Diagnostic and therapeutic tactics for closed abdominal injury
DOI:
https://doi.org/10.11603/2414-4533.2023.2.13833Keywords:
closed abdominal injury, diagnosis, treatmentAbstract
The aim of the work: to assess the effectiveness of diagnostic search and provision of surgical care to patients with closed abdominal trauma in emergency hospital.
Materials and Methods. The experience of treatment of 257 patients with closed trauma of the abdominal cavity who were on treatment in the Surgical Department of the Ternopil City Communal Emergency Hospital for the period 2016 to 2022 was analyzed.
Physical and laboratory research methods were used in 100 % of cases. Among the instrumental diagnostic methods, ultrasound examination according to the FAST protocol was used in 89.1 %, computer tomography – 36.7 %, laparoscopy – 78.2 %, laparocentesis – 3.9 %.
Statistical processing was carried out using methods of medical statistics.
Results and Discussion. Analysis of the results of the study allowed in 34.6 % of patients with hemoperitoneum to use conservative therapy with strict adherence to its criteria: absence of damage to hollow organs, presence of consciousness, stability of hemodynamics, damage to a parenchymal organ no more than III degree based on the OIS scale, hemoperitoneum up to 500 ml.
A thorough examination of the patient and a differentiated approach to treatment allows in 64.2 % of cases to eliminate the pathological process by means of minimally invasive laparoscopic methods.
Laparoscopic operations for injuries were completed with thorough revision, sanitation and drainage of the abdominal cavity. We did not observe any complications associated with endovideosurgery in this group of patients. There were no fatal consequences, which is caused primarily by careful selection of patients. The use of minimally invasive laparoscopic methods of treatment in this group of patients contributes to the reduction of the severity of surgical trauma and the frequency of various postoperative complications.
Therefore, for the successful treatment of the above patients, it is necessary to use a comprehensive examination, which allows to reduce the time of diagnostic search and to determine the tactics of differentiated treatment.
References
Mehta, N., Babu, S., Venugopal, K. (2014). An experience with blunt abdominal trauma: evaluation, management and outcome. Clin. Pract., 4 (2), 599. DOI: 10.4081/cp.2014.599
Zago, T.M., Pereira, B.M., Nascimento, B., Alves, M.S., Calderan, T.R., Fraga, G.P. (2013). Hepatic trauma: a 21-year experience. Rev. Col. Bras. Cir., 40 (4), 318-322. DOI: 10.1590/s0100-69912013000400011
Perel, P., Prieto-Merino, D., Shakur, H. (2012). Predicting early death in patients with traumatic bleeding: development and validation of prognostic model. BMJ. 345, 51-66. DOI: 10.1136/bmj.e5166
Soto, J.R., Zhou, C., Hu, D. (2015). Skip and save: utility of pelvic x-rays in the initial evaluation of blunt trauma patients. Am. J. Surg., 210 (6), 1079-1081. DOI: 10.1016/j.amjsurg.2015.07.011
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
Kozar, R.A., Crandall, M., Shanmuganathan, K., Zarzaur, B.L., Coburn, M., Cribari, C. (2018). Organ injuri scaling 2018 update: Spleen, liver, and kidney. J. Trauma Acute Care Surg., 85 (6), 1119-1122. DOI: 10.1097/TA.0000000000002058
Pace, J., Arntfield, R. (2018). Focused assessment with sonography in trauma: a review of concepts and considerations for anesthtsiology. Can. J. Anaesth., 65 (4), 360-370. DOI: 10.1007/s12630-017-1030-x
Rostas, J., Casjn, B., Simmons, J., Frotan, M.A., Brevard, S.B., Gonzalez, R.P. (2015). The validity of abdominal examination in blunt trauma patients with distracting injuries. J. Trauma Acute Care Surg., 78 (6), 1095-100. DOI: 10.1097/TA.0000000000000650
Lee, P.C., Lo, C., Wu, J.M., Lin, K.L., Lin, H.F., Ko, W.J. (2014). Laparoscopy decreases the laparotomy rate in hemodynamically stable patients with blunt abdominal trauma. Surg. Innjv., 21 (2), 155-65. DOI:10.1177/1553350612474496
Richards, J.R., McGayan, J.P. (2017). Focused assessment with sonography in trauma (FAST) in 2017: What radiologists can learn. Radiolog., 283 (1), 30-48. DOI: 10.1148/radiol.2017160107
Nishijima, D.K., Simel, D.L., Wisner, D.H., Holmes, J.F. (2012). Does this adult patient have a blunt intra-abdominal injury? JAMA, 307 (14), 1517-1527. DOI: 10.1001/jama. 201.422
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 П. О. Герасимчук, Д. В. Осадчук, Д. Б. Фіра, А. В. Павлишин
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:
- 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.
- 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.
- 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)
