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Keywords:
Abdomen, Trauma, CT, Surgery, Haemorrhage
Authors:
D. Alifa1, B. Khaled2, R. M. Lamia3; 1Nabeul 8000/TN, 2Nabeul/TN, 3Tunis/TN
DOI:
10.1594/ecr2014/C-1602
Results
- The average age of patients was 28 years with predominance of men and sex ratio 13.5 (men: 54,
women:4).
- All stab wounds were secondary to a criminal assault.
No cases of attempted suicide or work accident has been objectified.
- In 75% of cases,
the wounds were antero-lateral topography,
predominant in the left flank.
- The thoraco-abdominal wounds accounted for 22% of all wounds.
- In one case the wound was by impalement
Table 1 summarizes the various orifices skin input
Topography of gateway
|
|
Number
|
%
|
Antero-lateral wound
|
Epigastric
|
7
|
12
|
|
Left hypochondrium
|
5
|
8,5
|
|
Left side
|
15
|
26
|
|
Left iliac fossa
|
5
|
8,5
|
|
Right hypochondrium
|
4
|
7
|
|
Right side
|
6
|
10
|
|
Right iliac fosse
|
1
|
2
|
|
Hypogastrium
|
1
|
2
|
Thoraco-abdominal wound
|
|
13
|
22
|
Impalement
|
|
1
|
2
|
Total
|
|
58
|
|
- All patients were hemodynamically stable.
Physical examination did not objectified signs of peritoneal irritation and found a penetrating wound in all cases.
Thirty-eight patients underwent abdomino-pelvic CT with volume acquisitions in thin sections without and with injection of contrast material in the portal phase (70seconds).
Twenty were explored by thoraco-abdomino- pelvic CT.
At the thoracic level,
the acquisition volume was 1.25 mm thin section outset injection of contrast.
No oral or rectal opacification have been performed.
- The images were analyzed on native cuts and with the help of sagittal,
coronal and oblique multiplanar reconstructions in mediastinal and parenchymal windows at the thoracic level,
in soft tissues window at abdomino-pelvic level and wide in search of pneumoperitoneum.
- Computed tomography (CT) confirmed the penetrating wound in 57% of cases with third had lesions that necessitated emergency laparotomy such as hemo-pneumoperitoneum in 6 cases and diaphragmatic rupture in 4 cases.
- Table 2 summarizes the different elementary and visceral lesions that have been objectified in CT in cases of penetrating wounds
Elementary wound
|
Number
|
Hemo-peritoneum
|
14
|
Pneumoperitoneum
|
0
|
Hemo-pneumoperitoneum
|
6
|
Retro-Hemo-peritoneum
|
3
|
Liver
|
7
|
Spleen
|
3
|
Kidney
|
|
Right kidney
|
3
|
Left kidney
|
1
|
Pancreas
|
1
|
Intestine
|
|
Sigmoid colon
|
1
|
Left colon
|
1
|
Rectum
|
1
|
Mesenteric hematoma
|
2
|
Diaphragmatic rupture
|
|
Right
|
1
|
Left
|
3
|
Pleural effusion
|
|
Pneumothorax
|
3
|
Hemothorax
|
2
|
Hemo-pneumothorax
|
3
|
Pulmonary contusion
|
3
|
Hemo-pneumopericardium
|
1
|
- The wounds of solid organs were dominated by the wounds of the liver observed in 21% of cases (Fig.1),
followed by those of the kidney (n=4) (Fig.2) and spleen (n=3).
The left kidney is the most frequently injured (n=3),
one case of wound of the pancreas was observed.
- All these solid organ injuries required non operative treatment.
- CT suspected bowel organs wound in 6 cases in front of a hemo-pneumoperitoneum and only in three cases,
the digestive perforated segment has been specified to the CT.
There were wounds of the rectum (Fig.
3),
sigmoid colon (Fig.
4) and left colon.
- Four cases of diaphragmatic ruptures were observed in CT secondary to thoraco-abdominal wounds.
Seventy-five percent (n = 3) lesions were left (Fig.5) .
The associated lesions were observed such an association left diaphragmatic wounds with spleen injuries (Fig 6) and right diaphragmatic wound with the liver injury,
in one case a combination of wounds of the tail pancreas,
colon and left kidney (Fig 7).
- Treatment was non-operative in two thirds of patients (66%) with a penetrating wound of the abdomen.
It was solid organs wound,
patients who had a isolated intra or retroperitoneal fluid and two cases of hematoma of the mesentery.
The outcome was favorable in all cases.
The average hospital stay was 5 days.
- Emergency laparotomy was indicated for patients in whom CT showed a hemo-pneumoperitoneum (n = 6) and a diaphragmatic breach (n = 4).
Table 3 summarizes The causes of hemo-pneumoperitoneum
Causes of hemo-pneumoperitoneum
|
Number
|
Small intestine wound
|
3
|
Gastric wound
|
1
|
Sigmoid wound
|
1
|
Left colon wound
|
1
|
Rectal wound
|
1
|
- The postoperative course was favorable for all patients operated,
out of a single case that is complicated by a proximal bilateral pulmonary embolism and acute pancreatitis stage E with infection of castings necrosis treated by percutaneous drainage.
This was the patient who was operated on for perforation of the left colon and who had more wounds of the tail of the pancreas and left kidney.
A good correlation between computed tomography findings and intra-operative monitoring was found in our study.