Intra-abdominal Organ Injury Research Articles

SUCCESSFUL MANAGEMENT OF SHARP ABDOMINAL TRAUMA WITH DIAGNOSTIC LAPAROSCOPY AT DR. ZAINOEL ABIDIN ACEH HOSPITAL

Abdominal trauma is injury that occurs to organs in the abdomen, such as the stomach, intestines, liver, spleen, pancreas, bile and kidneys, damage to the structures located between the diaphragm and pelvis. Abdominal trauma is divided into two types, namely blunt abdominal trauma and stab abdominal trauma. Injuries to the intestines and liver are the most common in penetrating trauma to the abdomen. Case report: a 35 year-old man came to the Emergency Room at the Dr. Zainoel Abidin Regional General Hospital in Banda Aceh with the main complaint of a wooden stab wound (foreign body) on the right side of the abdomen which had penetrated to the back. The patient underwent diagnostic laparoscopy, it was found that a piece of wood (foreign body) was stuck in the liver segment V-VI which had penetrated to the right flank and a hematoma was found around the body and about 100 cc of hemorrhagic fluid originating from the liver due to contact with wood friction but the bleeding was not active. Based on the primary and secondary survey evaluations, the hemodynamic condition was stable. In the evaluation, there were no intra-abdominal organ injury. Extraction of the foreign body wood could be performed well after identification of being free from intra-abdominal organ injury. Conclusion: Abdominal trauma is an injury that occurs to organs in the stomach, such as the stomach, intestines, liver, spleen, pancreas, gallbladder, and kidneys. In this case, it was a penetrating stab wound with stable hemodynamics and no small intestine and omental protruding from the stomach, so this patient underwent diagnostic laparoscopic surgery. The operation with diagnostic laparoscopic in this case was successful and minimally invasive.

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.

THE RELATIONSHIP BETWEEN BODY MASS INDEX AND ABDOMINAL CIRCUMFERENCE WITH INTRAABDOMINAL ORGAN INJURY IN HIGH ENERGY BLUNT TRAUMA PATIENTS

ABSTRACT Objective: The aim of this study was to determine the impact of body mass index (BMI) and abdominal circumference on intra-abdominal organ injury in high energy blunt trauma patients presenting to the emergency department. Materials and Methods: This prospective, cross-sectional, and analytical study included patients who presented to the Ankara Bilkent City Hospital Emergency Medicine Clinic between June 15, 2022, and December 31, 2022, due to high-energy blunt trauma and underwent contrast-enhanced abdominal computed tomography (CT). Patient demographics, vital signs, height, weight, BMI, mechanism of injury, abdominal injuries, injuries to other systems, abdominal circumference measurements, emergency department outcomes, and laboratory results were recorded in the data collection form. CT images were evaluated by a single radiology specialist, and abdominal circumference and subcutaneous fat tissue thickness were measured. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 20.0. Statistical significance was assessed using the p-value, and a significance level of p

Obesity and Penetrating Trauma: Outcomes from a Level 1 Trauma Center in New York City.

Obesity is associated with increased morbidity and mortality in trauma scenarios; however, there has been conflicting evidence on outcomes of obesity and penetrating injuries, specifically gunshot wounds and stab wounds. We hypothesized that obesity may be protective due to a "cushioning effect" attributed to increased adiposity. This was a retrospective cohort study of patients presenting to a Level 1 Trauma Center with a penetrating trauma (gunshot/stab) injury during 2008-2021. Patients with a BMI ≥ 30 were compared to those with a BMI < 30. The primary outcome was Injury Severity Score (ISS). Secondary outcomes included intensive care unit (ICU) length of stay, days on ventilation, length of hospital stay, service of admission (trauma surgery, general surgery, discharged home, general medical floor), the body region of injury(s), Abbreviated Injury Scale (AIS), OR requirement, type of surgery, and discharge status. Statistical analysis was performed using χ2-test or Fisher's exact tests for categorical data, and Student's t-test or Mann-Whitney U-test for continuous variables with p < 0.05 as statistically significant. Subgroup analysis was performed based on the mechanism of injury. There were 721 patients that met inclusion criteria, of which 540 were classified in the non-obese group and 181 (25.1%) in the obese group. The primary outcome, mean ISS score, in obese patients (9.0, SD = 13.0) and non-obese patients (9.4, SD = 13.8) was similar between groups respectively. Secondary outcomes, which included rates of severe abdominal injury (AIS ≥ 3), rates of intra-abdominal organ injury, and rates of gastro-intestinal resection, were also similar between non-obese and obese patients. This study did not demonstrate the existence of a "cushioning effect" in the setting of penetrating traumatic injury. Patients with increased BMI had similar a ISS score and patterns of injury as their non-obese counterparts.

Hollow viscus perforation in blunt abdominal trauma: A 14-year experience from a trauma center.

Isolated perforations of hollow viscus (HV) represent less than 1% of injuries in blunt abdominal trauma (BAT). When they do present, they are generally due to high-impact mechanisms in the segments of the intestine that are fixed. The aim of this study is to determine the incidence of major HV injuries in BAT at the "Dr. Domingo Luciani" General Hospital (HDL), and address the literature gap regarding updated HV perforations following BAT, especially in low-income settings. A retrospective review was conducted on the medical records of patients admitted to our trauma center with a diagnosis of complicated BAT with HV perforation over 14years. Seven hundred sixty-one patients were admitted under the diagnosis of BAT. Of them, 36.79% underwent emergency surgical resolution, and 6.04% had HV perforation as an operative finding. Almost half (44.44%) of these cases presented as a single isolated injury, while the remaining were associated with other intra-abdominal organ injuries. The most common lesions were Grade II-III jejunum and Grade I transverse colon, affecting an equal proportion of patients at 13.33%. In recent years, an increased incidence of HV injuries secondary to BAT has been observed. Despite this, in many cases, the diagnosis is delayed, so even in the presence of negative diagnostic studies, the surgical approach based on the trauma mechanism, hemodynamic status, and systematic reevaluation of the polytraumatized patient should prevail.

Uterine Perforations Post-Manual Vacuum Aspiration: A Time for Re-Training

Manual vacuum aspiration (MVA) is the recommended surgical procedure for early miscarriages. Yet, its performance by unqualified and inexperienced hands without minimal medical knowledge and skills in the societies of developing nations is not uncommon. This can present some serious life threatening but preventable complications like uterine perforation with resultant intra-abdominal organ injuries that require surgical intervention. General awareness and retraining may decrease unsafe practices and thus reduce maternal morbidity and mortality. We present two cases of young multiparous women who underwent MVA for incomplete miscarriages, which were complicated by anterior and multiple fundal uterine perforations and resultant gangrenous bowel evisceration and entrapment respectively.

Contrast-enhanced Computed Tomography Versus Contrast and Non-contrast Enhanced Computed Tomography for Detecting Blunt Abdominal Injury

Objective: This study aimed to compare the diagnostic ability of contrast-enhanced computed tomography (CECT) and CECT combined with non-contrast computed tomography (NCT) for intraabdominal organ injury in patients with blunt abdominal injury.Material and Methods: Overall, 195 adult patients having had blunt abdominal trauma underwent CT at this institution; from 2016 and 2021. All CT images were retrospectively reviewed by two radiologists. The efficacy of detection of organ injuries and the degree of intra-abdominal injury were recorded. The radiologists scored their diagnostic confidence for each CT image dataset on a five-point scale: inter-observer agreement was also calculated.Results: All included patients underwent CT for blunt abdominal trauma. The most common cause of injury was motorcycle accident (59.5%), with patients being predominantly male: the mean patient age was 44 years. Hemoperitoneum was the most common CT finding, with a significantly higher detection rate on CECT combined with NCT than on CECT alone. There was no statistically significant difference in the diagnostic efficacy of the detected organ injury nor other types of organ injuries between CECT alone and CECT combined with NCT. Nevertheless, the accuracy of CECT in detecting hemoperitoneum may diminish in patients with severe fatty liver disease; especially in the perihepatic region.Conclusion: CECT alone is a potential tool for detecting abdominal injuries in patients with blunt trauma. NCT provides no additional benefits in detecting organ injury; except in cases of severe fatty liver disease. NCT is recommended as an optional protocol; particularly for patients with obesity.

Safety and Effectiveness of a Novel Tips Access Set with Steerable Cannula in a Swine Model

PurposeThis study aimed to assess the safety, effectiveness, and feasibility of the Liverty™ transjugular intrahepatic portosystemic shunt (TIPS) access set, which has an ergonomic handle that allows for in situ cannula tip deflection and a distal steerable cannula angle, versus the COOK® Rosch-Uchida Transjugular Liver Access Set (RUPS-100) in healthy pigs.MethodsTwelve pigs randomly underwent TIPS with the Liverty™ set or the RUPS-100 set. Three interventionalists performed 4 TIPS procedures, 2 with each set. The primary outcome was procedural success, defined as successful establishment of the intrahepatic portosystemic shunt and stent placement.ResultsThe shunt was successfully established in 11 pigs. The procedural success was achieved in all 6 pigs in the Liverty™ group and 5 out of 6 pigs for the RUPS-100 group (Fisher exact test, P > 0.999). The mean duration of puncture was shorter in the Liverty™ group versus the RUPS-100 group (12.3 ± 4.5 min vs. 16.2 ± 8.5 min), but without significant statistical difference (two sample t test, P = 0.359). The cannula angle was adjusted 69% of passes in the Liverty™ group, which was significantly higher than that in the RUPS-100 group (12%, P = 0.004). Overall, the TIPS procedural performance was comparable between the groups. Both sets were safe. No intraabdominal hemorrhage, vascular injuries, tissue or organ injuries, porto-biliary fistula, biliary peritonitis, and infection or abscess occurred in either group.ConclusionThe Liverty™ set is safe and has similar procedural metrics to the COOK® RUPS-100 set. It allows in situ adjustment of the angle of the stiffening cannula without increasing procedure time and lessens the occurrences of periprocedural complications.Graphical

Cases of pediatric intra-abdominal solid organ injury induced by blunt trauma experienced over a 15-year period at two centers in Japan

ObjectiveThe present study attempts to clarify the clinical features of pediatric intra-abdominal solid organ injury at two institutions.MethodsThe injured organ, patient age, sex, injury grade, imaging findings, intervention, length of...

Early ambulation in solid intra abdominal organ injury following blunt abdominal trauma in paediatric patients

BackgroundUncertainty exists surrounding the optimal time for ambulation in paediatric patients who have been conservatively managed post intra-abdominal solid organ injury (IASOI) following blunt abdominal trauma, specifically the safety of early ambulation. This study aims to assess the safety of early ambulation in this population. MethodsA single centre retrospective chart review of paediatric patients 15 years old and younger over a 10-year period 01 January 2010 – 31 December 2020 was conducted. Data was collected regarding demographics, time to ambulation, mean length of stay (LOS), Mechanism of Injury (MOI), need for intervention (operative, interventional radiological or medical), opiate analgesia prescription on discharge, and time to return to full physical activity. Logistical regression using Fishers Exact test was used in statistical analysis. ResultsOf the 138 patients included in the study, 115 (83%) sustained an isolated IASOI and 23 (17%) a multiple IASOI. The mean grade of injury for both isolated and multiple IASOI was 3.0. The mean time to ambulation was 2.5 days in isolated IASOI and 2.8 in multiple IASOI. In isolated IASOI, with the exception of pancreatic injures for all other organs over all grades, the mean time to ambulation in children was prior to the grade + rule in days. There were 6 complications (4%) requiring intervention (operative or interventional radiology). There were no cases of delayed haemorrhage in our study population. ConclusionEarly ambulation in isolated IASOI is safe and does not lead to clot destabilization and further haemorrhage requiring intervention. Level of evidenceIII

Small bowel obstruction as a complication of laparoscopic extraperitoneal inguinal hernia repair.

Laparoscopic hernia repeair is associated with its own set of complications, such as intra-abdominal organ and vascular injury, gas embolism, penumoperitoneum, small bowel obstruction secondary to trocar site fascial defects, intra-abdominal adhesion, and reaction to synthetic mesh. With the extraperitoneal approach, the abdominal cavity is not violated, thereby eliminating the risks for these complications. However, small bowel obstruction, albeit rarely, do occur with this approach because of inadvertent violation of the peritoneal cavity, or failure to close the peritoneal opening of the hernia sac, as shown in this case presentation.

Secondary blast injury: radiological characteristics of shrapnel injuries in children.

The aim of this study is to examine the radiological images of child victims suffering from secondary blast injuries, to reveal organ-based injury patterns and their interrelationships, and to record mortality rates that may develop due to injured systems. A total of 65 patients with secondary blast injury due to bomb explosion were included in the study. Injury findings due to shrapnel in radiologic images of the patients were examined. Injured systems and types of injuries were recorded. The most common injuries were intra-abdominal injuries (63%) and fractures (58.5%). Lung injury was observed in 4 (9.8%) of 41 patients with intra-abdominal injury, while 37 (90.2%) did not, and this was statistically significant (p = 0.003). The most common intra-abdominal organ injury was a small bowel injury in 23 (35.4%) patients. The coexistence of small bowel injury and large bowel injury was present in 8 patients (34.8%), and it was statistically significant (p = 0.019). A total of 14 (21.5%) of the patients died. There was no significant relationship between mortality and gender (p = 319). Brain damage was present in 10 (71.4%) of the 14 (21.5%) patients who died, which was statistically significant (p < 0.001). Our results showed that the most common injuries were intra-abdominal injuries, damage to different organs could occur at the same time, and deaths were especially associated with brain injuries. For this reason, it should not be forgotten that CT scans will have an important place in the triage of the patient, especially in victims with shrapnel at the abdominal and cranial levels in radiography examinations.

Pattern and Severity of Traumatic Renal Injury: A Three-Year Study at Single Level One Trauma Center in Southern Iran

Background: Renal trauma is among the most important trauma challenges. Better management of traumatic renal patients is necessary to improve the patients’ clinical outcome. Objectives: This study aimed to analyze the pattern, severity, mechanism of injury, and outcome in renal trauma. Methods: This cross-sectional study was conducted in the largest trauma center in southern Iran from March 2018 to June 2022. Adult patients with diagnosed renal trauma based on abbreviated injury scale guideline were included. Variables of age, gender, anatomy of injury, mechanism of injury, lenghth of hospitalization, level of blood pressure, severity of injury, and the outcome of patients have been collected. Results: In total, 4,416 traumatic patients were admitted to the Emergency Department of the Hospital during the study time, of which 46 cases had traumatic renal injury. The rate of renal injury in the level one trauma center in southern Iran was 0.96%, and the death rate in renal injury victims was 12(26.1%). Most of the injured with renal injury were men 39(84.8%). Blunt trauma was the dominant type of trauma in most victims with renal injury 34(73.9%). Thirty-seven percent (n=17) of traumatic renal injury victim was in mild level (grade 1 and 2), and 16(34.8%) in severe level (grade 4 and 5). Renal injury was mostly associated with thorax injury (n=46) as extra-abdominal organ injury, and liver injury (n=16) and spleen (n=15) as intra-abdominal organ injury. Conclusion: The results of the present study showed that the severity of injury in patients with renal injury is high, and it is usually associated by injury to other body organs. It is suggested that the traumatic patients should be immediately examined for renal injury in the resuscitation department due to the high mortality rate and severity of these patients.

The relationship between the presence of scapula fracture and mortality and morbidity in cases with blunt thoracic trauma.

Scapula fractures (SFs) occur as a result of high-energy trauma and are significant in terms of life-threatening injuries. There are few studies showing the relationship between SFs and mortality and morbidity in patients with blunt thoracic trauma (BTT). Our study aims to investigate the relationship between SF and mortality and morbidity in BTT. Adult patients admitted to the emergency department of Kahramanmaras Sutcu Imam University, School of Medicine with BTT between January 2019 and April 2021 were retrospectively scanned from hospital records. Patients' age, gender, trauma mechanism, additional organ injuries, need for intensive care, length of hospital stay, morbidity, and mortality rates were recorded. Statistical results were expressed as frequency, percentage, and mean±standard deviation (min-max). In comparisons between groups, p<0.05 was accepted as the significance level. Two hundred and thirty-eight cases were included in our study. The scapular fracture was present in 86 cases (36.1%). About 43% of the cases with SFs were falling from a height. Intrathoracic injuries accompanying SF were determined as rib fracture, lung contusion, pneumothorax, hemothorax, and sternum fracture, respectively (91.9%, 80.2%, 41.9%, 37.2%, and 15.1%). Extrathoracic injuries associated with SF were vertebral fractures, intracranial injuries, clavicle fractures, extremity fractures, and intra-abdominal injuries (18.6%, 16.3%, 12.8%, 10.5%, and 5.8%), respectively. When the groups with and without SF were compared, a statistically significant relationship was found between SF and the number of rib fractures, lung contusion, pneumothorax, and hemothorax (p<0.001, p=0.001, p=0.001, p=0.001). In extrathoracic injuries, there was a significant relationship between SFs and vertebral fractures, intra-cranial injuries, and clavicle fractures (p=0.004, p<0.001, p=0.005). There was no difference observed between the groups regarding sternum fractures, extremity fractures, and intra-abdominal organ injuries (p=0.288, p=0.682, p=0.261). In cases with accompanying SF, there was a significant difference in terms of length of hospital stay, need for intensive care, and mortality (p<0.001, p=0.001, p=0.002). The most common intrathoracic injuries accompanying SFs were rib fractures and lung contusion, and the most common extrathoracic injuries were vertebral fractures and intracranial injuries. Moreover, it was found that SF was highly correlated with length of hospital stay, need for intensive care, and mortality. The most common cause of mortality was found to be intracranial hemorrhage. Imaging of other systems is important in cases with SFs. Particular attention should be paid to head-and-neck injuries.

“CLINICAL EVALUATION AND MANAGEMENT OF PATIENTS WITH BLUNT TRAUMA ABDOMEN: A HOSPITAL BASED STUDY”

Introduction: Blunt trauma abdomen occurs as a result of direct forces causing compression or shearing type injuries or deceleration injuries that result in damage to relatively xed structures. The evaluation of abdomen is very challenging and can often result in missed diagnosis. Aims &amp; Objectives: To study the clinical presentation, evaluation, investigations and management of different intra-abdominal organ injury in blunt trauma abdomen. All the patients of trauma abdomen after initial resuscit Methods: ation and achieving hemodynamic stability, were subjected to careful clinical history and a thorough clinical examination. Based on the outcome of clinical and radiological evaluation, the management by operative or non-operative decision was made. A total of fty (50) consecutive blunt Results: trauma abdomen patients were admitted in Gulbarga institute of medical sciences hospital, from August 2021 to August 2022. In the present study, the blunt trauma abdomen was largely seen in age group of 21-30years with male predominance. Road trafc accidents was the leading cause for blunt trauma abdomen. And the Spleen was the most commonly injured organ. Conservative management was done in 28 patients and 22 patients were subjected to operative management. Conclusion: In blunt trauma abdomen, the initial hours after injury are very crucial and can be considered as the golden period of trauma which has better survival rate. The morbidity and mortality of the blunt trauma abdomen can be reduced by timely approach and appropriate management

Traumatic diaphragm rupture treated with left anterolateral thoracotomy approach: a case report

Background: Traumatic diaphragmatic rupture (TDR) is a life-threatening condition due to the herniation of abdominal organs into pleural cavities. Rupture can occur in patients with major blunt or penetration trauma of the lower chest. Blunt TDR is usually caused by momentary high energy damage and is associated with severe trauma. This study aims to evaluate our hospital's experience with managing patients with blunt TDR, including its incidence, modes of diagnosis, operative treatments, postoperative outcomes, and factors predictive of patient outcomes. Case Report: A 44 years old man was referred to our hospital complaining of dyspnea. Eleven hours before his admission, he was riding his motorcycle, fell to the road, and hit the tree on his left chest. After the accident, he feels dyspnea, chest pain, and abdominal pain. The patient was brought to the nearest hospital and underwent a chest x-ray and left chest tube insertion, with initial production was blood 1700 ml. On examination, there was an increased respiratory rate, a visible bruise of the posteroinferior left chest near the left flank and a pre-installed chest tube thoracostomy on the left chest. Chest x-ray showed an intrathoracic herniation of abdominal viscera, the "collar sign" appeared, and the abdomen x-ray showed the left upper quadrant abdominal organ displaced into the left thorax cavity. Thus suspected, the underlying condition of TDR in this patient. We decided to perform left anterolateral thoracotomy and continued with laparotomy and splenectomy Conclusion: TDR is a rare case. The trauma may include shearing a stretched diaphragm, avulsion from a muscular insertion point, or increased abdominal pressure exceeding the bursting pressure of the diaphragm. Intra-abdominal organ injuries are more common than intrathoracic injuries. Initial operative approaches were laparotomy and thoracotomy.

Difference in Presentation and Concomitant Intra-Abdominal Injury with Chance Fracture in Pediatric and Adult Populations.

Chance fracture (CFx) with concomitant intra-abdominal injury has variable occurrence rates ranging from 33 to 89%. No single study has compared the incidence of simultaneous abdominal injury between pediatric and adult populations. This study compares the rate of simultaneous intra-abdominal injury and chance fracture in these populations. A retrospective review of pediatric and adult patients with chance fracture in comparable pediatric and adult trauma centers was performed. Patient demographics, mechanism of injury (MOI), and injury patterns were collected from 2002 to 2019 for pediatric patients and 2015 to 2018 for adults. Student t-test analyses were performed to determine statistical significance between the cohorts. The pediatric group had a similar incidence of abdominal solid organ injuries compared to adults (16 [20.5%] vs. 40 [19.7%], p<0.879), but the pediatric group had a greater number of total intra-abdominal (49 [62.8%] vs. 47 [23.1%], p < 0.001) and hollow organ injuries (40 [51.3%] vs. 17 [8.4%], p < 0.001). Motor vehicle collision was the most common mechanism of injury for both groups (72 pediatric [92.3%] vs. 85 adult [41.7%]) but adults suffered from more falls (3 pediatric vs. 81 adult, p < 0.001). Pediatric patients with CFx caused by MVCs had more intra-abdominal injuries (48 [66.7%] vs. 25[29.8%], p < 0.001) and hollow organ injuries compared to adults (39 [54.2%] vs. 8[9.5%], p < 0.001). In the setting of Chance fracture after trauma, pediatric patients are more likely to have a concomitant intra-abdominal organ injury (63% vs. 23%), especially hollow viscus injury (51.3% vs. 8.4%) compared with adults regardless of mechanism.

Abdominal stab wounds with retained knife: 15 years of experience from a major trauma centre in South Africa.

This study reviews our cumulative experience with the management of patients presenting with a retained knife following an abdominal stab wound (SW). A retrospective study was conducted at a major trauma centre in South Africa over a 15-year period from July 2006 to December 2020 including all patients who presented with a retained knife in the abdomen following a SW. A total of 42 cases were included: 37 males (93%) with a mean age of 26 years. A total of 18 knives (43%) were in the anterior abdomen and 24 were posterior abdomen. Plain radiography was performed in 88% (37/42) of cases and computed tomography was performed in 81% (34/42); 90% (38/42) underwent extraction in the operating theatre. Laparotomy was performed in 62% (26/42). Of all the laparotomies performed, 77% (20/26) were positive for intra-abdominal organ or visceral injury. Overall morbidity was 31%. There were two mortalities (5%). Laparotomy was less commonly required for the posterior abdomen (33% (8/24) vs 100% (18/18), p<0.001). For retained knives in the anterior abdomen, 72% (13/18) of the laparotomies were positive for intra-abdominal organ or visceral injury. For the posterior abdomen, 7 of the 8 (88%) were positive for intra-abdominal organ or visceral injury. There were no differences in the need for intensive care unit admission, length of hospital stay, morbidities or mortalities. Uncontrolled extraction of a retained knife in the abdomen outside of the operating theatre must be avoided. Retained knives in the anterior abdomen usually require formal laparotomy, but this is generally not required for posterior abdomen.

Hemoperitoneum Due to Penetrating Intercostal Artery Injury: A Case Report of a Rare and Still Understudied Entity

Intercostal artery injury may be life-threatening and usually presents as hemothorax. We report a unique case of penetrating injury, causing hemoperitoneum due to intercostal artery injury, without thoracic involvement. During urgent laparotomy, no intra-abdominal organ injury was found. Hemostasis was successfully achieved via suturing through an additional lateral 10cm incision through the left thorax.

Diagnostic capability and radiation safety of low dose CT cystography in acute post-traumatic urinary bladder injuries

Background: Genitourinary tract injuries occur in up to 5% of all traumas and at least 10% of abdominal traumas. Pelvic fractures are commonly found in patients with blunt trauma, and up to 40% of patients with bladder injuries are associated with at least one other intra-abdominal organ injury. Conventional cystography was the diagnostic modality for suspected bladder injury. Recently CT cystography is commonly used for evaluating bladder injury. For the risk of possible effects of radiation exposure associated with medical imaging procedures, the imaging centers apply the principles of ALARA. Aim of work: We aim to assess the diagnostic capability of low-dose CT cystography in the diagnosis and classification of acute post-traumatic bladder injury. Patients and methods: 44 patients with suspected post-traumatic UB injury were enrolled in this study. Non- and post-contrast CT scan was done using “160” MDCT scanner. Low and standard-dose techniques were applied, and the images were analyzed by two radiologists with at least 15 years of experience. Results: The study involved 44 patients. 20 patients scanned with low-dose CT while 24 patients scanned with the standard technique. Statistically, there was a significant difference between low and standard-dose groups regarding CTDI volume and radiation exposure (p=0.001) with a good diagnostic capability of low-dose CT. Conclusion: Low-dose CT cystography offers a good diagnostic capability of bladder injuries comparable to standard dose CT and may be recommended for the assessment of acute UB injuries.