EUROMEDICAHanover3-4 Juni 2010 |
Advanced methods of diagnosis,
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European Academy of Natural Sciences, HanoverEuropean Scientific Society, HanoverBerliner Medizinischen Gesellschaft, Berlin |
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| V.N. Smirnov S.T. Turmakhanov M.M. Saadulayeva M.A. Popova A.Y. Malyshev M.G. Abbasov V.G.Lapeeva |
TREATMENT POLICY IN CLOSED ABDOMINAL INJURIES |
| Department of Surgery, Institute of Medical Education, Yaroslav-the-Wise Novgorod State University, Velikiy Novgorod, Russia |
Introduction: Treatment of closed abdominal injuries in polytrauma presents a topical problem in urgent surgery.
Objective: To conduct analysis of diagnostics and treatment of patients with polytrauma.
Data: There was treatment policy analysis conducted on 147 patients with polytrauma after car accidents, taken into Novgorod Regional Clinical Hospital in December 2004-March 2007 period. On the pre-admission stage diagnosis included: closed craniocerebral injury, fractures of lower and upper extremities, closed abdominal injury was not excluded.
Methods: Patients were performed abdominal paracentesis and lavage, USI of the abdominal cavity, diagnostic laparoscopy, various types of operative treatments of laparotomy access.
Results: Abdominal paracentesis and lavage was performed in 56 patients in order to exclude intraperitoneal hemorrhage, under urgent indications (systolic BP lower than 100mm Hg). Shifting to laparotomy after aquiring the laparocentesis results – in 39 patients (28 of them – spleen injury, 10 – liver, spleen, or mesojejunum rupture, 1 patient – jejunum rupture). 17 patients had negative laparocentesis results. On admission, 91 patients with BP 110-140 mmHg had their USI performed straight away, 40 of them had free liquid in abdominal cavity. Out of them 20 patients with brain contusion received diagnostic laparoscopy: 200-400ml of blood were found in abdominal cavity, but no internal injuries, the bursting of abdominal peritoneum with no signs of continuing hemorrhage were revealed. Due to contraindications to laparoscopy, 20 patients with brain contusion received laparotomy under the USI data. In 6 cases liver ruptures were revealed, and spleen rupture in 14 patients. According to USI data on admission, 51 patients with stable BP 110-140 mmHg did not have free liquid in abdominal cavity. After 4-6 hours of dynamic observation (BP control, abdominal USI in 4-6-12 hrs, Hb, RBC, and blood WBC control, clinical examination) in second USI, 8 patients were diagnosed with 500-700ml of free liquid in the abdominal cavity. Due to contraindications to laparoscopy (craniocerebral injury) 6 patients were performed laparotomy: liver rupture was revealed in 2 cases, in 4 – spleen rupture. Laparoscopy was performed in 2 patients: up to 500ml of blood was found in abdominal cavity, with no damage to internal organs. With further dynamic observation, no data for internal organs’ injury was aquired for 43 patients.
Conclusion: Treatment policy for patients entering with suspected closed abdominal injury, in order to exclude an injury of abdominal organs, so should consist of the following components: 1 – when in decompensated shock – urgently perform lapaocentesis; 2 – when in stable condition (BP 110-140 mmHg) to perform USI of abdominal cavity with diagnostic laparoscopy; 3 – if there are no clinical data in favor of abdominal organs’ injury at the time of admission, it is necessary to perform strict dynamic control (repetitive abdominal USI after 4-6-12 hours, clinical examination, BP control, HBC, WBC, HB control) for this category of patients. The combination of these methods allows to diagnose abdominal organs’ injuries early in time.