A prospective observational study of gastrointestinal perforations following blunt trauma abdomen

Abstract

Background: Blunt trauma abdomen often presents late leading to increased morbidity and mortality, therefore the challenges in management of such patients warrant a study in this area for early diagnosis and better outcomes. Methods: A prospective observational study was carried out at a government institute in Central India. All patients having blunt trauma abdomen with GI perforations were observed over 2 years wherein clinical presentation, time of presentation, diagnostic methods and the outcomes were the parameters studied. Results: Young men (21-30 yrs) were found to be the commonly injured group. Road traffic accidents were the most common cause of blunt trauma abdomen. We found that mechanism of injury is related to the outcome and high energy transfer injuries (76%) led to high morbidity and mortality. Abdominal pain with abdominal tenderness and guarding was the most common presentation. Chest X-ray showed free gas under diaphragm in 58%patients who underwent xray. Other modalities used were FAST (focussed abdominal scan for trauma) scan which showed hemoperitoneum. CT scan had 97% sensitivity in diagnosis. Jejunum was the most common site of perforation. Simple closure of perforation with peritoneal lavage was the most commonly performed operative procedure. Overall, 35 patients developed complications in the postoperative period, wound infection being the most common. Mortality in this study was 26%. Conclusions: Young men are the most commonly injured in road traffic accidents with jejunum being the commonest organ injured. High velocity trauma, late presentation, multi- organ injury worsens the prognosis hence early diagnosis becomes imperative for better outcome.