TORSO TRAUMA

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3. TORSO TRAUMA What is TORSO : The body excluding the head and neck and limbs M.A.Kubtan

4. What is trauma ? • The medical problems associated with physical injury . • Injury is the adverse effect of physical force upon a person . • Forces that can lead to injury include : mechanical , thermal ,ionizing radiation , and chemical . M.A.Kubtan

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6. Introduction • The Troso is generally regarded as the area between the neck and the groin ,made up of the thorax and abdomen . • Division of the body into abdomen and thorax is artificial . • Injury to the troso is more appropriate. • Our aim is restoration of normal physiology . • Accordingly trauma surgery requires knowledge of anatomy and physiology . M.A.Kubtan

7. Junctional zones • Between the neck and the thorax . • Between the thorax and the abdomen . • Between the abdomen and the pelvic structures and the groin . • This zones represent surgical challenges in terms of diagnosis of the area of injury and surgical approach . • It is related and balanced against the physiological stability of the patient . M.A.Kubtan

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13. Abdominal Injury Patients who have suffered abdominal injury can be generally classified into : • Haemodynamicllynormal . • Haemodinamicllystable . • Haemodynamicallyunstable . M.A.Kubtan

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15. A B C D E of trauma care M.A.Kubtan

16. Investigation • Cardiovascular status . • Radiological imaging . • Stable patient may be able to have CT scan . • Evaluation of torso trauma . M.A.Kubtan

17. Diagnostic tools • CT scan with intravenous contrast most valuable ( however in unstable patient it not always possible ) . • DPL Diagnostic peritoneal lavage. the presence of > 100 000 red cells /micro liter or > 500 white cells in the peritoneal washout is an indication of intraperitoneal bleeding and this is equivalent to 20 ml of free blood in the abdominal cavity . Drainage of peritoneal lavage fluids via chest drain is an indication of penetration of diaphragm . M.A.Kubtan

18. 4 quadrant tap • When positive it means that there is free blood in the peritoneal cavity . • Negativity does not rule out the presence of blood in the peritoneal cavity . M.A.Kubtan

19. FAST • FAST Focused abdominal sonar for trauma . • FAST is a technique whereby US imaging is used to assess the TORSO for the presence of blood . • This technique focuses on four areas : Pericardial, Splenic , Hepatic , Pelvic . FAST is accurate for the detection of < 100 ml of free blood in the peritoneom . It is extremely dependent on the operator experience . M.A.Kubtan

20. FAST M.A.Kubtan

21. Computerized Tomography • CT is the gold standered for the intra-abdominal diagnosis in the stable patient . • CT is performed using intravenous and often oral contrast as well . • CT has the advantages of sensitivity for the diagnosis of retroperitoneal injury . • CT is usually sufficient to exclude injury . M.A.Kubtan

22. DL Diagnostic Laparoscopy • DL is valuable screening investigation in penetrating trauma . • DL of course in stable patient s following an abdominal or thoraco-abdominal stab wound . • DL is not appropriate for use in the unstable patient . • DL is difficult to exclude all intra-abdominal injuries laparoscopic ally . • DL is not a substitute for open laparatomy especially in the presence of haemoperitonium or contamination. M.A.Kubtan

23. Individual Organ Injury • Liver • The majority of livers injuries occur as a result of blunt injury which may burst liver . • The use of CT for the evaluation of trauma patient ( liver , spleen , kidneys ) . • The liver is a solid organ and may be compressed between the forces and the rib cage or vertebral column. • Penetrating trauma relatively common ( stab wound , bullets cause significant damage ). • Not all penetrating wounds require operative management. M.A.Kubtan

24. Management of liver injury • Push : direct compression . • Pringle : The inflow from the portal triad is controlled by pringle maneuver . • Plug :any holes can be plugged directly . • Pack . M.A.Kubtan

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26. Biliary injuries • Occur mainly from penetrating trauma . • Common bile duct injuries often associate with portal vein injury . M.A.Kubtan

27. Spleen • Splenic injury occurs from direct trauma , • Overlaying ribs ( ninth to 11th ribs ) . • Most isolated splenic injuries espacially in children can be managed non operatively . • In adults in the presence of other injuries laparatomy may become indicated depending on physiological instability . • At laparatomy direct splenorrhaphy , or packed , repaired or placed in a mesh bag. • Selective embolisation of spleen can play a role . • Following splenectomy : changes in blood physiology ,raised platelets count > 1000000 , and white cell count rises and mimic sepsis. M.A.Kubtan

28. Pancreas • Due to blunt trauma . • CT scan the main test of value . • Amylase may be low or normal ( low amylase in 50% of cases .) . • Treatment : conservative , closed suction drainage , distal pancreatectomy , Wipple,s procedures . M.A.Kubtan

29. M.A.Kubtan Renal and urological tract Injury Major abdominal vessels Injury

30. hollow viscus • Stomach . • Duodenum . • Small bowel . • Colon . • Rectum. M.A.Kubtan

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