A Clinical Study of Blunt Trauma Abdomen in a Tertiary Care Hospital of Uttarakhand

Background: Blunt abdominal injuries are met more often nowadays due to increased industrialization and a greater numberof vehicles, and is the third most common form of injury in road traffic accidents (RTAs) after orthopedic injuries and headinjuries. Blunt injury to the abdomen can also occur as a result of fall from height, assault with blunt object and sports injuries,etc. Blunt trauma abdomen is seen in increasing number in the emergency department and therefore, the early diagnosis andtreatment are very important and crucial for patients.Methods: The study was carried out from January 2018 to December 2019. A total of 100 patients were studied. After detailedclinical history, physical examination various investigations such as complete blood count, X-rays, ultrasound of the abdomen,and computed tomography scan of the abdomen were done to complete the diagnosis. Then, data were statically analyzed.Results: In our study, male patients were commonly affected (73%). The younger population between the age group of 18 and40 years was predominantly affected (73%). The common mode of injury was RTAs (62%). The organ that was found to bemost commonly injured in our study was the liver (27%) than spleen (22%). About 59% patients were managed conservativelywhile 41% were operated. The most common cause of death was cardiorespiratory failure followed by septicemia.Conclusions: This research article shows that blunt injury abdomen is a major cause of morbidity and mortality in young agepatients with RTA being the most common cause. Patients that are received in the emergency department should be givenimmediate attention and a quick and thorough evaluation of the patient must be done. Early diagnosis reduces the mortalityrates and plays a major role in good outcome and lead to successful treatment in these patients.

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

Background: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. Methods: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.Results: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%).Conclusions: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.

Blunt abdominal trauma in Sanglah Hospital Bali, Indonesia: a study of 65 cases

Abdominal trauma is a challenge for every surgeon, whether related to diagnosis or treatment. In developing countries, the number of traumatic events associated with death makes it necessary for a study to be carried out to see the patterns and damage caused by abdominal trauma and the organs involved. Material and Method is all patients with blunt trauma of the abdomen who came to emergency unit Sanglah Hospital Bali, from January 2017 up to May 2018 that undergo laparotomy exploration were enrolled, the data were collected retrospectively using patient medical records. Results is 65 patients with blunt abdominal trauma came to the emergency department and undergoes laparotomy exploration, range of age was 4-74 year old and 75.3% of them were men. The most common injured organs were spleen and liver, both are 26 and 15 cases (40 and 23%). Another intraoperative finding are Ileum Perforation (10 cases) Left Zone II Retroperitoneal Haematoma (7 cases), and Mesenterium Rupture (5 cases). Splenectomy was the most performed procedure (26 cases). The most common cause of blunt abdominal trauma was motor vehicle accident. Hypovolemic shock was the most common clinical presentation (48 patient). The Conclusions are according to this study, men consisted 75.3% cases of blunt abdominal trauma and the range age of patients was 4-74 year old. The most common cause was motor vehicle accident. Among patients with intra-abdominal organ damage, spleen and liver were most commonly involved. About 84.6% of all patients with blunt abdominal trauma were discharged without complication and morbidity.

Isolated Sigmoid Colon Injury Following Blunt Trauma Abdomen - An Unusual Occurrence.

Colon injury is far more common in penetrating injury than blunt trauma. Blunt trauma to the abdomen is more likely to damage solid organs such as the liver, spleen, pancreas and kidneys. Colon injury in blunt trauma is severe and is associated with other organ injuries, making its diagnosis difficult. However, isolated sigmoid colon injury in blunt trauma is rare. We report a case of 42 year old male who presented to us with blunt trauma to abdomen following a fall on iron Jaal (Grid) with slipping of one lower limb between two iron bars. The patient presented 4 days after injury with tenderness and guarding all over abdomen. X-ray abdomen was normal, ultrasonogram of abdomen showed presence of free fluid. Patient was operated on clinical basis. A single perforation of size 2 cm×1 cm was present in proximal sigmoid colon and there was no other injury. The perforated colon loop was mobilized and brought to anterior abdominal wall as colostomy. Isolated sigmoid colon injury is rare presentation. Initial radiologic investigations and clinical presentation may be misleading.

Paediatric Duodenal Injury Following Trivial Abdominal Trauma.

Isolated duodenal injury following blunt abdominal trauma (BAT) is relatively rare. The incidence of duodenal injuries is 11.2-26% due to blunt trauma. The choice of treatment must be tailored to the nature of the defect and the amount of tissue lost. We present a series of three cases of duodenal injury due to trivial trauma of which two cases of duodenal perforation were treated surgically and one was a duodenal hematoma managed conservatively. Varieties of surgical techniques have been described for the management of patients with duodenal injuries. The surgeon should select the most appropriate procedure based on the type and conditions of the duodenal injury. CECTscan of abdomen remains valuable tool in children with BATfor diagnosis and further management.

Study Of Clinical Outcomes In Patients With Severe Hepatic Injury: Experience At A Tertiary Care Centre.

Background: Management of liver trauma earlier used to be primarily surgical. With advancement in diagnostic modalities it has gradually shifted to non operative management. Methods: The present study was conducted on 40 patients with severe hepatic injuries (grade 3 onwards). All the patients were compared in terms of various methods adopted for their management and their clinical outcomes Results: Out of a total of 40 patients, maximum numbers of patients were in age group 18-24 years. 82.50 % patients had grade IV and rest had Grade V. 12 patients presented with shock on admission. Failure of NOM (non operative management) was seen in 25% of cases . The average requirement of blood transfusion in our study was 2.157 1.74 units. Average hospital stay in successful NOM cases was lower than in failed NOM. A total of 6 patients had to be operated upon in our study. Active bleed was seen on laparotomy in four patients with no evidence of any injury causing peritonitis. Conclusion: The success rates of non-operative management were significantly higher than the failures rates of non-operative management, without any significant incidence of complications and delayed laparotomies. Grade of liver injury or the amount of hemoperitoneum as detected on CT scan did not influence the outcome of non-operative management. Non-operative management is thus the gold standard in hemo-dynamically stable patients.

Gastric Rupture Following Blunt Trauma Abdomen: A Case Report.

Blunt trauma abdomen is a common sequel to road traffic accident. The variety of intra-abdominal injuries following blunt trauma abdomen is diverse. We report a stomach laceration following a trivial trauma to abdomen in a otherwise healthy young male.