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What is TORSO : The body excluding the head and neck and limbs M.A.Kubtan3

 The medical problems associated with physical injury.  Injury is the adverse effect of physical force upon a person.  Forces that can lead to injury include : mechanical, thermal,ionizing radiation, and chemical. 4M.A.Kubtan

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 The Troso is generally regarded as the area between the neck and the groin,made up of the thorax and abdomen.  Division of the body into abdomen and thorax is artificial.  Injury to the troso is more appropriate.  Our aim is restoration of normal physiology.  Accordingly trauma surgery requires knowledge of anatomy and physiology. M.A.Kubtan6

 Between the neck and the thorax.  Between the thorax and the abdomen.  Between the abdomen and the pelvic structures and the groin.  This zones represent surgical challenges in terms of diagnosis of the area of injury and surgical approach.  It is related and balanced against the physiological stability of the patient. M.A.Kubtan7

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Patients who have suffered abdominal injury can be generally classified into :  Haemodynamiclly normal.  Haemodinamiclly stable.  Haemodynamically unstable. M.A.Kubtan13

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M.A.Kubtan15 A B C D E of trauma care

 Cardiovascular status.  Radiological imaging.  Stable patient may be able to have CT scan.  Evaluation of torso trauma. M.A.Kubtan16

 CT scan with intravenous contrast most valuable ( however in unstable patient it not always possible ).  DPL Diagnostic peritoneal lavage. the presence of > red cells /micro liter or > 500 white cells in the peritoneal washout is an indication of intraperitoneal bleeding and this is equivalent to 20 ml of free blood in the abdominal cavity. Drainage of peritoneal lavage fluids via chest drain is an indication of penetration of diaphragm. M.A.Kubtan17

 When positive it means that there is free blood in the peritoneal cavity.  Negativity does not rule out the presence of blood in the peritoneal cavity. M.A.Kubtan18

 FAST Focused abdominal sonar for trauma.  FAST is a technique whereby US imaging is used to assess the TORSO for the presence of blood.  This technique focuses on four areas : Pericardial, Splenic, Hepatic, Pelvic. FAST is accurate for the detection of < 100 ml of free blood in the peritoneom. It is extremely dependent on the operator experience. M.A.Kubtan19

M.A.Kubtan20 FAST

 CT is the gold standered for the intra- abdominal diagnosis in the stable patient.  CT is performed using intravenous and often oral contrast as well.  CT has the advantages of sensitivity for the diagnosis of retroperitoneal injury.  CT is usually sufficient to exclude injury. M.A.Kubtan21

 DL is valuable screening investigation in penetrating trauma.  DL of course in stable patient s following an abdominal or thoraco-abdominal stab wound.  DL is not appropriate for use in the unstable patient.  DL is difficult to exclude all intra-abdominal injuries laparoscopic ally.  DL is not a substitute for open laparatomy especially in the presence of haemoperitonium or contamination. M.A.Kubtan22

 Liver  The majority of livers injuries occur as a result of blunt injury which may burst liver.  The use of CT for the evaluation of trauma patient ( liver, spleen, kidneys ).  The liver is a solid organ and may be compressed between the forces and the rib cage or vertebral column.  Penetrating trauma relatively common ( stab wound, bullets cause significant damage ).  Not all penetrating wounds require operative management. M.A.Kubtan23

 Push : direct compression.  Pringle : The inflow from the portal triad is controlled by pringle maneuver.  Plug :any holes can be plugged directly.  Pack. M.A.Kubtan24

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 Occur mainly from penetrating trauma.  Common bile duct injuries often associate with portal vein injury. M.A.Kubtan26

 Splenic injury occurs from direct trauma,  Overlaying ribs ( ninth to 11 th ribs ).  Most isolated splenic injuries espacially in children can be managed non operatively.  In adults in the presence of other injuries laparatomy may become indicated depending on physiological instability.  At laparatomy direct splenorrhaphy, or packed, repaired or placed in a mesh bag.  Selective embolisation of spleen can play a role.  Following splenectomy : changes in blood physiology,raised platelets count > , and white cell count rises and mimic sepsis. M.A.Kubtan27

 Due to blunt trauma.  CT scan the main test of value.  Amylase may be low or normal ( low amylase in 50% of cases.).  Treatment : conservative, closed suction drainage, distal pancreatectomy, Wipple,s procedures. M.A.Kubtan28

M.A.Kubtan29 Renal and urological tract Injury Major abdominal vessels Injury

 Stomach.  Duodenum.  Small bowel.  Colon.  Rectum. M.A.Kubtan30

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