Blunt abdominal trauma; does clinical evaluation suffice?

ABSTRACT

To correlate preoperative clinical diagnosis with per-operative findings in cases of Blunt Abdominal Trauma. Observational study with prospective data collection from Jan. 2004 to Dec. 2005. Surgical Unit III of Civil Hospital, Karachi. All patients over 12 years of age who underwent surgery for admitted with Blunt Abdominal Trauma. The patients were resuscitated and prepared for surgery starting. blood transfusion in haemodynamically unstable patients, passage of nasogastric tube, bladder catheterization and doing appropriate investigations where conditions permitted. Pulse, Blood pressure, Temperature, Respiratory rate, Oxygen saturation and Urinary output monitoring started. As soon as possible surgical exploration was carried out through a midline incision under general anaesthesia. The surgical procedures performed depended upon the laprotomy findings. The data collection was done on a standard performa. During the two-year study period 25 patients, 21 males and 4 females, aged 16-52 years [mean 27 years] were admitted with Blunt Abdominal Trauma. At the time of presentation in the Casualty Dept. most of the patients [64%] were in a state of circulatory shock. Road Traffic Accident [RTA] was the commonest cause of Blunt Abdominal Trauma in our study, accounting for 16 [64%] patients, followed by fall from height in six [25%] and assault in three [12%] cases. A clinical diagnosis of splenic injury was made in 11 [44%] cases, liver injury in eight [32%],intestinal perforation in five [20%] and bladder injury in one [4%] case. Our pre-operative clinical diagnosis correlated with the operative findings in 22 [88%] cases. However in three [12%] cases, the operative findings did not correlate with clinical diagnosis. An early examination of Blunt Abdominal Trauma patients, enables the surgeon to reach a correct working diagnosis in the majority of cases