Missed abdominal injury: why and how to deal? A retrospective interventional study

Abstract

Introduction: Literature is silent on missed abdominal surgery mostly because, it has become rare after the use of routine whole body CT scan. Even if missed, it remains so small a number and for fear of negative publicity, it goes unpublished. It is felt that, missing an abdominal injury must be having an altered final outcome on the patients. With this question in mind, the old data, kept prospectively was analysed, with an aim to find out the prevalence of missed abdominal injury, why were the injures were missed and how to deal with them early and effectively so as to have a possible positive change in the final outcome. Materials and methods: It was a retrospective interventional study from Jan 2002 to May 2017, where cases of blunt abdominal injuries were included and war/ insurgency related gunshot, penetrating and bowel injuries were excluded in two large military hospital in peace locations. Only cases with blunt injuries including the transferred patients from the other hospital were included in the study, where the injuries were missed at three level, namely clinically unsuspected, at CT scan and at laparotomy. Result: There were 72 patients with blunt abdominal injuries. There were 67 males and five females with age range from 8- 72 years (mean 30.70 SD13.759).Forty-three (43) patients were managed by observation and 18 patients were operated. Twelve (12) injuries were missed mostly due to, not suspecting an injury, un-conscious patient with severe head injury and misinterpretation of CT images. Six patients underwent laparoscopy. Only one patient, a laparotomy was avoided. There were three mortalities from the missed organ injury group. Conclusion: Missing an injury is presumed to be relatively uncommon. Mesenteric and isolated pancreatic injury are most often missed. Diagnostic laparoscopy confirms mesenteric injury and saponification of fat suggest pancreatic injury and duodenal injury even missed at laparotomy, when done very early.