Computed tomography (CT) in blunt liver injury: a pictorial essay

Computed tomography (CT) is widely used in assessing clinically stable patients with blunt abdominal trauma. In these patients, liver is one of the commonest organs being injured and CT can accurately identify and assess the extent of the injury. The CT features of blunt liver trauma include laceration, subcapsular or parenchymal haematomas, active haemorrhage and vascular injuries. Widespread use of CT has notably influenced the management of blunt liver injury from routine surgical to nonsurgical management. We present pictorial illustrations of various liver injuries depicted on CT in patients with blunt trauma.     

An epidemiological analysis of patients with abdominal trauma in an eastern Indian metropolitan city

The profile and pattern of abdominal trauma is changing with progressing civilisation. We are lacking epidemiological data from most parts of the world. This study was conducted to prepare a database in our set up and look into the pattern of abdominal trauma, make an aetiological correlation of abdominal trauma with the types of injuries, identify the preventable factors causing delay in intervention and, compare the data with the other available national and international data. This prospective, observational study was done in a teaching hospital in a metropolitan city of eastern India. Records of patients with abdominal trauma were collected in predesigned forms, from admission to discharge. Data were analysed applying standard statistical techniques. Males (87.3%) predominated with the age range between 21 and 30 years, and the majority (73.5%) had blunt abdominal trauma. Compression injury (57.3%) commonly caused blunt trauma and stab injuries caused majority of penetrating trauma. The commonest organ injured both in blunt and penetrating trauma was small bowel (30.7% and 33.3% respectively). It was found that prehospital trauma care is virtually non-existent in this region. We are lacking a uniform protocol for the management of abdominal trauma across the hospitals. With the availability of better investigational modalities we are moving more towards a conservative approach to the abdominal trauma patients, especially the blunt abdominal trauma patients with solid organ injuries.     

Emergency thoracotomy in the management of trauma

The role of emergency room thoracotomy in the management of trauma remains poorly defined despite an increase in its use. Most authors agree that the procedure is effective in the treatment of penetrating thoracic injuries, while its benefit in penetrating injuries below the diaphragm and in blunt trauma has not been established. The best outcome can be expected in patients who have sustained penetrating cardiac and thoracic injuries. Penetrating abdominal wounds that are severe enough to require thoracotomy in the emergency room fare less well; those patients who suffer from blunt thoracoabdominal injuries are least fortunate. The anatomic location and mode of injury greatly influence the outcome of these patients and are useful in determining when to perform this procedure.     

147例闭合性肾脏损伤诊治分析

目的 探讨闭合性肾脏损伤诊断和治疗的方法。方法 对1999年8月～2005年4月收治的147例创伤性闭合性肾脏损伤临床病例资料进行回顾分析。结果 147例中出现血尿者136例（92．5％），合并休克者48例（32．7％）．伴有其他部位损伤者94例（63．9％）。全部病例均行CT检查明确损伤程度。保守治疗113例（76．9％），选择肾动脉栓塞13例．手术23例（15．6％），其中肾切除8例，肾修补15例；选择肾动脉栓塞11例（不包括保守治疗或手术治疗后出现继发性出血的患者4例）。死亡3例。结论 中、重度闭合性肾脏损伤患者伤后应尽可能选择CT检查，明确肾脏损伤程度及是否合并其它脏器损伤。闭合性肾脏损伤治疗以非手术为主，保守治疗期间严密观察病情进展，及时行选择性肾动脉栓塞或手术治疗。选择性肾动脉栓塞治疗肾脏损伤效果可靠，避免了手术和肾切除，值得推荐。     

Management of isolated splenic injuries after blunt trauma: an institution's experience over 6 years

Forty-two patients with traumatic blunt splenic injuries were admitted over a six year period. Vehicular-related collisions and fall from height accounted for the injuries in 38 (90.5%) of them. Eleven (26.2%) underwent immediate surgery (7 splenectomy and 4 splenorrhaphy), while the remaining 31 patients were treated nonoperatively of which 3 underwent angio-embolisation. Twenty seven patients had either grade III or IV splenic injuries. Operative management was more likely in patients with lower haemoglobin or with more severe splenic injury. Nonoperative management can be adopted in patients with blunt isolated splenic injuries but operative management is still indispensable in certain instances.     

Warfare vascular injuries

Vascular injuries as a part of combat injuries have been recorded since times immemorial. Responsible for death due to exsanguination, the management of vascular injuries was ligation or amputation till the landmark Vietnam experience. The present day management has evolved with advances in modern technology and may start at the battlefield with the application of a tourniquet with the definitive treatment continuing beyond the combat operation theatres. A basic understanding of both blunt and penetrating vascular injuries will help minimize mortality and morbidity.     

闭合性胰十二指肠损伤的诊治分析

目的:探讨闭合性胰十二指肠损伤的早期诊断及治疗。方法:回顾性分析6例闭合性胰十二指肠损伤的临床资料。结果:其中2例术前早期确诊;单纯胰腺及十二指肠损伤各1例,胰腺合并十二指肠损伤3例,胰腺合并空肠损伤1例;发生各种并发症4例,全组无1例死亡。结论:胰十二指肠损伤术前诊断比较困难,具备指征就应及早剖腹探查,治疗应选择损伤控制性手术。     

Multiple cardiovascular injuries and motor vehicle accidents.

A patient sustained blunt chest trauma in a motor vehicle accident. Cardiovascular trauma was initially obscured by more obvious orthopedic injuries. Thoracic aortic transection with false aneurysm formation was discovered incidentally during cardiac catheterization for traumatic tricuspid insufficiency. Successful repair of both lesions was subseqeuntly performed. This case demonstrates the difficulty in recognizing cardiovascular trauma in survivors of motor vehicle accidents and emphasizes the need for an aggressive diagnostic approach with consideration of coexisting injuries in patients who have sustained blunt chest trauma.     

Delayed presentation of traumatic rupture of the diaphragm

Diaphragmatic injuries occur frequently after penetrating rather than blunt trauma and account for 8% of all organ injuries from penetrating trauma. Motor vehicle accidents account for approximately 50% of blunt injuries, followed in frequency by falls from height. The mechanism of injury in these accidents is that the body quickly decelerates while the organs continue to move downward or forward at maximal velocity, tearing vessels and tissues from their points of attachment. In this paper we are presenting 3 cases of traumatic diaphragmatic rupture due to motor vehicle accidents and fall from height, in which the diagnosis was delayed. Patient one was initially diagnosed with hemorrhagic pleural fluid for investigation, patient 2 was diagnosed 4 months later and patient 3 presented 7 years after the initial trauma. All were successfully treated surgically once the diagnosis was established.     

Warfare Vascular Injuries

Vascular injuries as a part of combat injuries have been recorded since times immemorial. Responsible for death due to exsanguination, the management of vascular injuries was ligation or amputation till the landmark Vietnam experience. The present day management has evolved with advances in modern technology and may start at the battlefield with the application of a tourniquet with the definitive treatment continuing beyond the combat operation theatres. A basic understanding of both blunt and penetrating vascular injuries will help minimize mortality and morbidity.Key Words: Vascular, Haemorrhage, Tourniquet, Ischemia, Anastomosis     

腹部闭合性损伤769例临床分析

目的总结腹部脏器闭合性损伤的诊治方法,提高腹部闭合性损伤的诊疗救治水平。方法回顾性分析我院10年来769例腹部脏器闭合性损伤患者的诊治情况,总结相关的经验和教训。结果单个实质性脏器和空腔脏器损伤各占47.94%和29.58%,2个以上脏器损伤占22.48%,合并颅脑外伤和胸腹联合伤各占7.3%和4.9%。诊断性腹腔穿刺、X线、B超和CT检查的阳性率分别为92.98%、93.23%、92.79%和91.32%。接受手术治疗718例,非手术治疗51例,分别占92.91%和7.09%,手术组术中后死亡47例,占手术病例的6.55%,其中术中死亡6例,术后死亡41例,非手术组死亡9例,占非手术病例的17.65%,全组病例死亡率为7.28%。结论结合受伤情况、临床症状和检查进行综合分析是提高诊断率的关键,选择及时正确的治疗手段对提高伤者的生存率起到重要作用。     

Beware the boogie board: blunt abdominal trauma from bodyboarding

Riding waves on a bodyboard (boogie board) at the beach is popular with children. Three teenagers who sustained blunt abdominal trauma during bodyboarding are described. Two suffered lacerated livers, one a lacerated spleen. Serious blunt abdominal injuries from bodyboarding mishaps have not previously been reported. The usual method of riding a bodyboard may place the rider at risk of abdominal trauma.     

小儿闭合性肾损伤的诊治及疗效分析(附37例报告)

目的探讨提高小儿闭合性肾损伤的诊治效果.方法回顾分析37例小儿闭合性肾损伤的诊治资料,结果B超检查16例,15例有异常表现.CT检查22例,95.5%(21例)发现肾损伤.静脉肾孟造影10例,发现异常8例.保守治疗31例,其中肾挫伤26例,肾裂伤5例,手术治疗6例(保守治疗失败转手术3例).35例治愈出院,1例治疗好转后回当地治疗,死亡1例.21例(56.8%)随访1年～5年,血压、尿常规和肾功能均正常.结论小儿闭合性肾损伤的最主要原因是直接暴力.血尿是闭合性肾损伤最常见的症状,也是在保守治疗中观察病情变化的一项重要指标.B超可初步了解肾损伤和肾内外血肿,对合并的尿外渗及肾周积尿可明确诊断.CT在诊断肾挫伤、肾裂伤和肾内血肿中准确率很高,能对损伤进行分类,且可同时发现其他脏器的损伤.静脉尿路造影可了解分肾功能、肾孟肾盏形态、有无尿外渗.闭合性肾挫伤和轻度肾裂伤可保守治疗,严重的尿外渗、肾碎裂伤和肾蒂伤需及时手术探查.小儿生性顽皮,治疗中一定要注意保持卧床休息.     

成人钝性脾损伤88例治疗分析

目的探讨成人钝性脾损伤处理中保守治疗的选择。方法选取88例成人钝性脾损伤患者,分为手术治疗、保守无效和保守成功3组,回顾性分析其保守治疗的情况并与手术治疗进行比较。结果手术治疗62例,保守无效7例,保守成功19例。手术组CT检出腹腔积液量、损伤严重度评分(ISS)和美国创伤外科协会(AAST)器官损伤分级均显著大于保守成功组(P=0.000、0.026和0.009),手术组的最低舒张压、最快心率、最低血红蛋白浓度和最低红细胞比容与保守成功组差异显著(P=0.044、0.003、0.038和0.008)。结论血液动力学状况稳定的轻中度钝性脾损伤患者适合保守治疗;保守治疗期间血液动力学状况不能维持稳定者需中转手术;急诊腹部CT有助于保守治疗的病例选择。     

CT在肝脏钝性损伤非手术治疗中的意义

目的评价腹部CT在肝脏钝性损伤非手术治疗中的意义。方法回顾性分析我科近三年来收治的84例肝外伤非手术治疗患者的临床资料。结果本组患者均经腹部CT明确诊断。CT分级：Ⅰ级32例,Ⅱ级27例,Ⅲ级17例,Ⅳ级6例,Ⅴ级2例。非手术治疗期间行CT检查,发现胆痿、肝周脓肿各1例,延迟性出血2例,非手术治疗成功率为96．3％。结论CT是首选的肝脏损伤的检查方法;CT有助于辨别肝损伤的确切程度、定量分析腹腔积血量,还有助于对肝脏钝性损伤并发症的诊断;CT对于腹部其他脏器损伤的诊断及鉴别诊断亦有参考价值。     

小儿肝脾损伤的非手术治疗--附44例临床分析

目的 探讨小儿肝脾损伤的诊断和非手术治疗手法。方法 分析１９８８年１月￣１９９８年１０月收治肝脾损伤患儿４４例。结果 肝脏损伤２０例，腹腔穿刺阳性率９２．９％，肝包膜下血肿１２例（６０．０％），肝破裂，实质内血肿８例（４０．０％），平均输血量在２０ｍｌ／ｋｇ以下。     

46例胸腹联合伤临床分析

目的分析胸腹联合伤的临床表现特征,总结胸腹联合伤的早期诊断与手术治疗的经验,以降低病死率。方法回顾性分析安庆市第一人民医院1998年-2008年经手术证实的46例胸腹联合伤病例资料,其中开放性损伤17例,闭合性损伤29例,分析不同原因的损伤临床症状与治疗方法。结果46例患者中,治愈38例（82.60%）,死亡8例（17.40%）,主要并发症包括肺部感染（5例）,胸腔包裹积液（4例）,膈下感染（1例）,腹腔脓肿（1例）,均经治疗后痊愈。结论胸腹联合伤病情重,表现复杂 早期诊断,及时合理治疗是减少病死率、提高救治效果的关键。     

Non operative management of blunt bile duct injuries in children

Bile duct injuries after blunt abdominal trauma are rare in children. This report describes 2 cases of blunt bile duct injuries in children, which were managed non-operatively. One patient sustained partial tear in the right hepatic duct, which was managed successfully by passing a stent into the injured duct during endoscopic retrograde cholangio pancreatography. The 2nd patient had intrahepatic bile duct injury associated with liver trauma and was managed with a drain placed in the sub-hepatic area percutaneously. This non-operative management in our patients allowed healing of bile duct injuries without any stricture, at 2 years follow-up. Both children are symptom free with normal liver function tests and normal liver ultrasound. With the advancement in radiological and endoscopic techniques, some of the bile duct injuries can be managed conservatively. Conservative treatment must be individualized according to the site and extent of injury.