Blunt Abdominal Injury Research Articles

Management of Acute Injury and Illness in Pediatric Athletes by Athletic Trainers: Compliance With Emergency Medicine and Athletic Trainer Evidence-Based Guidelines.

This study aimed to determine athletic trainer compliance with emergency medicine and athletic training evidence-based guidelines for the on-the-field management of common pediatric sports-related injury and illness. A questionnaire was distributed electronically to selected members of the National Athletic Trainer Association. The questionnaire included 10 clinical scenarios describing common sports-related injury/illness (closed head injury, cervical spine injury, blunt chest injury, blunt abdominal injury, ankle injury, knee injury with laceration, heat-related illness). On-the-field management decisions for each scenario were compared with selected emergency medicine and athletic training guidelines. Analysis was performed on 564 completed questionnaires (9% response rate). Responders were compliant with practice guidelines for both emergency medicine and athletic training except for blunt chest trauma with tachycardia, closed head injury with loss of consciousness, closed head injury with repetitive speech, closed head injury with a fall higher than 5 feet, cervical spine injury with paresthesias, and heat-related illness with persistent symptoms. Discrepancies between emergency medicine and athletic training guidelines included closed head injury with repetitive speech, closed head injury and height of fall, closed head injury and unequal pupils, and cervical spine injury with neck pain and paresthesias. Based on our sample, athletic trainers were compliant with many guidelines supported by both emergency medicine and athletic training. We identified several deficiencies in the availability of evidence-based guidelines and discrepancies between these guidelines and athletic trainer responses. To provide optimal care to pediatric athletes who sustain injury or illness, emergency medicine and athletic training organizations should collaborate to improve these discrepancies.

Paediatric blunt abdominal trauma with organ injury: a comprehensive analysis of cases at a tertiary hospital in Bangladesh

Background: Pediatric blunt abdominal trauma with organ injuries is a critical issue in Bangladesh, lacking sufficient research. This study focuses on managing such cases in a tertiary hospital. Objectives were to assess clinical characteristics, injury patterns, and outcomes of pediatric patients with blunt abdominal trauma and organ injuries. It aims to identify causes, associated injuries, and hospital stay durations. Methods: A prospective study of 142 pediatric patients aged 1-12 was conducted at Rajshahi medical college hospital study period January 2020 to December 2021. In addition, this study aimed to identify and grade solid organ injuries according to the American association for the surgery of trauma organ injury scale. Results: Prevalence of hepatic injuries (76.8%), solid organ injuries (90.1%), road traffic accidents (71.8%), falls from height (25.4%). Most received conservative treatment, had short hospital stays, and a 7% mortality rate. Gender had no significant impact on organ injuries (p>0.001). Among the causes, 84.5% had hepatic injuries, 15.5% had spleen injuries due to road traffic accidents, and 58.3% had injuries from falls from height, with a highly significant cause-organ injury relationship (p<0.001). Conclusions: pediatric blunt abdominal injuries in Bangladesh affect various organs, primarily in males and school-aged children, primarily due to road accidents. Timely surgical intervention and preventive measures are crucial for improved outcomes.

Primary Reconstruction of Bladder Neck Transection and Vaginal Laceration Post Blunt Abdominal Injury a Case Report

Blunt abdominal injury is not uncommon in the paediatric population. The presentation can be immediate or delayed, and if not promptly recognized may be attended with complications such as septicaemia, shock or death. Simple, readily available and cheap imaging techniques such as abdominal radiograph and ultrasound scan still remain relevant in the diagnosis of blunt abdominal injuries where abdominal computerized tomography is unavailable or unaffordable. This can expedite the decision for an early surgical exploration. In girls, complete bladder neck transection with vaginal wall injury is a rarely reported and unusual association of blunt abdominal injury more so with delayed presentation in the absence of an associated pelvic fracture. This rare trauma entity in a child can pose a diagnostic difficulty leading to delayed presentation. This is a case of 3 year old girl with 3 weeks history of trauma to the abdomen from collapsed building fence during a heavy downpour. She later developed progressive abdominal distension with pain, constipation, vomiting, fever and drainage of clear fluid per vaginam. She had visited several hospitals but was managed non-operatively. Over the period the patient had some relief of symptoms until she presented to our facility with poorly defined features of peritonitis following a referral from a peripheral hospital. Abdominal ultrasound scan revealed intraperitoneal fluid collection. She was resuscitated and had exploratory laparotomy with primary reconstruction of the bladder neck transection and vaginal wall laceration. She did well immediate postoperative except for the superficial surgical site infection and during follow-up visits. Primary repair of traumatic bladder neck transection and vaginal wall laceration in paediatric patients with delayed presentation of blunt abdominal injury is a feasible option of management. However, long term follow up is recommended as secondary procedures may become necessary.

Successful Surgical Outcome after Traumatic Diaphragmatic Intra-Pericardial Herniation from Blunt Abdominal Injury

Successful Surgical Outcome after Traumatic Diaphragmatic Intra-Pericardial Herniation from Blunt Abdominal Injury

Contrast-enhanced Computed Tomography Versus Contrast and Non-contrast Enhanced Computed Tomography for Detecting Blunt Abdominal Injury

Objective: This study aimed to compare the diagnostic ability of contrast-enhanced computed tomography (CECT) and CECT combined with non-contrast computed tomography (NCT) for intraabdominal organ injury in patients with blunt abdominal injury.Material and Methods: Overall, 195 adult patients having had blunt abdominal trauma underwent CT at this institution; from 2016 and 2021. All CT images were retrospectively reviewed by two radiologists. The efficacy of detection of organ injuries and the degree of intra-abdominal injury were recorded. The radiologists scored their diagnostic confidence for each CT image dataset on a five-point scale: inter-observer agreement was also calculated.Results: All included patients underwent CT for blunt abdominal trauma. The most common cause of injury was motorcycle accident (59.5%), with patients being predominantly male: the mean patient age was 44 years. Hemoperitoneum was the most common CT finding, with a significantly higher detection rate on CECT combined with NCT than on CECT alone. There was no statistically significant difference in the diagnostic efficacy of the detected organ injury nor other types of organ injuries between CECT alone and CECT combined with NCT. Nevertheless, the accuracy of CECT in detecting hemoperitoneum may diminish in patients with severe fatty liver disease; especially in the perihepatic region.Conclusion: CECT alone is a potential tool for detecting abdominal injuries in patients with blunt trauma. NCT provides no additional benefits in detecting organ injury; except in cases of severe fatty liver disease. NCT is recommended as an optional protocol; particularly for patients with obesity.

Diagnostic Accuracy of FAST Scan in Hemodynamically Stable Blunt Abdominal Injury Patients; Is it "Fast" enough?

Objective: To determine the diagnostic accuracy of a Focused Assessment with Sonography for Injury (FAST) scan in blunt abdominal injury with suspected hollow viscus organ perforation, keeping a computed tomography (CT) scan of the abdomen as a reference. Study Design: Cross-sectional study. Place and Duration of Study: Radiology Department, Combined Military Hospital, Peshawar Pakistan, from Aug 2017 to Feb 2018. Methodology: One hundred forty-seven hemodynamically stable patients aged 20-60 years of either gender presenting in the Emergency Department (ED) with clinical suspicion of blunt abdominal injury were included. FAST scan and CT abdomen reporting were done by two separate consultants blinded to each other. Results: The mean age was 35.84±8.44 years, ranging from 21-60 years. Among 72 FAST-positive patients, 68(46.3%) were true positive, and 4(2.7%) were false positive. Among 75 FAST negative patients, 6(4.1%) were false negative, and 69(46.9%) were true negative. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FAST compared to CT was 91.89%, 94.52%, 94.44% and 92.00%, respectively; FAST scan was correct in 93.20%. Conclusions: FAST Ultrasound is a sensitive and specific tool in the screening and diagnosing of abdominal injury resulting from blunt abdominal injury.

Diagnosis, risk factors, and treatment of pediatric benign pneumoperitoneum: A single‐center retrospective study

AbstractPneumoperitoneum is one of the common acute abdominal emergencies that leads to surgical exploration in children, but not all pneumoperitoneum require emergency surgery. This study evaluated the diagnostic methods, predisposing risk factors, and therapeutic options in children with benign pneumoperitoneum for accurate diagnosis and reducing the risk of adverse surgical consequences. A total of 63 cases of pneumoperitoneum diagnosed by the radiographs were involved in this study and were divided into the surgical pneumoperitoneum and benign pneumoperitoneum groups, respectively, from 2009 to 2021. The general information, abdominal signs, laboratory examination, therapies and outcomes, total hospitalization time, and comorbidities were analyzed. Logistic regression analysis assessed the risk factors and protective factors of benign pneumoperitoneum. Promising biomarkers underwent receiver operating characteristic curve analysis. Children with surgical pneumoperitoneum were younger than those with nonsurgical pneumoperitoneum in the study. The C‐reactive protein (CRP) level in the surgical pneumoperitoneum group was higher than that in the other group, albumin (ALB) was lower than that in the benign pneumoperitoneum group, and the ratio of ALB to CRP can be used as an effective indicator to predict whether the pneumoperitoneum is benign or whether surgery is needed. Pulmonary injury, pneumonia, and blunt abdominal injury are the major causes in patients with benign pneumoperitoneum. The establishment and management of clinical criteria for the diagnosis of benign pneumoperitoneum in children will be important for the treatment and recovery of children diagnosed with pneumoperitoneum.

Utilization of Angiography in Pediatric Blunt Abdominal Injury at Adult versus Pediatric Trauma Centers

IntroductionAngiography has been widely accepted as an adjunct in the management of blunt abdominal trauma in adults. However, the role of angiography with or without angioembolization (AE) is still being defined in pediatric solid organ injury. We sought to compare the use of angiography in solid organ injury (SOI) at pediatric trauma centers (PTCs) versus an adult trauma center (ATC) in a large metropolitan city. MethodsData were drawn from a collaborative effort of three Trauma centers (one adult and two pediatric) in Atlanta, GA. All pediatric patients (ages 1-18) treated for SOI between January 1, 2016 and December 31, 2021 were included (n = 350). Registry data obtained included demographics, mechanism of injury, injury grade, injury severity score (ISS), procedures performed, and transfusions. Multivariate regression analysis was used to identify factors associated with angiography. ResultsA total of 350 patients were identified during the study period with 101 treated at ATC and 249 treated at the two PTCs. The median age at the ATC was 17 y (IQR 16, 18) compared to nine (6, 13) at the PTCs. ISS was significantly higher at the ATC 22 (14, 34) compared to 16 (9, 22) at PTCs (P < 0.001). At the ATC, 11 (10.9%) patients underwent angiography, 4 (4.9%) of which underwent AE compared to seven (2.8%) patients who underwent angiography and AE at PTCs. In the multivariate analysis, factors associated with angiography use included age (OR 1.44, 95% CI 1.09-1.90, P = 0.010) and ISS (OR 1.05, 95% CI 1.02-1.09, P = 0.004). Through setting, ATC versus PTC was significant on univariable analysis, it did not remain a significant predictor of angiography on multivariable regression. ConclusionsOur study demonstrated increased utilization of angiography for the management of SOI in pediatric patients treated at ATCs versus PTCs. On regression analysis, age and ISS remained significant predictors for angiography utilization, while setting (ATC versus PTC) was notably not a significant predictor. This data would suggest that differences in angiography utilization for pediatric SOI at PTCs and ATCs are influenced by differing patient populations (older and higher ISS), with otherwise uniform use. These findings provide a basis for future treatment algorithm revisions for pediatric blunt abdominal trauma that include angiography and provide support for the development of formal guidelines.

Blunt Abdominal Trauma Severity Scoring System: Exceptional Score in Blunt Abdominal Trauma Management

Objectives The abdomen is a diagnostic black box. Physical examination of the abdomen is unreliable in making this determination, and sometimes clinical evaluation is difficult due to the influence of drugs or alcohol by patients or abdominal injuries occurring with head or spinal cord injuries. However, the presence of abdominal rigidity or hemodynamic compromise is an indication for prompt surgical exploration. For the remainder of patients, a variety of diagnostic adjuncts are used to identify abdominal injury. In this study, our aim is to find the answer of these questions, (1) What was the major indication for operation in each case? (2) Did delays in getting the patient to the operating room affect the outcome? (3) How to find morbidity and mortality in blunt abdominal injuries, at the behest of the Blunt Abdominal Trauma Severity Scoring System (BATSS). Material and Methods A retrospective study of 100 cases of blunt abdominal trauma was done Sheth Lallubhai Gordhandas Municipal General Hospital, Narendra Modi Medical College, Ahmedabad, for the accuracy of the BATSS score. Patients were divided into three groups according to the BATSS: (1) ≥12 score group, (2) 8–11 score group, and (3) &lt;8 score group. Results Operative management was more common in the high-risk group, while the low-risk group was managed conservatively under expert guidance. The mean BATSS scores in operative and conservative management were 14.77 ± 2.91 and 5.12 ± 2.56, respectively. The BATSS score had an 87.1% Specificity, 100% Sensitivity, 94.5% Negative Predictive value (NPV), 100% Positive Predictive value (PPV) and an overall Accuracy of 96%. Conclusion BATSS is important for triage and is an excellent tool for recognising and picking up high-risk patients with blunt abdominal injuries.

Assessment of Frequency, Patterns, and Causes of Blunt Abdominal Trauma in a North Indian Cohort: An Autopsy-Based Study.

Introduction The abdomen is one of the most frequently damaged areas in trauma patients and is commonly encountered in road traffic accidents (RTAs). The present study evaluates the frequency, etiology, causation, and form of injuryin blunt abdominal trauma (BAT) cases who had autopsies. Method An autopsy-based observational prospective study was conducted at the Department of Forensic Medicine and Toxicology, Nalanda Medical College and Hospital Patna, India, during the period from October 2018 to September 2020, which included a total of 940 autopsy cases showing blunt abdominal injuries. A predesigned proforma for the postmortem evaluation of BAT victims was used to collect the required information on the cases. Descriptive statistics were performed, and the data were presented as frequency (%) and mean±SD. Chi-square tests were performed to compare categorical variables between groups. Results BAT accounted for 120 (12.76%) cases of all autopsies performed. The majority of victims were male(92.48%). Victims aged 21-30 years (31, 25.83%) were the ones most usually engaged in BAT cases. Among the mechanisms accountable for BAT, RTAs were the most common (99, 82.50%), followed by assault (16, 13.30%). In most of the cases, the liver was injured (107, 89.16%), followed by the spleen (60, 50.00%) and kidney (24, 20.00%). The majority of blunt abdominal injury-related deaths were accidental (100, 83.33%), followed by homicidal (15, 12.5%) and suicidal cases (5, 4.17%). Hemorrhage and neurogenic shock were the most prevalent causes of mortality, particularly if the individual died within a few hours. Conclusion RTAs are the most frequent cause of BAT in autopsy cases, and the liver is the most affected organ. The majority of deaths occur within the first 24 hours of injury. Since blunt abdominal injuries have the propensity to increase morbidity and mortality, appropriate emphasis on their precise diagnosis and satisfactory therapy is mandated.

Evaluation of clinical abdominal scoring system for predicting outcomes of blunt abdominal trauma

Background Trauma has been called the neglected disease of modern society and the most common cause of death under 45 years. Determining the optimal prospective course of action may be aided by the adoption of a scoring system to evaluate urgent laparotomy intervention. A quick and easy technique to identify whether there are any intra-abdominal injuries is to use the clinical abdominal scoring system (CASS). The objective of this study was to evaluate CASS in predicting the outcomes in patients with blunt abdominal trauma (BAT). Methods A retrospective observational study was conducted involving 80 patients with suspected BAT that arrived at the emergency department. All patients with suspected BAT were scored using CASS and radiological investigations that were done in the ED. The decision to proceed with the surgery would be made if the patient had CASS &gt;12 and/or if the radiological investigation showed features of BAT such as air under the diaphragm. Results Mean CASS score was 10.28 ± 1.340. The majority of the subjects (75 or 93.5%) had successful laparotomies, whereas only five (6.3%) had unsuccessful ones. Injuries to the spleen (42.6%), and liver (32%), combined injuries to the spleen and liver (2.6%), intestine (16%), pancreas (1.3%), bladder (4%), and kidneys (1.5%) were all found in positive laparotomies. The CASS has specificity of 60%, sensitivity of 80%, PPV 96.7%, and NPV 16.6%. Conclusions According to our data results, The CASS has a poor ability to predict the need for laparotomy in cases of blunt abdominal injuries as it shows low specificity.

Blunt abdominal trauma in children and adolescents: treatment concepts in the acute phase

Fatal accidents due to blunt force trauma are the leading cause of death in children and adolescents [1]. Abdominal trauma is the third most common cause of death after traumatic brain injury and thoracic injuries [2]. Abdominal injury is seen in approximately 2-5% of children involved in accidents [3]. Blunt abdominal injuries are common sequelae of traffic accidents (for example as seat belt injury), falls, and sports accidents. Penetrating abdominal injuries are rare in central Europe. Spleen, liver, and kidney lacerations are the most common injuries after blunt abdominal trauma [4]. In most situations, nonoperative management (NOM) has become the gold standard with the surgeon leading the multidisciplinary treatment [5].

Endovascular reconstruction of aortic bifurcation for aortic pseudoaneurysm in a pediatric trauma patient

Endovascular treatment options for vascular injury in pediatric patients are quite limited owing to concerns regarding long-term durability and the lack of devices suitable for the pediatric anatomy. However, in rare circumstances, open surgical therapy will not be an option, and patients will require unconventional endovascular solutions for lifesaving or limb-saving therapies. In the present report, we describe an endovascular treatment of a pediatric patient for whom initial surgical management of a blunt abdominal aortic injury had failed, with subsequent development of an aortic pseudoaneurysm. A 10-year-old girl had presented after a high-speed motor vehicle accident with a seatbelt sign. Multiple abdominal injuries were identified, including blunt aortic injury, significant devitalization of the small bowel, colonic perforation with fecal contamination, multiple lumbar spine fractures, and pulmonary contusions. The patient developed bilateral lower extremity ischemia from the aortic injury and had initially undergone open repair. One month later, the patient had developed a pseudoaneurysm of the aorta near the aortic bifurcation. Because of the hostile abdomen and ensuing short gut syndrome, the pseudoaneurysm was managed using endovascular techniques. The limb of an Excluder internal iliac branch endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ) was used as the endograft. The aortic bifurcation was raised and reconstructed using four Viabahn self-expanding stents (W.L. Gore & Associates). The completion angiogram showed complete resolution of the pseudoaneurysm. The follow-up computed tomography angiogram showed widely patent stent grafts with complete resolution of the pseudoaneurysm. Endovascular management of traumatic vascular injuries in pediatric patients is feasible. The likelihood of reintervention in the future is high with patient growth. However, it is a viable option in lifesaving or limb-saving situations in which open repair is high risk.

Blunt abdominal aortic trauma: a case report and review of the literature

Background: Blunt abdominal aortic injury (BAAI) is a rare injury which was reported in the world literature mostly in case report format. We sought to describe the experience of one patient with BAAI and to provide a contemporary review of the literature to better understand the natural history and management of this injury. Methods: This was a retrospective review of one patient with BAAI who was successful treated by bowel resection and abdominal aortic repair by cryopreserved arterial homograft. Results: No complications related to surgery and very good short-term outcomes. Conclusions: Although the mortality of BAAI is still high, early diagnosis and surgical can also save patient. Cryopreserved arterial homograft is one of the effective alternative material for replacement of abdominal aortic.

Spontaneous Splenic Rupture: Case Report from Yekatit 12 Medical College Hospital, Addis Ababa, Ethiopia

Splenic rupture can be traumatic or non-traumatic (spontaneous). The spleen is the commonest solid organ injured in blunt abdominal injury. Spontaneous splenic rupture is rare and one cause of acute abdomen which can lead to morbidity and mortality. Among patients having spontaneous splenic rupture, majority of them have underlying splenic pathology of different causes such as hematologic, infectious, inflammatory, drugs or mechanical. In endemic area of malaria, spontaneous splenic rupture is one of fatal complication of severe malaria fortunately it is rare complication. In rare cases there may be no splenic pathology identified which is called idiopathic. The treatment of ruptured spleen is mainly splenectomy though there are cases reports of angioembolization as treatment option. Here we present a case report of 20 year old male patient who presented with diffuse abdominal pain of 3 days duration with signs of generalized peritonitis. During exploratory laparotomy, he was having ruptured spleen with blood in the peritoneum. He was managed with splenectomy and cross match transfusion after the bleeding was controlled. The patient was discharged improved after he took pentavalent vaccine. In conclusion, though spontaneous splenic rupture is rare over all there are different case reports of this condition and one has to consider it as differential diagnosis in patient who presented with acute abdomen of unclear causes and especially if the patient has underlying diseases or drugs that can affect the spleen.

Hospital mortality of blunt abdominal aortic injury (BAAI): a systematic review and meta-analysis

BackgroundStudies on the mortality of blunt abdominal aortic injury (BAAI) are rare and have yielded inconsistent results. In the present study, we aimed to quantitatively analyse the retrieved data to more accurately determine the hospital mortality of BAAI.MethodsThe Excerpta Medica Database, PubMed, Web of Science and Cochrane Library databases were searched to identify relevant publications without date restrictions. The overall hospital mortality (OHM) of BAAI patients was set as the primary outcome measure. English publications with data that met the selection criteria were included. The quality of all included studies was assessed by the Joanna Briggs Institute checklist and the American Agency for Health Care Quality and Research’s cross-sectional study quality evaluation items. After data extraction, a meta-analysis of the Freeman–Tukey double arcsine transformation of data was performed using the Metaprop command in Stata 16 software. Heterogeneity was assessed and reported as a percentage using the I2 index value and as a P value using the Cochrane Q test. Various methods were used to determine the sources of heterogeneity and to analyse the sensitivity of the computation model.ResultsOf the 2147 references screened, 5 studies that involved 1593 patients met the selection criteria and were included. There were no low-quality references after assessment. One study that only included 16 juvenile BAAI patients was excluded from the meta-analysis of the primary outcome measure due to high heterogeneity. Due to the low heterogeneity (I2 = 47.6%, P = 0.126 for Q test) that was observed after using the random effects model, the fixed model was subsequently used to pool the effect sizes of the remaining four studies, thus yielding an OHM of 28.8% [95% confidence interval (CI) 26.5–31.1%]. The stability of the model was verified by sensitivity analysis, and Egger’s test (P = 0.339) indicated a low level of publication bias. In addition, we also performed meta-analyses and obtained a pooled hospital mortality of operation (13.5%, 95% CI 8.0–20.0%), a pooled hospital mortality of non-operation (28.4%, 95% CI 25.9–31.0%), and a pooled rate of aortic rupture (12.2%, 95% CI 7.0–18.5%) of BAAI.ConclusionsThe present study indicated that BAAI has an OHM of 28.8%, indicating that this disease deserves more attention and research.

DUODENAL OBSTRUCTION SECONDARY TO POST TRAUMATIC RETROPERITONEAL HEMATOMA: A CASE REPORT AND LITERATURE REVIEW

Retroperitoneal hematoma is caused by blunt abdominal injuries in a small percentage of the population. Obstruction of the duodenum by intramural haematoma has often been described, however, duodenal obstruction due to retroperitoneal hematoma is uncommon. Signs and symptoms are sometimes ambiguous and deceiving. In diagnosing this, a thorough history and clinical examination, as well as supplementary assistance with investigations, are all benecial. A strong index of suspicion and a multidisciplinary approach are required for timely care. With a review of the literature, we provide an interesting case that demonstrates the rarity and severity of this illness.

Surgical Thrombectomy for Complete Portal Vein Thrombosis Induced by Blunt Abdominal Trauma

Background: Blunt abdominal injury is a known, but very rare cause of portal vein thrombosis.In most cases, full anticoagulant therapy is sufficient. Surgical thrombectomy is an extremely rare procedure in the treatment of acute portal thrombosis. Materials and Methods: We present a case of a young patient with portal vein thrombosis and its branches after a blunt abdominal injury resulting from the sport. Due to severe infarction of the intestinal loops, we chose surgical thrombectomy as the only causal treatment option. This procedure is generally rarely reported in the scientific literature. However, it has not yet been described with a blunt abdominal injury. The patient was subsequently shown to have a Leiden mutation in a heterozygous form. The interplay of all factors including blunt abdominal injury, Leiden mutation, and intestinal malrotation could lead to acute thrombosis of the portal vein and its branches. Conclusions: We successfully used direct surgical thrombectomy from portal vein and its branches for the patient with portal vein thrombosis and severe small intestine infarction after a blunt abdominal trauma as the only available treatment option, because other treatment options were not suitable in this patient.In our case, early diagnosis, right decision to choose surgical treatment, and direct surgical trombectomy resulted in success and the patient has fully returned to normal life.

Analysis of Blunt Abdominal Solid Organ Injury in Children: A Single Centre Study

Aim: To determine the management of solid organ injuries in blunt trauma abdomen (BTA) in children whether to conserve or operate. Study design: Descriptive case series. Place and duration of study: Department of Paediatric Surgery Sahiwal Teaching Hospital and Sahiwal Medical College Sahiwal from 1st January 2020 to 31st March 2022. Methodology: Fifty eight patients with blunt abdominal trauma due to any cause, the medical records of all patients with trauma of any kind age upto 13 years were carefully reviewed. Initial resuscitation was done according to ATLS protocol. Ultimate management decision was based on stability of patients after resuscitation. Results: The mean age was 5.34 years. Most of the patients suffered from road traffic accident, 50(86.2%). Fifty two (89.65%) patients showed free fluid in the abdomen. Organ injury in 27(46.55%) patients. CT abdomen with intravenous contrast confirmed findings of ultra sonography. Despite resuscitation, 17(43.9%) patients remained unstable and were operated. Forty one patients were kept on conservative treatment. Hospital stay ranged from 1-19 days. Conclusion: Although non-operative management is the treatment of choice in blunt trauma abdomen with solid organ injury but stability of the injured child is the central pivot around which the whole management revolves. Delay in presentation and failure of timely resuscitation results into high operative intervention. Keywords: Blunt trauma, solid, Liver, Spleen, children

Abdominal Injuries from Civilian Conflicts: An Emerging Global Health Challenge in Rural Southeast Nigeria.

In recent time, incidence of abdominal injuries continues to increase steadily in most major regions of West Africa due to emergence of various religious, social and political conflicts. Indeed, violence and social conflicts constitute major global public health challenges that commonly lead to injuries and long-term physical and mental health problems. In our setting, increasing cases of abdominal trauma resulting from civilian violence led to additional workload in the general surgery unit and the audit of our experiences is presented in this paper. To analyze the etiological spectrum, trend and management outcome of abdominal injuries from civilian violence in our setting. This was a multicenter prospective study of adult patients with abdominal injuries from civilian conflicts managed at three selected district hospitals in Southeast Nigeria between January 2013 to December 2020. Of 398 patients evaluated, 359 (90.2%) sustained penetrating while 39 (9.8%) had blunt abdominal injuries. Gunshot was the most common mechanism, accounting for 248 (62.3%) cases, followed by stab wound (95, 23.9%). Armed robbery attack (68, 27.4%) was the main source of gunshot wounds. Overall, annual rates showed a four-fold rise over an eight-year period from 24 cases (6.0%) in 2013 to 96 (24.1%) in 2020. Majority (365, 91.7%) had operative management (OM); the rest (33, 8.3%) were treated non-operatively. Morbidity and mortality rates for operative cases were 29.6% and 12.1% respectively. The main factors associated with increased mortality rates were delayed presentation (p = 0.002), bowel resection (p = 0.006), gunshot wounds (p = 0.013), advanced age (p = 0.033), multiple visceral injury (p = 0.034) and ASA score ≥ III (p = 0.001). Abdominal trauma from civilian violence is on the steady rise in our setting. The main etiologic factors are armed-robbery, communal clashes, political thuggery and cultism perpetrated predominantly through gunshots and stab wounds. Advancing age, gunshot wounds, delayed presentation, bowel resection and multiple injuries were associated with increased mortality.