1、123the outline the incidence of abdominal injuries in peacetime: 0.4%-1.8% in wartime : 50% the mortality of abdominal injuries is 10%4Types of the abdominal injuriesabdominal injuryopen abdominal injuryclosed abdominal injurypenetrating abdominal injurynon-penetrating abdominal injuryIatrogenic inj
2、ury56Mechanism of closed injury Direct impact Deceleration and rotational forces Spleen,kidney,small bowel and liver are the most commonly closed abdominal injuried organs.7Mechanism of open injury Stab wounds Gunshot wounds Liver, small bowel, stomach and colon are commonly involved in the open abd
3、ominal injuries. 8 The severity of the injuries and involved organs depend on the intensity , velocity, position and direction of the force . Abdominal anatomic features and the functions of the organs are also important to the injuries. 9clinical manifestations abdominal pain hemorrhagic shock peri
4、tonitis10 abdominal organs injuries are divided to solid and hollow organs injuries. the main manifestation of the solid organs injuries is hemorrhage that can lead to shock. the main manifestation of the hollow organs injuries is peritonitis.11 Hemorrhage and peritonitis can exist simultaneously,wh
5、en the injuries involve the 2 kinds of abdominal organs.12Diagnosis Accurate diagnosis and management requires a thorough history, physical examination, and, when indicated, laboratory tests.13 when we diagnose the injury as the open abdominal injury,we should consider if there is a penetrating inju
6、ry.14Diagnosis of the closed abdominal injury Does the abdominal organ injury exist? Which organ is injuried? whether multiple organs are involved in the abdominal injuries?15when its still difficulty to diagnose, the following measures can be taken.auxiliary examinationdignostic abdominal paracente
7、sis and peritoneal Lavagex-ray UltrasoundAbdominal computed tomographyMRI, angiography, diagnostic laparoscopy 16 observing closely determine the pulse rate, respiratory rate, blood pressure every 15-30 minutes. examine the abdominal signs every 30 minutes. determine the erythrocyte number, hemoglob
8、in, hematocrit every 30-60 minutes.17 exploratory laparotomy The indications for laparotomy Abdominal pain and peritoneal irritation sign aggravate gradually. Bowel tones becomes more weaker,even disappeared. The erythrocyte number and blood pressure are instability. Gastrointestinal bleeding Refrac
9、tory shock18Management of the abdominal injury We should identify and correct any immediate life-threatening conditions and treat with the other anticipate problems. CPR is the most important thing in the critical case. AAirway BBreathing CCirculation with haemorrhage control19 Dont send the exposed
10、 abdominal organs back to the peritoneal cavity. Cover them with warm NS soaked gauze.20 Antishock therapy is a key step in the therapeutic procedure. If given active antishock therapy, the shock still difficulty to correct, it suggests that there is progressive intraperitoneal hemorrhage, the explo
11、ratory laparotomy is necessary.21 In principle, the laparotomy should explore the abdominal organs in order as the following: the solid organs diaphragma stomach duodenum jejunumileummesentery pelvic organs posterior surface of stomach panceas22Splenic rupture232425The spleen remains the most common
12、ly injured organ. in closed injury:20%40% in open injury: 10%26 The Magnitude of spleanic rupture depend on patient age, injury mechanism and presence of underlying disease . The Magnitude of spleanic rupture depend on patient age, injury mechanism and presence of underlying disease .27 Now spleen i
13、s recognized as an important immunologic factory. The risk of overwhelming postsplenctomy infection (OPSI) is greatest in child less than 2 yrs. Recognition of OPSI has stimulated efforts to Conserve spleen by splenorrhaphy. 28TREATMENT Initial ManagementInitial Management Non operative approachNon
14、operative approach: widely practiced in pediatric trauma the criteria for nonoperative approach Operative approach: Operative approach: Decision to perform splenctomy or splenorraphy is usually made after assessment & grading the splenic injury.29Contraindication for Contraindication for splenicsple
15、nic salvage: salvage: The patient has protracted hypotension Undue delay is anticipated in attempting repair the spleen The patient has other severe injury30Liver rupture 313233Operative management - liver Gauze packing may have infective complications (Ivatury RR et al 1986) Omental packing Resecti
16、onal debridement Mass liver suture Hepatic artery ligation Total hepatic isolation - good for retrohepatic venous injuries Atriocaval shunt343536pancreatic injury 37Character acute abdominal pain because of the chemical peritonitis caused by pancreatic juice AMY in the blood and urine difficult to d
17、iagnose before the lapartomy38 Treatmentkposthesispartial excision and drainage39Gastric injury40 Character Peritonitis pneumoperitoneum Treatmentkposthesisexcision41Duodenal injury42 Character not injuried easily not noticed easily mostly severe Treatmentkposthesisanastomosisdecompression and drain
18、age43Small intestine rupture44 Character high incidence rate Peritonitis is the main manifest. pneumoperitoneumTreatmentKposthesisPartial excision and anastomosisThe blood vessels of intestinal mesenteric radix should be anastomosed.45Colon rupture46 Character the thin intestinal wall and the poor v
19、ascular supply poor healing function serious infection easy to missing diagnose Treatmentexteriorize the intestinal canalColostomy and Kposthesissometimes primary suture47Rectal injury48 Characters are similar to the colon rupture. TreatmentsigmoidostomyKposthesis and anastomoses49Retroperitoneal hematoma50 Character worse condition more complicated injuries difficulty to diagnoseTreatmentexpectant treatmentthe exploratory laparotomy5152
