الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Currently, trauma is the most common cause of death in the age group of 15 to 45 years. Abdominal injury is a contributing factor in 20 % of trauma deaths, either early from exsanguinations or late from bowel injury, subsequent sepsis or multi-organ failure, and 85% of those abdominal traumas are of blunt character.
The most common causes of BAT are road traffic accidents followed by pedestrian accidents, abdominal blows and fall from heights.
Evaluation of patients who have sustained BAT may pose a significant challenge even to the most experienced surgeon. Blunt abdominal trauma produces a spectrum of injuries from minor, single-system injury to devastating, multi-system trauma.
Clinical abdominal examination is inaccurate for the assessment of the BAT patients since there are often distracting injuries, altered levels of consciousness, non specific signs and symptoms, and large differences in individual patient reactions to intra-abdominal injury.
In recent years, focused abdominal sonography for trauma (FAST) has emerged as a useful diagnostic test in the evaluation of BAT.
The advantages of the FAST examination have been clearly established, FAST is noninvasive, may be easily performed and can be done concurrently with resuscitation. In addition, the technology is portable and may be easily repeated if necessary.
The test is especially useful for detecting intra-abdominal hemorrhage in the multiply injured patient. Injuries not associated with hemoperitoneum may not be detected by this modality. Thus, ultrasound is not a reliable method for excluding hollow visceral injury. In addition the FAST examination cannot be used to reliably grade solid organ injuries. Therefore, in the hemodynamically stable patient, a follow-up CT scan should be obtained. Despite its disadvantages such as long time requirement, high cost, need for experienced personnel, CT has proven to be of significant assistance.
CT is notoriously inadequate for the diagnosis of mesenteric injuries and may also miss hollow visceral injuries. In patients at risk for mesenteric or hollow visceral injury, DPL is generally felt to be a more appropriate test. Diagnostic peritoneal lavage (DPL) is an invasive, rapid, and highly accurate test for evaluating intraperitoneal hemorrhage. DPL has an important role in diagnosis of hollow viscus injury and may reduce the rate of non-therapeutic laparotomy.
Combination of CT with US and DPL has an important role in the decision of laparotomy and may reduce the rate of unnecessary laparotomy.
It is important to emphasize that DPL, US, and CT should not be seen as competitive or alternative diagnostic methods. If these techniques are applied in a complementary rather than an exclusionary way, patients can be evaluated rapidly and safely and non-therapeutic laparotomies can be avoided.
The emergence of laparoscopy in the late 1980’s as a credible therapeutic intervention heralded a new surgical age.
Demonstrable reduction of wound complications, postoperative pain, hospital stay and costs in treating many of the abdominal and gynaecological conditions.
Initially laparoscopy was limited to elective surgery, but as technology and surgical experience expanded so did the application of laparoscopy into the emergency setting.
In our study, 15 patients underwent diagnostic laparoscopy Conversion to laparotomy occurred in some patients and was negative in about one third. Therapeutic intervention for the other patients in the form of splenectomy, resection anastomosis of small bowel and repair of small and large bowel laceration
Use of laparoscopy in blunt trauma is evolving. Laparoscopy is safe and feasible as a diagnostic and therapeutic modality in patients with blunt trauma the role of laparoscopy in blunt trauma has been shown to reduce the negative laparotomy rate and identify and treat visceral injuries and allows for minimal invasive management of selected intra-abdominal injuries.
What is clear is that as surgical expertise and technology both continue to improve, so the remit for laparoscopic surgery will expand, to the benefit of our patients
DPL, U/S, and CT in management of blunt abdominal trauma. Should be applied in a complementary fashion so that patients can be evaluated rapidly and safely and non-therapeutic laparotomies can be avoided.
Also in this study, it is clearly demonstrated that the diagnostic and therapeutic laparoscopy can be confidently used as a main tool for the evaluation and treatment of patients with abdominal trauma in stable hemodynamic status.