Intra-abdominal Solid Organ Injuries: An Enhanced Management Algorithm

Abstract

The organ injury scale grading system proposed by the American Association for the Surgery of Trauma provides guidelines for operative versus nonoperative management in solid organ injuries; however, major shortcomings of the American Association for the Surgery of Trauma injury scale may become apparent with low-grade injuries, in which conservative management may fail. Nonoperative management of common intra-abdominal solid organ injuries relies increasingly on computed tomographic findings and other clinical factors, including patient age, presence of concurrent injuries, and serial clinical assessments. Familiarity with characteristic imaging features is essential for the prompt diagnosis and appropriate treatment of blunt abdominal trauma. In this pictorial essay, the spectrum of the American Association for the Surgery of Trauma organ injury scale grading system is illustrated, and a multidisciplinary management algorithm for common intra-abdominal solid organ injuries is proposed.

Clinical update on management of pancreatic trauma

“…However, both MRCP and ERCP have higher sensitivity (approaching 100%) and each have their own indications when pancreatic injury and ductal disruption is suspected. 37,38,46 MRCP has the advantage of being non-invasive and is the first choice in a stable patient with suspicion of a pancreatic injury and to diagnose any injury to the pancreatic duct. Intraparenchymal hematoma may cause duct compression (showing as loss of duct on imaging).…”

Surgical management of atraumatic splenic rupture

“…Currently the indications for splenectomy in ASR, regardless of known or unknown etiology, have generally included those identified in association with splenic rupture owing to blunt abdominal trauma: hemodynamic instability, high grade splenic injury, and signs of peritonitis. 8 Renzulli et al performed a comprehensive review of ASR in the literature and similarly found the paucity of patient data as well as the simple rarity of ASR limiting to their analyses. 4 They were able however to find an overall ASR-related mortality rate of 12.2%, as well as to make several conclusions relating to risk factors and management of ASR as a general entity.…”

Abdominal Travma

“…Spesifik, direkt bulgular, pankreasta boyut artışı, laserasyon (fokal lineer kontrast tutmayan alan), inhomojen kontrast tutulumu, fragmantasyon ve hematom olarak görülebilir. İndirekt, nonspesifik bulgular, peripankreatik yağ planlarında silinme, laserasyonla ilişkili peripankreatik sıvı, splenik ven ve pankreas arasında sıvı, hemoraji, sol anterior pararenal fasiyada kalınlaşma, komşu yapılarda eşlik eden yaralanmalar olarak sayılabilir [1,4,[18][19][20][21][22].…”

“…Laserasyonlar, yüzeyel (parankim kalınlığının <%50 den azı) ve derin laserasyon(parankim kalınlığının >%50'den fazlası) olarak sınıflanır (Şekil 4, 5 [22][23][24][25].…”

“…Renal kontüzyonlar, normale göre az olmakla beraber kontrast tutulumu gösterebilir. Anjiyomyolipom başta olmak üzere bazı renal kitlelerde kanama görülebilir [17,22].…”