Patients with Associated Cerebral-Abdominal Trauma: An Algorithm of Diagnosis and Treatment

Kolesov V.*, Losev R.*, Mamaev .*, Voynilenko .**

* Saratov State Medical University, Saratov, Russia;
** Child Clinical Hospital, Saratov, Russia

 

The most complicated problems arise in diagnosis and treatment of casualties with associated craniocerebral trauma. Traumas of abdominal organs, characterized by massive internal bleeding, result in anemia development. In its turn, it leads to hypoxia of already injured medullary substance and is accompanied by gross additional disorders. Thus, our goal was to optimize an algorithm of diagnosis and surgical treatment of such cases.

There were 63 patients with craniocerebral trauma, associated with injuries of abdominal organs. Injuries of the liver, spleen, mesentery and intestine were watched in 14, 9 and 9 cases respectively. There were 7 cases with hemoperitoneum and 11 patients with retroperitoneal hematomas. Kidney rupture was diagnosed in 4 cases. Some patients had multiple injuries of internal organs (the liver + the spleen - 4; the kidney + the liver + the spleen - 5). The mortality rate was 29%.

The analysis of our results has shown, that a general clinical examination and examinations by a surgeon, neurosurgeon, traumatologist, vascular surgeon and a resuscitator are to be supplemented by mandatory use of such additional methods, as rentgenography of abdominal organs, ultrasonic examination of internal organs and laparoscopy, performed in case of necessity. An algorithm of treatment of such cases is to include resuscitative measures with simultaneous performance of life-saving operations in augmentation of brain compression by intracranial hematomas, intra-abdominal bleeding. If indicated, other surgical interventions can be made after complete stabilization of a patients state.