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Article
9- PREVALENCE OF INTERNAL ABDOMINAL ORGANS� INJURIES IN PATIENTS OPERATED UPON AFTER BLUNT ABDOMINAL TRAUMA.

Author: Kamal Ahmad Saeed
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2008 Volume: 14 Issue: 1 Pages: 42-47
Publisher: Basrah University جامعة البصرة

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Abstract

Blunt abdominal trauma may result in multiple severe injuries which make the abdomen difficultto assess and easy to overlook. Unrecognized intra-abdominal injury is a significant cause ofpreventable death in blunt trauma. This study aimed to find the frequency and features oflapratomy findings for different internal abdominal organs� injuries in patients subjected to bluntabdominal injury. A total of 450 patients subjected to blunt abdominal trauma were admitted tothe emergency surgical department of Sulaimania Surgical Teaching Hospital following, 140 ofthem were decided to undergo exploratory laparotomy depending on their clinical and imagingfindings that suggesting a visceral injury. Thirty one percent of the patients who subjected toblunt abdominal trauma need exploratory laparotomy, 80.7% of them were male, and 67.9%were young. The predominant causative factor of blunt abdominal trauma was the motor vehicleaccidents. Spleen and liver were the frequent injured solid organs. Almost all of the patients hadpositive laparotomy results. Traumatic head and neck injuries were the most commonassociated non abdominal injuries. Morality rate was only 5% while complication rate was only7%. It is concluded that males at young active productive age are the main persons suffer fromblunt abdominal trauma. This has an important economic impact on the productivity of thecommunity. Spleen injury being the most commonly intra abdominal solid injured organ followedby liver, other visceral structures are uncommonly involved.j1


Article
The Value of Focused Assessment Sonography for Trauma the Management of Patients with Blunt Trauma to the Abdomen

Authors: Nabil Isam Naiem --- yahya Kareem Hammodi --- Tharwat Idrees Sulaiman --- Mohammed M.Habash
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 3 Pages: 379-384
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: During the last decade focused assessment with sonography for trauma increasingly has become the initial diagnostic modality of choice in trauma patients.OBJECTIVE: This study was carried to evaluate the sensitivity, specificity and accuracy of FAST when done by residents in the emergency surgical department, & its effect in determining the type of management.PATIENTS AND METHOD: 210 patients with blunt abdominal trauma were assessed with FAST within 30 minutes from admission to the emergency room. FAST results were considered positive if it detected intra peritoneal fluid , negative if it did not detect intra peritoneal fluid , and indeterminate (equivocal) if the results were not conclusive. In cases with negative Fast results and no other injuries were detected the patients were kept in the emergency department for 24 hours for observation and discharged later on. Those with indeterminate initial FAST or who deteriorated clinically after negative initial FAST were subjected to repeated FAST and / or emergency abdominal and pelvic computed tomography (C.T scan) or explorative laparotomy according to their clinical condition. Patients with positive ultrasonography results underwent emergency abdominal or pelvic C.T, or surgery according to their clinical picture. RESULTS: From the 210 patients included in the study we found that 177 patients (84.2) % had negative FAST results, 22 patients (10.4)% had positive FAST results , 2 patients (0.95)% had false positive results , 8 patients (3.8)% had false negative FAST results and 11 patients (5.2)% had equivocal FAST results. After exclusion of equivocal cases , FAST had sensitivity of (71.4)% specificity of (98.8)% , accuracy of (89.1)%, positive predictive value of (90.9)% and negative predictive value of(95.4)%. CONCLUSION: FAST is useful adjunct to the initial evaluation of blunt trauma patients with reliable accuracy & high negative predictive value. FAST had a great effect in determining the type of treatment especially in case of mass causality.And using FAST by general surgeons helps in the determination of the type of treatment for patients with blunt trauma.


Article
Focused Abdominal Sonography for Trauma (Fast) At the Emergency Department of Kirkuk General Hospital

Author: Saad M. Attash* , Khalid A. Al-Dabbagh**, Mohammed A. Younus***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 2 Pages: 188-192
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND :Blunt abdominal trauma (BAT) is a diagnostic challenge. The introduction of bedside ultrasound provides another diagnostic tool for the emergency physician (EP) to detect intra-abdominal injuries.OBJECTIVE:To assess the benefits of FAST in the evaluation of patients with blunt abdominal trauma in the emergency department of Kirkuk General Hospital in Kirkuk.PATIENTS AND METHODS:This was a prospective study including100 consecutive cases of blunt abdominal trauma in the emergency department of Kirkuk General Hospital in Kirkuk. The results of FAST scans were analyzed and compared with operative findings, diagnostic laparoscopy and CT scanning when the FAST was positive or followed by a period of clinical observation when the FAST was negative. Descriptive statistics, sensitivity, specificity, and predictive values were calculated.RESULTS :There was a 100 consecutive blunt abdominal trauma cases during 9 months period, and FAST scans were performed in these cases. The sensitivity and specificity were 92% and 93.3%, respectively. The negative predictive value was 0.97, while the overall accuracy was 93%.CONCLUSION:The high specificity of FAST (93.3%) makes it a good ‘rule in’ tool for BAT patients. The high negative predictive value also makes the FAST scan a useful screening tool. However, ultrasound examination is operator dependent, and FAST scan has its own limitations. .


Article
The Value of Focused Assessment Sonography for Trauma (FAST) In The Management of Patients with Blunt Trauma to the Abdomen

Author: Nabeel Isam Naiem, Yahya Kareem Hammoodi, Mohammed mahmood ,Tharwat Idrees Sulaiman
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 4 Pages: 564-569
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: During the last decade focused assessment with sonography for trauma increasingly has become the initial diagnostic modality of choice in trauma patients.OBJECTIVE: This study was carried to evaluate the sensitivity, specificity and accuracy of FAST when done by residents in the emergency surgical department, & its effect in determining the type of management.PATIENTS AND METHOD: 210 patients with blunt abdominal trauma were assessed with FAST within 30 minutes from admission to the emergency room. FAST results were considered positive if it detected intra peritoneal fluid , negative if it did not detect intra peritoneal fluid , and indeterminate (equivocal) if the results were not conclusive. In cases with negative Fast results and no other injuries were detected the patients were kept in the emergency department for 24 hours for observation and discharged later on. Those with indeterminate initial FAST or who deteriorated clinically after negative initial FAST were subjected to repeated FAST and / or emergency abdominal and pelvic computed tomography (C.T scan) or explorative laparotomy according to their clinical condition. Patients with positive ultrasonography results underwent emergency abdominal or pelvic C.T, or surgery according to their clinical picture. RESULTS: From the 210 patients included in the study we found that 177 patients (84.2) % had negative FAST results, 22 patients (10.4)% had positive FAST results , 2 patients (0.95)% had false positive results , 8 patients (3.8)% had false negative FAST results and 11 patients (5.2)% had equivocal FAST results.After exclusion of equivocal cases , FAST had sensitivity of (71.4)% specificity of (98.8)% , accuracy of (89.1)%, positive predictive value of (90.9)% and negative predictive value of(95.4)%. CONCLUSION:FAST is useful adjunct to the initial evaluation of blunt trauma patients with reliable accuracy & high negative predictive value. FAST had a great effect in determining the type of treatment especially in case of mass causality.And using FAST by general surgeons helps in the determination of the type of treatment for patients with blunt trauma.


Article
The application of laparoscopy in abdominal trauma at Al-Jumhoori Teaching Hospital in Mosul

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Abstract

Objective: To evaluate laparoscopy as a diagnostic and therapeutic method in selected cases in abdominal trauma, and its value in avoiding unnecessary laparotomies at Al-Jumhoori Teaching Hospital in Mosul, Iraq. Patients and methods: From October 2009 to October 2011, sixty hemodynamically stable patients who were admitted with abdominal trauma (48 blunt, and 12 penetrating injuries), were submitted to diagnostic laparoscopy (DL) in the operating theatre of the Emergency Department of Al-Jumhoori Teaching Hospital in Mosul. Data collected and analyzed. Results: Negative and non therapeutic laparotomies were avoided in 38 patients (63.3%), and laparoscopic intervention was done in 4 patients (17.4%). The mean hospital stay of the (DL) negative patients was 2.1 days, and for the (DL) positive patients with laparoscopic intervention was 2.4 days, while of the patients with therapeutic laparotomy was 5.7 days. All the patients were discharged with no reported complication and no deaths were reported.Conclusion: Laparoscopy can be performed safely and effectively in hemodynamically stable patients with abdominal trauma. The most important advantages are reduction of the negative and non therapeutic laparotomy rate and shortening of hospitalization. Keywords: Blunt abdominal trauma, penetrating abdominal trauma, diagnostic laparoscopy.

الخلاصةالهدف: لمعرفة مدى فعالية منظار البطن كأداة تشخيصية في حالات إصابات البطن وإمكانية استخدامه في التعامل مع بعض هذه الإصابات.المرضى والأساليب: من تشرين الاول 2009 ولغاية تشرين الأول 2011 أجري منظار البطن التشخيصي لستين مصابا بإصابات البطن المختلفة (48 إصابات البطن الكليلة و12 إصابات البطن النافذة). تم إجراء المنظار في صالة عمليات الطوارئ في المستشفى الجمهوري التعليمي في الموصل.النتائج: تم تجنب عمليات استكشاف البطن غير الضرورية وغير العلاجية في 38 مريضا (63.3%) وتم التعامل مع 4 حالات منظارياً (17.3%) وكانت مدة رقود المرضى الذين كان منظار البطن التشخيصي لهم سلبيا (2.1) يوم والمرضى الذين كان منظار البطن التشخيصي لهم ايجابيا وتم التعامل مع إصاباتهم منظارياً (2.4) يوم، في حين كانت مدة رقود المرضى الذين أجريت لهم عمليات فتح البطن العلاجية (5.7) يوم. وقد غادر كل المصابين المستشفى بدون تسجيل أي مضاعفات ولم يتم تسجيل أي وفاة بين المصابين.الخلاصة: يمكن إجراء منظار البطن التشخيصي للمرضى المصابين بإصابات البطن بصورة أمينة وفعالة. أهم الفوائد من استخدام منظار البطن التشخيصي هي التقليل من عمليات فتح البطن الاستكشافية غير ضرورية والتقليل من فترة رقود المرضى في المستشفى.

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