Search

Background: Some reports suggest Diagnostic peritoneal aspiration (DPA) or lavage (DPL) may better select which hypotensive blunt trauma patients (BTPs) require operation, compared to ultrasonography. However, whether both moderately hypotensive (systolic blood pressure [SBP] < 90 mmHg) and severely hypotensive (SBP < 70 mmHg) patients benefit from DPA/DPL is unclear. We hypothesized DPA/DPL used within the first hour increases risk of death for severely vs moderately hypotensive BTPs. Methods: The 2017-2019 Trauma Quality Improvement Program database was queried for BTPs ≥ 18 years old with hypotension upon arrival. We compared moderately and severely hypotensive groups. A multivariable logistic regression analysis was performed controlling for age, comorbidities, emergent operation, blood transfusions, and injury profile. Results: From 134 hypotensive patients undergoing DPA/DPL, 66 (49.3%) had severe hypotension. Patients in both groups underwent an emergent operation (43.9% vs 58.8%, P =.09) in a similar amount of time (median, 42-min vs 54-min, P =.11). Compared to the moderately hypotensive group, severely hypotensive patients had a higher rate and associated risk of death (84.8% vs 50.0%, P <.001) (OR 5.40, CI 2.07-14.11, P <.001). The strongest independent risk factor for death was age ≥ 65 (OR 24.81, CI 4.06-151.62, P <.001). Discussion: Among all BTPs undergoing DPA/DPL within the first hour of arrival, an over 5-fold increased risk of death for patients with severe hypotension was demonstrated. As such, DPA/DPL within this group should be used with caution, particularly for older patients, as they may be better served by immediate surgeries. Future prospective research is needed to confirm these findings and elucidate the ideal DPA/DPL population in the modern era of ultrasonography. [ABSTRACT FROM AUTHOR]

Background: Positive peritoneal cytology is a critical factor in prognosis. Peritoneal lavage is associated with long-term survival in patients with gastric cancer. Diagnostic peritoneal lavage (DPL) is a method for diagnosing visceral injury in trauma patients. This study aimed to investigate the usage of DPL in staging the work-up of patients with gastric cancer. Method: In this prospective study, we enrolled gastric cancer patients referring to Cancer Institute; they underwent DPL and washing specimen was sent for cytology review. After DPL, all patients underwent staging laparoscopy (SL) via the same abdominal incision. Results: DPL and SL were successful in all patients. There were six (11%) cases of peritoneal seeding discovered in SL; all of these patients had positive peritoneal cytology on DPL. Also, four patients showed positive cytology in the absence of positive SL. Thus, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of DPL were 100 % (95% CI: 54.1-100), 91.6 % (95%: 79.2-97.5), 100 % (95%CI: 85.3-100), and 60 % (95%CI: 37-79.3). The accuracy of DPL in determining the peritoneal dissemination of gastric cancer was 92.31% (95% CI: 81.5-97.9). Conclusion: DPL had an excellent ability to find peritoneal dissemination in a gastric cancer patient, which is of great value in the setting of low-resource countries.

Background: Positive peritoneal cytology is a critical factor in prognosis. Peritoneal lavage is associated with long-term survival in patients with gastric cancer. Diagnostic peritoneal lavage (DPL) is a method for diagnosing visceral injury in trauma patients. This study aimed to investigate the usage of DPL in staging the work-up of patients with gastric cancer. Method: In this prospective study, we enrolled gastric cancer patients referring to Cancer Institute; they underwent DPL and washing specimen was sent for cytology review. After DPL, all patients underwent staging laparoscopy (SL) via the same abdominal incision. Results: DPL and SL were successful in all patients. There were six (11%) cases of peritoneal seeding discovered in SL; all of these patients had positive peritoneal cytology on DPL. Also, four patients showed positive cytology in the absence of positive SL. Thus, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of DPL were 100 % (95% CI: 54.1-100), 91.6 % (95%: 79.2-97.5), 100 % (95%CI: 85.3-100), and 60 % (95%CI: 37-79.3). The accuracy of DPL in determining the peritoneal dissemination of gastric cancer was 92.31% (95% CI: 81.5-97.9). Conclusion: DPL had an excellent ability to find peritoneal dissemination in a gastric cancer patient, which is of great value in the setting of low-resource countries. [ABSTRACT FROM AUTHOR]

Abdominal trauma can be mysterious to some practitioners. If patients are evaluated for being stable or unstable, then abdominal trauma can be easily managed. Using a combination of physical examination, eFAST Scan, DPL and CT scans, patients can be quickly and efficiently evaluated. To determine the positive predictive value (PPV) of computed tomography and diagnostic peritoneal lavage for diagnosis of solid organ damage in patients with blunt abdominal trauma (BAT) taking surgical findings as gold standard. Study Design: Cross sectional study. Setting: Department of Surgery at Lahore General Hospital, Lahore. Period: Six months i.e. from 21.5.2016 to 20.11.2016. Materials and Methods: CT scan was performed with oral and intravenous contrast. DPL was done with sample assessment. Only those cases were included with positive findings in CT Scan or DPL. These patients underwent laparotomy under general anesthesia by a one standard surgical team. Results of surgical findings were compared between groups with CT scan and DPL. All the information was collected on predesigned proforma. Results: The mean age of the patients was 44.48±14.83 years. There were 66 (55%) males and 54 (45%) females in our study. In this study PPV for CTscan group was 90.1% while PPV for group with DPL was 51.3%. Conclusion: PPV for CT Scan group was higher than that of DPL group for diagnosing solid organ damage in patients with BAT. Hence, evidence shows that CT Scan should be used as an initial investigation of choice in haemo-dynamically stable patients with BAT. [ABSTRACT FROM AUTHOR]

In the last 30 years, the management of liver injury has evolved significantly. The advancement of imaging studies has played an important role in the conservative approach for management. A shift from operative to nonoperative management for most hemodynamically stable patients with hepatic injury has been prompted by speed and sensitivity of diagnostic imaging and by advances in critical care monitoring. In this review article, the up-to-date recommendation on the management approach of liver trauma will be discussed.

Background: In the last decade, the risk of terrorist attacks has increased largely almost worldwide. In this setting, disaster response personnel must understand the unique physiopathology of injuries as-sociated with explosions and must be prepared to assess and treat the people injured in such tragedies. The ammunition explosion in Gërdec, Vora, just 13 miles from the capital of Albania, Tirana, confronted our country with a real human tragedy with severe casualties. The striking force of the two consecutive explosions resulted in two consecutive earthquakes with respectively an amplitude of 9.2 and 2.5 on the Richter scale. Objective: To explain the classification of explosives and in connection with it to identify the major types of explosive and blast injuries, and the management options in the cases of explosions and blast injuries. Material & Methods: Efforts to dismantle Albania’s stockpiles of obsolete munitions took a catastroph-ic turn on March 15th, when a series of explosions occurred as crews were clearing out a storage depot in Gërdec, on 15th of March 2008, at 12:15 AM hours. Gërdec is located 10 km northwest of the capital of Albania, Tirana; near the national highway Tirana-Durres and at a distance of 3-4 km in air line from National Airport. Data presented here were collected from the patients’ files in our Trauma UHC and from the official reports from the different governmental offices. Conclusion: The explosive and blast injuries now present a true modern epidemic disease that threat-en the very survival of the free world. A thorough understanding of detonation and blast dynamics by the treating teams is required to better correlate the injury patterns presented. This is also critical for revision of current multiple casualty protocols. It is up to the medical establishment to prepare suitable protocols, coordinate manpower and secure medical resources to successfully handle such events.

Background: Peritoneal cytology has received little attention in the literature, but it may be an additional useful means in evaluating patients with primary gastric cancer. The aim of this study was to examine the diagnostic accuracy of peritoneal fluid lavage cytology in detecting peritoneal seeding in patients with gastric adenocarcinoma. Methods: A total of 50 patients with gastric adenocarcinoma who were candidates for laparotomy based on the findings of computed tomographic examination were recruited. Diagnostic peritoneal lavage (DPL) was performed just before laparotomy and the peritoneal lavage fluid was sent for cytological examination for presence or absence of malignant cells. Findings in terms of peritoneal involvement during laparotomy were regarded as the standard results. Results: DPL cytology was positive for the presence of malignant cells in the peritoneal fluid in 25 cases (50%). According to the intraoperative findings 22 patients (44%) had peritoneal metastatic disease, whereas in 28 patients (56%) no gross indicator of metastasis was detected. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of cytology in detecting peritoneal seeding were 59%, 57%, 52%, 64%, 1.38 and 1.40, respectively. The agreement between cytology and diagnostic laparotomy was 58%. Conclusion: According to the findings of the present study peritoneal lavage solely is not a proper diagnostic method for early recognition of resectable/nonresectable gastric cancers. [ABSTRACT FROM AUTHOR]

Background:There are a large number of patients with penetrating abdominal trauma who have normal vital signs and negative abdominal examination when referred to trauma centers. Agreat deal of controversy exists between authorities about screening these patients for emergency explorative laparotomy. Many references have reported more than 90% sensitivity for DPL as a diagnostic method to determine whether intraabdominal injuries were present and emergent laparotomy is indicated or not. This study is for reassignment of this sensitivity according to our own evidence. Methods: All of the patients with abdominal stab wounds and normal vital signs plus negative abdominal examination who were referred to Shohada-e-Tajrish hospital between March 2004 to December 2005, underwent local wound exploration and those confirmed to have peritoneal penetration, underwent emergency laparotomy. In the operating room and prior to surgery, under general anesthesia, DPL was performed. Then DPL results were compared with laparotomy findings and DPL sensitivity was assigned. Results: Of the total number of 34 patients, 8 had a positive DPL and positive laparotomy; 2 had a positive DPL and negative laparotomy; 8 had negative DPL and positive laparotomy, and 16 patients had negative DPL and negative laparotomy. Conclusion: According to our study, DPL sensitivity is much less than mentioned in trauma texts (approximately 50%). So, it is not a valuable tool to discriminate between operative and conservative approaches in penetrating abdominal trauma. We suggest more sensitive modalities. Laparotomy is the most sensitive approach but at the price of a high negative laparotomy rate.

Background: The diagnosis of small bowel and mesenteric injuries (BBMI) after blunt abdominal trauma remains difficult, which results in delayed treatment and increased mortality and morbidity. Diagnostic peritoneal lavage (DPL) in patients with 1 or 2 abnormal CT findings that are suggestive of BBMI was proposed, but the rate of unnecessary surgical exploration remains high.Patients and Methods: Blunt abdominal trauma patients with 1 or 2 CT findings predictive of BBMI from 2001 to 2014 underwent a DPL with calculation of a cell count ratio (CCR) dividing the ratio of white blood cells (WBCs) to red blood cells (RBCs) (WBC/RBC ratio) in the lavage fluid by the WBC/RBC ratio in peripheral blood. Surgical exploration of the abdomen was performed immediately in cases with a CCR≥1. CT findings, DPL and surgery results, and global outcome were analyzed.Results: Thirty-seven were included in the study (27 males, median age of 30 years (range, 17-69 years)). Exploratory laparotomy was performed in 24 patients (65%). Sixteen patients (67%) had BBMI: 7 hollow organ perforations or tears (29%), including 4 bowel resection with primary anastomosis and 3 single sutures, and 9 patients had mesenteric injuries. CT findings associated with BBMI and hollow organ perforation were large peritoneal effusion (p=0.02) and small bowel wall abnormalities (p=0.002). No postoperative complications were observed. Sensitivity and specificity of DPL for the diagnosis of bowel injuries were respectively 100% (CI 95% [59-100]) and 43% (CI 95% [25-63]). The sensitivity remained 100% (CI 95% [59-100]) when the ratio was ≥4 (n=10 patients), and the specificity reached 90% (CI 95% [73-98]).Conclusion: DPL is sensitive for the diagnosis of BBMI in stable trauma patients with 1 or 2 unexplained CT abnormalities, but specificity is low with a high rate of nontherapeutic laparotomy in case of CCR≥1. Indications for exploratory laparotomy could be restricted to patients with a CCR≥4 to improve the specificity of diagnosis management. [ABSTRACT FROM AUTHOR]

Single isolated jejunal perforation (IJP) due to blunt abdominal trauma is uncommon and most often occurs with road traffic accidents. The diagnosis of traumatic single IJP is challenging as there are minimal clinical features initially. For most favorable results, strict monitoring, a high index of clinical suspicion, and the help of available appropriate diagnostic tools like diagnostic peritoneal lav age (DPL)/focused abdominal sonography for trauma (FAST) are preferable. Here we report a case of IJP following blunt trauma abdomen.

Unlike penetrating abdominal injuries where the decision to operate is relatively straight forward, those combat casualties that sustain blunt abdominal trauma offer more of a diagnostic and clinical challenge. For unstable patients with a positive focused abdominal sonography in trauma or diagnostic peritoneal lavage, exploratory laparotomy should be undertaken immediately. All grade IV-V splenic injuries should undergo splenectomy, patients undergoing attempted splenic salvage should be monitored in the Role 3 facility and embolization of such splenic injuries may be considered if available. Patients who fail non-operative management of the spleen require splenectomy at the Role 3 prior to aeromedical evacuation. Overwhelming post-splenectomy infection is a serious disease that can progress from a mild flu-like illness to fulminant sepsis in a short period of time. Although relatively rare, it has a high mortality rate with delayed or inadequate treatment. All splenectomized patients and those deemed to be functionally asplenic should be vaccinated within 14 days from splenectomy and prior to aeromedical evacuation. [ABSTRACT FROM AUTHOR]

Background: To analyse the role of Serial FAST scan in diagnosing bowel injury in blunt abdominal trauma Methods: In this descriptive study FAST scan was performed as part of the primary or secondary survey of the trauma patient in the emergency department, in all patients with suspected blunt abdominal trauma. Follow up scans were performed depending on the clinical condition. The findings were then confirmed with either a computed tomography (CT) or emergency exploration. The validity of FAST scan and Serial FAST scans in comparison to CT/ELAP was documented. Special attention was paid for diagnosing bowel injury. Initial FAST negative were conducted to Serial FAST scans and increased fluid and development of peritonitis lead to exploration. Results: This study included 174 patients with suspected blunt abdominal trauma. The mean age was 27.40±15.30 years with 93.6% males. Road traffic accidents accounted for 58.6% cases. There were 108 patients who underwent exploration. Majority (53) had isolated hollow viscus injury. Haemodynamically unstable patients had significantly more positive FAST scans and more positive CT/ELAP (p <0.05). Serial FAST scans increased the sensitivity and specificity of FAST from 70.83% to 98.67% and 80.36% to 93.10% and 100% diagnostic accuracy for bowel injury. Conclusion: Serial FAST scan is a good diagnostic modality with accuracy comparable to CT for clinically significant exploratory laparotomies, thus a good predictor for exploration when suspecting bowel injury. [ABSTRACT FROM AUTHOR]

Diagnostic peritoneal lavage (DPL) is considered by many as the most important investigation for the early detection of intraperitoneal injury. The aim of this study is to assess the accuracy of DPL as a diagnostic method in evaluating abdominal trauma. A prospectively maintained database of all DPLs performed in the past 36 months at Sina Hospital was analyzed. Information relative to the type of injury, indication for DPL, DPL and laparatomy results were analyzed in order to evaluate the accuracy, sensitivity and specificity of DPL. Over a 36-month period, 111 (13.9%) DPLs were performed for 800 patients with abdominal trauma at Sina Hospital. Fifty-five (49.5%) patients had negative and 56 (50.5%) patients had positive DPL. Among negative results, laparatomies were performed for 5 (9.1%) patients. Among positive results, 47 patients had organ injuries at laparatomy and 6 (11.3%) did not have any organ injuries (false positive). The overall accuracy, sensitivity and specificity of DPL were 87%, 90% and 85%, respectively, that were comparable to the other reports (p

Objective: Fast ultrasound is a basic tool to evaluate the blunt abdominal trauma patient and help to decision making for emergency surgery. Study design: Observational study. Place and duration of study: The King Fahad Hospital Madina Munawara, over a period between 2010 and 2011. Methodology: This study consisted of 765 patients came in Emergency department The King Fahad Hospital Madina Munawara Level II, or Regional Resource Trauma Center Saudi Arabia. Detailed History was taken from all the patients with special regard to bland abdominal trauma. All patients were brought to a trauma resuscitation area where a trauma team conducted a primary survey, after an airway and adequate oxygenation/ventilation were established. The FAST examinations were performed using 4 windows: subxiphoid, right upper quadrant, left upper quadrant, and suprapubic. The critical areas for intra-abdominal bleeding were the hepatorenal space (Morrison's pouch), the spleno-renal space, and the pelvic pouch of Douglas. The FAST examinations were interpreted on the spot and results Recorded. Results were prepared with help of tables and graphs. Data was analyzed through SPSS software. Results: 73 out of 765 patients who underwent FAST ultrasound in the Emergency Room. 40 (54.79%) cases were road traffic accident (RTA) injuries followed by injury due to fall were in 33(45.20%) cases. Findings are fast ultrasound observed 49 out of 73 patients (67.12%) were considered positive FAST who had fluid (blood) in the peritoneal cavity and these patients shift to Operative Room for surgery. While 24(32.87%) patients with no evidence of intraperitoneal fluid were considered negative for FAST and these patient underwent CT scans for evidence of solid organ injury(Chart No.2). 5 out of 24 cases of solid visceral trauma found on CT scan abdomen, but had not been detected by FAST then shift to operative room after resuscitation. Conclusions: We conclude that FAST ultrasound is very helpful to assessment of blunt abdominal trauma and to detect intraabdominal fluid. Fast ultrasound can help in the quick decision for surgical intervention within minutes of a patient's arrival at emergency department. [ABSTRACT FROM AUTHOR]

Abstract: Background: Recent guidelines do not support local wound exploration (LWE) or diagnostic peritoneal lavage (DPL) in the evaluation of patients with anterior abdominal stab wounds (AASWs), favoring computed tomography scanning or serial examinations. In patients without immediate indications for laparotomy, we hypothesized that LWE/DPL would identify patients requiring surgery while limiting unnecessary hospital admissions. Methods: Patients sustaining penetrating trauma at our level I trauma center over a 3-year period were reviewed. Results: During the study period, 139 patients with AASW followed our LWE/DPL algorithm. Fifty-six patients had LWE without fascial penetration: 46 were discharged immediately, 10 required admission. Fifty-eight patients had fascial penetration on LWE but negative DPL: 37 were observed for less than 24 hours, 19 were observed for more than 24 hours, and 2 patients developed peritonitis requiring exploration. Twenty-five patients had positive LWE/DPL: 13 had therapeutic laparotomy, 12 had nontherapeutic laparotomy. Conclusions: Only 11% of patients with AASWs without overt indication for laparotomy require surgical care. LWE remains a valid method to exclude intra-abdominal injury and to eliminate hospitalization in more than one third of AASW patients. [Copyright &y& Elsevier]

Abstract: Background: Stab wounds to the back and flank infrequently cause injuries requiring operative treatment. Triple-contrast CT scan (3CT) has essentially replaced diagnostic peritoneal lavage (DPL) as the primary means of identifying patients who require operative intervention. This study aims to review the evolution of the diagnostic work-up for stab wounds to the back and flank. Methods: We performed a retrospective review of haemodynamically stable patients with stab wound to the back or flank treated at a single Level 1 trauma centre over a 10-year period. Diagnostic accuracy of DPL and 3CT screening tests were evaluated against the patient''s subsequent clinical course. The elapsed time between emergency department (ED) presentation and test results was recorded and compared. Results: A total of 177 patients were identified. 76 patients had stab wounds isolated to the back, 90 had stab wounds isolated to the flank and 11 had wounds in both locations. CT ultimately became the predominant initial diagnostic test during the study period. Although less frequently used over time, DPL retained good sensitivity and specificity for injuries requiring operative intervention (92% and 83%, respectively). 3CT identified all injuries requiring laparotomy (100% sensitivity) and had a specificity of 96%. 3CT was a more time-consuming process, with results available at a median of 3:31h after arrival to the ED, as compared to 1:03h for DPL (p <0.01). Conclusions: 3CT diagnosed all injuries requiring operative intervention, and its use was associated with a lower rate of non-therapeutic laparotomies. However, average time to diagnosis by 3CT was prolonged compared to DPL. Although 3CT has become the predominant diagnostic test when evaluating patients with stab wounds to the back and flank at our institution, efforts to further expedite the diagnostic work-up are necessary. [Copyright &y& Elsevier]

Abstract: Background: To assess if diagnostic laparoscopy (DL) is superior to nonoperative modes (serial abdominal examination with/without computed axial tomography [CAT] and diagnostic peritoneal lavage) in determining the need for therapeutic laparotomy (TL) after anterior abdominal stab wound (ASW). Methods: Retrospective review of ASW patients. Patients were divided into group A (DL/exploratory laparotomy) to identify peritoneal violation (PV) and group B (initial nonoperative modes). Results: Seventy-three patients met inclusion criteria. In group A (n = 38), 29 patients (76%) had PV by DL and underwent exploratory laparotomy. Only 10 (35%) underwent TL (sensitivity for PV = 100%; specificity and positive predictive value of PV in determining need for TL = 29% and 33%, respectively). In group B (n = 35), 7 patients (20%) underwent TL, yielding an improved specificity (96%) and positive predictive value (88%). Conclusions: We find no role for DL in the evaluation of ASW patients solely to determine PV. [Copyright &y& Elsevier]

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To present our experience of mesenteric injuries after blunt abdominal trauma. Design: Retrospective study. Setting: University hospital, Greece. Subjects: 31 patients with mesenteric injuries out of 333 who required operations for blunt abdominal trauma between March 1978 and March 1998. 21 were diagnosed within 6 hours (median 160 min, early group) and in 10 the diagnosis was delayed (median 21 hours, range 15 hours-7 days, delayed group). Interventions: Emergency laparotomy. Main outcome measures: Mortality, morbidity, and hospital stay. Results: There were no deaths. The diagnosis was confirmed by diagnostic peritoneal lavage in 17/21 patients in the early group whereas 7/10 in the delayed group were diagnosed by clinical examination alone. Most of the injuries (n = 23) were caused by road traffic accidents. 30 patients had injured the small bowel mesentery and 4 the large bowel mesentery. 25 of the 31 patients had associated injuries. There were no complications in the early group, compared with 6 wound infections and 1 case of small bowel obstruction in the delayed group (p < 0.0001). Median hospital stay in the early group was 11 days (range 3-24) compared with 23 days (range 10-61) in the delayed group (p = 0.004). Conclusion: Because delay in diagnosis is significantly associated with morbidity and duration of hospital stay we recommend that all patients admitted with blunt abdominal trauma should have a diagnostic peritoneal lavage as soon as possible. [ABSTRACT FROM AUTHOR]

The evaluation of patients sustaining abdominal trauma remains one of the most challenging tasks for the general surgeon. Diagnostic peritoneal lavage and computerized tomography are well-established studies, each with its own indications, advantages, and disadvantages. Ultrasonography has been widely used in Europe and has only recently gained popularity in the United States. With the recent explosion of laparoscopic techniques in general surgery, it was only natural that its application in the evaluation and perhaps even treatment of the injured patient would be forthcoming. The definitive role of both ultrasonography and diagnostic laparoscopy in the evaluation of abdominal injury has yet to be determined. This review looks at the role of these various diagnostic procedures in the evaluation of both penetrating and blunt abdominal trauma. [ABSTRACT FROM AUTHOR]

The most important imaging decision that the clinician must make regarding the patient who sustains blunt abdominal trauma (BAT) is whether the patient is stable enough to undergo computed tomography (CT). CT is the most sensitive and specific examination for the evaluation of BAT. If the patient is unstable, the clinician has three choices: surgery, diagnostic peritoneal lavage, or ultrasound (US). If the patient then stabilizes, a CT scan should be obtained even if the US is negative. [ABSTRACT FROM AUTHOR]

Mine blasts typically cause multiple injury of the body with minute particles, which may be a combination of plastic or metallic particles, gunpowder, sand, dust, and organic debris. Because clinical examination is often unreliable in this population, Focused assessment with sonography for trauma FAST and diagnostic peritoneal lavage (DPL) are currently the only remaining diagnostic tools available to identify major intra-abdominal bleeding. We present a case who had injury of right foot wounded by antipersonnel mines. Physical examination revealed mild general condition, conscious but he has no orientation and cooperation. A comminuted fracture of the right tibia-fibula was found. Patient was enrolled in the operating room for surgery due to the hypovolemic shock, without other diagnostic tools used. After the blood sample was taken for cross matching, the operation was begun by orthopedist for fracture of the right tibia-fibula. We applied DPL for advance diagnosis. We found minimal hemorrhagic fluid and multiple perforations on the small bowel segments, on the laparotomy. All perforation on the small bowel were repaired with 3/0 vicryl as primer. The patient had an uneventful postoperative course and was discharged in good general condition on 10 th postoperative day. On conclusion, DPL is more sensitive than FAST and should be used to find hollow organ injury on penetrating inguries patients with hypotension. Albeit laparotomy have used in gunshots injury in 90% of patients, physical examination, FAST and DPL should be help for laparotomy decision in mines injuries. In patients presenting with lower extremity injuries should be kept in mind that injured the other systems such as abdomen, which may be determined by repeated physical examinations. [ABSTRACT FROM AUTHOR]

Non-penetrating gunshot abdominal wounds are rare in peacetime and mainly caused by firearm traumatic weapons. The main therapeutic measure in this case is primary surgical debridement with adequate drainage. At the same time, such injuries may be accompanied by damage to internal organs. Timely diagnosis of these lesions may be difficult, and surgical treatment may be necessary. We report a patient with combined gunshot injury, damage to superficial femoral artery and non-penetrating abdominal wound followed by contusion and necrosis of small bowel. When providing medical care in patients with non-penetrating gunshot abdominal wounds, one should remember possible damage to internal organs due to high kinetic energy of the wounding projectile resulting contusion-induced necrosis.

The present study is a retrospective survey of posttraumatic hemoperitoneum addmited in the Surgical Departament I and II of the County Clinical Emergency Hospital of Sibiu, during 2006-2010. The study material included the info-biographical and medical data from the medical documents of 142 pacients. The study revealed that, in most cases, the posttraumatic hemoperitoneum is secondary to traffic accidents (53 cases), falling accidents (40 cases) and interpersonal aggressions (39 cases). [ABSTRACT FROM AUTHOR]

The present study is a retrospective survey of posttraumatic hemoperitoneum addmited in Surgical DepartamentI and II of the County Clinical Emergency Hospital of Sibiu, between 2006-2010. The study material included the info-biographical and medical data from the medical documents of 142 pacients. The study revealed that, in most cases, the posttraumatic hemoperitoneum is secondary to traffic accidents (53 cases), falling accidents (40 cases) and interpersonal aggressions (39 cases) [ABSTRACT FROM AUTHOR]

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)