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Diaphragm laceration - laparotomy

Diaphragm laceration

Andrei Amatuzzi & Marolon Rangel, Cajuru Trauma Center, Brazil

Right diaphragm laceration - laparotomy

Right diaphragm laceration at laparotomy

Harry Voesten, Netherlands

Left diaphragm laceration stomach spleen herniation - Laparotomy

Left diaphragm rupture (blunt) with stomach & spleen herniation - Laparotomy

trauma.org

Left diaphragm laceration stomach spleen herniation - laparotomy 02

Left diaphragm laceration with stomach & spleen herniation - laparotomy view showing stomach injury

trauma.org

Left diaphragm laceration stomach spleen herniation - repair

Left diaphragm laceration with stomach & spleen herniation - repair

trauma.org

Left diaphragm injury with stomach, colon herniation 03

Left diaphragm injury with stomach, colon herniation

Renato Borba, Brazil

Left diaphragm injury with stomach, colon herniation 02

Left diaphragm injury with stomach, colon herniation

Renato Borba, Brazil

Left diaphragm injury with stomach, colon herniation 01

Left diaphragm injury with stomach, colon herniation

Renato Borba, Brazil

Grade 3 spleen injury following motor vehicle collision

Grade 3 spleen injury following MVC

Roy Danks, Northeast Regional Medical Center, Kirksville, MO

Mesh splenorraphy of Grade 3 spleen injury

Roy Danks, Northeast Regional Medical Center, Kirksville, MO

Grade 2 spleen injury - motor vehicle collision

Caesar Ursic

Grade 2 spleen injury - omental pedical repair 02

Grade 2 spleen injury - omental pedical repair

Caesar Ursic

Grade 2 spleen injury - omental pedical repair 01

Grade 2 spleen injury - omental pedical repair

Caesar Ursic

Grade 3 spleen injury - delayed rupture

Luis Filipe Pinheiro, Hospital S. Teot󮩯, Viseu, Portugal

Grade 3 spleen injury - splenectomy

Luis Filipe Pinheiro, Hospital S. Teot󮩯, Viseu, Portugal

Grade 3 spleen injury - mesh splenorrhaphy

Horacio A. Massotto, Costa Rica

Grade 5 spleen injury - post splenectomy

R M Khattar, Delhi, India

Grade 4 liver laceration (blunt trauma)

Ronald Stewart

Grade 4 liver laceration - omental patch repair 01

Grade 4 liver laceration - omental patch repair

Ronald Stewart

Grade 4 liver laceration - omental patch repair 02

Grade 4 liver laceration - omental patch repair

Ronald Stewart

Grade 2 liver injury - gunshot wound - entrance

Ronald Stewart

Grade 2 liver injury - gunshot wound - exit

Ronal Stewart

Gunshot wound to right flank - liver injury

Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel

Grade 3 liver injury - gunshot wound 01

Grade 3 liver injury - gunshot wound

Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel

Grade 3 liver injury - gunshot wound 02

Grade 3 liver injury - gunshot wound

Arieh Eitan, Western Galilee Hospital, Nahariyya, Israel

Grade 4 liver injury - relook laparotomy

Carlos Villa, Colombia

Grade 1 liver injury - argon beam haemostasis

Yoram Kluger, Rabin Trauma Center, Tel-Aviv

Gunshot liver - balloon tamponade

Jack Sava, Washington Hospital Center, Washington, D.C.

Grade 5 liver injury and IVC injury 01

Grade 5 liver injury and IVC injury

Horacio A. Massotto, Costa Rica

Grade 5 liver injury and IVC injury 02

Grade 5 liver injury and IVC injury

Horacio A. Massotto, Costa Rica

Grade 5 liver injury and IVC injury 03

Grade 5 liver injury and IVC injury

Horacio A. Massotto, Costa Rica

Grade 3 renal laceration - retroperitoneal haematoma

trauma.org

Grade 3 renal laceration - injury

trauma.org

Grade 3 renal laceration - teflon buttress repair

trauma.org

Gunshot kidney - grade 3 injury - entrance wound

Fabiano Erzinger

Gunshot kidney - grade 3 injury - exit wound

Fabiano Erzinger

Gunshot kidney - grade 3 injury - renal haematoma

Fabiano Erzinger

Gunshot kidney - grade 3 injury - omental patch repair

Fabiano Erzinger

Grade 4 intraperitoneal bladder injury 01

Grade 4 intraperitoneal bladder injury

Renata Borbo, Brazil

Grade 4 intraperitoneal bladder injury 01

Grade 4 intraperitoneal bladder injury

Renata Borbo, Brazil

Grade 3 renal injury 01

Grade 3 renal injury

Renata Borbo, Brazil

Grade 3 renal injury 02

Grade 3 renal injury

Renata Borbo, Brazil

Grade 3 renal injury 03

Grade 3 renal injury

Renata Borbo, Brazil

Grade 3 pancreas injury - distal pancreatectomy (spleen preserving)

Grade 3 pancreas injury - distal pancreatectomy

Richard Sidwell, Des Moines, Iowa, USA

Grade 3 pancreas injury - laparotomy

Richard Sidwell, Des Moines, Iowa, USA

Gunshot wound to pancreatic head - 01

Gunshot to pancreatic head

Andrei Amatuzzi, University Hospital of Cajuru, Brazil

Gunshot wound to pancreatic head - 02

Gunshot to pancreatic head

Andrei Amatuzzi, University Hospital of Cajuru, Brazil

Pancreatic and duodenal stab injury

pancreas and duodenum stab injury

Andrei Amatuzzi, University Hospital of Cajuru, Brazil

Grade 5 blunt pancreas & duodenum injury - superior mesenteric vein repair

Superior mesenteric vein repair - pancreaticoduodenal injury

Luis Filipe Pinheiro, Hospital S㯠Teot󮩯, Viseu, Portugal

Grade 5 blunt pancreas & duodenum injury

Blunt pancreaticoduodenal injury

Luis Filipe Pinheiro, Hospital S㯠Teot󮩯, Viseu, Portugal

Gunshot wound to stomach - anterior stomach wall

Gunshot wound to stomach - anterior wall

trauma.org

Gunshot wound to stomach - blood in NG

trauma.org

Gunshot wound to stomach - entry wound

trauma.org

Towel clip closure of the abdomen

Towel-clip closure of the abdomen

Maurício Mentz, Eduardo Jorgens, Jorge Carlotto, Hospital da Cidade, Passo Fundo, Rio Grande do Sul, Brasil

Post-traumatic diaphragm tear - mesh repair

Mesh repair of diaphragm laceration

Antonio di Muria, San Giovanni Bosco hospital, Naples, Italy

Post-traumatic diaphragm tear - suture repair

Suture repair of diaphragm laceration

Antonio di Muria, San Giovanni Bosco hospital, Naples, Italy

Post-traumatic diaphragm tear - laparotomy

Diaphragm laceration at laparotomy

Antonio di Muria, San Giovanni Bosco hospital, Naples, Italy

Balloon tamponade of liver laceration

Balloon tamponade of gunshot liver injury

Jorge Carlotto, Passo Fundo, Rio Grande do Sul, Brasil

Zone 1 retroperitoneal haematoma

Jorge Carlotto, Maurício Mentz, Júlio Zanini - Hospital da Cidade, Passo Fundo, Rio Grande do Sul, Brasil

Controlled zone 1 retroperitoneal haemorrhage

Oversewn gastroduodenal artery & haematoma evacuation.

Jorge Carlotto, Maurício Mentz, Júlio Zanini - Hospital da Cidade, Passo Fundo, Rio Grande do Sul, Brasil

Gastroduodenal artery injury with active haemorrhage

Suture ligation of gastroduodenal artery injury

Jorge Carlotto, Maurício Mentz, Júlio Zanini - Hospital da Cidade, Passo Fundo, Rio Grande do Sul, Brasil

Liver Explosion

Grade V liver injury from gunshot

Luis Filipe Pinheiro Hospital S. Teotónio - VISEU PORTUGAL

Liver and Kidney 02

Gunshot Liver Grade 4

Carlos Zavaleta

Liver and Kidney 03

Gunshot Kidney - Grade 4 injury

Carlos Zavaleta

Liver and Kidney 05

Liver injury post pack removal

Carlos Zavaleta

Towel clip closure of the chest and abdomen

Towel clip closure for damage control post thoracotomy and laparotomy

Luciano Pereira e Jorge Carlotto Serviço de Cirurgia Geral e do Trauma do Hospital da Cidade - Passo Fundo - RS – Brasil

Grade III Blunt Pancreatic Injury 02

Intraoperative Findings

Juan C Duchesne MD, FACS, FCCP Spirit Of Charity Hospital, NOLA

Grade III Blunt Pancreatic Injury 03 - Spleen Preserving Distal Pancreatectomy

Splenic Preserving Distal Pancreatectomy

Juan C Duchesne MD, FACS, FCCP Spirit of Charity Hospital NOLA

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Research Blog Entries

Variability in pediatric splenic injury care: results of a national survey of general surgeons.

Karim, London, UK, December 28, 2010

PubMed ID: 21079092
Arch Surg. 2010 Nov;145(11):1048-53
Authors: Bowman SM, Bulger E, Sharar SR, Maham SA, Smith SD

Abstract:

BACKGROUND: Although nonoperative management is the standard of care for hemodynamically stable children with blunt splenic trauma, significant variation in practice exists. Little attention has been given to physician factors associated with management differences.

DESIGN: Nationally representative mail survey conducted in June 2008.

SETTING: United States.

PARTICIPANTS: Ten percent random sample of active, dues-paying fellows in the American College of Surgeons.

MAIN OUTCOME MEASURES: Knowledge, attitudes, and beliefs toward pediatric splenic injury management, including the role of clinical practice guidelines.

RESULTS: Almost all of the 375 responding surgeons (97.4%) agreed that surgical intervention is not immediately necessary for hemodynamically stable children. However, surgeons reported significant disagreement regarding whether blood should be administered before operative intervention for hemodynamically unstable children and whether explorative surgery is needed for stable patients with evidence of contrast extravasation on computed tomography. Only 18.7% of surgeons reported being very familiar with the clinical practice guidelines for the management of pediatric blunt splenic trauma from either the Eastern Association for the Surgery of Trauma or the American Pediatric Surgical Association. Surgeons who were very familiar with either guideline were significantly more likely to rate the guidelines as beneficial (90.0% vs 72.8%, P = .002).

CONCLUSIONS: General surgeons reported varying degrees of familiarity with and use of clinical practice guidelines for pediatric splenic injury management. Limited pediatric experience and lack of pediatric hospital resources may limit more widespread adoption of nonoperative management. Targeted educational interventions may help increase surgeon knowledge of guidelines and best practices.