Efficacy and accuracy of focused assessment sonography for trauma [FAST] in management of isolated gastrointestinal injury due to blunt abdominal trauma

Objective: To determine the diagnostic accuracy of Focused Assessment Sonography for Trauma [FAST] in patients having isolated gastrointestinal injury due to blunt abdominal trauma

Study design, settings and duration: Prospective, interventional study was done in department of General Surgery and Diagnostic Radiology, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana from July 2012 to June 2014

Materials and Methods: All patients who came with blunt abdominal trauma underwent emergency ultrasound with FAST technique to detect free fluid/ collection in abdominal cavity as an indicator of intra-abdominal organ injury. After ultrasound examination, most patients underwent surgical laparotomy to identify the gut and solid organ injury and were managed accordingly. The surgical findings were compared with ultrasound findings to see the correlation

Results: A total of 317 patients with blunt abdominal trauma underwent emergency US with FAST technique. Out of these, 296 [93.37%] underwent exploratory laparotomy. During surgery, 52 [17.56%] patients had evidence of bowel injury with 38 [12.83%] having solid organ injury plus bowel injury and 14 [4.72%] having only bowel injury. Amongst them, FAST ultrasound showed free fluid/ collection in 28 [53.8%] patients [true positive] while it was negative in 24 [46.15%] patients [false negative]. Among these, 24 patients with negative FAST, 15 [62.5%] had both solid organ injury plus bowel injury and 09 [37.5%] had only bowel injury [False negative]

Conclusion: FAST ultrasound missed 46% bowel injury with or without other solid organ injury and is therefore not reliable in diagnostic tool for assessing isolated bowel injury due to blunt abdominal trauma

Complications of acute appendicitis: a review of 120 cases

To find out the frequency of complications of acute appendicitis. A retrospective study was conducted at surgical unit-I and III, Chandka Medical College Hospital, Larkana. Case records of patients who were admitted with complications of appendicitis from June 2004 to May 2007 were examined and data analysed. Most common complications of appendicitis were appendicular mass [38.3%] followed by appendicular perforation and peritonitis [37.5%], appendicular abscess [10%], gangrene of appendix [11.6%] and intestinal obstruction [2.5%]. Majority [66.6%] of the cases were operated while 33.3% were treated by conservative measures. Appendicular mass and perforation were the main complications of untreated acute appendicitis. Complications of appendicitis usually result due to delay in diagnosis and treatment