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Chapter 21. Trauma

The correct treatment for an intraperitoneal bladder rupture:

A. Foley catheter drainage

B. Suprapubic drainage

C. Suprapubic drainage with Foley catheter drainage

D. Bladder drainage, percutaneous paravesical drainage, and antibiotics

E. Laparotomy with open bladder exploration and repair, paravesical drainage, and Foley catheter drainage

Answer: E. An intraperitoneal bladder rupture must be operatively repaired. Drainage of the paravesical space at laparotomy, as well as Foley catheter drainage, is essential. Any option that suggests drainage without exploration would be inadequate.

A passenger was involved in a high-speed, head-on motor vehicle collision and sustained severe hyperflexion injury of the lumbar region. She was wearing a seat belt. The most important abdominal injury to exclude would be:

A. Pancreatic neck transection

B. IMV transection

C. Gastric rupture

D. Duodenal transection

E. Gallbladder rupture

Answer: A. A missed pancreatic injury could have devastating consequences. Hyperflexion injuries while wearing a seat belt trap abdominal viscera and cause severe deceleration injuries that could result in pancreatic neck transection. Interestingly, falling over bicycle handlebars in pediatric trauma is associated with pancreatic injury. All the other listed injuries are exceedingly rare with this mechanism; a duodenal hematoma is more commonly associated with a pancreatic injury.

A hypotensive patient had sustained multiple stab wounds to the abdomen. In the operating room, a through-and-through laceration to the stomach and also a pancreatic and low-grade splenic injury are detected. How would you manage the gastric perforations?

A. Gastric resection with primary closure

B. Primary closure of both wounds

C. A posterior gastrojejunostomy with primary repair of the anterior injury

D. Resection with Roux-en-Y reconstruction

E. Subtotal gastrectomy with gastrojejunostomy

Answer: B. This patient is a candidate for rapid primary closure of both wounds. There is no need for pyloric exclusion, resection, or gastrojejunostomy.

Which of the following scenarios requires immediate operative intervention?

A. A stab wound to zone II of the neck that violates the platysma

B. A grade III splenic injury in a stable 7-year-old girl

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