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Poškodba črevesja pri bolnikih s topo poškodbo trebuha - naše izkušnje = Bowel injury caused by blunt abdominal trauma - our experience
Vidmar, Dubravka ...
Introduction: the diagnosis of bowel injury caused by blunt abdominal truma could sometimes be a diagnostic challenge since there are no reliable radiological nor early clinical signes. The usual ...sequence of diagnostic path are abdominal sonography (US), plain abdominal radiograph, compjuted tomography and laparoscopy. In our article the diagnostic procedure performed on 18 patients with bowel injury examinated in our department is discused. Methods: among 18 patients average age 37 years (12-94 years) were found to have blunt abdominal trauma; 7 patients had isolated bowel injury, 11 patientsbeside bowel injury had associated injuries. Ther were different mecanisms of injury: traffic accidents (13 patients, 11 of them had seat-belt compression), a direct traumatizing force into abdomen caused by other mecanisms (5 patients). All the patients were examinated by US, additional plain abdominal radiograph to prove pneumoperitoneum was performed by 9 patients and additional CT by other 6 patients. Results: by 10 of 18 patients were evaluated with US on the admission: free fluid was detected by 7 patients, 6 patients were examined in one day delay: free fluid was detected by 5 patients. At 2 patients examinated with 3-9 days delay: solid free fluid (peritonitis) was found. At control or delayed examination intestinal injurieswere detected in 12 patients. Pneumoperitoneum was seen on plain radiograph in 5 patients. CT showed properly diagnose of bowel perforation in 4 patients. 7 patients undervent surgical treatment in less than 24 hours, 2 patients after 24 hours, 7 patients later than 24 hours. 3 patients died. Discussion: the diagnostic procedure for the patient with typical mecanism of injury and contusion mark should be the sequence of: US, plain abdominal radiograph (for evidence of pneumoperitoneum). CT may be helpful in diagnosing. (Abstract truncated at 2000 characters).
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