Global Journal of Medical Research, F: Diseases, Volume 22 Issue 1

laparoscopically or switch to laparotomy. In 73.3% of cases of associated injuries, diagnostic and therapeutic laparoscopy made it possible to complete the operation laparoscopically without unnecessary laparotomy, however, due to the diagnosis of extensive damage to the abdominal organs with active bleeding and the presence of a large amount of free blood in the abdominal cavity, in 26.0% of cases, conversion to laparotomy was performed. The sensitivity of diagnostic laparoscopy for blunt abdominal trauma was 100%, specificity - 91% and accuracy - 96%. It were not observed complications after diagnostic manipulations. The mortality rate of children with concomitant abdominal trauma was 21 (23%) children. The total number of bed-days was 9.3 ± 0.8. In case of combined injury, together with the operation of the abdominal cavity, operations were performed simultaneously: - 15 operations on the head. Craniotomy with removal of subdural hematoma - 3, intracerebral hematoma- 2, Imposition of dilated cranial holes with removal of intracerebral hematoma and drainage -1, Imposition of dilated cranial openings with removal of subdural hematoma-2, Open osteosynthesis-2 with pin osteosynthesis -2, Closed osteosynthesis by pinning-2, Closed osteosynthesis with an external fixation device-1. - 11 operations on the chest. Thoracotomy Suturing of a lung injury-1, Thoracoscopic hemostasis in case of injury of intercostal arteries-1, Thoracoscopic coagulation of a lung injury-4, Thoracoscopic suturing of a lung injury-2, Removal of coagulated hemothorax-3. - 66 surgical interventions for injuries of the musculoskeletal system. Most of all were hip injuries - 28 operations, lower leg bones - 32 and pelvic bones - 6. It was created a tactic based on the Ultrasound Score - USS scale (Fig. 2) to improve the diagnosis of injuries to the abdominal organs. An ultrasound scan in dynamics is conducted with a zero USS score, i.e. in the absence of free fluid in the abdominal cavity, and an operation of the dominant injury is performed in the presence of a dominating damage to another anatomical location. Diagnostic laparoscopy or laparotomy are performed when USS is equal to 1 or 2 or more. The operation of other anatomical locations is performed after intra-abdominal bleeding has been stopped and the integrity of the internal organs of the abdominal cavity has been eliminated. Figure 2: Algorithm for the treatment of patients with closed abdominal trauma According to the recommended algorithm, the first stage is to restore the functions of vital organs with the elimination of damage to the anatomical regions, where there is a dominant, life-threatening nature of damage. The restoration of the anatomical and functional integrity of other anatomical areas, where the nature of the damage is not dominant, is carried out in the second stage. IV. C onclusions 1. Ultrasound gradation of the volume of free fluid in the abdominal cavity USS (Ultrasound Score) makes it possible to determine the surgical tactics for concomitant abdominal trauma. 2. In cases of severe trauma with unstable hemodynamics, a total MSCT examination from the head to the lower extremities is justified for the timely detection of the dominant injury and other injuries. 3. Improvement of minimally invasive methods for diagnosing abdominal injuries by expanding the therapeutic capabilities of video laparoscopy improves the results of surgical treatment for concomitant abdominal trauma. 4. The proposed algorithm allows, first of all, to restore the dominant and life-threatening damage to the anatomical areas, from which, along with anti-shock Ultrasound (USS) 0 1 ≥2 Dynamicobservation, ultrasound Laparoscopy Laparotomy 17 Year 2022 Global Journal of Medical Research Volume XXII Issue I Version I ( D ) F © 2022 Global Journals Problems of Early Diagnosis of the Abdominal Cavity with Concomitant Abdominal Trauma in Children measures, it is necessary to begin the surgical treatment tactics.