Clinical and Radiological correlation in Blunt Injury Abdomen

Sathyaraj, P (2013) Clinical and Radiological correlation in Blunt Injury Abdomen. Masters thesis, Thanjavur Medical College, Thanjavur.


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INTRODUCTION: Abdominal trauma is one of the most common causes among injuries caused mainly due to road traffic accidents. The rapid increase in motor vehicles and its aftermath has caused rapid increase in number of victims to blunt abdominal trauma. Motor vehicle accidents account for 75 to 80 % of blunt abdominal trauma1. Blunt injury of abdomen is also a result of fall from height, assault with blunt objects, sport injuries, industrial mishaps, bomb blast and fall from riding bicycle. In view of increasing number of vehicles, rampant increase in construction work and consequent road traffic accidents, this dissertation has been chosen to study the cases of blunt abdominal trauma, its different modes of presentation and to study the different modalities of its management with reference to the patients presenting at Thanjavur Medical College Hospital, Thanjavur. OBJECTIVES: 1. To evaluate the importance of clinical examination in diagnosing blunt injury abdomen. 2. To evaluate the importance of radiological investigations in diagnosing blunt injury abdomen. 3. To correlate the clinical finding with radiological investigation to decide upon the management. 4. Results are analysed in terms of reduction in morbidity. MATERIALS AND METHODS: SOURCE OF DATA: This study is a prospective study of blunt abdominal injuries during the period from January 2011 to June 2012 in Thanjavur Medical College Hospital, Thanjavur. Number of cases studied is 52. METHODS OF COLLECTION OF DATA: Data were collected from the patients by their clinical history, clinical examination with appropriate investigations on those patients who were admitted. After initial resuscitation of the trauma victims, a careful history was taken to document any associated medical problem. Routine blood and urine tests were carried out in all the patients. Documentation of patients, which included, identification, history, clinical findings, diagnostic test, operative findings, operative procedures and post operative outcome were all recorded on a proforma specially prepared. Demographic data collected included the age, sex, occupation and nature and time of accident leading to the injury. After initial resuscitation and achieving, hemodynamic stability, all patients were subjected to careful examination, depending on the clinical findings; decision was taken for further investigations such as four-quadrant aspiration, x ray abdomen and ultrasound and CT abdomen. The decision for operative or non operative management depended on the clinical examination and results of diagnostic tests. Patients selected for non operative or conservative management were placed on strict bed rest, were subjected to serial clinical examination which included hourly pulse rate, blood pressure, respiratory rate and repeated examination of abdomen and other systems. Appropriate diagnostic tests especially ultrasound of abdomen and CT abdomen were repeated as and when required. Apart from routine investigations, abdomen x ray was done in 47 patients. 49 patients under went four-quadrant aspiration. An aspiration of blood, which did not clot, bilious aspiration, aspiration with flakes was taken as positive. When the aspirate clotted, the test was taken as negative. Ultrasound of abdomen was done in 22 cases. CT abdomen was done in 15 cases. CONCLUSIONS: 1. All cases of blunt injury abdomen should be viewed with high degree suspicion, to rule out solid/hollow viscus injury either by clinical and radiological examination, since the morbidity and mortality in blunt injury abdomen is high. 2. The mainstay of diagnosing blunt injury abdomen is by thorough and repeated clinical examination. 3. By adding radiological investigations to clinical examination, we avoid negative laparotomies which by itself can cause morbidity and mortality. 4. Radiological investigation like CT abdomen and USG abdomen not only help in diagnosing the injured organ but also help in grading the severity of injury, thus less severe injuries are managed conservatively, while more severe injuries require laparotomy. Patients who are managed conservatively should be scrutinized with clinical and appropriate radiological investigations. 5. By the advancements in radiological investigations there is increase in trend towards conservative managements. 6. Further with the help of radiological investigations we can know the organ involved, and we can plan preoperatively regarding the management, which will lessen the operating time and give better outcome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: blunt injury abdomen, Clinical, Radiological correlation.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 07 Jun 2018 02:56
Last Modified: 27 Mar 2020 03:37

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