All hemodynamically stable patients undergoing operations for blunt abdominal trauma over a 10. Review article avoiding of nontherapeutic laparotomies. Common mechanisms include road traffic crashes, falls, sports injuries and. Early laparoscopic approach to pancreatic injury following. A timely accurate diagnosis of such injury is difficult and also the management remains controversial. Blunt abdominal trauma american academy of pediatrics. According to some authors the role of laparoscopy in blunt abdominal trauma is controversial, limited and inconclusive. Value of diagnostic and therapeutic laparoscopy for. This study evaluated whether diagnostic and therapeutic laparoscopy can be used as effectively in select patients with blunt abdominal trauma. In acute care surgery, laparoscopy is becoming widely accepted and used with significant advantages in the majority of acs. Over a 4year period, patients managed laparoscopically for blunt abdominal trauma were retrospectively analyzed.
Laparoscopy has greatly improved surgical outcomes in many areas of elective abdominal surgery. Abdominal trauma is classified as blunt or penetrating, assessment and management is modified accordingly. Unfortunately there is still a paucity of prospective randomised trials to clearly define its role in both penetrating and blunt abdominal injuries. Nov 19, 2016 as stated before, laparoscopy in trauma can be used for diagnosis and therapy in several indications, both in blunt and penetrating trauma.
A free powerpoint ppt presentation displayed as a flash slide show on id. A standardized and systematic technique should be used when performing diagnostic laparoscopy in trauma. The national trauma data bank 20102014 was queried for encounters involving patients. Patients with laparotomy and intraabdominal pus were most likely to received tpn after abdominal procedure. The common condition associated with pelvic fractures is intraperitoneal rupture of urinary bladder. It is justified when there are hematomas or thrombi adherent on these organs andor on the basis of a ct image. The use of laparoscopy in blunt abdominal trauma has been traditionally limited due to concern regarding missed injuries and perceived dif. But many concerns of safety have limited its application in abdominal trauma. Laparoscopy can provide a secure diagnosis and a therapeutic issue. To characterize injury patterns and institutional trends associated with the utilization of laparoscopy in the management of pediatric abdominal trauma.
Laparocentesis and laparoscopy in blunt abdominal trauma. In some situations, radiological imaging methods might be insufficient for diagnosis, where diagnostic laparoscopy dl might be necessary. In 21 patients, diagnostic laparoscopic procedures were performed, and 5 of these children also underwent a therapeutic laparoscopy. Treatment depends on the equipment available in the. Abdominal trauma remains a leading cause of mortality in all age groups. Laparoscopy correctly identified the presence of an intraperitoneal injury in 26 patients. Laparoscopy for penetrating abdominal trauma pat is increasingly practiced all over the world with the reported sensitivity, specificity, and accuracy of nearly 100% 1 3.
Ppt abdominal trauma powerpoint presentation free to. Laparoscopy in blunt and penetrating abdominal trauma. In civilian life, the majority of abdominal injuries are due to blunt trauma secondary to high speed automobile accident. The role of laparoscopy in the diagnosis and management. The management of blunt abdominal trauma has evolved over time. If these patients present with hemoperitoneum with hemodynamic instability, the. Laparoscopy was performed using a forwardviewing laparoscope connected to two highresolution video monitors. Mar 08, 2015 laparoscopic surgery in the management of hemoperitoneum and colon injury after blunt abdominal trauma. Laparoscopy compared with laparotomy for the management of. Blunt mechanism of injury penetrating evaluation by surgeon observation 1 normal exam.
Ps003 abstract journal for paediatric surgery laparoscopy for. Role of laparoscopy in the evaluation of abdominal trauma. On the other hand, its utility in patients sustaining blunt abdominal trauma has received only minor attention, and the therapeutic role of laparoscopy in trauma patients is still evolving. Laparoscopy has not been widely applied in the investigation of blunt abdominal trauma. Laparoscopic repair of intraperitoneal bladder rupture secondary to blunt abdominal trauma dr. We will describe the experience of our paediatric trauma unit in the use of laparoscopy for these patients and. Value of diagnostic and therapeutic laparoscopy for patients. Today, the number of motor vehicle accidents mva and other causes of abdominal trauma are high. Narendra agarwal, c1 alkapuri sector c aliganj, lucknow, india.
Most common complication with tpn is the deranged liver functions. Diagnostic peritoneal lavage dpl is no longer the gold standard for determination of the need for laparotomy in blunt abdominal trauma not only because more specific and sensitive diagnostic. Traditionally, operative blunt abdominal injuries have been managed via laparotomy. Jul 07, 2004 in the setting of abdominal trauma, laparoscopy is used mainly for diagnosis, and its role in definitive operative repair is still debated. However, a number of safety issues have limited its. There was no difference in the demographic data and trauma severity between the 2 groups.
Laparoscopy, therapeutic laparoscopy, blunt abdominal trauma, penetrating abdominal trauma introduction laparoscopy has greatly improved surgical outcomes in many areas of elective abdominal surgery. A total of 628 patients with blunt and penetrating abdominal trauma were included in this retrospective 12year survey 2000 to 2011. A significant predictor of failure of nonoperative management. We hypothesized that laparoscopy could be safe and efficacious in treatment of patients with abdominal trauma, and reduce the laparotomy related complications i. Diagnostic and therapeutic laparoscopy in pediatric abdominal trauma. However, the role of laparoscopy in blunt abdominal trauma bat is not. Review article avoiding of nontherapeutic laparotomies in. It could, however, be useful in selecting patients with minor or nonbleeding injuries for nonoperative management after positive peritoneal lavage or computed.
Laparoscopy can be performed safely and effectively in stable patients with abdominal trauma. They include delayed perforation of bowel after blunt abdominal injury. Laparoscopic inspection of all intraperitoneal organs were performed in all patients, retroperitoneal organs were mobilized and inspected when indicated. We report the case of a 50yearold woman who underwent diagnostic and therapeutic laparoscopy after being subjected to blunt abdominal trauma in a traffic accident. All patients in the study underwent either laparotomy 280 patients or urgent. The role of laparoscopy in the diagnosis and management of.
Case report, diagnostic laparoscopy in blunt abdominal trauma and duodenal injuries in blunt abdominal trauma. The role of laparoscopy in trauma has received much attention in recent times with the advent of video laparoscopy. All patients in the study underwent either laparotomy 280 patients or urgent laparoscopy 348 patients. Laparotomy for blunt abdominal trauma in a civilian. The key issue in the choice of investigation is the cardiovascular stability of the patient. Dl enables us to make a direct visualization of intra abdominal organs, to see any injury if present and decide if laparotomy is necessary or not.
Laparoscopy in blunt abdominal trauma is challenging because of multiple associated injuries, higher trauma score values and higher. Commentary british journal of sports medicine bjsm. Although some studies have shown promising results on the use of laparoscopy in blunt abdominal trauma, randomized controlled studies are lacking. Laparoscopic repair of intraperitoneal bladder rupture. This episode of crackcast covers chapters 46 of rosens emergency medicine, abdominal trauma. Blunt abdominal injury bai is common and usually results from motor vehicle collisions mvc, falls and assaults. Laparoscopy for blunt abdominal trauma 275 abdominal tenderness, suspicious of hollow visceral injuries on abdominal ct, and unequivocal signs on physical examination. Value of peritoneal lavage in closed abdominal trauma. Laparoscopy in abdominal trauma springer for research. However, utilizing peritoneal breach as an indication for laparotomy is associated with a moderate incidence of non.
Here, we reported the successful use of laparoscopy to diagnose, characterize and treat blunt pancreatic trauma in a 28yearold male patient involved in a motor. One paediatric trauma centres experience leigh archer and elizabeth whan princess margaret hospital for. Of 4,836 pediatric trauma admissions over a period of 12 years, 92 had open or laparoscopic abdominal explorations for blunt n 47 and penetrating n 35 injuries. Diagnostic laparoscopy to detect peritoneal breach is a safe approach in the management of anterior abdominal stab wounds. Therapeutic laparoscopy for blunt abdominal trauma with bowel. In acute care surgery, laparoscopy is becoming widely accepted and used with significant advantages in the majority of acs patients in certain centers with specific experience and laparoscopic skills. Laparoscopy has been used for the diagnosis and treatment for hemodynamically stable patients with penetrating abdominal trauma. This episode covers some of the diagnostic and management dilemmas in patients with blunt and penetrating abdominal trauma a high yield action packed episode that cant be missed. The mechanism of injury was blunt trauma in eight, stab wounds sws in 16, and gunshot wounds gsws in 15. Laparoscopy is safe and accurate in blunt abdominal injuries with equivocal findings on imaging.
Back from 7th intercostal space to iliac crest posterior to posterior axillary line. In the setting of abdominal trauma, laparoscopy is used mainly for diagnosis, and its role in definitive operative repair is still debated. However, remarkable progress has been made in trauma management over the past few years that includes various specific protocols, emergence of a new surgical. Laparoscopy in trauma can potentially further decrease the negative laparotomy rate 11. This prospective study was designed to determine if laparoscopy is a safe and accurate method for abdominal evaluation in the trauma patient. Therapeutic laparoscopy in trauma is reserved for conditions amenable to simple intervention within the skill set of the provider. These diagnostic laparoscopy guidelines are a series of systematically developed statements to assist surgeons and patients decisions about the appropriate use of diagnostic laparoscopy dl in specific clinical circumstances. Laparoscopic splenectomy in a case of blunt abdominal trauma. Therapeutic laparoscopy for blunt abdominal trauma with. The principles of managing blunt and sharp abdominal injuries have been well established. Suad ali saleh alaghbari, md, general surgery resident level 3, omsb, sultanate of oman abstract.
Conversion rates in blunt trauma laparoscopy ranged from 8. Laparoscopic splenectomy in a case of blunt abdominal trauma narendra agarwal department of surgery, apollo hospital, sarita vihar, new delhi, india address for correspondence. Suspected hollow viscus injury hvi 22, 46, 53, 54, 55hvi occurs in about 0. Laparoscopy in blunt abdominal trauma is challenging because of multiple associated injuries, higher trauma score.
Diagnostic laparoscopy in abdominal trauma patients. This article is published with open access at abstract the management of blunt abdominal trauma has evolved over time. Stony brook university medical center stony brook, ny pediatric blunt abdominal trauma. Role of laparoscopy in blunt abdominal truma sages. Abdominal trauma might be blunt or penetrating type. Laparoscopy for abdominal trauma, is it safe and beneficial. Sep 14, 2019 imaging in blunt abdominal trauma in the absence of physical signs that indicate a need for immediate emergency laparotomy, imaging can be used to determine if emergency laparotomy is indicated, and help prioritise, identify and guide the management of other injuries. The aim of this study was to investigate the role of laparoscopy in the management of blunt abdominal trauma patients and to highlight related challenges. Laparoscopy in blunt abdominal trauma is challenging because of multiple associated injuries, higher trauma score values and higher morbidity and mortality, as compared with. Exploratory laparotomy in either blunt or penetrating abdominal trauma patients with. It has both diagnostic and therapeutic potential and, when negative, may reduce the number of unnecessary laparotomies. To assess the efficacy of laparoscopy and its role in patients with blunt abdominal trauma.
The current rate of missed injuries is reported to be below 0. Laparoscopic management of pediatric abdominal trauma. Role of laparoscopy in blunt abdominal truma sages abstract. Mar 12, 2015 laparoscopic surgery has greatly improved surgical outcome in many areas of abdominal surgery. Trauma is the leading cause of mortality in patients under 35 years worldwide and poses a major challenge to health care providers.
Laparoscopy can substantially reduce additional surgical aggression. In children less than or equal to 14 years of age, blunt abdominal trauma is the second most frequent cause of mortality preceded by head injuries. Avoiding of nontherapeutic laparotomies in blunt abdominal trauma with aid of laparoscopy gastric wall, and pancreas is only indicated when injury to these organs is suspected. Shownotes pdf link rosens in perspective principles to consider with any trauma patient. The objective of our study was to assess the abilities and limitations of laparoscopy and evaluate its role in examination and treatment of patients with abdominal trauma. List 5 ways to determine if peritoneum has been violated 7 list clinical indications for laparotomy in blunt and penetrating abdominal trauma 8 describe the management of unstable blunt abdominal trauma a. The most important advantages are reduction of the nontherapeutic laparotomy rate, morbidity, shortening of hospitalization, and costeffectiveness. Guidelines for diagnostic laparoscopy a sages publication. Diagnostic laparoscopy in penetrating abdominal trauma. The incidence of pancreatic injury following blunt abdominal trauma is rare. Diagnostic peritoneal lavage dpl is no longer the gold standard for determination of the need for laparotomy in blunt abdominal trauma not only because more specific and sensitive diagnostic procedures are. This descriptive, prospective study was conducted to evaluate the role of laparoscopy in the diagnosis and management of. Introduction abdominal trauma means any injury occurring to abdominal cavity.
Pdf role of laparoscopy in blunt abdominal trauma researchgate. Blunt abdominal injuries often managed conservatively, though interventional radiology and surgery are indicated for severe injuries. Shownotes pdf link rosens in perspective principles to consider with any trauma. Blunt abdominal trauma with mesenteric tear suspected on ct scan. Laparoscopic surgery in the management of hemoperitoneum and colon injury after blunt abdominal trauma.
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