Pattern of Bowel Injury and the Outcome of their Management in Blunt Abdominal Trauma in a Tertiary Care Hospital

Abstract

Background: Blunt abdominal injury is common in trauma patients. Evaluation of patients who have sustained blunt abdominal trauma may pose a formidable problem and significant intra abdominal injury is one of the most difficult problems faced by emergency doctors and surgeons in the management of trauma. Traumatic bowel injury is one of the curable traumatic conditions. An accurate and timely diagnosis and treatment giving an excellent outcome in most cases. A delay in diagnosis is associated with significant morbidity and mortality. Objectives: To determine the pattern of bowel injury from blunt abdominal trauma, and outcome of their management of the patient after surgery in a tertiary care hospital. Methods: It was an observational study carried out in the department of surgery, Shaheed Ziaur Rahman Medical College Hospital, Bogura from April '2020 to September '2020. Thereafter, they were scrutinized according to eligibility criteria and 50 patients were finalized. Patients with a history of bowel injury are managed with blunt abdominal trauma after proper counseling, results were tabulated and analyzed. Results: A total of 50 patients were enrolled comprising 42(84%) males and 8(16%) females and male-female ration 21:4. Out of 50 patients, most of 18(35%) patients had 31-40 years age group. The mean age was 33.9±7.2 years. Maximum patients reported within 1-6 hours 28(56%) and next group within about 1 hours 11(22%). The average time lapsed was 5.79 hours. 18(36%) patients had concomitant injuries, like 1(2%) patient had a head injury, 8(16%) had pelvic fracture, 4(8%) patients had long bone fracture, 3(6%) patients had soft tissue injury and 2(4%) patients had blunt chest injury. Features of peritonitis were present at initial evaluation 42(84%) patients abdominal pain and features of paralytic ileus 21(42%). 28(56%) cases sustained injury from motor vehicle accident as passenger. Sites of bowel injury were: duodenum 3(6%), jejunum 24(48%), ileum 8(16%), large gut 8(16%), both small and large gut 2(4%). Conclusion: Traumatic bowel injury is one of the commonest traumatic conditions that are encountered in hospitals, namely in the department of surgery. The management of traumatic bowel injury has a fairly good prognosis in developed countries. The outcome is not as good as expected in the third world countries, like our country, due to certain prevailing adverse conditions. The injury in the small bowel is associated with more morbidity than that in the large bowel injury.