Cases Of Abdominal Trauma Research Articles

Laparoscopy in Pediatric Abdominal Trauma: A 13-Year Experience.

Introduction Abdominal injuries are common, costly, deadly, and a source of considerable uncertainty in pediatric trauma. In some circumstances, laparoscopy offers a diagnostic and therapeutic alternative with less morbidity than standard exploration, and more certainty than most imaging. In this study, we review our experience with laparoscopic exploration for trauma. We hypothesized that laparoscopy could be employed effectively in stable blunt or penetrating trauma patients in whom diagnostic uncertainty was unresolved by imaging. Patients and Methods A retrospective review of the trauma database identified all children admitted to our Level I pediatric trauma center between January 1, 2000, and December 31, 2012, requiring surgical abdominal exploration. The utilization of laparoscopy and laparotomy was charted over the 13-year period. Negative laparoscopies and laparotomies and nontherapeutic laparoscopies and laparotomies were examined to investigate clinical scenarios in which laparotomy might have been avoided. Statistical analyses were performed using descriptive statistics, simple linear regression analysis, and Mann-Whitney U test (p < 0.05). Results Over the 13-year study period, there were 16,321 trauma admissions. Of these, 119 patients (0.7%) required surgical abdominal exploration: 81 patients underwent laparotomy and 38 patients underwent laparoscopy. In 13 patients (34.2%), laparoscopic exploration ruled out injuries. In nine patients (23.7%), laparoscopy identified an injury for which no surgical intervention was necessary. In nine patients (23.7%), an injury was repaired laparoscopically. In seven cases (18.4%), the identified injury required conversion to laparotomy. There were no missed injuries. In the laparotomy group, a less invasive approach could have yielded the same information in 8.7% of patients. Laparoscopy was more likely to be used after a qualitative change in institutional minimally invasive surgical capability. Conclusion Laparoscopy reliably resolves diagnostic uncertainty in selected cases of pediatric abdominal blunt and penetrating trauma. In a hemodynamically stable patient with a concerning exam and inconclusive imaging, laparoscopy provides sensitive diagnostic capability and opportunity for definitive repair with diminished surgical morbidity.

Review of a 10-year single center experience in treatment of thoracoabdominal aortic trauma

Objective To review the case data and treatment methods in a single center so as to search for rational treatments for thoracoabdominal aortic trauma. Methods This retrospective analysis was performed for 34 cases (28 males and 6 females) sustaining thoracoabdominal aortic trauma treated from October 2002 to February 2013. The mean age was 41 years (range, 11-60 years). Causes of injury included traffic crashes in 14 cases, high falls in 7, stab wound in 3, abdominal crash injury in 3, aorticoesophageal fistula caused by a fish bone in 3, interventional therapy-induced aortic dissection in 2, abdominal aortic injury caused by the dropped ventricular septal defect occluder in 1, and accidental aortic injury in spinal operation in 1. There were 23 cases of thoracic aortic trauma (6 sharp and 17 blunt) and 11 cases of abdominal aortic trauma (4 sharp and 7 blunt). Preoperative imaging findings, treatment methods and follow-up data were studied. Results Personal treatment was produced based on the mechanism of injury and imaging findings. Of sharp thoracic aortic trauma, 2 cases were treated non-operatively but both died, and four cases had endovascular repair (one progressed, two cured, and one died). All the four cases of sharp abdominal aortic trauma had open surgery (three cured and one severely complicated). Of thoracic aortic trauma, four cases were treated non-operatively (three cured and one died), twelve cases had endovascular repair (11 cured and one died), and one case had open surgery and cured. Six cases of blunt abdominal aortic trauma were treated non-operatively and one had open surgery. Conclusions Treatment of aortic trauma should be based on injury condition, injury site, and occurrence of aortic rupture or impending of aortic rupture. Endovascular repair has a high success rate and good clinical outcome in treatment of thoracoabdominal aortic trauma. Key words: Aorta; Wounds and injures; Endovascular repair

大動脈閉塞バルーン併用下の手術が有効であった腹部外傷の3例

大動脈閉塞バルーン併用下の手術が有効であった腹部外傷の3例

REGENERATIVE PECULIARITIES OF LIVER TISSUE AFTER HEMOSTASIS BY NONEQUILIBRIUM PLASMA ON 90TH AND 180TH DAY (EXPERIMENTAL STUDY)

Liver damages occur to 17.8% of blunt abdominal trauma cases. Postoperative mortality in liver damage is a high. It amounts to 4–10% in case of stab wounds, to 30.4–35,2% in case of closed injury, to 39.3% in case of concomitant injury. Complete hemostasis without damage to organ parenchyma is needed for liver surgical operation. The aim of research is to evaluate the regenerative characteristics of liver tissue after hemostasis by nonequilibrium plasma in a long-term period. Material and methods. Research was performed on 20 laboratory rats, 3 experimental groups. 10 intact animals and 5 animals in groups on 90th and 180th day. Surgery is resection of liver left lobe and coagulation with cold plasma coagulator. The biochemical control (glucose, ALT, AST, total bilirubin, direct, alkaline phosphatase, total protein, urea, α-amylase, CRP, fibrinogen, aPTT, PTT, INR), morphological study of rat liver were performed. Results. After surgery with cold plasma hemostasis animals are active, early begin to eat. Fatal cases are not. Analysis of biochemical markers doesn't reveal statistically significant differences from the norm for the majority of indicators. Decrease of glucose concentration in the blood serum is observed in a long-term period. Histological analysis reveals an increase of the central and interlobular veins and moderate signs of edema on the 90th day. Hepatocytes with pronounced signs of protein and fatty degeneration are identified. Liver histology corresponds to the usual structure and is represented by liver lobules, separated by a small layer of connective tissue on the 180th day. Conclusion. Cold plasma coagulation in liver surgery showed effective hemostasis, minimal trauma of organ parenchyma, the lack of systemic effect and the subsequent complete regeneration of liver tissue in the treatment area.

English

This prospective study based on the analysis of 60 consecutive cases of blunt abdominal trauma admitted to Department of Surgery M.K.C.G. Medical College hospital, Berhampur, Odisha, during the study period of JULY 2012- JULY 2014. Each patient was examined thoroughly, after taking a detailed history and Cases were admitted on emergency basis and possible immediate investigations were done. The diagnosis was made with history, clinical features and X-ray chest PA view and/or X-ray abdomen erect posture with/ without ultrasound abdomen computed tomography of abdomen and pelvis to support the diagnosis. AIMS AND OBJECTIVES: To determine the incidence, Patho-Physiology and Management of various abdominal organs injuries caused by blunt force. RESULTS: Among 60 cases of blunt abdominal injury, maximum number of cases belongs to the age group 21-30 yrs. Males were the predominant victims with ratio 7.5:1. It was found that road traffic accidents by heavy vehicle like bus; car and truck were responsible for 71.66% of blunt abdominal injuries. Among 60 cases of blunt injury, the incidence of the involvement of jejunum, spleen, liver and stomach were 30%, 25%, 15%, 8.33% cases respectively. Exploratory Laparotomy was done in 48 cases and 12 cases were managed conservatively to change the fate of these patients. The procedures adopted in the management were splenectomy, hepatorrhaphy, omental patch closure (either Grahams or modified Grahams technique according to the surgeon's preference), simple closure, resection anastomosis, iliostomy or colostomy etc according to the surgical pathology and general condition of the patient. Mortality rate in this study is 11.66% (n=7) and immediate cause of death was shock and haemorrhage and in those cases where death was delayed, cause of death was septicaemia. CONLUSION: Road Traffic Accidents is the major cause and small intestine is more frequently involved abdominal organ. Early diagnosis and treatment of blunt abdominal trauma carries better prognosis. The mortality is more in patients with other associated injuries especially head injuries and in patients who were admitted delayed in the hospital. Evaluation of other associated injury should be mandatory in all blunt abdominal trauma cases.

Left thoracotomy utilizing splenectomy in blunt thoracic injury: An alternative surgical approach

INTRODUCTIONPosterolateral thoracotomy could be an alternative surgical approach in selected cases coexistence of abdominal injuries with ipsilateral thoracic injury. PRESENTATION OF CASEA 65-year-old male with left sided chest injury was initially admitted to a regional health center after a crawler overthrow accident. He underwent chest tube drainage of left hemithorax and he was transferred immediately to our hospital. A CT scan showed a large spleen which was injured by a wedged splint of the 10th rib into its parenchyma. Lung parenchyma was also lacerated by chest tube misplacement with associated hemothorax. He underwent a lower left lateral thoracotomy. Splenectomy was performed via a phrenotomy and subsequently the injured lung was repaired. His postoperative course was uneventful. DISCUSSIONIncisions in the diaphragm are commonly made to provide adequate exposure during a variety of thoracic and abdominal operations. Thoracic approach could potentially be advantageous for thoracic and abdominal injuries. CONCLUSIONThoracic approach is a safe alternative, providing excellent exposure of upper abdominal organs, and should be considered in selected cases of abdominal trauma, especially when an ipsilateral thoracic injury coexists.

Imaging of traumatic adrenal injury

Traumatic adrenal injury is a relatively rare event, reported in 0.15 to 4 % of blunt abdominal trauma cases. The location of the adrenal glands, protected deeply within the retroperitoneum, accounts for the rarity of adrenal trauma. These injuries are unilateral in 75 to 90 % of cases and most commonly afflict the right adrenal gland. While no specific clinical symptoms or signs point directly to adrenal injury, and isolated adrenal injury is rare, the presence of adrenal injury can be an indicator of severe trauma. In fact, mortality rates in series of adrenal injuries range from 7 to 32 %. The most common associated injuries affect the liver, ribs, kidney, or spleen. Three theories of adrenal injury from blunt trauma have been proposed: (1) acute rise in intra-adrenal venous pressure due to compression of the IVC during impact, (2) crushing between the spine and surrounding organs, and (3) deceleration forces shearing the small adrenal arterioles. The most common imaging features include a 2-3-cm oval hematoma, irregular hemorrhage obliterating the adrenal gland, periadrenal hemorrhage or fat stranding, and uniform adrenal swelling with increased attenuation. The differential diagnosis of adrenal abnormalities on trauma CT includes adenoma, carcinoma, myelolipoma, metastases, pheochromocytoma, and tuberculosis. Preexisting adrenal disorders can predispose the adrenal to injury with minor trauma. Most adrenal traumatic injuries are managed conservatively.

Ultrasound and Ski Resort Clinics: Mapping Out the Potential Benefits

Skiing and snowboarding are popular activities that involve high kinetic energies, often at altitude, and injuries are common. As a portable imaging modality, ultrasound may be a useful adjunct for mountainside clinics. This review briefly discusses skier and snowboarder injury profiles and focuses on the role of ultrasound for each injury type. Twenty-two sources including 17 reviews and observational studies were obtained describing skier and snowboarder injuries. Forty-nine studies were identified defining ultrasound applications for these injuries, including 38 reviews and observational studies, 6 case reports or case series, 3 cross-sectional studies, and 2 randomized, blinded studies. Approximately 200 000 rider injuries are evaluated in the Unites States seasonally. Musculoskeletal injuries are the most common, and head, face, neck, and abdominal injuries are also prevalent, as are exacerbations of preexisting disease. Ultrasound has been shown to be useful and accurate for evaluating the aforementioned injury types, including joint, ligament, tendon, and fracture evaluation. Ultrasound has not been extensively studied in the prehospital setting, and only limited data address the utility of how it might influence management in a mountainside clinic setting. Ultrasound has the potential to be a useful diagnostic modality in ski resort clinics. The most promising areas for future, applied studies include evaluation of musculoskeletal injuries (especially injuries to joints and tendons and ruling out fractures), assessing for elevated intracranial pressure in minor head injuries and symptoms of altitude illness, and focused assessment with sonography for trauma and extended focused assessment with sonography for trauma examinations for cases of chest and abdominal trauma of unknown significance.

Management of severe blunt renal trauma in adult patients: a 10‐year retrospective review from an emergency hospital

What's known on the subject? and What does the study add? Immediate surgery for major renal truma has led to a high rate of nephrectomy in comparison with an expectant management. We reviewed our case material on the management of severe blunt renal trauma in adults with emphasis on conservative management. Only shattered kidneys and pedicle avulsion required immediate surgery. To review retrospectively the management of major blunt renal truma in adult patients admitted to our level I trauma centre. Among 1460 blunt abdominal trauma cases collected from January 2001 to December 2010, 221 (15%) affected the kidneys. All patients, except seven who needed immediate laparotomy, underwent a computed tomography scan to stage the injuries. Renal injuries were graded according to the American Association for the Surgery of Trauma Grading System; grade 4 and 5 injuries were subclassified based on vascular or parenchymal injury. Only 45/221 patients (20%) suffered major blunt renal trauma (21 grade 3, 18 grade 4 and six grade 5); 43% of the patients had associated lesions and 77% had gross haematuria. Nephrectomy rates were 9% for grade 3, 22% for grade 4 and 83% for grade 5 with an exploration rate of 26% for major renal trauma. Conservative management of grade 3-5 blunt renal trauma in haemodynamically stable patients yields more favourable results with high renal salvage rate. Grade 5 injuries still result in a nephrectomy rate of more than 80%. The absence of data on long-term outcomes and a potential inclusion bias due to the retrospective nature of the data represent major limitations of this review.

Trauma de Páncreas

RESUMEN Objetivo Analizar de forma retrospectiva una serie de casos de lesiones pancreáticas en el contexto de trauma abdominal penetrante asistidos en el Hospital Maciel en el año 2010, y realizar una revisión actualizada de los puntos más controversiales en trauma pancreático centrándonos en el diagnóstico y manejo terapéutico. Métodos Se analizó retrospectivamente una serie de 5 pacientes que fueron asistidos en el Servicio de Urgencias del Hospital en 2010. Todos presentaron trauma abdominal penetrante, siendo 4 por heridas de arma blanca y 1 por herida por proyectil de arma de fuego. La lesión pancreática fue diagnosticada en el intraoperatorio en todos los casos. Se constató lesión hepática asociada en 3 casos, seguida por el estómago en 2 y vena cava en 1. En 2 pacientes se comprobó la existencia de lesión del ducto principal a la izquierda de los vasos mesentéricos, y ambos fueron tratados con pancreatectomía distal. Los restantes casos fueron manejados con drenajes a nivel de la logia pancreática. En cuanto a la morbimortalidad, 1 paciente falleció en el postoperatorio reingresando luego del alta por shock hipovolémico en anemia aguda, probablemente vinculado a lesión vascular inadvertida. De los restantes pacientes 1 evolucionó favorablemente, sin complicaciones. Los restantes 3 presentaron una fístula pancreática que en todos los casos fue autolimitada y en 1 caso se constató una colección peripancreática que fue resuelta por vía percutánea sin incidentes. Resultados Las lesiones traumáticas del páncreas son poco frecuentes. (2-4% de los casos de trauma abdominal) En nuestra serie el 100% fue consecuencia de trauma penetrante y el diagnóstico intraoperatorio, siendo la asociación lesional la regla tal como se publica en la literatura. El manejo terapéutico de estas lesiones es uno de los puntos de mayor controversia. En tal sentido, 3 de 5 pacientes (60%) presentaron lesiones de baja complejidad y pudieron ser tratados con técnicas sencillas como procedimientos hemostáticos y colocación de drenajes. Los 2 pacientes restantes fueron sometidos a procedimientos resectivos. La morbimortalidad de nuestra serie fue elevada, como es esperable en estos casos. La fístula pancreática fue la complicación principal. La mortalidad fue de 20%. Conclusiones Las lesiones traumáticas del páncreas son de baja frecuencia y difícil diagnóstico preoperatorio por lo cual debe tenerse un alto índice de sospecha. Son más frecuentes en el trauma penetrante que en el contuso, siendo la asociación lesional y una elevada morbimortalidad la regla en estos casos. El tratamiento quirúrgico admite muchas posibilidades, siendo siempre aconsejable realizar lo menos posible.

Bilateral ureteropelvic disruption following blunt abdominal trauma: Case report

BackgroundUreteral injury occurs in less than 1% of blunt abdominal trauma cases, partly because the ureters are relatively well protected in the retroperitoneum. Bilateral ureteral injury is extremely rare, with only 10 previously reported cases. Diagnosis may be delayed if ureteric injury is not suspected, and delay of 36 hours or longer has been observed in more than 50% of patients with ureteric injury following abdominal trauma, leading to increased morbidity.Case presentationA 29-year-old man was involved in a highway motor vehicle collision and was ejected from the front passenger seat even though wearing a seatbelt. He was in a preshock state at the scene of the accident. An intravenous line and left thoracic drain were inserted, and he was transported to our hospital by helicopter. Whole-body, contrast-enhanced computed tomography (CT) scan showed left diaphragmatic disruption, splenic injury, and a grade I injury to the left kidney with a retroperitoneal haematoma. He underwent emergency laparotomy. The left diaphragmatic and splenic injuries were repaired. Although a retroperitoneal haematoma was observed, his renal injury was treated conservatively because the haematoma was not expanding. In the intensive care unit, the patient's haemodynamic state was stable, but there was no urinary output for 9 hours after surgery. Anuresis prompted a review of the abdominal x-ray which had been performed after the contrast-enhanced CT. Leakage of contrast material from the ureteropelvic junctions was detected, and review of the repeat CT scan revealed contrast retention in the perirenal retroperitoneum bilaterally. He underwent cystoscopy and bilateral retrograde pyelography, which showed bilateral complete ureteral disruption, preventing placement of ureteral stents. Diagnostic laparotomy revealed complete disruption of the ureteropelvic junctions bilaterally. Double-J ureteral stents were placed bilaterally and ureteropelvic anastomoses were performed. The patient's postoperative progress was satisfactory and he was discharged on the 23rd day.ConclusionDiagnosis of ureteral injury was delayed, although delayed phase contrast-enhanced CT and abdominal x-rays performed after CT revealed the diagnosis early. Prompt detection and early repair prevented permanent renal damage and the necessity for nephrectomy.

Clinical analysis of 64 cases of closed abdominal trauma

Objective To investigate the clinical diagnosis and treatment of blunt abdominal trauma(BAT).Methods The clinical data of 64 patients with BAT were retrospectively analyzed.Results 49 patients treated by surgery were cured and 12 cases treated by non-surgery were cured.3 patients died,two of them died for multi-organ dysfunction and one of them died for brain trauma.Conclusion Because the BAT is severe and complicate,so it shoald be diagnosed and treated as soon so possible. Key words: Wounds and Injuries; Abdominal Injuries

Children with Acute Abdomen Requiring Surgery at Muhimbili National Hospital Dar es Salaam

Background: Management of acute surgical abdominal emergencies in children is challenging accounting for significant morbidity and mortality. The latter can be overcome by making a prompt diagnosis so that appropriate treatment can be initiated at the primary health facility and then referred to a specialized centre for further management including surgery. Objective: The aim of this study was to examine the causes and clinical outcomes in children (>30days-10 years) with acute abdomen requiring surgical intervention at Muhimbili National Hospital, (MNH). Methodology: Data was prospectively collected on all children aged between one month and ten years who underwent surgery for acute abdominal emergencies at Muhimbili National Hospital for one year from January 2009 to December 2009. Data collected were patient’s profile, duration of symptoms, clinical diagnosis, clinical outcomes, period of hospitalisation and reasons for delayed presentation to Hospital (MNH). Data analysis was done using the computer program EPI info version 6. Results: A total of 97 children were recruited into the study. 62 were boys (64.0%) and the male to female ratio was 1.8:1. The mean age at presentation was 4.4years (SD ± 3.4). Intestinal obstruction was seen in 58 cases and was the leading cause of abdominal surgical emergency (59.8%). Other causes included 14 cases of abdominal trauma (14.4%), 13 children with peritonitis (13.4%) and 12 with acute appendicitis (12.4%). Wound sepsis was the main postoperative complication seen in13cases (13.4%) and 11 children died giving a mortality of 11.3%. Higher mortality was observed in those who were operated for peritonitis (15.4%) and the main reason for delayed presentation to MNH hospital (≥3 days of symptoms) was misdiagnosis at the primary health facilities (62.1%). Conclusions and Recommendations: Acute surgical abdomen predominantly occurred in boys and intestinal obstruction was the main cause. Children who presented late to hospital (MNH) had higher morbidity and mortality. Peritonitis was substantially associated with high mortality and misdiagnosis at the initial health facilities was the major cause for delayed referral to hospital from onset of symptoms. Therefore efforts should be made to improve awareness of clinical presentation of acute abdominal conditions in children at both in the local environment and primary health care level to facilitate early presentation and referral to appropriate specialized centres. Substantial improvement of paediatric surgical care is required in terms of personnel like paediatric surgeons, specialized paediatric anaesthesiologists and nurses as well as the availability of surgical and intensive care facilities for children to reduce mortality. Key wards: Children, acute surgical abdomen, clinical outcome.

Massive gastric bleeding from a blunt abdominal trauma: Report of a case

Blunt gastric injury (BGI) is a rare condition that accounts for 0.02%-1.7% of all blunt abdominal trauma cases. Blunt gastric rupture, which occurs in less than 40% of all BGI cases, presents unstable vital signs and symptoms of peritonitis due to massive peritoneal contamination. This article presents the case of a patient with BGI who did not present with symptoms of peritonitis in spite of presenting with persistent hypovolemic shock.

Handlebar hernia: a case report and literature review on traumatic abdominal wall hernia in children

A rare case of abdominal trauma, a handlebar hernia, is described, as well as a review of the pertinent literature. A 7-year-old boy presented to our emergency room after sustaining blunt force to the abdomen; he fell on the handlebar of his bicycle. Immediately after the accident, a bulge was noticeable at the point of impact. Handlebar hernia is a diagnosis that is easily missed, which can lead to strangulation and incarceration of the bowel. With this case report, we hope to augment the knowledge on traumatic abdominal wall hernia, hopefully leading to early diagnosis and treatment.

Laparoscopy in Abdominal Trauma

The decision in favor of surgery or nonoperative conservative treatment in blunt and penetrating abdominal trauma requires a precise diagnosis that is not always possible with imaging techniques, whereby there is great danger that an injury to the diaphragm or intestines may be overlooked. To avoid such oversights, indications for exploratory laparotomy have traditionally been generous, to the extent that up to 41% of exploratory laparotomies turn out to be nontherapeutic and could be, or could have been, avoided with laparoscopy. A diagnostic laparoscopy with therapeutic option should only be attempted in stable patients. Three trocars are usually used and the abdomen is explored systematically, beginning with the right upper quadrant and continuing clockwise. Hollow viscus injuries and injuries to the diaphragm and mesentery can be detected and sutured laparoscopically. Injuries to parenchymal organs are not a primary focus of laparoscopy, but with a laparoscopic approach, they usually no longer bleed in stable patients and can be sealed with tissue adhesive and collagen tamponade to prevent re-bleeding. The routine use of laparoscopy can achieve a sensitivity of 90-100% in abdominal trauma. This can reduce the number of unnecessary laparotomies and the related morbidity. Laparoscopy can be performed safely and effectively in stable patients with abdominal trauma. The most important advantages are reduction of the nontherapeutic laparotomy rate, morbidity, shortening of hospitalization, and cost-effectiveness. In the future, new developments in and the miniaturization of equipment can be expected to increase the use of minimally invasive techniques in abdominal trauma cases.

Ureteral injuries from gunshots and shells of explosive devices

Context:Penetrating rather than blunt trauma is the most common cause of ureteral injuries. The approach to management differs from the far more common iatrogenic injury.Aims:The purpose of this series is to report our experience in ureteral trauma management, with attention to the diagnosis, repair, and outcome of these injuries.Materials and Methods:From April 2003 to October 2009, all abdominal trauma cases received alive, reviewed for penetrating ureteric injuriesResults:A total of twenty (fifteen male, five female) penetrating ureteral injuries were evaluated. All penetrating ureteric injuries were due to (9 gunshot and 11 shells from explosive devices). Since the patients had a clear indication for surgery, no IVU or CT scan was done preoperatively, major intra-abdominal injuries were often associated. The diagnosis of ureteric injury was made intraoperatively in 8 cases (40%) While, twelve cases (60%) were diagnosed postoperatively. Eight ureteric injuries (40%) were proximal 1/3, 4 (20%) to middle 1/3 and 8 (40%) to the distal 1/3. Management was with stenting in 2 patients, ureteroureterostomy in 8, ureteroneocystostomy in 6, and nephrectomy in 4.Conclusions:In this study, a delay in diagnosis was a contributory factor in morbidity related to ureteral injury, the need for second operation in already compromised patients from associated injuries, The presence of shock on admission, delayed diagnosis, and colon injuries were associated with a high complication rate. Ureteral injuries must be considered early during the evaluation of penetrating abdominal injuries.

WOUND DEHISCENCE

Introduction: Exploratory laparotomy is a common procedure performed at the surgical floor, mainly in emergency. The need for exploration ranges from cases of abdominal trauma to those of preexisting abdominal ailments. Wound dehiscence, either partial or complete does occur after laparotomy and a number of studies have been performed to find out its frequency after laparotomy and to pin point the factors responsible for this complication. This study is designed to find out the frequency of wound dehiscence after exploratory laparotomy. Also it will compare frequency of wound dehiscence in trauma cases verses cases of abdominal pathology. O b j e c t i v e s : (1) To work out frequency of wound dehiscence after exploratory laparotomy. (2) To know the differential frequency of wound dehiscence after acute abdominal trauma compared with those having preceding underlying pathology and were explored. S t u d y D e s i g n : It was a prospective observational study. Settings: Surgical units Allied Hospital, Faisalabad department of surgery. S a m p l e Size: 200 patients operated in emergency and elective lists for abdominal exploration. S a m p l i n g t e c h n i q u e : Non probability (convenience). E x c l u s i o n criteria: (1) Children less than 10 years (2) Sub costal incision (3) Pfennensteil incision (4) Morrison's' incision (5) Grid iron incision and; (6) Incisions to explore the kidney were excluded. (7) Those patients who expired in emergency just after exploration. Inclusion criteria: All patients above 10 years opened by midline laparotomy incision. R e s u l t s : Out of 200 patients, 20 got wound dehiscence. It included 7 from Group I and 13 from Group 2. C o n c l u s i o n : Improved surgical technique, early arrival in hospital and control of infection can bring the incidence of wound dehiscence after exploratory laparotomy down to a level comparable to international figures.

Caracterização dos traumas abdominais em pacientes atendidos no Hospital Universitário Regional de Maringá, 2006

Of all the deaths due to external cause trauma, half could be avoided, and a third are potentially preventable. The objective of this study was to determine the common characteristics related to patients with abdominal trauma. A study was conducted of 57 cases of abdominal trauma at the University Hospital of Maringá, during the period from January to December 2006. The majority of victims are male; the most affected age group is in its third decade of life; open abdominal trauma proved to be slightly more prevalent, and wounds from cold steel weapons were the most common; most abdominal injuries were due to traffic accidents; the conduct of surgical intervention overcomes conservative treatment in open abdominal trauma; in contusion trauma, spleen and kidneys were the most affected organs, while in open wounds the most affected viscera was the small intestine; evolution to death predominated in open abdominal trauma. Because of the prevalence, severity and importance of the issue, it is suggested that further studies be conducted in order to establish conducts more appropriate to our reality.

Ultrasound in diagnosis of traumatic intra-abdominal lesions. Value in primary diagnosis in the shock unit

To evaluate sonography as a tool for initial diagnosis in emergency room patients with abdominal trauma. 174 cases of abdominal trauma were selected from 1837 emergency care patients. The initial sonographic findings were compared to CT-evaluation, operative and autopsy results, and both clinical and sonographic follow-up. In 31 cases initial sonographic findings were positive, leading to 6 laparotomies. In another 6 cases, changes of follow-up sonographic testing led to laparotomy. In 143 patients, the initial sonographic evaluation was negative. In this group, follow-up evaluation revealed changes in 16 cases leading to 3 laparotomies. In 8 patients with stab injuries, the negative sonographic study was confirmed by operative findings. Sonography is a well-tested diagnostic method in evaluating patients with abdominal trauma. Follow-up examinations-even with negative initial results-are needed. While the time interval between evaluations depends on the individual risk factors, hourly reevaluation is generally appropriate.