blunt abdominal trauma investigation

Buckley JC, McAninch JW. Diagnostic options for blunt abdominal trauma | SpringerLink The initial presentation and clinical examination belied serious intra-abdominal injuries. Injuries to solid organs from direct force Blunt force can press the abdominal contents against the vertebral column It is especially true as most injuries are minor and usually confined to one or two organs easily seen with US. The use of imaging modalities is also . Blunt abdominal trauma is one of the very common emergencies in the emergency department. Its use is recommended in all patients of blunt abdominal trauma a part of Blunt abdominal trauma - Northerntrauma Blunt abdominal injury resulting in a belly full of candy ... Despite several treatment algorithms, there is currently no consensus on how to manage patients with HVI. A 16-year-old male patient came to emergency department after a sports-related blunt abdominal injury. fall). Trauma is a physical injury caused by transfer of energy to and within the person involved. Colonic Overview of Abdominal Trauma - Injuries; Poisoning - MSD ... Blunt trauma occurs in approximately two-third of abdominal injury patients. Abdominal trauma is best categorised by mechanism as blunt or penetrating abdominal injury. American College of Surgeons Committee on Trauma. The most important initial concern in the evaluation of a patient with blunt abdominal trauma is an assessment of hemodynamic stability. The pancreas is a retroperitoneal structure and can be injured in blunt trauma to the epigastrium. Blunt abdominal trauma is a common injury that is most frequently caused by motor vehicle accidents and rarely by other mechanisms of injury. Methods: The study was done in the department of general surgery in a tertiary care centre that hasround the clock availability of all radiological investigations. He is also having lower limb sweling pittingvin nature and painless up tho . Detailed history of any recent abdominal blunt injury, regardless time and mechanism of the inciting event or a history of NOM for past splenic trauma seems to be important as it could lead to prompt diagnosis of DSR. Case presentation: A 67-year-old man presented after falling from a short step stool while . Patients with isolated TBI, low-impact rib pain, isolated abdominal trauma may be evaluated with PE plus US with 85% NPV. 4 Indications for emergency laparotomy - blunt trauma. Hypotension with evidence of abdominal injury 2. Can J Rural Med . Pain from splenic injury. 25(2):180-204. . seatbelt), or from deceleration forces (e.g. Background. The mechanism of injury dictates the diagnostic work-up. Hence, often missed, unless, repeatedly looked for Analysis of peritoneal lavage parameters in blunt abdominal trauma. Equivocal physical findings in patients who have sustained high-energy forces to the torso 5. A 16-year-old male patient came to emergency department after a sports-related blunt abdominal injury. These injuries can lead to serious morbidity. Yule SR, Loudon MA. 2008 Apr 26;336(7650):938-42. doi: 10.1136/bmj.39534.686192.80. Here, we report a case of isolated jejunal tear in a 24-year-old male truck driver. When blunt abdominal trauma is sustained, only 13% of cases are associated with intra-abdominal injuries, and of those, 25% require surgical intervention. Initial assessment of the patient must follow the usual trauma protocols with identification . Higher incidence of intra-abdominal injury in the presence of low rib Authors Jan O Jansen 1 , Steven R Yule, Malcolm A Loudon. Many of the structures within the abdominal cavity are highly vascular and damage following trauma can lead to life-threatening hypovolaemia. A case of blunt abdominal trauma 1 yrs ago *Chief Complaints* Abdominal distention for 2 weeks and bilateral lower limb swelling up the level of knee *History* Patient came with abdominal distension which started gradual Progressively increased in severity with time being relieved by diuretic with no aggravating factor. Abdominal Trauma - Blunt Inclusion Criteria: • Blunt Abdominal Trauma • Cooperative patient • Stable Vital Signs (RR>8 or <24, SBP>100, P>60 or <110) • No Peritoneal Signs • If done - negative initial imaging studies (AAS, CT Abdomen/Pelvis) • Pertinent labs acceptable (e.g., HgB) Exclusion Criteria: Evaluation of patients who have sustained blunt abdominal trauma (BAT) may pose significant diagnostic challenges due to confounding factors such as altered level of consciousness (neurological injury, alcohol or drugs) or neurological deficit (spinal cord injury), and the potential for delayed manifestation (particularly for mesenteric injury . Investigation of blunt abdominal trauma. Blunt abdominal trauma (BAT) is frequently encountered in the form of motor vehicle crashes (MVCs) (75%), followed by falls and direct abdominal impact. American College of Surgeons; 2008. Patients with abdominal tenderness, abdominal wall contusions, or an unreliable physical examination due to head injury, intoxication, or a distracting injury require further investigation by focused assessment with sonography for trauma (FAST) or an abdominal CT scan to diagnose potential intra-abdominal injury. Although this technology is becoming more available to trauma surgeons, for a variety of reasons, it has not become universally available in all centers. Potoka DA, Saladino RA. position of the liver and its large size makes it more prone for injury in blunt trauma of the abdomen. The investigation of blunt abdominal trauma is a challenging and contentious subject with a limited evidence base. These investigations are som e ti me mandator y f or pati ents hav ing equi voc al si gns of peritonitis. 2. In: ATLS Student Course Manual. 25% die in golden hour (4-6 hours) of trauma. [Google Scholar] Marx JA, Moore EE, Jorden RC, Eule J., Jr Limitations of computed tomography in the evaluation of acute abdominal trauma: a prospective comparison with diagnostic peritoneal lavage. The patient sustained a blunt abdominal assault several days earlier and workup revealed severe . Introduction . Methods: The present observational hospital based prospective study was carried out in 96 blunt abdominal trauma patients of both sexes aged up to 12 years, over a period of 2 years. Isolated jejunal tear which is caused by blunt abdominal trauma is rare and is most often seen in road traffic accidents. Notes Table 1:Association With Intra Abdominal Injury Cases Blunt Injury Abdomen Penetrating Injury Abdomen Total % With intra abdominal injury 22(55%) 10(25%) 32 80% Without intra abdominal injury 8 (20 %) 0 08 20% Total number of cases 30 (75%) 10 (25%) 40 100% Table 2:Isolated Organ Injury DOI: 10.9790/0853-1705132630 www.iosrjournals.org 27 . METHODS: A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. The algorithm proposed here is widely accepted and should help doctors in emergency departments decide on the most appropriate form of investigation pending the arrival of a specialist. Pediatric Blunt Abdominal Trauma. Investigation of blunt abdominal trauma. Background: Ultrasonography is regarded as the tool of choice for early diagnostic investigations in patients with suspected blunt abdominal trauma. Blunt abdominal trauma in cases of multiple trauma . 1985 May; 25 (5):393-399. Investigation of blunt abdominal . The algorithm proposed here is widely accepted and should help doctors in emergency departments decide on the most appropriate form of investigation pending the arrival of a specialist. Our method of investigation of' the child with blunt abdominal trauma is more rapid and less costly (in terms of sedation, time, radiation and dollars) than systematic examination by CT. The most common mechanisms of blunt abdominal SOI trauma are motor vehicle crashes, injury from sports, falls, and violence/abuse. 2006 Fall. Investigation of blunt abdominal trauma BMJ. Blunt abdominal trauma is a frequent emergency and is also associated with significant morbidity and mortality. Identification of serious intra-abdominal pathology is often challenging; many. Peritonism. blunt abdominal trauma .Blunt injury of abdomen is also a result of fall from height, assault with blunt Objects, industrial mishaps, sport injuries, bomb blast and fall from riding bicycle.Blunt abdominal trauma is usually not obvious. We present a case of a sports injury. Shanmuganathan K. Multi-detector row CT imaging of blunt abdominal trauma. These patients may initially present with minimal clinical signs. Liver & spleen most frequently damaged organs. The initial presentation and clinical examination belied serious intra-abdominal injuries. . Spleen is the commonest organ injured. He's in a lot of pain and points at his abdomen. Investigation of blunt abdominal . 50% die immediately at the time of accident. 25% may die late during treatment period due to sepsis and complications. 2. Footnotes Blunt abdominal trauma is a common injury that is most frequently caused by motor vehicle accidents and rarely by other mechanisms of injury. A rugby league player is brought in by ambulance. It causes death, disability or both. Ultrasound is a valuable tool for assessing abdominal injury to the woman and the fetus, but clinicians need to remain aware of the limitations. Wegner S, Colletti JE, Van Wie D. Pediatr Clin North Am. Blunt abdominal trauma is more likely to be delayed or altogether missed because . Splenic Injury Splenic injury usually results from blunt abdominal trauma. intervention, pregnancy or participation in other clinical investigations, peritonitis or sepsis, prior surgery and no history of blunt abdominal trauma. Objectives Despite the low incidence of pancreatic injury in the abdominal blunt trauma (BTA), its early diagnosis is very important; since pancreatic injury is associated with high rates of morbidity and mortality. Background: Blunt traumatic gastric perforations in children are rare. FAST is a reliable investigation among patients with blunt abdominal trauma. . Motor vehicle collisions cause the highest proportion of all TAWH. 8th. Management depends on the patient's stability and specific type of injury. He was the minced meat in a wholemeal sandwich when he was crash tackled by two opposing players as he dived for the try line. GSW) or stab wound (e.g . This paper describes the assessment, investigation and management of patients suffering blunt abdominal trauma. 4. In children (less than or equal to 14 years of age), blunt abdominal trauma is the second most frequent cause of mortality preceded by head injuries. . [1] Assessing patients of blunt abdominal trauma (BAT) remains one of the most challenging and tools-intensive aspects of trauma care. J Trauma. DPL in the investigation of blunt abdominal injury.910Each technique has inherent advantages and disadvantages. 2006;33:33-40Trauma is the leading cause of death and . Diagnosis of injury from abdominal trauma may require further investigation if clinical signs of trauma continue despite no evidence of abruption on ultrasound examination. In this study, we meet a special complication after splenectomy, atelectasis and mediastinal shift, and this is the complication with hemodynamic unstable. INTRODUCTION • Abdominal trauma is an injury to the abdomen. Multiple injuries and unexplained shock 3. The most common cause of blunt trauma abdomen was road traffic crashes. The algorithm proposed here is widely accepted and should help doctors in emergency departments decide on the most appropriate form of investigation pending the arrival of a specialist. Clin Pediatr Emerg Med. • Abdominal trauma is divided into: Penetrating abdominal trauma (PAT), usually diagnosed based on clinical signs. Mechanisms of injury include Direct blows to the abdomen. Splenic rupture, whatever the cause, is associated with significant mortality. the treating doctor in optimum management of blunt abdominal trauma include; Focused Assessment Sonography for Trauma (FAST), Diagnostic Peritoneal Lavage (DPL) and CT scan1. Blunt abdominal injury is also a result of fall from height, assault with objects, industrial mishaps, sports injuries, bomb blast and fall from riding bicycle. IVP. Falls, sporting injuries and assaults are other leading causes. Indications for DPL in blunt trauma: 1. This paper describes the assessment, investigation and management of patients suffering blunt abdominal trauma. Blunt abdominal injury (BAI) is common and usually results from motor vehicle collisions (MVC), falls and assaults. BLUNT ABDOMINAL TRAUMA BY: ANNE E. ODARO (MCM/2017/69852) FACILITATOR: DR. NYAGA. Though on clinical examination the injury did not seem to be serious, FAST revealed an obscured splenorenal window. The most common intra-abdominal injuries affect parenchymal organs, i.e. The investigation of blunt abdominal trauma is a challenging and contentious subject with a limited evidence base. Abdominal trauma is seen quite often in the Emergency Department and can result from blunt or penetrating mechanisms. high velocity missile (e.g. Abdominal Trauma. J Trauma. Blunt abdominal trauma (BAT) is a leading cause of morbidity and mortality in adult patients in the emergency department, and speedy diagnosis and . Blunt abdominal injuries are very common and usually result from motor vehicle collisions, recreational accidents or falls. 4 Indications for emergency laparotomy - blunt trauma. Learning Bite Unrecognised abdominal injury remains a significant cause of death. 2006;53:243-256Blunt Abdominal Trauma in the Pediatric Patient. Elevated liver enzymes as a predictor of liver injury in stable blunt abdominal trauma patients: case report and systematic review of the literature. the liver and spleen, followed by bowel and mesentery [].Missed intra-abdominal injuries and delays in surgical treatment are associated with a high morbidity rate. High degree of suspicion and watchfulness, regular examination, imaging and investigations are needed to diagnose blunt injury abdomen. Introduction . Patient 1 — Isolated blunt abdominal trauma. Peritonism. Urol Clin North Am. In blunt abdominal trauma, the bowel, spleen, liver, kidneys, and pelvic organs can be injured. We present a case of an adolescent who sustained blunt abdominal injury in a motocross accident and presented with remarkable hyperdense spherical shaped structures on the computed tomography (CT). We present a case of a sports injury. Can be used to assess renal trauma but the kidney can usually be assessed with IV contrast at the time of CT scan. Background: To study the clinical presentations, pattern, modes of management and outcome in a patientwith abdominal trauma. - When it comes to high-energy impacts/injuries, the combination of imaging modalities increases the sensitivity for identifying injuries not apparent on routine imaging. Seventy-five percent were male. Introduction. Operative management was required in 57 (37.01%) cases while 97 (62.98%) were managed non . The most important initial concern in the evaluation of a patient with blunt abdominal trauma is an assessment of hemodynamic stability. Without bronchoscopy, the patient is told to inspire deeply by blowing balloons with . Penetrating trauma Object breaching peritoneum, e.g. Blunt abdominal SOI results from a direct blow to the abdomen. . Advances in diagnosis and management of multiple trauma patients have lead to adopting a conservative approach for most patients with blunt abdominal trauma. Initial assessment of the patient must follow the usual trauma protocols with identification . Abdominal trauma remains a leading cause of mortality in all age groups. Diagnostic tools that help in optimum management of blunt abdominal trauma include; Focussed Assessment Intestinal obstruction is a rare . Blunt abdominal trauma Blunt abdominal trauma Ratcliffe, John 1996-11-01 00:00:00 Pediatr Radiol (1996) 26:830-831 Â© Springer-Verlag 1996 John Ratcliffe Received: 13 March 1996 Accepted: 10 May 1996 Sir, The recent commentaries and papers on blunt abdominal trauma (BAT) are most interesting and should engender much further discussion [1-3]. Case Presentation . Recent literature is replete with studies that emphasize the many advantages of ultrasound in the valuation of BAT. 2005;6:23-31The Diagnosis, Management, and Outcomes of Pediatric Renal Injuries. injuries following blunt abdominal trauma. 3. to improve outcomes in this subset further investigation is warranted. A short cut review was carried out to establish whether it is necessary to carry out further imaging in order to identify clinically significant renal injury in patients with microscopic haematuria after blunt abdominal trauma. Potential abdominal injury in patients who are unconscious, intoxicated, or paraplegic 4. Physical examinations signs following blunt abdominal trauma should raise suspicion of a severe injury when the following are present: seatbelt injury, rebound tenderness, hypotension BP<90, abdominal distension, abdominal guarding and concomitant femur fracture. In addition to providing evidence of bleeding it gives detailed anatomical information of injuries. Background. As there is a broad spectrum of abdominal injuries, abdominal trauma patients are often difficult to assess. Small intestinal injury following blunt abdominal trauma has been widely reported. Hollow viscus injury (HVI) due to blunt abdominal trauma remains a diagnostic challenge, often presenting late and results in delayed intervention. Liver and spleen together, account for 75% of injuries in blunt abdominal trauma.2 Though liver is the second most commonly injured organ in abdominal trauma, it is the most common cause of death following abdominal injury. 227 I 3 I I 200 I 20 The Role of Computed Tomography in Blunt Abdominal Trauma Om Bahadur Karki 1 1Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal. Future Investigation. Blunt abdominal trauma (see the image below) is a leading cause of morbidity and mortality among all age groups. Ultrasonography (USG) is the preliminary investigation of choice in the assessment of BAT. AbstrAct Introduction: Blunt injury trauma is regularly encountered in the emergency department. To aid initial diagnosis, investigation and management, abdominal trauma can be broadly grouped into penetrating or blunt, depending on the mechanism of injury. Background: Traumatic abdominal wall hernias (TAWH) are uncommon injuries classically associated with high-energy blunt traumatic mechanisms. It requires high degree of suspicion, investigation and management. Literature is currently limited, with some debate existing over surgical management strategies. Learning points. Yule SR, Loudon MA. CONCLUSION FAST is a better investigation than paracentesis in diagnosing blunt abdominal trauma with higher sensitivity and specificity. The extent and specific type of abdominal traumatic injury can be identified by a proper history and physical examination and confirmed by appropriate imaging studies. A 52-year-old male presented to our surgical service with high-grade small bowel obstruction secondary to an extensive small bowel intramural hematoma requiring resection. Delayed diagnosis will lead to abdominal contamination and may result in morbidity and even mortality. Jansen JO, Yule SR, Loudon MA. Indications in blunt trauma are as follows: epidemiological parameters that influences the causation of trauma as well as injury pattern in blunt trauma abdomen in pediatric population. Purpose: Physical examination, laboratory tests, ultrasound, conventional radiography, multislice computed tomography (MSCT), and diagnostic laparoscopy are used for diagnosing blunt abdominal trauma. the liver and spleen, followed by bowel and mesentery [].Missed intra-abdominal injuries and delays in surgical treatment are associated with a high morbidity rate. Nonoperative management (NOM) has been established as the standard therapy for hemodynamically stable patients with blunt abdominal injuries [1-5].Recently, adjunctive trans-catheter embolization (TAE) has reduced the rate of NOM failure even in patients with risk factors such as high-grade injury (IV-V Organ Injury Scale (OIS) of American Association of Surgery for Trauma (AAST . INTRODUCTION: Trauma during Road Traffic Accident is a major public health problem in all countries. The appropriate next step investigation plays a very vital role in management of such patients who otherwise face increase morbidity or even mortality. - In a scenario of blunt trauma, CXR, CT chest/abd/pelvis, and CT spine provides rapid assessment of the extent of patient injury and need for further workup/treatment. Motor vehicle accidents account for 75%-80% of blunt abdominal trauma. However, due to the high association of pancreatic injury with injury of other abdominal organs, its diagnosis may be delayed and complicated. Semin Ultrasound CT MR. 2004 Apr. It may fail to the diagnosis of patients with blunt abdominal trauma: a retrospective study. Injury. Setting and design: Retrospective observational study conducted in a tertiary carehospital. 1a Blunt Abdominal Trauma Image 1a and 1b (Computed Tomography): Traumatic lacerations to the right and left liver lobes (arrows, Image 1a) and pancreas (Image 1b, arrow) with left renal pedicle injury (lack of enhancement of the left kidney, arrow, 1b Image 1b) 2a Blunt Abdominal Trauma The majority of significant blunt abdominal trauma is sustained in road traffic crashes (50-75% of cases). Many of the structures within the abdominal cavity are highly vascular and damage following trauma can lead to life-threatening hypovolaemia. Though on clinical examination the injury did not seem to be serious, FAST revealed an obscured splenorenal window. that patient having blunt abdominal trauma is almost 99%. The investigation of blunt abdominal trauma is a challenging and contentious subject with a limited evidence base. AIMS AND OBJECTIVES: 1)To study the impact of blunt abdominal trauma on abdominal solid . Background: Blunt abdominal trauma is fairly common emergency and it is one of the important components of polytrauma. Abdominal trauma is classified as blunt or penetrating, assessment and management is modified accordingly BLUNT ABDOMINAL INJURY Blunt abdominal injuries often managed conservatively, though interventional radiology and surgery are indicated for severe injuries Common mechanisms include road traffic crashes, falls, sports injuries and assaults Version 2.1 Abdominal Trauma 23/04/2012 Types Blunt trauma Compression, secondary to a direct blow, or against a fixed external object (e.g. The primary endpoint of the study is to estimate the prevalence of peritoneal adhesions after blunt abdominal trauma with evaluation of the extent, severity and treatment options. 28: 261-265 III Retrospective study of PE in 204 patients with BAT. Intestinal intramural hematomas are a rare complication of blunt abdominal trauma in the setting of anticoagulation. Mesenteric tear and isolated small bowel injuries can also occur. Case Presentation . Compared to paracentesis, FAST is a better investigation with 63% chance of diagnosing blunt trauma and a specificity of 100%. These injuries can be difficult to detect initially if the patient has no signs of external trauma or alteration to their vital signs. Affiliation 1 Department of Surgery, Aberdeen . CT is currently accepted as the gold standard for the investigation of the trauma patient. Physical examinations signs following blunt abdominal trauma should raise suspicion of a severe injury when the following are present: seatbelt injury, rebound tenderness, hypotension BP<90, abdominal distension, abdominal guarding and concomitant femur fracture. Patients with abdominal tenderness, abdominal wall contusions, or an unreliable physical examination due to head injury, intoxication, or a distracting injury require further investigation by focused assessment with sonography for trauma (FAST) or an abdominal CT scan to diagnose potential intra-abdominal injury. The most common intra-abdominal injuries affect parenchymal organs, i.e. Abdominal pain typically is present; however, pain is often mild and thus easily obscured by other, more painful injuries (eg, fractures) and by altered sensorium (eg, due to head injury, substance abuse, shock). Data were collected on clinical presentation, investigations, diagnostic methods, associated injuries, and operative management. Inspite of improved imaging techniques leading to early recognition it is still associated with high morbidity and mortality. Although its sensitivity is too low for definite exclusion of abdominal organ injury, proponents of ultrasound argue that ultrasound-based clinical pathways enhance the speed of primary trauma assessment, reduce the number of computed tomography . 11(4):283-7 . Altogether 57 papers were found using the reported search, of which 10 presented the best evidence to answer the clinical question. 1985 Oct; 25 (10):933-937. The need for a laparotomy in blunt abdominal trauma cases, as previously stated, relates largely to clinical response to aggressive resuscitation and the nature of the organs injured in the trauma. [1,2] Blunt abdominal trauma is usually not obvious, hence often missed unless repeatedly looked for. The peak incidence of blunt abdominal trauma is between the ages of 14 and 30 years, but the highest mortality rate occurs in individuals 55 years of age or older. Blunt abdominal injury in paediatric patients is the primary mechanism for pancreatic injury. wIGFo, PKpK, unUz, fRnBnp, irpAt, uYkPYt, JCww, TQkcTlh, qfMVf, vOP, Yzr,
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