Blunt Trauma Abdomen Research Articles

A COMPREHENSIVE STUDY ON THE ROLE OF LAPAROSCOPY IN ABDOMINAL TRAUMA

Explorative laparotomy has been the mainstay of management in patients with blunt abdominal trauma . The advantage of laparoscopy is that it can provide both diagnostic and therapeutic interventions for those hemodynamically stable abdominal trauma patients. Methods: 30 patients of blunt trauma abdomen were retrospectively studied for whom laparoscopic intervention was done. Results: In our study 30 patients with abdominal trauma were included of which 22 (76%) had penetrating trauma and 8 had blunt trauma (24%). Among penetrating trauma, seven patients (31.8%) underwent therapeutic laparoscopy whereas diagnostic laparoscopy was done for 10 patients (45.5%). Conclusions: Laparoscopy can be safely performed in haemodynamically stable patients of abdominal trauma for both diagnostic and therapeutic purposes and can help in avoiding the negative laparotomies.

Evaluation of ISS, RTS, CASS and TRISS scoring systems for predicting outcomes of blunt trauma abdomen.

Trauma is the leading cause of mortality in people below the age of 45 years. Abdominal trauma constitutes one-fourth of the trauma burden. Scoring systems in trauma are necessary for grading the severity of the injury and prior mobilization of resources in anticipation. The aim of this study was to evaluate RTS, ISS, CASS and TRISS scoring systems in blunt trauma abdomen. A prospective single-center study was conducted on 43 patients of blunt trauma abdomen. Revised trauma score (RTS), Injury Severity Score (ISS), Clinical Abdominal Scoring System (CASS) and Trauma and Injury Severity Score (TRISS) were calculated and compared with the outcomes such as need for surgical intervention, post-operative complications and mortality. The majority of the study subjects were males (83.7%). The most common etiology for blunt trauma abdomen as per this study was road traffic accident (72.1%). Spleen was the most commonly injured organ as per the study. CASS and TRISS were significant in predicting the need for operative intervention. Only ISS significantly predicted post-operative complications. All scores except CASS significantly predicted mortality. Among the scoring systems studied CASS and TRISS predicted the need for operative intervention with good accuracy. For the prediction of post-operative complications, only the ISS score showed statistical significance. ISS, RTS and TRISS predicted mortality with good accuracy but the superiority of one score over the other couldn't be proved.

Blunt trauma abdomen

Introduction: Trauma is the main cause of morbidity and mortality worldwide in the first four decades of life. It remains a major public health problem amongst all countries, regardless of the socioeconomic status. Abdomen is the third most frequently injured body region. Most preventable deaths are those occurring in the abdomen. The paper studied the cause of injury, clinical presentation and management adopted for the patients admitted following blunt trauma abdomen for 1 year and compared the causes of injury and organs injured. Methodology: This is an observational study based on 241 cases of blunt abdominal trauma (BAT) with respect to clinical presentation, cause of injury, management and organs injured. Results: Demographic data such as age and sex, cause of injury, commonly injured organs and the management done were observed and compared. It was found that BAT commonly involves young males in the age group of 20–40 years. Road traffic accident (RTA) is found to be the most common cause of injury. Conservative management was done in 217 out of 241 patients. Out of 241 blunt trauma cases presented, liver was the most common organ injured and 118 patients with liver trauma were managed conservatively and 4 patients were taken up for surgery. Out of 112 splenic trauma patients, 106 were managed conservatively and 6 were taken up for splenectomy. Hollow viscus injury followed by pneumoperitoneum was directly taken up for surgery with no role of non-operative management. Out of 12 patients with mesenteric injury, 10 patients were taken up for surgery (primary suturing of torn mesentery) and 2 were conservatively managed. Multiple organs are usually involved in most of the cases rather than an isolated organ injury. Conservative management was done in 24 patients out of 241 blunt trauma abdomen patients. Conclusion: The study was conclusive of the fact that young males who sustained BAT due to RTA were the most commonly affected group. It was also conclusive that spleen and liver are the most commonly injured organs in BAT and conservative management should be followed wherever possible.

Role of diagnostic laparoscopy in blunt abdominal trauma

Background: The appropriate treatment for patients with blunt abdominal trauma depends on the precise diagnosis of the presence and severity of intra-abdominal injuries. Laparotomy, however, has remained the management of choice in certain situations following blunt abdominal trauma such as in patients who have free intraperitoneal fluid of uncertain origin, signs indicating intestinal ischemia caused by mesenteric bleeding, and signs indicating hollow viscus perforation. The objective of the study is to determine the role of diagnostic laparoscopy in blunt abdominal injuries.Method: A prospective study was conducted in general surgery department in Sree Mookambika Institute of Medical Sciences, kulasekharam, Tamil Nadu., a tertiary care center including all patients with blunt trauma abdomen who underwent diagnostic laparoscopy during the time period from June 2019 to December 2020.Results: 27 males and 3 females were selected in this study. The most common mode of injury was vehicle collision. Out of 30 diagnostic laparoscopies,12 patients had solid organ injury, 5 patients had bleeding with no organ injury, 2 patients had mesenteric vascular injury, 2 patients had small bowel perforation. There were no findings in laparoscopy in 7 patients. Laparoscopy was converted to open Laparotomy in 3 patients. Therapeutic Laparoscopy were done in 20 patients.Conclusion: Laparoscopy can play an important role in diagnosis and treatment of blunt and penetrating trauma in hemodynamically stable patients. Low missed injury rates, reduced duration of hospital stay, faster recovery and reduced cost make it an attractive and safe alternative to classical trauma laparotomy.

A CLINICAL STUDY OF BLUNT TRAUMAABDOMEN WITH RESPECT TO MANAGEMENT AND OUTCOME AT GMC, BETTIAH, BIHAR

Background: Following injury to the extremities and head, abdomen is the third most commonly injured part of the body. Blunt abdominal trauma (BAT) is particularly deceptive because of the delay in clinical manifestations for hours or even days, even though the damage to the internal organs might be serious and lethal. Road traffic accident (RTA) is the most common mode of injury to cause BAT. Diagnostic modalities like FAST and CT scans have caused a significant change in the trends regarding management from surgical to a more conservative approach. Current research aimed to study the blunt trauma abdomen with respect to management and outcome in GMC, Bettiah, W. Champaran, Bihar. Material and methods: This observational study is based on 50 cases of BAT who presented in Department of Surgery, Govt. Medical College & Hospital, Bettiah, Bihar with respect to clinical presentation, investigations, management and outcome. Results and outcomes will be depicted in various tables. Results: In the present study, demographic data like age and sex, the mode of injury, presenting Hb (in gm%), commonly injured organs, the management done and the associated mortality was observed and compared. It was found that BAT commonly involves young males in the age group of 30-40 years. RTA is found to be the most common mode of injury. Spleen was the most commonly injured solid organ followed by liver. Hollow viscus injury was seen in 10 out of 50 patients in our study. Conservative management was done in 37 out of 50 patients. Mortality was observed in 3 out of 50 cases. Conclusion: The study was conclusive of the fact that young males who sustained BAT due to RTA were the most commonly affected group. It also was conclusive that spleen and liver are the most commonly injured organs in BAT and conservative management should be followed wherever possible. Mortality was significantly higher in patient presenting with decreased hemoglobin.

A Prospective Study of Blunt Trauma Abdomen in Pediatric Patients – Our Institutional Experience

Background – Blunt trauma abdomen is a significant cause of morbidity and mortality in pediatric patients because of their peculiar body habitus and immature musculoskeletal system. We aimed to study clinical presentations and outcome analysis of blunt trauma abdomen in children. Method - A prospective observational study from 16 October 2018 to 15 April 2020, carried out in our tertiary care teaching institute. Results – A total of 121 patients of less than 16 year age were included in this study. Male to female ratio was 4.26: 1. Most common age group was 6 – 12 years. Most common mode of injury was RTA (41.32%) followed by fall from height (27.27%). Liver was most commonly involved solid organ in our study (25.61 %). One hundred five patients (86.77%) were managed successfully with conservative management. Surgery was done 16 (13.22%) patients. Out of these 16 patients emergency surgery was done in 14 patients (11.57%). While 2 (1.65%) patients were planned for conservative treatment but ultimately they required surgery. Conclusion- Conservative treatment is an effective management modality in majority of pediatric blunt trauma abdomen patients without bowel perforation. Key Words: - Blunt trauma abdomen, Liver injury, Bowel injury, BTA, RTA.

English

BACKGROUND Road traffic accidents are the most common cause of thoracic and abdominal trauma. The role of point of care ultrasound especially in developing countries is gaining evidence in management of acutely ill. We wanted to test the reliability of Fast and E-Fast in blunt abdominal and thoracic trauma cases and evaluate their role in the management of RTAs. METHODS A cross sectional study was conducted over a 12-month period among patients presenting at Emergency Medicine Department at Government Medical College, Kannur (then known as Academy of Medical Sciences, Pariyaram). After clinical examination and recording details, fast and E-Fast was done in the emergency department by emergency physicians trained in ATLS using a standard curvilinear probe of 2 - 5 MHz using Sonosite M-Turbo portable ultrasound machine (Fujifilm Sonosite) and compared with the gold standard CT. The CT used was 16 slice Spiral CT scan machine by GE Healthcare (Chicago, Illinois, United States). Results on continuous measurements presented on mean + SD (min-max) and results on categorical measurements were presented in numbers (%). Sensitivity and specificity were computed for analysis. RESULTS The overall sensitivity of Fast is 72.8 % and the specificity is 92 %. The overall sensitivity and specificity of E-Fast are 87 % and 92.3 % respectively. The reliability of point of care ultrasound as a screening tool to triage patients with blunt abdominal and thoracic trauma is 100 %. CONCLUSIONS Fast and E-Fast are quite reliable as screening tools in the management of acutely ill blunt trauma abdomen and chest patients. KEYWORDS Point of Care, Ultrasound, Blunt Trauma, Sensitivity, Fast, E-Fast

A Rare Case of Isolated Sigmoid Colon Perforation in Patient with Blunt Trauma Abdomen

A 47 years old male presented to emergency department with history of pain abdomen after road traffic accident 6 hours back. He had deceleration injury while driving a minivan when he hit a truck parked on road side. On presentation, his Airway and breathing was intact with GCS 15/15.Pulse was 110/min and blood pressure was 100/70 mmHg. His abdomen was generalized tender, mostly in the hypogastrium. Digital rectal examination was normal. Ultrasound abdomen showed free fluid in the peritoneal cavity and chest and abdominal X-rays were unremarkable. On opening the abdomen there was 7×7 cm isolated perforation in sigmoid colon 5 cm proximal to recto sigmoid junction. Repair of perforation was done and proximal double barrel sigmoid colostomy was made. Patient was discharged on 3rd post-operative day. Later after 4 months reversal of sigmoid colostomy was done and patient was discharged.

Long Term Effect of Acute Intestinal Obstruction Management following Laparotomy in a Tertiary Care Hospital

Background: Post-surgical outcomes are very crucial for acute intestinal obstruction following laparotomy.
 Objective: The purpose of the present study was to identify the causes and risk factors that influence the outcome of post laparotomy acute intestinal obstruction and also to assess their management and outcome.
 Methodology: This cross sectional study comprising fifty patients irrespective of age and sex with diagnosis of Acute intestinal obstruction following laparotomy who attended at the Department of Surgery in different tertiary Hospital of Dhaka city, within the time period of July 2017 to June 2019. All these data were analyzed and tried to find out the outcome of management of acute intestinal obstruction following laparotomy.
 Results: All the 50 patients had undergone some conventional surgeries in previous instance. Acute intestinal obstruction was found in 80.0% of cases who had undergone emergency surgery and 20.0% cases were after routine surgery. The reasons behind Laparotomy for burst appendix (16.0%) followed by laparotomy for blunt trauma abdomen (12.0%) and classical appendicectomy (12.0%). After conservative management complication rate was low (21.0%) and the most prominent complication was UTI (28.57%) whereas mortality was 14.29%. After surgical management complication rate was higher which was in 56.25% of cases.
 Conclusion: Post laparotomy of acute intestinal obstruction can improve the outcome and reduce the chance of relaparotomy, surgical morbidity.
 Journal of Current and Advance Medical Research 2020;7(2): 73-79

Traumatic pancreatic transection - Case reports

Pancreatic injury following blunt trauma abdomen is presentation with significant morbidity and mortality. Our first case here is the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) Grade V pancreaticoduodenal injuries following penetrating injury managed with pancreaticoduodenectomy and the second case is blunt trauma to the abdomen with pancreatic tail transection which is American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) Grade III that was managed with Endoscopic Retrograde Cholangiopancreaticography (ERCP) and pancreatic duct stenting. The outcome depends on early diagnosis and needs a high index of suspicion due to subtle clinical and radiological findings initially. Hemodynamically unstable patients may have other associated visceral and vascular injuries, and damage control strategy will be a suitable option. Same sitting resection procedures like pancreaticoduodenectomy are rarely performed. Pancreatic injuries can often be managed non-operatively with percutaneous drainage and pancreatic duct stenting.

Isolated Gastric Perforation in a Patient of Blunt Trauma Abdomen: A Case Report

Isolated Gastric Perforation in a Patient of Blunt Trauma Abdomen: A Case Report

A retrospective study of blunt trauma abdomen in a tertiary center in central India: evaluation, management and outcome

Background: Blunt abdominal trauma is fairly common emergency and it is one of the important components of polytrauma. It requires high degree of suspicion, investigation and management. Inspite of improved imaging techniques leading to early recognition it is still associated with high morbidity and mortality. Trauma is the leading cause of blunt abdominal injury. This aim of the study was to find etiology, early diagnosis and management of patients with blunt abdominal trauma.Methods: This a retrospective study conducted in Gandhi medical college, Bhopal in which 90 cases of blunt abdominal trauma presented to emergency and outpatient department were included in the study duration of January 2019 to December 2019.Results: Motor vehicle accident was the most common mode of injury. Liver being the most common visceral organ injured while the most common surgery performed was the repair or resection and anastomosis of hollow viscous perforation. Rib fracture was the most common extra abdominal injury seen in 17.7% cases. Mortality rate was 5.5%. Most of the liver, spleen and renal injuries can be managed non-operatively whereas hollow viscous injury needs laparotomy.Conclusions: The result of present study is similar to other studies. Rapid diagnosis, early and timely referral, adequate and trained staff, close and careful monitoring, early wise and skilled decision to go for operative or non-operative management can help save many lives.

A prospective study of injury pattern and outcome of blunt trauma abdomen patients in a tertiary care hospital in eastern part of India

Background: Abdominal trauma continues to account for a large number of trauma-related injuries and deaths. The evaluation and treatment of abdominal injuries are critical components in the management of severely injured trauma patients. The study was done to study pattern and outcome of BTA patients in a tertiary care hospital in eastern part of India as few studies exist in this part of the country.Methods: Prospective descriptive study conducted in in SRN Hospital, Prayagraj over a period of one year with all cases of blunt injury abdomen included with respect to inclusion criteria.Results: In our study mean age was 23.2±17.6 years. 92% were male and 8% were female RTA are responsible for most number of cases (78%). Conservative management done in 34 (68.0%) and Operative Intervention done in 16 (32.0%) cases. In our study, X-ray erect had 75% accuracy total subsets of 336 organ scans were performed on ultrasound specific injury was seen in total 50 cases and total 210 CT scans performed was able to pick up 59 injuries (p=0.0002). CECT forms the core investigation of choice in dealing with blunt injury abdomen cases. In our present study, paralytic ileus (prolonged) (31%) and pelvic intraabdominal abscess (31%) as postoperative complications.Conclusions: CECT abdomen is the investigation of the choice with RTA being the most common mode of BTA. So effort should be made to implement traffic rules. Hemodynamic instability with radiological findings useful in deciding operative versus conservative management of blunt trauma patients.

Study of pattern and management strategies of solid visceral injuries in blunt trauma abdomen in tertiary care centre

Background: Blunt trauma abdomen is a leading cause of morbidity and mortality among all age groups. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality still remain large. The aim was to evaluate pattern and management strategies of solid visceral injuries in blunt trauma abdomen patients.Methods: This was a prospective study on 100 consecutive patients admitted in Department of General Surgery at a tertiary care center with an antecedent history of blunt abdominal injury. All patients proven to have penetrating injury and hollow viscus injury were excluded. The pattern of injury, presentation and parameters associated with management strategies were evaluated.Results: In the present study, solid viscera injury in blunt trauma abdomen is more common in age group 21-30 years (43%) with male predominance (92%). RTA (75%) were the most common mode of injury followed by fall. Most common clinical presentation was abdominal pain (86%) followed by tachycardia (34%) and hypotension (6%). Most common viscera injured is liver (48.2%) followed by spleen (36.7%), kidney (12.3%) and pancreas (2.8%). Majority of patients were managed conservatively (84%).Conclusions: It was concluded from the study that irrespective of the solid organ injury in blunt trauma abdomen, patients can be managed conservatively due to aggressive resuscitation with supplement drug therapy, use of analgesia or sedation in ICU setup and close monitoring. Patients are grossly hemodynamically unstable at presentation do require intervention either immediate or in due course of time.

A Clinical Study of Blunt Trauma Abdomen with Respect to Management and Outcome in a Tertiary Care Hospital

A Clinical Study of Blunt Trauma Abdomen with Respect to Management and Outcome in a Tertiary Care Hospital

Step up approach for the management of late presentation of pancreatic trauma patients

Background: Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities and these injuries are often overlooked in cases with extensive multi-organ trauma. Our study was conducted to evaluate the outcome of a step-up approach in the management of pancreatic trauma patients with late presentation.Methods: The study included 15 patients who presented with grade III AAST delayed presentation of pancreatic trauma from September 2017 to 2019. In our step-up approach 2 staged procedure was done, firstly laparotomy with necrosectomy along with closure of proximal pancreatic duct with external drainage of pancreatic duct, in second stage Roux-en-Y pancreaticojejunostomy was done to drain the remnant pancreas as a definitive procedure 3 to 6 months after initial procedure.Results: In our study, blunt trauma abdomen (83.30%) (n=10) was the most common mode of injury. The main reason for delay in diagnosis of pancreatic trauma was delayed presentation of patient (83.3%) (n=10). Total of 4 patients were admitted to intensive care unit (ICU) at the time of admission. 10 patients underwent both the stages of step up approach management among which one patient had pancreatic fistula as a complication (n=1) (10%) and one patient had post-operative abscess as a complication (n=1) (10%). No mortality was noted in our study.Conclusions: The step-up approach discussed above proves to be beneficial towards management of patients with delayed presentation of pancreatic trauma in our setting.

Haemobilia of a 17 Years Girl Following Road Traffic Accident

Haemobilia is a rare cause of gastrointestinal bleeding, which develops as a result of communication between blood vessel and biliary tract. It should be considered in patients presenting with upper gastrointestinal bleeding with prior history of blunt trauma abdomen. We present a case of 17 years girl who sustained blunt trauma abdomen due to road traffic accident. She developed hematemesis & melena with bleeding from the wound after laparotomy for liver injury. Endoscopy of upper gastrointestinal tract revealed blood coming from ampulla of vater. CT angiography of abdomen showed pseudoaneurysm in a branch of right hepatic artery. Patient recovered completely after therapeutic embolization.
 Journal of Surgical Sciences (2019) Vol. 23 (1) : 40-42

Management of traumatic and non traumatic hollow visceral perforation in North India

<p class="abstract"><strong>Background:</strong> Hollow visceral perforation is the commonest perforation among all the hollow viscera in the body. The perforation can be traumatic or non-traumatic and it constitute commonest surgical emergency worldwide. The diagnosis of perforation can be made clinically but for confirmation basic radiological investigations and sometimes special investigation are required.</p><p class="abstract"><strong>Methods:</strong> This is a prospective observational study conducted in our institute in the Department of General Surgery. The patients who are included in this study were more than 15 years of age in both sexes having hollow visceral perforation presenting in accident and emergency department. </p><p class="abstract"><strong>Results:</strong> Out of 624 patients, 530 (84.93%) were males while only 94 (15.06%) were females, with a male: female ratio of 5.63:1. The site of perforation are ileum 37.01% duodenum, 28.36% maximum sites of hollow viscous perforation. Acid peptic disease was the cause of perforation in 27.40% of 171 cases. Enteric fever accounted maximally for 29% of 181 cases and all in the ileum. Acute appendicitis resulted in perforation of the appendix in 64 cases (10.25%) while blunt trauma abdomen causes perforation in 12.66% of 79 cases. Perforation due to stab injury accounted for 5.12% and fire arm injury perforation seen in 19 patients (3.04%).</p><p><strong>Conclusions:</strong> Early diagnosis of perforation, resuscitation with crystalloids with broad spectrum antibiotic coverage and urgent surgical intervention whenever patient is fit for anaesthesia are the important factors which decides the ultimate fate of the patient in case of hollow visceral perforation peritonitis. </p>

Sensitivity of FAST for hemoperitoneum in blunt trauma abdomen

Introduction: The great value of FAST lies in its high sensitivity for detecting intra peritoneal fluid which accumulates in dependent areas around the liver, spleen and pouch of Douglas (pelvic). Material and Methods: Prospective observational study was carried out for the duration of 2.5 years. 300 patients of blunt trauma abdomen admitted in trauma casualty were included in this study. In FAST assessment 255 patients were diagnosed positive for hemoperitoneum; in 50 patient’s emergency exploratory laparotomy were done. Conclusion: FAST has sensitivity of 85.26% for detecting free intra-peritoneal fluid in BAT cases.

A Retrospective Analysis of Blunt Trauma Abdomen in Patients Attending the Emergency Department in a Tertiary Care Hospital

A Retrospective Analysis of Blunt Trauma Abdomen in Patients Attending the Emergency Department in a Tertiary Care Hospital