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PENCITRAAN PADA
TRAUMA ABDOMEN
DEWASA DAN ANAK
Oleh:
dr. HANS MARPAUNG, SpB, FICS
Shotgun wounds
Non Penetrating
Trauma
-
Compression
- Gunshot wound
- Crush
- Stabbing
- Seat belt
- Acceleration/Deceleration
Abdominal Injuries
Blunt Trauma
Aortic rupture
Splenic rupture
Liver rupture or
laceration
Diaphragmatic tear
Pelvic fracture
Intestinal tear
Bladder rupture
Penetrating Trauma
Splenic rupture
Liver rupture or
laceration
Kidney laceration
Intestinal
lacerations
Bladder rupture
Laceration of
blood vessels
Regions of the
abdomen
The abdomen can be arbitrarily divided into
4 areas:
intrathoracic abdomen
pelvic abdomen
retroperitoneal abdomen
true abdomen
THIS TO SHOW YOU
HOW RADIOLOGY IS
BADLY NEEDED
You need
RADIOLOGY
Injury to
these structures may be
extraperitoneal in nature and
therefore difficult to diagnose.
fallopian tubes, and uterus.
Box
Black
- Organ injurie ?
You need
RADIOLOGY
is
How to establish non-invasively
the presence and extent of internal injury in a patient
presenting with abdominal trauma. Such patients are
often in severe pain and may sometimes be
unconscious.
Radiologic step
1.
Plain radiography
2.
FAST:
C T Scan
4.
Angiography
5.
MRI
is useful to diagnose
PNEUMOPERITONEUM
Radiologic step
Abdominal ultrasound is
the first imaging modality
of choice
(FAST = Focused
assessment with
sonography for trauma)
FAST
A POSITIVE FAST
indicates peritoneal
penetration, but is poor at discriminating for
injuries requiring intervention
significant abdominal injury.
It is therefore impossible to recommend FAST
as the only investigation for the assessment
of penetrating intra-abdominal injury. It MAY
have a role in combination with other
investigations
FASTFocused Assessment
with Sonography for Trauma
DPL
as the procedure of choice in the evaluation of
hemodynamically unstable trauma patients.
DPL
FAST
RSNA, 2003
Radiology 2003;227:95103
Hemodynamically unstable
OR
Hemodynamically stable
FAST Ultrasound,
DPL or
Celiotomy.
FAST examination is
NEGATIVE in hemodynamically unstable
When the
trauma patients.
are a diagnostic
challenge to the
treating physician.
Options include
DPL, exploratory
Laparotomy,
and, possibly, a CT
scan after aggressive
resuscitation.
FAST
POSTIVE
perform
exploratory
laparotomy
NEGATIVE
ULTRASONOGRAPHY
quick,
noninvasive,
inexpensive,
and
transportable
tool
Branney SW, Wolfe RE, Moore EE, et al. Quantitative sensitivity of ultrasound
in detecting free intraperitoneal fluid. J Trauma 1995; 39:375380.[Medline
A
Type IIIa renal injury from a traffic accident in a 6-year-old
boy.
A, Longitudinal sonogram of the right kidney showing a
poorly defined echogenic area with an irregular anechoic
area in the midpole of the kidney (arrows).
B, Computed tomographic scan showing a lowattenuation area in the renal parenchyma (arrow) with
perirenal hematoma (arrowhead), representing a deep
COLOUR DOPPLER
ULTRASOUND
Trauma may result in vascular damage with associated
disruption of blood supply to any of the abdominal
Colour Doppler
ultrasound
organs.
is
useful for mapping out the colour flow in the
spleen, liver or kidneys to confirm suspected
damage of vessels.
ABDOMINAL TRAUMA
IMAGING
GASTRO-INTESTINAL STUDIES
Bowel Rupture
Pneumoperitoneum
Imaging findings
There is a large quantity of
free air in this patient's
abdomen.
The image is obtained with the
patient supine, yet there are
crescents of air seen beneath
each hemidiaphragm (white
arrows), and both sides of the
bowel wall are visible (blue
arrow).
There is a lucency overlying
Postembolization selective
arteriogram The image
shows cessation of the
bleeding in the right lobe of
the liver.
CONCLUSION
Medical imaging has an invaluable role to play in the
management of the patient with blunt abdominal
trauma using various modalities that are currently
available in the radiological amarmentarium.
Choice and employment of any particular radiological
investigation would depend on the equipment available
at a particular facility and the urgency of the demand
especially in life threatening situations. In terms of
cost-effectiveness it is better to start with less
sophisticated and cheaper options like US for detection
of solid viscera injury especially when the patients
condition is stable. If there is doubt and in the face of
deteriorating condition of the patient without a clear-cut
diagnosis, then sophisticated CT examinations should
Thank You