Modern aspects of diagnosis of the abdominal gun-shot woundings. Experience of a hybrid war in the East of Ukraine

Abstract

Objective. To raise the efficacy of radiological diagnosis of the gun-shot abdominal woundings, using modern highly informative methods of medical visualization with determination of their sensitivity and specificity.
 Materials and methods. Retrospective analysis was done of the results of radiological diagnosis, endovideosurgical and invasive interventions under the radiological methods guidance in 70 injured persons with the gun-shot abdominal woundings, to whom a qualified surgical aid with some elements of specialized help was delivered in 2014-2020 yrs. Average age of the injured persons have constituted 30 complete years old. There were 68 (97.1%) men and 2 (2.9%) women. The results of digital roentgenography, ultrasonographic diagnosis, laparoscopy/laparocentesis, thoracoscopy/thoracocentesis, the puncture-draining interventions under the radiological methods guidance in the injured persons with the gun-shot abdominal woundings were compared to results of the multidetector computed tomography with dynamical contrasted enhancement as a “gold standard” of diagnosis of the gun-shot abdominal woundings and criterion of the foreign bodies visualization (metallic shrapnel, bullets, fragments of bone, drains etc.).
 Results. The main mechanism of damage in the affected persons with the gun-shot abdominal woundings were shrapnel, created as a result of application of various kinds of the gun-shot and explosive weapons. The part of the gun-shot shrapnel woundings statistically significantly prevailed over part of the bullet and explosive woundings. In accordance to the wound channel kind, the part of blind woundings have had prevailed over parts of the through and multiple woundings statistically significantly (p < 0,05). On a mobile tactical level the rate of application of ultrasonic diagnosis and digital roentgenography for primary selection and diagnostic monitoring was statistically significantly (p < 0.05) higher, than of other methods of medical visualization, what may be explained by improvement and optimization of the treatment and diagnosis tactics, application of urgent sonography in trauma and other modified protocols. Optimal diagnostic system was determined in accordance to indices of sensitivity and specificity of the medical visualization methods, endovideosurgical and puncture-draining interventions under the radiological methods of control - the multidetector computed tomography with dynamical contrasted enhancement.
 Conclusion. High sensitivity (99%) and specificity (98%) of the multidetector computed tomography with dynamical contrasted enhancement permits to apply it as a method of medical visualization of the gun-shot abdominal woundings for diagnostic selection of wounded persons and the diagnosis establishment.

Oblique projections in the analysis of multislice computed tomography data in gunshot wounds

“…Аксіальні, корональні, сагітальні й косі проєкції використовуються для розробки оптимального плану втручання [1,2]. У сучасних томографах застосовують алгоритм прямої мультипланарної реконструкції, що дозволяє проспективно реконструювати аксіальні, сагітальні, корональні й косі проєкції [1,[3][4][5].…”

“…МСКТ використовують не тільки для діагностики бойової вогнепальної травми, але й для вивчення моделювання поранень і травм [1,3,4,7,[9][10][11].…”

“…Частою практикою є виконання МСКТ голови, шиї, грудей і живота при політравмі та поєднаних вогнепальних пораненнях [1][2][3][4].…”

A clinical case of gunshot shrapnel penetrating wound of the chest with injury to the inferior vena cava with migration of a foreign body along the blood stream

“…Gunshot wounds with damage to organs and vascular structures of the retroperitoneal space are an extremely rare and very difficult problem that a surgeon must solve in a matter of moments to save life of the wounded. Damage to the major vessels due to abdominal trauma belongs to the most difficult category, including damage to the inferior vena cava [11][12][13]. Lethality in case of damage to the suprahepatic and retrohepatic part of the inferior vena cava is 100%, suprarenal and renal -60.6 %, infrarenal -30.6 %.…”

Surgical tactics in fire kidney injury and the first experience in performing laparoscopic nephrectomy at the II level of medical support (role II) in combat conditions: Case report

“…Surgical treatment remains the gold standard in unstable patients with gunshot and stab wounds [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] . Urologists prefer to save the organ, while emergency surgeons consider stabilization of the patient's condition during the “golden hour” more important than organ preservation [17] , [18] , [19] .…”