Post-traumatic hemoperitoneum
how is the diagnostic approach to it?
FAST ultrasound of the abdomen § useful to determine the presence of free floating blood in the peritoneum § typically serves to evaluate the need to perform a CT o CT with IV contrast § preferred imaging study as it can provide high quality images of the full peritoneal cavity o Diagnostic peritoneal lavage (DPL) § while NOT ideal § may be used to evaluate the presence of internal bleeding a person who is hemodynamically unstable
How is it treated?
Initial management consists of immediate blood transfusion if the patient is in hemorrhagic shock
The major causes of it can be ?
o Blunt force such as a car accident § such as motor vehicle accidents, falls, and sports injuries § Typically these blunt forces dissipate through and around the structure of the liver § and causes irreparable damage to the internal microarchitecture of the tissue o penetratingtrauma§ Given its anterior position in the abdominal cavity and its large size, it is prone to gunshot wounds and stab wounds
How do you diagnose the patient?
o FAST scan § For a person who is hemodynamically unstable § Used to find free floating fluid in the right upper quadrant and left lower quadrant of the abdomen o CT scan§ used in those who are hemodynamically stable o Diagnostic peritoneal lavage (DPL)§ generally discouraged when FAST is available as it is invasive and non-specific
If the spleen i affected how is the signs and symptoms for it?
o In minor injuries with little bleeding § there may be abdominal pain, tenderness in the epigastrium and pain in the left flank § Often there is a sharp pain in the left shoulder, known as Kehr's sign o In larger injuries with more extensive bleeding § signs of hypovolemic shock are most prominent § This may include a rapid pulse, low blood pressure, rapid breathing, paleness, and anxiety
What are the treatment ways you can do ?
o Nonoperative § chosen in those who are hemodynamically stable with non- worsening symptoms § with stable hemoglobin levels over 12-48 hours § minimal transfusion requirements (2 units or less) § involves strict bed rest between 24-72 hours with careful monitoring along with a CT 7 days after the injury o Surgical therapy § reserved for patients with signs of ongoing bleeding or hemodynamic instability § May include the following, either alone or in combinationØ Packing - absorbs any drainage from the wound, which helps the tissues heal from the inside out Ø Surgical diathermy - cauterize small blood vessels to stop bleeding Ø Topical hemostatics, e.g. Surgicel Ø Splenorrhaphy (suture of a ruptured spleen) - preferred method of surgical care in less emergent situations Ø Ligation of splenic vessels - decreased function with arterial ligation but preferred to splenectomy Ø Partial splenectomy for polar injuries Ø Total splenectomy
What are the treatment options available?
o The initial management § focus on maintaining airway, breathing, and circulation o Nonoperative management § A large majority of liver injuries are minor and require only observation § Indicated if there is Ø less than 300mL of free floating fluid Ø NO injury to surrounding organs Ø and NO need for blood transfusion o Surgical therapy § Indicated in severe liver injuries, or those with hemodynamic instability § includes the following alone or in combination Ø Packing the liver with gauze rolls to compress the injured segment Ø Diathermy to superficial bleeding Ø Deep liver sutures Ø Hepatotomy and vascular ligation (i.e. open laceration more to suture bleeding vessels) Ø Resect injured lobe - if a lobe is shattered, it may be better to resect Ø If exsanguinating, then Pringle's manoeuvre can be performed - clamp the hepatoduodenal ligament (free border of the lesser omentum) interrupting the flow of blood through the hepatic artery and the portal vein and thus helping to control bleeding from the liver
What is the main cause of this?
o The most common cause of a ruptured spleen is blunt abdominal trauma § such as in traffic collisions or sports accidents o Direct, penetrating injuries, for example, stab or gunshot wounds are rare o Non-traumatic causes are less common § Include infectious diseases, medical procedures such as colonoscopy, hematological diseases, medications, and pregnancy
In Liver injury what are the main signs and symptoms for it?
o abdominal pain in the right, upper quadrant of the abdomen § The pain is worse when taking a deep breath o In larger injuries with more extensive bleeding § signs of hypovolemic shock are most prominent § This may include a rapid pulse, low blood pressure, rapid breathing, paleness, and anxiety
If there is an emergency surgery what should you do?
§ Locate the source of bleeding § Recover spilled blood from the peritoneal cavity and to use it for auto- transfusion (if NOT contaminated) § Vascular bleeding Ø would be treated by clamping and ligation of the offending vessel Ø or repair of the vessel in the case of major arteries such as the aorta or mesenteric arteries § Bleeding from the spleenØ most often requires splenectomy, usually but NOT always in the form of a total splenectomy § Bleeding from the liverØ might be controlled by application of hemostatic sponges, thrombin, or more recently, argon beam cauterization
How can we diagnose a patient with this disease?
• Diagnosiso Focused assessment with sonography for trauma (FAST) o Paracentesis or diagnostic peritoneal lavageo Computed tomographyo Diagnostic laparoscopy or exploratory laparotomy
What is Post-traumatic hemoperitoneum
• the presence of blood in the peritoneal cavity after penetrating or blunt trauma The blood accumulates in the potential space between visceral and parietal peritoneumo generally classified as a surgical emergency
