FREE PERITONEAL FLUID IN TRAUMA PATIENTS: THE PARADIGM SHIFT

I. Negoi1,2, S. Păun1,2, S. Hostiuc1,3, B. Stoica1, I. Tănase1, M. Beuran1,2

1The University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania
2The Emergency Hospital of Bucharest, Romania
3The National Institute of Legal Medicine “Mina Minovici”, Romania

Corresponding author: : Ionuț Negoi
Phone no. 0040215992308
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Abstract

Trauma surgeons are confronted nowadays with various abdominal injuries, with a more and more increased severity, secondary to urban violence and traffic related accidents. We aim to better define the prognostic value of post-traumatic hemoperitoneum (PTH) in the nowadays era of nonoperative management of abdominal lesions, and to correlate it with the current pattern of traumatic injuries. Retrospective study of patients admitted during 24 months. Selections criteria: (1) Traumatic injury; (2) Free peritoneal fluid on preoperative imaging; (3) Surgical exploration of the abdomen. Setting: A level I trauma center. Results: There were 64 patients, with two peak frequencies between 18-35 and 50-70 years old. Abdominal wall ecchymoses were found in 36 (55%) of cases. Out of 64 cases 37 (58.7%) were transportation related, 12 (19%) caused by human aggression and 10 (16.9%) by falls. According to the Trauma Score (TS) there were 50 (78.2%) cases with TS between 14-16, 9 (17.2%) between 10 –13 and 3 (4.8%) with TS 1500 ml (p=0.04), colonic trauma (p=0.001), head (p=0.01) and thoracic injuries (p=0.04). Dedicated trauma surgeons should balance between trauma kinetics details, patients’ clinical examination, and diagnostic workup, in an effort to decrease morbidity and mortality secondary to missed injuries or unnecessary laparotomies.

Keywords: trauma, hemoperitoneum, free peritoneal fluid

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