Back End Approaches To MRIP

This group of patients had a significantly shorter length of stay in hospital. The remaining 118 patients presenting with PAI were managed operatively (Table 2). Table 2 Characteristics of operative group of http://www.selleckchem.com/products/Temsirolimus.html patients. Of those patients operatively managed, 12 underwent LWE in theatre of which 10 (66.7%) had a CT scan reported as normal (Table 3). None of these patients were found to have fascial penetration. Twenty patients had diagnostic laparoscopy only, of which 11 (55%) had a normal CT scan. There were 16 patients who underwent laparoscopy converted to laparotomy (five of whom (31.3%) had normal CT imaging) and 70 patients proceeded directly to laparotomy (with further 5 patients (7.1%) having normal CT scans in this subgroup). Table 3 CT findings in relation to operative findings. The operative diagnoses were classified into 3 groups: superficial or nonperitoneal-breaching injuries (n = 27); intraperitoneal penetration without organ damage (n = 38); or intraperitoneal injury with organ damage (n = 53), Table 2. Patients with superficial or nonperitoneal-breaching injury had undergone a CT scan reported as normal in 94% of cases (n = MRIP 16). Similarly, in more than one third of patients with peritoneal breach but no intra-abdominal injury, CT scanning had been reported as normal (n = 14, 56%). There was only 1 patient who had peritoneal breach and organ injury in whom the CT scan had been reported as normal (1.9%); this patient had a small contained liver haematoma that did not require further intervention. From the entire cohort of 189 patients, 85 patients had CT scans reported as normal, 54 of whom were treated nonoperatively while 31 had operative management (only 1 of which had intra-abdominal injury). Table 4 demonstrates the total negative laparotomy/laparoscopy rate for all patients presented with PAI of 33.9% (n = 40); almost half of these patients had a normal CT scan (n = 16 (40%)). The average length of stay in hospital for the total cohort was 4.1 (1.8�C6.8) days with 28 (14.8%) patients admitted to the ICU. Postoperative patients had a hospital stay of 5.7 (3.7�C8.8) days compared to 2.3 (0.6�C3.5) days for patients that were managed nonoperatively (P PD173074 supplier of patients with nontherapeutic operation versus conservative management. 4. Discussion The present study highlights the approach of an Australian major trauma hospital to the management of PAI. Mandatory laparotomy for stab wound injuries had been the gold standard since World War I [11]; however there is a shift towards SNOM for haemodynamically stable patients without signs of peritonitis. Peritoneal breach is an indication for laparotomy at our cohort despite other studies suggesting that these patients can be managed conservatively [12]. Procedures such as FAST scan, LWE under GA, CT scan, and diagnostic laparoscopy have been used to make such a diagnosis.