medico-legal study at abdominal injury cases referred to Menoufiya University Hospital over one year [incidence type site, cause, associated injuries, management and outcome]

Abdominal injuries have a specific character as a very minimal or non-apparent external injuries may be associated with severe internal damage to solid or hollow abdominal organs. So trauma to the abdomen is dangerous and often life threatening. The present study aimed to throw light upon the incidence, the type, the site, causative instruments, associated injuries, management and outcome of abdominal injuries over one year from first of April 2000 to the end of March 2001. A clinical examination sheet was filled for each case including all personal data, clinical examination, investigations and follow up of the patients till their discharge. Two hundred and sixty cases of different abdominal injuries were referred to Forensic Medicine andClinical toxicology Department in Menoufiya University Hospital during the period of the study. They were 193 males and 67 females with a sex ratio 2.88:1.The highest number of injuries was in the age group 15-<25 years [32.3%] followed by the age group 25-<35 years old [21.9%] and the least number was in the age group less than 5 years old [2.3%]. The study revealed that the less the level of education the more the incidence of injuries due to assault as the highest number of cases were illiterates [40.4%] and only the least [10.8%] were university educated. Most injuries were encountered among un-employed patients [50.4%] and the least was met with in the professionals [11.2%]. As regards the residence or district, the large number of patients came from rural areas [68.5%] while only 31.5% came from urban areas. Regarding the circumstances of injuries the study showed that abdominal injuries due to assault were more than the accidental cases [68.8%, 31.2% respectively]. A significant relation between the circumstances of injuries and the age and sex of patients was present where accidental causes of injuries were more than assault in the age groups less than 15 years old and the reverse was in the age groups > 15 years old. As regards the sex, assault cases outnumbered accidental cases in both sexes. The commonest causative instruments were blunt objects [55.4%] followed by mobile vehicles [27.3%] followed by sharp cutting instruments [14.2%] the falling from height 1.9% and lastly firearm injuries were only 1.2%. Regarding the type of the lesion, contusions were present in about 35.4% of the cases followed by abrasions [26.9%], then contused, incised and stab wounds were 10%, 5.7%, 3.5% respectively, while firearm lesions were 1.2% only. The commonest site exposed to trauma in the abdomen was in the front [45%] while the injuries in the back were present in 33.9% of cases. Injuries in both front and back of abdomen were present in 9.6% and no apparent injuries were seen in 11.5% of the cases. The study showed that cases of abdominal injuries per-se were 46.6%, while abdominal injuries were associated with limb injuries in 20%, with head injuries in 13.9%, and with chest injuries in 8% of cases. Majority of cases were treated as outpatients [64.2%] most of them were due to assault, while 32.37% of cases were admitted in the hospital most of them were accidental injuries.50.6% of all inpatient cases were discharged without any surgical interference within 24 hours or more as their abdominal ultrasounds were free while 49.4% of inpatient cases were explored and all of them showed internal injuries. Solid organ injuries were in 42.86% of all admitted cases while gastrointestinal injuries were found in 30.95% of cases. 4.76% of cases showed diaphragmatic injuries. Abdominal wall and vascular injuries were 2.38%, and 4.76% respectively. Multiple internal injuries were present in 14.29%. Mortality rate was 8.85%. Most of these cases sustained fatal abdominal injuries were polytraumatic. Conclusions and Reconimendations: - Age, gender, education, occupation, type. and cause of mortality associated with abdominal injuries. So interventions to minimize the complications and mortalities of abdominal injuries should focus on: More efforts should be done to decrease the incidence of illiteracy and get rid of unemployment, more strict law enforcement with severe penalty is suggested for carrying sharp or firearm weapons illegally, and also for disobeying speed limits and traffic safety rules. Also dangerous injured cases should be referred as early as possible to the highly equipped hospitals