Abdominal Visceral Injuries Research Articles

Isolated Transverse Process Spinal Fractures Increase the Likelihood of Incurring Visceral and Pelvic Injuries: A Retrospective Review at a Level-1 Trauma Center.

Although isolated transverse process fractures (ITPF) do not confer any inherent risk of compromised spinal stability, there is increasing interest in their overall prognostic significance. As a proxy for localized or directional forces in high-energy traumatic mechanisms, ITPF may serve as an indicator for the presence of other coexisting traumatic injuries. Specific injuries may be predicted by the presence of ITPF at specific spinal levels, but few studies have examined this in depth and may not account for confounding variables. We retrospectively analyzed data from 306 patients presenting with acute traumatic ITPF. ITPF number and location by spinal segment were determined from initial computed tomography. Mechanism of trauma, Injury Severity Score, and extent of non-spinal-associated injuries were recorded. Correlation analysis compared ITPF location with injury severity, non-spinal-associated injury location, type, and patterns. Significant injury associations were further explored with logistic regression analysis controlling for age, mechanism of injury, and Injury Severity Score. The adjusted odds of pulmonary visceral injury was 4.69 (95% confidence interval, 2.33-9.44) times higher among patients with thoracic-level ITPF compared with other ITPF levels. Lumbar ITPFs had increased odds of abdominal visceral injury (odds ratio, 4.85; P= 0.0002), pelvic fractures (odds ratio, 4.2; P < 0.0001). The number needed to scan to observe a pelvic injury among patients with lumbar ITPF was 3. Other significant associations were also observed. Spinal level of ITPF is associated with increased likelihood of specific patterns of injury, and additional investigation is warranted.

Frequency and influencing factors of cardiopulmonary resuscitation-related injuries during implementation of the American Heart Association 2010 Guidelines: a retrospective study based on autopsy and postmortem computed tomography

To determine the frequency of cardiopulmonary resuscitation (CPR)-related injuries and factors involved in their occurrence, data based on forensic autopsy and postmortem computed tomography (PMCT) during implementation of the 2010 American Heart Association Guidelines for CPR were studied. We retrospectively evaluated data on adult patients with non-traumatic deaths who had undergone manual CPR and autopsy from January 2012 to December 2014. CPR-related injuries were analyzed on autopsy records and PMCT images and compared with results of previous studies. In total, 180 consecutive cases were analyzed. Rib fractures and sternal fractures were most frequent (overall frequency, 66.1 and 52.8%, respectively), followed by heart injuries (12.8%) and abdominal visceral injuries (2.2%). Urgently life-threatening injuries were rare (2.8%). Older age was an independent risk factor for rib fracture [adjusted odds ratio (AOR), 1.06; 95% confidence interval (CI), 1.04-1.08; p<0.001], ≥3 rib fractures (AOR, 1.06; 95% CI, 1.02-1.09; p=0.002), and sternal fracture (AOR, 1.03; 95% CI, 1.01-1.05; p<0.001). Female sex was significantly associated with sternal fracture (AOR, 2.08; 95% CI, 1.02-4.25; p=0.04). Chest compression only by laypersons was inversely associated with rib and sternal fractures. Body mass index and in-hospital cardiac arrest were not significantly associated with any complications. The frequency of thoracic skeletal injuries was similar to that in recent autopsy-based studies. Implementation of the 2010 Guidelines had little impact on the frequency of CPR-related thoracic skeletal injuries or urgently life-threatening complications. Older age was the only independent factor related to thoracic skeletal injuries.

An Analysis of Presentation, Pattern and Outcome of Chest Trauma Patients at an Urban Level 1 Trauma Center.

Chest trauma is an important public health problem accounting for a substantial proportion of all trauma admissions and deaths. It directly account for 20-25% of deaths due to trauma. Therefore, this study was conducted to analyze the presentation, patterns, and outcome of chest trauma in a level-1 urban trauma center. It was a prospective observational study of all patients presented with chest trauma to an urban level 1-trauma center over a period of 3years. Demographic profile, mechanism of injury, injury severity scores (ISS), associated injuries, hospital stay, etc. were recorded. Morbidity and mortality rates were analyzed and compared with the published literature. Chest injuries comprised 30.9% of all trauma admissions and the mechanism was blunt in majority (83.5%) of the cases. Vehicular crashes (59.7%) followed by assault were the most common modes of injury. Rib fracture was the most common chest injury seen in 724 of the 1258 patients while abdominal visceral injuries were the commonest associated injuries in polytrauma cases. Majority of the patients were managed non-operatively. Inter costal tube drainage (ICD) was the main stay of treatment in 75% of the cases, whereas, thoracotomy was required only in 5.56% of the patients. Overall mortality was 11% and it was found to be significantly higher following blunt chest trauma. We observed that associated extra thoracic injuries resulted in higher mortality as compared to isolated chest injuries. Thoracic injuries can be readily diagnosed in the emergency department by meticulous and repeated clinical evaluation and majority require simple surgical procedures to prevent immediate mortality and long-term morbidity.

Child Abuse—A Review of Inflicted Intraoral, Esophageal, and Abdominal Visceral Injuries

Recognizing the clinical presentation of a child with abusive injuries is crucial. This review article gives an updated summary on inflicted intraoral, esophageal, and abdominal visceral injuries, including current recommendations on recognition, evaluation, screening value, and management of at risk children. Physical abuse should be suspected in precruising infants with intraoral injuries. When sexual abuse is suspected, referral to specialized centers equipped to conduct comprehensive examination and forensic testing by an experienced provider adhering to chain of evidence protocol is recommended. Abdominal trauma is the second most common cause of death in children who have been abused. The diagnosis and management of these injuries require careful consideration. Routine screening hepatic transaminases should be guided by the age of child and clinical scenario. A definitive confirmatory computed tomography scan of the abdomen and pelvis should be performed for those with transaminase levels more than 80 IU/L, or in all concerning cases with history and examination consistent with abusive abdominal trauma.

Assessment of Extent and Severity of Pellet Induced Abdominal Injuries, a Rare Variant of Weapon Violence: A Prospective Study

Background: The use of a Pellet gun, a form of short gun used for mob control in many conflict zones, has posed a serious challenge to the surgeons in assessing the extent of trauma caused by these pellets. Objectives: To study the role of conventional available investigations for trauma like ultrasonography and computed tomography scans in assessing the severity of the injuries caused by the pellets. Methodology: 50 patients having pellet injuries predominantly in abdomen without other associated trauma were included in the study. The decision for surgery was taken on the basis of clinical and CECT (Contrast Enhanced Computed Tomography) findings and these findings were then compared with intra-operative findings. Results: 30/50 patients were decided to be operated on the basis of Clinical and CECT findings. On exploration, it was observed that 18/33 patients really needed exploration while as 15/33 patients could have been managed conservatively. This was observed in next 20/50 patients who were put on conservative management with similar CECT findings. Of these 20 patients, 17 did well while as 3 were explored later in view of developing peritonitis and were found to have small bowel perforations. Conclusion: Conventional investigations for trauma like FAST and CECT abdomen are not ideal for assessing the severity of pellet induced abdominal visceral injuries which result in high rate of unnecessary laparotomies. Also the abdominal pellet trauma patients can be well managed conservatively until hemodynamically stable even though CT scan shows pellet penetration into peritoneal cavity or bowel lumen.

B-mode ultrasound is effective in guiding percutaneous nephrolithotomy

Aim The aim of the present study was to assess the application value of B-mode ultrasound in percutaneous nephrolithotomy (PCNL). Methods and Patients PCNL was performed in 218 consecutive patients with upper urinary calculi using B-mode ultrasound. The percutaneous renal access was established, and residual stone was detected by nephroscope through B-mode ultrasound. Results Phase I percutaneous renal access was successfully established in all 218 patients. Operation time ranged from 40 min to 132 min. The nephrostomy tube was retained 2–7 days. After PCNL treatment, 12 patients received blood transfusion because of obvious bleeding, 19 had severe fever and three had reactive hydrothorax. No serious complications, such as pleural injury, pneumothorax, abdominal visceral injury or renal penetrating injury, occurred. The phase I stone-free rate was 81.19 per cent (177/218), and the total stone-free rate was 92.66 per cent (202/218), as revealed by postoperative computed tomography. Conclusions B-mode ultrasound is a safe, simple, clear, real-time and helpful method to improve the accuracy and safety of the establishment of percutaneous renal access during PCNL.

English

Injuries to hepatic artery is uncommon, often associated with other abdominal visceral and vascular injuries. They can have a delayed presentation. The diagnosis, management of this condition requires high index of suspicion and surgical expertise. Most of injuries are due to penetrating trauma with blunt abdominal trauma being less common. Isolated hepatic artery injury without any abdominal visceral and vascular injuries is extremely rare. We present a case of isolated injury to the hepatic artery for which we did simple ligation of hepatic artery after achieving haemostasis by pringles maneuver. Post-operative period for the patient is uneventful. We want to emphasize that hepatic artery ligation will not cause major vascular compromise. We want to present this case because for its rarity of an isolated hepatic artery injury.

Bullhorn and bullfighting injuries

Our purpose was to present our hospital experience with bullhorn injuries. A retrospective analysis of patients in our Trauma Registry (1993-2012). Fifteen patients were included. All were hemodynamically stable on presentation, with a mean Glasgow Coma Scale (GCS) score and a Revised Trauma Score (RTS) of 15 and 11.9, respectively. The Injury Severity Score (ISS) and New Injury Severity Score were 13.6±6 and 15.9±9, respectively. Seven had an ISS>15. Injuries resulted from an isolated blunt trauma (BT) in four, penetrating trauma (PT) in seven, with extensive soft tissue injuries (STI) in three, and a combined BT+PT mechanism in four patients, with extensive STI in all. Three patients had injuries to vessels in the groin, two with prehospital vein ligation. Five patients had abdominal visceral injuries, and another had a sheathed goring, with a traumatic abdominal wall hernia and retroperitoneal hematoma. Four patients had thoracic injuries, and one of them had a traumatic thoracoplasty with a large open thoracic wound, a flail chest, and extensive STI. Two patients had traumatic brain injury, and six had bone fractures. Two-thirds of patients required a surgical procedure under general anesthesia. Morbidity included three surgical site infections, one leg compartment syndrome, and one persistent lymph drainage. There was no mortality, and the mean length of hospital stay was 16days. Bullhorn and bullfighting injuries frequently have a multimechanistic origin which goes beyond a pure penetrating trauma. Associated blunt and STI were common in our series, and the overall prognosis of patients admitted to hospital was good.

CT Evaluation of Pelvic and Hip Fractures

To analyze the spectrum of pelvic and hip joint injuries by computed tomography in patients attending to emergency. CT evaluation with multiplanar and 3-D reformations of 62 patients done with pelvic and hip fractures during 18 months. The mode of injury and treatment were recorded. Forty four (70.9%) of the injuries were sustained in high speed vehicle accidents (automobile, motorcycle, autopedestrian), 14 patients (22.5%) had sustained fall injury and 4 patients (6.4%) sustained injury following slip on the ground. 31 patients underwent surgery for acetabular fractures. Associated injuries included spinal fractures (5), abdominal visceral injury (3), extremity fractures (13), chest injury (5), head injury (1), urethral injury (4), clavicle fracture (1). Forty patients (64.5%) had acetabular fractures, 25 (40.3%) patients had iliac bone fractures, 47 (75.8%) had pubic bone fracture. Sacral fracture was found in 17 (27.4%) patients. Associated femoral fracture was found in 4, hip joint dislocation was seen in 5 (2- central, 3-posterior). Sacroiliac joint diastasis was found in 13(20.9%) patients, pubic diastasis in 7 (11.2%), fracture ischium in 7(11.%), protrusio acetabuli in 5 (8%). Spiral CT with multiplanar and 3-D reformations has clinical values for precise diagnosis and treatment plan for the pelvic and hip fractures.

Evaluation and Management of Blunt Trauma Abdomen: Experience With 132 Cases at Chittagong Medical College Hospital

Identification and management of serious intra abdominal and associated injuries due to blunt mechanisms are challenging. This study aims to evaluate current approach to manage such patients in a leading teaching hospital of a low income country. Methods: This prospective study was carried out in the departments of General surgery and Paediatric surgery, Chittagong Medical College and Hospital; Chittagong; Bangladesh from July, 2001- June, 2002. Total 132 patients suffering from blunt abdominal trauma (BAT) were evaluated. Results: The majority of the trauma victims aged 30 years and below with male predominance. Road traffic accident (RTA) was the leading cause (57.57%). Sixty eight percent (68%) patients were brought to the hospital within 24 hours of injury. Abdominal pain was the commonest mode of presentation (83.33%). External signs of injury in abdomen were noticed in only 39% patients. The most important abdominal finding was features of peritonitis (generalized muscle guard/ rigidity 56% and localized 42%) and absence of bowel sound (73%). Plain X-ray abdomen (100%) and Ultrasonography (USG) were the principal imaging tool (46.87%). Extra abdominal associated injuries were found in 55% patients. Thirty four patient (26.56%) were managed non-operatively. Ileum injury was maximum (21.87%) and liver was the most frequently injured solid organ (14.06%). Wound infection (23.40%), wound dehiscence (17%) and anastomotic leakage (10.63%) were the complications related with laparotomy. Total 8 patients died (mortality 6.06%). Conclusion: Early detection of abdominal visceral injury by proper clinical evaluation and imaging is the key for successful management. The main danger is on delay, not always to the extent of injury, as most of the blunt abdominal trauma patients are amenable to surgical treatment. JCMCTA 2013 ; 24 (1): 35-40

Extra-abdominal injuries associated with blunt abdominal visceral injury: utility of prediction across age and mechanism of injury

Jensen, Aaron R. MD; Burke, Rita V. PhD, MPH; Pontarelli, Elizabeth M. MD; Bliss, David W. MD, FACS; Ford, Henri R. MD, MHA, FACS; Upperman, Jeffrey S. MD, FACS Author Information

Thoracic trauma trends in Northern India- single center experience

Thoracic trauma comprises 10–15 % of all traumas. The incidence and etiological pattern of chest trauma varies from region to region and is related to cultural and socio-political circumstances. This paper details our experience with thoracic trauma in a North Indian state. All patients who were hospitalized for thoracic trauma from June 2010 to June 2012 in our hospital were enrolled. Data was collected prospectively and analysed. Factors analysed were age, gender, mode of injury, type of thoracic injury, associated injuries, management modalities, and outcome. The total number of patients was 250. The male to female ratio was about 10:1. The mean age of patients was 36.62 years. Road Traffic Accident (RTA) was the most common mode of chest injury. Motor-bike accident was the most common type of RTA. Majority of patients were managed with tube thoracostomy (183, 73.2 %). One hundred and eighty nine (75.6 %) patients were discharged after recovery. Ten (4.0 %) patients absconded. In all, 29 (11.6 %) patients died, while 22 (8.8 %) patients left the hospital against medical advice. A significant association between presence of associated injury and outcome was observed (p < 0.001). We found mortality rate was significantly higher in chest injury associated with neurotrauma and abdominal visceral injury. Chest trauma is a major health problem since it has high morbidity and mortality rate. The majority of patients with simple chest injuries can be managed by tube thoracostomy. According to our analysis; mortality predictors were: RTAs, blunt chest trauma, unstable hemodynamic status upon arrival, neurotrauma, abdominal visceral injury, flail chest, ventilator use, cardiac contusion and complications of therapy.

Pneumoperitoneum without visceral trauma: an under-recognised phenomenon after blast injury?

ObjectivesThe management of patients who have sustained blast injuries poses an important challenge for military healthcare professionals. Current military operations are generating large numbers of casualties and modern military healthcare...

Blunt versus bladed trocars in laparoscopic surgery: a systematic review and meta-analysis of randomized trials

Trocar-associated visceral injuries are rare but potentially fatal complications of laparoscopic access. More commonly, abdominal wall bleeding occurs, which usually requires hemostatic measures and prolongs operative time. Blunt-tipped trocars have been postulated to carry a lower risk of abdominal wall bleeding and intra-abdominal injuries. The aim of the present systematic review and meta-analysis was to comparatively evaluate the relative risks of abdominal wall bleeding, visceral injuries, and overall complications with the use of bladed and blunt-tipped laparoscopic trocars. The databases of Medline, EMBASE, and the Cochrane Central Register of Randomized Trials were searched to identify randomized studies that compared trocar-associated complications with the use of blunt and bladed trocars. Primary outcome measure was the relative risk of abdominal wall trocar site bleeding, and secondary outcome measures included visceral injuries and overall complications. Outcome data were pooled and combined overall effect sizes were calculated using the fixed- or random-effects model. Eight eligible randomized trials were identified; they included 720 patients with a median Jadad score of 4. The incidence of abdominal wall bleeding for the blunt and the bladed trocar group was 3 and 9 %, respectively [odds ratio (OR) 0.42, 95 % confidence interval (CI) 0.21-0.88]. Trocar-associated morbidity rate, excluding bleeding events of the abdominal wall, was documented at 0.2 and 0.7 % of the blunt and the bladed trocar arm, respectively (OR 0.43, 95 % CI 0.06-2.97). The overall trocar-associated morbidity rate was 3 % in the blunt trocar group and 10 % in the bladed trocar group (OR 0.38, 95 % CI 0.19-0.77). Reliable data support a lower relative risk of trocar site bleeding and overall complications with blunt laparoscopic cannulas than bladed trocars. Transition to blunt trocars for secondary cannulation of the abdominal wall is thus strongly recommended. Larger patient populations are required to estimate the relative risk of visceral injuries.

Isolated Jejunal Perforation Following Bicycle Handlebar Injury in Adults: A Case Report

The small intestine is the third in frequency intraperitoneal organ which is injured after blunt trauma of the abdomen. In most of the cases, this type of injuries is accompanied by other injuries, which make it more difficult to diagnose. Failure of diagnosis and delay in treating these injuries significantly increase the morbidity and mortality of these patients. Abdominal visceral injuries after flipping the handlebar of the bike are common in children. Such injuries can cause injury to both solid and hollow abdominal viscera. Unlike children, adults' abdominal visceral injuries after flipping the bike's handlebar are extremely rare. A 25-year-old man was admitted to our department due to progressively abdominal pain after an accident with the handlebar of his bike. The subsequent CT scan after per os administration of contrast medium revealed the presence of free intraperitoneal contrast. It is a rare case of jejunal perforation after flipping the handlebar of the bicycle which was treated by partial removal of the injured part of jejunum and end-to-end anastomosis. To the best of our knowledge this is the first time we describe such an injury with this mechanism to an adult.

Late presentation with whole limb gangrene following open traumatic hemipelvectomy

Traumatic hemipelvectomy is a rare type of devastating injury with a very high mortality rate and often the result of high energy transfer trauma. Most patients, who survive this injury, do so on the basis of prompt and immediate advanced medical care. Abdominal and pelvic visceral injuries are frequently seen in those cases that survive. We present an unusual case of a 17-year-old patient who survived this injury after presenting 4 days following a motor cycle crash with whole limb gangrene and clinical evidence of septicaemia and without associated abdominal and pelvic visceral injury. She had successful management of her wound and was rehabilitated with axillary crutches and without a prosthetic limb due to financial constraints. The possible mechanism of injury was reviewed and peculiarities of management of this case in our environment were highlighted.

Upper abdominal visceral injury resulting from blunt trauma to the pelvis: a specific variant of shockwave injury?

Two patients who sustained severe blunt injury to the pelvis without external injury to the upper abdomen or lower chest, yet who were found to have a ruptured solid upper abdominal viscus, are reported. The first patient on delayed arrival revealed clinical features suggestive of intra-abdominal bleeding and was found to have a grade 3 ruptured spleen. With the second patient, upper abdominal injury (in this instance, a pancreatic laceration) was not initially suspected owing to the absence of clinical evidence of injury to the abdomen. It is postulated that both the splenic and pancreatic injuries were the result of a shockwave propagated through the abdomen following the severe external impact to the pelvis.

The value of spleen sub-pedicle two steps severance with LigaSure in laparoscopic splenectomy

To evaluate the safety and utility of the methods of spleen sub-pedicle two steps severance with LigaSure Vessel Sealing System combined with ultrasound scalpel to resect peri-splenic ligaments during laparoscopic splenectomy. The methods and the curative effect of 32 patients with laparoscopic splenectomy performed by the way as mentioned above were summarized and analyzed. 4 males, 28 females, median 36 years (range 16 - 64 years). Mean dimensions of spleens were 17 cm (range 11 - 23 cm). Nineteen patients had idiopathic thrombocytopenia purpura (ITP), 6 hereditary spherocytosis (HS) (5 of them were the same family constellation), 3 hemolytic anemia (HA), 2 spleen injury with haematoma infection, 1 Evan syndrome, 1 leukemia. Peri-splenic ligaments were resected by LigaSure combined with ultrasound scalpel, splenic pedicle was resected by spleen sub-pedicle two steps severance with LigaSure when splenic pedicle were sufficiently free. Splenic pedicle was non-excisional occluded by LigaSure at pancreatic cauda, in the first step and was occluded and resected alongside of the spleen in the second step. All of the 32 cases were completely succeed, the average operating time was 70 min (55 - 130 min), the estimated intraoperative blood loss was 200 ml (50 - 600 ml), no complications such as abdominal haemorrhage, visceral injury, pancreatic leakage and infection were observed. All the patients were healed well, the average hospital stay after an operation was 6 days. The average expense of each patients could save 8050 yuan because Endo-GIA was not used. Spleen sub-pedicle two steps severance with LigaSure Vessel Sealing System combined with ultrasound scalpel to resect peri-splenic ligaments during laparoscopic splenectomy, which shorten the operating persistence time with less hemorrhage is a safe, effective and low-cost minimally invasive surgery in selective cases.

Invited Commentary

HomeRadioGraphicsVol. 28, No. 1 PreviousNext RSNA Education ExhibitsInvited CommentaryStuart E. MirvisStuart E. MirvisAuthor AffiliationsDepartment of Diagnostic Imaging and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MarylandStuart E. MirvisPublished Online:Jan 1 2008https://doi.org/10.1148/radiographics.28.1.0280241MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 KörnerM, Krotz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current role of emergency US in patients with major trauma. RadioGraphics2008; 28(1): 225–244. Link, Google Scholar2 TsoP, Rodriguez A, Cooper C, et al. Sonography in blunt abdominal trauma, a preliminary progress report. J Trauma1992; 33(1): 39–43. Crossref, Medline, Google Scholar3 BodePJ, Edwards MJ, Kruit MC, van Vugt AB. Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma. AJR Am J Roentgenol1999; 172(4): 905–911. Crossref, Medline, Google Scholar4 ScaleaTM, Rodriguez A, Chiu WC, et al. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma1999; 46(3): 466–472. Crossref, Medline, Google Scholar5 JangT, Sineff S, Naunheim R, Aubin C. Residents should not independently perform focused abdominal sonography for trauma after 10 training examinations. J Ultrasound Med2004; 23: 793–797. Crossref, Medline, Google Scholar6 PolettiPA, Kinkel K, Vermeulen B, Irmay F, Unger PF, Terrier F. Blunt abdominal trauma: should US be used to detect both free fluid and organ injuries? Radiology2003; 227: 95–103. Link, Google Scholar7 ShanmuganathanK, Mirvis SE, Sherbourne CD, Chiu WC, Rodriguez A. Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma. Radiology1999; 212(2): 423–430. Link, Google Scholar8 McGahanJP, Richards JR, Jones CD, Gerscovich EO. Use of ultrasonography in the patient with acute renal trauma. J Ultrasound Med1999; 18(3): 207–213. Crossref, Medline, Google Scholar9 UdobiKF, Rodriguez A, Chiu WC, Scalea TM. Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. J Trauma2001; 50(3): 475–479. Crossref, Medline, Google Scholar10 McGahanJP, Horton S, Gerscovich EO, et al. Appearance of solid organ injury with contrast-enhanced sonography in blunt abdominal trauma: preliminary experience. AJR Am J Roentgenol2006; 187(3): 658–666. Crossref, Medline, Google Scholar11 ShanmuganathanK, Mirvis SE, Boyd-Kranis R, Takada T, Scalea TM. Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology2000; 217(1): 75–82. Link, Google Scholar12 PolettiPA, Mirvis SE, Shanmuganathan K, et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J Trauma2004; 57(5): 1072–1081. Crossref, Medline, Google Scholar13 LambAD, Qadan M, Gray AJ. Detection of occult pneumothoraces in the significantly injured adult with blunt trauma. Eur J Emerg Med2007; 14(2): 65–67. Crossref, Medline, Google ScholarArticle HistoryPublished in print: Jan 2008 FiguresReferencesRelatedDetailsCited ByUltrasound, Vol. 18, No. 1Recommended Articles Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can LearnRadiology2017Volume: 283Issue: 1pp. 30-48A Multiscale Deep Learning Method for Quantitative Visualization of Traumatic Hemoperitoneum at CT: Assessment of Feasibility and Comparison with Subjective Categorical EstimationRadiology: Artificial Intelligence2020Volume: 2Issue: 6Imaging Manifestations of Chest TraumaRadioGraphics2021Volume: 41Issue: 5pp. 1321-1334Effect of an Institutional Triaging Algorithm on the Use of Multidetector CT for Patients with Blunt Abdominopelvic Trauma over an 8-year PeriodRadiology2016Volume: 282Issue: 1pp. 84-91Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric InjuryRadioGraphics2017Volume: 37Issue: 2pp. 613-625See More RSNA Education Exhibits Chest Trauma: The Role of the Radiologist From Diagnosis to InterventionDigital Posters2020To the OR or to IR? That is the Question: Review of Important Pancreatic, Liver, and Splenic CT Findings For the Surgeon and InterventionalistDigital Posters2020Pictorial Review of Cardiac Tamponade: What Radiologists Need to KnowDigital Posters2019 RSNA Case Collection Splenic Injury following ColonoscopyRSNA Case Collection2021Traumatic Diaphragmatic RuptureRSNA Case Collection2021Cardiac tamponadeRSNA Case Collection2022 Vol. 28, No. 1 Metrics Altmetric Score PDF download

Hepatic “split lesion” in a fatal electrocution case

The first recorded death caused by electrical current from an external source was reported in 1879, when a carpenter in Lyon, France, inadvertently contacted a 250 V alternating current generator [1]. Electrical injuries (excluding lightning) are responsible for >500 deaths per year in the USA. A little more than half of them occur in the workplace and constitute the fourth leading cause of work-related traumatic death (5–6% of all worker’s deaths) [2]. Medical literature typically categorizes electrocution according to the level of applied voltage: low voltage (less than 1000 V) and high voltage (greater than 1000 V); as reported from medical-legal practice, 14–40% of mortal electrocution are caused by high-voltage injuries [3,4]. It is well known that an electrical shock may cause death or any degree of damage to various organs and systems; the severity of electric shock injury is dependent upon many variables: type of current, level of applied voltage, duration of shock, body contact surface area, resistance of tissue involved, contact with water or metal conductor and current pathway through the body [5]. The electrical shock may strike the victim’s central nervous system, the cardiovascular apparatus, the skeletal muscular tissue, the lungs, the skin and other internal organs [6]. Severe abdominal visceral injuries by electricity are a rare entity; in particular, we rarely come across cases of hepatic lesions. In