Blunt abdominal trauma

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

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)... 

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. 

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

The majority of renal injuries are a result of blunt abdominal trauma. In severe blunt renal injury controversy exists on treatment, with some advocating surgical exploration, accompanied with a significant increase in nephrectomy rates, whereas others advocate conservative treatment. Selective TAE has a high success rate without significant complications post-procedural hypertension can occur but is generally temporary in nature. 

In emergency cases, such as acute hemorrhage within the liver (e.g., in a preexisting tumor, after liver biopsy, or after blunt abdominal trauma), acute vascular occlusion, or inflammatory lesions such as abscesses, MDCT... 

While intravenous contrast material is undisput-edly needed in any multisystem trauma patient, the appHcation of oral contrast material is not uniformly recommended. In patients with penetrating trauma to the chest, abdomen, or pelvis, oral and rectal contrast media application increases sensitivity for the detection of hollow organ injury (Shanmuganathan et al. 2004 Sampson et ah 2006). However, installation of contrast fluids takes some time, and patients that are unable to swallow need a gastric tube before contrast material can be given. In blunt abdominal trauma, oral contrast appHcation is not imperatively necessary to rule out bowel injuries because CT without oral contrast leads... 

Bakker J, Genders R, Mali W et al. (2005) Sonography as the primary screening method in evalimting blunt abdominal trauma. J Clin Ultrasound 33 155-163... 

Levi L, Michaelson M, Admi H et al. (2002) National strategy for mass casualty situations and its effects on the hospital. Prehospital Disaster Med 17 12-16 Lindner T, Bail HJ, Manegold S et al. (2004) [Shock trauma room diagnosis initial diagnosis after blunt abdominal trauma. A review of the literature.] (In German) Unfallchirurg 107 892-902... 

Poletti PA, Mirvis SE, Shanmuganathan K et al. (2004) Blunt abdominal trauma patients can organ injury be excluded without performing computed tomography J Trauma 57 1072-1081... 

James CA, Emanuel PG, Vasquez WD et al. (1996) Embolization of splenic artery branch pseudoaneurysms after blunt abdominal trauma. J Trauma 40 835-837... 

Becker CD, Mentha G, Schmidlin F et al. (1998) Blunt abdominal trauma in adults role of CT in the diagnosis and management of visceral injuries. 11. Gastrointestinal tract and retroperitoneal organs. Eur Radiol 8 772-780... 

Baron BJ, Scalea TM, Sclafani SJ et al. (1993) Nonoperative management of blunt abdominal trauma the role of sequential diagnostic peritoneal lavage, computed tomography, and angiography. Ann Emerg Med 22 1556-1562... 

Miller DC, Forauer A, Faerber GJ (2002) Successful angio-embolization of renal artery pseudoaneurysms after blunt abdominal trauma. Urology 59 444xiii-444xv... 

Jebra VA, El Rassi I, Achouh PE et al. (1998) Renal artery pseudoaneurysm after blunt abdominal trauma. J Vase Surg 27 362-365... 

After blunt abdominal trauma, hematuria is very common, and its grade does not correlate with injury (Mayor et al. 1995). CT is the unanimous gold-standard method, but has been shown not to be cost effective (Filiatrault and Garel 1995). When US can be performed in satisfactory conditions, it seems able to exclude severe renal injury. Of course, any clinical or sonographic abnormality should lead to CT. Patients with multiple injuries are also investigated by enhanced CT on an emergency basis. 

No indication remains for angiography in the diagnostic evaluation of blunt abdominal trauma. On the one hand, the risk of the examination is relatively high. On the other hand, vascular injuries are extremely well depicted by the association of color Doppler ultrasound and MDCT. Angiography can be proposed in relatively rare instances when percutaneous treatment (embolization, angioplasty) appears to be the best option (Fig. 25.6). In the con-... 

This classification does not take into account the possible ureteric injuries that are known to be more frequent in children than in adults (Reda and Lebowitz, 1986). Uretero-pelvic junction disruption is the most common location in cases of blunt abdominal trauma it predominates in children with ureteropelvic junction obstruction. Diagnosis is difficult due to the usual absence of hematuria. 

Bladder injury is relatively infrequent in children. It is usually the consequence of blunt abdominal trauma in a child with a full bladder. Motor vehicle accident is a common cause. Seat belt ecchymosis, hematuria and pelvic fractures can be associated. Urinary leakage into the peritoneum is more fre-... 

Fig. 25.14a,b. Bladder neck disruption in a young boy who underwent blunt abdominal trauma. Intravenous urography. Plain film (a) showed traumatic widening of the pubic symphysis, (b) As soon as 5 min, the faintly opacified urinary bladder (B) appears elevated by an infravesical leak (arrows)... 

Benya EC, Lim-Dunham JE, Landrum O, Statter M (2000) Abdominal sonography in examination of children with blunt abdominal trauma. Am J Roentgenol 174 1613-1616... 

Chirdan LB, Uba AF, Yiltok SJ, Ramyil VM (2007) Paediatric blunt abdominal trauma challenges of management in a developing country. Eur J Pediatr Surg 17 90-95... 

Filiatriault D, Garel L (1995) Commentary Pediatric blunt abdominal trauma to sound or not to sound Pediatr Radiol 25 329-331... 

Kunin JR, Korobkin M, Ellis JH et al (1993) Duodenal injuries caused by blunt abdominal trauma value of CT in differentiating perforation from hematoma. Am J Roentgenol 160 1221-1223... 

Hofer GA, Cohen A] (1989) CT signs of duodenal perforation secondary to blunt abdominal trauma. J Comput Assist... 

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