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Penetrating Abdominal Trauma


Presentation

  • A pulse rate less than 100 was documented in 35.2% of all patients presenting with a systolic blood pressure less than 100 mm Hg (25 of 71).[ncbi.nlm.nih.gov]
  • Each of these six patients had either a shattered kidney or a renovascular injury and had a nephrectomy performed with the knowledge that a normal functioning kidney was present on the contralateral side.[ncbi.nlm.nih.gov]
  • Five cases of intestinal injury alone due to non-penetrating abdominal trauma are presented. The possible mechanisms of intestinal injury are discussed, together with the presentation, investigation and management of these cases.[ncbi.nlm.nih.gov]
  • DESIGN: We prospectively observed patients with penetrating abdominal trauma over 15 months and recorded demographics, presentation, imaging, surgical procedure, and outcome.[ncbi.nlm.nih.gov]
  • We present a retrospective study of the patients managed in our hospital (Polokwane Hospital, Limpopo) from January 1999 to March 2000.[ncbi.nlm.nih.gov]
Fever
  • Fever and leucocytosis are poor indicators of the need for continued postoperative administration in the severely traumatised patient.[ncbi.nlm.nih.gov]
  • Laparoscopy may also have a role in patients who have localised tenderness or develop a white cell count or fever without generalised peritonitis after a period of clinical observation.[trauma.org]
  • You have a fever. Your wound is red, swollen, and draining pus. Your pain does not go away, or it gets worse, even after treatment. You feel dizzy or are vomiting. You have trouble urinating. You have blood in your urine.[drugs.com]
  • Steadily worsening pain within the first day suggests hollow viscus perforation or, if after several days, abscess formation, particularly if accompanied by fever and leukocytosis.[merckmanuals.com]
Multiple Organ Dysfunction Syndrome
  • Morbidity and mortality were commonly associated with peritonitis and multiple organ dysfunction syndrome.[ncbi.nlm.nih.gov]
  • Major injuries, extensive blood loss and transfusions, prolonged preoperative hypotension, and long operative time may be followed by multiple organ dysfunction syndrome or failure (MOF) requiring prolonged treatment in an Intensive Care Unit.[medicosecuador.com]
Camping
  • This article describes a series of patients with complex abdominal wall problems managed at the UK-led Role 3 Medical Treatment Facility (MTF) in Camp Bastion, Afghanistan.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Ten years after injury, 16 patients had no problems, whereas 3 reported occasional abdominal pain. CONCLUSION: Penetrating abdominal injuries in war demand urgent diagnostic procedures and, in almost all cases, urgent laparotomy.[ncbi.nlm.nih.gov]
  • For information on abdominal trauma in children, please go to the Assessment of abdominal pain in children topic.[bestpractice.bmj.com]
  • An open wound that may be bleeding Abdominal pain, redness, and swelling Bruises, swelling, or scratches on the abdomen Nausea or vomiting Blood in your urine Trouble urinating or passing little to no urine Signs of shock, such as a fast heartbeat, dizziness[drugs.com]
  • Reasons for such concern include increasing abdominal pain or anticipated inability to monitor the patient clinically (eg, patients who require heavy sedation or who will be undergoing lengthy surgical procedures).[merckmanuals.com]
Acute Abdomen
  • Those with signs of acute abdomen or hemodynamic instability had immediate surgery. Patients who were hemodynamically stable had a CT scan with contrast. If no intra-abdominal injury requiring surgery was evident, patients were observed.[ncbi.nlm.nih.gov]
  • Of the 651 patients, 345 (53%) had signs of an acute abdomen and were operated on immediately. The remaining 306 patients had minimal or no peritoneal signs and were observed.[sjtrem.biomedcentral.com]
Absent Bowel Sounds
  • Clinical signs which may suggest operative management include tenderness not localised to the area of injury, as well as absent bowel sounds. In this particular case, laparotomy was indicated due to the knife still being in situ.[radiopaedia.org]
  • Absent bowel sounds and abdominal wall rigidity were the most sensitive indices as their presence was always associated with intraperitoneal injury.[jpgmonline.com]
Hypotension
  • Vascular injury, subsequent hypotension, blood transfusion, and complicated postoperative course are common in this population.[ncbi.nlm.nih.gov]
  • Predictors of immediate celiotomy were hypotension (p 0.03), anteriorly located entrance wounds (p 0.0005), and transaxial wounds (p 0.03). Overall morbidity and mortality was 32% and 2%, respectively. The negative celiotomy rate was 25%.[ncbi.nlm.nih.gov]
  • Animal data and several studies in humans have suggested that "permissive hypotension"—actively or passively allowing the blood pressure to remain in the hypotensive range (ie, systolic pressure less than 90 mm Hg)—may prevent disruption of clot and dilution[emedicine.medscape.com]
  • Keywords Penetrating Abdominal Trauma DPL FAST Laparotomy Massive transfusion protocol Permissive hypotension Nonoperative management Abdominal compartment syndrome Suggested Reading Nicholas JM, Rix EP, Easley KA, et al.[link.springer.com]
Loss of Initiative
  • The principles of management identified included minimising tissue loss on initial laparotomy by joining adjacent wounds and marginal debridement of dead tissue; contraction of the abdominal wall was minimised by using topical negative pressure dressing[ncbi.nlm.nih.gov]

Workup

  • […] hollow organ injury if solid, liver is most common Presentation Mechanism of injury can create wide spectrum of presentations symptoms and signs of blood loss may not be evident therefore, mechanism of injury can solely determine need for further imaging workup[medbullets.com]
Pneumoperitoneum
  • TECHNIQUE: After having established pneumoperitoneum and ports placement, the source of bleeding is identified and controlled. Systematic inspection of intraperitoneal and retroperitoneal organs is done.[ncbi.nlm.nih.gov]

Treatment

  • Of the 30 patients with trauma to the dorsum or thoracoabdominal transition, 23 underwent nonoperative treatment and seven, laparotomy. There were three nonoperative treatment failures.[ncbi.nlm.nih.gov]
  • Demographic information, treatments, and outcomes were analyzed using descriptive statistics.[ncbi.nlm.nih.gov]
  • METHODS: The study was a prospective double-blind trial of 24-hour treatment (cefoxitin or cefotetan) compared with 5-day treatment in 515 patients. Major abdominal infections (MAI) included abscess, necrotizing fasciitis, and diffuse peritonitis.[ncbi.nlm.nih.gov]
  • Data were collected and organised according to the following categories: general patient information, age, gender, hospitalisation period, trauma mechanisms, concomitant injuries, radiological assessment, diagnosis and treatment methods, treatment forms[ncbi.nlm.nih.gov]
  • INTRODUCTION: In France, non-operative management (NOM) is not the widely accepted treatment for penetrating wounds.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis of patients with abdominal trauma is usually good. The hospital mortality rates for abdominal stab wounds is 1-5%, and for abdominal gunshot wounds 10-13%.[medicosecuador.com]
  • […] arrive at a hospital. [11] Injuries from firearms are the leading cause of TBI-related deaths. [11] Penetrating head trauma can cause cerebral contusions and lacerations, intracranial hematomas, pseudoaneurysms, and arteriovenous fistulas. [11] The prognosis[en.wikipedia.org]

Epidemiology

  • Epidemiology, mechanism of injury, patterns of injury, management, morbidity and overall mortality were recorded for analysis. Morbidity and mortality were commonly associated with peritonitis and multiple organ dysfunction syndrome.[ncbi.nlm.nih.gov]
  • The epidemiological and clinical features were evaluated as probable risk factors for mortality. The risk factors for mortality were revealed using univariate and multivariate analyses.[ncbi.nlm.nih.gov]
  • BACKGROUND: The epidemiology of penetrating abdominal trauma is changing to reflect an increasing incidence of multiple injuries.[ncbi.nlm.nih.gov]
  • OBJECTIVES Discuss the incidence and epidemiology of abdominal trauma Review abdominal anatomy Discuss the mechanisms of injury for abdominal trauma Explain an abdominal assessment as part of a trauma exam Discuss prehospital management Identify emergency[emsworld.com]
Sex distribution
Age distribution

Pathophysiology

  • Detailed attention is paid to pathophysiology, clinical symptoms and findings, all relevant imaging modalities and other tests employed to evaluate abdominal injuries at the time of admission of the trauma victim.[books.google.com]

Prevention

  • OBJECTIVES: To determine whether a combination of ciprofloxacin hydrochloride and metronidazole hydrochloride would be as effective or more effective than a combination of gentamicin sulfate and metronidazole hydrochloride for preventing infection in[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Twenty-four hours of presumptive intravenous cefoxitin versus 5 days of therapy made no difference in the prevention of postoperative infection or length of hospitalization.[ncbi.nlm.nih.gov]
  • Despite such preventive measures, major infection remains a problem.[ncbi.nlm.nih.gov]
  • Abstract There were 73 evaluable patients entered into a prospective, double-blinded trial comparing aztreonam/clindamycin (A/C) to gentamicin/clindamycin (G/C) for the prevention of infection after penetrating abdominal trauma.[ncbi.nlm.nih.gov]
  • Prophylactic mesh closure of the abdomen may facilitate the prevention and bedside treatment of IAH and reduce these complications.[ncbi.nlm.nih.gov]

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