ABSTRACT
Background: Penetrating abdominal trauma is a commonly encountered emergency surgical condition. Though it is less common compared to blunt abdominal trauma, it is more dramatic due to the nature of the causative modes of injury involved. Mandatory laparotomy, which was earlier advocated for these cases, has gradually been replaced by conservative management in carefully selected cases thereby avoiding the unnecessary complications associated with laparotomy. Aims and objectives: To study the efficacy of conservative management in cases of penetrating abdominal trauma thereby obviating the need for unnecessary laparotomy. Methods: It was a prospective study conducted in a tertiary hospital, involving 64 patients, over a 2 year period. All patients underwent a CT scan to identify their injuries following a clinical examination and patients were managed conservatively or underwent laparotomy based on the CT findings.Results: Of the 64 patients 53 were managed conservatively making it a success rate of 82.81%. Only 2 patients who had a negative CT scan needed a subsequent laparotomy making it a very reliable investigation in these patients. Conclusion: Conservative management for penetrating abdominal trauma patients is effective in the majority of cases and hence can be advocated in the initial management plan of these cases supplemented by serial assessment of physical symptoms and signs, unless laparotomy is considered necessary based on their initial CT or physical examination findings.
ABSTRACT
Background: Necrotizing pancreatitis is one of the severe complications associated with acute pancreatitis. Serum creatinine has recently emerged as a reliable predictor of this severe complication associated with acute pancreatitis. Aims and objectives: The aim of this study is to evaluate the sensitivity and specificity of this simple biochemical marker in predicting the likelihood of developing pancreatic necrosis in any case of acute pancreatitis. Methods: A prospective study was carried out in Victoria Hospital, Bangalore over a period of two years and a total of 200 patients who presented with features suggestive of acute pancreatitis and further confirmed by computerized tomographic evaluation carried out within 96 hours of admission. Serum creatinine levels were documented at the time of admission, 24hrs and 48hrs after admission to notice if an elevation in serum creatinine corresponded with the development of pancreatic necrosis. Results: Out of the 200 test subjects, 26 (13%) patients developed pancreatic necrosis, which was confirmed by a contrast enhanced CT scan performed within 96 hours of admission into our centre. The sensitivity of serum creatinine alone in predicting the development of necrotizing pancreatitis was found to range between 75%-83% and the specificity varied between 71%-79% in our study. The positive predictive value ranges between 11%-23% with a negative predictive value ranging between 98%-99%. Conclusion: Serum creatinine though not highly sensitive is more specific and hence is a valuable simple and inexpensive biochemical parameter for predicting the development of pancreatic necrosis in cases of acute pancreatitis.