Trauma
Sam Mehta, Andrew Hindmarsh, Leila Rees in Handbook of General Surgical Emergencies, 2018
A significant abdominal injury is likely if there is: a relevant mechanism of injuryabdominal pain that may be referred to the shoulderunexplained hypotensiona penetrating wound to the lower chest, abdomen or perineum/gluteal regionbruising of the abdominal wall/flanksa seatbelt sign11peritonismabsent bowel sounds (unreliable)blood on digital rectal examination (DRE)related injury (e.g. chest or pelvis).
Implications of a single kidney for the young athlete
Roy J. Shephard in Physical Activity and the Abdominal Viscera, 2017
Winter sports such as skiing, snowboarding and sledding are other likely causes of abdominal trauma. The incidence of skiing injuries in Austria is about one per visitor-year, with 2% of these injuries affecting the kidneys.[30] The Urology Department of an Innsbruck hospital treated 254 children for renal trauma over a 26-year period, mostly due to skiing incidents. In about a third of these patients, the renal injury was severe, but only four nephrectomies were needed.[30] The risk of abdominal injuries is higher for snowboarding than for skiing;[44, 45] the abdomen accounted for 0.7% of injuries in skiers and 1.2% in snowboarders, with renal injury accounting for 29.7% of all abdominal trauma in skiers and 68.4% in snowboarders.[44] Most of the skiing injuries were sustained in the afternoons, possibly because of a deterioration in snow conditions or fatigue of the skier. Problems were also more frequent in children, adolescents and those with low skill levels, suggesting the value of lessons that embrace safety precautions.[44–46] In many skiers, other adverse factors were defective bindings and the use of rented equipment.[46]
Surgery and traumatology: Surgical management of severely injured patients when resources are limited
Jan de Boer, Marcel Dubouloz in Handbook of Disaster Medicine, 2020
If an abdominal injury is confirmed or suspected, the following measures should be taken: – Oxygen, assisted ventilation, and endotracheal intubation if the patient is shocked;– Large, centrally placed intravenous lines (it is of little value to give fluid in the lower extremities in the patient with intra-abdominal bleeding);– Gastric tube;– Bladder catheter (contraindicated in a patient with a suspicion of urethral injury. If possible take a sample of urine before inserting the catheter);– If the patient has circulatory instability, start intravenous infusion (see under treatment of shock). Note: To give extensive volume replacement without control of the source of bleeding may increase the blood loss and also cause impairment of coagulation with the risk of systemic reactions. Therefore, remember that identification and control of the source of bleeding as soon as possible is the most important measure.
Acute portal vein thrombosis in noncirrhotic patients – different prognoses based on presence of inflammatory markers: a long-term multicenter retrospective analysis
Published in Scandinavian Journal of Gastroenterology, 2019
Radan Keil, Jana Koželuhová, Jiří Dolina, Aleš Hep, Radek Kroupa, Vladimír Kojecký, Tomáš Krejčí, Jan Havlín, Ivana Hadačová, Jitka Segethová, Petra Koptová, Zdena Zádorová, Jan Matouš, Barbora Frýbová, Petr Chmátal, Martin Wasserbauer, Jan Šťovíček, Melvin Bae, Tolga Guven, Mahmood Zaeem, Štěpán Hlava
The most common clinical symptom that patients presented with at the hospital was abdominal pain (70 patients, 89.7%), followed by dyspepsia (four patients, 5.1%) and bleeding from esophageal varices (3 patients 3.8%). One patient (1.4%) had singultus. Thirty-three patients (44.9%) were admitted with abdominal pain, septic fever and elevated CRP (more than 150 mg/l). All of them had acute surgical abdomen or severe infection (diverticulitis, pancreatitis, cholecystitis, etc.). 45 (55.1%) patients were admitted with abdominal pain without fever and low levels of CRP.(less than 60 mg/l) One patient was examined for abdominal pain which appeared a few weeks after a complicated fundoplication with splenectomy because of a lienal vein lesion. Two patients experienced an abdominal injury in the period before the onset of symptoms.
Suspicion of abdominal injuries in high-energy trauma patients: which clinical factors influence decision making for diagnostic imaging?
Published in Acta Chirurgica Belgica, 2020
Bart G. J. Candel, Yvonne Admiraal-van de Pas, Fenneke Smit-van de Wiel
This study reveals that abdominal pain and the degree of concomitant injury are the main clinical factors to perform diagnostic imaging. Patients with moderate or severe concomitant injury are more likely to receive diagnostic imaging than patients with a low degree of concomitant injury. The severity of concomitant injury does not affect the sensitivity of the physical examination [34]. HET-patients do not necessarily also have BAT. Severe concomitant injury forewarns the physician that possibly more kinetic energy is transferred to the patient, which could increase the chance for abdominal injuries [35]. In the literature, a femoral or pelvic fracture and thoracic injury are clinical predictors for abdominal injury in level I trauma centres [36]. These clinical predictors could be translated to our degree of concomitant injury. We believe these clinical predictors would also be independent predictors to perform diagnostic imaging. However, our sample size was too small to study these independent factors.
The long-term urinary dysfunction after type C2 radical hysterectomy in patients with cervical cancer
Published in Journal of Obstetrics and Gynaecology, 2022
Linjuan Huang, Yingdi He, Yao Gong
Laparoscopic surgery is associated with less abdominal trauma and shorter recovery period when compared with an open approach (Turnbull et al. 2012). A retrospective study by Corrado et al. (2018) confirmed that minimally invasive surgery (laparoscopy or robotics) was as adequate and effective as abdominal surgery in terms of surgical and oncological outcomes in the treatment of early-stage cervical cancer. Laterza et al. reported that laparoscopic approach could reduce the occurrence of postoperative urinary incontinence and increase bladder sensation with the time of 6 months after surgery when compared with ARH (Laterza, Salvatore, et al. 2015). More and more LRH were done globally until the findings by Ramirez et al. (2018) that LRH was associated with lower rates of disease-free survival and overall survival than ARH among women with early-stage cervical cancer. Our findings indicate that patients after type C2 RH by laparoscopy had more urinary dysfunction than those after ARH. The reason is unclear. Laparoscopy utilises more electric manipulations, which could lead to more injury to autonomic nerve around lower urinary tract (Laterza, Sievert, et al. 2015). This might explain the high incidence of recatheterisation and LUTS after LRH.
Related Knowledge Centers
- Abdominal Pain
- Bleeding
- Ultrasound
- Abdomen
- Blunt Trauma
- Bruise
- Infection
- CT Scan
- Diagnostic Peritoneal Lavage
- Penetrating Trauma