Penetrating Abdominal Trauma Research Articles

Localization of a Bullet in a Firearm Injury Victim Using X-ray Imaging During Autopsy: A Case Report

Firearm injuries can result in varying degrees of trauma, depending on factors such as the type of firearm, range, and wound location. This case report presents the role of X-ray imaging in detecting a projectile causing fatal penetrating abdominal trauma in a 45-year-old male. The patient was found with a gunshot wound in his abdomen, and despite medical interventions, he succumbed to his injuries. X-ray imaging revealed a hyper-dense area resembling a bullet lodged in the abdominal cavity. Autopsy confirmed a close-range gunshot with significant internal damage to the peritoneum, mesentery, liver, and the bullet lodged near the L1 vertebra. This case underscores the value of radiological imaging in identifying projectile trajectory and injury severity, particularly in resource-limited settings. X-rays assist in distinguishing between penetrating and perforating wounds, aiding both forensic investigation and legal procedures. The integration of imaging in forensic autopsies improves the accuracy of injury assessment, especially in cases involving gunshot wounds.

Indocyanine Green Fluorescence Angiography (ICG-FA) in the management of intestinal injuries following penetrating abdominal trauma: a case-control study comparing postoperative outcomes.

The surgical management of penetrating hollow visceral injuries includes primary repair or exteriorization. Tissue perfusion at the site of gastrointestinal suture repair may be challenging to assess and is vulnerable to local energy transfer-related injury, micro- or macro-circulatory insufficiency, or splanchnic vasoconstriction for various reasons. Breakdown of suture lines can lead to potentially life-threatening complications. The intraoperative use of Indocyanine Green Fluorescence Angiography (ICG-FA) may reduce the risk of postoperative morbidity and mortality by ensuring optimal tissue perfusion at the chosen site of suture repair. We conducted a retrospective review of the postoperative complications, length of Intensive Care (ICU) stay, and length of hospital stay in patients undergoing laparotomy, with and without ICG-FA for penetrating abdominal trauma at a Level One Trauma Center in Cape Town, South Africa. One hundred patients were included in the study, of which 20 underwent laparotomy with ICG-FA, and 80 did not. The overall complication rate was significantly lower in the ICG-FA group (OR 0.336, p-value=0.0412). The anastomotic leak rates in the ICG-FA and control groups were 0% and 6.25%, respectively (p-value=0.5799). Revision surgery was required in 2 and 14 patients in the ICG-FA and control groups, respectively (OR 0.524, p-value=0.516). The mean length of stay in hospital showed no statistical difference, 8.6 and 5.3 days for the ICG-FA and control groups, respectively (p-value=0.092). The mean length of ICU stay was 6.3 and 2.3 days for the ICG-FA and control groups, respectively (p-value=0.1642). Lower levels of overall postoperative complications and lower rates of revision surgery in patients undergoing laparotomy with ICG-FA are promising. Non-significant findings regarding the relationship between the usage of ICG-FA and anastomotic leak rates suggest the need for larger randomized studies.

Scoping it Out: The Use of Laparoscopy After Penetrating Trauma in Stable Children

IntroductionIn stable children with penetrating abdominal trauma, literature regarding the use of laparoscopy (LAP) remains limited. Given increasing evidence in favor of LAP for selective adult trauma patients, we reviewed contemporary practices and outcomes in pediatric trauma patients. MethodsThe American College of Surgeons (ACS) Trauma Quality Programs data was utilized to identify children (<18 years) from 2016 to 2021 with a penetrating abdominal injury who underwent surgery within 24 h of admission. Patients with non-abdominal abbreviated injury score (AIS) ≥3, Glasgow Coma Scale (GCS) < 13, or instability using a shock index pediatric adjusted (SIPA) cutoff were excluded. Patients were compared based on whether they had LAP, open, or laparoscopic converted to open (LCO) exploration. Primary outcomes were length of stay (LOS) and complications, including missed injuries. ResultsAmong 1945 patients who underwent abdominal surgery for penetrating trauma, 32% were stabbed and 68% had gunshot wounds (GSW). LAP occurred in 235 (12%) and LCO in 145 (7.4%) patients. The proportion of LAP did not change over the study period. LAP was used more in patients presenting with stab wounds than GSW (24 vs. 7%, p < .01). There was higher use of LAP at pediatric centers (p < .01). Although there was no difference in mortality or complications by operative type, open patients were more severely injured, had a longer LOS (p < .01), and had more subsequent procedures (11% of open, 2 % LAP, 7% LCO, p < .01). ConclusionIn stable children with penetrating abdominal trauma, LAP is most often utilized after stabbing and at pediatric trauma centers, but its overall use remains uncommon. LAP patients had lower rates of subsequent procedures and no increase in unexpected operations suggesting low rates of missed injuries. Criteria are needed to identify stable patients presenting after penetrating trauma who can benefit from a LAP approach. Level of EvidenceIII.

Early Operative Risk Assessment Using the Modified Mannheim Peritonitis Index in Patients With Generalised Peritonitis at a Tertiary Hospital in Abuja, Nigeria.

Introduction The use of validated prognostic scoring tools in resource-poor environments has been hampered by the cost of procuring and maintaining devices, such as arterial blood gas analysers, to measure critical physiological derangements.Attempts need to be made to adapt these applicable risk stratification tools so they can be easily adopted in developing countries like Nigeria. Aim This study assessed the usefulness of a modified Mannheim peritonitis index (mMPI) as arisk stratification tool in predicting surgical outcomes in managing patients with generalised peritonitis in Abuja, Nigeria. Methods This was a prospective study of consecutive adult patients managed for generalised peritonitis at a tertiary hospital in Abuja over 12 months. Approval numbers NHA/EC/037/2019 and AF/013/17/110/1514 were ascribed to the project by the Institute Review Board Committee (IBR) of the National Hospital Abuja (NHA) and the National Postgraduate Medical College of Nigeria. The MPI was modified using respiratory rate and suboptimal percentage oxygen saturation (SpO2). Patient characteristics and treatment outcomes obtained were entered into a structured proforma, checked, and analysed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). The threshold score of the modified MPI and the accuracy, sensitivity, and specificity were derived from the receiver operating characteristic (ROC) curve analysis and its coordinates. The level of statistical significance was set at a p-value of <0.05. Results There were 49 patients with generalised peritonitis during the study period with a male-to-female ratio of 2.5:1. The commonest cause of peritonitis in this study was penetrating abdominal injury (n=15, 30.6%), followed by complicated appendicitis (n=12, 24.5%). This study's mortality and morbidity rates were 14.3% and 63.3%, respectively. On the ROC curve, the modified MPI best predicts mortality at a threshold score point of ≥26 (accuracy of 79.4%, sensitivity of 85.7%, specificity of 61.9%, p=0.013) and morbidity at a threshold score of ≥23 (accuracy of 78.4%, sensitivity of 77.4%, specificity of 72.2%, p=0.001). Conclusion The modified MPI can be used as a risk assessment tool to predict postoperative outcomes in adult patients operated on for generalised peritonitis within 30 days of operative intervention at Abuja.This modification may be helpful in low-resource centres with limited access to arterial blood gas analysers. However, the original MPI might be a more accurate tool.

FP7.18 - Early Operative Risk Assessment Using Modified Mannheim Peritonitis Index in Patients with Generalised Peritonitis at a Tertiary Hospital in Abuja, Nigeria

Abstract Aim This study assessed the usefulness of a modified Mannheim Peritonitis Index (MPI) as a risk stratification tool in predicting surgical outcomes in the management of patients with generalized peritonitis in Abuja, Nigeria. Methods This is a prospective study of consecutive adult patients managed for generalized peritonitis at a tertiary hospital in Abuja Nigeria within a one-year duration. The MPI was modified using respiratory rate and SpO2. Patient characteristics and outcome of treatment obtained were entered into a structured proforma, checked and analysed using the SPSS, version 25. The threshold score of the modified MPI, as well as the accuracy, sensitivity, and specificity, were derived from the receiver-operator characteristic (ROC) curve analysis and its coordinates. Results There were 49 patients with generalised peritonitis during the study period with a male-to-female ratio of 2.5:1. The commonest cause of peritonitis in this study was penetrating abdominal injury (30.6%) followed by complicated appendicitis (24.5%). This study's mortality and morbidity rates were 14.3% and 63.3%, respectively. On the ROC curve, the modified MPI best predict mortality at a threshold score point of ≥26 (Accuracy of 79.4%, sensitivity of 85.7% specificity of 61.9%, P-value = 0.013), and morbidity at a threshold score of ≥23 (Accuracy 78.4%, sensitivity of 77.4%, specificity of 72.2%, P-value = 0.001). Conclusion The modified MPI can be used as a risk assessment tool in predicting postoperative outcomes in adult patients operated for generalised peritonitis within 30 days of operative intervention at Abuja. This modification can be useful in low-resource centres with limited access to arterial blood gas analysers.

Laparoscopic removal of renal foreign body in an isolated gunshot penetrating abdominal wound (description of two clinical cases)

Laparoscopic removal of renal foreign body in an isolated gunshot penetrating abdominal wound (description of two clinical cases)

Selective non–operative treatment of gunshot penetrating abdominal wounds

Objective. To analyse own experience and determine the feasibility and tactics of selective non–operative treatment of gunshot penetrating abdominal wounds. Materials and methods. The study involved 74 servicemen (all men) with gunshot shrapnel penetrating abdominal wounds, who were divided into two groups: the main group – 26 (35.2% ± 0.2%) wounded who received non–surgical treatment, and the control group – 48 (64.8% ± 0.3%) wounded who received surgical treatment in the form of diagnostic laparotomy or laparoscopy. Non–surgical treatment included pain relief, antibiotic prophylaxis, tetanus toxoid administration and dressings. Results. In general, selective nonoperative treatment of gunshot penetrating abdominal wounds was used in 1% of the wounded. Isolated abdominal wounds were present in 32 (43.2% ± 0.2%) and thoracoabdominal wounds in 42 (56.8% ± 0.3%) patients. In terms of the number of foreign bodies, wounds were single in 66 (89.2% ± 0.3%) and multiple (liver and retroperitoneal space) in 8 (10.8% ± 0.1%) patients. In the main group, there were no surgical interventions or complications, in the control group, 8 (16.7% ± 0.1%) diagnostic laparotomies and 40 (83.3% ± 0.3%) diagnostic laparoscopies were performed, and there were 2 (4.2% ± 0.1%) complications – seroma and pneumonia. The average treatment period was (5 ± 0.3) days in the main group and (8 ± 0.4) days in the control group. Conclusions. Selective non–surgical treatment of gunshot penetrating abdominal wounds is indicated in haemodynamically stable patients without reduced level of consciousness and signs of peritonitis and intra–abdominal bleeding, abdominal pain syndrome with a follow–up period of 24 – 48 hours. The tactic of selective non–operative treatment of gunshot penetrating abdominal wounds is advisable mainly in case of damage to parenchymal organs. This tactic can be used in the presence of expert–class equipment, experienced specialists in the conditions of the third level of medical care and interaction between the second and third levels of medical care.

Systematic Review of Surgical Care in the Incarcerated Population: Identifying Knowledge Gaps for Future Research.

This study, examining literature up to December 2023, aims to comprehensively assess surgical care for incarcerated individuals, identifying crucial knowledge gaps for informing future health services research and interventions. The US prison system detains around 2 million individuals, mainly young, indigent males from ethnic and racial minorities. The constitutional right to healthcare does not protect this population from unique health challenges and disparities. The scarcity of literature on surgical care necessitates a systematic review to stimulate research, improve care quality, and address health issues within this marginalized community. A systematic review, pre-registered with the International Prospective Register of Systematic Reviews (CRD42023454782), involved searches in PubMed, Embase, and Web of Science. Original research on surgical care for incarcerated individuals was included, excluding case reports/series (<10 patients), abstracts, and studies involving prisoners of war, plastic surgeries for recidivism reduction, transplants using organs from incarcerated individuals, and nonconsensual surgical sterilization. Out of 8209 studies screened, 118 met inclusion criteria, with 17 studies from 16 distinct cohorts reporting on surgical care. Predominantly focusing on orthopedic surgeries, supplemented by studies in emergency general, burns, ophthalmology, and kidney transplantation, the review identified delayed hospital presentations, a high incidence of complex cases, and low postoperative follow-up rates. Notable complications, such as nonfusion and postarthroplasty infections, were more prevalent in incarcerated individuals compared with nonincarcerated individuals. Trauma-related mortality rates were similar, despite lower intraabdominal injuries following penetrating abdominal injuries in incarcerated patients. While some evidence suggests inferior surgical care in incarcerated patients, the limited quality of available studies underscores the urgency of addressing knowledge gaps through future research. This is crucial for patients, clinicians, and policymakers aiming to enhance care quality for a population at risk of surgical complications during incarceration and postrelease.

Renal artery pseudoaneurysm following robot assisted nephron sparing surgery: two case reports

BackgroundRenal artery pseudoaneurysm following partial nephrectomy is a rare entity, the incidence of this entity is more common following penetrating abdominal injuries, percutaneous renal interventions such as percutaneous nephrostomy(PCN) or Percutaneous nephrolithotomy (PCNL). Although rare, renal artery pseudoaneurysm can be life threatening if not managed timely, they usually present within two weeks postoperatively with usual presenting complains being gross haematuria, flank pain and/or anaemia.Case presentationWe report case of two female patients 34 and 57 year old respectively of South Asian ethnicity, presenting with renal artery pseudoaneurysm following left sided robot assisted nephron sparing surgery for interpolar masses presenting clinically with total, painless, gross haematuria with clots within fifteen days postoperatively and their successful treatment by digital subtraction angiography and coil embolization.ConclusionRenal artery aneurysm is a rare fatal complication of minimally invasive nephron sparing surgery however considering the preoperative and intraoperative risk factors for its development and prompt suspicion at the outset can be life saving with coil embolization of the bleeding arterial aneurysm.

Isolated Gastric Perforation following Blunt Trauma Abdomen not to be Missed: A Case Series

Abdominal trauma is a commonly encountered emergency which may be because of roadside accidents, assaults, or falls from height. Blunt injury to the abdomen is far more common than penetrating injury. Gastric perforation commonly occurs following penetrating abdominal trauma. However, gastric rupture is an uncommon entity following blunt trauma abdomen (BTA). Here, we are presenting three cases of isolated gastric perforation after BTA, two were due to a roadside accident, and one was a result of a fall from height. History suggests of a full stomach is usually found in traumatic gastric rupture. This condition usually presents with insignificant clinical or radiological signs. Isolated gastric rupture due to trauma is rare as it is usually associated with other injuries such as splenic and liver injuries. Early suspicion plays an important role in diagnosing this entity which carries higher morbidity and mortality if not managed timely. As isolated gastric perforation because of trauma leads to high morbidity and mortality, hence thorough lavage of the peritoneal cavity followed by double-layer closure after adequate debridement will reduce chances of intraperitoneal contamination thus improving outcome. Presentation after the last meal, the severity of gastric rupture, and other associated injuries play an important role in the prognosis of the patient.

Comparison of Clinical Characteristics, Therapy, and Short-Term Prognosis between Blunt and Penetrating Abdominal Trauma: A Multicentric Retrospective Cohort Study.

Large-scale studies on the characteristics and management of abdominal trauma in megacities in China are lacking. The aim of this study was to analyze and present the clinical patterns and treatment status of abdominal trauma in regional medical centers. Cases of abdominal trauma treated at seven medical centers in Beijing from 2010 to 2021 were collected. Clinical information about age, sex, injury cause, geographic distribution, abbreviated injury scale/injury severity score (AIS/ISS) value, injury-hospital time, preoperative time, surgically identified organ injuries, type of surgery, causes of reoperation and 90-day mortality was included in this study. Clinical characteristics, treatment methods, and short-term prognoses (90-days survival) were compared between blunt abdominal trauma (BAT) and penetrating abdominal trauma (PAT) cases. Non-normally distributed data are described as medians (IQR), and the Mann‒Whitney U test was performed; qualitative data were analyzed using the X2 test. Univariate and multivariate survival analyses were performed by the Cox proportional hazards model. A total of 553 patients (86.98% male) with a median age of 36.50 (27.00-48.00) years were included. The BAT group had a significantly higher proportion of serious injury (P=0.001), lower initial hemoglobin level (P=0.001), and a lower laparoscopy surgery rate (P=0.044) compared to the PAT group. Additionally, more BAT cases were from the area around Beijing (P=0.008) and a longer injury-regional hospital time (10.47 (5.18-22.51) hours vs. 7.00 (3.80-15.38) hours, P=0.001). In the hollow viscus injury subgroup, the BAT group had a significantly longer injury-regional hospital time and preoperative time compared to the PAT group (injury-regional hospital time: 10.23 (6.00-21.59) hours vs. 7.07 (3.99-13.85) hours, P=0.002; preoperative time: 3.02 (2.01-5.58) hours vs. 2.81 (1.85-3.63) hours, P=0.047). The overall 90-day mortality was 11.9%, and longer injury-regional hospital time (HR: 1.01, 95% CI: 1.00-1.02, P=0.008), receipt of ICU treatment (HR: 4.69, 95% CI: 2.54-8.65, P=0.001), and severe ISSs (ISS > 25 vs. ISS < 16, HR: 2.78, 95% CI: 1.38-5.601, P=0.004) had a worse impact on survival. More patients with BAT were transferred to higher-level hospital, leading to significantly longer prehospital and preoperation time. In the subgroup of hemodynamically stable individuals, more patients with BAT experienced hollow viscus injuries. For those patients, aggressive diagnostic laparoscopic exploration may be beneficial. Patients with longer injury-regional hospital intervals, the need for ICU care, and higher injury severity scores (ISSs) suffered from worse prognoses.

Urinoma mimicking pancreatic pseudocyst: Case report

Introduction. A urinoma is a localized urine collection in the retroperitoneum, occurring outside the urinary tract. Although relatively rare, traumatic urinomas in pediatric patients pose significant diagnostic and therapeutic challenges. Initial diagnosis primarily relies on ultrasonography, but computed tomography (CT) and magnetic resonance imaging (MRI) provide clearer differentiation and localization. The treatment strategy focuses on preventing potential complications and promoting urinary tract recovery. Case Report. We present the case of a seventeen-year-old male with a penetrating abdominal injury. Prompt abdominal exploration revealed and managed minor colon and spleen lacerations. Upon readmission due to the fever and abdominal pain, further diagnostics initially misinterpreted the formed traumatic urinoma as a pancreatic pseudocyst. Postoperative computed tomography, cystoscopy, and retrograde pyelography subsequently confirmed the existence of a urinoma. Conclusion. Through this case report and its atypical manifestation, we aim to highlight the importance of differential diagnosis, the complexity of abdominal injuries, and diagnostic and treatment protocols in pediatric populations. Emphasizing a multidisciplinary strategy is crucial to optimizing treatment outcomes.

Are trauma victims with obesity lucky in penetrating trauma injuries?

We aimed to reveal the protective effect of body mass index (BMI) and subcutaneous adipose tissue thickness (SATT), together with scores covering the abdomen, in patients with penetrating abdominal trauma. The data of 234 abdominal penetrating trauma patients over the age of 16 who applied to the emergency general sur-gery unit of Istanbul Medipol Hospital between 2017 and 2021 were analyzed retrospectively. Sex, age, types of penetrating injuries, BMI, need for blood transfusion and intensive care unit (ICU), mortality, Injury Severity Score (ISS), Penetrating Abdominal Trauma Index (PATI), and Flint Colon Injury Score (FCIS) were recorded. The patients were divided into two groups: Gunshot Wound (GW) and Stab Wound (SW).While there was no significant difference in all parameters examined in all patients and GW patients in terms of BMI, a statistically significant difference was found in terms of blood transfusion need in SW patients (p=0.035). As a result of the Receiver Operating Characteristic curve analysis for the SATT variable, the cutoff value between mortality (p=0.866) and SATT (mm) values in all patients was 11 mm for all patients and 12 mm for GW patients. A significant difference was found in all patients and separately in GW and SW groups in terms of ICU and blood transfusion need, length of stay, ISS, PATI, and FCIS scores in non-operated patients (p<0.05). When all patients were examined, a statistically significant difference was found in terms of mortality (p=0.002). It is the first study to evaluate penetrating abdominal injuries with both BMI and SATT comprehensively and with all abdominal scores. A cutoff value to be determined for SATT with larger and multicenter studies can take its place as a parameter in the penetrating trauma algorithm.

Penetrating abdominal stab and gunshot injuries: 10-year experience of a secondary public hospital located in a suburban area with solo surgeons.

Trauma care systems are life-saving significant implementations of a country's healthcare systems. Trauma care requires well-established trauma settings and organizations with experienced trauma teams including experienced emergency medicine, surgery and anesthesiology staff. This study aimed to investigate the outcomes of penetrating abdominal injuries treated by solo surgeons in a suburban area. Medical records of the patients who were admitted to the emergency department with penetrating abdominal injuries between January 2012 and December 2021 were retrospectively analyzed. Patients were evaluated based on their injury sites and treatment approaches. In total, 110 patients with anterior abdominal penetrating injuries were enrolled in the study; 83 (75.4%) were stabbed and 27 (24.6%) had gunshot wounds. According to the injury site, there were 90 (81.8%) anterior; 11 (11%) right thoracoabdominal and 9 (7.2%) left thoracoabdominal injuries. Fifty-one (61.4%) stab wounds were treated with immediate laparotomy and 21 (41.1%) of these operations resulted in negative or nontherapeutic laparotomy. Also, 32 (38.6%) stab wounds were managed nonoperatively; three (9.3%) failed conservative management and received delayed laparotomy. All gunshot wounds were treated with immediate laparotomy and 14.8% resulted in either negative or nontherapeutic laparotomy. On-call surgeons were found to be more prone to perform immediate laparotomy on weekends when they were on call for 48 or 72 hours. Being a solo surgeon may increase negative laparotomy rates of penetrating abdominal injuries. This high percentage (41.1%) of negative laparotomy rates can be reduced by establishing well-organized trauma teams.

MACROSCOPIC AND MICROSCOPIC FEATURES OF FIREARM PENETRATING ABDOMINAL INJURIES WITH DAMAGE TO THE APPENDIX

Introduction. In the structure of combat abdominal trauma during all periods of hostilities (according to ATO/JFO data), gunshot wounds dominated, accounting for 87.1%. An analysis of the distribution of those injured with gunshot wounds by the type of projectile causing the injury showed a prevalence of shrapnel injuries over bullet wounds – more than 80%.&#x0D; The aim of the research was to analyze the macroscopic and microscopic changes in firearm penetrating abdominal injuries with damage to the appendix.&#x0D; Materials and Methods. Eight appendectomies were performed due to firearm penetrating abdominal injuries with damage to the appendix. Complaints, medical history, examination data, ultrasound examination according to the FAST protocol, and radiological examinations were studied in all injured patients. To refine the diagnosis and determine the scope of surgical intervention, the WOLF videoendoscopic system was used.&#x0D; Histological examination of the removed appendices was performed, which were stained with hematoxylin and eosin and with the Van Gieson stain. A complex of pathomorphological studies was conducted using the Primo Star microscope (Carl Zeiss) at a magnification of ×140.&#x0D; Results. All injuries occurred while wearing a bulletproof vest and were characterized as blind, with 1 (12.5%) being gunshot wounds and 7 (87.5%) being shrapnel wounds. The entrance wound in firearm blind penetrating abdominal injuries with appendix damage was located in the right hypochondriac region – 4 (50%), right flank – 1 (12.5%), right inguinal region – 2 (25%), and mesogastric region – 1 (12.5%) cases. The average size of the entrance wound on the skin was 23.3±0.4×12.4±0.3 cm. All skin wounds were outside the bulletproof vest protection area.&#x0D; The injuries to the appendix had an average size of 15.4±1.2×9.3±0.1 cm. All removed foreign bodies were larger than 1 cm in their largest dimension.&#x0D; Conclusions. In most cases of firearm penetrating abdominal injuries, damage to the appendix is noted with an entrance wound predominantly on the right side. Macroscopically, in firearm blind penetrating abdominal injuries with appendix involvement, the wound on the skin is larger than on the appendix. All foreign metal bodies removed from the abdominal cavity after firearm shrapnel blind abdominal injuries with appendix involvement were of large size. Contusional injuries to the appendix tend to undergo destructive transformation, requiring surgical treatment - appendectomy. The increased frequency of appendix injuries can be explained by the widespread use of shrapnel ammunition in abdominal injuries when personal protective equipment does not provide protection for this area.

Analysis of traumatic acute diaphragmatic injuries.

Diaphragm rupture (DR) is a rare pathological event usually caused by trauma. We aimed to analyse the characteristics of acute diaphragmatic injuries due to trauma and the treatment of such injuries. This study included the data of 15 patients who sustained diaphragmatic injuries due to trauma and underwent surgery at the Diyarbakır Gazi Yaşargil Training and Research Hospital General Surgery Service between January 2016 and December 2019. There were 240 patients who presented with abdominal trauma during the study period, and DR was detected in 15 (6.25%) of these patients. The male to female ratio was 14 to 1, and the average age of the patients was 29.66 ± 10.56 (15-46) years. The most common cause of diaphragmatic injury was penetrating abdominal injuries (86.7%). Blunt abdominal trauma accounted for 13.3% of the DR cases. Preoperative shock was present in four (26.7%) patients. Preoperative diagnosis was made in only one (6.7%) of 15 patients with DR. Other patients were diagnosed during operation. Thirteen (86.7%) patients had additional organ injuries, and two patients had isolated diaphragmatic injuries. The most frequently injured organ was the lung (n = 7, 46.6%). Complications developed in six patients (morbidity rate 40%), and pulmonary complications were most frequently encountered (n = 5, 33.3%). The mortality rate was 6.7%. As traumatic DRs are uncommon and often associated with additional organ injuries, a careful general assessment of the patient should be made.

The impact of colon injuries on the outcome of gunshot wounds to the abdomen

PurposeFactors predicting morbidity and mortality in patients with colon-related gunshot injuries and the management of these injuries are not always straightforward. This aimed to assess the impact of abdominal gunshot wounds with colonic injuries on patients’ overall outcomes.MethodsThis cross-sectional prospective observational study compared patients with colon injuries and without colon injuries. Data was collected from admission, theatre and postoperative care. Patients were recruited between 1 January 2020 and 20 October 2021.ResultsOf 132 patients with abdominal gunshot injuries, 71 (54.0%) had colon injuries. The colon injury group had a higher incidence of laparotomy wound sepsis (p<0.0001), bullet exit wound infection (p<0.0001), tract necrotizing fasciitis (p<0.0001), relook laparotomies (p<0.0001) and a longer hospital stay (p<0.0001). Septicaemia (p=0.002) or anastomotic leak (p=0.041) was associated with a penetrating abdominal trauma index (PATI) ≥25. Most patients who developed tract necrotizing fasciitis did not have their tract debrided/ lavaged (p=0.004). The type of colon repair did not influence the length of hospital stay (p=0.688) or the development of a colon-related complication (p=0.578). Between 18 and 25 years (p<0.0001) and >2 organs injured (p=0.018) were associated with colon-related complications. Patients between 18 and 25 years were 4.748 times more likely to develop a colon-related complication (p=0.046).ConclusionGunshot wounds to the abdomen with associated colonic injuries had a worse outcome with an increased risk of developing wound infections. There is no difference in the operative management of colonic injury. Patients between the ages of 18 and 25 years or >2 organs injured are more likely to develop a complication.

Concordance of CT imaging and surgical lesions in penetrating abdominal trauma

The management of penetrating abdominal wounds has greatly benefited from the development of computed tomography (CT), particularly in stable patients. In this setting, the scanner is the reference examination. Our study aims to evaluate the performance of preoperative CT in the assessment of penetrating abdominal lesions. Between January 1, 2015 and January 1, 2022, 81 patients were hospitalized following penetrating abdominal trauma at the Army Training Hospitals of Sainte-Anne and Laveran. Fifty-one stable patients who had an abdominopelvic CT scan and thereafter underwent abdominal surgery (laparotomy or laparoscopy) were included. Radiological and surgical data were collected from the electronic record and compared by a descriptive analysis (calculation of the sensitivity, specificity, positive and negative predictive value of the CT for the detection of lesions of the various organs) and by a correlation of the CT findings with surgical findings using Kripendorff's alpha coefficient. The cohort was largely male (n=45; 88%), with injuries by knife wound in 62.7% of cases (n=32) and gunshot in 35.3% (n=18) of cases. The median age was 36years (25-47). The median index of severity score (ISS) was 17 (10-26). Excellent agreement between predicted and actual findings was obtained for solid organs (α=0.801) with high sensitivity and specificity (81.8% and 96.6%, respectively). The largest discrepancies were observed for the hollow organs (α=26.2%, sensitivity of 53.3% and specificity of 76.2%) and the diaphragm (α=67.3%, sensitivity 75%, specificity 92.3%). Surgical exploration was non-therapeutic for five patients (9.8%). The failure rate for non-operative treatment was 10% (n=1). CT detection of solid organ lesions in patients with penetrating abdominal wounds is excellent. However, the detection of hollow organ and diaphragmatic wounds remains a challenge with a risk of over- and underdiagnosis. Laparoscopic exploration should be able to fill in the gaps in the CT findings.

Post-traumatic biliopleural fistula treated with endoscopic retrograde cholangiopancreatography: a case report

Thoracobiliary fistulae are a rare disorder caused by iatrogenic injury or trauma. Because these fistulae are uncommon, no standard of care has been established, but non-operative management (NOM) is often advised. As a result, endoscopic retrograde cholangiopancreatography (ERCP) appears to be playing a growing role in the treatment of select cases. A 42-year-old male patient involved in a street fight developed a biliopleural fistula as a result of an abdominal penetrating injury. Even in the lack of a clearly defined site of biliary leak, NOM and ERCP have proven to be safe and effective therapy in this case.

Relationship of Obesity and Severe Penetrating Thoracic and Abdominal Injuries in Adolescent Patients.

Over 20% of United States adolescents are obese. A thicker layer of subcutaneous adiposity might provide a protective "armor" layer against penetrating wounds. We hypothesized that adolescents with obesity presenting after isolated thoracic and abdominal penetrating trauma have lower rates of severe injury and mortality than adolescents without obesity. The 2017-2019 Trauma Quality Improvement Program database was queried for patients between 12 and 17 years old presenting with knife or gunshot wounds. Patients with body mass index (BMI) ≥30 (obese) were compared to patients with BMI <30. Sub-analyses were performed for adolescents with isolated abdominal trauma and isolated thoracic trauma. Severe injury was defined as an abbreviated injury scale grade >3. Bivariate analyses were performed. 12,181 patients were identified; 1603 (13.2%) had obesity. In isolated abdominal gunshot or knife wounds, rates of severe intra-abdominal injuries and mortality were similar (all P > .05) between groups. In isolated thoracic gunshot wounds, adolescents with obesity had a lower rate of severe thoracic injury (5.1% vs 13.4%, P = .005) but statistically similar mortality (2.2% vs 6.3%, P = .053) compared to adolescents without obesity. In isolated thoracic knife wounds, rates of severe thoracic injuries and mortality were similar (all P > .05) between groups. Adolescent trauma patients with and without obesity presenting after isolated abdominal or thoracic knife wounds had similar rates of severe injury, operative intervention, and mortality. However, adolescents with obesity presenting after an isolated thoracic gunshot wound had a lower rate of severe injury. This may impact the future work-up and management of adolescents sustaining isolated thoracic gunshot wounds.