A study to assess the 30 days outcome of penetrating injuries to the abdomen

Authors

  • Neeraja Tillu Department of General Surgery, Lokmanya Tilak Medical College, Sion, Mumbai, Maharashtra, India
  • Chetan Rathod Department of General Surgery, Lokmanya Tilak Medical College, Sion, Mumbai, Maharashtra, India
  • Meena Kumar Department of General Surgery, Lokmanya Tilak Medical College, Sion, Mumbai, Maharashtra, India
  • Vinit Kumar Department of General Surgery, Lokmanya Tilak Medical College, Sion, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20164053

Keywords:

Abdominal trauma, Conservative management, Exploratory laparotomy, Morbidity score

Abstract

Background:Abdominal trauma is among the leading causes of morbidity and mortality in all age groups in the world. Many injuries may not manifest during the initial assessment and treatment period. The study was conducted to determine the different characteristics of the patients with abdominal trauma, to analyse the extent of organ involvement and to determine the surgical interventions done for the same and to understand the morbidity caused by various operative procedures, especially due to negative laparotomy.

Methods: A descriptive, prospective, hospital-based study involving observation of patients from admission to final outcome of management at discharge or death was carried out. Consecutive admissions of 54 patients with abdominal injuries attended to at the department of surgery, Lokmanya Tilak Medical College, Sion, Mumbai were enrolled in the study. The study was conducted from September 2013 to September 2015. The data were analyzed using SPSS software.

Results:54 patients were enrolled in the study. Male to female ratio was 5.75:1. Mean age was 29.31 years. Majority of the patients (83.33%) were affected with homicidal stab wounds. The object causing penetrating injury was most commonly a knife, which was used in 44 patients (81.5%). Thirty patients (55.55%) had isolated penetrating injuries to the abdomen whereas 24 patients (44.45%) had associated injuries. Amongst the stab wounds, the commonest site of injury was the umbilical region. The average systolic BP was measured in all the patients. The mean revised trauma score of all patients was 7.66. The contingency values of patients undergoing chest X-ray, FAST, CT scan and peritoneal breach v/s patients undergoing exploratory laparotomy were noted. Primary closure of jejunal perforation (12.5%) and gastric perforation (12.5%) were the most common operative procedures done. Jejunum was the most frequently damaged organ in most of the patients. The average penetrating abdominal trauma index of the patients was 6.77. The operative time, time spent on ventilator, days stayed in ICU, length of hospital stay, time taken by the patients to walk , to sip and to remove mid line suture were noted.

Conclusions:Increased efforts to repair early are likely to reduce the incidence and mortality in patients with abdominal trauma. Selective non operative management can be practiced in tertiary care centers but its benefits must be weighed against the risk of missed injuries.

References

Aldemir M, Taçyildiz I, Girgin S. Predicting factors for mortality in the penetrating abdominal trauma. Acta Chir Belg. 2004;104(4):429-34.

National Crime Records Bureau, M.o.H.A. G of I. Accidental deaths and suicides in India. Available at http://ncrb.gov.in/ADSI2014/adsi-2014 full report.pdf. Accessed on 11 December 2015.

Gad MA, Saber A, Farrag S, Shams ME, Ellabban GM. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. N Am J Med Sci. 2012;4(3):129-34.

Jansen JO, Yule SR, Loudon MA. Investigation of blunt abdominal trauma. Br Med J 2008;336(7650):938-42.

Sikka R. Unsuspected internal organ traumatic injuries. Emerg Med Clin N Am. 2004;22(4):1067-80.

Walker ML. The damage control laparotomy. J Natl Med Assoc. 1995;87(2):119-22.

Nance FC, Wennar MH, Johnson LW, Ingram JC, Cohn I. Surgical judgment in the management of penetrating wounds of the abdomen: experience with 2212 patients. Ann Surg. 1974;179(5):639-46.

Nagy K, Roberts R, Joseph K, An G, Barrett J. Evisceration after abdominal stab wounds: is laparotomy required? J Trauma. 1999;47(4):622-6.

Asuquo M. Penetrating Abdominal Trauma: Experience in A Teaching Hospital, Calabar, Southern Nigeria. Int J Clin Med. 2012;3:427-31.

Pridgen JE, Herff AF Jr, Watkins HO, Halbert DS, D'Avila R, Crouch DM, et al. Penetrating Wounds of the Abdomen : Analysis of 776 Operative Cases. Ann Surg. 1967;165(6):901-7.

Dawood Al-Aswad F. Abdominal Stab Wounds. J Abdom Surg. Winter 2009 / Spring 2010. http://www.abdominalsurg.org/journalSpring2010_5.htm . Accessed 15 October 2016

Njile IE. Pattern and early treatment outcome of abdominal injuries at Muhibili national Hospital, Dar ES Salaam, Tanzania. 2012:1-55.

Kumar V, Suryawanshi P, Dharap SB, Roy N. Does Prehospital Delay Change Trauma Outcomes in Mumbai? Prehosp Disaster Med. Cambridge University Press. 2011;26(1):53.

Omer MY, Hamza AA, Musa MT. Penetrating Abdominal Injuries : Pattern and Outcome of Management in Khartoum. Sci Res. 2014;5(1):18-22.

Kester DE, Andrassy RJ, Aust JB. The value and cost effectiveness of abdominal roentgenograms in the evaluation of stab wounds to the abdomen. Surgery, gynecology & obstetrics. 1986;162(4):337-9.

Yucel M, Bas G, Özpek A, Alimoglu O. The predictive value of physical examination in the decision of laparotomy in penetrating anterior abdominal stab injury. Int J Clin Exp Med. 2015;8(7):11085-92.

Sanei B, Mahmoudieh M, Talebzadeh H, Shahmiri SS, Aghaei Z. Do patients with penetrating abdominal stab wounds require laparotomy? Arch trauma Res. 2013;2:21-5.

Asuquo M. Penetrating Abdominal Trauma: Experience in a teaching hospital, Calabar, Southern Nigeria. Int J Clin Med. 2012;3:427-31.

Leppäniemi AK, Voutilainen PE, Haapiainen RK. Indications for early mandatory laparotomy in abdominal stab wounds. Br J Surg. 1999;86(1):76-80.

Moore EE, Dunn EL, Moore JB, Thompson JS. Penetrating abdominal trauma index. J Trauma. 1981;21(6):439-45.

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Published

2016-12-13

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Original Research Articles