This document discusses the increasing use of ultrasound by surgeons. It provides examples of how ultrasound is used in trauma settings to detect internal bleeding and guide procedures. The author also shares their experience using ultrasound to diagnose acute cholecystitis and guide radiofrequency ablation of liver tumors. Percutaneous drainage of intra-abdominal collections under ultrasound guidance is described as well, with a high success rate.

1. ULTRASOUND
THE SURGEON`S NEW
BEST COMPANION
FELIPE CATAN MD FACS
ADJUNCT PROFESSOR
UNIVERSITY OF CHILE

2. HISTORY
• ULTRASOUND IN TRAUMA
• INTRAOPERATIVE US
• DETECTION AND MANAGEMENT
OF POST OPERATIVE
COMPLICATIONS

3. COMMON US APPLICATIONS
MANAGED BY SURGEONS
• TRAUMA
• ACUTE NON TRAUMA PATIENT
• INTRAOPERATIVE
• VASCULAR
• US GUIDED PROCEDURES
• BREAST
• SOFT TISSUE

4. OUR EXPERIENCE
• EMERGENCY ULTRASOUND
ARRIVED IN SEPTEMBER 1998
• 10 WEEKS OF FORMAL TRAINING IN
A RADIOLOGY SERVICE
• TEACH TO A SMALL NUMBER OF
EMERGENCY SURGEONS

5. OUR EXPERIENCE
• US IN THE ACUTE NON TRAUMATIC
PATIENTS SINCE 1999
• PERCUTANEOUS DRAINAGE SINCE
1999
• INTRAOPERATIVE US SINCE 1999
• RADIOFREQUENCY SINCE 2001

6. ULTRASOUND IN TRAUMA
PATIENTS
• 357 PATIENTS
• ALTERED MENTAL STATUS
• BLUNT AND STAB ABDOMINAL
WOUNDS
• CLINICAL FOLLOW UP

7. ULTRASOUND IN TRAUMA
PATIENTS
• EVIDENT SURGICAL INDICATION
EXCLUDED THE PATIENT
• MEAN AGE 35,1±8,3 YEARS
• 60.9% MALE
• BLUNT TRAUMA 211(59.1)
• STAB WOUND 146 (40.9)

9. ULTRASOUND IN TRAUMA
PATIENTS
• TABLA FINDINGS IN TRAUMA PATIENTS
US
Findings Number of Patients Percentage
Free Peritoneal Fluid 66 18,5
Free Pleural Fluid 9 2,5
Pericardic Fluid 6 1,7
Solid Viscus Lesion or Haematoma 33 9,2
Fetal Death 1 0,3
Normal US 242 67,8
Total 357 100

10. FOLLOW UP
• 242 NEGATIVE PATIENTS
– 64% BLUNT TRAUMA
– 36% PENETRATING INJURY
• 5 PATIENTS REQUIERED SURGERY
BECAUSE OF BOWEL
PERFORATION
• 1 OPERATED HEMOPERITONEUM

11. US IN UPPER RIGTH
ABDOMINAL QUADRANT
• 1307 PATIENTS
• CHOLELITHIASIS 54.4%
• ACUTE ACUTE CHOLECISTITIS 26.5%
• NORMAL US 30.5 %
• BILIARY TREE DILATATION 14.5%
• OTHER FINDINGS 19.5%

13. US IN UPPER RIGTH
ABDOMINAL QUADRANT
• IN ACUTE CHOLECISTITIS
– SENSITIVITY 92.1%
– SPECIFICITY 97.8%
– PPV 98.9%
– PNV 89.7%

14. ULTRASOUND GUIDED
RADIOFRQUENCY

17. US GUIDED
RADIOFREQUENCY
ABLATION
• 27 PATIENTS
• 30 PROCEDURES
• PRIMARY LIVER TUMOR OR
METASTASIS
• UNRESECTABLE OR HIGH RISK
• DIAGNOSIS CONFIRMED BIOPSY
OR ELEVATED α-FP

18. US GUIDED RADIOFREQUENCY ABLATION
ETIOLOGY
• 10 HEPATOCARCINOMA
• 12 COLON CANCER METASTASIS
• 3 GASTRIC CANCER METASTASIS
• 1 COLANGIOCARCINOMA
• 1 ENDOCRINE TUMOR
METASTASIS

19. US GUIDED
RADIOFREQUENCY
• 1 PUNCTION IN TUMOR < 3cm
• 2 TO 5 IN BIGGER TUMORS
• MEAN AGE 62 YEARS ( 34 A 88)
• MEAN ENERGY 9275 Watt/sec

22. PERCUTANEOUS TREATMENT OF
INTRA ABDOMINAL COLLECTIONS
• PROSPECTIVE TRIAL
• ACUTE PANCREATITIS EXCLUDED
• US TO DEFINE WINDOW
• US GUIDED PUNCTION
• PERCUTANEOUS DRAINAGE 12 F
• ANTIBIOTICS
• CONTROL US
• MINUMUM FOLLOW UP 1 MONTH AFTER
DISCHARGE

23. US GUIDED PERCUTANEOUS
TREATMENT OF INTRA ABDOMINAL
COLLECTIONS
• 101 PATIENTS
• 30% IN SEPTIC SHOCK
• 2 NO WINDOW
• 3 ATEMPTED BUT UNSUCCESFULL
• 5 REQUIRED A SECOND DRAINAGE
• 3 DIED
• 93 SUCCESSFUL DRAINAGE