| Management of penetrating abdominal trauma in the conflict environment: the role of computed tomography scanning. | |
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MedLine Citation:
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PMID: 20845038 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: Computed tomography (CT) scanning is a vital imaging technique in selecting patients for nonoperative management of civilian penetrating abdominal trauma. This has reduced the rate of nontherapeutic laparotomies and associated complications. Battlefield abdominal injuries conventionally mandate laparotomy, and with the advent of field deployable CT scanners it is unclear whether some ballistic injuries can be managed conservatively. METHODS: A retrospective 12 month cohort of patients admitted to a forward surgical facility in Afghanistan who sustained penetrating abdominal injury severe enough to warrant laparotomy or CT scan were studied. Patient details were retrieved from a prospectively maintained operative log and CT logs. Case notes were then reviewed and data pertaining to injury pattern, operative intervention, and survival were collected. RESULTS: A total of 133 patients were studied: 73 underwent immediate laparotomy (Lap group) and 60 underwent CT scanning (CT group). Of those undergoing CT scanning 17 underwent laparotomy and 43 were selected for nonoperative management. There were 15 deaths in the Lap group and none in the CT group. The median New Injury Severity and Revised Trauma Score was 29 and 7.55 in the Lap group and 9 and 7.8408 in the CT group, which is statistically significantly different (p < 0.001). Five patients in the CT-Lap group had nontherapeutic laparotomies and 1 patient failed nonoperative management. CONCLUSIONS: Computed tomography scanning can be used in stable patients who have sustained penetrating battlefield abdominal injury to exclude peritoneal breach and identify solid abdominal organ injury that can be safely managed nonoperatively. |
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Authors:
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Jonathan J Morrison; Jon C Clasper; Iain Gibb; Mark Midwinter |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: World journal of surgery Volume: 35 ISSN: 1432-2323 ISO Abbreviation: World J Surg Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2010-12-24 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7704052 Medline TA: World J Surg Country: United States |
Other Details:
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Languages: eng Pagination: 27-33 Citation Subset: IM |
Affiliation:
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Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham, B15 2SQ, UK. jonny_morrison@doctors.org.uk |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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