Isolated free fluid on computed tomography for blunt abdominal trauma

Isolated free intraperitoneal fluid in young male after blunt abdominal sport trauma: two case reports from the World Cup 2022

The presence of isolated intraperitoneal free fluid (IFIPF) indicates the presence of mesenteric, organ, or bowel injury, which necessitates surgical exploration. The advances in computerized tomographic scanning (CT scan) allow even smaller amounts of IFIPF being detected. However, the clinical significance of IFIPF following blunt abdominal trauma remains not well-studied. Moreover, IFIPF is an unexpected condition in healthy male in the absence of mesenteric or organ injury on abdominal imaging. Herein, we presented two cases with IFIPF detected by CT scan in two healthy football male players during the World Cup 2022. The two players were managed conservatively and rejoined safely their football team during the same competition.

Surgeon choice in management of pediatric abdominal trauma

BACKGROUND

No guidelines exist for management of hemodynamically stable children with suspected hollow viscus injury. We sought to determine factors contributing to surgeon management of these patients.

METHODS

Surgeon members of the Eastern Association for the Surgery of Trauma and American Pediatric Surgical Association completed a survey on 3 blunt abdominal injury scenarios: (1) isolated, (2) with multisystem injury, and (3) with traumatic brain injury (TBI), and a penetrating injury scenario. Multivariable logistic regression was used to determine factors associated with initial management of observation vs. operation for blunt injury and observation vs. local wound exploration versus laparoscopy for penetrating injury.

RESULTS

Of 394 surgeons (response rate 22.3%), 50.3% were pediatric surgeons. For scenarios 1-3, 32.2%, 49.3%, and 60.7% of surgeons chose operation over observation, respectively. Compared to isolated blunt injury, surgeons were more likely to choose operation for patients with multisystem injury (aOR 2.20, 95%CI: 1.78-2.72) or TBI (aOR 3.60, 95%CI: 2.79-4.66). Pediatric surgeons were less likely to choose operation (aOR 0.32, 95%CI: 0.22-0.44). For penetrating injury, 39.1%, 29.5%, and 31.5% of surgeons chose observation, local wound exploration, and laparoscopy, respectively.

CONCLUSIONS

Large variation exists in management of hemodynamically stable children with suspected hollow viscus injury. Although patient injury characteristics account for some variation, surgeon factors such as type of surgeon also play a role. Evidence-based practice guidelines should be developed to standardize care.

TYPE OF STUDY

Cross-Sectional Survey.

LEVEL OF EVIDENCE

N/A.