MISSED INJURIES IN ABDOMINAL-TRAUMA

Injuries missed at initial diagnoses or operations have the potential to cause disastrous complications in abdominal trauma patients, The ai m of this retrospective study is to assess the causes and the outcomes of missed abdominal injuries. Twelve patients (2%) with missed injuri es were identified among 607 abdominal trauma patients operated on fro m 1985 to 1993, Ten patients were male and two were female, The modes of the trauma were ten blunt injuries (83%) and two stab penetrating i njuries (17%), Five cases had delayed operations because of clinical e rrors in the initial diagnosis, Their causative factors were obscured trauma history (two cases), radiologic misinterpretation (two cases), no reliable radiologic finding (one case), and admission to inappropri ate department (one case), Missed injured organs were spleen (two case s), liver (one case), diaphragm (one case), and rectum (one case), Med ian delayed time was 7 days (3 to 96 days), Another seven cases of inj uries were missed at the time of initial operation because of incomple te exploration, Their causative factors were surgical inexperience (tw o cases), severe peritoneal adhesions (one case), neglected exploratio n of retroperitoneal hematoma (two cases), underestimated mesocolic va scular injury (one case), and early contraction of the perforating wou nd with intraoperative hypotension (one case), Missed injured organs w ere stomach (two cases), duodenum (one case), rectum (one case), pancr eas (one case), urinary bladder (one case), and rectosigmoid mesocolon (one case), Median time interval between initial and second operation was 9 days (4 to 32 days), Two patients died of complications directl y related to their missed injuries, Major complication and mortality r ates of missed injuries were 83 and 17%, respectively. These were sign ificantly higher compared with those (39 and 6.3%, respectively) of de tected abdominal injuries. We conclude that missed abdominal injuries can cause high mortality and morbidity; and, therefore, a systematic a pproach, including careful history taking, complete diagnostic procedu re, complete surgical explorations, and early reoperation are mandator y for patients with multiple trauma.