Computed tomographic scanning and selective laparoscopy in the diagnosis of blunt bowel injury: a prospective study
| Autor: | Egawa Tomohisa, Doi Masakazu, Hayashi Shinobu, Nagashima Atsushi, Yoshii Hiroshi, Sasaki Jun'ichi, Kitano Mitsuhide |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Abdominal pain Adolescent medicine.medical_treatment Physical examination Peritonitis Critical Care and Intensive Care Medicine Wounds Nonpenetrating Pneumoperitoneum Clinical Protocols Laparotomy Intestine Small medicine Humans Local anesthesia Hemoperitoneum Prospective Studies Laparoscopy Child Aged Aged 80 and over medicine.diagnostic_test business.industry Middle Aged medicine.disease Surgery Endoscopy Intestinal Perforation Child Preschool Female Radiology medicine.symptom business Tomography X-Ray Computed |
| Zdroj: | The Journal of trauma. 58(4) |
| ISSN: | 0022-5282 |
| Popis: | Background We prospectively evaluated whether computed tomographic (CT) scanning and selective laparoscopy (LP) for the diagnosis of blunt bowel injury (BBI) could prevent nontherapeutic laparotomy and delayed diagnosis. Methods Between April 1994 and May 2002, hemodynamically stable patients suspected of having BBI were enrolled in this study. Patients with hemodynamic instability or solid organ injuries with hemoperitoneum were excluded. All patients underwent a physical examination and contrast CT scanning at admission and once again approximately 12 hours (range, 6-24 hours) after admission. LP was performed under general anesthesia in patients who had local peritoneal signs and indirect CT signs (bowel thickening or isolated intraperitoneal fluid) or in whom abdominal pain or tenderness increased or intraperitoneal fluid increased on the repeat CT scan. The indications for a celiotomy were diffuse peritonitis, pneumoperitoneum on the abdominal CT scan, or bowel perforation visible on LP. Results During the study period, 399 of 1,074 patients admitted for blunt torso injuries were enrolled in this study. Eleven patients underwent emergency celiotomy and 11 underwent LP immediately after admission to the emergency department. One nontherapeutic laparotomy was performed among the patients who underwent celiotomy. The LPs revealed seven bowel perforations and one mesenteric laceration. After a repeat CT scan, three and seven of the patients underwent laparotomy and LP, respectively. Four bowel perforations were found by LP. The remaining 198 patients were treated conservatively, and no complications related to a delayed BBI diagnosis occurred. Conclusion CT scanning and selective LP can prevent nontherapeutic laparotomy and delayed diagnosis in patients with suspected BBI. |
| Databáze: | OpenAIRE |
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