Blunt and penetrating trauma--has anything changed?
| Autor: | Paul J. Schenarts, Roy Cobean, Lisa A. Rutstein, Brad M. Cushing, David E. Clark |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Diagnostic Imaging
Reoperation medicine.medical_specialty Abdominal compartment syndrome Poison control Wounds Penetrating Abdominal Injuries Wounds Nonpenetrating Compartment Syndromes Diagnostic peritoneal lavage Injury prevention Medicine Humans Minimally Invasive Surgical Procedures Prospective Studies medicine.diagnostic_test business.industry Protective Devices Accidents Traffic medicine.disease Surgery medicine.anatomical_structure Liver Abdomen Wounds Gunshot business Trauma surgery Penetrating trauma Abdominal surgery |
| Zdroj: | The Surgical clinics of North America. 77(6) |
| ISSN: | 0039-6109 |
| Popis: | This article describes changes that have occurred in the last several years in the epidemiology as well as the diagnostic and therapeutic approaches to abdominal injury. An increasing amount of abdominal injury results from bullets, and the specific injuries resulting from the interaction of vehicles and occupants are different. Both of these epidemiologic changes require that the trauma surgeon adopt a new diagnostic and operative skill set. The approach to the diagnosis of abdominal injury has changed enormously with the advent of surgeon-performed ultrasonography and the increasing availability and use of the CT scan. The diagnostic peritoneal lavage is being supplanted in many institutions by these newer modalities. Laparoscopy is transforming some areas of general abdominal surgery, but its impact in trauma surgery is perhaps less pronounced. Therapeutic approaches to abdominal injuries have also evolved. Nonoperative management of liver injuries is now the rule rather than the exception, and primary closure of penetrating colon wounds has been demonstrated to be safe and effective in several prospective studies. Studies demonstrate that some gunshot wounds to the abdomen can be managed nonoperatively if they are seen to traverse only the liver. Patients who previously died from massive or exsanguinating abdominal injuries are now surviving through initial "damage control" laparotomies, followed by definitive surgery after a period of resuscitation and rewarming. Surgeons also have a better understanding of the negative physiologic effects of increased intra-abdominal pressure and the role for decompression in the setting of the newly termed "abdominal compartment syndrome." |
| Databáze: | OpenAIRE |
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