ABDOMINAL TRAUMA - CLINICAL PROFILE AND MANAGEMENT - A PROSPECTIVE STUDY

Abstract

Background: Blunt abdominal trauma is usually not obvious hence, often missed, unless, repeatedly looked for. Delay in diagnosis and inadequate treatment of the abdominal injuries may prove fatal. Objectives: To study the cases of abdominal trauma with reference to the patients presenting at SKIMS Soura Srinagar both in form of evaluation and management. Methods: After obtaining the proper informed consent patients fulfilling the selection criteria were enrolled in the study. Patients were evaluated starting with all routine baseline investigations like complete blood count, liver function test, kidney function test, ultrasonography Abdomen, FAST after proper history and clinical examination. A proper plan was formulated regarding the management of the patient whether to be managed conservatively or whether any surgical intervention was done. A complete postoperative care and follow up was ensured. Results: Mode of injury includes road traffic accident, fall from height, hit by stone and assault.Presenting symptoms including abdominal pain was seen in 91.4%, abdominal tenderness in 48.6%, rigidity in 25.7%, shock in 21.4% patients while 15.7% presented with vomiting.On FAST 38.6% patients had both organ injury and free fluid.Grade II spleen injury was observed in 28% patients, Grade I in 24% patients, Grade IV in 20% patients, Grade V in 16% patients and Grade IIII injury in 12% patients.Grade IV liver injury was observed in 28.6% patients, Grade I injury in 23.8% patients, Grade II and Grade V in 19% and Grade III in 9.5% patients. 68.6% were conservatively managed while 31.4% underwent surgery with 2.9% mortality. Majority of patients were conservatively managed. 4 patients encountered postoperative complications like surgical site infection (10.3%) and re-exploration (3.4%). Conclusion: Prompt evaluation of abdomen is mandatory to minimize preventable morbidity and mortality. Early diagnosis can decrease mortality by 50%. Mortality is related to delayed presentation and diagnosis, associated injuries and delayed surgical intervention.