Anterior Abdomen Research Articles

Time required to stabilize thermographic images at rest

Thermography for scientific research and practical purposes requires a series of procedures to obtain images that should be standardized; one of the most important is the time required for acclimatization in the controlled environment. Thus, the objective of this study was to identify the appropriate acclimatization time in rest to reach a thermal balance on young people skin. Forty-four subjects participated in the study, 18 men (22.3±3.1years) and 26 women (21.7±2.5years). Thermographic images were collected using a thermal imager (Fluke®), totaling 44 images over a period of 20min. The skin temperature (TSK) was measured at the point of examination which included the 0min, 2, 4, 6, 8, 10, 12, 14, 16, 18 and 20. The body regions of interest (ROI) analyzed included the hands, forearms, arms, thighs, legs, chest and abdomen. We used the Friedman test with post hoc Dunn’s in order to establish the time at rest required to obtain a TSK balance and the Mann–Whitney test was used to compare age, BMI, body fat percentage and temperature variations between men and women, considering always a significance level of p<0.05. Results showed that women had significantly higher temperature variations than men (p<0.01) along the time. In men, only the body region of the abdomen obtained a significant variance (p<0.05) on the analyzed period, both in the anterior and posterior part. In women, the anterior abdomen and thighs, and the posterior part of the hands, forearms and abdomen showed significant differences (p<0.05). Based on our results, it can be concluded that the time in rest condition required reaching a TSK balance in young men and women is variable, but for whole body analysis it is recommended at least 10min for both sexes.

Multiple FDG-Avid Injection Site Granulomas Due to Lovenox Injection

An initial staging FDG PET/CT scan in a 15-year-old female patient with lymphoma revealed FDG-avid tumor in the mediastinum and the neck. After chemotherapy, a restaging PET/CT scan was performed. Although mediastinal and cervical lesions were not visualized, multiple new foci of activity were noted in the bilateral anterior thighs, which corresponded to soft tissue nodules in the subcutaneous tissue on the low-dose CT. On the third PET/CT study, multiple new foci appeared in the subcutaneous tissue in the anterior abdomen. Additional clinical history was obtained, indicating multiple recent subcutaneous injections of anticoagulants.

Periodic heartbeat reversals cause cardiogenic inspiration and expiration with coupled spiracle leakage in resting blowfliesCalliphora vicinaR.-D.

Respiration in insects is thought to be independent of the circulatory system because insects typically lack respiratory pigments and because oxygen transport occurs in the gaseous phase through a ramified tracheal system by diffusion and convection directly to the tissues. In the blowfly, as in other insects with periodic heartbeat reversal, the haemolymph is periodically shifted between the anterior body and abdomen, exerting alternating pressure changes on the compliant tracheae in the thorax and in the abdomen. Simultaneous pressure and O2 optode measurements show that, during negative pressure periods, the tracheal partial pressure of oxygen (PO2) increases by 0.5 kPa. In the quiescent fly, tracheal PO2 is rather high (17.5-18.9 kPa), although the thoracic spiracles remain constricted. Microscopic video recordings and reflectance measurements revealed that the dorsal soft edges of the valve lips of the second spiracle leave a very small leak, which is passively widened during backward pulses of the heart. Thus, negative pressure, combined with increased leakage of the spiracle Sp2 valve enable inspiration in the thorax. The positive pressure periods are correlated with a new type of convective CO2 micro-bursts as shown in flow-through measurements. The bulk of the CO2 is, however, released after longer interbursts in macro-bursts with actively opening valves reminiscent of the open phase in a cyclic gas exchange. When the valves open, the PO2 in the thoracic air sacs unexpectedly drops by a mean of 2.75±1.09 kPa, suggesting a displacement of O2 by the transient accumulation of CO2 in the tracheal system before its release.

The diagnostic value of dual-energy dual-phase CT in small clear cell renal cell carcinoma

Objective To detect the best phase and best tube voltage for the diagnosis of small (diameter≤3 cm) clear cell renal cell carcinoma with dual-energy dual-phase CT. Methods Image manifestations of 27 patients with small (diameter≤3 cm) cc RCCs confirmed by pathology were retrospectively analyzed.All subjects underwent dual-energy biphase (early corticomedullary and delayed phase) scan preoperatively.Two senior radiologists analyzed the images in consensus.The definition of images in different phases and with different tube voltage was classified into 4 levels and was compared by Wilcoxon and Friedman test.The attenuation of the lesions and the adjacent renal parenchyma,the SD value of the anterior abdomen fat were measured.The contrast noise ratio (CNR),lesion kidney ratio (LKR) and the early corticomedullary phase and delayed phase value were calculated.They were all compared with one-way ANOVA. Results The score of definition of lesions in early corticomedullary phase at 80 k V,140 k V and average-weighted 120 k V were 3.30±0.87,2.81±0.92 and 3.11±0.85,respectively,which in delayed phase were 3.70±0.54,3.30±0.82 and 3.52±0.64,respectively.Definition of lesions was better in delayed phase than that in early corticomedullary phase (Z=-2.296,-2.446 and-2.392,respectively;P<0.05).Either in early corticomedullary phase or in delayed phase,CT value,noise value and CNR were the highest on 80 k V images,which were (302±80) HU,(16.2±2.2) and (4.1±3.4) in corticomedullary phase and (152±31) HU,(16.4±2.7) HU,and (4.7±1.7) in delayed phase.The change of lesion attenuation between early corticomedullary phase and delayed phase on 80 k V,140 k V and average-weighted 120 k V images were (150±76),(72±33) and (96±46) HU,respectively.There was significant difference among the three groups (F=4.541,P<0.01). Conclusions Delayed phase scan is in favor of small clear cell renal cell carcinoma display.80 k V images are the best for detecting and qualitation of small clear cell renal cell carcinoma when compared with 140 k V and the average-weighted 120 k V images. Key words: Renal neoplasms; Tomography,X-ray computed

Not Your Everyday Case of Acute Pancreatitis: A Rare Complication of a Common Diagnosis

Purpose: Pancreaticopericardial fistula is an extremely rare complication of chronic pancreatitis, and is virtually unheard of in the setting of acute pancreatitis. A 67-year-old male presented with acute necrotizing pancreatitis complicated by pancreatic pseudocyst with a cystoduodenal fistula and pancreaticopericardial fistula. On presentation, the patient had signs of tachypnea, tachycardia, hypotension and cyanosis. Initially, an emergent percardiocentesis was performed for cardiac tamponade with eventual placement of a pericardial window as a result of persistent reaccumulation of fluid. Computed tomography (CT) demonstrated a gas containing pericardial fluid collection extending into the anterior upper abdomen and ill-defined fluid collections within the pancreatic head and neck, representing pancreatic necrosis with probable superimposed infection. Analysis of pericardial fluid showed elevated levels of lipase at 24,000 u/L. Surgical exploration of the subxiphoid window revealed a pancreatic pericardial cutaneous fistula and an infected pericardial window. The patient ultimately passed away from septic shock. We present this rare complication of acute pancreatitis and review the relevant literature.FigureFigureFigure

Fournier’s gangrene of the penis caused by Streptococcus dysgalactiae subspecies equisimilis: case report and incidence study in a tertiary-care hospital

BackgroundFournier’s gangrene is a rare necrotizing soft tissue infection of the scrotum and penis. We report, to our knowledge, the first case of Fournier’s gangrene caused by Streptococcus dysgalactiae subsp. equisimilis (SDSE), a strain of pyogenic β-hemolytic streptococci that is increasingly being recognized as an important human pathogen.Case presentationWe describe a healthy 59 year-old Caucasian male who presented to the emergency department with Fournier’s gangrene of the penis and scrotum, with extension to the anterior abdominal wall. He underwent urgent surgical debridement of his scrotum, penis, and anterior abdomen. Swabs from the scrotum grew Gram-positive cocci, which were initially identified as Streptococcus anginosus group by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS). However, polymerase chain reaction (PCR) amplification and sequencing of the 16S rRNA gene identified the isolate as Streptococcus dysgalatiae subspecies equisimilis (SDSE). The incidences of invasive S. anginosus group and SDSE infections at the London Health Sciences Centre, a tertiary-care institution in southwestern Ontario, were determined between August 1, 2011 and August 31, 2012, revealing a slightly lower rate of SDSE (3.2 cases per 100,000 population) than other studies.ConclusionsThis case highlights a unique disease manifestation of the emerging human pathogen Streptococcus dysgalatiae subspecies equisimilis that has not been previously reported. This case also underscores the limitations of MALDI-TOF MS in differentiating between closely-related streptococcal species which may have different pathogenic profiles.

Odoriferous Defensive Stink Gland Transcriptome to Identify Novel Genes Necessary for Quinone Synthesis in the Red Flour Beetle, Tribolium castaneum

Chemical defense is one of the most important traits, which endow insects the ability to conquer a most diverse set of ecological environments. Chemical secretions are used for defense against anything from vertebrate or invertebrate predators to prokaryotic or eukaryotic parasites or food competitors. Tenebrionid beetles are especially prolific in this category, producing several varieties of substituted benzoquinone compounds. In order to get a better understanding of the genetic and molecular basis of defensive secretions, we performed RNA sequencing in a newly emerging insect model, the red flour beetle Tribolium castaneum (Coleoptera: Tenebrionidae). To detect genes that are highly and specifically expressed in the odoriferous gland tissues that secret defensive chemical compounds, we compared them to a control tissue, the anterior abdomen. 511 genes were identified in different subtraction groups. Of these, 77 genes were functionally analyzed by RNA interference (RNAi) to recognize induced gland alterations morphologically or changes in gland volatiles by gas chromatography-mass spectrometry. 29 genes (38%) presented strong visible phenotypes, while 67 genes (87%) showed alterations of at least one gland content. Three of these genes showing quinone-less (ql) phenotypes – Tcas-ql VTGl; Tcas-ql ARSB; Tcas-ql MRP – were isolated, molecularly characterized, their expression identified in both types of the secretory glandular cells, and their function determined by quantification of all main components after RNAi. In addition, microbe inhibition assays revealed that a quinone-free status is unable to impede bacterial or fungal growth. Phylogenetic analyses of these three genes indicate that they have evolved independently and specifically for chemical defense in beetles.

Effect of Patient Size on Mean Sterile Water Attenuation During Multiphase CT Examinations

The purpose of this study was to determine the variability of attenuation measurements in a water phantom included in the FOV during multiphase 64-MDCT. Ninety-seven consecutively registered patients undergoing multiphase kidney and liver protocol CT of the abdomen on the same 64-MDCT scanner had a sealed water bottle placed on their anterior abdomen during the examination. Region of interest (ROI) measurements of the mean attenuation (in HU) of the water bottle were made during the unenhanced, dynamic, and delayed phases of contrast enhancement. Generalized estimating equations were used to model mean attenuation in the ROI as a function of cross-sectional patient area, contrast phase, and protocol. Day of month and time of day were covariates. A phantom was created to model the patient study. The mean attenuation values in the water bottle ROIs were -13.1 HU for the kidney protocol and -9.1 HU for the liver protocol in the unenhanced phase, -11.7 HU for the kidney and -9.5 HU for the liver protocol in the dynamic phase, and -11.9 HU for the kidney and 11.0 HU for the liver protocol in the delayed phase. Kidney protocol water bottle ROI attenuation values were lower than the liver values (p = 0.04). In all phases with both protocols, the values differed from 0 HU (all p < 0.0001). Water bottle ROI attenuation decreased as patient cross-sectional area increased (-0.01 HU/cm(2), p < 0.0001). Three patients had absolute water bottle attenuation changes greater than 20 HU between phases. Day of the month (p = 0.08) and time of day (p = 0.93) were not significant factors. Phantom data supported the study findings. The mean attenuation of water decreased as patient diameter increased. Both artifactual enhancement and decrease in enhancement greater than 20 HU were found in three larger patients.

Primary closure of the Urinary Bladder, Urethra and Anterior Abdomen of Classical and Cloacal 39 Exstrophy - A Preliminary Experience of Three Consecutive Cases

A 4 years old female and 1.5 months old male with classical exstrophy and a 2 days old male child with cloacal exstrophy were admitted in Paediatric Surgery Department of Sher-e-Bangla Medical College Hospital (SBMCH), Barisal. The mothers of all children had complaints of protrusion of fleshy mass in lower abdomen from birth. They always remain wet producing smell of urine. The cloacal exstrophy case had a prolapsed ileum that was discharging stool. He had no anus too. All of the cases underwent one stage closure of urinary bladder and urethra and lower abdomen without osteotomy and patient was discharged. After 8 months of first operation the female patient underwent repair of the wound dehiscence. At the time of discharge her urinary bladder capacity was 10 ml and remained dry for 5 minute after manual evacuation. The male patient with classical exstrophy developed urethrocutaneous fistula on 15th post-operative day. The cloacal exstrophy case was discharged with end ileostomy on 10th post-operative day. DOI: http://dx.doi.org/10.3329/jss.v16i1.14447 Journal of Surgical Sciences (2012) Vol. 16 (1) : 39-43

ISUOG Practice Guidelines: use of Doppler ultrasonography in obstetrics

<scp>ISUOG</scp> Practice Guidelines: use of Doppler ultrasonography in obstetrics

Patients with Penetrating Abdominal Stab Wounds Which Require Laparotomy?

BackgroundThe optimal management of hemodynamically stable asymptomatic patients with anterior abdominal stab wounds (AASWs) remains controversial. The goal is to identify and treat injuries in a safe cost-effective manner. Common evaluation strategies are local wound exploration (LWE), diagnostic peritoneal lavage (DPL), serial clinical assessment (SCAs) and computed tomography (CT) imaging. Making a decision about the right time to operate on a patient with a penetrating abdominal stab wound, especially those who have visceral evisceration, is a continuing challenge.ObjectivesUntil the year 2010, our strategy was emergency laparotomy in patients with penetrating anterior fascia and those with visceral evisceration. This survey was conducted towards evaluating the results of emergency laparotomy. So, better management can be done in patients with penetrating abdominal stab wounds.Patients and MethodsThis retrospective cross-sectional study was performed on patients with abdominal penetrating trauma who referred to Al- Zahra hospital in Isfahan, Iran from October 2000 to October 2010. It should be noted that patients with abdominal blunt trauma, patients under 14 years old, those with lateral abdomen penetrating trauma and patients who had unstable hemodynamic status were excluded from the study. Medical records of patients were reviewed and demographic and clinical data were collected for all patients including: age, sex, mechanism of trauma and the results of LWE and laparotomy. Data were analyzed with PASW v.20 software. All data were expressed as mean ± SD. The distribution of nominal variables was compared using the Chi-squared test. Also, diagnostic index for LWE were calculated. A two-sided P value less than 0.05 was considered to be statistically significant.ResultsDuring the 10 year period of the study, 1100 consecutive patients with stab wounds were admitted to Al-Zahra hospital Isfahan, Iran. In total, about 150 cases had penetrating traumas in the anterior abdomen area. Sixty-three (42%) patients were operated immediately due to shock, visceral evisceration or aspiration of blood via a nasogastric tube on admission. Organ injury was seen in 78% of patients with visceral evisceration. Among these 87 cases, 29 patients’ (33.3%) anterior fascia was not penetrated in LWE. So, they were observed for several hours and discharged from the hospital without surgery. While for the remaining 58 patients (66.6%), whose LWE detected penetration of anterior abdominal fascia, laparotomy was performed which showed visceral injuries in 11 (18%) cases.ConclusionsAll in all, 82 percent of laparotomies in patients with penetrated anterior abdominal fascia without visceral evisceration, who had no signs of peritoneal irritation, were negative. So, we recommended further evaluation in these patients. However, visceral evisceration is an indication for exploratory laparotomy, since in our study; the majority of patients had organ damages.

Necrotizing Fasciitis of the Breast: A rare presentation in postpartum mother

Necrotizing Fasciitis (NF) is a rapidly spreading flesh eating disease of skin & subcutaneous tissue. It can involve any part of the body mostly involving perineal region & anterior abdomen wall but breast involvement is rare. Thus early diagnosis and proper surgical treatment can prevent significant morbidity.

Penetrating Stab Injuries to the Anterior Abdomen: Use of Multi-Detector Computed Tomography to Predict the Need for Laparotomy

Penetrating Stab Injuries to the Anterior Abdomen: Use of Multi-Detector Computed Tomography to Predict the Need for Laparotomy

Gunshot Wound of the Thoracic Aorta with Right Popliteal Artery Embolization: A Case Report of Bullet Embolism with Review of Relevant Literature

Bullet embolism is a well-known but relatively uncommon complication of gunshot injuries. Their rarity and the potential lack of early symptoms lead to delays in diagnosis and often in inadequate early management that can potentially result in the loss of a limb or life. We present an interesting case in which a small caliber bullet to the upper anterior abdomen penetrated the thoracic aorta and traveled to the right popliteal artery embolizing the vessel. The exploratory laparotomy failed to locate neither the bullet nor the trajectory resulting in sudden deterioration and eventual death 5 hours into the postoperative period.

English

Pinkus first described Lichen nitidus a rare variety of dermatitis of unknown etiology in 1901. Its incidence was 0.034% in a study in blacks over a 25-years period. Various clinical variants of lichen nitidus includeslinear, confluent, vesicular, haemorrhagic, spinous follicular, perforating, generalised, palmar and plantar. We hereby report a rare case of linear Lichen nitidus in a 17-year-old male presented with skin lesions spreading in linear fashion from anterior abdomen to back since 2 months. On examination, round, flat-topped, shiny papules, 2 to 3 mm in diameter presented over anterior abdomen wall extending towards back. Skin biopsy confirmed diagnosis of linear Lichen nitidus. Sections revealed vacuolar alternation of basal cell layer, diminished granular layer along with mixed-cell granulomatous infiltrate closely attached to the lower surface of the epidermis and confined to widened dermal papillae. The infiltrate composed of lymphocytes and epithelioid histiocytes. At places, rete ridges bend downward and inward and seem to clutch the infiltrate in the manner of “claw clutching a ball”. Differential diagnosis of lichen striatus and lichen planus was ruled out on histopathology. Patient responded to treatment.

Beyond Fat Grafting

The concept of aging and the mechanisms responsible for soft tissue aging have become progressively more important as the world's population ages and demands a higher quality of life. Although molecular mechanisms of aging have been evaluated in model organisms, specific genomic, genetic, and epigenetic modifications that can be translated to normal human tissue aging have yet to be identified. We propose that adipose tissue is an excellent model with which to investigate molecular aging pathways. The goal of this study is to demonstrate that primary human adipose tissue can serve as a model of human aging, and further, can be used to detect differences in genomic transcriptional profiling between cell types in adipose tissue as well as between youthful and older age groups. Subcutaneous adipose tissue was excised during cosmetic procedures from healthy patients. Adipocytes and stromal vascular fractions from the anterior abdomen were isolated from 3 young (26-39 years) and 3 old (52-64 years) patients and analyzed for genome-wide transcriptional differences between varying ages and cell types using the Affymetrix GeneChip Human Gene Chip 1.0ST. Genes specific to adipocytes were more highly expressed in adipocytes than in stromal vascular fractions, validating that adipose tissue should be examined in a cell-specific manner. An increase in overall gene expression was observed among patients in the older age group, consistent with senescence-related chromatin dysregulation. Principal components analysis revealed no clear delineation between age groups and a clear separation by cell type. Analysis of variance revealed cell type as the most significant variable in transcriptional differences, whereas age-related differences were a distant second. Gene Ontology categories of the most significantly modified genes included RNA splicing and mRNA metabolism, plasma membrane, and mitochondrial metabolism. Primary adipose tissue is an effective model for the study of the molecular mechanisms of human aging. Our findings are consistent with the hypothesis that epigenetic modifications play a more important role than transcriptional modifications in early human adipose tissue aging. Our future studies will examine the contribution of specific epigenetic markers to human adipose tissue aging and promise to advance approaches in regenerative medicine, and the prevention and treatment of aging.

Stomach in the Pelvis - Itʼs Not A Joke!

Introduction: We report a rare case of massive gastric dilatation secondary to closed loop small bowel obstruction caused by internal hernia leading to obstruction of biliary intestinal limb of Whipple procedure. Case Report: A 59-year-old woman with multiple abdominal surgeries including sigmoid colectomy for sigmoid volvulus, pylorus preserving Whipple surgery for pancreatic hamartoma 3 years prior, presented with nausea, vomiting, constipation and periumbilical abdominal pain for 2 days. Examination was remarkable for tachycardia and soft but distended abdomen, diffuse tenderness and hypoactive bowel sounds. Lab evaluation showed WBC 14 K/μl and creatinine 2.62 mg/dl. Nasogastric tube placement yielded 4 l bilious fluid in the first hour. CT scan of abdomen demonstrated massively distended stomach, measuring 15 cm transversely, 14 cm antero-posteriorly and 35 cm craniocaudally extending into the pelvis with proximal small bowel dilatation. Patient responded to conservative management and small bowel follow through study performed 48 hours later showed marked decompression of the stomach. Six weeks later, patient was readmitted with similar clinical presentation. CT scan showed evidence of gastric distension and partial bowel obstruction in the mid anterior abdomen involving multiple segments of small bowel. She did not respond to conservative management for 10 days and laparotomy was performed later on. Laparotomy revealed small bowel closed loop obstruction due to internal hernia, obstructing the biliary limb of Whipple procedure adjacent to the gastrojejunostomy. Discussion: Closed loop obstruction is a rare type of bowel obstruction associated with high mortality of 35% at 36 hours of delayed diagnosis. Internal hernia is an uncommon cause of bowel obstruction reported in 0.2% to 0.9% of autopsies and in 0.5-4.1% of cases of intestinal obstruction. Internal hernia cause closed loop obstruction when the narrow defect causes occlusion of the loops of small bowel entering and exiting through mesenteric defect or congenital mesenteric opening. Postsurgical adhesions can cause more narrowing of the defect. We present a very unusual case of closed loop intestinal obstruction of the biliary limb of Whipple procedure that in addition lead to massive gastric distension of stomach.Figure: CT scan with oral contrast.

Safety and Tolerability of High-Intensity Focused Ultrasonography for Noninvasive Body Sculpting: 24-Week Data From a Randomized, Sham-Controlled Study

High-intensity focused ultrasonography (HIFU) is a nonsurgical, noninvasive method for body sculpting in nonobese patients. The technique ablates subcutaneous adipose tissue by causing molecular vibrations that increase tissue temperature and induce rapid cell necrosis. The authors evaluate the long-term safety of a HIFU device for sculpting the abdomen and flanks. Adults with subcutaneous abdominal fat ≥2.5 cm in thickness who met screening criteria were randomized to receive HIFU treatment of the anterior abdomen and flanks at 1 of 3 energy levels (3 passes per patient): 47 J/cm(2) (141 J/cm(2) total), 59 J/cm(2) (177 J/cm(2) total), or 0 J/cm(2) (no energy applied; sham control). Safety was assessed for 24 weeks and included laboratory testing, physical examinations, and documentation of adverse events. Adverse events (AE) included mild to moderate discomfort, ecchymosis, and edema, all of which were transient. There were no reports of scarring or burns and no clinically meaningful changes in lipid panel findings, inflammatory markers, or renal or hepatic function. Physical examination results were unremarkable. This HIFU device exhibited an AE profile similar to that of sham treatment. There were no significant changes from baseline in laboratory values, including lipid levels.

Multidetector Computed Tomography of Penetrating Abdominal Trauma

Although there is no debate that patients with peritonitis or hemodynamic instability should undergo urgent laparotomy after penetrating injury to the abdomen, it is also clear that certain stable patients without peritonitis may be managed without the need for an operation. The practice of deciding which patients may not need surgery after penetrating abdominal wounds has been termed “non-operative management.” This practice has been readily accepted during the past few decades with regard to abdominal stab wounds; however, controversy persists regarding when a conservative management approach is appropriate for penetrating gunshot wounds. Abdominal gunshot injuries are still commonly treated with mandatory exploration because of the multiple reports emphasizing a high incidence of significant injuries and the complications that result from a missed injury or a delayed diagnosis. The enthusiasm for nonoperative management in patients with penetrating abdominal trauma is based on a relatively high incidence of nontherapeutic or negative laparotomy from civilian low-velocity injuries. Reports on the incidence of unnecessary laparotomies range from 23% to 53% for patients with stab wounds and 5.3%-27% for patients with gunshot wounds.1 Complications develop in 2.5%-41% of all trauma patients undergoing unnecessary laparotomy, and small bowel obstruction, pneumothorax, ileus, wound infection, myocardial infarction, visceral injury, and even death have been reported secondary to unnecessary laparotomy. 2,3 The process of selecting patients for nonoperative management requires considering several factors: the specific mechanism (stab vs gunshot), the velocity of the inflicting agent (low vs high), and the different areas of the torso that may be affected (intraperitoneal, retroperitoneal, and thoracoabdominal). In developing management strategies for penetrating abdominal trauma, it is helpful to divide the abdomen into regions: the anterior abdomen (from xiphoid to pubis, between the anterior axillary lines); the flank and back (posterior to the anterior axillary lines); and the thoracoabdomen (from the nipple line to the costal margin). The approach for each of these regions varies. If the patient is selected for initial nonoperative management, additional diagnostic methods often become necessary. An abdominopelvic multidetector computed tomography is now strongly regarded as the main diagnostic tool to facilitate initial management decisions. However, other methods that can be considered include diagnostic peritoneal lavage, ultrasonography (US), and laparoscopy.

Use of a novel abdominal aortic tourniquet to reduce or eliminate flow in the common femoral artery in human subjects

Penetrating injuries of proximal femoral and iliac vessels are a common cause of death on the battlefield. Previous studies have shown that by applying 80 lb to 140 lb of pressure externally over the distal abdominal aorta, flow can be ceased in the common femoral artery (CFA). It has also been demonstrated that in a porcine model, an externally applied pneumatic abdominal aortic tourniquet (AAT) can occlude the aorta and inferior vena cava for 60 minutes without bowel injury or significant potassium elevations.The objectives of this study were (1) determine if AAT use in humans results in flow cessation in the CFA, (2) measure the pressure required to cease flow in the CFA, and (3) measure discomfort associated with application of the AAT. Pulse wave Doppler measurements were taken in supine volunteers at the right CFA. The AAT was placed just above the iliac crests over the anterior abdomen. The AAT was inflated using a hand pump with an integrated manometer. Measurements were taken every 30 mm Hg. Discomfort was measured using a 10-point pain scale. In all subjects, flow was reduced in the CFA. Flow ceased in seven of nine subjects at a median pressure of 180 mm Hg (150-230 mm Hg). Median discomfort at ceasing of flow was 7 (3-10), returning to 0 after device removal. The AAT device was effective at reducing flow in the CFA and ceased flow in most of the subjects. Application of the device was associated with discomfort varying from moderate to severe and resolving with device removal.