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      Identification of Hollow Viscus Injury with FAST Examination in Kurdistan, Iraq

      case-report

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          Abstract

          Point-of-care ultrasound has become indispensable in the evaluation of trauma, particularly in low resource areas, where it may be the only rapidly available imaging modality. The FAST (Focused Assessment with Sonography in Trauma) in particular can be lifesaving, by rapidly detecting signs of intra-abdominal hemorrhage. However, the FAST is primarily designed to identify free fluid associated with solid organ injury and is thought to have less sensitivity and power in identifying evidence of hollow viscus injury. We present a case of an unidentified man that presented to a hospital in the Kurdistan region of northern Iraq, a region of low resources, surrounded by war. The FAST exam proved to be the key to identifying this patient's injuries.

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          Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience.

          S Fakhry, M R Brownstein, D K Oller … (2000)
          Blunt small bowel injury (SBI) is uncommon, and its timely diagnosis may be difficult. The impact of operative delays on morbidity and mortality has been unclear. The purpose of this study was to determine the relationship of diagnostic delays to morbidity and mortality in blunt SBI. Patients with blunt SBI with perforation were identified from the registries of eight trauma centers (1989-1997). Patients with duodenal injuries were excluded. Data were extracted by individual chart review. Patients were classified as multi-trauma (group 1) or near-isolated SBI (group 2 with Abbreviated Injury Scale score < 2 for other body areas). Time to operation and its impact on mortality and morbidity was determined for each patient. A total of 198 patients met inclusion criteria: 66.2% were male, mean age was 35.2 years (range, 1-90 years) and mean Injury Severity Score was 16.7 (range, 9-47). 100 patients had multiple injuries (group 1). There were 21 deaths (10.6%) with 9 (4.5%) attributable to delay in operation for SBI. In patients with near-isolated SBI, the incidence of mortality increased with time to operative intervention (within 8 hours: 2%; 8-16 hours: 9.1%; 16-24 hours: 16.7%; greater than 24 hours: 30.8%, p = 0.009) as did the incidence of complications. Delays as short as 8 hours 5 minutes and 11 hours 15 minutes were associated with mortality attributable to SBI. The rates of delay in diagnosis were not significantly associated with age, gender, intoxication, transfer status, or presence of associated injuries. Delays in the diagnosis of SBI are directly responsible for almost half the deaths in this series. Even relatively brief delays (as little as 8 hours) result in morbidity and mortality directly attributable to "missed" SBI. Further investigation into the prompt diagnosis of this injury is needed.
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            Evaluation of bowel and mesenteric blunt trauma with multidetector CT.

            Nicole Brofman, Mostafa Atri, John M Hanson … (2006)
            Bowel and mesenteric injuries are detected in 5% of blunt abdominal trauma patients at laparotomy. Computed tomography (CT) has been shown to be accurate for the diagnosis of bowel and mesenteric injuries and is the diagnostic test of choice in the evaluation of blunt abdominal trauma in hemodynamically stable patients. Specific CT findings of bowel and mesenteric injuries include bowel wall defect, intraperitoneal and mesenteric air, intraperitoneal extraluminal contrast material, extravasation of contrast material from mesenteric vessels, and evidence of bowel infarct. Specific signs of mesenteric injury are vascular beading and abrupt termination of mesenteric vessels. Less specific signs of bowel and mesenteric injuries include focal bowel wall thickening, mesenteric fat stranding with focal fluid and hematoma, and intraperitoneal or retroperitoneal fluid. When only nonspecific signs of bowel and mesenteric injuries are seen on CT images, correlation of CT features with clinical findings is necessary. A repeat CT examination after 6-8 hours if the patient's condition is stable may help determine the significance of these nonspecific findings. Copyright RSNA, 2006
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              Practice Management Guidelines for the Evaluation of Blunt Abdominal Trauma: The EAST Practice Management Guidelines Work Group

              William S Hoff, Michelle Holevar, Kimberly Nagy … (2002)
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                Author and article information

                Contributors
                Christine Butts:
                ORCID: http://orcid.org/0000-0002-4109-0829
                Journal
                Journal ID (nlm-ta): Case Rep Emerg Med
                Journal ID (iso-abbrev): Case Rep Emerg Med
                Journal ID (publisher-id): CRIEM
                Title: Case Reports in Emergency Medicine
                Publisher: Hindawi
                ISSN (Print): 2090-648X
                ISSN (Electronic): 2090-6498
                Publication date Collection: 2018
                Publication date (Electronic): 13 February 2018
                Volume: 2018
                Electronic Location Identifier: 5019415
                Affiliations
                1Emergency Hospital, Duhok, Kurdistan, Iraq
                2Section of Emergency Medicine, Louisiana State University, New Orleans, LA, USA
                Author notes

                Academic Editor: Aristomenis K. Exadaktylos

                Author information
                http://orcid.org/0000-0002-4109-0829
                Article
                DOI: 10.1155/2018/5019415
                PMC ID: 5831703
                SO-VID: 44226983-aa4a-4c18-afca-9161f8116395
                Copyright © Copyright © 2018 Ruj Al-Sindy et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 26 September 2017
                Date revision received : 2 January 2018
                Date accepted : 4 January 2018
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Emergency medicine & Trauma
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma

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