Ultrasound examination in closed abdominal trauma with damage to parenchymal organs

Authors

  • D. B. Fira I. Horbachevsky Ternopil National Medical University
  • P. O. Gerasymchuk I. Horbachevsky Ternopil National Medical University
  • N. O. Dobrynska Municipal Non-Profit Organization “Ternopil City Municipal Emergency Hospital”
  • A. V. Pavlyshyn I. Horbachevsky Ternopil National Medical University

DOI:

https://doi.org/10.11603/2414-4533.2022.4.13536

Keywords:

closed abdominal trauma, ultrasound examination, FAST protocol

Abstract

The aim of the work: to study the effectiveness and diagnostic value of ultrasound examination according to the FAST protocol in closed abdominal trauma with damage to parenchymal organs.

Materials and Methods. The results of the use of ultrasound examination according to the FAST protocol in the diagnosis of closed abdominal trauma with damage to parenchymal organs in 119 patients were retrospectively analyzed.

Results and Discussion. An urgent ultrasound of the abdominal cavity was carried out in all patients at the stage of hospitalization, which allowed to establish the presence of damage to parenchymal organs by direct or indirect signs.

Free fluid in the abdominal cavity, as an indirect sign of damage, was diagnosed in 89 (74.8 %) patients upon admission.

At the time of admission, free fluid in the abdominal cavity could not be detected in 19 (16.0 %) patients, but its appearance was diagnosed during further ultrasound monitoring of the victims during the day.

In 24 (20.2 %) patients, direct signs of spleen damage were diagnosed during the primary ultrasound, and in 7 (5.9 %) patients – liver.

Subcapsular or intra-organ hematomas without hemoperitoneum formation were found in 8 (6.7 %) patients with liver injuries and in 11 (9.2 %) patients with spleen injuries. 21 (17.6 %) patients in critical condition with unstable hemodynamic parameters were immediately sent to the operating room or intensive care unit, where the FAST protocol was performed. Changes in the echogenicity and structure of tissues, contours of parenchymal organs, their defects, changes in blood circulation, and hemoperitoneum served as indications for urgent surgical treatment.

Ultrasound examination of the abdominal cavity in case of a closed trauma with damage to parenchymal organs according to the FAST protocol allows to diagnose the damage in the shortest possible time and to decide on the tactics of treatment. Its informativeness in the diagnosis of parenchymal organ damage in closed abdominal trauma is 96.7 %, specificity – 94.6 %, sensitivity – 90.8 %.

The widespread implementation of the FAST protocol in the diagnostic program of closed abdominal trauma is a mandatory basic non-invasive study, which allows you to decide on treatment tactics in a short period of time and reduce the level of more traumatic laparocentesis and unfounded surgical interventions.

References

Kleber, C., Giesecke, M.T., Tsokos, M., Haas, N.P., & Buschmann, C.T. (2013). Trauma-related preventable deaths in Berlin 2010: need to change prehospital management strategies and trauma management education. World J. Surg., 37(5), 1154-1161. DOI:10.1007/s00268-013-1964-2.

Mehrzad, H., Jones, R.G., McCafferty, I.J., & Magnat, K. (2014). Imaging in abdominal trauma. Trauma, 16(4), 269-278. DOI: 10.1177/1460408614548006.

Malaki, M., & Mangat, K. (2011). Hepatic and splenic trauma. Trauma, 13(3), 233-244. DOI: 10.1177/1460408611400972.

Stengel, D., Rademacher, G., & Ekkernkamp, A. (2015). Emergency ultrasound-based algorithms for diagnosing blunt abdominal trauma. Cochrane Database Syst. Rev., 9, CD004446. DOI: 10.1002/14651858.CD004446.pub4.

Svitlychnyi, E.V., & Hrechanyk, O.I. (2016). Ultrazvukova diahnostyka travmy ta yii uskladnen. [Ultrasound diagnosis of trauma and its complications]. Kyiv: SPD Chaplynska N.V. [in Ukrainian].

Khomenko, I.P., Svitlychnyi, E.V., Hrechanyk, O.I., Melnyk, O.M., Tarasiuk, B.A., & Muradian, K.R. (2018). Ekstreni ultrazvukovi doslidzhennia pry travmi FAST-protokol. [Emergency ultrasound examinations in trauma FAST-protocol]. Kyiv: Liudmyla [in Ukrainian].

Choi, Y., Kim, S., Ko, J., Kim, M., Shim, H., Han, J., Lim, J., & Kim, K.A. (2022). Study on Trauma Mechanisms and Injury Sites in Patients with Blunt Abdominal Trauma. Emerg. Med. Int., 2022, 2160766. DOI: 10.1155/2022/2160766. eCollection 2022. PMID: 35875247 Free PMC article.

Iacobellis, F., Abu-Omar, A., Crivelli, P., Galluzzo, M., Danzi, R., Trinci, M., … Scaglione, M. (2022). Current Standards for and Clinical Impact of Emergency Radiology in Major Trauma. Int. J. Environ. Res. Public Health, 19(1), 539. DOI: 10.3390/ijerph19010539. PMID: 35010799.

Agi, A. L., & Marini, F. (2012). Focused assessment with sonography for trauma. Echocardiogr. Intensivists, 46, 397-399.

Ianniello, S., Giacomo, Di.V., Sessa, B., & Miele, V. (2014). First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. Radiol. Med. (Torino), 119(9), 674-680.

Jang, T., Kryder, G., Sineff, S., & Naunheim, R. (2012). The technical errors of physicians learning to perform focused assessment with sonography in trauma. Acad. Emerg. Med., 19(1), 98-101.

Engles, S., Saini, N.S., & Rathore, S. (2019). Emergency Focused Assessment with Sonography in blunt Trauma Abdomen. Int. J. Appl. Basic Med. Res., 9(4), 193-196. DOI: 10.4103/ijabmr.IJABMR_273_19.

Mcgahan, J.P., Richards, J., & Gillen, M. (2002). The focused abdominal sonography for trauma scan: Pearls and pitfalls. J. Ultrasound Med., 21, 789-800.

Downloads

Published

2022-12-29

How to Cite

Fira, D. B., Gerasymchuk, P. O., Dobrynska, N. O., & Pavlyshyn, A. V. (2022). Ultrasound examination in closed abdominal trauma with damage to parenchymal organs. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (4), 79–84. https://doi.org/10.11603/2414-4533.2022.4.13536

Issue

No. 4 (2022)

Section

EXPERIENCE OF WORK

License

Copyright (c) 2023 Hospital Surgery. Journal named by L.Ya. Kovalchuk

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).