Abdominal trauma

After acute bacterial contamination, such as with abdominal trauma where GI contents spill into the peritoneum, combination antimicrobial regimens are not required. If the patient is seen soon after injury (within 2 hours) and surgical measures are instituted promptly, antianaerobic cephalosporins... 

Hooker KD, DiPiro JT, Wynn JJ. Aminoglycoside combinations versus single [1-lac la ms for penetrating abdominal trauma A meta-analysis. J Trauma 1991 31 1155-1160. 

Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Parenter Enteral Nutr 2003 27 355-373. Kudsk KA, Croce MA, Fabian TC, et al. Enteral versus parenteral feeding Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 1992 215 503-513. 

Blunt abdominal trauma with rupture of intestine Penetrating abdominal trauma Iatrogenic intestinal perforation (endoscopy)... 

RDIg may be used after abortion, miscarriage, amniocentesis, or abdominal trauma. 

Neurogenic shock is generally occur in abdominal trauma, spinal anasthesia, spinal cord injury and is managed by vasopressor agents e.g. dopamine. 

Combination therapy is often used when dealing with infections caused by both aerobic and anaerobic bacteria [50,80]. Combination of metronidazole with either gentamicin or ciprofloxacin appeared to be effective in preventing infection of abdominal trauma [101] when combined with ciprofloxacin, metronidazole was affective as a preoperative antibiotic in colorectal surgery and appeared equal in efficacy to impipenem/cilastin for the treatment of complicated intraabdominal infections [103]. Combination therapy is not always indicated for the treatment of polymicrobial infections. New antibiotics, whose spectrum includes multiple classes of microorganisms (e.g., imipenem), may often preclude combination therapy. 

Complications Blunt abdominal trauma increases the risk of rupture, which can also occur spontaneously. The mortality rate is 60-80%. (71) Large shunt volumes may give rise to the development of cardiac insufficiency, particularly during childhood. The development of portal hypertension has also been observed. (92) Anaemia, thrombopenia and hypofibrinogenaemia may occur due to the haemangioma-thrombocytopathy syndrome (= Kasabach-Merritt syndrome). (82)... 

Four types of cysts can be differentiated (i.) dysontogenetic cysts, (2.) parasitic (or infectious) cysts, (i.) neoplastic cysts and (4.) post-traumatic cysts. The cause of cystic neoplasms is unknown. Traumatic cysts (C. Whipple, 1898) occur from an injured intrahepatic bile duct after blunt abdominal trauma. (136)... 

Abdominal trauma Laparoscopic cholecystectomy Membranous obstruction (73) Polycystic liver disease (35) Retroperitoneal neurilemmoma (65) Tumour in the right atrium (42)... 

Whereas penetrating injuries are less common today, the number of blunt injuries has increased, frequently accompanied by liver rupture. A liver injury is involved in up to 40% of patients with blunt abdominal trauma. Conservative treatment is recommended as far as possible in order to avoid unnecessary laparotomy. (353) The overall mortality rates were 11.8% and 16.8%, respectively. (345, 347) In many cases, the urgency of the situation does not allow the requisite examinations (e.g. US, CT (350, 352), angiography, laparoscopy) to be made -an emergency operation has to be performed. Such an operation must even be done under shock if the patient does not respond directly to conservative methods. 

A 20-year-old man with abdominal trauma received a single dose of piperacillin (1 g) followed by nine doses of imipenem + cilastatin (500 mg tds for 3 days) and 2 weeks later developed jaundice, fatigue, and pruritus (94). A liver biopsy showed centrilobular cholestasis, portal infiltration with eosinophils, and cholangitis. Lymphocyte transformation tests for piperacillin and imipenem/cilastatin were positive, suggesting an immunological mechanism. He made a full clinical and biochemical recovery after 3 months. 

E491 Steele, B.W., Buechter, K. and Arnold, M. (1988). Ektachem lipase levels in blunt abdominal trauma. Clin. Chem. 34, 1290, Abstr. 672. 

Trauma Abdominal trauma, postoperative pancreatitis, ERCP... 

Acute Contamination from Abdominal Trauma Pelvic Inflammatory Disease... 

Bozorgzadeh A, Pizzi WE, Barie PS, et al. The duration of antibiotic administration in predicting abdominal trauma. Am J Surg 1999 172 125-135. 

Kudsk KA, Croce MA, Eabian TC, et al. Enteral versus parenteral feeding Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 1992 215 503-513. 

Critical reviews of available randomized controlled trials comparing EN to PN in the critically ill adult patient with an intact GI tract suggest a significant reduction in infectious complications associated with EN. Decreased infectious complications have been documented in patients with abdominal trauma, burns, or severe head injury given EN compared to PN. The use of EN has been recommended over PN as the preferred route of feeding in the critically ill patient requiring specialized nutrition support. ... 

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