Isolated Free Fluid on Abdominal Computed Tomography in Blunt Trauma: Watch and Wait or Operate?

Gonser-Hafertepen, Laura N.; Davis, James W.; Bilello, John F.; Ballow, Shana; Sue, Lawrence P.; Cagle, Kathleen M.; Venugopal, Chandrasekar; Hafertepen, Stephen C.; Kaups, Krista L.

doi:10.1016/j.jamcollsurg.2014.04.020

Cited by 31 publications

(16 citation statements)

References 5 publications

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“…The incidence of isolated free fluid in these studies was comparable with that in our series, at 5.4% and 5.7%. 21,32 On the other hand, this is not consistent across all studies; a series reported in 2014 showed that 72% of patients with free fluid did not require intervention. 33 The incidence of isolated free fluid in our study was high at 11.6% but the ability to predict the need for surgery was low, with only 18.5% of these patients requiring operative intervention at some stage.…”

Section: Discussionmentioning

confidence: 98%

Contemporary characteristics of blunt abdominal trauma in a regional series from the UK

Pande

Saratzis

Beatty

et al. 2017

annals

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INTRODUCTION Blunt abdominal trauma (BAT) is a common injury in recent trauma series. The characteristics of patients with BAT have changed following the reconfiguration of UK trauma services. The aim of this study was to build a new profile for BAT patients undergoing immediate or delayed laparotomy. METHODS All 5,401 consecutive adults presenting with major trauma between April 2012 and April 2014 in the 3 major trauma centres in the West Midlands were analysed to identify all patients with BAT. A total of 2,793 patients with a mechanism of injury or symptomatology consistent with BAT were identified (52%). Outcomes were analysed using local electronic clinical results systems and notes. RESULTS Of the 2,793 patients, 179 (6.4%) had a mesenteric or hollow viscus injury, 168 (6.0%) had a hepatobiliary injury, 149 (5.4%) had a splenic injury and 46 (1.6%) had a vascular injury. Overall, 103 patients (3.7%) underwent an early (<12 hours) laparotomy while 30 (1.1%) underwent a delayed (>12 hours) laparotomy. Twenty (66.7%) of those undergoing a delayed laparotomy had a hollow viscus injury. In total, 170 deaths occurred among the BAT patients (6.1%). In the early laparotomy group, 53 patients died (51.5%) whereas in the delayed laparotomy group, 6 patients died (20.0%). CONCLUSIONS This series has attempted to provide the characteristics of patients with BAT in a large contemporary UK cohort. BAT was found to be a common type of injury. Early and delayed laparotomy occurred in 3.7% and 1.1% of these patients respectively, mostly because of hollow viscus injury in both cases. Outcomes were comparable with those in the international literature from regions with mature trauma services.

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Section: Discussionmentioning

confidence: 98%

Contemporary characteristics of blunt abdominal trauma in a regional series from the UK

Pande

Saratzis

Beatty

et al. 2017

annals

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“…Morbidity was 27.6% and mortality was statistically significantly higher (19.8% with HVI vs. 12.2% without HVI, p < 0.001). Severe symptoms may develop after HVI, sometimes with a delay of several days after initial trauma [47]. Signs of intraperitoneal free air or free fluid on CT without detectable solid organ injury paired with signs of peritoneal irritation should prompt surgical exploration [25].…”

Section: For Whom?mentioning

confidence: 99%

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

2017

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The management of blunt abdominal trauma has evolved over time. While laparotomy is the standard of care in hemodynamically unstable patients, stable patients are usually treated by non-operative management (NOM), incorporating adjuncts such as interventional radiology. However, although NOM has shown good results in solid organ injuries, other lesions, namely those involving the hollow viscus, diaphragm, and mesentery, do not qualify for this approach and need surgical exploration. Laparoscopy can substantially reduce additional surgical aggression. It has both diagnostic and therapeutic potential and, when negative, may reduce the number of unnecessary laparotomies. Although some studies have shown promising results on the use of laparoscopy in blunt abdominal trauma, randomized controlled studies are lacking. Laparoscopy requires adequate training and experience as well as sufficient staffing and equipment.

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“…Пациентам с болью при пальпации живота и наличием СЖБП на КТ целесообразно проводить повторное физикальное обследование. В некоторых специализированных детских травматологических центрах допускается госпитализация детей с травмой при нормальных результатах КТ [14][15][16].…”

Section: Discussionunclassified

Isolated free fluid in children with blunt abdominal trauma: Does it alters the management approach?

Khan

Ахмад²,

Wahab

et al. 2018

Pediatr Traum Orthop Reconstr Surg

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Introduction. Isolated free fluid (IFF) on abdominal computed tomography in children with blunt abdominal trauma poses a diagnostic dilemma. The aim of this study is to present our experience of the entity and its role in management of these children. Methods. A prospective study was performed over a period of two and half years on all the children less than 14 years of age admitted to our hospital with blunt abdominal trauma and in whom the CT abdomen was done which demonstrated isolated free fluid with no sign of visceral injury. Demographic data, presenting clinical status, imaging data and management (nonoperative progress and operative findings) were collected and analyzed. Results. A total of 108 children were admitted with blunt abdominal trauma and who underwent abdominal CT during the period from July 2015 to December 2017. Isolated free fluid (IFF) was found in 26 children (24%). The mean age was 7.8 years with male predominance. Motor vehicle collisions were the most common mechanism of injury. At presentation abdominal tenderness was present in 8 of these children. Twenty two children had small IFF and 2 each had moderate and large fluid collections and the most common site being the hepatorenal pouch. One child each from moderate and large IFF group needed subsequent exploration. Conclusion. Children of blunt abdominal trauma with isolated free fluid on abdominal CT are managed conservatively. However, they need admission and repeated clinical assessment for early detection of delayed presentation of visceral injury entailing surgical intervention.

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Isolated Free Fluid on Abdominal Computed Tomography in Blunt Trauma: Watch and Wait or Operate?

Cited by 31 publications

References 5 publications

Contemporary characteristics of blunt abdominal trauma in a regional series from the UK

Contemporary characteristics of blunt abdominal trauma in a regional series from the UK

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

Isolated free fluid in children with blunt abdominal trauma: Does it alters the management approach?

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