CHALLENGE TO ABDOMINAL TRAUMA SURGERY

Abstract

　　We have improved and developed surgical procedures for abdominal trauma based on reported operations. In patients with severe hepatic trauma who had an increase of hemoperitoneum on repeat US or CT, we performed hepatectomy in order for resection of devitalized liver parenchyma and reliable hemostasis. Two of seventeen patients with hepatectomy died from hemorrhage of liver injuries. Ten patients who had injury to the main pancreatic duct underwent pancreatic duct repair rather than Letton & Wilson operation. Pancreatic fistulas occurred in three patients, who later recovered with conservative therapy. As additional operative procedures for duodenal injuries, we performed diverticulization on 20 patients and pyloric exclusion without gastrojejunostomy on 4 patients, of whom one patient had duodenal fistula. Eighteen patients suspected of bowel injuries without free air on CT and exhibiting peritoneal signs underwent laparoscopic examination under general anesthesia. There were no delayed laparotomies and one nontherapeutic laparotomy.