دانلود کتاب بیماری های شکم و لگن 2023-2026

In a patient admitted with a potential abdominal trauma, a normal clinical examination has been shown insufficient per se to rule out a major intra-abdominal injury. An imaging method should therefore be systematically obtained. Based on the ATLS recommendations, a FAST (focused assess­ment with sonography for trauma) is immediately performed, in addition to pelvic X-Ray, for the initial triage of trauma patients. Six regions are classically examined at FAST: right upper quadrant, hepatorenal fossa (Morison’s pouch), left upper quadrant (subphrenic space), splenorenal recess, pel­vis (Douglas recess), and pericardium.

Depiction of a large amount of free intraperitoneal fluid in a hemodynamically unstable patient will mandate imme­diate laparotomy, or CT examination in a stable patient. In a hemodynamically stable patient, a normal FAST examina­tion along with a normal clinical examination are not suf­ficient to rule out a significant intra-abdominal injury. Indeed, in addition to the well-known limitation of the clini­cal abdominal examination up to 34% of abdominal injury could be present without associated free fluid, 17% of them would eventually require surgery or angiography embo­lization. Furthermore, FAST examination can miss a major retroperitoneal bleeding. In isolated minor abdomi­nal trauma, there is no unanimously accepted criteria for systematically performing or not CT in the absence of free intraperitoneal fluid at FAST. It has been suggested that the addition of normal bedside imaging (chest and pelvis X-ray, FAST) normal blood tests and a normal clinical examination could be sufficient to safely discharge an alert patient with­out further observation or investigation. However, only a minority of patients (<20%) with suspicion of blunt abdomi­nal trauma fulfill these criteria. All other should undergo fur­ther investigations.