CLINICAL STUDY AND MANAGEMENT OF BLUNT TRAUMA ABDOMEN in 59 CASES

D. Lokanatham; B.Vanya; Dr.Ayyappa Srinivas

Volume : VII, Issue : II, February - 2017

CLINICAL STUDY AND MANAGEMENT OF BLUNT TRAUMA ABDOMEN in 59 CASES

D. Lokanatham, B. Vanya, Dr. Ayyappa Srinivas

Abstract :

Objective: 1. To evaluate the impact of blunt abdominal trauma on the intraperitoneal organs and various modes of presentation in early diagnosis. 2. To evaluate various modalities of treatment and common complications. Background data: Blunt abdominal trauma is one of the most common injuries caused mainly by road traffic accidents. They are usually not obvious. Hence, often missed, unless repeatedly looked for. In view of increasing number of vehicles and consequently road traffic accidents, this dissertation has been chosen to study the cases of blunt abdominal trauma. Material and methods: This is a prospective study of blunt abdominal injuries during the period from August 2014 to November 2016 in ASRAMS Hospital, Eluru. Number of cases studied is 59. Data were collected from the patients by their clinical history, examination and appropriate investigations. Post operative follow up was done to note for complications. Documentation of patients, which included, identification, history, clinical findings, diagnostic test, operative findings, operative procedures, complications during the stay in the hospital and during subsequent follow–up period, were all recorded on a proforma specially prepared. The decision for operative or non operative management depended on the outcome of the clinical examination and results of diagnostic tests. Results: The majority of the patients belonged to 11–20 years age group, followed by 21–30 years age group. 53 cases were males, with females accounting for only about 6 cases. 44 patients were operated and 15 patients were subjected for non operative management. Road traffic accident was responsible for 61% of blunt abdominal trauma cases, while fall from heights accounted for 27% of cases and blow with blunt object was responsible for 12% of injuries. Majority of the patients presented with abdominal pain (86%) and abdominal tenderness (81%). Average latent period was between 16–20 hours. Majority of patients (30%) were taken for surgery between 11–15 hours of latent period. Associated extra abdominal injuries were found in 29 cases. Apart from routine investigations, abdomen x ray was done in 55 patients. 41 patients under– went four–quadrant aspiration. 21 patients underwent diagnostic peritoneal lavage. DPL was done in patients who had equivocal signs or obscured by adjacent soft tissue injury. Ultrasound of abdomen was done in 33 cases. CT scan was done in 6 cases. Conclusion: Road traffic accidents form the most common mode of injury. Males are predominantly affected. A thorough and repeated clinical examination leads to successful treatment in these patients. Plain x ray abdomen, ultrasound scan, four quadrant aspiration and diagnostic peritoneal lavage are valuable investigations. Multiple organs are usually involved in most of the cases rather than an isolated organ injury. Associated extra abdominal injuries greatly influence the morbidity and mortality. Post operative complications like wound infection, dehiscence and respiratory complications are common in blunt abdominal trauma. The present study shows a mortality of 15%.