21 Questions
What is the primary concern when evaluating pancreatic injuries?
Figuring out if the pancreatic duct is involved
What may be necessary for a pancreatic head duct injury that is not reparable?
Placement of drains only
What is indicated by persistent or rising amylase levels in the context of pancreatic injury?
Missed pancreatic injury
What imaging modality is poor at diagnosing pancreatic injuries initially?
CT scan
What is a major sign of extremity vascular injury?
Pulse deficit
What should be considered for superficial femoral or popliteal artery injuries?
Prophylactic fasciotomy
What can compartment syndrome lead to?
Rhabdomyolysis and subsequent renal failure
How should bleeding of the inferior vena cava be best controlled?
Using proximal and distal pressure, not clamps
What should be done in cases where residual stenosis of the IVC is greater than 50% after repair?
Placement of saphenous vein or synthetic patch
When should prophylactic fasciotomy be considered?
For any ischemia lasting more than 4–6 hours
What is the most common organ injured with penetrating small bowel trauma?
Small bowel
Intra-abdominal fluid not associated with a solid organ injury, bowel wall thickening, and mesenteric hematoma on abdominal CT scan is suggestive of injury to which organ?
Small bowel
What is the recommended approach for small lacerations in the small bowel?
Repair transversely
When should resection and anastomosis be performed for small bowel injuries?
> 50% of bowel circumference or lumen diameter < ⅓ normal
What should be done if there are multiple close lacerations in the small bowel?
Resect that segment
When should mesenteric hematomas be opened intra-operatively?
> 2 cm or expanding
What is the recommended management for right and transverse colon injuries?
Primary repair without diversion
In cases of left-sided colectomy for destructive lesions, what is indicated for gross contamination, delayed repair, comorbidities, or significant blood transfusions?
Diverting ileostomy
What is generally not recommended for rectal trauma?
Presacral drains and rectal washout
What is a potential management option for common bile duct injury?
Repair over stent
What is the treatment approach for intra-operative portal triad hematomas?
Varies based on different factors
Study Notes
Trauma Surgery: Management of Colon, Rectal, Liver, Spleen, and Pancreatic Injuries
- Colon injuries: right and transverse colon injuries do not require diversion; left colon injuries may require primary repair without diversion for non-destructive injuries
- In cases of left-sided colectomy for destructive lesions, diverting ileostomy is indicated for gross contamination, delayed repair, comorbidities, or significant blood transfusions
- Rectal trauma: treatment varies based on location and type of injury, with different approaches for intraperitoneal, extraperitoneal, and low, middle, and high rectal injuries
- Presacral drains and rectal washout are generally not recommended for rectal trauma
- Liver trauma: common with blunt abdominal trauma, damage control peri-hepatic packing may be used for severe penetrating liver injuries if the patient becomes unstable in the OR
- Intra-operative portal triad hematomas and contained subcapsular hematomas require different approaches
- Common bile duct injury management depends on the extent and complexity of the injury, with options including repair over stent or choledochojejunostomy
- Portal vein injury requires repair, and ligation of the portal vein is associated with high mortality
- Omental graft can be used in liver laceration to control bleeding and prevent bile leaks
- Nonoperative management of blunt liver injuries is an option for stable patients, with specific criteria for transitioning to operative or angioembolization management
- Spleen trauma: splenic salvage is associated with increased transfusions, and the risk of postsplenectomy sepsis is highest within 2 years post-splenectomy
- Pancreatic trauma: penetrating injuries account for the majority of cases, and edema or necrosis of peripancreatic fat is indicative of injury; most injuries are treated with drains
Test your knowledge about diagnosing small bowel trauma, including the most common organ injured in penetrating injury, challenges in early diagnosis, and interpretation of abdominal CT scans. Learn about identifying occult small bowel injuries and the need for close observation.
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