A prospective evaluation of blunt trauma abdomen in rural setup

  • Dr. Yunus Shah Associate Professor, Department of Surgery, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
  • Dr. Alok Singh Junior Resident, Department of Surgery, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
  • Dr. Prasad Y. Bansod Senior Resident, Department of Surgery, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
  • Dr. Murtaza Akhtar Professor & HOD, Department of Surgery, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
Keywords: Blunt trauma abdomen, Polytrauma, Exploratory laparotomy, Ultrasonography, CT scan, Liver injury, Spleen injury

Abstract

Introduction: Blunt abdominal trauma accounts for the majority of abdominal injuries seen in the Emergency Department. It is responsible for substantial morbidity and mortality. Selecting appropriate approach has been recently a point of conflict in management of abdominal blunt trauma, and criteria for non- operative management are being changed frequently.

Objective: With aim to identify some of the determining factors of successful non-operative management.

Methods: A 2 year tertiary care teaching hospital based longitudinal study was done. Selection criteria were defined and a prestructured proforma was made to assess and note the findings.

Results: 34 patients were studied. 29.4% of patients were in the age group of >20-30 years with the mean age 35.29 ± 15.84 years. 79.4% were male. Road traffic accident was responsible for 79.4% of blunt abdominal trauma cases while majority of the patients presented with abdominal pain (91.2%) and abdominal tenderness (91.2%). Associated extra abdominal injuries were found in 10 cases. The common extra abdominal injuries were head injuries (14.7%). 9 patients underwent exploratory laparotomy. 25 were selected for non-operative management. The most commonly injured organ was spleen (38.9%) followed by liver & stomach. 3 patients died in the present study. The sensitivity and specificity of the Emergency USG findings were 80.9% and 92.3% respectively, and that of the CT findings were 100% and 0% respectively.

Conclusion: Non operative management (NOM) was found to be highly successful and safe. Hemodynamic stability along with ultra sound, CT scan and repeated clinical examination were the sheet anchors of NOM

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References

Nishijima DK, Simel DL, Wisner DH, Holmes JF. Does this adult patient have a blunt intra-abdominal injury?. JAMA. 2012 Apr 11;307(14):1517-27.

Isenhour JL, Marx J. Advances in abdominal trauma. Emergency medicine clinics of North America. 2007 Aug 31;25(3):713-33.

Davis JJ, Cohn Jr IS, Nance FC. Diagnosis and management of blunt abdominal trauma. Annals of surgery. 1976 Jun;183(6):672.

Shah SM, Shah KS, Joshi PK, Somani RB, Gohil VB, Dakhda SM. To study the incidence of organ damage and post-operative care in patients of blunt abdominal trauma with haemoperitoneum managed by laparoscopy. Journal of minimal access surgery. 2011 Jul;7(3):169.

Deunk J, Brink M, Dekker HM, Kool DR, Blickman JG, van Vugt AB, Edwards MJ. Predictors for the selection of patients for abdominal CT after blunt trauma: a proposal for a diagnostic algorithm. Annals of surgery. 2010 Mar 1;251(3):512-20.

Abbasi HR, Mousavi SM, Akerdi AT, Niakan MH, Bolandparvaz S, Paydar S. Pattern of traumatic injuries and Injury Severity Score in a major trauma center in Shiraz, Southern Iran. Bulletin of emergency & trauma. 2013 Apr;1(2):81.

Gwinnutt CL, Driscoll PA. Advanced trauma life support. European journal of anaesthesiology. 1996 Feb 1;13(02):95-101.

Giannopoulos GA, Katsoulis IE, Tzanakis NE, Patsaouras PA, Digalakis MK. Non-operative management of blunt abdominal trauma. Is it safe and feasible in a district general hospital?. Scandinavian journal of trauma, resuscitation and emergency medicine. 2009 May 13;17(1):22.

Hashemzadeh SH, Hashemzadeh KH, Dehdilani M, Rezaei S. Non-operative management of blunt trauma in abdominal solid organ injuries: a prospective study to evaluate the success rate and predictive factors of failure. Minerva chirurgica. 2010 Jun;65(3):267-74.

Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP. Non operative management of abdominal trauma–a 10 years review. World Journal of Emergency Surgery. 2013 Apr 5;8(1):14.

Hassan R, Aziz AA. Computed tomography (CT) imaging of injuries from blunt abdominal trauma: a pictorial essay. The Malaysian journal of medical sciences: MJMS. 2010 Apr;17(2):29.

Kendall J, Kestler AM, Whitaker KT, Adkisson MM, Haukoos JS. Blunt abdominal trauma patients are at very low risk for intra-abdominal injury after emergency department observation. Western Journal of Emergency Medicine. 2011 Jan 1;12(4).

Baradaran H, Salimi J, Nassaji-Zavareh M, Rabbani AK. Epidemiological study of patients with penetrating abdominal trauma in Tehran-Iran. Acta Medica Iranica. 2007;45(4):305-8.

Farrath S, Parreira JG, Perlingeiro JA, Solda SC, Assef JC. Predictors of abdominal injuries in blunt trauma. Revista do Colégio Brasileiro de Cirurgiões. 2012 Aug;39(4):295-301.

Hedrick TL, Sawyer RG, Young JS. MRI for the diagnosis of blunt abdominal trauma: a case report. Emergency radiology. 2005 Jul 1;11(5):309-11.

Cokkinos D, Antypa E, Stefanidis K, Tserotas P, Kostaras V, Parlamenti A, Tavernaraki K, Piperopoulos PN. Contrast-enhanced ultrasound for imaging blunt abdominal trauma–indications, description of the technique and imaging review. Ultraschall in der Medizin-European Journal of Ultrasound. 2012 Feb;33(01):60-7.

Kontopodis N, Kaouraki A, Panagiotakis GI, Miliadis O, Volakakis J, Spiridakis K. Diagnosis of intra-abdominal injuries can be challenging in multitrauma patients with associated injuries. Our experience and review of the literature. Il giornale di chirurgia. 2013;33(1/2):27-31.

Baker SP, O'neill B. The injury severity score: an update. Journal of Trauma and Acute Care Surgery. 1976 Nov 1;16(11):882-5.

Guirguis EM, Hong C, Liu D, Watters JM, Baillie F, McIntyre RW. Trauma outcome analysis of two Canadian centres using the TRISS method. Journal of Trauma and Acute Care Surgery. 1990 Apr 1;30(4):426-9.

Rhodes M, Aronson J, Moerkirk G, Petrash E. Quality of life after the trauma center. Journal of Trauma and Acute Care Surgery. 1988 Jul 1;28(7):931-8.

Enderson BL, Reath DB, Meadors J, Dallas W, Deboo JM, Maull KI. The tertiary trauma survey: a prospective study of missed injury. Journal of Trauma and Acute Care Surgery. 1990 Jun 1;30(6):666-70.

Ravikanth J, Gejji SB, H KRC. Our Experience in Blunt Trauma Abdomen. Int J Sci Res. 2015;4(8):75–7. http://www.ijsr.net/archive/v4i8/SUB157202.pdf

Kreis Jr DJ, Fine EG, Gomez GA, Eckes J, Whitwell E, Byers PM. A prospective evaluation of field categorization of trauma patients. Journal of Trauma and Acute Care Surgery. 1988 Jul 1;28(7):995-1000.

Oreskovich MR, Carrico CJ. Pancreaticoduodenectomy for trauma: a viable option?. The American journal of surgery. 1984 May 1;147(5):618-23.

Allen RB, Curry GJ. Abdominal trauma: a study of 297 consecutive cases. The American Journal of Surgery. 1957 Mar 1;93(3):398-404.

Cox EF. Blunt abdominal trauma. A 5-year analysis of 870 patients requiring celiotomy. Annals of surgery. 1984 Apr;199(4):467.

Boutros SM, Nassef MA, Abdel-Ghany AF. Blunt abdominal trauma: The role of focused abdominal sonography in assessment of organ injury and reducing the need for CT. Alexandria Journal of Medicine. 2016 Mar 31;52(1):35-41.

Sato M, Yoshii H. Reevaluation of Ultrasonography for Solid‐Organ Injury in Blunt Abdominal Trauma. Journal of ultrasound in medicine. 2004 Dec 1;23(12):1583-96.

Jalli R, Kamalzadeh N, Lotfi M, Farahangiz S, Salehipour M. Accuracy of sonography in detection of renal injuries caused by blunt abdominal trauma: a prospective study. Ulus Travma Acil Cerrahi Derg. 2009 Jan 1;15(1):23-7.

Körner M, Krotz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current Role of Emergency US in Patients with Major Trauma 1. Radiographics. 2008 Jan;28(1):225-42.

Shaftan GW. Indications for operation in abdominal trauma. The American Journal of Surgery. 1960 May 1;99(5):657-64.

Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP. Non operative management of abdominal trauma–a 10 years review. World Journal of Emergency Surgery. 2013 Apr 5;8(1):14.

Stassen NA, Bhullar I, Cheng JD, Crandall M, Friese R, Guillamondegui O, Jawa R, Maung A, Rohs Jr TJ, Sangosanya A, Schuster K. Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. Journal of Trauma and Acute Care Surgery. 2012 Nov 1;73(5):S288-93.

Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs Jr TJ, Sangosanya A, Schuster KM. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. Journal of Trauma and Acute Care Surgery. 2012 Nov 1;73(5):S294-300.

Carlin AM, Tyburski JG, Wilson RF, Steffes C. Factors affecting the outcome of patients with splenic trauma/Discussion. The american surgeon. 2002 Mar 1;68(3):232.

Stevens SL, Maull KI. Small bowel injuries. Surgical Clinics of North America. 1990 Jun 30;70(3):541-60.

Shojaee M, Dolatabadi AA, Sabzghabaei A, Malekirastekenari A, Faridaalaee G, Yousefifard M, Yaseri M. New scoring system for intra-abdominal injury diagnosis after blunt trauma. Chinese journal of traumatology. 2014 Feb 1;17(1):19-24.

Mohammadi A, Ghasemi-rad M. Evaluation of gastrointestinal injury in blunt abdominal trauma" FAST is not reliable": the role of repeated ultrasonography. World Journal of Emergency Surgery. 2012 Jan 20;7(1):2.

Lee BC, Ormsby EL, McGahan JP, Melendres GM, Richards JR. The utility of sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy. American journal of roentgenology. 2007 Feb;188(2):415-21.

A prospective evaluation of blunt trauma abdomen in rural setup
CITATION
DOI: 10.17511/ijmrr.2017.i07.07
Published: 2017-07-31
How to Cite
1.
Shah Y, Singh A, Y. Bansod P, Akhtar M. A prospective evaluation of blunt trauma abdomen in rural setup. Int J Med Res Rev [Internet]. 2017Jul.31 [cited 2024Mar.28];5(7):691-0. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/897
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