By Harry M. Delany M.D., F.A.C.S., Robert S. Jason M.D. (auth.)
Trauma to the stomach, either unintentional and willful, has develop into more and more universal during this period of accelerating violence. huge numbers of sufferers everywhere in the state are admitted to emergency rooms due to belly trauma of various levels of severity. All too usually the proper prognosis is suspected belatedly or by no means, in order that right therapy isn't really initiated in enough time to be lifesaving. now not infre quently, the injured sufferer is tested by means of an intern or an insufficiently skilled resident health professional. Even in circumstances the place extra senior internists and surgeons can be found, unique wisdom in regards to the helpful method to set up the proper prognosis and institute the perfect therapy is missing. This monograph, representing the felicitous collaboration of a doctor and a radiolo gist including a number of different participants, is well timed and significant. The authors (and their members) have approached their topic with a wealth of scientific experi ence acquired in numerous very energetic acute-care municipal hospitals within the greatest urban during this nation. they've got saw and taken care of a really huge variety of sufferers with a large number of anxious explanations, together with firearm accidents, stab wounds, vehicular injuries, falls, and attacks. The authors have divided this paintings into 4 major sections: normal views on belly damage, varieties of belly accidents, particular Diagnostic concepts, and particular Organ or Supporting-Structure Injury.
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Additional info for Abdominal Trauma: Surgical and Radiologic Diagnosis
C 30 ~ 0 ~ 20 , ,,/ ~)'"" c '"0. DE :::l Z 10 1930- 1939- 1947- 1956- 1963- 5 1938 1946 1955 1962 1970 FIG. 2. Graphic representation of mortality and incidence of gunshot wounds of the abdomen. From Taylor FW (1973) Ann Surg 177: 174-177 for the increasing problem of missile injury is the declining mortality and morbidity from such trauma. Surgical-trauma experience and education in the diagnostic aspects and medical management of the problem have contributed to the favorable current outlookespecially in civilian life.
Injury to the liver or spleen may produce pain in the epigastrium or flank, but there may also be pain in the shoulders from diaphragmatic irritation. If the hepatic or splenic injury is localized to the posterior surfaces, it may irritate the undersurfaces of the diaphragm with very little associated peritoneal reaction; thus, a history of shoulder pain, difficulty in breathing, or shortness of breath in the abdominal injury case has special significance. The referral of pain to the tip of the shoulder was described by Kehr as an important diagnostic sign in patients with splenic injury .
Liver injury was present in 70% of deaths in the Fitzgerald et al. 37). Multiple Injury The presence of associated head, chest, and limb trauma significantly increases the mortality of blunt abdominal injury. In the Bolton et al. series of 59 blunt-abdominal-trauma cases, multiple injuries occurred in 47 patients. The mortality increased with the number of systems injured. 38). 's series of 100 patients with blunt trauma who died before hospital admission, 97% had extraabdominal injuries. Death occurred in only 3 patients with injuries limited to the abdomen.