Type Of Abdominal Trauma Research Articles

Management of Abdominal Gunshot Wounds in Children - Case Report

ABSTRACT Introduction One of the causes of mortality in pediatric population is penetrating abdominal injuries, which can affect several organs. Among all types of abdominal trauma, in gunshot wounds a good prognostic requires prompt diagnosis and treatment. In Romania, there is no specific database on gunshot injuries in the pediatric population, but from various sources, it was found that there are 3 cases (1 case of abdominal injury caused by gunshot in rural area and 2 cases of head and cervical spine injury due to gunshot that took place in urban area). Case presentation A 13-year-old boy is brought to the emergency care unit with a penetrating gunshot wound by ricochet in the left lower abdominal quadrant. Abdominal computed tomography revealed abdominal wall discontinuity in the left iliac fossa with oblique and posterior trajectory and a foreign body in the peritoneal cavity measuring 19/7 mm. Intraoperatory, the projectile was found in the sigmoid colon. Conclusion Penetrating gunshot wounds in pediatric population need adequate investigation and prompt diagnosis despite hemodynamic stability at presentation. Successful management of such a patient depends on the accuracy of the surgical intervention as well as the existence of a multidisciplinary medical team, which helps to prevent significant complications, including death.

Visceral Injuries in Patients with Blunt and Penetrating Abdominal Trauma Presenting to a Tertiary Care Facility in Karachi, Pakistan

IntroductionAbdominal injuries are responsible for 10% of the mortalities due to trauma. Delays in early diagnosis or misdiagnoses are two major reasons for the mortality and morbidity associated with abdominal trauma. The objectives of this study were to determine the frequency of visceral injuries in patients with abdominal trauma and compare the frequency of visceral injuries in patients with blunt and penetrating abdominal trauma.MethodsWe conducted a cross-sectional study from May 2016 to May 2018 of patients presenting to the emergency department (ED) at Jinnah Postgraduate Medical Center in Karachi, Pakistan. Patients were 12 to 65 years old and presented within 24 hours of abdominal trauma. We recorded the type of abdominal visceral injuries, such as liver, spleen, intestine, stomach, mesentery, and pancreas.ResultsThe mean patient age was 31 ±13 years. Penetrating trauma was found in most patients (n=72, 51%). Liver injuries were found in 37 patients (26.4%), spleen injuries in 29 patient (20.7%), stomach injuries in eight patients (5.7%), intestine injuries in 67 patients (47.9%), mesentery injuries in 21 patients (15%), and pancreas injuries in nine patients (6.4%). The type of abdominal trauma was found significantly associated with liver injury (p-value 0.021), and intestine injury (p-value <0.001).ConclusionPenetrating trauma (51.4%) was more common than blunt trauma (48.5%), and intestines are the most commonly affected by penetrating and blunt trauma injuries (70.1% and 47.8%, respectively). The liver is the most commonly affected (42.85%) in blunt trauma injuries, followed by the spleen (28.5%). The appropriate authorities should consider this information when instituting public health and safety initiatives.

Epidemiological evaluation and outcome of pure abdominal trauma victims who underwent surgical exploratory laparotomy

Objective The aim of this study was to evaluate the epidemiological profile, surgical treatment, and outcome of patients suffering from pure abdominal injuries who underwent exploratory laparotomy in the emergency department of Aswan University Hospital, Egypt. Patients and methods This was an evaluation and assessment of observational and descriptive study with prospective approach through interviews of 80 patients with pure abdominal trauma who were subjected to surgical treatment in the form of exploratory laparotomy and evaluation of their medical records. Results The most affected individuals were male patients younger than 49 years, most of them with low educational level and single. There was a predominance of trauma in the rural areas that mostly occurred at night-time and evening. Blunt trauma was the most common type of abdominal trauma, and road traffic accidents were the most frequent mechanism of trauma. The upper abdomen was the most affected region. Pain was the most common presenting symptom, and the spleen was the most affected organ. The hospital stay ranged from 1 to 11 days. Most patients were discharged with permanent sequelae; there were six deaths. Conclusion Blunt trauma was the most common type of abdominal injury. Road traffic accidents were the most common mechanism of blunt trauma, and stab wounds were the most common type of penetrating injuries. A number of risk factors were identified in this study, which include the type of abdominal trauma, presence of chronic diseases, delay in early transport from the site of trauma to the emergency department, and age of patient. Despite the magnitude of traumas, the outcome was satisfactory.

Intestinal and multivisceral transplantation after abdominal trauma.

BACKGROUND Some trauma victims who survive acute illness develop lingering, debilitating syndromes that are incompatible with any semblance of normalcy. Intestinal failure, in particular, exacts a high price in terms of quality of life. Total parenteral nutrition (TPN) has served these patients well, but complications limit its long-term therapeutic effect. Consequently, transplantation is emerging as a life-saving therapy for some patients with the short gut syndrome. METHODS We reviewed eight adult and two pediatric recipients of intestinal and multivisceral transplants after severe abdominal trauma. Background demographics, type of abdominal trauma, transplant procedure, postoperative complications, and survival rates were appraised. This group was also compared with 47 nontrauma recipients of intestinal transplants performed during the same period. RESULTS Four patients (40%) died postoperatively (postoperative days 7, 53, 87, and 91) as a result of multiple organ failure after graft pancreatitis (n = 1), viral encephalitis (n = 1), and sepsis after severe rejection (n = 2). Six patients (60%) are alive (postoperative days 52-1,783). All are off TPN. The 4-year patient survival was 58%, with no significant difference between trauma and nontrauma patients.CONCLUSION Intestinal and multivisceral transplantation are viable options for the treatment of irreversible intestinal failure associated with severe trauma. Surviving patients are TPN independent and have a satisfactory quality of life.

Abdominal trauma from the standpoint of the railway surgeon

I HAVE no startling spectacular new facts to present. I have only some sober, tragic findings to report which I hope may stimuIate some interest in a phase of clinical diagnosis and treatment sorely needed for the benefit of patients. It may be that if we heed some of the Iessons to be gained from a study of clinical experience and the literature, a few patients may be saved. The saving of one life wiII more than justify my efforts. My remarks wiI1 be limited to the non-perforating or non-penetrating types of abdominal trauma. The elasticity of the abdomina1 waI1, free mobility of the hollow viscera and comparative mobility of the solid viscera are responsible for the comparative infrequency of lacerations of the spleen, liver, rupture of the intestines and the stomach, folIowing crushing bIows applied to the surface of the abdomen. There are several axioms which should be accepted when dealing with patients who have had trauma to the abdomen : (I ) Every patient should be hospitalized for a period of at least twenty-four hours. (2) Every patient should be examined carefully; not only a physica examination but x-ray studies should be made and laboratory data accumulated. The reason for the above statements is obvious when one realizes the infinite variety of combinations of injuries which may occur folIowing the initiaI blow. Authorities have classified the etiologic factors in abdominal trauma into: (I) crushing or squeezing, where the patient is impaIed between moving objects; (2) from a direct blow from a bIunt object and (3) from a fal1. To this may be added the classification given by Moty : bursting, crushing and tearing injuries. The statement that the abdomen, like Pandora’s box, is fulI of surprises is clearly proven by this type of case. UnfortunateIy symptoms and signs of the true nature of many of these cases are not manifested early. The Iiterature is fuI1 of statements like the following : “The prognosis is directly related to the promptness of surgical intervention” (Wilensky). “During the first few hours after injury no signs nor symptoms may appear. Decision not to operate in many instances is more dangerous than the hazard of an unnecessary operation” (Poer). “There are many cases of abdomina1 injury on record in which the symptoms at onset are trivial; but, later definite evidence of abdominal lesions requiring operation develop” (Estes). “The time lag between the injury and the definitive treatment must be reduced to as short a time as possible” (Arthur Metz). “Cases of traumatic rupture of the spleen have remained undiagnosed until necropsy ” (Roetting). This statement can be easiIy verified in any large hospital service where cases of trauma are handled. “ Injury due t’o non-perforating abdomina1 trauma is accompanied by symptoms which vary to such an extent that no clear clinical picture can be set down” (Poer). Since the cIinica1 picture is not clear, the signs delayed and the multiplicity of combinations of organs involved, it is incumbent on us to consider each injury as potentialIy serious until evidence proves to the contrary. It is essential to observe and examine carefulIy for a few hours in order to determine the need for an operation that wiI1 save a life. This is certainly better than to have a patient return to the hospita1 in an irreversabIe shock or with peritonitis when surgery, if done as an