Abstract
A 26-year-old male is the driver of an automobile that swerved off the road. On admission, he is intoxicated and smells of alcohol. Central nervous system examination is otherwise normal. His pulse is 120; his blood pressure is 110/40. Chest examination is normal. There is a large contusion over the midabdomen. The abdominal examination is difficult to perform owing to the patient’s uncooperative status, but it seems to disclose tenderness and guarding throughout. Which of the following studies is most likely to benefit this patient?
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A.
Chest and abdominal X rays.
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B.
Abdominal angiography.
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C.
Liver-spleen scan.
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D.
Peritoneal lavage.
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E.
Abdominal CAT scan.
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References
Olsen, W.R.: The serum amylase in blunt abdominal trauma. J. Trauma 13: 200, 1973.
Lim, R.C., Glickman, M.G., Hunt, T.K.: Angiography in patients with blunt trauma to the chest and abdomen. Surg. Clin. North Am. 52: 551, 1972.
Freeark, R.J.: Role of angiography in the management of multiple injuries. Surg. Gynecol. Obstet. 128: 761, 1969.
Love, L., Greenfield, G.B., Braum, T.W., Moncada, R., Freeark, R.J., Baker, R.J.: Arteriography of splenic trauma. Radiology 91: 96, 1968.
Olsen, W.R., Redman, H.C., Hildreth, D.H.: Quantitative peritoneal lavage in blunt abdominal trauma. Arch. Surg. 104: 536, 1972.
Perry, J.F., Strate, R.G.: Diagnostic peritoneal lavage in blunt abdominal trauma: Indications and results. Surgery 71: 898, 1972.
Ahmad, W., Polk, H.C.: Blunt abdominal trauma: A prospective study with selective peritoneal lavage. Arch. Surg. 111: 489, 1976.
Thal, E.R., Shires, G.T.: Peritoneal lavage in blunt abdominal trauma. Am. J. Surg. 125: 64, 1973.
Sachatello, C.R., Bivins, B.: Technic for peritoneal dialysis and diagnostic peritoneal lavage. Am. J. Surg. 131: 637, 1976.
Civetta, J.M., Williams, M.J., Richie, R.E.: Diagnostic peritoneal irrigation: A simple and reliable technique. Surgery 67: 874, 1970.
Parvin, S., Smith, D.E., Asher, W.M., Virgilio, R.W.: Effectiveness of peritoneal lavage in blunt abdominal trauma. Ann. Surg. 181: 255, 1975.
Freeark, R.J.:Penetrating wounds of the abdomen. N. Engl. J. Med. 291: 185, 1974.
Lowe, R.J., Boyd, D.R., Folk, F.A., Baker, R.J.: The negative laparotomy for abdominal trauma. J. Trauma 12: 853, 1972.
Forde, K.A., Ganepola, G.A.P.: Is mandatory exploration for penetrating abdominal trauma extinct? The morbidity and mortality of negative exploration in a large municipal hospital. J. Trauma 14: 764, 1974.
Nance, F.C., Cohn, I.: Surgical judgment in the management of stab wounds of the abdomen: A retrospective and prospective analysis based on a study of 600 stabbed patients. Ann. Surg. 170: 569, 1969.
Nance, F.C., Wennar, M.H., Johnson, L.W., Ingram, J.C., Cohn, I.: Surgical judgment in the management of penetrating wounds of the abdomen: Experience with 2212 patients. Ann. Surg. 179: 639, 1974.
Richter, R.M., Zaki, M.H.: Selective conservative management of penetrating abdominal wounds. Ann. Surg. 166: 238, 1967.
Wilder, J.R., Lotfi, M.W., Jurani, P.: Comparative study of mandatory and selective surgical intervention in stab wounds of the abdomen. Surgery 69: 546, 1971.
Netterville, R.E., Hardy, J.D.: Penetrating wounds of the abdomen: Analysis of 155 cases with problems in management. Ann. Surg. 166: 232, 1967.
Spenler, C.W., Benfield, J.R.: Esophageal disruption from blunt and penetrating external trauma. Arch. Surg. 111: 663, 1976.
Rosoff, L., White, E.J.: Perforation of the esophagus. Am. J. Surg. 128: 207, 1974.
Sheely, C.H., Mattox, K.L., Beall, A.C., DeBakey, M.E.: Penetrating wounds of the cervical esophagus. Am. J. Surg. 130: 707, 1975.
Sawyers, J.L., Lane, C.E., Foster, J.H., Daniel, R.A.: Esophageal perforation an increasing challenge. Ann. Thorac. Surg. 19: 233, 1975.
Loop, F.D., Groves, L.K.: Esophageal perforations. Ann. Thorac. Surg. 10: 571, 1970.
Urschel, H.C., Razzuk, M.A., Wood, R.E., Galbraith, N., Pockey, M., Paulson, D.L.: Improved management of esophageal perforation: Exclusion and diversion in continuity. Ann. Surg. 179: 587, 1974.
Loop, F.D.: Trauma to the esophagus. Cleve. Clin. Q. 42: 175, 1975.
Jones, W.R., Hardin, W.J., Davis, J.T., Hardy, J.D.: Intramural hematoma of the duodenum: A review of the literature and case report. Ann. Surg. 173: 534, 1971.
Margolis, I.B., Carnazzo, A.J., Finn, M.P.: Intramural hematoma of the duodenum. Am. J. Surg. 132: 779, 1976.
Fullen, W.D., Selle, J.G., Whitely, D.H., Martin, L.W., Altemeier, W.A.: Intramural duodenal hematoma. Ann. Surg. 179: 549, 1974.
King, W.L.M., Provan, J.L.: Diagnosis and management of duodenal injuries. Can. J. Surg. 15: 269, 1972.
Corley, R.D., Norcross, W.J., Shoemaker, W.C.: Traumatic injuries to the duodenum: A report of 98 patients. Ann. Surg. 181: 92, 1975.
Morton, J.R., Jordan, G.L.: Traumatic duodenal injuries: Review of 131 cases. J. Trauma 8: 127, 1968.
Bender, H.W., Sebor, J., Zuidema, G.D.: Serosal patch grafting for closure of posterior duodenal defects. Am. J. Surg. 115: 103, 1968.
Jones, S.A., Gazzaniga, A.B., Keller, T.B.: The serosal patch: A surgical parachute. Am. J. Surg. 126: 186, 1973.
McInnis, W.D., Aust, J.B., Cruz, A;B., Root, H.D.: Traumatic injuries of the duodenum: A comparison of 1° closure and the jejunal patch. J. Trauma 15: 847, 1975.
White, E.J., Yellin, A.E., Berne, C.J., Donovan, A.J.: Duodenal “diverticulization” for duodenal and pancreatic injury. Am. J. Surg. 127: 503, 1974.
Beall, A.C., Bricker, D.L., Alessi, F.J., Whisennand, W.W., DeBakey, M.E.: Surgical considerations in the management of civilian colon injuries. Ann. Surg. 173: 971, 1971.
Josen, A.S., Ferrer, J.M., Forde, K.A., Zikria, B.A.: Primary closure of civilian colorectal wounds. Ann. Surg. 176: 782, 1972.
LoCicero, J., Tajima, T., Drapanas, T.: A half century of experience in the management of colon injuries: Changing concepts. J. Trauma 15: 575, 1975.
Kirkpatrick, J.R.:The exteriorized anastomosis: Its role in surgery of the colon. Surgery 82: 362, 1977.
Getzen, L.C., Pollak, E.W., Wolfman, E.F.: Abdominoperineal resection in the treatment of devascularizing rectal injuries. Surgery 82: 310, 1977.
Winkelstein; J.A.: Splenectomy and infection. Arch Intern. Med. 137: 1516, 1977.
Eraklis, A.J., Filler, R.M.: Splenectomy in childhood: A review of 1413 cases. J. Pediatr. Surg. 7: 382, 1972.
Eraklis, A.J., Kevy, S.V., Diamond, L.K., Gross, R.E.: Hazard of overwhelming infection after splenectomy in childhood. N. Engl. J. Med 276: 1225, 1967.
Gopal, V., Bisno, A.L.: Fulminant pneumococcal infections in “normal” asplenic hosts. Arch Intern. Med. 137: 1526, 1977.
Ellis, E.F., Smith, R.T.: The role of the spleen in immunity with special reference to the post-splenectomy problem in infants. Pediatrics 37: 111, 1966.
Constantopoulos, A., Najjar, V.A., Wish, J.B., Necheles, T.H., Stolbach, L.L.: Defective phagocytosis due to tuftsin deficiency in splenectomized subjects. Am. J. Dis. Child. 125: 663, 1973.
Ein, S.H., Shandling, B., Simpson, J.S., Stephens, C.A., Bandi, S.K., Biggar, W.D., Freedman, M.H.: The morbidity and mortality of splenectomy in childhood. Ann. Surg. 185: 307, 1977.
Douglas, G.J., Simpson, J.S.: The conservative management of splenic trauma. J. Pediatr. Surg. 6: 565, 1971.
Shandling, B.: Splenectomy for trauma: A second look. Arch. Surg. 111: 1325, 1976.
Burrington, J.D.: Surgical repair of a ruptured spleen in children. Arch. Surg. 112: 417, 1977.
Mishalany, H.: Repair of the ruptured pleen. J. Pediatr. Surg. 9: 175, 1974.
Morgenstern, L.: Microcrystalline collagen used in experimental splenic injury. Arch. Surg. 109: 44, 1974.
Morgenstern, L.: The avoidable complications of splenectomy. Surg. Gynecol. Obstet. 145: 525, 1977.
Dickerman, J.D.: Bacterial infection and the asplenic host: A review. J. Trauma 16: 662, 1976.
Ammann, A.J., Addiego, J., Wara, D.W., Lubin, B., Smith, W.B., Mentzer, W.C.: Polyvalent pneumococcalpolysaccharide immunization of patients with sickle cell anemia and patients with splenectomy. N. Engl. J. Med. 297: 897, 1977.
Smit, P., Oberholzer, D., Hayden-Smith, S., Koornhof, H.J., Hilleman, M.R.: Protective efficacy of pneumococcal polysaccharide vaccines. J.A.M.A. 238: 2613, 1977.
Brewster, D.C.: Spenosis: Report of two cases and review of the literature. Am. J. Surg. 126: 14, 1973.
Widmann, W.D., Laubscher, F.A.: Splenosis: A disease or a beneficial condition? Arch. Surg. 102: 152, 1971.
Shifir, M., Deysine, M., Bramis, J., Acker, P., Aufses, A.H.: Immunologic function of subcutaneous splenic implants in mice. Surg. Forum 28: 335, 1977.
Walt, A.J.: The mythology of hepatic trauma—Or Babel revisited. Am. J. Surg. 135: 12, 1978.
Trunkey, D.D., Shires, G.T., McClelland, R.: Management of liver trauma in 811 consecutive patients. Ann. Surg. 179: 722, 1974.
Defore, W.W., Mattox, K.L., Jordan, G.L., Beall, A.C.: Management of 1590 consecutive cases of liver trauma. Arch. Surg. 111: 493, 1976.
Graham, R.R., Cannell, D.: Accidental ligation of the hepatic artery. Br. J. Surg. 20: 566, 1932.
Aaron, S., Fulton, R.L., Mays, E.T.: Selective ligation of the hepatic artery for trauma of the liver. Surg. Gynecol. Obstet. 141: 187, 1975.
Mays, E.T., Wheeler, C.S.: Demonstration of collateral arterial flow after interruption of hepatic arteries in man. N. Engl. J. Med. 290: 993, 1974.
Koehler, R.E., Korobkin, M., Lewis, F.: Arteriographic demonstration of collateral arterial supply to the liver after hepatic artery ligation. Radiology 117: 49, 1975.
Merendino, K.A., Dillard, D.H., Cammock, E.E.: The concept of surgical biliary decompression in the management of liver trauma. Surg. Gynecol. Obstet. 117: 285, 1963.
Lucas, C.E.: Prospective clinical evaluation of biliary drainage in hepatic trauma. Ann. Surg. 174: 830, 1971.
Lucas, C.E., Walt, A.J.: Analysis of randomized biliary drainage for liver trauma in 189 patients. J. Trauma 12: 925, 1972.
Bowen, J.C., Flemming, W.H.: Upper gastrointestinal bleeding associated with biliary diversion after hepatic injury. Ann. Surg. 177: 402, 1973.
Schrock, T. Blaisdell, F.W., Mathewson, C.: Management of blunt trauma to the liver and hepatic veins. Arch. Surg. 96: 698, 1968.
Jones, R.C., Shires, G.T.: Pancreatic trauma. Arch. Surg. 102: 424, 1971.
Smith, A.D., Woolverton, W.C., Weichert, R.F., Drapanas, T.: Operative management of pancreatic and duodenal injuries. J. Trauma 11: 570, 1971.
Jones, R.C.: Management of pancreatic trauma. Ann. Surg. 187: 555, 1978.
Moretz, J.A., Campbell, D.P., Parker, D.E., Williams, G.R.: Significance of serum amylase level in evaluating pancreatic trauma. Am. J. Surg. 130: 739, 1975.
White, P.H., Benfield, J.R.: Amylase in the management of pancreatic trauma. Arch. Surg. 105: 158, 1972.
Northrup, W.F., Simmons, R.L.: Pancreatic trauma: A review. Surgery 71: 27, 1972.
Yellin, A.E., Vecchione, T.R., Donovan, A.J.: Distal pancreatectomy for pancreatic trauma. Am. J. Surg. 124: 135, 1972.
Anderson, C.B., Connors, J.P., Mejia, D.C., Wise, L.:Drainage methods in the treatment of pancreatic injuries. Surg. Gynecol. Obstet. 138: 587, 1974.
Mitchell, J.P.: Trauma to the urinary tract. N. Engl. J. Med. 288: 90, 1973.
Holcroft, J.W., Trunkey, D.D., Minagi, H., Korobkin, M.T., Lim, R.C.: Renal trauma and retroperitoneal hematomas: Indications for exploration. J. Trauma 15: 1045, 1975.
Ring, E.J., Waltman, A.C., Athanasoulis, C., Smith, J.C., Baum, S.: Angiography in pelvic trauma. Surg. Gynecol. Obstet. 139: 375, 1974.
Andrus, C.H., Morton, J.H.: Rupture of the diaphragm after blunt trauma. Am. J. Surg. 119: 686, 1970.
Hauser, C.W., Perry, J.F.: Control of massive hemorrhage from pelvic fractures by hypogastric artery ligation. Surg. Gynecol. Obstet. 121: 313, 1965.
VanUrk, H., Perlberger, R.R., Muller, H.: Selective arterial embolization for control of traumatic pelvic hemorrhage. Surgery 83: 133, 1978.
Paster, S.B., VanHouten, F.X., Adams, D.F.: Percutaneous balloon catherization: A technique for the control of arterial hemorrhage caused by pelvic trauma. J.A.M.A. 230: 573, 1974.
Hawkins, L., Pomerantz, M., Eiseman, B.: Laparotomy at the time of pelvic fracture. J. Trauma 10: 619, 1970.
Batalden, D.J., Wickstrom, P.H., Ruiz, E., Gustilo, R.B.: Value of the G suit in patients with severe pelvic fracture: Controlling hemorrhagic shock. Arch Surg. 109: 326, 1974.
Parmley, L.F., Mattingly, T.W., Manion, W.C., Jahnke, E.J.: Non-penetrating traumatic injury of the aorta. Circulation 17: 1086, 1958.
Kirsh, M.M., Behrendt, D.M., Orringer, M.B., Gago, O., Gray, L.A., Mills, L.J., Walter, J.F., Sloan, H.: The treatment of acute traumatic rupture of the aorta: 1 10 year experience. Ann. Surg. 184: 308, 1976.
Schwartz, M.L., Fisher, R., Sako, Y., Castaneda, A.R., Grage, T.B., Nicoloff, D.M.: Post-traumatic aneurysms of the thoracic aorta. Surgery 78: 589, 1975.
Moore, C.H., Wolma, F.J., Brown, R.W., Derrick, J.R.: Vascular trauma: A review of 250 cases. Am. J. Surg. 122: 576, 1971.
Drapanas, T., Hewitt, R.L., Weichert, R.F., Smith, A.D.: Civilian vascular injuries: A critical appraisal of three decades of management. Ann. Surg. 172: 351, 1970.
Burnett, H.F., Parnell, C.L., Williams, G.D., Campbell, G.S.: Peripheral arterial injuries: A reassessment. Ann. Surg. 183: 701, 1976.
McDonald, E.J., Goodman, P.C., Winestock, D.P.: The clinical indications for arteriography in trauma to the extremity. Diagn. Radiol. 116: 45, 1975.
Snyder, W.H., Thal, E.R., Bridges, R.A., Gerlock, A.J., Perry, M.O., Fry, W.J.: The validity of normal arteriography in penetrating trauma. Arch. Surg. 113: 424, 1978.
Perry, M.O., Thal, E.R., Shires, G.T.: Management of arterial injuries. Ann. Surg. 173: 403, 1971.
Bradley, E.L.: The anterior tibial compartment syndrome. Surg. Gynecol. Obstet. 136: 289, 1973.
Sheridan, G.W., Matsen, F.A.: Fasciotomy in the treatment of the acute compartment syndrome. J. Bone Joint Surg. (Am.) 58-A: 112, 1976.
Clayton, J.M., Hayes, A.C., Barnes, R.W.: Tissue pressure and perfusion in the compartment syndrome. J. Surg. Res. 22: 333, 1977.
Matsen, F.A., Mayo, K.A., heridan, G.W., Krugmire, R.B.: Monitoring of intramuscular pressure. Surgery 79: 702, 1976.
Whitesides, T.E., Haney, T.C., Morimoto, K., Harada, H.: Tissue pressure measurements as a determinant for the need of fasciotomy. Clin. Ortho. 113: 43, 1975.
Weinstein, L.: Tetanus. N. Engl. J. Med. 289: 1293, 1973.
Faust, R.A., Vickers, O.R., Cohn, I.: Tetanus: 2449 cases in 68 years at Charity Hospital. J. Trauma 16: 704, 1976.
Furste, W., Wheeler, W.L.: Tetanus: A team disease. Curr. Probl. Surg., October 1972, p. 25.
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Pickleman, J. (1982). Trauma. In: Problems in General Surgery. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-1755-6_12
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