Pancreatic ultrasound following blunt abdominal trauma

Ten patients with suspected pancreatic injury from blunt abdominal trauma were evaluated by ultrasound. One examination performed on the day of the trauma was nondiagnostic. Nine examinations were performed between 6 days and 9 months following the trauma and revealed a pseudocyst in 3, and pancreatic enlargement in 2 patients. The remaining 4 examinations were normal and helped to exclude pancreatic injury.     

Mesenteric injury caused by minor blunt abdominal trauma

The authors present an unusual case of mesenteric injury caused by minor blunt abdominal trauma and also provide a review of the literature.     

Extensive isolated inferior vena caval injury following blunt trauma

A patient with an isolated blunt-trauma laceration involving almost the entire infrarenal vena cava was successfully treated by ligation and resection without sequelae. Diagnostic and therapeutic aspects of the injury are discussed.     

儿童钝性胸部创伤后主支气管断裂临床分析

目的　探讨儿童钝性胸部创伤后主支气管断裂的临床特点和早期诊治。方法　本组 11例 ,年龄 3～ 7岁 ,平均 (5 1± 1 4 )岁。患者均为闭合性损伤后主支气管完全性断裂 ,左侧 7例 ,右侧 4例。 4例伤后 2 4h内急诊行支气管断裂吻合术 ;7例延误诊断患儿于伤后 2～ 12个月内晚期手术 ,其中 3例行支气管断裂吻合术 ,4例行全肺切除术。结果　本组无手术死亡 ,7例行支气管断裂吻合术 ,恢复顺利 ,术后1个月胸片复查 ,肺组织复张良好。结论　认识儿童钝性胸部创伤后气管支气管断裂的临床特点 ,可提高早期诊断水平 ,明显降低其并发症和病死率。     

腹腔镜治疗腹部闭合性外伤临床分析

目的探讨腹腔镜在治疗腹部闭合性外伤中的临床价值。方法回顾性分析25例腹部外伤腹腔镜探查应用的临床资料结果24例在腹腔镜下明确诊断（96．00％）,其中19例腹腔镜下完成手术,5例转开腹完成手术。全组均痊愈出院,无死亡病例。结论在腹部外伤病人中选择适合的病人进行腹腔镜治疗,具有安全可靠、创伤小、恢复快的特点,有助于降低治疗风险．避免部分不必要的开腹手术。     

Reevaluation of ultrasonography for solid-organ injury in blunt abdominal trauma.

OBJECTIVE: To reevaluate the usefulness of ultrasonography for detecting and classifying solid-organ injuries from blunt abdominal trauma by comparing ultrasonography with computed tomography (CT) and laparotomy. METHODS: Six hundred four patients with blunt abdominal trauma were examined by both B-mode ultrasonography and CT for a study period of 14 years. The ultrasonographic examiners were divided into 2 groups depending on their experience with ultrasonography. The ultrasonographic results were then compared with CT and surgical findings. This was a retrospective study. RESULTS: In 198 patients, solid-organ injuries were identified on CT, laparotomy, or both. Sensitivity values in group A (experts) were 87.5% for hepatic injuries, 85.4% for splenic injuries, 77.6% for renal injuries, and 44.4% for pancreatic injuries. Sensitivity values in group B were 46.2% for hepatic injuries, 50.0% for splenic injuries, and 44.1% for renal injuries. The detection rates in group A were 80% to 100% for different types of hepatic injuries except superficial injuries (20%) and 70% to 100% for different types of splenic injuries. The detection rates for renal parenchymal and pancreatic duct injuries were 53.3% and 80%, respectively. The detection rates for injuries requiring intervention were 86.1% in group A and 66.7% in group B. CONCLUSIONS: The sensitivity of ultrasonography with the use of CT and surgical findings as reference standards decreased compared with our prior study. However, ultrasonography was found to enable experienced examiners to detect and classify parenchymal injuries efficiently, despite disadvantages in detecting superficial and vascular injuries. Ultrasonography should be used to explore not only free fluid but also solid-organ injuries.     

Traumatic appendicitis in minor blunt abdominal injury

Trauma has been reported as a cause of appendicitis on several cases in the literature. The present study reports the relationship between blunt abdominal trauma (BAT) of injury severity score less than 4 and appendicitis. A 17‐year‐old girl developed appendicitis after a minor BAT. An ecchymosis at the right lower quadrant misled the diagnosis, which was made 1 day later. Laparotomy revealed an inflamed appendix, a few enlarged mesenteric lymph nodes, contusion, as well as punctuated bleeding sites of the caecum. Moreover, based on a brief literature review, the different pathophysiological mechanisms and the difficulties of diagnosis of this entity are discussed. It is suggested that appendicitis should be considered as a possibility in the setting of right lower quadrant pain following minor BAT, when there is clinical suspicion of an inflammatory process within the right iliac fossa.     

急诊超声对钝性腹部创伤内脏破裂出血的诊断与研究

目的:探讨分析急诊超声对钝性腹部创伤内脏破裂出血的诊断效果。方法:选我院收治的100例钝性腹部创伤内脏破裂出血患者作为研究对象,这些患者的纳入时间为2018年9月到2019年10月。对这些患者的临床资料进行整理分析,主要是对其在手术前进行的超声检查图像的诊断情况进行分析。结果:通过对患者的临床资料进行整理分析,其结果为超声检查的出血诊断正确率为100%,出血位置诊断正确率为86%,在对各个内脏的破裂出血情况中都有较高的诊断效果。本次实验中有20例患者为复合性内脏破裂出血,这些患者的出血诊断正确率为100%,出血位置诊断正确例数为19例,诊断正确率为95.00%。结论:对钝性腹部创伤内脏破裂出血患者进行超声检查,可以有效的对患者的内脏出血情况进行诊断,可以有效的为后续的治疗提供参考。     

Melaena as the presenting symptom of gastric mucosal injury due to blunt abdominal trauma

Blunt abdominal trauma is a common cause of admission to the typical trauma centre. Hollow viscus injury from blunt trauma, however, is unusual and rarely involves the stomach. A 15 year old boy sustained a bicycle handle bar injury to the abdomen and presented to the casualty department four days later with melaena. A computed tomography (CT) scan of the abdomen showed normal findings but endoscopy revealed two “kissing” areas of mucosal ulceration on the anterior and posterior wall of the gastric antrum. The patient received a blood transfusion for anaemia but was otherwise treated conservatively and made a full recovery. The authors believe this to be the first reported case of melaena as the primary presenting symptom of gastric ulceration secondary to blunt abdominal trauma. Diagnosis of hollow viscus injuries due to blunt abdominal trauma requires a high index of suspicion and thorough investigation, particularly if the presentation is delayed.     

腹部创伤CT诊断及其临床价值分析

目的:探讨和研究CT诊断方式对腹部创伤患者的临床价值。方法:本次研究选取的开始时间与结束时间分别为2017年10月、2019年10月,研究对象为前来我院就医的腹部创伤患者,总例数为40例,对40例腹部创伤患者均采取CT技术进行诊断,分析和比对CT扫描仪诊断的最终结果。结果:通过CT诊断检查后,在本次研究所选取的40例腹部创伤患者中,有12例确诊为肾损伤,占比30%;肝损伤为8例,占比20%;脾损伤为10例,占比25%;胰腺损伤为3例,占比7.5%;胆道损伤为6例,占比15%;膀胱损伤为1例,占比2.5%。CT机扫描的诊断准确率为95%(38/40)。结论:对于腹部创伤的患者,在进行检查的过程中工作人员可以采取CT扫描仪的方式进行诊断,其临床效果较为明显,值得使用和进一步的推广。     

Rate of intra-abdominal injury after a normal abdominal computed tomographic scan in adults with blunt trauma

Objective

The objective of this study is to determine the rate of intra-abdominal injury (IAI) in adults with blunt abdominal trauma after a normal abdominal computed tomographic (CT) scan. We hypothesize that the risk of subsequent IAI is so low that hospital admission and observation for possible IAI are unnecessary.

Methods

We conducted a prospective, observational cohort study of adults (>18 years) with blunt trauma who underwent abdominal CT scanning in the emergency department. Computed tomographic scans were obtained with intravenous contrast but no oral contrast. Abnormalities on abdominal CT included all visualized IAIs or any finding suggestive of possible IAI. Patients were followed up to determine the presence or absence of IAI and the need for therapeutic intervention if IAI was identified.

Results

Of the 3103 patients undergoing abdominal CT, 2734 (88%) had normal CT scans. The median age was 39 years (interquartile range, 26-51 years); and 2141 (78%) were admitted to the hospital. Eight (0.3%; 95% confidence interval, 0.1%-0.6%) were identified with IAIs after normal abdominal CT scans including the following injuries: pancreas (5), liver (4), gastrointestinal (2), and spleen (2). Five underwent therapy at laparotomy. Abdominal CT had a likelihood ratio (+) of 20.9 (95% confidence interval, 17.7-24.8) and likelihood ratio (−) of 0.034 (0.017-0.068).

Conclusion

Adult patients with blunt torso trauma and normal abdominal CT scans are at low risk for subsequently identified IAI. Thus, hospitalization for evaluation of possible IAI after a normal abdominal CT scan is unnecessary in most cases.     

多层螺旋CT诊断对急性胸腹部创伤患者的作用

目的:观察多层螺旋CT平扫对急性胸腹部创伤患者的诊断效果。方法:选取2017年3月—2018年6月我院收治的急性胸腹部创伤患者60例,在未口服造影剂的情况下进行16层螺旋CT平扫,详细记录患者的个人资料、基础疾病、临床特征及CT扫描结果,观察多层螺旋CT平扫对胸腹部创伤诊断的敏感性和特异性。结果:诊断实质脏器损伤的敏感性为94.4%(51/54),特异性为83.3%(5/6),空腔脏器损伤的敏感性为76%(19/25),特异性为80%(28/35)。结论:多层螺旋CT平扫对急性胸腹部创伤患者具有较高的诊断价值,其中对肾上腺损伤诊断的敏感性和特异性较高,对空腔脏器和系膜血管损伤诊断的敏感性和特异性较低。     

超声造影在腹部实脏器外伤诊断及治疗中的价值

超声造影（CEUS）技术的发展和应用显著提高了超声在腹部实脏器外伤的诊断水平,其在腹部实脏器外伤治疗方法筛选及治疗中发挥着重要的作用。根据腹部实脏器外伤治疗的现状,综述CEUS在腹部实脏器外伤的诊断、治疗方法的筛选及治疗中的价值。     

Determining the accuracy of base deficit in diagnosis of intra-abdominal injury in patients with blunt abdominal trauma

Background

Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. A multiplicity of diagnostic modalities exists to evaluate the abdomen. We sought to assess the diagnostic performance of base deficit (BD) in identifying intra-abdominal injury in patients with blunt abdominal trauma.

Methods

A prospective, nonrandomized series of patients with blunt abdominal trauma admitted into the 2 emergency departments was investigated from September 2007 to September 2008. Arterial blood samples were analyzed. According to BD, the patients were divided into 2 groups: group 1 who had a BD of −6 or lower and group 2 who had a BD more than −6. Ultrasonography, computed tomographic scan, or laparotomy was performed to find intra-abdominal injury. Follow-up at 7 days by telephone interview was obtained on patients who were discharged.

Results

A total of 400 patients were enrolled, with a mean (SD) age of 34.8 ± 17.1 years. Two hundred sixty-eight (67%) of them were male. Seventy-six (19%) of patients had a BD of −6 or lower. Sixty-eight (17%) of them showed to have intra-abdominal injury with a BD of approximately −8.7 ± 3.2, compared with patients without intra-abdominal injury, −0.4 ± 0.1. Patients with a BD of −6 or lower achieved more laparotomy and blood transfusion compared with patients with a BD more than −6. On receiver operating characteristic curve analysis, the cutoff point of −6 was obtained with sensitivity and specificity of 88.2% and 95.2% and with positive and negative predictive values of 79% and 97.5%, respectively. None of outpatients had abdominal problem in telephone follow-up.

Conclusions

These data show that the BD is an early available important indicator to identify intra-abdominal injury in patients with blunt abdominal trauma, as well as a high transfusion requirement.     

Value of computed tomography in the evaluation of retroperitoneal organ injury in blunt abdominal trauma

Computed tomography (CT) is widely used in the evaluation of blunt abdominal trauma. One of its purported advantages is in the evaluation of the retroperitoneum. This study was undertaken to determine the utility of CT in diagnosing retroperitoneal organ injury. A retrospective chart review of 466 stable patients with blunt abdominal trauma who received abdominal CT was conducted. Twelve percent of the patients had CT scans showing retroperitoneal organ injury. There were 58 total injuries, with the kidney being the most frequently injured organ. Twenty-four patients required laparotomy, confirming the CT diagnosis in 8 patients (7 renal and 1 pancreatic). Two duodenal injuries were found at laparotomy that had not been seen on CT scan. Fourteen percent of the patients with positive CT scans had a positive laparotomy, and of those, 38% were therapeutic. Five percent of the patients with positive scans had therapeutic laparotomies. These data infer that the utility of CT to define retroperitoneal organ injury is lower than previously suspected.     

早期肠内营养在以严重腹部外伤为主的多发伤患者术后的应用

目的　探讨早期肠内营养在多发伤患者中的应用价值。方法　对本院收治的 2 1例以严重腹部外伤为主的多发伤患者术后实施早期肠内营养。术后第 1天和第 14天分别测定血清白蛋白、前白蛋白、转铁蛋白 ,T淋巴细胞表面抗原和CRP ,并进行比较。结果　所有患者术后 2周的血清白蛋白、前白蛋白、转铁蛋白、CD3+ 、CD4+ 和CD4+ CD8+ 等比术后第 1日明显增加 (P <0 0 5 ) ,CRP和CD8+ 明显下降 (P <0 0 5 ) ,而且无严重感染发生。结论　术后早期肠内营养在以严重腹部外伤为主的多发伤患者中运用是安全可行并有价值的     

Screening sonography in pregnant patients with blunt abdominal trauma.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of screening sonography for the detection of clinically significant abdominal injury in pregnant patients with blunt trauma. METHODS: We retrospectively reviewed the records of 5173 patients with blunt abdominal trauma who underwent screening sonography. Pregnant patients were identified, and the prospective sonographic interpretations were compared with surgical findings, computed tomography (CT), subsequent sonography, cystography, and the clinical course. RESULTS: Of 1567 female patients with trauma, 947 were of reproductive age and, 102 (11%) of these 947 were pregnant. One patient was excluded because a truth standard was not available. Five (5%) of these 101 patients were found to have injuries at surgery. These injuries involved the placenta (2 injuries), spleen (2 injuries), liver (1 injury), and kidney (1 injury); all required surgery. Initial sonographic findings were positive in 4 of 5 patients with injuries. The missed injury was a placental injury detected 15 hours after screening sonography because of fetal bradycardia. After screening sonography, 6 patients underwent additional abdominal imaging: CT (3 patients), cystography (1 patient), and additional sonography (2 patients). Of 101 patients, 95 (94%) required no additional tests, and 97 (96%) required no test involving ionizing radiation. No pregnant patient underwent diagnostic peritoneal lavage. Sensitivity was 80% (95% confidence interval, 28%-100%), and specificity was 100% (96 of 96; 95% confidence interval, 96%-100%) for detecting major abdominal injury. CONCLUSIONS: Sonography is an effective screening examination that can obviate more hazardous tests such as CT, cystography, and peritoneal lavage in most pregnant patients with trauma requiring objective evaluation of the abdomen.     

Bronchial tear consecutive to blunt chest trauma

Tracheobronchial injuries following blunt chest trauma are rare and can be lethal. CT scan can help to diagnose it when a defect to the tracheobronchial wall is visible or to suspect it in front of indirect signs.