A prospective study on blunt injury abdomen

INTRODUCTION: Abdominal trauma continues to account for a large number of trauma related injuries and deaths. Motor vehicle accidents, accidental fall are leading causes of blunt and penetrating trauma to abdomen. Blunt abdominal trauma is one of the leading preventable causes of the unnatural death in developed and developing countries. Blunt trauma is particularly deceptive as the clinical manifestations of the injury may be delayed for hours or days even though internal damage is serious and sometimes lethal. In open cases of abdominal trauma the clinical manifestations, diagnosis and management will be easier but closed cases of abdominal trauma offers a great challenge to the treating surgeon. Injuries to the abdominal viscera, caused by blunt trauma, are particularly common in civilian life. The blunt trauma differs from penetrating trauma, as the different organs are characteristically injured by compression from blunt straining. The solid organs such as spleen, liver, kidney, pancreas, etc., are the most vulnerable, while the hollow viscera like stomach, intestines and bladder are less likely to be involved. The outstanding features of injury to solid organ are the haemorrhage and shock, while in hollow visceral injury shock follows with the development of peritonitis. The aim of this study is to analyse the incidence of hollow viscus perforation and solid organ injuries and find out the morbidity and mortality in blunt abdominal trauma. AIM OF THE STUDY: 1. To evaluate the age and sex incidence of the involved patient population. 2. To evaluate the different organ systems involved in various modes of presentations as a primary tool in early diagnosis. 3. To find a possible treatment protocol cases of blunt trauma to the abdomen following road traffic accident. MATERIALS AND METHODS: 162 cases of blunt trauma following road traffic accidents admitted in all the surgical units at Thanjavur Medical College Hospital during the period of September 2016 to September 2017 The cases were selected with accurate history of trauma including the mode of injury, the time elapsed since injury till admission and history of primary resusitation documented carefully. Based on a careful history and meticulous physical examination combined with adjunctive investigations, a decision to operate or to manage conservatively was taken. Baseline laboratory parameters like blood urea, blood sugar, serum electrolytes and blood grouping was done in all cases. Plain x-ray abdomen in an erect posture was taken for all stable patients. Other investigations appropriately taken for associated injuries. Ultra sonogram and CT scan abdomen was not done as a routine diagnostic investigation, however few cases were subjected to the same in view of special circumstances. A performa of each case including the case, sex, mode of injury, and an accurate history suggesting the mode of injury was compiled. Personal history of previous trauma or surgeries and alcohol or drug intoxication was specifically sought for. Plain skiagram of the abdomen and four quadrant aspiration was done in all the cases. 17 All the patients were resusitated with ringer lactate solution and blood before surgical intervention. All the patients were manadatorily maintained on nasogastric suction, intravenous fluid replacement and broad spectrum antibiotics. Selected cases were catheterised. Post operative complications were specifically sought for and treated appropriately. DISCUSSION: In our study of blunt injury abdomen, caused due to road traffic accidents, 162 cases were admitted in thanjavur medical college and hospital from september 2016 to september 2017. Males accounted for 103 patients [45%]. Vijay malhotra et al also reported similar sex incidence in the landmark 1998 study. The proportionate majority of males could account for the male preponderance involved in road traffic accidents, also to a certain exten by their aggressive behaviour. Solid organ injuries like liver and spleen injuries due to direct compressive forces resulting from collision. Bowel injuries might have been contributed by deceleration shear stess and sudden increase in abdominal pressure. 49 cases [30.2%] were hemodynamically unstable at presentation and required aggressive reusitation. The connectialt and suffolk show a 44% shock incidence at presentation. 20 cases died among 162 cases, in which peritonitis waas the cause of death in 15 cases and 5 patients died due to hypovolemic shock, this is due to late presentation after which they have treated in mofsul hospitals and was referred to TMCH. Physical examination revealed abdominal bruises in 62 cases, abdominal pain and distension in 70 cases. Guarding found in all cases. Rigidity was noticed in 20 patients. Davis et al reported abdominal pain in 75% of the patienst, rigidity and rebound tenderness in 25%