A STUDY ON PATTERN OF BLUNT ABDOMINAL TRAUMA AND ITS OUTCOME FOLLOWING NON OPERATIVE MANAGEMENT

Abstract

INTRODUCTION: Abdomen is the third most commonly injured part of the body following injuries to extremities and head. Blunt injury remains to be the most prevailing mode of abdominal injury. Motor vehicle accidents are the most common mode to cause Blunt abdominal trauma. Evolving imaging modalities like FAST, CT scans have resulted in signicant shift from surgical to more selective conservative management of blunt injury abdomen. MATERIALS AND METHODS: This is a prospective study of selected cases of Blunt injury abdomen managed in the Department of General Surgery in Rajah Muthiah Medical College and Hospital (RMMCH) during the period from September 2019 to October 2021. AIMS AND OBJECTIVES: The current study establishes the incidence and demographic distribution of patients who have sustained blunt abdominal trauma, also gives an outline which type of patient will benet conservative management and detects downfalls of surgical and conservative management and identies the causes of failure of Non operative management following blunt injury abdomen. RESULTS: In our study males were more commonly affected than females in the ratio 4:1 and age group involved ranging from 4 years to 69 years, majority were in second, third, fourth decades taking a toll of 71.25% of patients. The common presentations in these victims were abdominal pain, tenderness, diffuse guarding, rigidity, abdominal distention, sluggish/ absent bowel sounds, pallor, hypotension with features of shock. In unstable patients to detect hemoperitoneum, ultrasonography/FAST was a very helpful mode of investigation. But, it missed 3 cases with kidney injury, 5 cases with liver injury, and 9 cases with splenic injury. It is not an imaging of choice to detect bowel, kidney, pancreas and mesenteric injuries. CECT abdomen is the investigation of choice to grade the organ injuries. 37 patients with splenic injuries were identied by CT abdomen, of which 29 were managed conservatively. CT abdomen detected liver injuries in 21 patients, of which 16 were managed conservatively. Kidney injures were picked up in 5 patients with help of CT abdomen and all were subjected to conservative management. MANAGEMENT: From a total of 100 patients studied, 64 patients were selected for conservative management after initial resuscitation. Most common organ to get involved following Blunt abdominal trauma is Spleen (37%), followed by liver (21%), mesentery, small bowel and bladder. Out of 37 patients with splenic injuires, 29 were managed conservatively. 16 cases with isolated hepatic injury, 5 cases with kidney injury, 2 cases with bladder injury, 2 patients with mesenteric injury and one patient with pancreatic injury were managed conservatively. Morbidity and mortality: Mortality was not observed in patients subjected to conservative management. A total of 4 cases died in the operative group. Two patients due to pancreatic head transection, one due to associated head injury, one due to delayed hospitalization. The duration of hospitalization in patients who were managed conservatively ranged from 9-11 days and 14-20 days in patients who underwent surgery. One patient developed pseudocyst of pancreas following pancreatic injury and another patient developed clot retention following conservative management for bladder injury. The causes of failure of non operative management in patients with blunt abdominal trauma were patients with pancreatic head transection, ongoing hemorrhage/ features of peritonitis with hemoperitoneum and hollow viscus perforation. CONCLUSION: The success rates following conservative management of solid organ injures after blunt injury abdomen have been increasing and it is quite challenging also, since it requires close observation by experienced surgeon and there is a narrow line to choose the line of management (conservative / surgical) for better outcome. Involvement of multiple intra abdominal organs, other associated extra abdominal injuries, coexisting comorbid diseases and late presentation following injury increases the morbidity and mortality. Ultimately early diagnosis, aggressive adequate resuscitation and timely surgical intervention when needed in severely injured patients may boost the outcome in these patients who have failed conservative management.