الفهرس 
Anatomy of abdominal wallOnly 14 pages are availabe for public view
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Abstract
Abdominal trauma affects 10% to 15% of injured patients. Although significant intra-abdominal injury is relatively infrequent, the consequences of missed or delayed diagnosis can be significant. Therefore, accurate and timely diagnosis of injuries is essential. The initial history and physical examination are of paramount importance information regarding the mechanism of injury and state of the patient before arriving in the emergency department.
In hemodynamically stable victims of blunt trauma, Computed Tomography (CT) with intravenous contrast has become the gold standard for the diagnostic evaluation of the abdomen, with greater than 95% specificity for detecsting injury to the solid organs (liver, spleen, and kidney). Injury to the intestine, pancreas, mesentery, and diaphragm are more difficult to diagnose with CT. Even in the current era of multidetector scanners, up to 21% of patients with bowel or mesenteric injuries may initially have negative studies. In hemodynamically unstable victims, diagnostic laparoscopy has proven to be a useful modality in these situations.
Minimally invasive techniques continue to evolve. Current laparoscopic advancements include finer in-line instruments with superior function, newer methods to access the abdomen and robotic technology to increase operative freedom. Whereas some advances are due to better understanding of laparoscopy itself (lower insufflation pressures, thorough evacuation of intraperitoneal blood, intraoperative modification of patients, position, optimal port access placement and adjuncts such as intestinal methylene blue).
The utility of the laparoscope has been confirmed as a diagnostic and a therapeutic tool in the care of ”the injured patient”. As a result of significant variability among training, facility resources, patient cohorts and institutional experiences, there is still a paucity of rigorous prospective researches. We must strengthen our resolve to investigate fully the appropriate uses of this technology among trauma victims.
With increasing incorporation of endoscopic surgery into general practice, we believe that in the future there will be a solid place for the laparoscopic approach to diagnosis and therapeutic modality in abdominal trauma. It may be particularly beneficial for hemodynamically stable patients that sustained a focal abdominal trauma. We expect that this approach will lead to a decline in laparotomies, and its associated complications.