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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991On-line version ISSN 1809-4546


PARREIRA, José Gustavo; COIMBRA, Raul; RASSLAN, Samir  and  RUIZ, Dan Enger. Severe blunt head trauma: the relevance of associated abdominal lesions. Rev. Col. Bras. Cir. [online]. 2001, vol.28, n.5, pp.336-341. ISSN 0100-6991.

BACKGROUND: The present study was carried out to analyze the abdominal lesions in victims of multiple trauma sustaining severe blunt head trauma. METHODS: We retrospectively reviewed charts and trauma protocols of patients admitted from January 1996 to July 1997, who sustained blunt head trauma and underwent head CT Scan. Those admitted with a Glasgow Coma Score (GCS) < 8 were selected for this study. There were 52 patients who fulfilled the inclusion criteria, 44 male and 8 female, with a mean age of 37 years. Demographic data, mechanism of injury, trauma indices (RTS and ISS), diagnostic exams, treatment and evolution were evaluated. We employed the X2 test, Student - t test, and Fisher exact test for the statistical analysis. RESULTS: Pedestrian versus auto was the most frequent mechanism of trauma, occurring in 25 cases. The mean RTS and ISS were 5.18 and 27 respectively. None of these patients had the diagnosis of abdominal lesion based only in physical examination. Forty four were assessed with diagnostic peritoneal lavage and 8 with abdominal ultrasound or computed tomography. Eight (15%) patients sustained abdominal lesions, including 5 hepatic, 4 splenic and one colonic injury. There were 17 craniotomies and 8 laparotomies (4 non therapeutic). A higher incidence of abdominal lesions was observed in patients sustaining either shock on admission or orthopedic lesions requiring surgical repair. The mortality was 71%. CONCLUSION: Considering the incidence of abdominal lesions and the difficulties for their diagnosis in those patients sustaining severe head trauma, the objective assessment of abdomen by complementary methods is advisable in all cases.

Keywords : Brain injury; Abdominal trauma; Laparotomy; Diagnostic; Head trauma.

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