Prospective observational study of blunt abdominal trauma and hemoperitoneum
DOI:
https://doi.org/10.18203/2349-2902.isj20261994Keywords:
Blunt abdominal trauma, Solid organ injury, Hemoperitoneum, Road traffic accidents, Clinical shock, Trauma outcomesAbstract
Background: The early recognition and appropriate management of solid organ injuries in blunt abdominal trauma are pivotal in improving patient outcomes. The aim of this study was to evaluate the factors affecting outcome of solid organ injury with blunt abdominal trauma and hemoperitoneum.
Methods: A prospective observational study was conducted over a period of two years at a tertiary care centre providing advanced trauma and emergency surgical services in Western Maharashtra. A total of 44 patients presenting with blunt abdominal trauma and radiological or clinical evidence of solid organ injury with hemoperitoneum were included. Demographic characteristics, mechanism of injury, clinical presentation, imaging findings, associated injuries, management strategies, and outcomes were analysed.
Results: Among the 44 patients, the majority (38.6%) were aged 16–30 years, and males constituted 84.1% of the cohort. Road traffic accidents were the most common cause of injury (61.4%). Associated injuries were present in 38.6% of patients. Computed tomography revealed mild intraperitoneal fluid collection in 22.7% of cases. Only 6.8% of patients required operative management, with intraoperative findings showing liver injury in two patients and splenic injury in one patient. The overall mortality rate was 4.5%. Younger age and associated head injury were significantly associated with mortality. Clinical shock at presentation significantly influenced the management approach.
Conclusion: Blunt abdominal trauma with solid organ injury predominantly affects young males and is most commonly caused by road traffic accidents. Mortality is mainly associated with high-grade splenic injury and concomitant head injury. Continuous monitoring of haemoglobin levels and clinical signs of shock is essential for guiding management and predicting outcomes rather than relying solely on the patient’s condition at admissions.
References
Shah SM, Shah KS, Joshi PK, Somani RB, Gohil V, Dakhda SM. To study the incidence of organ damage and post-operative care in patients of blunt abdominal trauma with haemoperitoneum managed by laparoscopy. J Minim Access Surg. 2011;7:169-72.
Radwan M, Abu-Zidan F. Focused assessment sonograph trauma (FAST) and CT scan in blunt abdominal trauma: surgeon's perspective. Afr Health Sci. 2006;6(3):187-90.
Brooks A, Davies B, Connolly J. Prospective evaluation of handheld ultrasound in the diagnosis of blunt abdominal trauma. J R Army Med Corps. 2002;148:19-21.
Au H, Mak Y, Luk S, Cheung CC, Kam C, Lee ACW. Chronic myeloid leukemia presenting as traumatic haemoperitoneum and duodenal injury. Hong Kong J Emerg Med. 2000;7:236-7.
Sirlin CB, Brown MA, Andrade-Barreto OA, Deutsch R, Fortlage DA, Hoyt DB. Blunt abdominal trauma: screening US in 2,693 patients. Radiology. 2007;244(3):789-98.
Holmes JF, Gladman A, Chang CH. Performance of abdominal ultrasonography in paediatric blunt trauma patients: a meta-analysis. J Pediatr Surg. 2010;45(5):987-94.
Natarajan B, Gupta PK, Cemaj S, Sorensen M, Hatzoudis GI, Forse RA. FAST scan: is it worth doing in hemodynamically stable blunt trauma patients? Surgery. 2010;147(1):51-5.
Zhang Q, Jin W, Deng L, Lv H, Zhu J. Mechanisms of blunt liver trauma patterns: an analysis of 53 cases. Exp Ther Med. 2012;5:395-8.
Mahmood I, Abdelrahman H, Al-Hassani A, Nabir S, Sebastian M, Maull KI. Clinical implications of isolated free intra-abdominal fluid on computed tomography scan in blunt abdominal trauma. World J Emerg Surg. 2013;8(1):37.
Zarzaur BL, Kozar R, Myers JG, Claridge JA, Scalea TM, Neideen TA. The splenic injury outcomes trial: an American Association for the Surgery of Trauma multi institutional study. J Trauma Acute Care Surg. 2015;79(3):335-42.
Fikry K, Velmahos GC, Bramos A, Janjua S, de Moya M, King DR. Successful nonoperative management of the most severe blunt liver injuries. Arch Surg. 2016;151(5):423-8.
Becker A, Leiderman DB, Lockary V, Rowell S, Hyatt S, Shaves S. Hemoperitoneum in stable blunt trauma patients: is laparotomy always necessary? J Trauma Acute Care Surg. 2011;70(3):701-5.