NONOPERATIVE MANAGEMENT OF BLUNT ABDOMINAL-TRAUMA - THE ROLE OF SEQUENTIAL DIAGNOSTIC PERITONEAL-LAVAGE, COMPUTED-TOMOGRAPHY, AND ANGIOGRAPHY

被引：29

作者：

BARON, BJ ^{[1
]}

SCALEA, TM ^{[1
]}

SCLAFANI, SJA ^{[1
]}

DUNCAN, AO ^{[1
]}

TROOSKIN, SZ ^{[1
]}

SHAPIRO, GM ^{[1
]}

PHILLIPS, TF ^{[1
]}

GOLDSTEIN, AM ^{[1
]}

ATWEH, NA ^{[1
]}

VIEUX, EE ^{[1
]}

SHAFTAN, GW ^{[1
]}

机构：

[1] SUNY HLTH SCI CTR,DEPT EMERGENCY MED,BOX 1228,450 CLARKSON AVE,BROOKLYN,NY 11203

来源：

ANNALS OF EMERGENCY MEDICINE | 1993年 / 22卷 / 10期

关键词：

angiography; computed tomography; peritoneal lavage; trauma; blunt abdominal;

D O I：

10.1016/S0196-0644(05)81258-2

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Study objective: To determine the usefulness of sequential nonoperative diagnostic studies in the evaluation and treatment of stable patients after blunt abdominal trauma. Design and setting: Retrospective review of a prospective treatment plan in a large urban Level I trauma center. Participants: Fifty-two patients deemed stable after initial evaluation following blunt abdominal trauma. Interventions: Patients with a positive diagnostic peritoneal lavage for red blood cells underwent abdominal computed tomography (CT) scanning. If CT demonstrated a visceral injury, it was followed by diagnostic angiography. Attempts were made to treat on-going bleeding by transcatheter embolization. Results: Fifteen patients had negative CT scans and were successfully observed. In the other 37 patients, CT identified 17 liver, 16 splenic, and eight kidney injuries; eight extraperitoneal bleeds; and one mesenteric hematoma. Six of these patients were observed. Thirty underwent diagnostic angiograms. Twelve had no active bleeding, and all were observed successfully. Seventeen underwent successful embolization of the bleeding site(s). One had injuries not controllable by embolization and required exploration. Six patients required laparotomy later in their course, but none had intra-abdominal bleeding or a missed intestinal injury. Despite being performed after diagnostic peritoneal lavage, CT missed only two injuries. There was one main complication, delayed recognition of a diaphragmatic injury. Three patients died, two from multiple organ failure and one from a pulmonary embolus; none was believed to be related to this technique. With our algorithm, 45 patients (86%) were spared laparotomy. Conclusion: Diagnostic peritoneal lavage and CT are complementary when evaluating blunt abdominal trauma. Diagnostic peritoneal lavage is an effective screening tool. CT may be reserved for stable patients with a positive diagnostic peritoneal lavage to specify the organs injured. Bleeding often may be treated by embolization, limiting the rate of surgery.

引用

页码：1556 / 1562

页数：7

共 33 条

[1]

American College of Surgeons Committee on Trauma, Advanced Trauma Life Support Course. Instructors Manual, (1988)

[2]

Lazarus, Nelson, A technique for peritoneal lavage without risk of complications, Surg Gynecol Obstet, 149, pp. 889-892, (1979)

[3]

Feliciano, Diagnostic modalities in abdominal trauma, Surg Clin North Am, 136, pp. 241-256, (1991)

[4]

Jones, Walsh, Maull, Diagnostic imaging in blunt trauma of abdomen, Surg Gynecol Obstet, 157, pp. 389-398, (1983)

[5]

Root, Hauser, McKinnley, Et al., Diagnostic peritoneal lavage, Surgery, 57, pp. 633-637, (1965)

[6]

Fabian, Mangiante, White, Et al., A prospective study of 91 patients undergoing both computed tomography and peritoneal lavage following blunt abdominal trauma, J Trauma, 26, pp. 602-608, (1986)

[7]

Fisher, Beverlin, Engrav, Et al., Diagnostic peritoneal lavage Fourteen years and 2586 patients later, The American Journal of Surgery, 136, pp. 701-704, (1978)

[8]

Frame, Browder, Lang, Et al., Computed tomography versus diagnostic peritoneal lavage: Usefulness in immediate diagnosis of blunt abdominal trauma, Ann Emerg Med, 18, pp. 513-516, (1989)

[9]

Sherman, Delaurier, Kawkins, Et al., Percutaneous peritoneal lavage in blunt trauma patients: A safe and accurate diagnostic method, J Trauma, 29, pp. 801-805, (1989)

[10]

Kearney, Blunt trauma to the abdomen, Ann Emerg Med, 18, pp. 1322-1325, (1989)

← 1 2 3 4 →