Blunt Force Abdominal Trauma Research Articles

Delayed presentation of traumatic hepatic pseudoaneurysm in a child

An 8-year-old male presented twenty days after blunt force abdominal trauma, involving a steering wheel impact into the patient's right-upper quadrant after collision of a ride-on-lawnmower into a tree followed by ejection off the vehicle. He reported significant pain initially, which was followed by abdominal and flank bruising. At the time, his parents thought the injury trivial and did not seek medical attention. For the subsequent 3 weeks they noted he was not his normal self, with lethargy and poor oral intake. He missed school because of persistent abdominal pain. They presented to their General Practitioner (GP) and were referred for basic blood tests, which identified a haemoglobin (Hb) of 56g/L. The GP referred them to the nearest Emergency Department, a metropolitan level 2 centre. On presentation, the patient was haemodynamically unstable, with a fever of 38.6° Celsius, tachycardia of 130 beats/minute and tachypnoea of 30 breaths/minute. The patient was examined by the adult general surgical registrar who felt a right-upper quadrant mass and organised an urgent contrast-enhanced CT scan. This demonstrated a liver laceration through the right lobe with a large subcapsular haematoma (139 x101 × 189mm), and an associated 10 × 8mm pseudoaneurysm continuous with a branch of the right hepatic artery, in keeping with an AAST grade 3 liver injury [1] (Fig. 1.). The mass effect of the haematoma was causing almost complete occlusion of the Inferior Vena Cava, displacement of the liver hilum and slight compression of the right kidney (Fig. 2.). Blood tests confirmed a severe normochromic, normocytic anaemia (Hb 57g/L) with thrombocytosis (Platelets 764) and Haematocrit 0.17, INR 1.5 and Prothrombin time 17 seconds. Liver function tests were only mildly deranged; lactate dehydrogenase was elevated at 890U/L; electrolyte deficiencies were noted with Na 129mmol/L, Cl 95mmol/L and Albumin 25g/L.

Turbulent tackle: a novel surgical approach to a rugby-related jejunal perforation

Viscus perforation in the context of blunt-force abdominal trauma is a rarity. Within a sporting context, it is especially rare. However, the increasing physicality observed in rugby union, both in...

Kontrastmittelsonographie beim stumpfen Bauchtrauma

With the introduction of second generation ultrasound contrast agents, contrast-enhanced ultrasound (CEUS) has become available as an adjunct to the conventional FAST (focused assessment with sonography in trauma) protocol and B-mode sonography of the abdomen after blunt force abdominal trauma. Results from several controlled studies indicate excellent diagnostic accuracy of CEUS for the exclusion of clinically relevant parenchymal injuries after blunt force abdominal trauma. Particularly in younger, hemodynamically stable patients this technique could contribute to a reliable exclusion of parenchymal injuries without the use of ionizing radiation. This report provides details on the technical performance of CEUS, shows examples of typical CEUS findings after blunt abdominal trauma and summarizes the current clinical evidence regarding the use of CEUS after blunt abdominal trauma.

Moderne Bildgebung nach Lebertrauma

Involvement of the liver is one of the most common injuries in addition to those of the pancreas following blunt force abdominal trauma. Due to the even now high mortality radiological imaging must provide a rapid, definitive and exact assessment of the extent of the damage. Despite conflicting study results ultrasound has become established as a rapid and relatively simple method in emergency room treatment and is irreplaceable for initial orientation diagnostics. The use of contrast medium-assisted examinations promises to be an advantage for diagnostics in the secondary phase. Due to the high sensitivity and specificity modern multidetector computed tomography is the most effective examination modality for the detection of liver damage and hepatobiliary complications and plays a central role in non-operative management following abdominal trauma. Shorter and shorter scan times even allow the examination of metastable patients and a rapid assessment even of large body volumes.

Histologic Evidence of Repetitive Blunt Force Abdominal Trauma in Four Pediatric Fatalities

In cases of acute fatal child abuse, certain injuries, including cutaneous blunt force trauma, skull fractures, subdural hematomas, intra-abdominal hemorrhage, and retinal hemorrhages are common and well described in the pediatric and forensic literature. These gross findings at autopsy, when taken into consideration with scene investigation and interviews with caregivers, may indicate both a clear manner and cause of death. In such cases, the discovery of additional pathologic changes attributable to older abusive injuries helps support a conclusion of death due to inflicted trauma. We discuss four cases of fatal child abuse in which acute blunt force abdominal trauma was the cause of death. In each of these cases, careful examination with proper sectioning and microscopy of select abdominal tissues revealed that the acute tissue trauma was superimposed on a background of older, healing injury. This older trauma was characterized by classic histologic elements of tissue repair, including fibroblast proliferation, early scar formation, increased vascularity, and hemosiderin-laden macrophages. Iron and trichrome stains were used to confirm the presence of hemosiderin and fibrosis in all four cases, but the recognition of fibroblast proliferation and a reactive vascular pattern was best seen on routine hematoxylin and eosin stains. The gross and microscopic autopsy findings, along with available investigative information, established the diagnosis of chronic physical abuse.

Lacerations of the Hepatoduodenal Ligament, Pancreas and Duodenum in a Child due to Blunt Impact

Descriptions of the nature of pediatric injury as reported by parents and caretakers is frequently tainted, even fraudulent. We present here such a case of trauma incurred in the presence of a parent which resulted in hepatoduodenal ligament laceration with associated pancreatic and duodenal injuries, the certain result of severe blunt force abdominal trauma. These findings were at variance with the father's description of the events leading up to the child's untimely demise.