Hollow Viscus Injury Following Blunt Abdominal Trauma: A Retrospective Study

Background: Gastrointestinal and mesenteric injuries are the third most common type of injury from blunt trauma abdomen and are associated with high rates of morbidity and mortality.Objectives: To determine the clinico-demographic profile, localization of injury, diagnostic and management methods and the outcome in cases of hollow viscus injury (HVI) following blunt trauma abdomen which were admitted to our unit. Methods: Records of patients who were admitted emergently with gastrointestinal injuries and blunt abdominal trauma between July 2014 and July 2016 were reviewed retrospectively. Results: The study group comprised 65 patients with mean age of 33.3 ± 16.2 years and a male predominance (89.2%). The commonest cause of injury was road traffic accident in 44 (67.7%) cases. Ileum was the most common site of injury detected in 31 (41.3%) followed by jejunum in 26 (34.7%) cases. Treatment comprised primary closure of perforation in 48 (64%) cases, segmental resection and anastomosis in 22 (29.3%), and stoma in 5 (6.7%) cases. Three out of 5 cases of anastomotic leak occurred in patients who were operated at 8-24 hours or beyond. Associated injury to intra-abdominal solid viscera and other sites were present in 30.7%. The mean duration of hospitalization was longer in patients with associated injuries as compared to those with isolated HVI (12.2±4.6 days versus 9.3±0.8 days). Conclusion: Early diagnosis followed by prompt surgical intervention and careful monitoring for associated injuries is the key to favourable outcome in blunt HVI.

Influence of position and radiation technique on organs at risk in radiotherapy of rectal cancer / 华中科技大学学报（医学）（英德文版）

The influence of the position and radiation technique on the organs at risk (OARs) in radiotherapy of rectal cancer was evaluated. The relationship between the volume of irradiated small bowel (VSB) and acute bowel toxicity was determined. A total of 97 cases of rectal cancer were retrospectively randomized to receive radiotherapy with the designated treatment positions and radiation plans. Among 64 patients in the supine position, 32 patients were given three-dimensional conformal radiotherapy (3DCR) and 32 patients were subjected to intensity-modulated radiation therapy (IMRT) respectively. The rest 33 patients were treated with 3DCRT in the prone position with a belly board. The VSB was calculated for doses from 5 to 45 Gy at an interval of 5 Gy. With prescription dose in planned target volume (PTV) of 50 Gy, the dose distribution, conformal index for PTV (CI), dose-volume histogram (DVH) of OARs, the correlation of VSB and the acute toxicity were compared. The results were shown as follows: (1) Among the 3 methods, there were no differences in PTV's converge including V95 and D95; (2) For IMRT under a supine position, CIwas closest to 1, the mean dose of small bowel decreased (P<0.05), and the mean VSB from V30 to V45 significantly decreased (P<0.05). (3) For 3DCRT with a belly board under a prone position, the mean dose and the mean VSB from 40 to 45 Gy were less than those for 3DCRT under a supine position (P<0.05); (4) Mean proportion of VSB was significantly greater in the patients experiencing diarrhea grade 2-4 than in those with diarrhea grade 0-1 at dose levels from V30 to V45 (P<0.05). It was concluded that for the radiotherapy of rectal cancer, IMRT technique might decrease the high-dose VSB to reduce the risk of acute injury. 3DCRT with a belly board under a prone position is superior to 3DCRT under a supine position, which could be a second choice for radiation of rectal cancer.

Influence of belly board device and the distended bladder on dosimetric analysis and normal tissue complication in postoperative radiation therapy of rectal cancer / 中华放射医学与防护杂志

Objective To evaluate the influence of belly beard device and the distended bladder on the dose distribution of PTV and the dose-volume histograms(DVHs)of organs at risk(OARs)for postoperative radiation tIlerapy of rectal cancer.Methods A total of 23 patients(8 and 15)with distended bladder receiving 3-field postoperative radiation therapy were dealed with or without a special belly beard in the prone position.At the same time,15 cages with belly board were scanned with empty bladder.The volume of irradiated small bowel was calculated for doses between 5-50 Gy at 5 Gy intervals.With prescription dose in plan target volume(PTV)of 50 Gy,we compared the dose distribution,DVH of OARs,conformity index(CIPTV),the volume of irradiated small bowel and the acute toxicity under the condition of thlee different moulds.Results There was no significant difference in PTV's converge,DVHs of femoral head and CI among 3 moulds(P＞0.05).With the belly board,the high-dose volume of irradiated small bowel(V20-V52.5)was significantly decreased(P＜0.05),specially with distended bladder.However,the low dose volume(V5-V15)was slightly increased.The bladder distension significanfly decreases the volumes of the irradiated small howel at dose levels from 15-52.5 Gy(P＜0.05).Furthermore,the mean volume(V5-V30)of irradiated small bowel differed significantly between patients experiencing Grade 0.1 and ≥2 diarrhea(P＜0.05).Conclusions The combination of belly board and distended bladder was more effectively to reduce the irradiated small bowel volume among 3 moulds,so as to minimized acute diarrhea toxicity.