الفهرس 
Introduction
Surgical AnatomyOnly 14 pages are availabe for public view
 |  | from | 46 |  |  |
| | | from | 46 | | |
Abstract
Background: Penetrating abdominal trauma (PAT) is commonly seen in emergency departments and poses a significant challenge to trauma surgeons. The most important decision that must be obtained during the management of these traumas is which patient must be operated on. Mandatory laparotomies for all patients with penetrating abdominal trauma have resulted in non-therapeutic laparotomy (negative or insignificant findings) in 11% to 40% of patient. Complications of non-therapeutic laparotomy may be sever and when it is performed for PAT, mortality and complication rates vary from 0% to 5% and 5% to 22% respectively. ¬Aim of work: The aim of this prospective study is to evaluate the technique of”selective conservatism” in the management of penetrating abdominal trauma. Methods: This study included 50 patients admitted to emergency hospital, faculty of medicine, Mansoura university, with penetrating abdominal trauma from June 2005 to January 2007. Local Wound Exploration was done for suspected cases to document penetration. No LWE was done for cases presented with omental evisceration. Eviscerated omentum were ligated extra-corporally then resected, the remaining parts of the omentum were pushed back into the abdomen. LWE was performed by senior surgical residence. First the region of the wound sterilely prepared and draped. Epinephrine containing local anesthetic was used to improve tolerance and haemostasis. Results: Gastric tear was found in 7 patients and successfully managed by repair, whereas small intestinal tear was found in 4 patients, 2 of them were managed by simple repair, however one need resection and primary anastomosis and serosal tear was found in one patient and needed nothing. Colonic injuries were found in 7 patients, primary repair without colostomy was done for 4 patients, and only 3 patients were managed by colostomy. Liver injury was found in 3 patients, and two of them needed suture, while, in the third patient the bleeding was stopped. Renal injuries were found in 4 patients, two of them were managed by repair, while the other two patients needed nephrectomy. Mesenteric tear was found in 3 patients, two of them needed repair while in the third patient nothing was done. Pancreatic injury was found in one patient and needed only drainage. Urinary bladder injury was found in one patient and successfully managed by repair and Suprapubic cystocatheter. Retroperitoneal haematoma alone was found in one patients in zone III and exploration was done with successful control of the bleeding and in associated with renal injury in one patient where nephrectomy was done. We have 5 patients in our study have two injuries. Conclusions: Selective management of penetrating abdominal trauma based on this protocol is safe, applicable method and reduces significantly the rate of unnecessary laparotomy and hospital stay, but with adequate coverage. Diagnostic peritoneal lavage may be investigated as a screening tool for peritoneal penetration to minimize the unnecessary hospital admissions and improve immediate identification of hollow viscus injury. Also, laparoscopy will have a major impact in the management algorithm of penetrating abdominal trauma.