Non-operative management of blunt abdominal solid organ trauma in adult patients

Introduction: Despite agreement in the literature that"stable"blunt trauma patients may be managed con-servatively, in Egypt many such patients receive operative management. This paper presents the results of apragmatic, prospective, observational study to evaluate outcomes of non-operative (NOP) versus operative (OP)management of blunt abdominal solid organ trauma in hemodynamically stable adults admitted to TantaUniversity Emergency Hospital (TUH) in Egypt.Methods:A prospective observational study enrolled adult blunt abdominal trauma patients with solid organinjury at TUH over a 3-year period (June 2014­June 2017). Inclusion criteria were age≥18 yr, mean arterialpressure > 65 mm Hg, heart rate < 110 bpm, hematocrit≥7 mg/dl, and abdominal organ injury diagnosed byultrasound or computed tomography (CT). Excluded patients were those with pelvis and femur fractures; pa-tients with penetrating abdominal trauma; predominate burn injuries, children and pregnant women. All pa-tients were assigned to non-operative or operative management based on clinician preference. Outcomes ofinterest were 30-day mortality, blood transfusion volume, and length of stay. Descriptive statistics andχ2wereused to compare outcomes. Results:During the study period, 4254 trauma patients presented to TUH. Of these, 790 had blunt abdominaltrauma and 111 (14.1%) met inclusion criteria. Injury severity scores for each group were comparable (24 ± 10­NOP vs. 28 ± 11­OP,p= 0.126). NOP received less transfused blood (213.41 ± 360.3 ml [NOP]vs.1155.17 ± 380.4 ml [OP] (p< 0.0001)) but had a longer length of stay (8.29 ± 2.8 [NOP] vs.6.45 ± 1.97 days [OP] (p= 0.012)). There was no difference in mortality between groups (p= 0.091). Conclusion:Our study demonstrated that non-operative management in Egypt of blunt abdominal trauma wassafe and resulted in fewer procedures, fewer units of blood transfused, and no increase in mortality. Longerlength of stay for non-operative patients might reflect treating physician caution in their management

Intra-abdominal injury identified by CTA in stable blunt polytrauma patients

Background: Patients with multiple injuries are a challenge to evaluate and to exclude abdominal injury, especially those who are intubated and sedated. Ultrasound is a screening tool and peritoneal lavage is unreliable. The aim of the study was to determine the incidence of intra-abdominal injury and describe the subsequent management after CT "panscan" in patients sustaining blunt trauma with injuries both above the thoracic and below the pelvic diaphragm. Methods: In a retrospective analysis anonymised patient data were extracted from a prospective ethics approved database of patients admitted to the level I Trauma Unit at Inkosi Albert Luthuli Central Hospital for the period from April 2007 to March 2011. Blunt polytrauma patients, aged 2 years and older with injuries above the diaphragm and below the pelvic floor were included, provided they were investigated by a full-body trauma Computed Tomography contrast study. Descriptive statistics were employed for all variables of interest, with counts/frequencies and associated percentages being reported. Results: Of 284 patients with injuries above the thoracic and below the pelvic diaphragm, 87 (30.6%) had intra-abdominal injury and 197 (69.4%) had no intra-abdominal injuries. Of those 87 patients, 54 (62.1%) were treated non-operatively and 33 (37.9%) were treated surgically with regard to their abdominal injuries. Twenty (22.9%) patients died, 4 due to intra-abdominal injuries and 16 due to of extra-abdominal injuries. Nine (45%) of the twenty patients who died were treated operatively for intra-abdominal injuries and the remaining 11 (55%) were treated non-operatively.Conclusion: Around thirty percent of patients with injuries above the thoracic and below the pelvic diaphragm had concomitant intra-abdominal injuries. Of those with abdominal injury, just over half required laparotomy. For haemodynamically stable patients CT scanning identified those who require surgical intervention and those who may be managed non-operatively, therefore liberal CT-scanning is advisable for this patient group

Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria

Background: Abdominal wounds following surgery for typhoid perforation are classified as dirty; with an infection rate of over 40. To date; the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice; is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife; Nigeria; and advocates a multidisciplinary wound management protocol. Patients and Methods: This is a retrospective study of children aged 1-15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria; over a period of ten years. Results: Thirty-two patients; 18 males and 14 females; in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8) patients; while 19 (59.4) patients had surgical site infections. Wound dehiscence; intraabdominal abscess; and faecal fistulas were the other complications documented in the study. Conclusion: Abdominal wounds of typhoid perforation; though classified as being dirty; can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs

Lavage Drain Extension for Local Anaesthetic Instillation into Abdominal Wounds

BACKGROUND. A new device made by ThebeMedicare allows efficient local anaesthetic washout of wound areas; by utilising an attachment to an existing drain. The aim of this trial was to explore 'proof of concept' in patients undergoing abdominoplasty procedures. PATIENTS AND METHODS. Thirty-one patients who had undergone abdominoplasty procedures were selected for instillation of a local anaesthetic preparation; ropivacaine (Naropin; AstraZeneca) into the wound site on day 1 and 2 after surgery; followed by early mobilisation. Efficacy of the system; patient comfort and mobilisation were documented. RESULTS. The abdominoplasty patients experienced no discomfort from the procedure and claimed effective relief of pain for an average of 12 hours following instillation of local anaesthetic. All mobilised effectively. The device worked well; with no technical problems. CONCLUSION. The lavage drain extension has proved to be a cost-effective and efficient way of providing postoperative pain control and promoting early mobilisation in this patient group

Abdominal injuries in olabisi onabanjo university teaching Hospital Sagamu, Nigeria: Pattern and outcome

Objective: The aim was to study the pattern and outcome of abdominal trauma managed by Laparotomy in Olabisi Onabanjo University teaching Hospital Sagamu (OOUTH), South Western Nigeria.Method: This is a retrospective study. The records of the patients were retrieved and relevant data extracted such as age, sex, occupation, address, cause of injury, vital signs on admission, abdominal signs, other injuries, number of units of blood transfused, investigations, indications for surgery, operative findings, procedure carried out, complications and outcome.Results: Seventy seven subjects were reviewed. There were 23 females (29.9%), and 54 males (70.1%). The age range was 3years to 68years, 32 patients (41.6%) were in 20-30 years age group. The mechanism of injury was blunt trauma in 61 (79.2%) and penetrating injury in 16 patients (20.8%). Road traffic accident was the commonest cause of injury, in 53 patients (68.8%). 42 patients (54.5%) had extra abdominal injuries. Positive paracentesis abdominis was the commonest indication for surgery, in 53 patients (68.8%). The spleen was the most commonly injured organ, in 31 patients (40.2%) while the organs were normal in 4 patients (5.2%). The complication observed includes acute renal failure, in 5 patients (6.5%), multiple organ failure in 5 patients, and wound infection in 8 patients (10.4%). Ten patients died. (13%)Conclusion: Splenic rupture is the most common abdominal injury treated by Laparotomy in OOUTH Sagamu and the commonest cause is road traffic accident. Mortality was due mainly to acute renal failure and multiple organ failure

Plaies et pratique civile au CHR de San-Pedro a propos de 160 cas

Notre travail avait pour but d'etablir les caracteristiques epidemiologiques; cliniques; (anatomo-pathologiques et therapeutiques afin d'ameliorer le pronostic des plaies et contusions de l'abdomen au CHR de San-Pedro. Les traumatismes abdominaux ont represente 160 cas (3.65 pour cent) de l'ensemble des pathologies du service; 14;92 pour cent des pathologies abdominales d'urgence et 11;82 pour cent des pathologies traumatiques. Les plaies ont represente 68 cas (1;55 pour cent) des pathologies et occupaient le cinquieme rang des pathologies abdominales d'urgence. Les contusions ont represente 92 cas (2;09 pour cent) de l'ensemble des pathologies. Les plaies et contusions de l'abdomen ont touche preferentiellement le sujet de sexe masculin (89;7 pour cent et 72;8 pour cent) dont l'age variait de 15 a 29 ans (45;6 pour cent et 47;8 pour cent). Cette pathologie a interesse les ivoiriens en majorite. L'arme blanche a ete majoritaire dans les plaies (51;5 pour cent) et les automobiles et motos (70;7 pour cent) dans les contusions. Les agressions (41;2 pour cent) et les bagarres (19;1 pour cent) etaient les circonstances les plus frequentes dans les plaies de l'abdomen. Le tableau clinique etait par la douleur abdominale et l'hemoperitoine. La region antero-laterale de l'abdomen etait plus interessee par le traumatisme. Pour les plaies; les organes creux etaient plus touches avec en tete le grele (37;83 pour cent) tandis que pour les contusions; les organes pleins etaient concernes avec en tete la rate 42;4 pour cent. La splenectomie totale a ete la regle dans tous les cas. Pour les autres organes; une suture simple a ete pratiquee. Les complications hemodynamiques ont domines l'evolution. La mortalite est importante pour une pathologie apparemment benigne (19;1 pour cent et 6;5 pour cent). Face a la gravite du probleme; il est important de proposer des mesures preventives individuelles et collectives. Il faudrait ameliorer les soins d'urgence dans les villes de l'interieur du pays tout en insistant sur la formation du personnel de sante

Les plaies de l'abdomen en pratique civile : a propos de 80 cas

Les plaies abdominales en pratique civile connaissent ces dernieres annees une frequence accrue surtout dans les grandes villes a forte concentration juvenile. D'octobre 1985 a septembre 1991; 80 plaies ont ete traitees. L'age des blesses varie de 5 a 60 ans avec une moyenne de 27;6 ans. On compte 70 hommes et 10 femmes. Les sans-emplois; les eleves et les etudiants constituent les categories socio-professionnelles les plus touchees. La repartition selon l'agent causal montre que les plaies par arme blanche viennent largement en tete (49 cas) suivies des plaies par arme a feu (21 cas) et les plaies par tesson de bouteilles (6 cas). Les details de consultation sont longs en raison des difficultes d'evacuation des malades des campagnes et meme de grandes villes qui varient de 5 heures (78;75 pour cent) a plus de 48 heures (11;25 pour cent). L'etat clinique des malades a leur admission se presente de la maniere suivante: tableau d'hemorragie interne (17 cas); tableau de peritonite (11 cas); evisceration (27 cas); tableau douteux (25 cas). 74 plaies penetrantes ont ete operees avec 25 laparotomies blanches (33;78 pour cent). Parmi les lesions viscerales celles du grele (14 cas) occupent la 1ere place; suivies du foie (13 cas); de la rate 8 cas et du colon 7 cas. L'evolution est dominee par la suppuration de paroi (20 cas). Dans cette serie les auteurs deplorent 3 deces

Tropical Surgical abdominal emergencies blunt splenic rupture in Calabar

A detailed study of splenic rupture in 34 consecutive patients living in souttheastern equatorial rainforest Nigeria was conducted during a 5-years period. The results clearly show that blunt abdominal injury from road traffic accident (RTA) was the cause of rupture in the vast majority of cases. Road traffic accident was due in many cases to collision with a motor bike which is a popular means of transportation in this region. Although the external injury to the abdomen was slight; and in some cases nil; the ensuing trauma to the spleen was extensive. In contrast RTA due to the motor car; seen in 5 of the 34 patients studied; caused much associated injury to the patient. The pattern of splenic rupture seen in this tropical African community is out-standingly in contrast with that of the developed countries of the West where spontaneous rupture of diseased spleen seems to be common

Pattern of abdominal injuries in Korle Bu Teaching Hospital; Accra

Two hundred and thirty-four cases of abdominal trauma over the past 6 years were reviewed. There were four times as many male as female patients. The peak age incidence was in the second and third decades. Road traffic accidents were the commonest causes of blunt injuries whereas stab wounds predominated penetrating injuries. The spleen and the small bowel were the most common viscera injured. Although accidental injury in our environment is a common cause of morbidity; fatalities are few in those with abdominal trauma