J Trauma
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The purpose of this study was to evaluate the sensitivity, specificity, and predictive value of diagnostic laparoscopy (DL) in a large group of stable patients with abdominal gunshot wounds (ABGSWs). ⋯ In stable patients with ABGSWs and questionable intra-abdominal injury, DL can be safely used. It is highly sensitive and specific. It can effectively reduce the incidence of negative and nontherapeutic laparotomies, and the overall morbidity and hospital stay in this group of patients.
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The presentation, diagnosis, and successful management of posttraumatic pseudoaneurysms of the intraparenchymal splenic artery after nonoperative therapy in an adult patient is described. Pseudoaneurysm formation of the intraparenchymal splenic artery is a rare complication of traumatic splenic injury, which is a potential mechanism of delayed splenic rupture and demonstrates the importance of follow-up in the nonoperative therapy of blunt injury to the spleen.
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Injuries to the portal triad are a rare and complex challenge in trauma surgery. The purpose of this review is to better characterize the incidence, lethality, and successful management schemes used to treat these injuries. ⋯ Injuries to the anatomical structures of the portal triad are rare and often lethal. Intraoperative exsanguination is the primary cause of death, and hemorrhage control should be the first priority. Bile duct injuries should be identified by intraoperative cholangiography and repaired primarily or by enteric anastomosis; lobar bile ducts can be managed by ligation.
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Blunt injuries to the gallbladder are very uncommon, whereas penetrating gallbladder trauma occurs more frequently. Over the last 19-year period through 1994, 22 cases with blunt gallbladder trauma were treated. Avulsion (partial or complete) and contusion were observed in 10 cases each (45%). ⋯ Associated intra-abdominal trauma was present in 100% of the cases and accounted for both mortalities. Gallbladder injury was diagnosed after celiotomy, except for one case that was diagnosed and treated nonoperatively. Based on the experiences gained herein and an extensive review of the literature, a classification scheme for gallbladder trauma and its treatment is presented.
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Nonoperative management of blunt splenic trauma is widely accepted; however, reported failure rates have ranged as high as 40%. There are few factors available to identify failures reliably. To characterize failures of nonoperative management better, we retrospectively reviewed 309 blunt splenic injuries treated at our level I trauma center over a 5-year period. ⋯ Upon review of the initial computed tomography scans, a hyperdense collection of contrast media in the splenic parenchyma, or "contrast blush," was noted in 8 of 12 (67%) patients who failed and in 5 of 77 (6%) of those who were successfully managed nonoperatively (p < 0.0001). These data suggest that the presence of a contrast blush is an important consideration when deciding the method for management of the splenic injury. If these results are confirmed in a prospective fashion, the failure rate of nonoperative management of blunt splenic trauma could be reduced by identification of the contrast blush.