Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
The Abdomen
Laparotomy and Abdominal Trauma
Labarotomy
Abdominal trauma
Acute Abdominal Conditions
Assessment and diagnosis
Intestinal obstruction
Peritonitis
Stomac and duodenum
Gallbladder
Appendix
Abdominal Wall Hernia
Groin hernia
Surgical repair of inguinal hernia
Surgical repair of femoral hernia
Surgical treatment of strangulated groin hernia
Surgical repair of umbilical and para-umbilical hernia
Surgical repair of epigastric hernia
Incisional hernia
Urinary Tract and Perineum
The urinary bladder
The male urethra
The perineum
Abdominal Trauma
 


> RUPTURED SPLEEN
> LACERATION OF THE LIVER
> SMALL INTESTINE
> COLON
> RETROPERITONEUM
> RUPTURE OF THE BLADDER
> MANAGEMENT OF RUPTURED
> BLADDER


RETROPERITONEUM

Haematoma

A retroperitoneal haematoma may indicate trauma to a major vessel. If the patient is stable it should not be opened or disturbed. However, to save life, control and repair of a major vessel should be attempted at the district hospital.

Duodenum

Blunt trauma to the upper abdomen can result in retroperitoneal rupture of the duodenum. Air in the retroperitoneum is diagnostic. The retroperitoneum is opened with blunt dissection and the duodenal perforation closed transversely in two layers. This repair should be protected with a nasogastric tube and, after thorough cleansing of the retroperitoneum, a drain should be placed near but not on the duodenal repair.

Pancreas

Confirm an injury to the pancreas by opening the lesser sac through the gastrocolic (greater) omentum. The only safe procedure at the district hospital is to put a drain at the site of injury. The drain should traverse the lesser sac and come out in the flank. Specialized surgery may be necessary. Make arrangements for referral when the patient is stable.

Kidney

Do not expose the kidney unless there is life-threatening bleeding. An expanding or pulsating haematoma is evidence of such bleeding. Stop the bleeding at the site of the tear with stitches. Consider the need for specialized surgery.


> RUPTURED SPLEEN
> LACERATION OF THE LIVER
> SMALL INTESTINE
> COLON
> RETROPERITONEUM
> RUPTURE OF THE BLADDER
> MANAGEMENT OF RUPTURED
> BLADDER


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