DIAGNOSTIC AND TREATMENT OPTIONS OF BLUNT ABDOMINAL TRAUMA IN A REGIONAL HOSPITAL

Czech version

Authors: Michal Kristen; Zuzana Šerclová
Authors‘ workplace: Surgical department Hospital Hořovice, a. s. ; Chirurgické oddělení, NH Hospital a. s.
Published in: Úraz chir. 24., 2016, č.2

Overview

The aim of the study:
The evaluation of diagnostic and treatment possibilities and procedures in the regional Hořovice Hospital.

This is a retrospective analysis of a group of 39 patients treated in Hořovice Hospital from January 1, 2010 to August 31, 2015 for blunt abdominal trauma.

Materials and methods:
From January 2010 until the end of August 2015, there were 449 patients treated with the initial diagnosis of blunt abdominal trauma in Hořovice Hospital. In 39 patients, injuries of the abdomen or retroperitoneum were confirmed, of whom 10 were women and 29 men. The median age of the patient population was 52 (15-87) years. The most common cause of injury was a fall from a height. In 13 cases, it was only an isolated injury, in 26 cases also injuries of other body regions were observed. Most frequently the combination blunt abdominal trauma-chest injury was seen. The median ISS was 13 (4-27). The median length of hospitalization was 10 (1-77) days.

Results:
Diagnosis of abdominal organ injury was based of clinical examination and medical imaging. 37 patients had a CT scan with a contrast media, while 35 patients had ultrasound examinations, one underwent MRI scan and one ERCP. Urgent surgical treatment was indicated for 8 patients. 5 patients were transferred to a higher-level facility. 27 patients were primarily treated conservatively. From the group of conservatively treated patients, surgical treatment was later indicated in 5 patients. Altogether, we successfully treated without complication 33 (84.6 %) patients.

Conclusion:
Isolated injuries to parenchymatous organs with a degree of damage from I to III and milder associated injuries not exceeding ISS 16 can be safely diagnosed and treated at a regional hospital. Patients with more severe injuries classified with degrees IV and V, which are often part of polytrauma, should be primarily directed to trauma centers.

Key words:
Blunt abdominal trauma, CT scan, conservative treatment, surgical treatment.

Sources

1. ATLS Advanced Trauma Life Support for Doctors: Student Course Ma-nual. 9th ed. Chicago: American College of Surgeons, 2012. 366 s. ISBN 978-1-880696-02-6.

2. BUDZISZ, I., WASILEWSKI, G., ONICHIMOWSKI, D. et al. Arterial Embolisation for Post-Traumatic Retroperitoneal Bleeding. Anestezjol Intens Ter. 2011, 43, 174–177. ISSN 0209-1712

3. CIROCCHI, R., BOSELLI, C., CORSI, A. et al. Is Non-Operative Management Safe and Efective for All Splenic Blunt Trauma? A Systematic Review. Crit Care. 2013, 17, R185. DOI: 10.1186/cc12868. ISSN 1364-8535

4. CIROCCHI, R., TRASTULLI, S., PRESSI, E. et al. Non-Operative Management Versus Operative Management in High-Grade Blunt Hepaic Injury. Cochrane Database Syst Rev. 2015, 24; Art. No. CD010989. DOI 10.1002/14651858.CD010989.pub2. ISSN 1361-6137

5. EL-MENYAR, A., ABDELRAHMAN, H., AL-THANI, H. et al. Compartmental Anatomical Classification of Traumatic Abdominal Injuries from the Aca-demic Point of View its Potential Clinical Implication. J Trauma Manag Outcomes. 2014, 8, 14. DOI 10.1186/1752-2897-8-14. ISSN 1752-2897

6. GÖNÜLLÜ, D., ILGUN, S., GEDIK, ML. et al. Gastrointestinal Injuries in Blunt Abdominal Traumas. Chirurgia. 2015, 110, 346–350. ISSN 1221-9118

7. COCANOUR, CS., MOORE, FA., WARE, DN. et al. Delayed Complications of Nonoperative Management of Blunt Adult Splenic Trauma. Arch Surg. 1998, 133, 619–625. ISSN 0004-0010

8. CHMÁTAL, P., KUPKA, P., FUKSA, Z. et al. Poranění jater – rozbor souboru nemocných. Bull HPB Chirur. 2004, 12, 134–137. ISSN 1210-6755

9. Injury Severity Scoring [online]. Orlando: Orlando Regional Medical Center, 2015, [cit. 2015-09-25.] Dostupná z www: <http://www.surgicalcriticalcare.net/Resources/injury_severity_scoring.pdf>.

10. KAUTZA, B., ZUCKERBRAUN, B., PEITZMAN, AB. „Management of Blunt Renal Injury: What is New?“. Eur J Trauma Emerg Surg. 2015, 41, 251–258. DOI 10.1007/s00068-015-0516-x. ISSN 1863-9933

11. LEPPÄNIEMI, AK., MENTULA, PJ., STRENG, MH. et al. Severe hepatic trauma: Nonoperative management, definitive repair, or damage control surgery? World J Surg. 2011, 35, 2643–2649. DOI 10.1007/s00268-011-1309-y. ISSN 0364-2313

12. LIM, KH., CHUNG, BS., KIM, JY. et al. Laparoscopic Surgery in Abdominal Trauma: a Single Center Review of a 7-year Experience. World J Emerg Surg. 2015, 10, 16. DOI 10.1186/s13017-015-0007-8. ISSN 1749-7922

13. MEHTA, N., BABU, S., VENUGOPAL, K. An Experience with Blunt Abdominal Trauma: Evaluation, Management and Outcome. Clin Pract. 2014, 4, 599. DOI 10.4081/cp.2014.599. ISSN 2039-7275

14. OČADLÍK, M. Současný postup u poranění sleziny. Rozhl Chir. 2012, 91, 643–644. ISSN 0036-9351

15. OKUS, A., SEVINC, B., AY, S. et al. Conservative Management of Abdominal Injuries. Ulus Cerrahi Derg. 2013, 29, 153–157. DOI 10.5152/UCD.2013.2300. ISSN 1300-0705.

16. PARREIRA, JG., OLIARI, CB., MALPAGA, JM. et al. Severity and Treatment of „Occult“ Intra-Abdominal Injuries in Blunt Trauma Victims. Injury. 2015, Jul 9, In Press. DOI 10.1016/j.injury.2015.07.002. ISSN 0020-1383

17. POKORNÝ, V. Traumatologie. 1.vyd. Praha: Triton, 2002, 307 s. ISBN 80-7254-277-X

18. RAZA, M., ABBAS, Y., DEVI, V. et al. Non Operative Management of Abdominal Trauma – a 10 years review. World J Emerg Surg. 2013, 8, 14. DOI 10.1186/1749-7922-8-14. ISSN 1749-7922

19. THOMSON, DA., KRIGE, JE., THOMSON, SR. et al. The Role of Endoscopic Retrograde Pancreatography in Pancreatic Trauma: a Critical Appraisal of 48 Patients Treated at Tertiary Institution. J Trauma Acute Care Surg. 2014, 76, 1362–1366. DOI 10.1097/TA.0000000000000227. ISSN 2163-0755

20. STUHLFAUT, JW., ANDERSON, SW., SOTO, JA. Blunt Abdominal Trauma: Current Imaging Techniques and CT Findings in Patients with Solid Organ, Bowel, and Mesenteric Injury. Semin Ultrasound CT MR. 2007, 28, 115–129. ISSN 0887-2171

21. ŠILLER, J. Poranění pankreatu. Rozhl Chir. 2012, 91, 639–642. ISSN 0036-9351

22. SCHROEPPEL, TJ., CROCE, MA. Diagnostika a léčba tupých poranění solidních břišních orgánů. Curr Opin Crit Care (čes. vyd.). 2008, 2, 49–54. ISSN 1802-3819

23. TLUSTÝ, Z., TLUSTÝ, Z.-sr., MERHAUT, P. Traumatologická triage v běžné praxi záchranné služby – opravdu funkční?. Urgent Med. 2010, 13, 7–8. ISSN 1212-1924

24. Traumatologická péče v České republice. Věstník ministerstva zdravotnictví České republiky, 28. 11. 2008, článek 10, příloha 3 a 4.

25. VYHNÁNEK, F. Postup při poranění břicha. Rozhl Chir. 2012, 91, 632–638. ISSN 0036-9351

26. VYHNÁNEK, F., DENEMARK, L., DUCHÁČ, V. Neoperační postup u tupého poranění jater. Bull HPB Chirur. 2004, 12, 138–141. ISSN 1210-6755

27. WIESSNER, DH. 32 Injury to the Spleen. In Moore EE. et al. Trauma. 5. ed. New York: McGraw-Hill 2004. s. 663–684. ISBN 978-0-07-137069-1

Labels

Surgery Traumatology Trauma surgery

POSTTRAUMATIC INSTABILITY OF THE KNEE JOINT IN PARTIAL ANTERIOR CRUCIATE LIGAMENT LESION. CONSERVATIVE VERSUS OPERATIVE TREATMENT PROCEDURE

PRINCIPLES OF INDICATION OF INTRA-ARTICULAR DISTAL RADIUS FRACTURES FOR CONSERVATIVE OR SURGICAL TREATMENT USING LOCKING PLATES

SELECTIVE EMBOLIZATION OF ARTERIAL BLEEDING IN INJURIES OF THE ACETABULUM – A CASE REPORT

Article was published in

Trauma Surgery

2016 Issue 2