Selected Aspects in Abdominal Trauma Management

Abstract

The aim of the study was analysis of diagnostic techniques relative to the type of trauma sustained (blunt versus penetrating), the patients' haemodynamic status (stable versus in shock), the character of injuries (isolated versus multiple) and the type of treatment employed (conservative versus operative) in patients with suspected abdominal injuries. Material and methods. The study included 1406 trauma victims hospitalized in the 2nd Department of Surgery in Cracow from 1995 to 2004 who were diagnosed with or underwent surgery for suspected abdominal organ injury. In addition to the clinical examination performed in each case, the ultrasonographic examination according to FAST procedure was used in 1373 patients, diagnostic peritoneal lavage (DPL) in 46, computed tomography (CT) in 27, laparoscopy in 45 and contrast studies of the urinary tract in 45 patients. Data concerning treatment process were obtained retrospectively from the computer databases entitled "Kopernik" and "Pacjenci". The efficiency of diagnostics provided in our clinic was estimated on the basis of the percentage of exploratory laparotomies and the number of missed injuries. Results. Of 218 patients with abdominal organ injuries, 72% underwent surgery and the remaining 28% were treated conservatively. Regardless of the type of trauma, the patients in shock received surgical treatment more often. In the group of patients suffering from blunt injuries, exploratory laparotomies were performed in 5.9% of haemodynamically stable patients and in 12.3% of patients admitted in shock. In the group of penetrating injuries the percentage of exploratory laparotomies reached 23.5 and 6.25% respectively. In six patients with blunt abdominal trauma who were treated conservatively the abdominal injuries were missed. One out of every ten patients was qualified for laparotomy solely on the basis of clinical examination. Most of these patients suffered from abdominal wounds. In the vast majority of remaining patients, FAST was used as the only diagnostic technique or (more often) in combination with additional diagnostic techniques. Except for FAST, additional diagnostic techniques were used in every tenth patient with isolated abdominal injury and in every fourth with multiple injuries. In the most abundant group of patients operated on due to bleeding, FAST was supplemented by additional techniques in half of the patients. Conclusions. FAST played a crucial role in diagnosing patients with injuries of the torso. CT or laparoscopy was additionally recommended for patients with suspected intra-abdominal organ injury, especially in cases of multiple injuries. Peritoneal penetration of the wound without symptoms of intra-abdominal organ injury should not constitute an indication for laparotomy. Qualification for laparotomy on the basis of clinical examination only is permissible only in haemodynamically unstable patients with abdominal wounds.