Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients’ management

Firetto, Maria Cristina; Sala, F.; Petrini, Marcello; Lemos, A.; Canini, T; Magnone, Stefano; Fornoni, G.; Cortinovis, Ivan; Sironi, Sandro; Biondetti, Pietro

doi:10.1007/s10140-018-1608-9

Cited by 18 publications

(17 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Por otro lado, se debe tener en cuenta que después de un trauma puede haber alteraciones del estado de consciencia o lesiones raquimedulares, que afectarían la interpretación semiológica de los signos; además, los pacientes pueden estar bajo los efectos del alcohol o de sustancias psicoactivas. Por todo ello, hay que correlacionar la evaluación física con el estudio de imágenes para un dictamen más específico 9 .…”

Section: Discussionunclassified

Traumatismo abdominal contuso manejado con embolización mesentérica: reporte de caso

Hernández¹,

Martín-González²,

Luna-Álvarez³

et al. 2021

CIRU

View full text Add to dashboard Cite

El trauma abdominal cerrado se presenta en el 20% de los pacientes politraumatizados, de los cuales aproximadamente el 5% pueden llegar a tener lesiones mesentéricas. Presentamos el caso de una mujer que sufre un traumatismo abdominal cerrado a la cual se le realizó tomografía computarizada con evidencia de un hematoma en el flanco derecho, que se logra controlar por angioembolización de la arteria mesentérica superior. El tratamiento de las lesiones mesentéricas se determinará según el estado hemodinámico del paciente, pues ante la estabilidad se puede escoger entre cirugía abierta y embolización, pero en caso de inestabilidad se recomienda la laparotomía.

show abstract

Section: Discussionunclassified

Traumatismo abdominal contuso manejado con embolización mesentérica: reporte de caso

Hernández¹,

Martín-González²,

Luna-Álvarez³

et al. 2021

CIRU

View full text Add to dashboard Cite

show abstract

“…Traumatic injuries of the heart, aorta or abdominal organs are poorly detectable be clinical examination [22,24,27]. Only CT brings a safe diagnosis that forms the basis for causal surgical or interventional therapy [28][29]. Depending on the examination method, a pelvic fracture can be clinically diagnosed and a possible bleeding can be provisionally treated by using a pelvic sling.…”

Section: Discussionmentioning

confidence: 99%

“…In a study from Firetto et al (2018), 34 of 831 patients who had a blunt abdominal trauma and had unspecific clinical symptoms showed a blunt bowel and/or mesenteric injury in CT scan. Sensitivity and specificity for abdominal pain and guarding is 57.18% / 53.85% and 38.1% / 100.0% [29]. Lavingia et al (2015) described a NPV of 100% for abdominal symptoms for patients with abdominal injury, intraabdominal hematoma, and hollow viscus injury, aortic or urologic injury [15].…”

Section: Abdomenmentioning

confidence: 99%

A critical look at the value of clinical examination in polytraumatized patients

Pliske¹,

Lucas²,

Schmidt³

et al. 2018

J Transl Sci

View full text Add to dashboard Cite

Background and question:The Advanced Trauma Life Support (ATLS) offers a concept for the treatment of severely injured patients. In the so-called "primary survey", the patients are first examined clinically by "A-E". Subsequently, a CT scan will be performed to make accurate diagnosis. But what benefit do the clinical examinations have if a CT is performed immediately afterwards? Are the examinations just a waste of time or do they provide important information? Method: Systematic mesh-term research on pubmed.com with 62 studies to compare the latest literature on the value of clinical examinations with ATLS recommendations.Results: Relevant airway problems can directly threaten the patient and should be quickly diagnosed and fixed. Clinical examination of the cervical spine has poor sensitivity and should be avoided. The examination for hemato-/pneumothorax after blunt and penetration trauma shows a middle sensitivity but a good negative and positive predictive value. If a serious thoracic injury is suspected, a thoracic puncture or a chest tube should be done. Internal bleeding is difficult to diagnose clinically and often cannot be treated without surgical or radiological intervention. The CT scan should be done promptly and time delays by numerous clinical examinations should be avoided. Unstable pelvic fractures can be well diagnosed, depending on the technique used. If the pelvis is unstable a pelvic sling should be applied to avoid a "C-problem". Intracranial and spinal injuries cannot be diagnosed clinically. If suspected, a CT scan should be performed. During a prolonged examination of the undressed patient, the body temperature can decrease, which may be accompanied by deterioration in blood coagulation. Conclusion:The extent of the physical examination in the shock room, immediately before the CT scan, should be taken individually. With exception of airway and breathing problems, most diagnoses can only be reliably detected and treated after the CT scan..

show abstract

“…Previous studies presented free peritoneal fluid indicating the surgically important TBMI [12][13][14][15]. However, CT's various performance in diagnosing surgically important TBMI was reported to be between 11-98% [13,14,[16][17][18][19][20][21]. Overdiagnosis of the surgical TBMI resulted in numerous non-therapeutic surgeries.…”

Section: Introductionmentioning

confidence: 99%

The Current Diagnostic Accuracy on Free Peritoneal Fluid in Computed Tomography to Determinate the Necessity of Surgery in Blunt Bowel and Mesenteric Trauma—Systemic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

Traumatic bowel mesenteric injury (TBMI) is a challenge in trauma care. The presence of free peritoneal fluid (FF) in computed tomography (CT) was considered the indication for surgical intervention. However, conservative treatment should be applied for minor injuries. We conduct a systematic review to analyze how reliable the FF is to assess the TBMI. Publications were retrieved by structured searching among databases, review articles and major textbooks. For statistical analysis, summary receiver operating characteristic curves (SROCs) were computed using hierarchical models. Fourteen studies enrolling 4336 patients were eligible for final qualitative analysis. The SROC line was created by a hierarchical summary receiver operating characteristic model. The summary sensitivity of FF to predict surgical TBMI was 0.793 (95% CI: 0.635–0.894), and the summary specificity of FF to predict surgical TBMI was 0.733 (95% CI: 0.468–0.896). The diagnostic odds ratio was 10.531 (95% CI: 5.556–19.961). This study represents the most robust evidence (level 3a) to date that FF is not the absolute but an acceptable indicator for surgically important TBMI. However, there is still a need for randomized controlled trials to confirm.

show abstract

Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients’ management

Cited by 18 publications

References 28 publications

Traumatismo abdominal contuso manejado con embolización mesentérica: reporte de caso

Traumatismo abdominal contuso manejado con embolización mesentérica: reporte de caso

A critical look at the value of clinical examination in polytraumatized patients

The Current Diagnostic Accuracy on Free Peritoneal Fluid in Computed Tomography to Determinate the Necessity of Surgery in Blunt Bowel and Mesenteric Trauma—Systemic Review and Meta-Analysis

Contact Info

Product

Resources

About