DOI: http://dx.doi.org/10.18203/2349-2902.isj20213129

Management of solid organ injury in patient of blunt abdominal trauma

Aafrin S. Baldiwala, Vipul C. Lad

Abstract


Background: In this ongoing era of 21st century, trauma is the leading cause of death in individuals between age 1 and 44. In trauma, also road traffic accidents (RTAs) are the major cause of death. Blunt abdominal trauma is a frequent emergency and is associated with significant morbidity and mortality.

Methods: A prospective analysis of 50 patients of blunt abdominal trauma admitted in SMIMER hospital Surat within a span of 12 months was done. Unstable patients with initial resuscitation underwent focused assessment sonography for trauma (FAST). Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen.

Results: Most of the patients in our study were in the age group of 21-45 years with M:F ratio of 4:1. RTAs (62%) was the most common mechanism of injury. Spleen (38%) was the commonest organ injured and the most common surgery performed was splenectomy. In total non-operative management (NOM) was done in 58% of cases and surgical management was done in 42% of cases.

Conclusions: Appropriate patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in management of blunt abdominal trauma. To conclude, initial resuscitation measures and correct diagnosis forms the most vital part of blunt abdominal trauma management.


Keywords


Blunt trauma, Kidney injury, Liver injury, Solid organ injury, Spleen injury

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References


Martin RS, Meredith JW. Management of Acute Trauma, Sabiston’s textbook of surgery. 20th ed. New York: Elsevier Health; 2016.

Ochsner MG. Factors of failure for nonoperative management of blunt liver and splenic injuries. World J Surg. 2001;25(11):1393-6.

Mehta N, Babu S, Venugopal K. An experience with blunt abdominal trauma: evaluation, management and outcome. Clin Pract. 2014;4(2):599.

Richardson JD, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, et al. Evolutions in management of hepatic trauma: a 25-year perspective. Ann Surg. 2000;232(3):324-30.

Radwan MM, Abu-Zidan MI. Focused assessment sonographic for trauma (FAST) and CT scan in blunt trauma. Surgeon’s perspective. J Africa Health Sci. 2006;6(3):187-90.

Velmahos GC, Toutouzas KG, Radin R, Chan L, Demetriades D. Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg. 2003;138(8):844-51.

Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, et al. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38(2):185-93.

Perry JF. A five-year survey of 152 acute abdominal injuries. J Trauma. 1965;5:53-61.

Schroeppel TJ, Croce MA. Diagnosis and management of blunt abdominal solid organ injury. Curr Opin Crit Care. 2007;13(4):399-404.

Musau P, Jani PG, Owillah FA. Pattern and outcome of abdominal injuries at Kenyatta national hospital, Nairobi. East Afr Med J. 2006;83(1):37-43.

Davis JJ, Cohn I, Nance FC. Diagnosis and management of blunt abdominal trauma. Ann Surg. 1976;183(6):672-8.

Bolton PM, Wood CB, Quartey-Papafio JB, Blumgart LH. Blunt abdominal injury: a review of 59 consecutive cases undergoing surgery. BJS. 1973;60(8):657-63.