Management of patients with abdominal wounds
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ROTARU, Mihai; ŞCERBATIUC-CONDUR, Corina. Management of patients with abdominal wounds. In: MedEsperaInternational Medical Congress for Students and Young Doctors. 7, 3-5 mai 2018, Chişinău. Chisinau, Republic of Moldova: 2018, pp. 109-110.
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Dublin Core
MedEspera
7, 2018
Congresul "International Medical Congress for Students and Young Doctors"
7th edition, Chişinău, Moldova, 3-5 mai 2018

Management of patients with abdominal wounds


Pag. 109-110

Rotaru Mihai, Şcerbatiuc-Condur Corina
 
”Nicolae Testemițanu” State University of Medicine and Pharmacy
 
Disponibil în IBN: 6 noiembrie 2020


Rezumat

Introduction. Modern management of abdominal wounds remains controversial and undergoes continuous re-evaluation. Abdominal wound management varies according to the following factors: mechanism, site, haemodynamics and neurological status, associated injuries and institutional resources. Aim of the study. Analysis of treatment outcomes in patients with abdominal wounds. Materials and methods. A retrospective and prospective study was performed on a group of 89 patients with abdominal wounds treated at the PMSI Institute of Emergency Medicine for the period 01.01.2015 - 31.12.2017. Clinical features and evolution, paraclinical investigations and surgical protocols in patients with abdominal wounds were analyzed. Results. Data analysis revealed: M:F ratio -7.9:1; mean age - 36.34 ± 1.3 years; patients with non-penetrating wounds - 44 (49.4%) and penetrating wounds - 45 (50.6%). Patients with non-penetrating wounds (n = 44) were subject to revision of the wound canal and subsequent primary surgical wound debridement. Haemodynamically stable patients with penetrating wounds without peritoneal signs (n = 18) had the following diagnostic algorithm: abdominal X-ray (17), FAST (17), laparoscopy (4), they underwent primary surgical wound debridement and were admitted for monitoring. Haemodynamically unstable patients with penetrating wounds and with peritoneal or hemorrhagic syndrome (n = 27) followed: abdominal X-ray (14), FAST (15), diagnostic laparoscopy (5), subsequently undergoing emergency exploratory laparotomy, in all cases injuries of intra- and extra-abdominal viscera (32) and blood vessels (3) were detected. Nine (33.33%) patients developed complications after laparotomy in the postoperative period: pneumonia (7), evisceration (1), wound sepsis (1). The duration of hospital stay of patients with non-penetrating wounds was on average 3.45 ± 0.3 days, of nonoperatively treated penetrating wounds - 2.42 ± 0.52, compared with cases of lesions of the abdominal viscera treated with curative laparotomy - 8.2 ± 1.2, (p <0.001). One patient died before laparotomy. Of patients which underwent laparotomy, 3 died (11.11%). Conclusions. Abdominal wound management is of major concern and includes patient selection for different treatment tactics. Haemodynamically stable patients without peritoneal signs require clinical examination and dynamic monitoring, and those haemodynamically unstable with hemorrhagic and peritoneal syndrome - emergency exploratory laparotomy. Differentiated therapeutic attitude leads to avoidance of non-therapeutic laparotomies, decrease of the postoperative complications rate, hospital stay and medical costs.

Cuvinte-cheie
Abdominal wounds, Diagnosis, treatment