急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.     

急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.     

急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.     

B超对腹部闭合性损伤的诊断价值

目的:为客观评价B超对诊断腹部闭合性损伤的实用性,为临床应用B超诊断腹部闭合性损伤提供依据。方法:收集352例腹部闭合性损伤病例的B超与手术资料,进行对照分析。结果:腹部闭合性损伤B超诊断的正确率明显高于腹穿、腹腔灌洗等传统方法;B超可对实质性脏器破裂做出诊断,并可在一定程度上进行定位诊断,但准确率仍偏低;B超对空腔性脏器损伤可做出诊断,但难以定位。结论:B超在闭合性腹部损伤的诊断和评价方面是首选诊断工具。     

急诊B超在腹部脏器闭合性损伤中的应用

目的：探讨B超在腹部脏器闭合性损伤中的应用。方法：通过对280例腹部脏器闭合性损伤的患者的受伤时间及声像图进行分析，旨在提高超声对本病的诊断价值。结果：超声对本病的诊断符合率92．24％。结论：B超对腹部脏器闭合性损伤的应用，能根据声像图特点，及时判断腹部脏器损伤的程度和种类，血肿部位及内出血情况，为临床提供手术依据及处理方案，是首选而重要的诊断方法。     

腹部脏器闭合性损伤的超声诊断价值

超声检查作为有价值的临床辅助检查手段,被广泛应用于腹部脏器损伤的常规检查。本文通过对我院2000年6月~2006年10月因腹部脏器闭合性损伤住院患者声像图及手术病理对比或住院保守治疗并进行其他影像学检查证实的157例进行回顾性分析。探讨超声检查在腹部脏器闭合性损伤声像图特征。1材料与方法本院2000年6月~2006年10月因腹部脏器闭合性损伤住院手术保守治疗的患者157例,其中男性96例,女61例,年龄7~62岁。肝损伤45例,脾损伤62例,胰腺损伤4例,肾脏损伤13例,肠管及肠系膜损伤12例,腹膜后血肿5例,膀胱破裂4例,多脏器损伤12例。仪器采用Philip…     

超声诊断急诊腹部闭合性损伤内脏破裂出血临床应用

超声检查对于急性腹部闭合性损伤内脏破裂出血的诊断具有重要意义[1～4]。本文探讨超声应用于急诊腹部闭合性损伤内脏破裂出血诊断的临床价值。1材料与方法本组96例患者,其中男62例,女34例,年龄23～49岁,平均36.7岁。患者均有明确的外伤史,手术均证实为闭合性腹部损伤内脏破裂出血,其中交通事故37例,坠落伤34     

150例闭合性腹部外伤的超声诊断分析

目的:探讨超声检查对闭合性腹部外伤的诊断价值及漏、误诊原因。材料和方法:150例闭合性腹部损伤患者在受伤后1～12小时内接受超声检查。结果:经临床证实总符合率94.0%(141/150)。脾损伤符合率96.6%(84/87),肝脏损伤符合率90.5%(19/21),肾损伤符合率为93.9%(31/33)。结论:超声检查是诊断闭合性腹部外伤的有效方法之一。     

腹部闭合性损伤88例临床救治分析

目的总结腹部闭合性损伤的诊断与治疗经验。方法对本院2000年7月—2004年7月收治的88例腹部闭合性脏器损伤的诊断与治疗的临床资料进行回顾分析。结果腹腔穿刺的诊断阳性率92105%(81/88),腹部B超诊断的阳性率92105%(81/88),B超损伤脏器的定位诊断准确率8118%(72/88),腹部CT检查阳性率100%(22/22)。手术治疗78例,非手术治疗10例;治愈83例(9413%),死亡5例(517%)。结论腹腔穿刺,腹部B超及CT检查对腹部闭合损伤的诊断都有重要价值,治疗应以手术治疗为主,如有适应证非手术治疗也可取得满意效果。     

航海状态下腹部闭合性实质脏器损伤的超声诊断

目的探讨航海状态下超声诊断对腹部闭合性损伤的意义。方法回顾性分析1992年2月至2003年12月间256例发生在舰船、海岛、码头等与航海有关的各种场所和各种原因所致的腹部闭合性实质性脏器损伤患者的超声检查结果。结果超声诊断为腹壁软组织损伤144例，合并脾肝肾损伤140例；实质性脏器损伤196例，合并腹壁软组织损伤140例；空腔脏器损伤13例。结论航海状态下腹部闭合性损伤的超声诊断可指导临床对伤员采取合理的治疗措施，对航海环境及海战场的伤员抢救有重要意义。     

Focused abdominal US in patients with trauma

PURPOSE: To evaluate the accuracy of focused abdominal ultrasonography (US) in detecting abdominal injuries that require in-hospital patient treatment in the setting of blunt abdominal trauma. MATERIALS AND METHODS: One thousand ninety patients with blunt abdominal trauma were assessed with focused abdominal US within 30 minutes of arrival at the hospital. Focused abdominal US results were positive if intra- or retroperitoneal fluid was detected. Patients with negative US results and no other major injuries were observed in the emergency department for 12 hours before discharge. Patients who deteriorated clinically after negative initial US underwent repeat US and/or emergency abdominopelvic computed tomography (CT). Patients with positive or indeterminate US results underwent emergency abdominopelvic CT. RESULTS: Nine hundred seventy-four (89%) patients had negative focused abdominal US results; eight of these underwent CT. Sixty-six (6%) had positive US results. Four (0.4%) had false-negative and 19 (1.7%) had false-positive US results. Twenty-seven (2.5%) had indeterminate US results; of these, five (18.5%) had positive CT results. One hundred twenty-four (11.4%) required emergency CT. After indeterminate cases were excluded, focused abdominal US had 94% sensitivity, 98% specificity, 78% positive predictive value, 100% negative predictive value, and 95% accuracy. CONCLUSION: Focused abdominal US has a high negative predictive value for major abdominal injury in patients with blunt abdominal trauma.     

Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma

OBJECTIVE: The purpose of this study was to evaluate the efficacy of sonography in our algorithm when differentiating patients with blunt abdominal trauma who need immediate surgery from patients who would benefit from further diagnostic workup or who need no treatment. SUBJECTS AND METHODS: We performed abdominal sonography as the primary screening tool in 1671 consecutive patients in our prospective study. Radiologists performed sonography in the trauma room within minutes of the arrival of each patient. Hemodynamic instability in conjunction with positive sonographic findings led to emergency laparotomy. Otherwise, positive sonographic findings warranted additional diagnostic tests. Observing free fluid or organ injury caused us to categorize sonographic findings as positive. RESULTS: Sonography correctly identified all patients requiring emergency laparotomy. No inconclusive laparotomies were performed in this group. The sensitivity of sonography for revealing intraabdominal injury was 88%, the specificity was 100%, and the accuracy was 99%. In 132 patients (8%), abdominal CT was performed. CT revealed relevant posttraumatic abnormalities in 61% of all patients. Four hundred seventy patients with negative sonographic findings were discharged approximately 12 hr after admission; two of these patients (0.4%) were mistakenly discharged. Trauma scores did not influence the efficacy of sonography. CONCLUSION: Our algorithm that uses sonography as the primary diagnostic tool provides accurate, fast, cost-effective, and noninvasive initial management of patients with blunt abdominal trauma. Our test characteristics were excellent indicators of the need for emergency laparotomy. Sonography also achieves high values in revealing relevant injury. Our algorithm produced medically satisfactory and economically prudent management of patients with blunt abdominal trauma.     

Emergency excretory urography in blunt abdominal trauma

In a prospective study the authors correlated the degree of hematuria and of blunt abdominal trauma with the results of emergency excretory urography. Urograms were obtained for 37 patients who presented with blunt abdominal trauma, no gross hematuria and at least five erythrocytes per high-power field (hpf) on microscopic urinalysis. Microscopic hematuria was defined as an erythrocyte count of more than 5 and fewer than 50 per hpf. Major trauma was defined as shock (systolic blood pressure of less than 90 mm Hg), fracture of the lumbar spine, the pelvis or the lower ribs, ecchymosis in the flank or acute abdominal injury. Contusions and small subcapsular hematomas were defined as nonsignificant renal injuries; all other renal injuries were defined as significant. Of 17 patients with minor blunt abdominal trauma 14 had fewer than 50 erythrocytes per hpf; none of these had a significant renal injury, whereas 1 of the 3 with more than 50 erythrocytes per hpf did have a significant injury. Of 20 patients with major trauma 5 had a significant renal injury. The authors conclude that microscopic hematuria associated with blunt abdominal trauma but without shock or major nongenitourinary injury does not warrant routine excretory urography.     

Complete transection of the pancreas due to a single stamping injury: a case report

Complete transection of the pancreas due to a single stamping injury is reported. A 47-year-old female was stamped on in the epigastric region by her common-law husband when lying on her back. Immediately after the stamping, she complained of severe abdominal pain. In an emergency hospital, the abdominal CT (computed tomography) scan showed a large haematoma around the pancreas head. In the surgical operation that followed, a complete transection of the pancreas between the head and body was unexpectedly discovered. Furthermore, severe traumatic changes were found in the liver, mesentery, splenic artery and vein. The medico-legal autopsy revealed marked haemorrhaging in the abdominal subcutaneous adipose tissue and rectus muscle in the epigastric region. The external blunt force that acted on the abdomen had forcibly compressed the pancreas against the spinal column. Blunt pancreatic injury is relatively uncommon, but pancreatic injuries should always be considered in patients or autopsy cases after external blunt force to the abdomen. Received: 17 July 2000 / Accepted: 7 January 2001     

Post traumatic arterial occlusive mesenteric ischemia: a rare case report

Mesenteric ischemia is an uncommon condition with very high mortality rates characterized by inadequate blood supply, inflammatory injury, and subsequent necrosis of the bowel wall. Acute arterial mesenteric ischemia is usually caused by cardiac emboli, atherosclerotic vascular disease, aortic aneurysm, or dissection. We report a case of a 60-year-old male who presented to the accident and emergency department complaining of abdominal pain following blunt abdominal trauma. An urgent contrast enhanced computed tomography scan demonstrated superior mesenteric artery thrombosis with ischemic small bowel. Surgical intervention was carried out with resection of the necrotic bowel followed by anastomosis. Acute occlusive mesenteric ischemia needs to be considered in cases of blunt trauma presenting with abdominal pain. Proper early diagnosis and management is essential as it carries a high risk of morbidity and mortality.     

Blunt abdominal trauma in soccer causing duodenal rupture: case report and review

A case of blunt abdominal trauma in soccer is reported A forward player sustained a rupture of the distal duodenum in a collision with the opposing team's goalkeeper. The injured player had abdominal pain radiating to the back and a sustained high pulse but no sign of shock or peritonitis. The x-ray diagnosis was followed by emergency surgery and uneventful recovery. Injuries from blunt abdominal trauma occur rarely in sports. In soccer, the most frequently injury from this type of trauma is abdominal wall contusion, followed by injuries to the kidneys and spleen. However, death has also been reported in soccer. Athletes sustaining blunt trauma to the upper abdomen should be carefully monitored due to the risk of possible severe intra-abdominal injuries.     

The role of follow-up imaging in paediatric blunt abdominal trauma

AIM: To assess the role of follow-up imaging in paediatric blunt abdominal trauma. METHOD: All children who underwent CT scanning of their abdomen at our institution following acute blunt injury between January 1997 and December 2000 were included in the study. Case notes where researched for details regarding mechanism of injury, initial clinical presentation, acute management, complications and follow-up until discharge. Reports of imaging investigations were retrieved from the RIS database. RESULTS: In the study period 75 children underwent CT scanning of their abdomen as a primary investigation for acute blunt abdominal trauma. Of these, 12 were normal, 52 showed evidence of intra-abdominal organ injury and 11 showed findings other than abdominal organ injury. Of the 52 children that sustained intra-abdominal organ injury, 48 (92 percent) were treated conservatively. 4 (8 percent) underwent emergency surgery, 3 for bowel injury and 1 for renal trauma. Of the 48 that were treated conservatively, 9 had a complicated clinical course with 7 showing complications on follow-up imaging. The remaining 39 children had an uneventful clinical course with follow-up imaging by CT or US in 34. None showed complications that required a change in management. CONCLUSION: In our series, follow-up imaging did not contribute to further management in children with an uncomplicated clinical course following blunt abdominal trauma.