Abdominal Wall Injuries Following Blunt Trauma
Transcript of Abdominal Wall Injuries Following Blunt Trauma
![Page 1: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/1.jpg)
Abdominal Wall Injuries Following
Blunt Trauma
Roxie M. Albrecht, MD, FACS, FCCM
Medical Director Trauma and Surgical Critical Care
Vice Chair and Professor of Surgery, OUHSC
Region Chief, Region VI ACS Committee on Trauma
![Page 2: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/2.jpg)
Introduction First reported in 1906
Rare but increasingly recognized
66 patients prior to 2004
Netto J Trauma 2006, 34 patients
Bender Am J Surg 2008, 22 patients
Dennis Am J Surg 2009, 26 patients
Coleman J Trauma Acute Care Surgery 2016, 80
patients
![Page 3: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/3.jpg)
Incidence:
0.2-0.9 % All Trauma Admission
9.2 % of blunt trauma patients with abd/pelvis CT
Location
Severity-based classification
Management Timing
Associated injuries
Location
![Page 4: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/4.jpg)
Locations Anterior – Rectus
Flank – Involving Abdominal Obliques
Lumbar – Superior/Inferior lumbar Triangle
Inguinal
Spigelian
![Page 5: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/5.jpg)
Grade I
Subcutaneous tissue
contusion
Dennis RW. Am J Surg 2009; 197:413-7
![Page 6: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/6.jpg)
Grade II
AW muscle hematoma
Dennis RW. Am J Surg 2009; 197:413-7
![Page 7: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/7.jpg)
Grade III
Single AW muscle
disruption
Dennis RW. Am J Surg 2009; 197:413-7
![Page 8: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/8.jpg)
Grade IV
Complete abdominal
wall muscle disruption
Dennis RW. Am J Surg 2009; 197:413-7.
![Page 9: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/9.jpg)
Grade V
Complete abdominal
wall disruption with
herniation of
abdominal contents
![Page 10: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/10.jpg)
Grade VI
Complete abdominal
wall disruption with
open evisceration
![Page 11: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/11.jpg)
AWI – Associated Injuries
![Page 12: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/12.jpg)
AWI – Associated injuries
Bowel Ischemia with Mesentery Injury
![Page 13: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/13.jpg)
AWI Associated Injuries
Vascular – Infra renal Aorta and Common Iliac Artery
![Page 14: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/14.jpg)
AWI – Associated injuries
Bowel Injury with Free Air
AWI
Iliac
![Page 15: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/15.jpg)
AWI – Associated Injuries
Urine extravasation – ureter injury
![Page 16: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/16.jpg)
When to Operate
Immediate
Associated intra-abdominal injury requiring
operation
Type of Repair
Primary muscle repair
Biologic mesh/absorbable mesh bridge repair
Staged closure
Primary muscle with biologic/absorbable mesh
![Page 17: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/17.jpg)
When to Operate
Delayed Repair
Acute – Within 2 weeks/index hospitalization
Early – 2 weeks to 6-12 months
Get them over their other injuries
Late - > 5 years
![Page 18: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/18.jpg)
Type and Outcome of Repairs
Initial Repair N Reinforce Recur F/U Days F/U CT Days
Immediate 8 5 2 6/7 223 +/- 37 6/8 176 +/- 30
Delayed
In Hospital 5 2 1 3/5 130 +/- 44 1/5 180
Readmit 6 6 0 6/6 293 +/- 86 5/6 254 +/- 113
Late 3 3 0 3/3 113 +/- 83 1/3 280
Total 22 16 3 18/21 170+/- 32 13/22 212 +/- 41
![Page 19: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/19.jpg)
Do They all Need Operations
![Page 20: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/20.jpg)
![Page 21: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/21.jpg)
![Page 22: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/22.jpg)
Complications
Six wound infections
3 Immediate/Damage control group
2 Delayed In-hospital group
1 Expectant
![Page 23: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/23.jpg)
Management Scheme
![Page 24: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/24.jpg)
Delayed Repair Approach
Laparotomy
Flank Approach – Lateral Position – preference for lumbar
Laparoscopic – preference for anterior/lateral
Technique
Mesh Reinforcement – my preference
Intramuscular – open
Extra-peritoneal Laparoscopic
Challenge – Inferior attachment to iliac crest
Laparoscopic Tacks
Get out the orthopaedic toys
Drill
Suture anchors
![Page 25: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/25.jpg)
![Page 26: Abdominal Wall Injuries Following Blunt Trauma](https://reader030.fdocuments.in/reader030/viewer/2022021415/620a10cb5eebb70c1d47ab02/html5/thumbnails/26.jpg)
Conclusions
Look for it – Radiologist may miss it
Staged repair for instability or contamination
Early repair if stable is acceptable
Delaying repair appears to be safe and
potentially beneficial
Reinforcement in majority of cases