Intraperitoneal Fluid In Patients Research Articles

Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study

BackgroundFocussed Assessment with Sonography for Trauma (FAST) is a bedside ultrasonography technique used to detect free intraperitoneal fluid in patients presenting with blunt abdominal trauma (BAT) in the emergency department.MethodsIn this retrospective cohort study we investigated the potential of FAST as a risk stratification instrument in haemodynamically (HD) stable patients presenting after BAT by establishing the association between the FAST exam result and final outcome. An adverse outcome was defined in this context as the need for either a laparoscopy/laparotomy or an angiographic embolization or death due to abdominal injuries).ResultsA total of 421 patients with BAT were included, of which nine had an adverse outcome (2%). FAST was negative in 407 patients. Six of them turned out to have free intraperitoneal fluid (sensitivity 67 [41–86]%). FAST was positive in 14 patients, 12 of whom had free intraperitoneal fluid (specificity 99 [98–100]%). A positive FAST (positive likelihood ratio 34.3 [15.1–78.5]) was stronger associated with an adverse outcome than Injury Severity Score (ISS) or any individual clinical- or biochemical variables measured at presentation in the ED.DiscussionThe FAST exam can provide valuable prognostic information at minimal expenses during the early stages of resuscitation in haemodynamically stable patients presenting with BAT.ConclusionsFAST exam should not be omitted in patients with BAT.

Less Common Causes of Acute Abdomen

In this presentation, less common causes of acute abdomen are reviewed. Emphasis is on three topics. First, the anatomy of the superior mesenteric vein and mesentery is reviewed, together with the anatomical basis and clinical/radiological presentation of midgut volvulus. Emphasis is on diagnostic clues (whirl sign, abnormal position of cecum, small bowel, and third part of duodenum) and pitfalls (positional variation of small bowel loops with pseudo-twisting of mesenteric vessels). Second, atypical presentations of acute appendicitis and appendagitis, as well as their mimics, are discussed. Finally, an overview is given of uncommon but important causes of free intraperitoneal fluid in patients with acute abdominal pain.

Predicting the amount of intraperitoneal fluid accumulation by computed tomography and its clinical use in patients with perforated peptic ulcer.

The correlation between the amount of peritoneal fluid and clinical parameters in patients with perforated peptic ulcer (PPU) has not been investigated. The authors' objective was to derive a reliable formula for determining the amount of peritoneal fluid in patients with PPU before surgery, and to evaluate the correlation between the estimated amount of peritoneal fluid and clinical parameters. We investigated 62 consecutive patients who underwent emergency surgery for PPU, and in whom prediction of the amount of accumulated intraperitoneal fluid was possible by computed tomography (CT) using the methods described by Oriuchi et al. We examined the relationship between the predicted amount of accumulated intraperitoneal fluid and that measured during surgery, and the relationship between the amount of fluid predicted preoperatively or measured during surgery and several clinical parameters. There was a significant positive correlation between the amount of fluid predicted by CT scan and that measured during surgery. When patients with gastric ulcer and duodenal ulcer were analyzed collectively, the predicted amount of intraperitoneal fluid and the amount measured during surgery were each associated with the period from onset until CT scan, perforation size, the Mannheim peritoneal index, and the severity of postoperative complications according to the Clavien-Dindo classification. Our present results suggest that the method of Oriuchi et al is useful for predicting the amount of accumulated intraperitoneal fluid in patients with PPU, and that this would be potentially helpful for treatment decision-making and estimating the severity of postoperative complications.

Diagnostic accuracy of secondary ultrasound exam in blunt abdominal trauma.

Background:In stable patients with blunt abdominal trauma, accurate diagnosis of visceral injuries is crucial.Objectives:To determine whether repeating ultrasound exam will increase the sensitivity of focused abdominal sonography for trauma (FAST) through revealing additional free intraperitoneal fluid in patients with blunt abdominal trauma.Patients and Methods:We performed a prospective observational study by performing primary and secondary ultrasound exams in blunt abdominal trauma patients. All ultrasound exams were performed by four radiology residents who had the experience of more than 400 FAST exams. Five routine intraperitoneal spaces as well as the interloop space were examined by ultrasound in order to find free fluid. All patients who expired or were transferred to the operating room before the second exam were excluded from the study. All positive ultrasound results were compared with intra-operative and computed tomography (CT) findings and/or the clinical status of the patients.Results:Primary ultrasound was performed in 372 patients; 61 of them did not undergo secondary ultrasound exam; thus, were excluded from the study.Three hundred eleven patients underwent both primary and secondary ultrasound exams. One hundred and two of all patients were evaluated by contrast enhanced CT scan and 31 underwent laparotomy. The sensitivity of ultrasound exam in detecting intraperitoneal fluid significantly increased from 70.7% for the primary exam to 92.7% for the secondary exam. Examining the interloop space significantly improved the sensitivity of ultrasonography in both primary (from 36.6% to 70.7%) and secondary (from 65.9% to 92.7%) exams.Conclusions:Performing a secondary ultrasound exam in stable blunt abdominal trauma patients and adding interloop space scan to the routine FAST exam significantly increases the sensitivity of ultrasound in detecting intraperitoneal free fluid.

Abstract No. 312: Expanding Traditional Criteria for Percutaneous Abscess Drainage for Intra-Abdominal Fluid Collections

To determine if percutaneous drainage can serve as the definitive treatment for multifocal, non-loculated abdominal fluid collections or free intraperitoneal fluid in patients with suspected intra-abdominal infection. A one-year retrospective review of percutaneous abscess drainages was performed. Patients included in the study were evaluated based on pre-procedural imaging. The study group included patients with multifocal, non-loculated collections or patients with free intra-peritoneal fluid. Culture results, complete blood counts, and treatment outcomes were retrieved from the electronic medical records. A total of 83 patients underwent percutaneous abscess drainage. Eighteen patients demonstrated either multiple, non-loculated collections or free intraperitoneal fluid with subsequent placement of one or more drains. Four patients with pancreatic collections, one tubo-ovarian abscess, one epidural abscess with associated bilateral psoas abscesses, and one case of peritoneal carcinomatosis were excluded. Seven patients demonstrated complete resolution of the target collections, one patient was lost to follow-up, and four deaths occurred in nonsurgical candidates. Two patients had pre-procedural CT-documented bowel perforations and diffuse peritonitis, with one patient treated exclusively with catheter drainage. A total of two patients required adjunctive surgery. Three aspirates were sterile, three aspirates showed one organism, and five aspirates showed polymicrobial colonization. Classically described criteria for percutaneous drainage is a well-defined unilocular abscess cavity. Percutaneous drainage of multifocal, non-loculated collections or free intra-peritoneal fluid in patients with suspected intra-abdominal infection is feasible and may lead to complete resolution despite the lack of classic indications and predisposing factors for successful catheter drainage.

Sonographic Intraperitoneal Fluid in Patients With Pelvic Fracture: Two Cases of Traumatic Intraperitoneal Bladder Rupture

No AccessJournal of UrologyUrological Survey: Trauma, and Genital and Urethral Reconstruction1 Dec 2005Sonographic Intraperitoneal Fluid in Patients With Pelvic Fracture: Two Cases of Traumatic Intraperitoneal Bladder Rupture Allen F. MoreyM.D. Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)68977-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Sonographic Intraperitoneal Fluid in Patients With Pelvic Fracture: Two Cases of Traumatic Intraperitoneal Bladder Rupture." The Journal of Urology, 174(6), p. 2264 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 6December 2005Page: 2264 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Allen F. Morey More articles by this author Expand All Advertisement PDF downloadLoading ...

NONOPERATIVE TREATMENT OF ISOLATED POSTTRAUMATIC INTRAPERITONEAL BLADDER RUPTURE IN CHILDREN—IS IT JUSTIFIED?

Open surgical repair has been the standard treatment for intraperitoneal bladder rupture. We sought to explore the possibility of nonoperative treatment of isolated intraperitoneal bladder rupture in children. Eight children (4 girls and 4 boys) with a mean age of 6.3 +/- 4.6 years (range 1 to 13) presented with isolated posttraumatic intraperitoneal bladder rupture between 1993 and 2003. Retrograde cystogram was performed in all cases. Diagnosis was confirmed by aspiration and chemical analysis of the free intraperitoneal fluid in patients with an equivocal cystogram. Four patients who presented early in the series (group 1) were treated with the classic open repair, whereas the last 4 patients (group 2) were treated nonoperatively with adequate bladder drainage and percutaneous intraperitoneal tube drain. The mechanisms of injury, clinical presentation, management, complication, hospital stay and duration of catheterization were reviewed in both groups. Six patients had a history of a direct blow to the full bladder, while 2 presented following a motor vehicle accident. All patients presented with vomiting and abdominal distention, and 5 had mild gross hematuria without associated clots or hemodynamic instability. One patient in group 1 had early urinary leakage and wound sepsis, and was treated conservatively. All patients in group 2 demonstrated significant improvement in general condition within a few hours of the bladder and peritoneal drainage. Intraperitoneal tube drains were removed at 1 to 4 days. There were no post-intervention complications in group 2 and surgical treatment was never required. Mean indwelling catheter duration was 9.3 +/- 7.9 and 11.8 +/- 2.6 days (p = 0.24), and mean hospital stay was 10.5 +/- 8.4 and 7.3 +/- 3.9 days (p = 0.56) in groups 1 and 2, respectively. Nonoperative treatment is a justified initial approach for isolated intraperitoneal bladder rupture in children. Indications for surgical intervention include improper bladder drainage, unduly prolonged urinary drainage through the peritoneal drain and/or lack of clinical improvement.

Sonographic Intraperitoneal Fluid in Patients with Pelvic Fracture: Two Cases of Traumatic Intraperitoneal Bladder Rupture

Sonographic Intraperitoneal Fluid in Patients with Pelvic Fracture: Two Cases of Traumatic Intraperitoneal Bladder Rupture

Sonographic intraperitoneal fluid in patients with pelvic fracture: two cases of traumatic intraperitoneal bladder rupture

Two patients who presented to the Emergency Department (ED) in shock with severe pelvic fractures were evaluated for intra-abdominal injury with a focused assessment with sonography in trauma (FAST) examination. Free intraperitoneal fluid was identified in the hepato-renal recess of both patients. At laparotomy both patients were found to have extensive uroperitoneum resulting from intraperitoneal bladder rupture and no other intra-abdominal injuries. The source of shock in both cases was ultimately determined to be arterial hemorrhage from pelvic vessels. The utility of FAST examinations in the setting of major pelvic injury is relatively unstudied. Coincident injuries make the evaluation for source of hemorrhage in this subset of patients challenging. This is a report of sonographic intraperitoneal fluid in the setting of major pelvic injury and hemodynamic instability found to be uroperitoneum and not hemoperitoneum.

Clinical importance of intraperitoneal fluid in patients with blunt intra-abdominal injury

The purpose of this study was to determine the prevalence of intraperitoneal fluid (IF) in blunt trauma patients with intra-abdominal injuries, to determine the rate of exploratory laparotomy in patients with and without IF, and to identify the location of this IF. We retrospectively reviewed the records of 604 patients with intra-abdominal injuries after blunt trauma who were admitted to a level 1 trauma center over a 42-month period. Patients were considered to have intra-abdominal injuries if an injury to the spleen, liver, urinary tract, pancreas, adrenal glands, gallbladder, or gastrointestinal tract was identified on abdominal computed tomography (CT) or at exploratory laparotomy. Patients were considered to have IF if fluid was identified on abdominal CT or during exploratory laparotomy. In patients undergoing abdominal CT or abdominal ultrasound (US), the specific location of the IF was identified. Four hundred forty-three (73%, 95% confidence interval [CI] 69 - 77%) of the 604 patients with intra-abdominal injuries had IF. Patients with IF had an increased risk of laparotomy (344/443 [78%] v 44/161 [27%], odds ratio = 9.2, 95% CI 6.1-13.9). Of the 539 patients undergoing abdominal CT or abdominal US, IF was identified in 389 (72%) and was visualized in the following locations: 258 of 389 (66%) in Morison's pouch, 216 of 389 (56%) in the left upper quadrant, 187 of 389 (48%) in the pelvis, and 139 of 390 (36%) in paracolic gutters. Three patients with IF visualized solely in the paracolic gutters underwent laparotomy. The majority of patients with intra-abdominal injuries have IF, and these patients are more likely to undergo laparotomy. Morison's pouch is the most common location for IF to be detected with radiologic imaging. However, visualization of the paracolic gutters with abdominal US may detect IF in patients with intra-abdominal injuries that would otherwise not be detected by US. (Am J Emerg Med 2002;20:595-600. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Free intraperitoneal fluid in patients with intestinal obstruction without clinical or radiological evidence of perforation

Two patients with clinical evidence of intestinal obstruction underwent abdominal ultrasound examination; in both, free intraperitoneal fluid was noted. There was no clinical or radiographic evidence of perforation.