Blunt Trauma Abdomen Research Articles

Traumatic Spigelian Hernia Due to Blunt Trauma in Elderly with Delayed Presentation – An Unusual Case Report

Abstract Traumatic abdominal wall hernia (TAWH) is an unexpected clinical diagnosis. Amongst them, traumatic Spigelian hernia is the rarest form where contrast-enhanced computed tomography (CECT) abdomen is the imaging of choice. Treatment options include exploratory open or minimally invasive surgery with or without the use of prosthetic mesh. Non-operative treatment can be an option in selected patients. Almost all the cases reported in the past show preponderance of TAWH in young male patients with immediate manifestation requiring emergency laparotomy. We present our experience of successfully managing a 65-year-old woman who had delayed presentation after blunt trauma abdomen who was diagnosed with Spigelian hernia on CECT abdomen and underwent an elective mesh hernioplasty. The patient was followed up till 3 months post-operatively with an uneventful course. Traumatic Spigelian hernia is an unexpected clinical condition and is mostly missed during the initial presentation. It should be suspected in cases having abdominal protrusion following blunt trauma. Treatment is tailored according to the patient’s mode of injury, presentation and associated comorbidities. Presentation in elderly females with delayed symptoms days after the trauma is unreported yet.

EVALUATION AND MANAGEMENT STRATEGIES FOR PATIENTS WITH BLUNT ABDOMINAL TRAUMA: A HOSPITAL-BASED STUDY

Introduction:Blunt trauma to the abdomen occurs due to forces that induce shearing, compression, or deceleration injuries, particularly affecting anatomical structures that are relatively immobile. The evaluation of abdominal injuries is challenging and often results in missed diagnoses due to the complexity of symptoms and the difficulty in identifying subtle signs of internal injury. Aims & Objectives:To study the clinical presentation, evaluation, diagnostic investigations, and management strategies for various intra-abdominal organ injuries resulting from blunt trauma to the abdomen. Methods: - Following initial resuscitation and attainment of hemodynamic stability, all blunt abdominal trauma patients underwent meticulous clinical history-taking and comprehensive physical examination. Subsequent management decisions, whether operative or non-operative, were determined based on the integrated findings of clinical assessments and radiological evaluations. Results:Between August 2022 and August 2023, fifty (50) patients with blunt trauma to the abdomen were admitted to Basaveshwara Teaching and General Hospital, Kalaburagi. In this study, males predominated in the 21 to 30-year age group, which represented the most frequent demographic for abdominal blunt trauma. Traffic collisions were identified as the leading cause of abdominal blunt trauma. The spleen emerged as the organ most frequently affected. Of the patients, 28 underwent conservative management, while 22 required surgical intervention. Conclusion:In cases of blunt trauma to the abdomen, the early hours following injury are critically significant and represent a crucial window, often referred to as the golden period of trauma, associated with higher survival rates. Timely intervention andappropriate management during this phase have been shown to significantly decrease morbidity and mortality rates associated with blunt trauma abdomenandappropriate management during this phase have been shown to significantly decrease morbidity and mortality rates associated with blunt trauma abdomen.

Combined Rupture of the Diaphragm and Urinary Bladder in Blunt Trauma Abdomen.

The authors examined a 25-year-old man with a combined rupture of the diaphragm and urinary bladder following blunt trauma to the abdomen. The presence of hematuria, suprapubic tenderness, and elevated serum urea and creatinine levels in this patient raised suspicion of urinary bladder rupture. Documentation of bowel gas shadows on the chest x-ray suggested underlying diaphragm injury. A computed tomogram of the thorax and abdomen confirmed the tear in the left hemidiaphragm with intrathoracic herniation of abdominal contents; however, it failed to detect the intraperitoneal urinary bladder rupture. Both the defects were identified and repaired during laparotomy. The sudden increase in intraabdominal pressure in blunt trauma to the abdomen often resulted in full-thickness tears of the diaphragm and the urinary bladder. Although radiological investigations were pivotal for assessing the damage to the internal organs, a methodical and thorough exploratory laparotomy was invaluable for successfully managing patients with blunt abdominal trauma.

Determinants of Readmission in the Intensive Care Unit: A Prospective Observational Study.

Background The antecedents of readmission among survivors of intensive care units (ICUs) are complex and comprise an array of elements that impact the rehabilitation process after leaving the ICU. The aforementioned determinants may comprise socioeconomic factors, access to follow-up healthcare, the nature and severity of the initial illness or injury, the presence of comorbidities, the sufficiency of transitional care and rehabilitation services, and patient and family support systems. Added to this, the risk of readmission may be increased by complications that develop during the ICU stay, including but not limited to infections, organ dysfunction, and psychological distress. Comprehending these determinants is of the utmost importance for healthcare providers in order to execute focused interventions that seek to diminish readmission rates, enhance patient outcomes, and elevate the standard of care for survivors of ICUs. Objective The objective of the study is to determine the factors associated with readmission among ICU survivors and the cause of readmission. Methodology This prospective observational study was conducted in a tertiary-level ICU. The duration of the study was one year and we enrolled 108 ICU survivors in our study. We have recorded patient demographic data, comorbidity, primary diagnosis, previous treatment history (vasopressor, sedation), causes of readmission, duration of previous ICU stay, and outcome of readmitted patient (discharge, death, and transfer to lower facility). Result The incidence of readmission in our ICU is 10.4%; 50-70 age groups are more prone to readmission of which the male sex is predominant (64.81%). In our study, hypertension (cardiac, 18.52%) and diabetes mellitus (11.11%) were the most common comorbidities reported in readmitted patients. The majority of patients who get readmissionsuffered from blunt trauma abdomen. In the majority of readmitted patients, sedation was used in the previous admission for ventilation and patient comfort (66.67%). Most of the readmitted patients (68.51%) have a previous ICU stay of more than five days. Patients were readmitted mainly because of respiratory (30.56%) and neurological (25%) complications. In this study, readmitted patients have high mortality (59.26%). Conclusion In a tertiary care ICU, the incidence rate of readmitted patients was 10.4%. Respiratory and neurological problems were themain cause of readmission. In readmitted patients, mortality was high up to 59.26%. Oldage, male sex, prolonged ICU stay, comorbidities like hypertension, blunt trauma abdomen, use of sedation, and prolonged mechanical ventilation in previous ICU admission are major risk factors for ICU readmission.

A prospective observational study of gastrointestinal perforations following blunt trauma abdomen

Background: Blunt trauma abdomen often presents late leading to increased morbidity and mortality, therefore the challenges in management of such patients warrant a study in this area for early diagnosis and better outcomes. Methods: A prospective observational study was carried out at a government institute in Central India. All patients having blunt trauma abdomen with GI perforations were observed over 2 years wherein clinical presentation, time of presentation, diagnostic methods and the outcomes were the parameters studied. Results: Young men (21-30 yrs) were found to be the commonly injured group. Road traffic accidents were the most common cause of blunt trauma abdomen. We found that mechanism of injury is related to the outcome and high energy transfer injuries (76%) led to high morbidity and mortality. Abdominal pain with abdominal tenderness and guarding was the most common presentation. Chest X-ray showed free gas under diaphragm in 58%patients who underwent xray. Other modalities used were FAST (focussed abdominal scan for trauma) scan which showed hemoperitoneum. CT scan had 97% sensitivity in diagnosis. Jejunum was the most common site of perforation. Simple closure of perforation with peritoneal lavage was the most commonly performed operative procedure. Overall, 35 patients developed complications in the postoperative period, wound infection being the most common. Mortality in this study was 26%. Conclusions: Young men are the most commonly injured in road traffic accidents with jejunum being the commonest organ injured. High velocity trauma, late presentation, multi- organ injury worsens the prognosis hence early diagnosis becomes imperative for better outcome.

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.

Efficacy and Rationale of Endoscopic Ultrasound-Guided Thrombin Injection in Visceral Artery Pseudoaneurysm Not Amenable to Angioembolization.

Pseudoaneurysm usually occurs after vascular injuries or erosions such as in trauma or inflammation like pancreatitis and is associated with high morbidity and mortality. The aim of study is to assess efficacy and safety of EUS-guided thrombin injection in pseudoaneurysm. Prospective data collection was done at SMS Hospital, Jaipur, from January 2015 to March 2023. All patients with pseudoaneurysm were consecutively enrolled. Twenty patients (M/F, 18:2) with median age of 41 years (25-58 years), were studied. Underlying etiology of pseudoaneurysm was chronic pancreatitis in 75% of the patients, blunt trauma abdomen in 15% of the patients, recurrent acute pancreatitis in 5%, and idiopathic in 5% of the patients. At the time of admission, mean hemoglobin was 6.7 g/dL (3.4-8.2), with median blood transfusion requirement was 2 units (0-6 units). Hemoglobin values after 4-6 weeks showed a significant improvement ( t = 9.21, P < 0.05).Mean dose of human thrombin required for complete obliteration of pseudoaneurysm was 520 ± 188.6 IU per patient (300-800 IU). Amount of thrombin (IU) dose needed to achieve complete obliteration correlated well significantly with the dimension of pseudoaneurysm, P value less than 0.05 ( R = 0.80). Median follow-up duration in this study was 44 months (3-84 months), which was the longest follow-up period by far. Endoscopic ultrasound-guided thrombin injection in visceral artery pseudoaneurysm is a safe and effective alternative for patients not amenable for digital subtraction angiography-guided angioembolization.

Evaluation of clinical and radiological correlation in blunt trauma abdomen

Background: Abdominal trauma is commonly encountered injury caused mainly due to road traffic accidents (RTA). The research aimed to study the cases of abdominal trauma, its different modes of presentation and correlation of radiological and clinical findings with operative findings in these patients. Material and methods: An observational study was conducted in a tertiary care institute. Hemodynamic instability and finding of shattered solid viscera on imaging and/or other injury requiring exploration were the criteria for surgical intervention. Radiological findings were then compared with the operative findings. In addition, clinical parameters were recorded till the patient was discharged and then analyzed. Results: A total of 62 patients presenting in Trauma Centre with an antecedent history of blunt abdominal trauma. Most common age group affected was 21-40 years and mean age was 30.4 + 11.56 years. Males were more affected and RTA was the most common mode of injury. Associated injuries included chest injuries (20.9%), limb fracture (19.35%) and soft tissue injuries (4.83%). Twenty patients were operated and rest of patients were managed conservatively. Sensitivity of USG in detecting liver and splenic injuries was 100% and specificity was 92.3% and 92.8% respectively. Sensitivity of CT for detecting injury to liver, spleen, renal, pancreas and small bowel was 100%, 83.3%, 100%, 100% and 83.3% and specificity was 100% in all injuries. Mortality rate in our study was 4.83%. Conclusion: High degree of suspicion and prompt screening by radiological investigations of patients should be done to rule out intraabdominal injury. Necessary investigations and early surgery whenever required is the key to management of blunt trauma patients.

A Case Series on Transarterial Embolization in Treatment of Hepatic Artery Pseudoaneurysm (Indian perspective) - our experience in a Single Institute (Centre of Excellence)

ABSTRACT Purpose: To evaluate the role of transarterial embolization in hepatic artery pseudoaneurysm (HAP) in the Indian population with an analysis of cases done in our hospital in 1 year. Materials and Methods: We searched our database on the computer of the School of Digestive and Liver Disease (SDLD) for cases of HAP within the last 1 year (from May 2021 to April 2022) and then reviewed in detail, examining causes, clinical data, laboratory data, treatment given, and any intervention and if yes then its complications and outcome. We then analyzed all the data from the perspective of the Indian population and compared them with those of previous literature. Result: Eight patients of HAP were found during investigations, who were admitted to SDLD. Another two patients were referred from another department to GI Radiology of SDLD. Causes were identified as blunt trauma abdomen, chronic pancreatitis, liver biopsy, and liver abscess, with blunt trauma being the most common cause. We found two HAPs in the extra-hepatic location, whereas in the rest of the cases, it was intra-hepatic. Among them, the left hepatic artery was involved in one patient and the right hepatic artery was involved in two patients. All the patients were evaluated carefully by both ultrasonography (USG) and tri-phasic computed tomography of the liver. We successfully embolized all of the total 10 patients of HAP in the last 1 year; however, one patient died due to sepsis. Each patient was followed up by USG. Conclusion: HAP is a complication related to blunt injury abdomen, pancreatitis, and post-surgical cases, which should be treated promptly. It can be deadly if left untreated. Successful and prompt intervention can provide good outcomes for these patients and prevent rupture-related complications.

Correlation between pulse pressure variation and carotid artery corrected flow time in patients undergoing emergency laparotomy for blunt trauma abdomen: A retrospective study.

Correlation between pulse pressure variation and carotid artery corrected flow time in patients undergoing emergency laparotomy for blunt trauma abdomen: A retrospective study.

Factors determining the requirement of surgical intervention and prognosis in cases of traumatic bifrontal contusions: A prospective observational study

Background: Traumatic brain injury, being a notorious cause of mortality and morbidity across the globe, presents with a variety of lesions. One of the distinct patterns of injury is characterized by contusions of both frontal lobes, labeled “traumatic bifrontal contusions” (TBCs). TBC is often associated with the presence of significant edema and mass effect leading to rapid clinical deterioration after a usually benign presentation at the time of first evaluation. Formulating a management plan in a patient with TBC is often more difficult than in a patient with a major intracranial hematoma. Methods: A prospective observational study with aims and objectives to identify predictors of an unfavorable outcome, analysis of the evolution of TBC, evaluation of the specific indications for surgery, and determination of the prognosis. All head trauma patients harboring bifrontal contusions were included in the study. Patients with other associated operable injuries involving blunt trauma abdomen and orthopedic injuries, counter-coupe injuries, and obvious open fractures noted over calvaria were excluded from the study. Glasgow coma scale (GCS) was recorded during the first assessment, followed by non-contrast computerized tomography (NCCT) Head. Results: A total of 53 patients satisfying inclusion and exclusion criteria were included in the study. The average GCS score recorded before surgical intervention was 9. The mean and median best motor response noted was M5. The interval from the time of injury to the first NCCT of the brain at the study hospital ranged from 3 h to 163 h, averaging 17.66 h. The median category w.r.t Marshall’s CT classification observed was “Diffuse Injury IV.” The volume of the contusions in each scan was estimated, and the average anterior cranial fossa volume observed was 125 mL. “Upfront surgery” (“Bifrontal decompressive craniectomy” or “unilateral Fronto-Temporo-Parietal [FTP] decompressive hemicraniectomy”) was carried out on the day of admission based on the findings on the first NCCT brain. About 49% of patients at presentation needed surgical intervention as per existing protocols. The duration of observation for patients who were initially observed but eventually had to undergo surgery ranged from 1 to 5 days, with an average observation period of 2 days. The duration of observation in those who did not subsequently need surgery ranged from 7 to 10 days, with an average duration of 9 days. Conclusion: What leads to the poorly predictable, delayed, and rapid deterioration that sets TBCs apart from other traumatic brain injuries is still unclear. Our study finds that having a low threshold for repeat CT imaging of the patient led to earlier identification of progression, and a low threshold for surgical intervention led to favorable outcomes.

INCIDENCE, OUTCOME, AND MORTALITY PROFILE OF SOLID ORGAN INJURIES AMONG PATIENTS WITH BLUNT ABDOMINAL TRAUMA IN A TERTIARY CARE HOSPITAL: A PROSPECTIVE STUDY

Objective: The objective is to evaluate the histopathology and establish a correlation between placental changes in hypertensive disorders of pregnancy and fetal outcome. To access the solid organ injuries in blunt trauma abdomen patients with respect to management and outcome in a tertiary care hospital. Methods: A prospective descriptive type of study was conducted in a tertiary care hospital including 100 study participants from December 2021 to November 2022. All the patients with the diagnosis of the blunt abdominal trauma were assessed clinically at the time of presentation. After obtaining written informed consent, the detailed information regarding the mode of injury, clinical presentation was collected and recorded. Records were maintained about nonoperative and operative management duration of stay and outcome of patients. The data collected were then entered into MS Excel sheet and analyzed using SPSS v20.0. The data were presented in the form of numbers and proportions. Results and Conclusion: 76% of study participants reported to hospital within 6 h of trauma. 83% of patients had undergone conservative management, while 13% were managed surgically. The mortality rate among study participants was 5%.

A Clinical Study of Surgical Management of Various types of Intra Abdominal Injuries due to Blunt Trauma Abdomen and their Outcome

A Clinical Study of Surgical Management of Various types of Intra Abdominal Injuries due to Blunt Trauma Abdomen and their Outcome

Survival Secrets: Unmasking the Factors Predicting Failure of Non-operative Management (NOM) in Splenic Injuries.

Splenic injuries are common solid organ injuries resulting from blunt abdominal trauma in road traffic accidents. Very often, splenic injuries can be life-threatening. Earlier, splenic injuries were often dealt with surgical intervention, such as splenectomy. With the recognition of the immunological function of the spleen and possible complications of splenectomy surgery, such as overwhelming post-splenectomy infections (OPSI), there has been a recent trend for non-operative management (NOM). To study the variables predicting failure of NOM in blunt abdominal trauma patients with splenic injury. This is a retrospective study that includes 235 patients who presented to the Safdarjung Hospital emergency room (New Delhi, India) with blunt trauma abdomen and splenic injuries with or without associated injuries between January 2019 and December 2021. The data was entered in a Microsoft Excel spreadsheet (Microsoft Corp., Redmond, WA, USA). Categorical variables were expressed as frequencies and percentages. Pearson's chi-square test of association was used to determine if there is a relationship between two variables. A p-value of <0.05 was considered statistically significant. Out of 235 patients with blunt abdominal trauma and splenic injuries, 82 were hemodynamically unstable despite resuscitation and were taken up for emergency laparotomy. The remaining 153 patients, who were either hemodynamically stable or stabilized after adequate resuscitation, were managed on the lines of NOM. The number of patients with splenic injury in AAST grades 1, 2, 3, 4, and 5 was 36, 50, 40, 24, and three, respectively. Out of 153 patients, 130 (85%) were successfully managed by NOM, while eight (5%) had to discontinue NOM as they required surgical intervention. The failure of NOM (fNOM) is seen mostly with grade 5 injuries (2/2, 100%, p<0.01), followed by grade 4 (4/20, 20%) and grade 3 (2/37, 5.7%). The mean age in fNOM was 58.3 years, as compared to 42.2 years in the success of NOM (sNOM). All eight patients had multiple concomitant injuries, with femur fracture being the most common association in up to six patients (p<0.01), followed by liver injury in four patients. There were 15 mortalities, irrespective of AAST severity grade. All of these patients had associated concomitant injuries, with intracranial bleeding (n = 10, 32%, p<0.01) being the most common association, followed by femur fracture (n = 6, 20%) and liver injury (n = 5, 16%). Also, the cause of death was unrelated to splenic trauma (p = 0.67), with pulmonary embolism (n = 6, 40%, p<0.01) being the most common cause, followed by brain stem herniation (n = 5, 34%). Non-operative management is a safe and efficient method for treating patients with splenic injuries who are hemodynamically stable or stabilized. The factors associated with fNOM include elderly age, a higher American Association for the Surgery of Trauma(AAST) grade of splenic injury, and associated concomitant injuries. Femur fracture was the most common concomitant injury present in cases where NOM failed, followed by liver injury. The presence of intracranial bleeds in these patients was a common association with mortality, irrespective of the grade of splenic injury.

Solid and Hollow Organ Injuries in Blunt Trauma Abdomen Following Road Side Accidents and Fall from Height

Background: Fall from height are the second most common cause of injury-associated mortality after road side traffic accidents. They comprise a significant percentage of blunt trauma abdomen cases. Blunt abdominal trauma can result in complications such as hemoperitoneum due to injuries to solid organs such as spleen, liver, kidney and may even cause a retroperitoneal haematoma. It can also cause various modalities of injuries to hollow viscus such as stomach, small and large intestines.

Prospective validation of Bowel Injury Prediction Score for early diagnosis of surgically significant blunt bowel and mesenteric injury

Background Blunt bowel and mesenteric injuries (BBMI) are frequently missed despite the widespread use of computed tomography (CT). Early diagnosis for timely management of surgically significant blunt bowel and mesenteric injuries (sBBMI) can be challenging. Several tools predictive for sBBMI have been proposed such as the “Bowel Injury Prediction Score” (BIPS) that is based on presence of abdominal tenderness, white blood cell count ≥17,000/mm3 and CT grade. The utility of this scoring system for early diagnosis of sBBMI has neither been studied in an Indian population nor prospectively validated. Methods A single-centre prospective cohort study was conducted at a Trauma Centre in India. After screening of 1793 patients with blunt trauma abdomen who presented between 1st January 2022 and 31st August 2022 and underwent CT scan, eventually, 80 patients of age &gt;18 years, hemodynamically stable and CT finding suspicious of BBMI were included. BIPS score was calculated. Patients were followed to evaluate the outcome. Results The incidence of sBBMI was 3.06%. Mean age of study patients was 36.2 ± 16.5 years with male predominance (92.5%) and road traffic accidents the commonest mode of injury. Patients with BBMI were more likely to require operative intervention in the presence of abdominal tenderness at presentation (p &lt; 0.01) and CT grade ≥4 (p &lt; 0.01). For patients with WBC counts of ≥17,000/mm3, no statistically significant difference was noted in the need for operative intervention. BIPS ≥2 had 94.5% sensitivity, 72% specificity, 88% PPV, and 86% NPV for identifying patients with sBBMI. Conclusion Calculation of BIPS at the time of presentation can avoid unnecessary delays in surgical management and thereby reduce overall morbidity and mortality even in an Indian setup. However, WBC counts &gt; 17,000/mm3 were not found to be predictive of sBBMI.

CASS – A cost-effective strategy in the management of blunt trauma abdomen

Background: Abdominal trauma is one of the leading causes of morbidity and mortality in both developing and developed countries. Management of blunt trauma abdomen (BTA) relies on most importantly, the clinical presentation of the patient. Aims and Objectives: This study aims at determining the accuracy of the clinical abdominal scoring system (CASS) in predicting the need for operative management of blunt abdominal trauma patients and also comparing the CASS score with the American association for the surgery of trauma – computed tomography (AAST CT) score. Materials and Methods: A total of 50 patients with BTA presenting to the Government tertiary care center Mysore were evaluated for age, sex, type of trauma, systolic blood pressure, Glasgow coma scale, pulse rate, time of presentation after trauma, abdominal clinical findings, respiratory rate, and hemoglobin concentration. Radiological investigations were done as indicated. CASS score was calculated and a comparison of the same with CT findings, in determining the need for laparotomy, was studied. Patients with co-existing head injuries and comorbidities were excluded from the study. Results: Among 50 cases, 44 were male accounting for 88% of the study population and 6 were female. The majority belonged to 18–30 years of age, accounting for 46%. In 42% of cases, a road trafficaccident was the mode of injury, followed by a fall from height in 4%. Latent period 52% of cases presented to the hospital between 0 and 6 h of the incident. 10% associated chest injuries. 42% showed splenic injury, thereby making it the most commonly injured organ. 28% had the liver injury. 28% had hemoperitoneum with source of bleed being unknown. Conclusion: CASS is a reliable and promising scoring system with sensitivity comparable to AAST CT grading in determining the need for surgical intervention in BTA patients. CASS provides an effective means of saving time and resources and gives the added advantage of avoiding expenses to underprivileged patients in our country.

Enterolithotomy for Gallstone Ileus: An Uncommon Cause of Intestinal Obstruction

Gallstone ileus is a rare complication of cholelithiasis which represent 1-3% of the causes of intestinal obstruction in the general population and is more commonly seen in females. Gallstone ileus does not present with unique symptoms, making the diagnosis difficult. Symptoms are often non-specific with intermittent intestinal obstruction. The management is surgical, but there is no consensus as to which of the different surgical techniques is the procedure of choice. We report an interesting case of a 78-year-old male brought to casualty with abdominal pain following a history of fall. Managed as a case of blunt trauma abdomen initially. Surprisingly investigations showed features of small bowel obstruction, a hyperdense structure in the distal jejunum with dilated proximal jejunal loops suggestive of gallstone ileus. The patient had undergone exploratory laparotomy with enterotomy and removal of gallstones without any postoperative complications. Intraoperatively cholecystoduodenal fistula was identified and the patient was electively planned for cholecystectomy and fistula repair.

Management of liver trauma after blunt trauma abdomen

Objective: is to investigate the better management plan for liver injury after blunt trauma abdomen according the latest classification system. Methodology: Prospective study was conducted at department of general surgery Nishtar hospital Multan from 31st July 2022 to 30th June 2023 in one year duration. A total of 70 patients with liver injury diagnosed intraoperatively or by CT scan were enrolled in the study. Main variables of study were Moore score, Mirvis score, mechanism of injury, organ affected and type of injury according to classification. SPSS version 23 was used for data analysis. Results: Frontal car accident was the most common trauma mechanisms in type A patients 51.6% and complex traffic accident was the most common trauma mechanisms in type B patients 38.5%. High-energy trauma in type A and type B patients was 80.6% and 89.7% patients respectively. Further, demographic and baseline characteristics of type A and type B patients were almost equal, (p&gt;0.010). Conclusion: The management of liver injury has shift towards a more individualized approach depending on the localization of parenchymal disruption (damage to the liver tissue) and may correlate with the mechanism of trauma. Type of injury is the correlation with necessity of surgical management.

Role of FAST in blunt trauma abdomen: A promising diagnostic tool to evaluate management in patients and comparison of its accuracy with CT and laparotomy

Background: Focused assessment with sonography for trauma (FAST) is a limited ultrasound examination directed solely at identifying the presence of free intraperitoneal or pericardial fluid. In the context of traumatic injury, free fluid is usually due to hemorrhage and contributes to the assessment of the circulation. Performed in the trauma room by properly trained and credentialed staff, it allows the timely diagnosis of potentially life-threatening hemorrhage and is a decision-making tool to help determine the need for transfer to the operating room, computed tomography (CT) scanner, or angiography suite. The FAST scan is a 4 view scan reliant on detecting the presence of fluid within the pericardium and most dependent zones of the peritoneum in the horizontal patient. It is capable of detecting more than 100–250 mL of free fluid. CT scanning, in comparison, is capable of detecting more than approximately 100 mL of free fluid in the abdominal cavity. As a “rule of thumb,” a rim of 0.5 cm of fluid in Morison’s pouch represents approximately 500 mL of free fluid, and a 1 cm rim represents approximately 1000 mL. Aims and Objectives: The aims of this study were as follows: Role of FAST in blunt trauma abdomen: A promising diagnostic tool to evaluate management in patients and comparison of its accuracy with CT and laparotomy. Materials and Methods: The FAST scan was performed by Color Doppler Siemens Sonoline G-50 machine using either 2–5 MHz convex transducers or 5–10 MHz linear transducer department of Radiology L.L.R. Hospital, Kanpur. At FAST examines four areas for free fluid, perihepatic and hepatorenal space, perisplenic, and pelvis pericardium. Results: Sensitivity of FAST: 87.5%, specificity of FAST: 75%, and negative predictive value (NPV) of FAST are 80%. CT scan had sensitivity of: 97%, specificity of: 95%, and positive predictive value of CT scan: 92% NPV of: 100%. Laparotomy was GOLD standard with specificity of 100%. Conclusion: FAST was positive in 62.5% cases of blunt trauma abdomen. Sensitivity of FAST: 87.5%, specificity of FAST: 75%, and NPV of FAST are 80%. CT scan had sensitivity of: 97%, specificity of: 95%, positive predictive value of CT scan: 92%, and NPV of: 100%. Laparotomy was GOLD standard with specificity of 100%.