Lokeshwaran, A (2020) A Study of Conservative Management of Liver Injury in Blunt Abdominal Trauma. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION The liver is the most commonly injured intraabdominal organ with an incidence of 30% to 40%. The overwhelming majority of liver injuries, however, are minor, with spontaneous cessation of hemorrhage almost always the rule, and operative intervention is rarely required. On the other hand, complex hepatic injuries continue to challenge even the most experienced trauma surgeons. Hepatic injuries have been a fascinating topic since the publication of “Notes on the Arrest of Hepatic Hemorrhage Due to Trauma” in 1908 by J. Hogarth Pringle of the Glasgow Royal Infirmaries who provided the first published scientific foray into the management of severe hepatic trauma and describes one of the operative maneuvers that remains a mainstay in hepatic hemorrhage control to this day. AIM OF THE STUDY 1) To study the sex and age distribution of liver injury in blunt abdominal trauma. 2) To evaluate the morbidity and mortality due to severity of the injury. 3) To evaluate the various modes of injury causing the blunt abdominal trauma. 4) To evaluate the various diagnostic methods and techniques available in the management of blunt abdominal trauma. MATERIALS AND METHODOLOGY 50 consecutive cases which are admitted in the Govt. Stanley medical college and hospital during the period of September 2018 - September 2019 are studied. It is a prospective observational study. METHODS OF COLLECTION OF DATA My study was collected by 1) Detailed history of the patient either directly or from the patient relatives 2) Clinical examination 3) Diagnostic investigations made to the patients Patients admitted in the emergency surgical ward are thoroughy examined from head to foot. Patients with clinical findings of abdomen tenderness , guarding are initially resuscitated and then shifted to investigations of ultrasonography , CECT abdomen. RESULTS The above mentioned findings were collected from the patients who admitted in govt. Stanley medical college which is a prospective study done between September 2018 - September 2019. The distribution of gender showing that the males (80%) outnumbered females (20%) . Most common group of age affected are between 21-30 yrs and the less common between 50-60 yrs. The latent period in our study < 16hrs was 98%. The most common mode of injury was the Road traffic accidents, least with blow with blunt objects. 30% of the alcoholics were affected and more prone to injury in our study. Majority of the patients presented with pain( 100 %).most of them had tenderness over abdomen. Guarding was present in 52% whereas Rigidity in 14%. 6% of them presented with shock , with polytrauma even though resuscitation made could not be saved due to increased latent period. 36% of the patients presented with the other associated injuries . Ultrasonography was used in all patients , showing the sensitivitiy of 92% in detecting the hemoperitoneum in our study. X ray , CECT was taken in all the patients in our study. CONCLUSION Nonoperative management can be used to successfully manage most Blunt hepatic trauma patients and a select group of penetrating hepatic trauma patients. The cornerstone of nonoperative management is hemodynamic stability. An active “blush” on contrastenhanced CT mandates immediate angiography, irrespective of CT grade of injury. Successful embolization of the lesion usually permits continued nonoperative management. Should the patient under observation become hemodynamically unstable or develop peritoneal signs, operative intervention should be undertaken without the slightest hesitation.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711056 |
| Uncontrolled Keywords: | Blunt Injury Abdomen, Liver Laceration, CECT Abdomen and Pelvis. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 09 Feb 2021 01:15 |
| Last Modified: | 09 Feb 2021 01:15 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13943 |
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