FREE PERITONEAL FLUID IN TRAUMA PATIENTS: THE PARADIGM SHIFT

ORIGINAL PAPER

  • I. Negoi The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania & The Emergency Hospital of Bucharest, Romania
  • S. Păun The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania & The Emergency Hospital of Bucharest, Romania
  • S. Hostiuc The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania & The National Institute of Legal Medicine “Mina Minovici”, Romania
  • B. Stoica The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
  • I. Tănase The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
  • M. Beuran The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania & The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
Keywords: trauma, free peritoneal fluid, hemoperitoneum

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 <9. More frequent extraabdominal associated lesions were: head injuries – 38 (58.5%), thoracic trauma – 34 (52.3%), orthopedic injuries – 24 (36.9%). Diagnostic peritoneal lavage was performed in 5 (7.8%) cases. FAST has a sensibility of 70.21% and CT scan a sensibility of 100%. Most frequent injured abdominal organs were the spleen – 36 (56.25%), liver 17 (26.56%) and mesentery 14 (21.87%). Laparotomy was performed in 59 (92.2%) of cases, laparoscopy in 2 (3.1%) of cases and conversion to open surgery in 3 (4.7%) cases. Mortality was 23.43%. We observed several predictive factors for mortality on univariate analysis: haemoglobin < 8g/dl (p=0.02), haematocrits < 25% (p=0.01), hemoperitoneum > 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.

Published
2015-01-01
How to Cite
[1]
I. Negoi, S. Păun, S. Hostiuc, B. Stoica, I. Tănase, and M. Beuran, “FREE PERITONEAL FLUID IN TRAUMA PATIENTS: THE PARADIGM SHIFT”, JSS, vol. 2, no. 1, pp. 3-8, Jan. 2015.
Section
Articles