THÔNG TIN TÀI LIỆU
Stab Wounds Stab wounds to the abdomen carry potential for devastating injury, depending on which intra-abdominal structures are involved The extent of the injury also depends on the type, size, and length of the weapon and on the trajectory Major vascular injuries pose the greatest threat; commonly injured vessels include the intra-abdominal aorta, the inferior vena cava, the portal vein, and the hepatic veins Anterior stab wounds should be explored via laparoscopy or laparotomy if hemodynamic instability or signs of peritonitis are present, if blood is noted in the gastric aspirate or on rectal examination, or if pneumoperitoneum or evisceration is noted ( Fig 103.3 ) Local exploration may be used to rule out penetration of the peritoneum, even in minor stab wounds, but laparoscopy is a very effective means for the evaluation of stab wounds and many minor injuries can be repaired without open surgery Stab wounds to the flank or back are less readily and less quickly diagnosed than anterior wounds; the retroperitoneal structures are more protected by paraspinal musculature, and bleeding is often tamponaded in this area Dorsal stab wounds are sometimes managed nonoperatively unless hemodynamic instability or signs of peritonitis are present, although selective laparotomy is a common surgical strategy ABDOMINAL INJURIES—THE LAP BELT COMPLEX AND CHILD ABUSE Goals of Treatment Occult injuries in the context of motor vehicle crashes and abusive trauma are not unusual The goal of evaluation and treatment is detection of injuries; hence, the index of suspicion must remain high CLINICAL PEARLS AND PITFALLS Children who are too small for adult seat belts are at increased risk for injuries, including intra-abdominal injuries Fractures of the lumbar spine may be found in association with these intra-abdominal injuries Blunt abdominal trauma in child abuse is uncommon but mortality rates are as high as 50%
Ngày đăng: 22/10/2022, 13:04
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