Severe Blunt Abdominal Trauma Research Articles

Association between intra-abdominal injured organs and abdominal compartment syndrome in patients with severe blunt trauma: A propensity score matched study using nationwide trauma registry in Japan.

Abdominal compartment syndrome (ACS) after blunt abdominal trauma is a rare complication that requires early recognition and subsequent surgical intervention for optimal outcome. We aimed to investigate how differences in injured abdominal organs affect ACS development in patients with severe blunt abdominal trauma. This nested case-control study used a nationwide registry of trauma patients, namely, the Japan Trauma Data Bank (JTDB), and only included patients aged ≥ 18 years with blunt severe abdominal trauma, defined as an AIS score of abdomen ≥ 3, sustained between 2004 and 2017. Patients without ACS were used as control subjects and identified using propensity score (PS) matching. Characteristics and outcomes between patients with and without ACS were compared and logistic regression was used to identify specific risk factors for ACS. Among 294,274 patients in the JTDB, 11,220 were eligible for inclusion before PS matching, and 150 (1.3%) developed ACS after trauma. PS matching led to the inclusion of 131 and 655 patients with and without ACS, respectively. Compared to controls, patients with ACS had higher number of injured organs in the abdomen and displayed a greater frequency of vascular and pancreatic injuries, need for blood transfusion, and disseminated intravascular coagulopathy, a complication of ACS. In-hospital mortality was higher in patients with ACS than those without ACS (51.1% vs. 26.0%, p < 0.01). Logistic regression analysis revealed that a higher number of injured organs in the abdomen [odds ratio (OR) (95% confidence interval [CI]): 1.76 (1.23-2.53)] and pancreatic injury [OR (95% CI): 1.53 (1.03-2.27)] were independently associated with ACS. Greater number of injured organs in abdomen and pancreatic injury are independent risk factors for the development of ACS.

Camera, action, liver injury: a preventable case of extreme sports body camera causing severe blunt abdominal liver trauma

Camera, action, liver injury: a preventable case of extreme sports body camera causing severe blunt abdominal liver trauma

ЭКСПЕРИМЕНТАЛЬНОЕ ОБОСНОВАНИЕ АСПЕКТОВ ПАТОГЕНЕЗА ГНОЙНО-ВОСПАЛИТЕЛЬНЫХ ОСЛОЖНЕНИЙ В ОСТРОМ ПЕРИОДЕ ТРАВМАТИЧЕСКОЙ БОЛЕЗНИ

В работе представлено патофизиологическое обоснование формирования MODS и ранних гнойно-воспалительных осложнений в раннем посттравматическом периоде на модели тяжелой тупой травмы груди и живота у крыс. Показано, что на фоне снижения кишечной экстракции кислорода, развившегося в ответ на травму, нарушается проницаемость кишечного барьера, что сопровождается массивным поступлением эндотоксинов кишечных бактерий в кровь, что проявляется значительным снижением концентрации Анти–ЛПС–IgG в плазме крови крыс. Данный процесс является индуктором каскадных иммунопатологических реакций организма и запускающих в ряд патологических кругов с последующим развитием MODS и способствует развитию ранних гнойно-воспалительных осложнений.

Serum levels of NLRP3 and HMGB-1 are associated with the prognosis of patients with severe blunt abdominal trauma

OBJECTIVES:To investigate the relationship between the serum levels of NLRP3 and HMGB-1 and the prognosis of patients with severe blunt abdominal trauma.METHODS:In total, 299 patients were included in the current study from July 2014 to December 2015. All patients were divided into the mild/moderate blunt abdominal trauma group and the severe blunt abdominal trauma group according to their injury severity scores. Serum levels of NLRP3 and HMGB-1 were measured upon admission (0 h) and at 12 h, 24 h, 48 h, 72 h and 7 days after admission.RESULTS:Compared with the healthy controls, both the mild/moderate and severe blunt abdominal trauma groups had higher serum levels of NLRP3 and HMGB-1 at admission. At all points, the serum levels of NLRP3 and HMGB-1 were significantly higher in the severe group than in the mild/moderate group. The serum levels of both NLRP3 and HMGB-1 were significantly higher in the deceased patients than in the living patients. The Kaplan-Meier curve showed that compared with patients with higher levels of NLRP3 or HMGB-1, those with lower levels had longer survival times. The serum levels of both NLRP3 and HMGB-1 were independent risk factors for 6-month mortality in severe blunt abdominal trauma patients.CONCLUSION:The serum levels of NLRP3 and HMGB-1 were significantly elevated in severe blunt abdominal trauma patients, and the serum levels of both NLRP3 and HMGB-1 were correlated with 6-month mortality in severe blunt abdominal trauma patients.

Blunt abdominal trauma with uterine rupture and fetal demise

Traumatic uterine rupture is rare, occurring in 0.6% of blunt trauma cases, and usually results from very violent accidents in which patients usually also sustain other major injuries. Following severe blunt abdominal trauma, fetal loss can result from maternal hypotension or hypoxemia, placental abruption, maternal death, and uterine rupture. Although less common, fetal loss can also occur in minor injuries. We report a patient who sustained an isolated anterior uterine rupture with fetal demise without any associated abdominal or pelvic injuries. This case report highlights the importance of proper seat belt usage and placement because both can reduce maternal and fetal morbidity and mortality in motor vehicle accidents.

Correlation Between Intra-Abdominal Free Fluid and Solid Organ Injury in Blunt Abdominal Trauma.

Background:In previous studies, the diagnostic value of Focused Assessment with Sonography for Trauma (FAST) has been evaluated but few studies have been performed on the relationship between the amount of free intra-abdominal fluid and organ injury in blunt abdominal trauma. To select patients with a higher probability of intra-abdominal injuries, several scoring systems have been proposed based on the results of FAST.Objectives:The aim of this study was to determine the prognostic value of FAST according to the Huang scoring system and to propose a cut-off point for predicting the presence of intra-abdominal injuries on the Computed Tomography (CT) scan. The correlation between age and Glasgow Coma Scale (GCS) and the presence of intra-abdominal injuries on the CT scan was also assessed.Patients and Methods:This study was performed on 200 patients with severe blunt abdominal trauma who had stable vital signs. For all patients, FAST-ultrasound was performed by a radiologist and the free fluid score in the abdomen was calculated according to the Huang score. Immediately, an intravenous contrast-enhanced abdominal CT scan was performed in all patients and abdominal solid organ injuries were assessed. Results were analyzed using Kruskal-Wallis test, Mann-Whitney test and ROC curves. The correlation between age and GCS and the presence of intra-abdominal injuries on CT-scan was also evaluated.Results:The mean age of the patients was 29.6 ± 18.3 years and FAST was positive in 67% of the subjects. A significant correlation was seen between the FAST score and the presence of organ injury on CT scan (P < 0.001). Considering the cut-off point of 3 for the free fluid score (with a range of 0-8), sensitivity, specificity, positive predictive value and negative predictive value were calculated to be 0.83, 0.98, 0.93, and 0.95, respectively. Age and GCS showed no significant correlation with intra-abdominal injuries.Conclusions:It seems that FAST examination for intra-abdominal fluid in blunt trauma patients can predict intra-abdominal injuries with very high sensitivity and specificity. Using the scoring system can more accurately determine the probability of the presence of abdominal injuries with a cut-off point of three.

Nonoperative management of hemodynamically unstable abdominal trauma patients with angioembolization and resuscitative endovascular balloon occlusion of the aorta.

Many hemodynamically stable patients with blunt abdominal solid organ injuries are successfully managed nonoperatively, while unstable patients often require urgent laparotomy. Recently, therapeutic angioembolization has been used in the treatment of intra-abdominal hemorrhage in hemodynamically unstable patients. We undertook this study to review a series of hemodynamically unstable patients with abdominal solid organ injuries managed nonoperatively with angioembolization and resuscitative endovascular balloon occlusion of the aorta. The institutional review board approved this study. All patients were appropriately resuscitated with transfusions, and angiography was performed after computed tomography. Resuscitative endovascular balloon occlusion of the aorta was performed before computed tomography in all patients. Seven patients underwent resuscitative endovascular balloon occlusion of the aorta following severe blunt abdominal trauma. The 28-day survival rate was 86% (6 of 7). There were no complications related to the procedure. We describe the first clinical series of hemodynamically unstable patients with abdominal solid organ injury treated nonoperatively with angioembolization and resuscitative endovascular balloon occlusion of the aorta. Survival rate was 86%, supporting the need for further study of this modality as an adjunct to the nonoperative management of patients with severe traumatic injuries. Therapeutic study, level V.

Non-Operative Management of Isolated Pneumoperitoneum Due to Severe Blunt Abdominal Trauma

DOI: 10.4328/JCAM.3847 Received: 21.08.2015 Accepted: 02.08.2015 Publihed Online: 03.09.2015 Corresponding Author: Ahmet Turkan, Department of General Surgery, Faculty of Medicine, Turgut Ozal University, Ankara, Turkey, Gsm: +905055951637 E-Mail: draturkan@gmail.com Ozet Kunt karin travmasinin cerrahi disi yonetimi hemodinamik olarak stabil hastalarda tercih edilen tedavi yontemidir. Cerrahi disi yonetimin sonuclari, ici bos organ yaralanmasina gore, karaciger ve dalak gibi izole solid organ yaralanmalarinda daha basarilidir. Bu yaklasimda, hem hastanin klinik seyri hem de bilgisayarli tomografi bulgulari onemli bir rol oynar. Kunt karin travmasinda serbest peritoneal hava klinisyenler icin cerrahi bir zorluk olabilir cunki genellikle ici bos organ perforasyonu icin onemli bir radyolojik isarettir. Burada, ciddi bir kunt karin travmasina maruz kalan genc bir erkekte, bilgisayarli tomografide saptanan ve cerrahisiz yonetilen, izole pnomoperitonyum olgusu sunuyoruz. Amacimiz, kunt karin travmasinda, diger radyolojik bulgularin yoklugunda, pnomoperitonum varliginin yonetim sorunlarina cerrahlarin ilgisini cekmektir.

Traumatic Diaphragmatic Rupture: A Diagnostic Challenge!

Traumatic diaphragmatic rupture is usually associated with severe blunt abdominal trauma. It is a marker of the severity of trauma, and is accompanied with serious injuries to other organ systems. Preoperative diagnosis of this condition is a challenge to the surgeon. If missed, it can manifest later in the form of a diaphragmatic herniawith all of its associated thoracoabdominal morbidity. Delayed repair is associated with increased morbidity and mortality. Hence, diagnosing the condition preoperatively enables immediate repair thus preventing complications. A plain chest x-ray can help in diagnosing this condition. We report here two cases wherein the diagnosis was made preoperatively enabling prompt repair with excellent recovery highlighting the significance of chest x-ray.

Traumatic Diaphragmatic Rupture: A Diagnostic Challenge!

Traumatic diaphragmatic rupture is usually associated with severe blunt abdominal trauma. It is a marker of the severity of trauma, and is accompanied with serious injuries to other organ systems. Preoperative diagnosis of this condition is a challenge to the surgeon. If missed, it can manifest later in the form of a diaphragmatic herniawith all of its associated thoracoabdominal morbidity. Delayed repair is associated with increased morbidity and mortality. Hence, diagnosing the condition preoperatively enables immediate repair thus preventing complications. A plain chest x-ray can help in diagnosing this condition. We report here two cases wherein the diagnosis was made preoperatively enabling prompt repair with excellent recovery highlighting the significance of chest x-ray.

Combination of white blood cell count with liver enzymes in the diagnosis of blunt liver laceration

Background It is sometimes difficult to decide whether to perform abdominal computed tomographic (CT) scans for possible liver laceration in patients who have sustained less severe or minor blunt abdominal trauma. This study was conducted to find out whether the basic laboratory workup could provide information of possible liver laceration in blunt abdominal trauma patients and act as an indication for CT scans. Methods In this retrospective case-control study, we included 289 patients who had sustained blunt abdominal injury for which they received abdominal CT scans in our emergency department. Of the 289 patients, the study group (n = 42) included patients who had been found to have liver lacerations after obtaining the CT; the controls (n = 42) were those not found to have such injuries by the same method with matching of age and sex. Results In patients with blunt abdominal injuries, there is a strong difference in liver laceration between elevation of white blood cell (WBC) counts ( P = .001), aspartate aminotransferase (AST) ( P < .001), and alanine aminotransferase (ALT) ( P < .001). A logistic regression model demonstrated that WBC count and AST were independently associated with liver laceration. With elevations of serum AST greater than 100 IU/L, ALT greater than 80 IU/L, and WBC count greater than 10 000/mm 3, we found a sensitivity and specificity of 90.0% and 92.3%, respectively, in the 42 liver laceration victims. Conclusion In patients with blunt abdominal trauma, elevated WBC counts together with elevated AST and ALT are strongly associated with liver laceration and warrant further imaging studies and management.

Successful rotational thromboelastometry‐guided treatment of traumatic haemorrhage, hyperfibrinolysis and coagulopathy

Transfusion of allogeneic blood products is associated with increased morbidity and mortality. Therefore, strategies for reducing transfusion of these products during trauma management are valuable. We report a case of severe blunt abdominal trauma, successfully treated with antifibrinolytic medication and fibrinogen concentrate. Rotational thromboelastometry (ROTEM) was used to identify hyperfibrinolysis and afibrinogenaemia. In order to achieve haemostasis, over a 3-h period, the patient received a total of 1 g of tranexamic acid, 7 U of packed red blood cells, 16 g of fibrinogen concentrate (Haemocomplettan P), 3500 ml of colloids and 5500 ml of lactated Ringer's solution. Together with surgical measures, this treatment stopped the bleeding and stabilised the patient. There was no transfusion of either fresh-frozen plasma or platelets. The limited need for allogeneic blood products is of particular interest, and clinical studies of the approach used here appear to be warranted.

Traumatismes abdominaux : les lésions élémentaires

Abdominal injuries are more often observed in the setting of polytrauma. Detection and accurate description of hemoperitoneum, solid organ injuries (contusion, hematoma, laceration, fracture), bowel perforation and arterial bleeding allow optimal multidisciplinary management. Mesenteric and bowel injuries are often difficult to diagnose and may be masked by the presence of more frequent injuries (spleen, liver). MDCT is the gold standard imaging modality for severe blunt abdominal trauma.

The effect of blunt abdominal trauma on appendix vermiformis

Objectives: Trauma and appendicitis are the most common conditions of childhood for which surgical consultation is sought in emergency departments. Occasionally, appendicitis and trauma exist together, which causes an interesting...

Traumatic Lumbar Hernia: Report of Cases and Comprehensive Review of the Literature

Acute lumbar hernia secondary to blunt trauma is an uncommon injury of the abdominal wall and, when encountered, is a difficult challenge for the trauma surgeon. Three cases of lumbar hernia secondary to blunt trauma are described and a review of the literature was conducted for other such cases. Clinical, anatomic, and demographic data were extracted from these reports and analyzed. Sixty-three cases of lumbar hernia secondary to blunt trauma were found in the English literature and three cases are described here. Hernias occurred most commonly in the inferior lumbar triangle (70%) and were most frequently a result of a motor vehicle collision (71%). Physical examination findings were variable and reported in only a minority of cases (palpable hernia, 33%; flank hematoma, 27%) and associated intra-abdominal injuries were common (61%). Most traumatic lumbar hernias were diagnosed immediately, and computed tomography was 98% sensitive for diagnosis. Fifty-eight percent of patients were managed initially with exploratory laparotomy. Timing of hernia repair was variable. Traumatic lumbar hernias are associated with a high incidence of intra-abdominal injury and should be considered in all cases of severe blunt abdominal trauma. Computed tomography should be implemented when the diagnosis is suspected in a hemodynamically stable patient. Repair should be performed by mesh patching techniques at a time based on clinical correlation.

Aggressive conservative treatment of esophageal perforations in children

Background/Purpose: In contrast with adult patients in whom surgical closure of the defect is preferred, nonoperative treatment has been the usual approach for esophageal perforation (EP) in children. This report aims to assess whether this strategy stands the passage of time. Methods: We reviewed retrospectively the charts of 17 patients aged 5.3 ± 0.9 years (mean ± SD) treated at our institution for EP between 1991 and 2001. Results: Nineteen episodes of EP were caused by stricture dilation in 9 cases, foreign body extraction in 3, and blunt trauma and sclerosis of varices in 2 cases each. The remaining child had multiple gastrointestinal perforations in the course of chemotherapy for leukemia. Vigorous treatment, consisting of nasopharyngeal aspiration, wide spectrum antibiotics, prompt drainage of effusions and either parenteral or infraesophageal nutritition, was implemented immediately after diagnosis. Perforations were closed without direct surgery in 18 of 19 episodes (16 of 17 children). One or more pleural drains were inserted in 12 cases, and pericardial drainage was required once. Seven gastrostomies, 2 jejunostomies, and one esophagostomy were performed. Several major abdominal operations were necessary to repair concomitant lesions in a child who sustained severe blunt abdominal trauma and in the patient with leukemic perforations. All patients survived, and all recovered esophageal function. However, 2 with intractable lye strictures ultimately required esophageal replacement. The only patient in whom a direct approach for esophageal necrosis due to variceal endosclerosis was unavoidable, lost her organ and had a retrosternal colonic interposition after a successful portosystemic shunt. Excluding patients with other concomitant lesions and the patient who underwent surgery, median length of stay was 11 days (range, 6 to 47). Conclusions: Prompt and aggressive nonoperative treatment of esophageal perforations in children allows survival with conservation of the organ in most cases and remains, in the authors' hands, the first therapeutic choice at this age. J Pediatr Surg 38:685-689. © 2003 Elsevier Inc. All rights reserved.

Surgical options in colorectal injuries.

Colonic or rectal injuries occur in up to 10% of patients that suffer penetrating or severe blunt abdominal trauma. The majority of colon injuries are diagnosed intraoperatively following a penetrating abdominal injury. Rectal injuries are usually diagnosed preoperatively with a high index of suspicion based upon the wounding missile trajectory. The vast majority of colon injuries can be primarily repaired with a significant trend toward avoiding colostomy whenever possible. Colostomy is increasingly reserved for rectal injuries and destructive colon injuries with extenuating circumstances such as hemodynamic instability and significant associated injuries.

Un cas de pseudo-anévrysme hépatique traité par embolisation percutanée chez un enfant polytraumatisé

Hepatic artery pseudoaneurysms are rare complications of blunt abdominal trauma in children. Diagnosis is frequently delayed and made by splanchnic angiography. Most of the indications for surgical treatment have disappeared after the development of selective catheterization and embolization. We report a case in an 8-year-old pedestrian who was struck by a car and suffered a multiple trauma with a severe blunt abdominal trauma. A severe collapse upon admission commanded immediate laparotomy that depicted a liver fracture with associated jejunal and pancreatic lesions. Recovery was progressive until the 15 th postoperative day where an abrupt haemobilia occurred. A CT-scan exploration was performed and revealed a vascular mass lesion in the left lobe of the liver. The performance of a selective angiography confirmed the diagnosis of left artery pseudoaneurysm, but because of technical difficulties, no embolization could be performed by this way. A direct percutaneous puncture and embolization of the aneurysm allowed a complete exclusion of the lesion. Eventually, recovery was complete. This percutaneous technique could be a valuable alternative to classical embolization and could avoid surgical treatment that still carries a high morbidity.

Clinical pathways — can they be used in trauma care. An analysis of their ability to fit the patient

This study prospectively evaluated the appropriateness and ability of clinical pathways to fit trauma patients in five key conditions, severe head injury, fractured ribs, fractured pelvis, fractured femur and blunt abdominal trauma, who were admitted to a single Level 1 Trauma Centre, between February and July 1999. Each pathway consisted of 14 elements of care divided into observable outcomes. Failure to achieve an outcome resulted in a variance or deviation from the pathway, which was assessed by the number of non-applicable variances. Appropriateness of clinical pathways was assessed by the applicability index (the number of non-applicable variances divided by the potential variances). Critical mismatches occurred when non-applicable variances exceeded 50% of potential variances. 146 patients, with the mean age 41.9 years (S.D. 20.7), mean ISS 11.1 (S.D. 10.7) were enrolled; 18 with severe head injury, 59 with fractured ribs, 13 with fractured pelvis, 20 with fractured femur and 36 with blunt abdominal trauma. Critical mismatch occurred in seven patients. Applicability indexes were 87 for head, 93 for ribs, 92 for blunt abdominal trauma, 91 for femur and 92 for the pelvic pathway. Patient assessment, pain management, skin integrity and patient education were the most appropriate key elements of care, discharge planning, patient satisfaction, treatment and activity were least applicable. This study identified, for the first time, that clinical pathways are clinically appropriate for major trauma conditions.

Lacerations of the Hepatoduodenal Ligament, Pancreas and Duodenum in a Child due to Blunt Impact

Descriptions of the nature of pediatric injury as reported by parents and caretakers is frequently tainted, even fraudulent. We present here such a case of trauma incurred in the presence of a parent which resulted in hepatoduodenal ligament laceration with associated pancreatic and duodenal injuries, the certain result of severe blunt force abdominal trauma. These findings were at variance with the father's description of the events leading up to the child's untimely demise.