Abdominal Injury. Pathogeniesis and Outcome of the Treatment

Open access

Abdominal Injury. Pathogeniesis and Outcome of the Treatment

Abdominal injuries seem to appear rather not frequently. In a presented material their prevalence does not exeed 0.3% of all patients. In spite of that they are significant problem of surgical wards on duty for in many cases surgical intervention is necessary.

The aim of the study was to assess the extent of required surgical treatment and the results of injury management.

Material and methods. 95 patients with abdominal injury were treated in our clinic between years 1996 and 2006. There were 29 women (30.5%) and 66 males (69.5%) in this group at the age ranging from 17 to 91 years /mean-44 years/. The reasons of the injury were as follow: traffic accidents in 33 patients (34.7%), sudden collapse and the fall from the height in 25 patients (26.3%) and the assault in the rest 32 patients (33.7%). Blunt abdominal trauma was diagnosed in 69 patients (72.6%) while penetrating one in 26 persons (27,4%). Isolated injury to abdominal cavity concerned 35 cases (36,8%) and in the rest 60 cases (63,2%) were poly-trauma patients. Abdominal trauma was accompanied most frequently by chest trauma (34 cases-35.8%), then by head injury (32 cases - 33.7%) and bone fracture (29cases -30.5%). In 24cases (25.3%) all the mentioned injuries appeared simultaneously. Diagnosis was based on physical evaluation and ultrasound examination. In selected cases computed tomography was done. As the result of performed evaluation the diagnosis was made and 53 patients (55.8%) were operated. In 18 patients splenectomy was performed because of its rupture, the following 14 patients required suture of the intestine, 13 patients required drainage of intraperitoneal haematomas and ruptured mesocolon. 8 patients had injury to the liver and kidney. 42 patients (44.2%) were treated conservatively.

Results. All of the operated patients survived and were discharged home. There were 8 deaths (8.4%) in the group treated conservatively. Six of them appeared just after the admission to the clinic or in the emergency room and two of them in the fist several days of patients stay. The reason of all the deaths was profound posttraumatic shock due to multi-organ injury.

Conclusions. 1. Intraperitoneal hemorrhage and peritonitis due to gastrointestinal tract injury are the most frequent indications for surgery in patients with abdominal trauma. 2. The main reasons for unsuccessful treatment of isolated abdominal injuries are multi-organ injury and postraumatic shock.

Smith J, Caldwell E, D'Amours S et al.: Abdominal trauma: a disease in evolution. ANZ J Surg 2005; 75(9): 790-94.

Gonzales RP, Han M, Turk B et al.: Screening for abdominal injury prior to emergent extra-abdominal trauma surgery: a prospective study. Trauma 2004; 57(4): 739-41.

Nast-Kolb D, Bail HJ, Taeger G: Current dignostics for intra-abdominal trauma. Chirurg 2005; 76(10): 919-26.

Brongel L, Jarzynowski W: Algorytmy postępowania w obrażeniach narzαdów jamy brzusznej. Pol Przegl Chir 2001; 73(9): 866-71.

Gwoździewicz J, Lipiński J, Lasek J et al.: Punktowe skale ciężkości obrażeń w ocenie wyników leczenia chorych z mnogimi obrażeniami ciała. Nowiny Lekarskie 1999; 68, Supl. I, 329-37.

McFarlane M: Management of penetrating abdominal injures. West Indian Med J 1995; 44(4): 140-42

McCarthy MC, Lowdermilk GA, Canal DF et al.: Prediction of injury caused by penetrating wounds to the abdomen, flank and back. Arch Surg 1991; 126(8): 962-65.

Tsai MJ, Chen JP et al.: Management of penetrating abdominal injury. Gaoxiong Yi Xue Ke Za Zhi 1991; 7(1): 32-37.

Burns RK, Sariol HS, Ross SE: Penetrating posterior abdominal trauma. Injury 1994; 25(7): 429-31.

van Haarst EP, van Beooijen BP, Coene PP et al.: The efficacy of serial physical examination in penetrating abdominal trauma. Injury 1999; 30(9): 599-604.

Majewski W: Diagnostyka i leczenie urazów jamy brzusznej z zastosowaniem laparoskopii w oddziale ogólnochirurgicznym. Pol Przegl Chir 2002; 74(2): 136-49.

Szczygieł B: Rola leczenia żywieniowego w zapobieganiu i leczeniu następstw urazu. Pol Przegl Chir 2002; 74(3): 273-76.

Szulc R: Rola jelita w niewydolności wielonarzαdowej w mnogich obrażeniach ciała. Pol Przegl Chir 2002; 74(2): 196-201.

Catre MG: Diagnotic peritoneal lavage versus abdominal computed tomography in blunt abdominal trauma: a review of prospective studies. Can J Surg 1995; 38: 117-22.

Sriussadaporn S, Pakart R, Pattaratiwanon M et al.: Clinical uses of diagnosyic peritoneal lavage In stab wounds of the anterior abdomen: a prospective study. Eur J Surg 2002; 168: 490-93.

Gonzalez RP, Ickler J, Gachassin P: Complementary role sof diagnostic peritoneal lavage and computed tomography In the evaluation of bunt abdominal trauma. J Trauma 2001; 51: 1128-34.

Polish Journal of Surgery

The Journal of Foundation of the Polish Journal of Surgery

Journal Information


CiteScore 2016: 0.29

SCImago Journal Rank (SJR) 2016: 0.166
Source Normalized Impact per Paper (SNIP) 2016: 0.207

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 115 83 9
PDF Downloads 69 53 4