Selected Aspects in Abdominal Trauma Management

• Authors: Marek Kuliś , Leszek Brongel , Piotr Budzyński , Waldemar Hładki , Jacek Lorkowski , Rafał Nazimek , Wiesław Jarzynowski , Jan Magiera
• Languages of publication: EN

Abstracts

EN

The aim of the study was analysis of diagnostic techniques relative to the type of trauma sustained (blunt versus penetrating), the patients' haemodynamic status (stable versus in shock), the character of injuries (isolated versus multiple) and the type of treatment employed (conservative versus operative) in patients with suspected abdominal injuries.Material and methods. The study included 1406 trauma victims hospitalized in the 2nd Department of Surgery in Cracow from 1995 to 2004 who were diagnosed with or underwent surgery for suspected abdominal organ injury. In addition to the clinical examination performed in each case, the ultrasonographic examination according to FAST procedure was used in 1373 patients, diagnostic peritoneal lavage (DPL) in 46, computed tomography (CT) in 27, laparoscopy in 45 and contrast studies of the urinary tract in 45 patients. Data concerning treatment process were obtained retrospectively from the computer databases entitled "Kopernik" and "Pacjenci". The efficiency of diagnostics provided in our clinic was estimated on the basis of the percentage of exploratory laparotomies and the number of missed injuries.Results. Of 218 patients with abdominal organ injuries, 72% underwent surgery and the remaining 28% were treated conservatively. Regardless of the type of trauma, the patients in shock received surgical treatment more often. In the group of patients suffering from blunt injuries, exploratory laparotomies were performed in 5.9% of haemodynamically stable patients and in 12.3% of patients admitted in shock. In the group of penetrating injuries the percentage of exploratory laparotomies reached 23.5 and 6.25% respectively. In six patients with blunt abdominal trauma who were treated conservatively the abdominal injuries were missed. One out of every ten patients was qualified for laparotomy solely on the basis of clinical examination. Most of these patients suffered from abdominal wounds. In the vast majority of remaining patients, FAST was used as the only diagnostic technique or (more often) in combination with additional diagnostic techniques. Except for FAST, additional diagnostic techniques were used in every tenth patient with isolated abdominal injury and in every fourth with multiple injuries. In the most abundant group of patients operated on due to bleeding, FAST was supplemented by additional techniques in half of the patients.Conclusions. FAST played a crucial role in diagnosing patients with injuries of the torso. CT or laparoscopy was additionally recommended for patients with suspected intra-abdominal organ injury, especially in cases of multiple injuries. Peritoneal penetration of the wound without symptoms of intra-abdominal organ injury should not constitute an indication for laparotomy. Qualification for laparotomy on the basis of clinical examination only is permissible only in haemodynamically unstable patients with abdominal wounds.

Keywords

EN

abdominal trauma; nontherapeutic laparotomy; US-FAST; laparoscopy; trauma diagnostic peritoneal lavage

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2007
• Volume: 79
• Issue: 5
• Pages: 353-361

Dates

published

1 - 5 - 2007

online

17 - 10 - 2007

Contributors

author

Marek Kuliś

• Department of Emergency Medicine and Multiple Injuries, 2 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Leszek Brongel

• Department of Emergency Medicine and Multiple Injuries, 2 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Piotr Budzyński

• Department of Emergency Medicine and Multiple Injuries, 2 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Waldemar Hładki

• Department of Emergency Medicine and Multiple Injuries, 2 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Jacek Lorkowski

• Department of Emergency Medicine and Multiple Injuries, 2 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Rafał Nazimek

• Department of Emergency Medicine and Multiple Injuries, 2 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Wiesław Jarzynowski

• Department of Emergency Medicine and Multiple Injuries, 2 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

author

Jan Magiera

• Department of Emergency Medicine and Multiple Injuries, 2 Chair of General Surgery, Collegium Medicum Jagiellonian University, Cracow

References

• Lasek J, Lipiński J, Białko M i wsp.: Charakterystyka obrażeń ciała u zmarłych po ciężkim urazie. W: Mackiewicz Z (red.) Wybrane Zagadnienia z Chirurgii. Fundacja Polskiego Przeglądu Chirurgicznego. Warszawa 1999; t I, 83-87.
• Cox EF: Blunt abdominal trauma. A 5-year analysis of 870 patients requiring celiotomy. Ann Surg 1984; 199(4): 467-74.[Crossref][PubMed]
• Hładki W, Anielski R, Cichoń S: Obrażenia brzuszno-piersiowe w mnogich obrażeniach ciała. W: Mackiewicz Z. (red.) Wybrane Zagadnienia z Chirurgii. Fundacja Polski Przegląd Chirurgiczny. Warszawa 1999, t I, 54-59.
• Brongel L, Gedliczka O: Obrażenia ciała w badaniu prospektywnym II. Epidemiologia urazów. Pol Przegl Chir 1993; 65: 559-69.
• Brongel L, Gedliczka O: Obrażenia ciała w badaniu prospektywnym V. Pomoc doraźna na miejscu wypadku i w transporcie. Postępowanie w stanach najcięższych. Pol Przegl Chir 1994; 66: 254-62.
• A Committee of Medical Aspects of Automotive Safety: Rating the severity of tissue damage. I. The abbreviated scale. JAMA 1971; 215(2): 277-80.
• A Committee of Medical Aspects of Automotive Safety: Rating the severity of tissue damage. II. The comprehensive scale. JAMA 1972; 220(5): 717-20.
• Baker SP, O'Neill B, Haddon W, Jr. et al.: The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14(3): 187-96.[PubMed][Crossref]
• Brongel L: Własna modyfikacja skali punktowej AIS i wskaźnika ciężkości obrażeń ISS: Liczbowa Skala Obrażeń (LSO). Pol Przegl Chir 1988, 60, 986-93.
• Osler T, Baker S, Long W: A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997; 43(6): 922-25.[PubMed][Crossref]
• Dolich MO, McKenney MG, Varela JE et al.: 2,576 ultrasounds for blunt abdominal trauma. J Trauma 2001; 50(1): 108-12.
• Schurink GW, Bode PJ, van Luijt PA et al.: The value of physical examination in the diagnosis of patients with blunt abdominal trauma: a retrospective study. Injury 1997; 28(4): 261-65.[PubMed][Crossref]
• Walcher F, Kortum S, Kirschning T et al.: Optimized management of polytraumatized patients by prehospital ultrasound. Unfallchirurg 2002; 105(11): 986-94.[Crossref][PubMed]
• Branney SW, Moore EE, Cantrill SV et al.: Ultrasound based key clinical pathway reduces the use of hospital resources for the evaluation of blunt abdominal trauma. J Trauma 1997; 42(6): 1086-90.[Crossref][PubMed]
• Feussner H, Papaziogas W, Siewert JR: Modern diagnostic workup of blunt abdominal trauma. Chirurg 1999; 70(11): 1246-54.[PubMed][Crossref]
• Ivatury RR, Zantut LF, Yelon JA: Laparoscopy in the new century. The Surg Clin N Amer 1999; 79(6): 1291-95.
• Smith RS, Fry WR, Morabito DJ et al.: Therapeutic laparoscopy in trauma. Am J Surg 1995; 170(6):632-36.[PubMed][Crossref]
• Zantut LF, Ivatury RR, Smith RS et al.: Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience. J Trauma 1997; 42(5): 825-29.[Crossref][PubMed]
• Villavicencio RT, Aucar JA: Analysis of laparoscopy in trauma. J Am Coll Surg 1999; 189(1): 11-20.
• Rehm CG: Bedside laparoscopy. Crit Care Clin 2000; 16(1): 101.[PubMed][Crossref]
• Goldstein AS, Sclafani SJ, Kupferstein NH et al.: The diagnostic superiority of computerized tomography. J Trauma 1985; 25(10): 938-46.[PubMed][Crossref]
• Matsubara TK, Fong HM, Burns CM: Computed tomography of abdomen (CTA) in management of blunt abdominal trauma. J Trauma 1990; 30(4): 410-14.[PubMed]
• Peitzman AB, Makaroun MS, Slasky BS et al.: Prospective study of computed tomography in initial management of blunt abdominal trauma. J Trauma 1986; 26(7): 585-92.[PubMed][Crossref]
• Taylor CR, Degutis L, Lange R et al.: Computed tomography in the initial evaluation of hemodynamically stable patients with blunt abdominal trauma: impact of severity of injury scale and technical factors on efficacy. J Trauma 1998; 44(5): 893-901.[PubMed][Crossref]
• Rieger M, Sparr H, Esterhammer R et al.: Modern CT diagnosis of acute thoracic and abdominal trauma. Radiologe 2002; 42(7): 556-63.[PubMed][Crossref]
• Okamoto K, Norio H, Kaneko N et al.: Use of early-phase dynamic spiral computed tomography for the primary screening of multiple trauma. Am J Emerg Med 2002; 20(6): 528-34.[Crossref]
• Linsenmaier U, Krotz M, Hauser H et al.: Whole-body computed tomography in polytrauma: techniques and management. Eur Radiol 2002; 12(7): 1728-40.[Crossref][PubMed]
• van Haarst EP, van Bezooijen BP, Coene PP et al.: The efficacy of serial physical examination in penetrating abdominal trauma. Injury 1999; 30(9): 599-604.[PubMed][Crossref]
• Ferrada R, Birolini D: New concepts in the management of patients with penetrating abdominal wounds. Surgical Clinics of North America 1999; 79(6): 1331-56.[Crossref]
• Leppaniemi AK, Voutilainen PE, Haapiainen RK: Indications for early mandatory laparotomy in abdominal stab wounds. Br J Surg 1999; 86(1): 76-80.[Crossref]
• Udobi KF, Rodriguez A, Chiu WC et al.: Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. J Trauma 2001; 50(3): 475-79.[Crossref][PubMed]
• Boulanger BR, McLellan BA, Brenneman FD et al.: Prospective evidence of the superioriority of a sonography-based algorithm in the assessment of blunt abdominal trauma. J Trauma 1999; 47: 632-37.[Crossref][PubMed]
• Boulanger BR, Brenneman FD, McLellan BA et al.: A prospective study of emergent abdominal sonography after blunt trauma. J Trauma 1995; 39(2): 325-30.[Crossref][PubMed]
• Yoshii H, Sato M, Yamamoto S et al.: Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma. J Trauma 1998; 45(1): 45-50.[Crossref]

Identifiers

DOI

10.2478/v10035-007-0055-1