Challenges in management of blunt abdominal trauma: a prospective study

Authors

  • Rajkumar P. N. Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Kushal Kumar T. R. Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Deepak G. Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20184078

Keywords:

ATLS (Advanced trauma life support), BAT, MVA (Motor vehicle accidents), SNOM (Selective non-operative management)

Abstract

Background: Trauma meets the pandemic criteria, with a daily worldwide mortality as high as 16000. Abdominal trauma remains a leading cause of mortality in all age groups. Blunt abdominal trauma (BAT) mainly results from motor vehicle accident, fall from height and assaults. The commonest organ injured is the spleen, followed by the liver and small bowel. Lately, the management of BAT has changed from operative to non-operative management. This study was done to analyse the incidence, patterns, current management practiced, and challenges encountered in BAT treated operatively.

Methods: This Prospective study was conducted in tertiary care centre in Bangalore during August 2015 to December 2017. 475 patients with blunt abdominal injuries who reported to emergency department were selected for the study based on following inclusion and exclusion criteria.

Results: A total of 475 cases of BAT were assessed with a mean age of males and females was 32.6 and 28.3year respectively. Most patients (65%) were between 21 to 30 years of life. Most common mode of injury was motor vehicle accident (57.68%), 60% patients presented to hospital within the initial 4 hours. Abdominal CT had highest accuracy. Most common solid organ injury being spleen (26.5%). 80.84% patients were selected for SNOM and 15.62% had Failed SNOM. 28.48% patients had complications with most common complication wound infection followed by aspiration pneumonia and 7 patients had mortality.

Conclusions: Initial resuscitation with thorough clinical examination with correct usage of imaging modalities with timely and proper decision making is the key of management of patients with BAT and there is a need to identify newer imaging modality/procedure which helps to determine better management scheme in all blunt trauma patients.

 

References

Paun S, Beuran M, Negoi I, Runcanu A, Gaspar B. Trauma-epidemiology: where are we today? Chirurgia (Bucur). 2011;106:439-43.

ACR Appropriate Criteria blunt abdominal trauma. National Guideline Clearing House, NGC-9232. 2012. Available at https://www.guidelinecentral.com/summaries/acr-appropriateness-criteria-blunt-abdominal-trauma/

Schroeppel TJ, Croce MA. Diagnosis and management of blunt abdominal solid organ injury. Curr Opin Crit Care. 2007;13:399-404.

Yanar H, Ertekin C, Taviloglu K, Kabay B, Bakkaloglu H, Guloglu R. Non-operative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. J Trauma. 2008;64:943-8.

American College of Surgeons Committee on Trauma. Advanced Trauma Life Support. 6th ed. Chicago: American College of Surgeons. 1997;10.

Lone GN, Peer GQ, Warn AK, Bhat AM, Warn NA. An experience with abdominal trauma in adults in Kashmir. JK Pract. 2001;8:225-30.

Gad MA, Saber A, Farrag S, Shams ME, Ellabban GM. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. Am J Med Sci. 2012;4:129-34.

Asuquo M, Umoh M, Nwagbara V, Ugare G, Agbor C. and Japhet E. “Penetrating abdominal trauma: experience in a teaching hospital, calabar, Southern Nigeria,” Intl J Clin Med. 2012;3(5):426-30.

Mnguni MN, Muckart DJJ, Madiba TE. Abdominal Trauma in Durban, South Africa: factors influencing outcome. Int J Surg. 2012;97(2):161-8.

Monzon-Torres BI, Ortega-Gonzalez M. Penetrating abdominal trauma. SAJS. 2004;42(1)11-3.

Ohene-Yeboah M, Dakubo JCB, Boakye F, Naeeder SB. Penetrating abdominal injuries in adults seen at two teaching hospitals in Ghana. Ghana Med J. 2010;44(3):103-8.

Salim A, Velmahos GC. When to operate on ab-dominal gunshot wounds. Scandinavian J Surg. 2002;91(1):62-6.

Karamercan A, Yilmaz TU, Karmercan MA, Aytac B. Blunt abdominal trauma: Evaluation of diagnostic options and surgical outcomes. Turk J Trauma Emerg Surg. 2008;14:205-10.

Abdelrahman H, Ajaj A, Atique S, El-Menyar A, Al-Thani H. Conservative management of major liver necrosis after angioembolization in a patient with blunt trauma. Case Rep Surg. 2013;2013:954050.

Salimi J, Ghodsi M, Zavvarh MN, Khaji A. Hospital management of abdominal trauma in Tehran, Iran: A review of 228 patients. Chin J Traumatol. 2009;12:259-62.

Ponifasio P, Poki HO, Watters DA. Abdominal trauma in urban Papua New Guinea. P N G Med J. 2001;44:36-42.

Chalya PL, Mabula JB, Dass RM, Mbelenge N, Ngayomela IH, Chandika AB, et al. Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania. J Trauma Manag Outcomes. 2012;6:1.

Smith J, Caldwell E, D’Amours S, Jalaludin B, Sugrue M. Abdominal trauma: A disease in evolution. ANZ J Surg. 2005;75:790-4.

Clancy TV, Gary Maxwell J, Covington DL, Brinker CC, Blackman D. A statewide analysis of level I and II trauma centers for patients with major injuries. J Trauma. 2001;51:346-51.

Matthes G, Stengel D, Seifert J, Rademacher G, Mutze S, Ekkernkamp A. Blunt liver injuries in polytrauma: Results from a cohort study with the regular use of whole-body helical computed tomography. World J Surg. 2003;27:1124-30.

Wisner DH, Chun Y, Blaisdell FW. Blunt intestinal injury. Keys to diagnosis and management. Arch Surg. 1990;125:1319-22.

Costa G, Tierno SM, Tomassini F, Venturini L, Frezza B, Cancrini G, et al. The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry. Ann Ital Chir. 2010;81:95-102.

Croce MA, Fabian TC, Menke PG, Waddle-Smith L, Minard G, Kudsk KA, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg. 1995; 221(6):744-53.

Osborn TM, Tracy JK, Dunne JR, Pasquale M, Napolitano LM. Epidemiology of sepsis in patients with traumatic injury. Crit Care Med. 2004;32:2234-40.

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Published

2018-09-25

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Original Research Articles