2.81 Vs 14.04+8.05; p = 0.005). Subcutaneous suction drainage is beneficial in abdominal wall closure in cases of peritonitis as it significantly reduces the incidence of incisional surgical site infection and the duration of postoperative hospital stay. The reduction in surgical wound dehiscence observed in this study was, however, not statistically significant. None declared.

Evaluation of management of CT scan proved solid organ injury in blunt injury abdomen-a prospective study.

Trauma especially road traffic injury is one of the major health-related issues throughout the world, especially in developing countries like India (Mattox 2022). Solid organ injury is the most common cause of morbidity and mortality in patients with blunt abdominal trauma. The non-operative management (NOM) is being consistently followed for hemodynamically stable patients with respect to solid organ injuries. This study aims to provide an evidence base for management modalities of solid organ injuries in blunt abdominal trauma. The aim of this study is to evaluate the effectiveness of various treatment modalities for solid organ injury in blunt abdominal trauma. Evaluating the characteristics of blunt abdominal injury with respect to age and gender; distribution, mode of injury, most common organ injured, and severity of injury; effect of delay in getting treatment on the management outcome for patients with solid organ injury; evaluating the various modalities of treatment of CT-proven solid organ injury; incidence of complications in different modes of treatment. All patients aged more than 18years and suffering from CT-proven solid organ injury secondary to blunt abdominal trauma between February 2021 and September 2022 were included in this prospective observational study. Sixty-five patients were enrolled in the study after meeting the inclusion criteria. Details such as age, gender, mechanism of injury, the time between injury to first hospital contact, presenting complaints, organ and grade of injury, Revised Trauma Score (RTS), Trauma Score and Injury Severity Score (TRISS), management, and outcomes were collected using self-designed pro forma and analyzed. Different modalities of treatment were evaluated and patients undergoing operative and non-operative management were compared. Patients in whom non-operative management failed were compared with patients with successful non-operative management. The mean age of patients involved were 36.8years with a male:female ratio of 7.125:1 and the most common age group affected being between 21 and 30years. The most common mode of injury was noted to be road traffic accidents (72.3%). The most common presenting complaints were abdominal pain (64.6%) followed by chest pain (29.2%) and vomiting (13.8%). There was no significant relationship between latent period and type of intervention or failure of non-operative management. FAST positivity rate was noted to be 92.3%. Chronic alcoholism and bronchial asthma were significant predictors for patients undergoing upfront surgery (p = 0.003 and 0.006 respectively). The presence of pelvic and spine injury was statistically significant for predicting mortality in polytrauma patients (p = 0.003). Concurrent adrenal injury was found in 24.6% of patients but was not related to failure of non-operative management or mortality. RTS significantly predicts the multitude of organ involvement (p = 0.015). The liver was the most common organ injured (60%) followed by the spleen (52.3%) and the kidney (20%). The liver and the spleen (9.2%) were noted to be the most common organ combination involved. No specific organ or organ injury combination was noted to predict failure of non-operative management or mortality. But the multitude of organ involvement was statistically significant for predicting patients undergoing upfront surgery (p = 0.011). Out of 65 patients enrolled in the study, 7 patients (10.8%) underwent immediate surgery, and 58 patients (89.2%) underwent non-operative management. Among the 68 chosen for non-operative management, 6 patients (9.2%) failed non-operative management and 52 patients (80%) had success of non-operative management. A significant drop in hemoglobin (83.3%) on day 1 (66.6%) was seen to be the commonest reason for failure of non-operative management. The spleen was noted to be the most commonly involved organ intra-operatively (61.5%) followed by the liver (30.8%). Concordance between pre-operative and intra-operative grading of organ injuries was highest for liver and kidney injuries (100%) and lowest for pancreatic injuries (0%). Requirement of blood transfusion and liver injuries were significant factors for failure of non-operative management (p = 0.012 and 0.045 respectively). The presence of pancreatic leak was significant between the non-operated patients and patients operated upfront (p = 0.003). Mortality was noted to be 10.8% (7 patients) in our study. Solid organ injury in blunt abdominal trauma is an important cause of morbidity and mortality. RTS was noted to be a good predictor for solid organ injury in blunt abdominal trauma. Pancreatic injuries are notorious for being under-staged on CT findings; hence, the need arises for multimodality imaging for suspected pancreatic injuries. Non-operative management is a successful modality of treatment for majority of patients suffering from multiple solid organ injuries in blunt abdominal trauma provided serial close monitoring of patient's clinical signs and hemoglobin is instituted along with the presence of an emergency surgery team.

Splenectomy is Associated With More Complications Than Spleen Preservation in Patients With Blunt Abdominal Trauma

Splenectomy is Associated With More Complications Than Spleen Preservation in Patients With Blunt Abdominal Trauma

The impact of body mass index on abdominal injuries in motorcycle crashes in South Korea

AbstractObjectiveMotorcyclists face a higher risk of severe morbidity and mortality compared to automobile passengers. This study aimed to determine the injury characteristics of motorcyclists according to their body mass index (BMI).MethodsA retrospective observational cross‐sectional study was conducted using data from the Emergency Department‐based Injury In‐depth Surveillance (EDIIS) registry. Motorcycle riders aged 18 or older who were injured and admitted to study hospitals between 2019 and 2020 were included. Patients were divided into three groups based on BMI cutoffs of 18.5 and 25 kg/m2: the low, optimal, and high BMI groups. The primary outcome was anatomical injury location according to the abbreviated injury scale. The secondary outcomes were the surgery and intensive care unit admission rate, and the 48‐h and 30‐day in‐hospital mortality. Multivariable logistic regression analysis was performed to assess the impact of BMI on outcomes.ResultsAmong 1280 patients, the low and high BMI groups had higher risk of abdominal injuries (AIS ≥ 2) than the optimal BMI group, with adjusted odds ratios of 2.82 (95% CI 1.41–5.63) and 1.61 (95% CI 1.17–2.21), respectively. Only the low BMI group had a significant association with severe abdominal injury (AIS ≥ 3), with an adjusted odds ratio of 3.11 (95% CI 1.31–7.39). No significant association was found between BMI and surgery, ICU admission, or mortality.ConclusionThe low BMI group was more likely to have an abdominal injury (AIS score ≥2 or AIS score ≥3) during motorcycle injuries. BMI was not associated with surgery, ICU admission, or mortality.

Multidisciplinary Simulation for Blunt and Penetrating Pediatric Trauma Utilizing Standard and Rapid Cycle Deliberate Practice Models.

Pediatric trauma resuscitations are low-frequency, high-stakes events that require skilled multidisciplinary teams with strong medical knowledge and communication skills. This pediatric trauma simulation training session included two cases and formats. The first case was designed in a traditional format and featured a 12-month-old child with inflicted blunt head and abdominal trauma. The second case was organized in successive rounds utilizing the rapid cycle deliberate practice (RCDP) model and featured an 18-month-old with gunshot wounds to the abdomen and chest. Educational objectives included effective communication in a multidisciplinary team, timely completion of primary and secondary surveys, awareness of systems and processes related to trauma care, and increasing competency with low-frequency pediatric trauma skills. Necessary equipment included high-fidelity toddler-sized mannequins, chest tube task trainer or applicable mannequin and equipment, intubation equipment and supplies, intraosseous access, and blood products with rapid delivery infusers. This training session was designed for learners in a multidisciplinary team including physician trainees, nurses, and advanced practice providers; adjustments could be made to the team members as desired. Quantitative and qualitative evaluations demonstrated high learner satisfaction and engagement, particularly in the RCDP style of learning. Multidisciplinary team practice of pediatric trauma scenarios, particularly utilizing the RCDP simulation model, provides the opportunity to improve teamwork and communication, practice procedural skills, and deepen team members' understanding of and comfort with trauma resuscitations.

COMPARISON OF BLUNT ABDOMINAL TRAUMA SEVERITY SCORING (BATSS) AND CLINICAL ABDOMINAL SCORING SYSTEM (CASS) IN BLUNT ABDOMINAL TRAUMA FOR NEED OF SURGICAL INTERVENTION

Blunt abdominal trauma can result in severe intra-abdominal injuries that may necessitate surgery. Scoring systems such as Clinical Assessment Score for Suspected Abdominal Injury (CASS) and Blunt Abdominal Trauma in Severe Spleen Score (BATSS) aid in predicting the need for surgery but require further evaluation. Objective: To assess the efficacy of the CASS and BATSS scoring systems in predicting the necessity of surgical intervention for patients with blunt abdominal trauma. Methods: This comparative study was conducted at Dr. Ruth K. M. Pfau Civil Hospital Karachi from July 1, 2023, to December 31, 2023. Vital signs on admission, signs of abdominal tenderness, distension, guarding, and organ-specific symptoms were recorded for all participants. Diagnostic imaging findings from studies such as abdominal ultrasound, computed tomography (CT) scans, or X-rays were also collected. The study included a total of 185 participants. Statistical analysis included sensitivity and specificity calculations to compare the predictive accuracy of the CASS and BATSS scoring systems. Results: The mean age of the participants was 35.8±12.67 years, with 87% being males. Road traffic accidents were the most common mode of injury (89%). The BATSS scoring system demonstrated higher accuracy in predicting the necessity of surgical intervention after blunting abdominal trauma, with 65.9% sensitivity and 95% specificity compared to the CASS scoring system. Conclusion: The BATSS scoring system shows superior efficacy in predicting the need for surgical intervention following blunt abdominal trauma compared to the CASS scoring system. This suggests that the BATSS score may be a more reliable tool for clinicians in assessing the severity of abdominal injuries and determining the appropriate course of treatment.

Deletion of Transient Receptor Channel Vanilloid 4 Aggravates CaCl2-Induced Abdominal Aortic Aneurysm and Vascular Calcification: A Histological Study

Vascular calcification is calcium deposition occurring in the wall of blood vessels, leading to mechanical stress and rupture due to a loss of elasticity and the hardening of the vessel wall. The role of the Transient Receptor Channel Vanilloid 4 (TRPV4), a Ca2+-permeable cation channel, in the progression of vascular calcification is poorly explored. In this study, we investigated the role of TRPV4 in vascular calcification and the development of abdominal aortic aneurysm (AAA). Experimental mice were randomly divided into four groups: wild-type (WT) sham operated group, WT CaCl2-induced aortic injury, TRPV4-KO sham operated group, and TRPV4-KO CaCl2-induced aortic injury. The TRPV4-knockout (TRPV4-KO) mice and wild-type (WT) mice were subjected to the CaCl2-induced abdominal aortic injury. In histopathological analysis, the aorta of the TRPV4-KO mice showed extensive calcification in the tunica media with a significant increase in the outer diameter (p < 0.0001), luminal area (p < 0.05), and internal circumference (p < 0.05) after CaCl2 injury when compared to WT mice. Additionally, the tunica media of the TRPV4-KO mice aorta showed extensive damage with apparent elongation and disruption of the elastic lamella. These results indicate a protective function of TRPV4 against vascular calcification and the progression of AAA after CaCl2 injury.

Pattern of Intra-Abdominal Injuries among Patients Presented with Blunt Abdominal Trauma

Background: Blunt abdominal trauma (BAT) represents a significant challenge in trauma care, particularly in developing countries where road traffic accidents (RTA) predominate as a cause. Understanding the demographic characteristics, etiology, and injury patterns associated with BAT is crucial for effective management and preventive strategies. Objective: This study aims to evaluate the patterns of BAT in patients presenting to Lady Reading Hospital, Peshawar, focusing on identifying the leading causes, affected demographic groups, and organ-specific injuries to inform better clinical practice and preventive measures. Methods: Conducted from January 1, 2023, to June 1, 2023, this cross-sectional study included 60 patients with BAT. Participants underwent comprehensive evaluations involving clinical assessments, radiological imaging, and laboratory tests, following Advanced Life Trauma Support guidelines. Data analysis utilized SPSS version 25, focusing on categorical and numerical variables to assess injury etiology, demographics, and organ involvement. Results: The majority of BAT patients were male (percentage provided in the full study), with a mean age of 35.42±11.31 years. RTAs were identified as the leading cause of BAT, contributing to (specific percentage) of cases. The liver (48.3%) and spleen (36.7%) were the most commonly injured organs. Other significant findings included injury rates for the intestine (13.3%), mesentery (10%), and kidney (5%). Conclusion: BAT predominantly affects younger males, with RTAs serving as the principal etiological factor. The high incidence of liver and spleen injuries necessitates prompt and precise diagnostic approaches. The study underscores the need for improved road safety measures and public health interventions to reduce BAT incidences, alongside enhancing emergency and trauma care capabilities.

Delayed presentation of traumatic hepatothorax: An anesthetic and surgical perspective

: Traumatic diaphragmatic hernia is an uncommon sequela of blunt and penetrating trauma. It is estimated that 0.8–1.6% of patients with blunt trauma develop diaphragmatic rupture. However, the diagnosis of this condition is often overlooked, with right-sided hernias missed more frequently than left-sided hernias. Early diagnosis and repair are essential to prevent future complications such as strangulation and ischemia of intra-abdominal organs, lung collapse, and cardiovascular demise.: A 17-year-old male (180 cm; 86 kg) with no comorbidities presented to the emergency department (ED) following a high-velocity, unrestricted, rear-ended motor vehicle crash (MVC). The patient was intubated and hemodynamically stabilized in the ED, with planned surgical exploration of the abdomen. Six days following the accident, the patient was extubated; he became increasingly hypoxic and tachypneic over the next day. A CT of the chest and pelvis was ordered, confirming the diagnosis of a post-traumatic right-sided diaphragmatic hernia. An exploratory laparotomy was scheduled. Difficulties with ventilation were encountered due to suspected lung compression by the liver and movement of the endotracheal tube into the right main lung bronchus. : Traumatic diaphragmatic hernia should be considered in all patients presenting with abdominal trauma and should be suspected if respiratory distress arises during the patient’s clinical course. The recommended anesthetic approach is rapid sequence intubation with a cardiovascular-stable agent like etomidate and gastric decompression. Difficulties with intubation and ventilation should be anticipated due to the presence of the visceral organs within the thoracic cavity.

Sex-related disparities in vehicle crash injury and hemodynamics.

Multiple studies evaluate relative risk of female vs. male crash injury; clinical data may offer a more direct injury-specific evaluation of sex disparity in vehicle safety. This study sought to evaluate trauma injury patterns in a large trauma database to identify sex-related differences in crash injury victims. Data on lap and shoulder belt wearing patients age 16 and up with abdominal and pelvic injuries from 2018 to 2021 were extracted from the National Trauma Data Bank for descriptive analysis using injuries, vital signs, International Classification of Disease (ICD) coding, age, and injury severity using AIS (Abbreviated Injury Scale) and ISS (Injury Severity Score). Multiple linear regression was used to assess the relationship of shock index (SI) and ISS, sex, age, and sex*age interaction. Regression analysis was performed on multiple injury regions to assess patient characteristics related to increased shock index. Sex, age, and ISS are strongly related to shock index for most injury regions. Women had greater overall SI than men, even in less severe injuries; women had greater numbers of pelvis and liver injuries across severity categories; men had greater numbers of injury in other abdominal/pelvis injury regions. Female crash injury victims' tendency for higher (AIS) severity of pelvis and liver injuries may relate to how their bodies interact with safety equipment. Females are entering shock states (SI > 1.0) with lesser injury severity (ISS) than male crash injury victims, which may suggest that female crash patients are somehow more susceptible to compromised hemodynamics than males. These findings indicate an urgent need to conduct vehicle crash injury research within a sex-equity framework; evaluating sex-related clinical data may hold the key to reducing disparities in vehicle crash injury.

A multidimensional approach to identifying high-performing trauma centers across the United States.

The differentiators of centers performing at the highest level of quality and patient safety are likely both structural and cultural. We aimed to combine five indicators representing established domains of trauma quality and to identify and describe the structural characteristics of consistently performing centers. Using American College of Surgeons Trauma Quality Improvement Program data from 2017 to 2020, we evaluated five quality measures across several care domains for adult patients in levels I and II trauma centers: (1) time to operating room for patients with abdominal gunshot wounds and shock, (2) proportion of patients receiving timely venous thromboembolism prophylaxis, (3) failure to rescue (death following a complication), (4) major hospital complications, and (5) mortality. Overall performance was summarized as a composite score incorporating all measures. Centers were ranked from highest to lowest performer. Principal component analysis showed the influence of each indicator on overall performance and supported the composite score approach. We identified 272 levels I and II centers, with 28 and 27 centers in the top and bottom 10%, respectively. Patients treated in high-performing centers had significant lower rates of death major complications and failure to rescue, compared with low-performing centers ( p < 0.001). The median time to operating room for gunshot wound was almost half that in high compared with low-performing centers, and rates of timely venous thromboembolism prophylaxis were over twofold greater ( p < 0.001). Top performing centers were more likely to be level I centers and cared for a higher number of severely injured patients per annum. Each indicator contributed meaningfully to the variation in scores and centers tended to perform consistently across most indicators. The combination of multiple indicators across dimensions of quality sets a higher standard for performance evaluation and allows the discrimination of centers based on structural elements, specifically level 1 status, and trauma center volume. Therapeutic /Care Management; Level IV.

Distinctive Pathology Associated With Focal Stenosis of the Main Pancreatic Duct Secondary to Remote Trauma: A Long-term Complication of Seat Belt Pancreatitis.

The radiologic finding of focal stenosis of the main pancreatic duct is highly suggestive of pancreatic cancer. Even in the absence of a mass lesion, focal duct stenosis can lead to surgical resection of the affected portion of the pancreas. We present four patients with distinctive pathology associated with non-neoplastic focal stenosis of the main pancreatic duct. The pathology included stenosis of the pancreatic duct accompanied by wavy, acellular, serpentine-like fibrosis, chronic inflammation with foreign body-type giant cell reaction, and calcifications. In all cases, the pancreas toward the tail of the gland had obstructive changes including acinar drop-out and interlobular and intralobular fibrosis. Three of the four patients had a remote history of major motor vehicle accidents associated with severe abdominal trauma. These results emphasize that blunt trauma can injure the pancreas and that this injury can result in long-term complications, including focal stenosis of the main pancreatic duct. Pathologists should be aware of the distinct pathology associated with remote trauma and, when the pathology is present, should elicit the appropriate clinical history.

Associated injuries and complications in pediatric pelvic fractures requiring hospitalization: A series of 315 cases.

Pediatric pelvic fractures are uncommon. This study aimed to investigate the clinical characteristics of pediatric pelvic fractures requiring hospitalization and analyze their correlation with associated injuries and complications. Data from 315 pediatric pelvic fracture patients admitted to our hospital from January 2006 to December 2021 were retrospectively analyzed. Sex, age, modified Torode-Zieg classification, abbreviated injury scale score, injury severity score, mortality, and concomitant injuries were analyzed. Of the 285 (90.5%) cases of combined injuries, most injuries occurred in the abdomen (64.8%) and lower extremities (47.6%), followed by the chest (45.4%) and head (34.6%). A total of 78 patients (24.8%) were transferred to the intensive care unit. In total, 94 patients (29.8%) had complications during hospitalization. There were differences based on injury mechanism (p = 0.001), with the highest complication rate in the fall injury group (32 cases (46.4%)). Approximately 51.4% of patients received surgical treatment for problems that were not related to pelvic fractures. Among these, 30.2% necessitated surgical intervention on the lower limbs. Abdominal surgery was necessary in 19.0% of patients. Children who have pelvic fractures frequently require hospitalization due to the presence of severe injuries in other areas of their bodies. IIIB pelvic fractures frequently occur in conjunction with more severe abdominal injuries; therefore, the prompt management of cavity and organ injuries is of particular importance. Blood transfusion and injury severity score were associated risk factors for intensive care unit admission.

Scapular fractures: A regional and rural perspective.

Scapular fractures (SFs) have historically been associated with severe trauma and multiple injuries. Recent studies have demonstrated improved outcomes. However, SFs have never been studied from a strictly rural or Australian perspective. The study's objective was to assess whether associations still exist between a fractured scapula and trauma scores, mortality rates, and other commonly associated injuries in a regional Australian trauma centre. The study design examined prospectively collected data from a regional hospital between the years 2012 to 2021 presenting to the emergency department with traumatic SFs. Primary outcomes of interest were mortality rate, method of injury, ISS scores, and associated injuries. One hundred and five patients had a SF. The median age was 49 with 93 (89%) being male. Most fractures were located in the body of the scapula (80%). The primary mechanism of injury was motorbike accidents (36%), falls (24%), and motor vehicle accidents (22%). Two patients died from their injuries (1.9%). Thirty-four percent demonstrated mild trauma scores, with 36% moderate, 28% severe, and 1.9% critical. Commonly observed associated injuries included chest wall fractures, vertebral fractures, thoracic injuries, brain injury, and abdominal trauma. A minority of SFs were associated with severe or critical trauma, and overall, patients who sustained a SF had a low mortality rate. These findings suggest that patients from regional areas have similar outcomes to those from more urban centres in other parts of the world. Given these results, a re-examination of whether SFs are a reliable marker of severe trauma should be considered.

Nephrotic syndrome with rectus sheath hematoma: a case report

BackgroundRectus sheath hematoma is a rare presentation often associated with abdominal trauma and anticoagulant therapy. Here, we present a patient with severe rectus sheath hematoma accompanied by nephrotic syndrome who achieved significant clinical improvement without the need for invasive treatment.Case presentationA 72-year-old Japanese woman was referred to our hospital for the treatment of nephrotic syndrome. She was receiving steroid and anticoagulant therapy. Then she had abdominal pain and she was diagnosed with spontaneous rectus sheath hematoma by abdominal computed tomography. She received transfusion and was managed conservatively with bed rest, which led to improvement in abdominal pain.ConclusionDespite the absence of trauma history, rectus sheath hematoma should be considered in patients at risk of vascular failure, including those receiving anticoagulant or steroid therapy, those who are elderly, and those with nephrotic syndrome.

Functional outcome and analysis of factors affecting health-related quality of life of surgically managed pelvic ring fractures: a cross-sectional study.

Pelvic ring fractures, particularly those involving the posterior pelvis, pose significant challenges due to their inherent instability. The posterior pelvic ring is critical in providing structural support and stability to the pelvis. This study evaluates the functional outcomes and health-related Quality of life (HRQOL) of patients who underwent internal fixation for unstable pelvic fractures. Various factors influencing the outcomes are also investigated. A single-center cross-sectional study was conducted on patients with unstable sacral fractures treated with posterior tension band plate or sacroiliac plating with or without symphyseal plating between 2016 and 2020. Patient demographics, injury mechanisms, associated injuries, surgical details, complications, and return-to-work data were collected. HRQOL was assessed using specific pelvic fracture instruments and general HRQOL questionnaires. Logistic regression analysis was performed to identify factors associated with lower SF-12 and SF-36 scores RESULTS: The study included 54 patients, predominantly males (55.6%), aged 18-70 years, with high-energy trauma mechanisms, such as road traffic accidents and occupational injuries. The majority of patients had lateral compression pelvic fractures. Overall, the functional outcomes were favorable, with excellent or good outcomes observed in 86.1% of cases. Patients with associated injuries, such as abdominal, chest, or head injuries, were likelier to have lower SF-12 physical component scores. Sexual satisfaction scores remained stable for most patients post-surgery. This study highlights the favorable functional outcomes and HRQOL for patients undergoing fixation for unstable pelvic ring fractures. Younger, working-age males were the most commonly affected demographic. Associated injuries significantly affected physical HRQOL scores. Despite high-energy trauma, patients generally reported satisfactory sexual function post-surgery.

Laparoscopy versus laparotomy in the management of abdominal trauma

AbstractObjectiveThe objective of this study was to compare, evaluate and manage abdominal trauma using two distinct surgical techniques: laparoscopy and laparotomy. The aim was to assess the effectiveness and safety of laparoscopic procedures compared with laparotomy for treating penetrating or blunt abdominal trauma.MethodologyIn this prospective comparative study, we recruited 60 patients clinically diagnosed with abdominal trauma. The research was conducted at the Emergency Unit of the Department of General Surgery, Faculty of Medicine, Aswan University Hospital. All participants provided signed informed consent before their inclusion in the study.ResultsThere was a significant statistical difference between the two groups in terms of the operation duration, length of stay in the intensive care unit post‐operatively, occurrence of gas passage and duration of hospitalisation.ConclusionsLaparoscopic surgical procedures present a viable and practical alternative to laparotomy in appropriate cases for patients. The decision to choose laparoscopy as a surgical approach should depend on the surgeon's proficiency and the availability of required resources.

Prevalence of prehospital pain and pain assessment difference between patients and paramedics: a prospective cross-sectional observational study

Adequate analgesia is one of the most important interventions in emergency medicine. However, studies suggest that many patients are undertreated for pain. There can be many reasons why patients assess their pain differently to the paramedics. This study aimed to assess the differences in pain ratings between patients and paramedics and factors influencing them in prehospital emergencies. This prospective cross-sectional observational study included patients treated and transported by paramedics or paramedics and emergency physicians of the German Red Cross in Reutlingen, Germany. This study included 6,365 patients. The prevalence of pain was 49.7%. Among patients with a self-reported numerical rating scale (NRS) > 0, the mean patient pain rating was NRS 4.2 ± 2.7, while the mean paramedic pain rating was NRS 3.6 ± 2.4 (p < 0.001). Approximately 11.8% (n = 751) of patients reported subjectively unbearable pain. Patients reported a mean NRS of 7.7 ± 1.8 for unbearable pain, but a mean NRS of 3.3 ± 2.0 for bearable pain (p < 0.001). The difference in pain ratings between patients and paramedics increased with pain severity. Univariate analysis showed that there were no gender differences, but the difference in pain rating was influenced by patient age (p < 0.001) and paramedic age (p = 0.042). The differences in pain ratings were particularly pronounced for abdominal diseases (p < 0.001) and trauma (p < 0.001). There is a difference in pain ratings between patients and paramedics, which increases with pain severity and appears to be associated with the patient’s age and the paramedic’s age. To determine the desire and need for analgesics, the question about unbearable pain is a good addition to the NRS.

Blunt Trauma-Induced Diaphragmatic Hernia: Surgical Strategy and Outcomes

Blunt trauma-induced diaphragmatic hernia (DIH) is a rare but potentially life-threatening condition. Prompt diagnosis and management are crucial for successful outcomes. We present the case of a 40-year-old male who sustained blunt abdominal and chest trauma resulting in a left DIH with extensive gastrointestinal involvement. The patient underwent emergency laparotomy with primary repair of the diaphragmatic defect and resection of gangrenous stomach and bowel segments. Postoperatively, the patient recovered well and was discharged on day 14. Diagnosis of DIH relies on high clinical suspicion and radiological imaging, with CT scan being the modality of choice. Management involves surgical repair, either by primary closure or with the use of mesh, depending on the extent of the injury and presence of infection. Mortality rates are high in emergency repairs, especially when associated with bowel necrosis and perforation. This case highlights the importance of early recognition and timely intervention in DIH. Clinicians should maintain a high index of suspicion for DIH in patients presenting with a history of trauma and respiratory or abdominal symptoms. Improving awareness and understanding of abdominal injuries in trauma centers can help in early diagnosis and appropriate management, ultimately leading to better outcomes for patients with DIH.

Application of vacuum-instillation laparostomy in gunshot abdominal wounds

Application of vacuum-instillation laparostomy in gunshot abdominal wounds