ЛУЧЕВАЯ ДИАГНОСТИКА ТРАВМЫ ЖИВОТА У ДЕТЕЙ

Статья в Elpub

Детская хирургия. Журнал им. Ю.Ф. Исакова. 2018; 22: 21-28

ЛУЧЕВАЯ ДИАГНОСТИКА ТРАВМЫ ЖИВОТА У ДЕТЕЙ

Ахадов Т. А., Карасёва О. В., Чернышова Т. А., Семёнова Н. А., Мельников И. А., Ублинский М. В., Манжурцев А. В., Меньщиков П. Е.

https://doi.org/10.18821/1560-9510-2018-22-1-21-28

Аннотация

Список литературы

1. Aldemir M., Tacyildiz I., Girgin S. Predicting factors for mortality in the penetrating abdominal trauma. Acta. Chir. Belg. 2004; 104: 429-34.

2. Gad M.A., Saber A., Farrag S., Shams M.E., Ellabban G.M. Incidence, Patterns, and Factors Predicting Mortality of Abdominal Injuries in Trauma Patients. N. Am. J. Med. Sci. 2012; 4(3): 129-34.

3. de Jong W.J., Stoepker L., Nellensteijn D.R., Groen H., El Moumni M., Hulscher J.B. External validation of the Blunt Abdominal Trauma in Children (BATiC) score: ruling out significant abdominal injury in children. J. Trauma Acute Care Surg. 2014; 76: 1282-7.

4. Туманова М.В., Карасёва О.В., Гранников О.Д. Эхографические критерии в обосновании рациональной лечебной тактики при закрытой травме живота у детей с политравмой. В кн.: Тезисы докладов Всероссийского симпозиума детских хирургов «Политравма у детей» 2001; 42-4.

5. Подкаменев В.В., Пикало И.А. Критерии выбора способа лечения детей с повреждением селезёнки. Детская хирургия. 2014; 18(5): 23-7.

6. Sivit C.J. Imaging Children with Abdominal Trauma. Am. J. Roentgenol. 2009: 192(5): 1179-89.

7. Hemmila M.R., Wahl W.L. Management of the Injured Patient. In: Doherty GM, editor. Current Surgical Diagnosis and Treatment. McGraw-Hill Medical; 2008: 227-8.

8. Wing V.W., Federle M.P., Morris J.A. Jr, Jeffrey R.B., Bluth R. The clinical impact of CT for blunt abdominal trauma. Am. J. Roentgenol. 1985; 145: 1191-4.

9. Lutz N., Mahboubi S., Nance M.L., Stafford P.W. The significance of contrast blush on computed tomography in children with splenic injuries. J. Pediatr. Surg. 2004; 39: 491-4.

10. Ефременков А.М., Залогин К.А., Сниткин Н.А., Коваленко И.Б., Трофимов К.С., ЛысовА.Е. и др. Травматический разрыв печени у подростка и последующие осложнения. Детская хирургия. 2016; 20(6): 328-30

11. Poletti P.A., Mirvis S.E., Shanmuganathan K., Takada T., Killeen K.L., Perlmutter D. et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J. Trauma. 2004; 57(5): 1072-81.

12. Chaumoître K., Merrot T., Petit P, Panuel M. Thoracic and abdominal trauma in children. J. Radiol. 2008; 89(11): 1871-88.

13. Ruess L., Sivit C.J., Eichelberger M.R., Taylor G.A., Bond S.J. Blunt hepatic and splenic trauma in children: correlation of a CT injury severity scale with clinical outcome. Pediatr. Radiol. 1995; 25: 321-5.

14. Пулатов А.Т. Закрытые разрывы почек у детей. Детская хирургия. 2007: 2; 26-30

15. Streck C.J. Jr, Jewett B.M., Wahlquist A.H., Gutierrez P.S., Russell W.S. Evaluation for intra-abdominal injury in children following blunt torso trauma. Can we reduce unnecessary abdominal CT by utilizing a clinical prediction model. J. Trauma Acute Care Surg. 2012; 73(2): 371-6

16. Holmes J.F., Sokolove P.E., Brant W.E., Palchak M.J., Vance C.W., Owings J.T. et al. Identification of children with intra-abdominal injuries after blunt trauma. Ann. Emer.Med. 2002; 39: 500-9.

17. Karam O., Sanchez O., Chardot C., La Scala G. Blunt abdominal trauma in children: a score to predict the abscense of organ injury. J. Pediatr. 2009; 154(6): 912-7.

18. Morozov D.A., Pimenova E.S., Filippov Yu.V., Gorodkov S.Yu., Nikolaev A.V., Masevkin V.G. et al. Complete traumatic rupture of the pancreas with a circular rupture of the stomach. Detskaya khirurgiya. 2015; 19(1): 51-3. (in Russian)

19. Canty T.G., Weinman D. Management of major pancreatic duct injuries in children. J. Trauma. 2001; 50: 100--7.

20. Gupta A., Stuhlfaut J.W., Fleming K.W., Lucey B.C., Soto J.A. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radio Graphics. 2004; 24: 1381-95.

21. Gutierrez I.M., Mooney D.P. Operative blunt duodenal injury in children: a multi-institutional review. J. Pediatr. Surg. 2013; 47: 1833-6.

22. Wegner S., Colletti J.E., Van Wie D. Pediatric blunt abdominal trauma. Pediatr. Clin. North. Am. 2006; 53: 243-56.

23. Скобелев В.А., Разин М.П., Сырчин Э.Ф., Ральников В.В., Кузнецов С.Ю., Помелов С.А. Тяжелая сочетанная травма легких, диафрагмы, кишечника, селезёнки, позвоночника, спинного мозга и обеих почек. Детская хирургия. 2014: 18(6); 51-2

24. Hawkins A.E., Mirvis S.E. Evaluation of bowel and mesenteric injury: role of multidetector CT. Abdom Imaging. 2003; 28: 505-14.

25. Croce M.A., Fabian T.C., Kudsk K.A., Baum S.L., Payne L.W., Manqiante E.C. et al. AAST organ injury scale: correlation of CT-graded liver injuries and operative findings. J. Trauma 1991; 31: 806-12.

26. Marmery H., Shanmuganathan K., Mirvis S.E., Richard H. 3rd, Sliker C., Miller L.A. et al. Correlation of multidetector CT findings with splenic arteriography and surgery: prospective study in 392 patients. J. Am. Coll. Surg. 2008; 206(4): 685-93.

27. Naulet P., Wassel J., Gervaise A., Blum A. Evaluation of the value of abdominopelvic acquisition without contrast injection when performing a whole body CT scan in a patient who may have multiple trauma. Diagn. Interv. Imaging. 2013; 94(4): 410-7.

28. Willmann J.K., Roos J.E., Platz A., Pfamatter T., Hilfiker P.R., Marincek B. et al. Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma. AJR Am. J. Roentgenol. 2002; 179: 437-44.

29. Arnold M., Moore S.W. Paediatric blunt abdominal trauma - are we doing too many computed tomography scans? S. Afr. J. Surg. 2013; 51(1): 26-31.

30. Harris A.C., Zwirewich C.V., Lyburn I.D., Torreggiani W.C., Marchinkow L.O. CT findings in blunt renal trauma. Radio Graphics. 2001; 21: 201-14.

Russian Journal of Pediatric Surgery. 2018; 22: 21-28

RADIATION DIAGNOSIS OF ABDOMINAL TRAUMA IN CHILDREN

Akhadov T. A., Karaseva O. V., Chernyshova T. A., Semenova N. A., Mel’Nikov I. A., Ublinskiy M. V., Manzhurtsev A. V., Men’Shchikov P. E.

https://doi.org/10.18821/1560-9510-2018-22-1-21-28

Abstract

Blunt abdominal trauma is one of the leading causes of the morbidity and mortality in all age groups. Among all the causes of deaths due to injury, abdominal damage accounted of about 10%, and in children - 8.5%. Timely imaging takes a key place in assessing abdominal injury in traumatized children. Computer tomography (CT) is a method of visualization that allows recognize and evaluate characteristic signs of the traumatic damage in hemodynamically stable children. Modern multislice spiral computer tomographs (MSCT) provide high quality of the image due to the improvement of both scanning methods and post-processing facilities. Currently, CT allows most accurately detect lesions of parenchymal and hollow organs, as well as reveal and quantify intraperitoneal and extraperitoneal fluid and blood. In addition, CT has an exceptional sensitivity in the diagnosis of the combined trauma of various organs and systems. The use of CT as the main screening method for the examination of traumatized children along with the improvement of maintenance therapy plays a crucial role in the success of the not operative treatment of trauma to parenchymatous organs. The rapid assessment of the state of traumatized children according to CT findings also contributed to the decline of the incidence of complications and mortality rate. The decision about surgical intervention in a small number of children in need of surgical treatment is primarily made on the basis of clinical criteria, not CT results. Thus, CT mainly determines non-operative decisions regarding, for example, duration of hospitalization, intensity of care and limitation of the activity. In this paper, we propose a standardized CT technique and the main symptomatology that determines the severity of the damage of abdominal organs in children, based on own experience, taking into account the world literature data on CT.

References

1. Aldemir M., Tacyildiz I., Girgin S. Predicting factors for mortality in the penetrating abdominal trauma. Acta. Chir. Belg. 2004; 104: 429-34.

2. Gad M.A., Saber A., Farrag S., Shams M.E., Ellabban G.M. Incidence, Patterns, and Factors Predicting Mortality of Abdominal Injuries in Trauma Patients. N. Am. J. Med. Sci. 2012; 4(3): 129-34.

4. Tumanova M.V., Karaseva O.V., Grannikov O.D. Ekhograficheskie kriterii v obosnovanii ratsional'noi lechebnoi taktiki pri zakrytoi travme zhivota u detei s politravmoi. V kn.: Tezisy dokladov Vserossiiskogo simpoziuma detskikh khirurgov «Politravma u detei» 2001; 42-4.

5. Podkamenev V.V., Pikalo I.A. Kriterii vybora sposoba lecheniya detei s povrezhdeniem selezenki. Detskaya khirurgiya. 2014; 18(5): 23-7.

6. Sivit C.J. Imaging Children with Abdominal Trauma. Am. J. Roentgenol. 2009: 192(5): 1179-89.

7. Hemmila M.R., Wahl W.L. Management of the Injured Patient. In: Doherty GM, editor. Current Surgical Diagnosis and Treatment. McGraw-Hill Medical; 2008: 227-8.

8. Wing V.W., Federle M.P., Morris J.A. Jr, Jeffrey R.B., Bluth R. The clinical impact of CT for blunt abdominal trauma. Am. J. Roentgenol. 1985; 145: 1191-4.

9. Lutz N., Mahboubi S., Nance M.L., Stafford P.W. The significance of contrast blush on computed tomography in children with splenic injuries. J. Pediatr. Surg. 2004; 39: 491-4.

10. Efremenkov A.M., Zalogin K.A., Snitkin N.A., Kovalenko I.B., Trofimov K.S., LysovA.E. i dr. Travmaticheskii razryv pecheni u podrostka i posleduyushchie oslozhneniya. Detskaya khirurgiya. 2016; 20(6): 328-30

12. Chaumoître K., Merrot T., Petit P, Panuel M. Thoracic and abdominal trauma in children. J. Radiol. 2008; 89(11): 1871-88.

14. Pulatov A.T. Zakrytye razryvy pochek u detei. Detskaya khirurgiya. 2007: 2; 26-30

16. Holmes J.F., Sokolove P.E., Brant W.E., Palchak M.J., Vance C.W., Owings J.T. et al. Identification of children with intra-abdominal injuries after blunt trauma. Ann. Emer.Med. 2002; 39: 500-9.

17. Karam O., Sanchez O., Chardot C., La Scala G. Blunt abdominal trauma in children: a score to predict the abscense of organ injury. J. Pediatr. 2009; 154(6): 912-7.

19. Canty T.G., Weinman D. Management of major pancreatic duct injuries in children. J. Trauma. 2001; 50: 100--7.

20. Gupta A., Stuhlfaut J.W., Fleming K.W., Lucey B.C., Soto J.A. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radio Graphics. 2004; 24: 1381-95.

21. Gutierrez I.M., Mooney D.P. Operative blunt duodenal injury in children: a multi-institutional review. J. Pediatr. Surg. 2013; 47: 1833-6.

22. Wegner S., Colletti J.E., Van Wie D. Pediatric blunt abdominal trauma. Pediatr. Clin. North. Am. 2006; 53: 243-56.

23. Skobelev V.A., Razin M.P., Syrchin E.F., Ral'nikov V.V., Kuznetsov S.Yu., Pomelov S.A. Tyazhelaya sochetannaya travma legkikh, diafragmy, kishechnika, selezenki, pozvonochnika, spinnogo mozga i obeikh pochek. Detskaya khirurgiya. 2014: 18(6); 51-2

24. Hawkins A.E., Mirvis S.E. Evaluation of bowel and mesenteric injury: role of multidetector CT. Abdom Imaging. 2003; 28: 505-14.

29. Arnold M., Moore S.W. Paediatric blunt abdominal trauma - are we doing too many computed tomography scans? S. Afr. J. Surg. 2013; 51(1): 26-31.

30. Harris A.C., Zwirewich C.V., Lyburn I.D., Torreggiani W.C., Marchinkow L.O. CT findings in blunt renal trauma. Radio Graphics. 2001; 21: 201-14.