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PURPOSE@#Rib fractures are one of the most common causes of morbidity and mortality and are associated with abdominal solid organ injury (ASOI). The purpose of this study was to investigate the correlation of ASOI with the number, location, and involved segments of rib fracture(s) in blunt chest trauma.@*METHODS@#This retrospective cohort study was conducted on patients with blunt chest trauma over the age of 15 years, who were hospitalized with the diagnosis of rib fractures from July 2015 to September 2020. After ethic committee approval, a retrospective chart review was designed and patients with a diagnosis of rib fractures were selected. Patients who had chest and abdominopelvic CT scan were included in the study and additional data including age, gender, injury severity score, trauma mechanism, number and sides of the fractured ribs (left/right/bilateral), rib fracture segments (upper, middle, lower zone) and results of chest and abdominal spiral CT scan were recorded. The correlation between ASOI and the sides, segments and number of rib fracture(s) was assessed by Pearson's correlation coefficient.@*RESULTS@#Altogether 1056 patients with rib fracture(s) were included. The mean age was (42.76 ± 13.35) years and 85.4% were male. The most common mechanism of trauma was car accident (34.6%). Most fractures occurred in the middle rib zone (60.44%) and the most commonly involved ribs were the 6th and 7th ones (15.7% and 16.4%, respectively). Concurrent abdominal injuries were observed in 103 patients (34.91%) and were significantly associated with middle zone rib fractures.@*CONCLUSION@#There is a significant relationship between middle zone rib fractures and ASOI. Intra-abdominal injuries are not restricted to fractures of the lower ribs and thus should always be kept in mind during management of blunt trauma patients with rib fractures.
Subject(s)
Adolescent , Adult , Humans , Male , Middle Aged , Abdominal Injuries/diagnostic imaging , Retrospective Studies , Rib Fractures/epidemiology , Thoracic Injuries/epidemiology , Wounds, Nonpenetrating/diagnostic imagingABSTRACT
Background and objective : Blunt abdominal injury remains one of the commonest injuries. The solid organs, namely the Liver, Spleen & Kidney are the most commonly injured intra-abdominal organs. Non operative line of management is now considered the line of treatment for patients with intra-abdominal organ injury who are hemodynamically stable. In the case of polytraumatized patients with open or blunt abdominal trauma, the liver is the most frequently injured abdominal organ. Earlier, surgical treatment was the standard procedure globally for all kinds of trauma-related liver injuries. However, development of new interventional radiological techniques has changed the paradigm towards a non-surgical patient management. Methodology: An observational study of 50 patients with solid organ injuries of the abdomen following abdominal trauma admitted over a period from July 2018 up to August 2020 was carried out. Patient management either operative or conservative was decided on basis of hemodynamic status and they were divided in groups OP (Operated) and NOM (Non Operative Management). Interpretation and conclusion : In our study, majority of liver injury were treated conservatively. Splenic injury patients were mostly managed by operative intervention and renal injury patients were managed according to grading of organ injury.
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Introduction: Blunt Abdominal trauma is the most common caused by road traffi c accidents (RTA). It also occurs as a result of fall from a height, assault with blunt objects, industrial mishaps, sports injuries, bomb blast. Investigative modality can only supplement the clinical evaluation and cannot replace it in the diagnosis of blunt abdominal trauma. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality remain at large. Purpose: To estimate the frequency of various intra-abdominal organ involved, assess the various mode of blunt abdominal trauma and clinical presentation and various available investigation, treatment and complications. Methods: This a prospective study conducted in SRM Medical College among patients presenting to the casualty and general surgery outpatient department with a sample size of 72. Results: Males (91.6%) outnumbered females (8.33%). RTA forms the most common mode of injury. The most common age group affected is 21-30 years. Majority of the population presented with pain abdomen. Focused assessment with sonography for trauma has picked up solid organ injury in 46 cases. Computed tomography abdomen was performed in 100% of the population and forms the core investigation of choice and becomes more important in dealing operative versus conservative management. For splenic injury, the most common surgery performed was splenectomy (26 cases). Multiple intra-abdominal organs were involved accounting for 9.7%. Wound infection is the most common post-operative complication. The study showed a mortality of 19%. Conclusion: Blunt injury abdomen with solid organ injury forms a considerable load of patients in our society and is usually less obvious. Early diagnosis, repeated clinical examination and use of appropriate investigations form the key in the management.
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Background: Blunt abdominal trauma is one of the most common causes among solid organ injuries. Morbidity and mortality in blunt abdominal injuries is major cause of concern for surgeons. Aims & Objective: This study was carried out to analyse patient profile, investigations and management of such patients. Material and Methods: 50 patients, who admitted to civil hospital Surat were studied prospectively. Age and gender distribution, Mode of injury, clinical presentation, solid organs injured, and investigations carried out, length of hospital stay, management – conservative or operative and their outcome were studied. Results: Out of 50 patients 46 were male, and 4 female patients. 60% patients are from 20-40 year age group. Majority are due to road traffic accidents (54%), and abdominal pain is the most common mode of presentation. Spleen (46%) and liver (38%) are the 2 most common organs involved. 88% patients are managed conservatively, remaining have to undergo laparotomy. Length of hospital stay (1-10 days in 37 patients) is lower patients who are managed by conservative management in comparison to operative management (11-20 days in 4 patients). 54% patients required 1 or more units of blood during hospital stay. Conclusion: Non penetrating abdominal injuries are major cause of concern. Ultrasonography and CT scan play major role in detecting solid organ injuries. Conservative management is safer and reliable mode of management in solid organ injuries due to blunt abdominal trauma.
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PURPOSE: In pediatric solid organ injury, non-operative management is considered as a standard treatment when the patient is hemodynamically stable. However, treatment according to the injured organ and the depth of injury is controversial. The purpose of this study is to evaluate treatment results in the management of abdominal solid organ injuries in children. METHODS: This analysis was performed retrospectively with 57 consecutive children under 15 year of age who were diagnosed with abdominal solid organ injuries at Ewha Womans University Mokdong Hospital from January, 1999 to June, 2007. RESULTS: The major cause of pediatric solid organ injury was traffic accidents (59.6%) and the most frequently injured organ was the liver (66.7%). 54 patients (94.7%) were treated non-operatively and the success rate was 100%. There was no difference in type of management and success rate according to the depth of injury or the injured organs. The average ICU stay was 4.3 days, and the average hospital stay was 13.6 days and that was extended depending on the depth of injury. And according to the cause of injury, cases by traffic accident stayed significantly longer than cases by other causes. CONCLUSION: High grade of injury is not contraindication of nonoperative management in pediatric solid organ injury. Hemodynamic instability is the only absolute indication of operation. Therefore, if the patient is stable, non-operative management with intensive observation is the choice of treatment.