Ultrasonographic findings in Blunt Abdominal Trauma among Yemeni Patients in Sanaa

69 Pages·2005·2.24 MB·English

SD0500027
UNIVERSITY OF KHARTOUM
Faculty of Medicine
Postgraduate Medical Studies Board
Ultrasonographic findings in Blunt Abdominal
Trauma among Yemeni Patients in Sanaa
By.
Dr. AI Najjar Ahmed Hussien Al Najjar
A thesis submitted in partial fulfillment for the requirements of the
Degree of Clinical MD in Radiology, 2004
Supervisor
Dr. Yahia Akayeb AlArabi
FRCSE, FRCS (L), MD (B'ham)
Professor of Surgery
Faculty of Medicine
University of Khartoum
Co-supervisor
Dr. Osman Abdel Wahab Abd Alia
MBBS, DMRD,
Consultant Radiologist and Sonologist
Ass. Professor -
Faculty of Medicine
University of Khartoum
CONTENTS
Page
Dedication I
Acknowledgment II
Abbreviations Ill
Abstract (English) IV
Abstract (Arabic) VI
List of tables VIII
List of figures X
CHAPTER ONE
INTRODUCTION AND LITERATURE REVIEW 1
OBJECTIVES 29
CHAPTER TWO
PATIENTS, MATERIALS & METHODS 30
CHAPTER THREE
RESULTS 33
CHAPTER FOUR
DISCUSSION 47
CONCLUSION 51
RECOMMENDATIONS 52
REFERENCES 53
APPENDIX (Questionnaire)
dedication
To my late father, who would have been
thrilled by this work, to my mother,
to all members of my family "Wife and
children", and my teachers.
Dr. AI najjar
Acknowledgements
/ would like to express my deepest gratitude and thanks to
Professor Yahia Altayeb AlArabi, for his continuous guidance,
constant supervision, assistance and advice during the preparation
of this work.
I am also grateful to Dr. Osman Abdel Wahab, for his
help, guidance, support and supervision in completing this work.
I would also like to thank my co-supervisor in Yemen,
Dr. Mohammed Issa, the consultant surgeon in Al Thawra
Hospital, Sana'a, Yemen and Dr. Adil Mahyoob, consultant
radiologist in Al Thawra Hospital, Sana'a, Yemen, for their help,
encouragement, support and supervision.
I would also like to thank Dr. Ramiz Al Aswadi,
Dr. Mohammed AlAbsi (Head Department of Radiology in Sana'a
University, Faculty of Medicine) and Dr. Mohammed AlKatta'a
(Head Department of Surgery in Al Thawra Hospital, Sana'a,
Yemen), for his advice and help.
My thanks are also to the members of staff in the Surgery
and Radiology Departments at Al Thawra Hospital, Sana'a, for
their help and co-operation.
My thanks are also extended to Miss. Khadiga at the
Sudanese Ministry of Health, Statistical Department and Miss
Widad for analysis of data and typing the manuscript in its final
form.
Dr. Al Najjar Ahmed Hussein Al Najjar.
II
ABBREVIATIONS
BAT Blunt Abdominal Trauma
CT Computed Tomography
DPL Diagnostic Peritoneal Lavage
HZ Hertz
I.V.U Intravenous Urography
MHZ Megahertz
US, U/S Ultrasonography / Ultrasound
in
ABSTRACT
A hundred and thirty patients (104 males, and 26 females)
with suspected blunt abdominal trauma were admitted to this
prospective study at Althawra Hospital, Sana'a, Yemen in the
period between June and December 2003.
Real-time ultrasonography of the abdomen was performed
in all patients. Fifty-six patients showed U/S evidence of visceral
injury. Fourteen injuries of spleen, 7 had evidence of liver and 8
had renal injuries. Only eight needed a laparatomy because of
cardiovascular instability and the laparatomy confirmed the
ultrasound findings. The remainder were treated conservatively
with good results. It is of interest that there was one ultrasonic sign
of fluid in one patient who progressed well on conservative
therapy. Ultrasonic signs of visceral laceration or contusion were
found in patients who had 2 up to 8 sonic findings. It appears that
visceral injury always gives more than two sonic signs.
The remaining 33 patients only had intraperitoneal fluid,
only one of them had volvulus. It is not possible to state the nature
of fluid, whether it is an exudate, transudate, blood or lymph.
Diagnostic peritoneal lavage would have been helpful. Seven
patients died, most of them due to associated injuries, mainly head
JV
injury and cardiovascular collapse, one patient died on table and
had retroperitonieal haematoma extending from pelvis to the
mesentery of transverse colon and had no abdominal organ injury.
The sensitivity of ultrasonography for liver was 87.5% and for
spleen 100%.
Ultrasonography is sensitive, safe, cost effective and non
invasive method for screening patients with blunt abdominal
trauma.
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VII
List of Tables
Page No.
Tables in introduction and literature review:
Table I: Velocity of sound in various materials 3
Table II: Operative findings and U/S results 17
Table III: DPL and U/S in the evaluation of solid viscus injury 23
Table IV: Injuries detected at CT in patients with true positive
abdominal U/S results 24
Table V: Injuries detected at CT in patients with false negative
abdominal U/S results 25
Table VI: False negative U/S findings 28
Table VII: False positive U/S findings 28
Tables in Results:
Table 1a: Sex distribution of 130 patients with blunt
abdominal trauma. 38
Table 1 b: Age distribution of 130 patients with blunt
abdominal trauma. 39
Table 1c: Age distribution of 104 males and 26 females
patients out of 130 total patients with blunt
abdominal trauma 40
Table 2: Causes of injury to the 130 patients with blunt
abdominal trauma 41
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