DIAGNOSIS OF MASKED ABDOMINAL INJURY IN PATIENTS WITH LOWER RIB FRACTURES ; IS EMERGENCY ULTRASONOGRAPHY
EFFECTIVE AS A SCREENING TOOL ?

Lim, Kyoung Soo; Lee, Kang Hyun; Hong, Eun Seok; Hwang, Sung Oh

J Korean Soc Emerg Med > Volume 7(2); 1996 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 1996;7(2): 254-258.

DIAGNOSIS OF MASKED ABDOMINAL INJURY IN PATIENTS WITH LOWER RIB FRACTURES ; IS EMERGENCY ULTRASONOGRAPHY EFFECTIVE AS A SCREENING TOOL ?

Kyoung Soo Lim, Kang Hyun Lee, Eun Seok Hong, Sung Oh Hwang

Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea

Published online: June 30, 1996.

ABSTRACT

Some emergency physicians neglect abdominal injuries if a patient does not complaint of abdominal pain or abdominal tenderness was absent on physical examination. But intra-abdominal injuries are correlated closely with lower rib fractures and pelvic bone fractures. In cases of lower rib fractures, intra-abdominal organs are injured as a diaphragm is elevated as high as 5th intercostal space in expiration period When intra-abdominal solid organ is ruptured, a patient complaints of abdominal pain, but there's no abdominal pain if small hematoma occurs in solid organs. Although the most of solid organ hematoma are resolved spontaneously without complications, sometimes delayed rupture of hematoma occurs especially in patients with the coagulopathy. So emergency physician must evaluate the abdomen closely when the possibility of intra-abdominal injury is high. To evaluate the intra-abdominal injuries, we investigated 57 patients with lower rib fractures by ultrasonography. The patients were divided in 2 groups according to presence of abdominal symptomes; patiens with abdominal symptoms(n=47) vs. patients without abdominal symptoms(n=10). Among 57 patients, intra-abnominal injuries were found in 35 patients. In group with lower rib fractures and presence of abdominal symptoms, intra-abdominal injuries were diagnosised in 32 patients(68.9%) with 48 cases(hepatic injury; 20, spleen injury; 19, renal injury 7, hemoperitoneum without solid organ injury; 2). In group with lower rib fractures and abscence of abdominal symptoms, intra-abdominal injuries were diagnosised in 3 patients(30%) with 3 cases(spleen injury; 1, hemoperitoneum without solid organ injury; 2). In conclusion, emergency physician must do ultrasonography to evaluate intra-abdominal injuries in patients with lower rib fractures although a patient does not complaint of abnominal pain.

Key words: Masked abdominal injury, Lower rib fracture, Emergency ultrasonography