الفهرس 
Epidemiology of BATOnly 14 pages are availabe for public view
 |  | from | 141 |  |  |
| | | from | 141 | | |
Abstract
Blunt abdominal trauma ( B.A.T) is more frequently encountered in the emergency department ( E.D) than the penetrating one & usually results from motor vehicle collisions
Blunt abdominal trauma is a leading cause of morbidity & mortality among all age groups. Identification of intra-abdominal pathology is a challenging problem as we don’t see or know what was injured in the abdomen in the initial assessment.
Trauma mechanisms include mechanical, thermal, electrical, radiation, and blast. For each of these mechanisms, there are precipitating agents or vectors that produce injury. Mechanical injury can result from blunt force or penetrating trauma. Examples of blunt trauma include motor vehicle crashes, pedestrians struck by a motor vehicle, and falls.
Early identification of significant intra-abdominal injuries is necessary for the successful management of blunt trauma, because delay in diagnosis can lead to significant morbidity and mortality
The circumstances of the accident and the clinical condition of the patient before admission to the emergency room should be ascertained from emergency medical services records, the patient (if possible), and eyewitnesses.
The key determinant for the choice of the appropriate investigation or management of solid organ injuries following blunt abdominal trauma is the hemodynamic stability of the patient.
The most important test to obtain is the cross-match. Other investigations include blood chemistries, hematologic analysis, coagulation profile, toxicologic analysis (with ethanol level), urine analysis, and beta-human chorionic gonadotropin level if the patient is a woman of child-bearing age. The hematocrit is the most commonly misinterpreted test because it is not altered immediately with acute haemorrhage
Diagnostic imaging is essential to the management of the trauma patient. Radiography, computed tomography (CT), angiography, ultrasonography (US), and magnetic resonance imaging (MRI) are routinely used for directing management in the acute trauma setting and for follow-up care.
Patients who are unstable with unequivocal abdominal signs require a laparotomy, not investigation or imaging. The dilemma arises in multisystem injury, where the abdomen is only one of the potential sources for the cardiovascular instability. In this situation a rapid bedside test is required. Local resources will dictate whether DPL or ultrasound is the primary choice. In the haemodynamically normalized pateint the appropriate choice of study is the CT scan, which provides organ specifity and allows the option of conservative management of solid organ injury when appropriate.
The four basic principle in the management of liver trauma requiring surgery are hemostasis, adequate exposure, debridement, and drainage.
Splenectomy was the treatment of choice for all splenic injuries. However, During the last decade, improved imaging methods and the demonstrated success of non-operative treatment for children have increased the frequency of non-operative management of blunt splenic trauma such as splenorraphy, splenic mesh wrap or even splenic reimplantation in the greater omentum .
The only absolute indications for renal exploration are pedicle avulsion, pulsatile or expanding hematoma, and hemodynamic instability resulting from renal injury.
Duodenal haematoma is an uncommon injury caused by blunt trauma. It occurs more frequently in children than in adults; the mechanism is often blunt injury to the upper abdomen caused by a fall on the handlebar of a bicycle.
Small isolated perforation probably results from blow outs of pseudoclosed loops, (lap belt injuries). Larger perforations, complete disruptions, and injuries associated with large mesenteric hematomas or lacerations are due to direct blows or shearing injury.
Pancreatic & duodenal injuries continue to challenge trauma surgeons due to difficult diagnosis in a timely manner and high morbidity & mortality associated with them
Injury to the major arteries and veins in the abdomen are a technical challenge to the surgeons and are often fatal.
Nonoperative treatment for blunt injuries of the liver, spleen, and kidneys is now the rule rather than the exception.
Other organs injured in BAT should be managed selectively according to type of organ injured site and grade of injury.
Therapeutic laparoscopy recently plays an important role in the management of BAT especially diaphragmatic, liver, splenic& many other injuries.
Finally, all these methods led to improve prognosis and decrease morbidity & mortality caused by blunt abdominal trauma (BAT).