General surgery Series: Expert Approaches to Abdominal Trauma | Rebekka Troller

Summary

This on-demand session, led by a Consultant Surgeon with expertise in colorectal, emergency, and humanitarian surgery, explores the important topic of Abdominal Trauma. Learn about Assessment, Diagnostic, and Treatment strategies for abdominal injuries including blunt and perforating trauma. Become skilled at damage control, treating such injuries as spleen, liver, bile leaks and pancreatic and bowel injuries. Understand why early closure of the abdomen is essential and get a step by step closure strategy. The session gives case-by-case insights into emergency situations for both stable and haemodynamically unstable patients. It's ideal for medical professionals aspiring to enhance their emergency medical skills and save lives. Don’t miss out on a chance to delve deeper into Trauma Laparotomy, Damage Control, and Non-operative management strategies.

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Description

Embark on a journey of surgical excellence with "General Surgery Series: Expert Approaches to Abdominal Trauma." This webinar is a deep dive into the critical and complex world of abdominal trauma surgery. Designed for surgeons and surgical trainees,Dr Troller will share insights and techniques in managing traumatic abdominal injuries.

This comprehensive learning experience is essential for any healthcare professional looking to enhance their expertise in trauma surgery. Join us to gain valuable knowledge, refine your surgical skills, and stay updated with the evolving practices in the management of abdominal trauma.

None of the planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Dr.Troller, faculty for this educational event, has no relevant financial relationship(s) with ineligible companies to disclose.

Learning objectives

Understand the primary assessment and resuscitation steps for abdominal trauma and be able to identify the hallmarks of catastrophic haemorrhage.
Learn the diagnostic tools and procedures for abdominal trauma, such as FAST scans and CT scans, and know their limitations and recommended applications.
Gain knowledge on the specific treatments for blunt injuries and perforating injuries, including non-operative management, diagnostic laparoscopy, damage control, and trauma laparotomy.
Understand the processes involved in trauma laparotomy, such as immediate evisceration of small bowel and packing, careful removal of packs and systematic inspection of abdomen, and the principles of temporary closure.
Acquire knowledge about the various strategies for laparotomy closure, including techniques for temporary closure, and the timeline for starting to close top to bottom and closing the abdomen fully.

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Abdominal Trauma Assessment, Diagnostic, Treatment Consultant Surgeon, Colorectal, Emergency and Humanitarian Surgery MedAll 18/12/2023Abdominal Trauma: Assessment Primary Survey Primary Assessment and Resuscitation Primary Survey <C> Catastrophic haemorrhage Airway maintenance and C-spine control Breathing and ventilation Circulation with haemorrhage control Disability – address neurological status Exposure Diagnostic FAST scan: Operator dependent, false negative Not detected: diaphragmatic tears, bowel perforation, mesenteric trauma, <200ml CT scan: stable patient, gold standard Treatment Blunt injuries Perforating injuries - Definitive Surgery for most patients(>90%) Damage control! - for haemodynamic unstable patients due to massive blood loss (<10%)Necessity of Damage Control Hypothermic Coaculopathic Low pH Triad of death Treatment: Damage Control Treat the physiology and not the anatomy! Stop the bleeding (pack/clamp) Control sepsis (staple of bowel) Restore perfusion (shunt) Short operation time! Restoration of physiology: ICU After 24-48h: definitive surgery (graft, anastomosis/stoma) Treatment: Damage Control Trauma Laparotomy Immediate evisceration of small bowel and packing: above and below liver, right gutter, above and medial to spleen, left gutter, pelvis Careful removal of packs and systematic inspection of abdomen: Right lobe of liver, gallbladder, left lobe, spleen Diaphragmatic hiatus, oeophagus, stomach, duodenal loop, right kidney, head of pancreas Body and tail of pancreas, left kidney, root of mesentery, small bowel from ligament of Trietz to ileocaecal junction Appendix, caecum, large bowel to rectum Pelvis, uterus, tubes and ovaries Hernial orifices and main iliac vessels Treatment: Blunt/Penetration injuries Non-operative management (NOM)? - watch and wait - conservative management for blunt trauma, stable patient, CT scan Diagnostic laparoscopy (suspected diaphragmatic injury, stable patient) Trauma laparotomy - all penetrating injuries (laparoscopy if stable?) - all unstable patients Treatment: Blunt injuries - Watch and wait for stable patient - high success rate for liver, spleen and renal injuries - But be mindful of point of injury! - splenic injury (splenectomy vs embolisation) - ileocaecal junction - ligament of Treitz - bleeding from hepatic veins - Laparotomy if signs of peritonitis, bleeding, or worsening of clinical signsTreatment: Blunt injuriesPenetration injuries: Clinical ExaminationPenetration injuries: ImagingPenetration injuries: Laparotomy Treatment: spleen IR Embolisation Splenectomy Postsplenectomy: Vaccines - Pneumococcal - Haemophilus - Meningococcal Treatment: Liver Manual compression Pack and resuscitate Pringle maneuver for uncontrolled bleeding Liver suturing Omental packing Treatment: Bile leaks/Pancreatic injuries Drain! Distal pancreatectomy for pancreatic duct injuries Treatment: Bowel injuries Damage control: staple/tie off injured bowel Resection and anastomosis Suture small injuries Stoma Treatment: Trauma laparotomy To close or not to close? Not to close: After damage control laparotomy, risk for abdominal compartment syndrome (extreme swelling, high pressure when closure, aggressive resuscitation), second look laparotomy required Principles of temporary closure: - Protect viscera, prevent compartment syndrome - Protect heat loss, provide mechanical stability - Drain intra abdominal fluids - Prevent retraction of fascia - Easy to apply and allows rapid access - Available and affordable Open Abdomen Techniques for temporary closure: Abthera : negative pressure Bogoto bag: temporary closure without negative pressure. Sterile iv bags/urine bags, sutured to edges of skin using running suture. + abdominal drain. Low costs, availability. Baker’s wound therapy: (Neg. pressure) (+/- continuous fascial traction): suction should not exceed 20-50mmHg neg pressure Skin closure: running suture or clips. Intraabdominal pressure! Treatment: Strategy for laparotomy closure 1. After 48h start to close top to bottom - interrupted figure of 8, 0 Vicryl (fascia) (every 48h +washout, adhesiolysis) 2. Trickle enteral tube feed as soon as off pressors 3. Close the abdomen by day 7-8! Summary ● CT if available ● Damage control ● Continuous reassessment ● Nonoperative management (blunt injuries) ● In doubt → laparotomy ● Close abdomen within 1 week