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Intra-abdominal abscess after blunt abdominal trauma
W A Goins1, A Rodriguez, M Joshi
1Department of Surgery, Maryland Institute for Emergency Medical Service Systems, Baltimore.
Annals of Surgery
|July 1, 1990
Summary
Blunt abdominal trauma can lead to intra-abdominal abscesses (IAA), particularly with spleen, liver, kidney, or pancreas injuries. Risk factors include splenectomy, multiple injuries, and high transfusion needs.
Area of Science:
- Trauma Surgery
- Surgical Infections
- Abdominal Trauma Management
Background:
- Intra-abdominal abscess (IAA) following blunt abdominal trauma is infrequently discussed.
- A significant association exists between blunt abdominal trauma and the subsequent development of IAA.
Purpose of the Study:
- To investigate the incidence, risk factors, and outcomes of intra-abdominal abscesses in patients with blunt abdominal trauma.
- To identify prognostic indicators for IAA in trauma patients.
Main Methods:
- Retrospective review of 4050 blunt trauma admissions from January 1986 to July 1988.
- Analysis of 325 patients who underwent laparotomy for blunt abdominal trauma, identifying those with IAA.
Main Results:
- 15 patients (4.6%) developed 40 IAAs. Common injuries involved spleen and liver; splenectomy increased IAA risk. Kidney and pancreas injuries also posed significant risks.
- Multiple extra-abdominal injuries, high transfusion requirements, and upper quadrant abscess locations were noted. Multiple IAAs occurred in 46% with 80% recurrence after drainage. Enterobacter species were implicated.
- Poor prognostic indicators included high injury severity score, high transfusion needs, pelvic fracture, positive blood cultures, and multiple-organ system failure. Mortality was 20%.
Conclusions:
- Blunt abdominal trauma, especially involving solid organs and requiring significant intervention, carries a risk of IAA.
- Early recognition and management of risk factors are crucial for improving outcomes in trauma patients who develop IAA.