Complication Of Blunt Abdominal Trauma Research Articles

Development and validation of a nomogram to predict postsurgical intra-abdominal infection in blunt abdominal trauma patients: A multicenter retrospective study

BackgroundIntra-abdominal infection is a common complication of blunt abdominal trauma. Early detection and intervention can reduce the incidence of intra-abdominal infection and improve patients’ prognoses. This study aims to construct a clinical model predicting postsurgical intra-abdominal infection after blunt abdominal trauma. MethodsThis study is a retrospective analysis of 553 patients with blunt abdominal trauma from the Department of General Surgery of 7 medical centers (2011–2021). A 7:3 ratio was used to assign patients to the derivation and validation cohorts. Patients were divided into 2 groups based on whether intra-abdominal infection occurred after blunt abdominal trauma. Multivariate logistic regression and least absolute shrinkage and selection operator regression were used to select variables to establish a nomogram. The nomogram was evaluated, and the validity of the model was further evaluated by the validation cohort. ResultsA total of 113 were diagnosed with intra-abdominal infection (20.4%). Age, prehospital time, C-reactive protein, injury severity score, operation duration, intestinal injury, neutrophils, and antibiotic use were independent risk factors for intra-abdominal infection in blunt abdominal trauma patients (P < .05). The area under the receiver operating curve (area under the curve) of derivation cohort and validation cohort was 0.852 (95% confidence interval, 0.784–0.912) and 0.814 (95% confidence interval, 0.751–0.902). The P value for the Hosmer-Lemeshow test was .135 and .891 in the 2 cohorts. The calibration curve demonstrated that the nomogram had a high consistency between prediction and practical observation. The decision curve analysis also showed that the nomogram had a better potential for clinical application. To facilitate clinical application, we have developed an online at https://nomogramcgz.shinyapps.io/IAIrisk/. ConclusionThe nomogram is helpful in predicting the risk of postoperative intra-abdominal infection in patients with blunt abdominal trauma and provides guidance for clinical decision-making and treatment.

A Woman with Abdominal Pain After Lap-belt Trauma.

A 24-year-old female presented to the emergency department with diffuse abdominal pain after involvement as a restrained driver in a motor vehicle collision (MVC). Computed tomography of the abdomen revealed a traumatic abdominal wall hernia due to rectus wall rupture with complete bowel herniation. A traumatic abdominal wall hernia is a rare complication of blunt abdominal trauma that is typically associated with injury from a motorcycle handlebar but is more commonly seen after a MVC. It is important to consider this diagnosis when evaluating patients with abdominal pain after blunt abdominal trauma from either of these mechanisms.

Case Report: Delayed Presentation of Bowel Obstruction Caused by Blunt Abdominal Trauma.

IntroductionBowel obstruction is a rare but well reported complication of blunt abdominal trauma (BAT). Obstruction is most often seen acutely caused by bowel wall hematomas and chronically as a result of post-traumatic strictures. Here, we present a novel case of BAT causing a subacute obstructing bowel wall hematoma.Case ReportA healthy, 32-year-old male presented to our emergency department with three days of nausea and vomiting. Chart review revealed he had been seen two weeks prior after a high-speed motor vehicle collision. During that initial visit, the patient had a benign abdominal exam and was discharged without imaging. On this return visit, the patient was found to have a large, obstructing colonic hematoma.ConclusionBecause emergency physicians care for patients in both the acute and subacute phases of trauma, clinicians should recognize the more subtle sequelae of BAT.

Case Report of Traumatic Uterine Rupture in a Multigravida Woman with Emergency Department Cesarean Section.

IntroductionUterine ruptures in blunt trauma are an extremely rare complication. Furthermore, while perimortem cesarean sections in cardiac arrest patients are a well-established practice in emergency medicine, cesarean sections in the emergency department are rarely performed on non-arresting patients.Case ReportA multigravida woman at approximately 24 weeks gestation presented as a transfer from an outside hospital after a motor vehicle collision. Upon arriving to our facility, she underwent an emergency cesarean section in the trauma bay and was found to have a uterine rupture with the fetus free floating in the right upper quadrant of the abdomen.ConclusionUterine rupture is a rare but important complication of blunt abdominal trauma in pregnant patients. Resuscitative cesarean sections may be necessary for favorable outcomes. A well prepared and diversified team was essential to maternal survival.

Blunt abdominal injury: a rare cause for delayed small bowel obstruction

Blunt abdominal trauma is a cause of acute abdomen leading to visceral injury and shock. Intestinal obstruction though rare has been a known complication of blunt abdominal trauma. We present to a case of a blunt abdominal trauma leading to delayed intestinal obstruction 4 weeks after primary injury. We present to you a case of blunt abdominal trauma leading to delayed intestinal obstruction 4 weeks after primary injury.

Non-operative management of pancreatic injury

Abstract Background/purpose Pancreatic injury is a rare complication of blunt abdominal trauma in pediatric populations. Non-operative management is increasingly common in pediatric pancreatic injury, using endoscopic interventions. We report our institutional experience with non-operative management of pediatric pancreatic trauma, with a focus on the role of endoscopic interventions. Methods We performed a retrospective review of all cases of blunt pancreatic trauma in children presenting to our urban, academic, level I pediatric trauma center from 1996 to 2016. Results We identified six cases of blunt pancreatic trauma in children aged 2–15 years. One patient required operative intervention for duodenal perforation, but no patients underwent pancreatic surgery. Endoscopic interventions were used in four cases to manage complications, such as pancreatic fluid collections and ductal stenosis. Conclusions Pancreatic trauma can be managed safely and effectively using non-operative interventions in the pediatric population.

Significant bleeding from Meckel\u2019s diverticulum after blunt abdominal trauma: a case report

BackgroundMeckel’s diverticulum, with an incidence of 2%, is the most common congenital anomaly in the gastrointestinal tract. Its main complications are perforation, obstruction, and bleeding. A few studies have reported that blunt abdominal trauma may result in perforation or obstruction to Meckel’s diverticulum. However, reports of significant major intestinal bleeding from Meckel’s diverticulum as a complication of blunt abdominal trauma is rare. This paper present what we believe to be the first reported case of significant intestinal bleeding from a Meckel’s diverticulum following blunt abdominal trauma.Case presentationA 12-year-old Saudi boy of Arab ethnicity presented to the King Saud Medical City emergency department with bleeding per rectum and mild abdominal pain following blunt trauma to his abdomen. On examination, his abdomen was slightly tender, bowel sounds were present, and he was hemodynamically stable. During admission, rectal bleeding was ongoing. On day 3 he deteriorated with decreasing blood pressure and hemoglobin, and increasing pulse rate with fever. After resuscitation and stabilization, he was urgently taken to the operating room for further diagnostic management and treatment. His nasogastric tube revealed bile without blood, and an intraoperative colonoscopy revealed altered blood within his whole colon and terminal ileum without a definite bleeding site. A laparotomy was performed, and an injured branch of the mesenteric artery supplying the Meckel’s diverticulum was identified as the source of the significant arterial bleeding. Suture ligation controlled the bleeding, and the Meckel’s diverticulum was resected. The patient remained stable after that until discharge without any further intestinal bleeding.ConclusionIdentifying bleeding as a complicated Meckel’s diverticulum following blunt trauma to the abdomen can be challenging due to its low incidence and difficulties while making the diagnosis.

Traumatic Superior Mesenteric Artery Pseudoaneurysm: A Rare and Potentially Lethal Complication of Blunt Abdominal Trauma

Pseudoaneurysm arising from the Superior mesenteric artery is very rarely seen as a complication of trauma to abdomen. It has a very low incidence and because of this reason it is less likely to be suspected in patients with traumatic injury to abdomen. If a pseudoaneurysm is ruptured, it can be a life threatening condition and this is the reason, it should always be in mind during management of patients with abdominal trauma. We have reported a case of a young female who was brought in emergency department after blunt traumatic injury to abdomen. She was having the complaints of enlarging lump in epigastric region and pain. She underwent ultrasound followed by CT angiogram and was found to have a pseudoaneurysm arising from superior mesenteric artery.

Arterial Embolization in the Management of Mesenteric Bleeding Secondary to Blunt Abdominal Trauma.

Mesenteric bleeding is a rare but potentially life-threatening complication of blunt abdominal trauma. It can induce active hemorrhage and a compressive hematoma leading to bowel ischemia. Emergency laparotomy remains the gold standard treatment. We aimed to study the effectiveness and complications of embolization in patients with post-traumatic mesenteric bleeding. The medical records of 7 consecutive patients with active mesenteric bleeding treated by embolization in a level-one trauma center from 2007 to 2014 were retrospectively reviewed. All patients presented with active mesenteric bleeding on CT scans without major signs of intestinal ischemia. We focused on technical success, clinical success, and the complications of embolization. Six endovascular procedures were successful in controlling hemorrhage but 1 patient had surgery to stop associated arterial and venous bleeding. One patient suffered from bowel ischemia, a major complication of embolization, which was confirmed by surgery. No acute renal failure was noted after angiography. For 1 patient we performed combined management as the endovascular approach allowed an easier surgical exploration. In mesenteric trauma with active bleeding, embolization is a valuable alternative to surgery and should be considered, taking into account the risk of bowel ischemia.

Arterielles Pseudoaneurysma der Leber nach stumpfem Bauchtrauma

Posttraumatic hepatic artery pseudoaneurysms are a rare but life-threatening complication of blunt abdominal trauma with liver damage. We report the case of a child who developed a pseudoaneurysm of the right hepatic artery after a bicycle accident with central liver rupture. After an episode of hemodynamically relevant hemobilia due to delayed bleeding, the asymptomatic pseudoaneurysm was diagnosed coincidentally by ultrasound. Because of the progression in size angiographic coiling was performed and led to thrombotic occlusion of the pseudoaneurysm. After a symptom-free period of 1 month the child required surgery because of acute cholecystitis.

Tension Viscerothorax after Blunt Abdominal Trauma: A Case Report and Review of the Literature

BackgroundTension viscerothorax is herniation of abdominal viscera into the thorax. Tension viscerothorax can simulate tension pneumothorax. Immediate decompression with a nasogastric tube is required for hemodynamic stabilization. ObjectiveA case of tension viscerothorax is reported along with a review of the literature to highlight this rare complication of blunt abdominal trauma, and to emphasize the importance of nasogastric tube decompression in tension viscerothorax. Case ReportA 10-year-old boy with a remote history of trauma related to a motor vehicle crash was brought into the Emergency Department with a 3-day history of vomiting, epigastric pain, and dyspnea. By physical examination and chest X-ray study, tension gastrothorax was diagnosed. Nasogastric tube placement was difficult and delayed, and the patient deteriorated into cardiac arrest, but after successful cardiopulmonary resuscitation and nasogastric tube insertion, the patient was stabilized. Laparotomy was performed and primary repair of a ruptured diaphragm was done. The patient made an uneventful recovery. ConclusionAcute tension viscerothorax should be considered in the differential diagnosis of tension pneumothorax, and its initial resuscitation should include nasogastric tube insertion for immediate decompression.

Upper Gastrointestinal Bleeding from A Post-traumatic Pseudoaneurysm of the Right Hepatic Artery: Think Outside the Box

Purpose: Case: A 68-year old male with a past medical history of alcohol abuse presented to the ED as a pedestrian involved in a motor vehicle accident. He had stable basal skull fractures, stable vertebral fractures, multiple right rib fractures with associated pulmonary contusions, and stable liver lacerations without bleeding. He was intubated and mechanically ventilated secondary to respiratory failure from his lung and chest wall injuries. His laboratory workup initially showed elevated liver enzymes, but was otherwise unremarkable. He was admitted to the surgical intensive care unit and developed maroon colored stools with a 3-gram drop in his hemoglobin. An upper endoscopy was performed and showed a non-bleeding visible vessel at the gastro-esophageal junction (GEJ) that was clipped with no further bleeding noted, normal stomach, and unremarkable duodenum with bile present up to the second portion of duodenum. A colonoscopy showed maroon colored stool in the colon with diffuse diverticulosis but no source of active bleeding was identified. In the interim, the patient continued to have obscure, overt bleeding and was not adequately responsive to red blood cell transfusion. His bilirubin and alkaline phosphatase were rising, and he had fresh episodes of coffee ground aspirates from his orogastric tube. A repeat upper endoscopy was performed which showed a small area of gastric erosion, an intact endoclip at the GEJ, and blood with blood clots throughout the stomach into the second portion of the duodenum. No source of bleeding was identified to explain the patient's persistent upper GI bleeding. In the view of his recent liver injuries, a duodenoscope was used to examine the ampulla to exclude hemobilia. A blood clot was seen protruding from the ampulla of vater. A recommendation was made to obtain an angiogram to exclude an active source of bleeding. Angiogram of the celiac artery showed a 2x1 cm pseudoaneurysm of the right hepatic artery (RHA) within the right inferior lobe of the liver. Successful coil embolization of the RHA was done with good post angiographic results. Conclusion: We present a unique case of RHA pseudoaneurysm causing hemobilia and upper GI bleeding. There are few reports of hepatic artery pseudoaneurysm as a delayed complication of blunt abdominal trauma. Continued signs of UGI bleeding in a setting of abdominal injury should raise the suspicion of hemobilia and possible hepatic artery injury. The use of a duodenoscope in these situations has great benefit in establishing an accurate diagnosis.

Duodenal rupture following trauma in a child

We present a case of delayed presentation of a traumatic duodenal rupture in a 15-year-old boy. He presented 12 hours after falling six feet and sustaining blunt trauma to his anterior abdominal wall. On arrival in the Emergency Department he was shocked and peritonitic. After initial resuscitation he was stable and transferred to computed tomography where free retroperitoneal air and duodenal rupture was found. He was transferred to theatre where he underwent laparotomy and successful repair of the rupture. He made an uneventful recovery and was discharged nine days later. Duodenal rupture is a rare but serious complication of blunt abdominal trauma. Diagnosis is difficult but missed diagnosis and delayed presentation is associated with high morbidity and mortality. A high index for suspicion must be kept when dealing with blunt abdominal trauma to ensure this is not missed.

Bowel injury in children: high-risk mechanisms and CT findings

Bowel and mesenteric injuries are, fortunately, uncommon complications of blunt abdominal trauma, occurring in 6–16% of injured children and adults. However, unlike injury to solid organs in which operative intervention is rarely necessary, injury to hollow viscera often requires early surgical repair. Delayed diagnosis can result in bowel ischemia, peritonitis and sepsis. Imaging plays a key role in the early and accurate identification of these lesions. This review will focus on high-risk mechanisms of injury and physical findings, as well as the frequency, sensitivity and specificity of CT findings of significant bowel and mesenteric injuries.

Delayed Endovascular Treatment of Renal Artery Dissection and Reno-Vascular Hypertension after Blunt Abdominal Trauma

As a rare complication of blunt abdominal trauma, dissection of the renal arteries can be observed among other severe complications [1, 2] and necessitates immediate surgical or endovascular intervention to prevent significant ischemic organ damage. If successful intervention cannot be performed immediately, patients are prone to develop renovascular hypertension over time through the activation of the renin-angiotensin-aldosterone system (RAAS). However, they still may benefit from a delayed surgical reconstruction of the vessel or percutaneous endovascular treatment. If recovery of kidney function and reversal of renovascular hypertension before the intervention is in doubt due to prolonged delay of revascularization, percutaneous endovascular treatment may be the first option because complication rates can be kept reasonably low. We report a case of a successful but delayed endovascular treatment of a traumatic renal artery dissection and reversal of consecutive renovascular hypertension after blunt abdominal trauma.

Laparoscopic drainage of an intramural duodenal haematoma: a novel technique and review of the literature

Intramural Duodenal Haematoma (IDH) is an uncommon complication of blunt abdominal trauma. IDH's are most often treated non-operatively. We describe laparoscopic treatment of an IDH after failed conservative management. To our knowledge, successful laparoscopic drainage of an IDH in an adult has not been described previously in the literature.

Imaging for Hepatic Vascular Injury from Blunt Trauma in Children—Nine Cases Report

Introduction Hepatic vascular injury (HVI) is an uncommon complication of blunt abdominal trauma (BAT) in children. Diagnosis and management must be done by imaging. Methods A retrospective review of pediatric patients over a seven-year period (2000–2007). Of 25 files of liver injuries (LI), 9 cases of HVI were diagnosed. All of our cases were explored by sonographic, duplex sonography and computed tomography. Results Of twenty-five cases of LI, nine cases of HVI were recorded. Sex ratio male/female = 1.25 with mean age = 7.88, five cases of vein injuries, two cases of traumatic hepatic artery pseudoaneurysm, and two cases of arteriovenous fistula. Conclusion HVI affects 36% of liver injuries. Those injuries are often lethal, so systematic detection and treatment in emergency is essential. The role of imaging is both diagnosis and therapeutic.

Delayed duodenal intramural hematoma with obstruction

An intramural duodenal hematoma with duodenal obstruction is usually a complication of blunt abdominal trauma, endoscopic biopsy, or peptic ulcer disease. Possible management strategies include conservative treatment, surgical evacuation, and percutaneous or endoscopic drainage. We report on a 40-year-old man with a remote history of trauma who presented with vomiting for 3 days. At surgery, he was found to have an intramural duodenal hematoma causing obstruction.

Inframesocolic Abdominal Aortic Injury and Lumbar Vertebral Body Fracture Secondary to Hyperextension with Blunt Trauma.

This case study describes an abdominal aortic injury and lumbar vertebral body fracture after blunt trauma. Abdominal aortic pseudoaneurysm is a rare complication of blunt abdominal trauma. Recent data reveal seven other reports in the literature. We describe a case of an inframesocolic abdominal aortic injury and lumbar vertebral body fracture from blunt trauma in a 16-year-old male after a hyperextension injury while body board surfing.

Traitement conservateur d’un traumatisme hépatique fermé compliqué d’un pseudoanévrisme et de biliomes

Hepatic artery pseudoaneurysm and bilioma are rare complications of blunt abdominal trauma in children. We report a case in an 11-year-old patient after a hepatic and splenic blunt trauma following a car accident. The initial evolution was simple with haemodynamic stability. On Day 12, a pseudoaneurysm was discovered on an abdominal magnetic resonance imaging whereas the patient presented a major pain syndrome and an icteric cholestase. Embolisation was realised a few hours later in emergency because of a haemorrhagic shock. On Day 26, an endoscopic retrograde cholangiopancreatography highlighted two bilary leaks: one extrahepatic, the other intrahepatic. The first one was treated with a stent and the second one needed three drains: two peritoneal and one in the biloma. The characteristic of this case relies on the association of two complications. It underlines the need of multidiscipline and non-operative management of pediatric blunt hepatic trauma.