Abdominal Trauma

Ultrasonography in Japanese emergency departments

This is a review of 50 consecutive cases where ultrasound was performed in the emergency department of a general hospital demonstrating the efficacy of its usage by "nonspecialists." This study demonstrates that in the Japanese model of emergency care delivery, abdominal ultrasound has been shown to be used in the emergency department with accuracy and safety.

Small bowel injuries

Small bowel injuries are becoming more commonplace. Difficult to diagnose and treacherous when missed, small bowel injuries should be searched for assiduously in all patients at risk. Use of DPL or CT scanning, coupled with a low threshold for exploration, improves the diagnosis and treatment of small bowel injuries. A delayed diagnosis results in a progressive septic insult and markedly increased mortality. Early diagnosis is the key. After addressing life-threatening problems, the operation should include a thorough and systematic exploration to identify all injuries. Sound surgical technique includes debridement of nonviable tissue, restoration of small bowel continuity, generous irrigation, and placement of enteral feeding catheters. By adhering to the preceding principles and by exercising meticulous postoperative care and maintaining a low threshold to reoperate, catastrophic complications can be avoided.