An Analysis of Visceral Injuries in Blunt Abdominal Injury

Perungo, T (2008) An Analysis of Visceral Injuries in Blunt Abdominal Injury. Masters thesis, Chengalpattu Medical College, Chengalpattu.

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Abstract

INTRODUCTION: TRAUMA is a major cause of mortality and morbidity in day to day life. Trauma can cause fatal injuries involving any major organ or system in the body like central nervous system, cardiovascular system, respiratory system, genitorurinary system, skeletal system, abdomen etc., Most of the injuries reveal itself earlier, but for blunt abdominal injuries which can be silent initially but causing fatal outcome later. Abdomen is the third most common organ injured following extremities and head injury. Most preventable deaths are those occurring in abdomen. Here we recollect the words of Ogden Nash “Your hopeless patients will live, your healthy patients will die” which aptly fits to blunt abdominal injuries. Blunt abdominal injuries can occur from trivial insult to a major force acting. 80% of the injuries are due to Road Traffic Accidents. Assault, fall from height, fall of weight over the body etc., are other modalities accounting for remaining percentage. Today we have well developed investigation modalities for diagnosing the blunt abdominal injuries. The clinician who first sees the patient is an important deciding factor apart from type of injury, time between injury and intervention, general health of the patient etc., affecting the outcome. In this study effort has been made to know about the different kinds of intra abdominal organs injured from various etiologies and the outcome overall in blunt abdominal injuries. AIMS AND OBJECTIVES: This dissertation has been chosen to study about the blunt abdominal injuries encountered in Govt. Chengalpattu Medical College Hospital, Chengalpattu for a period of two and half years from June 2005 to August 2007. Aims of the study are:- 1. To find the incidence of Hepatosplenic injuries among visceral injuries in blunt abdominal injury. 2. To find the incidence of various etiologies. 3. To find the different modes of presentation of blunt abdominal injuries. 4. To find the age and sex distribution. 5. To find the incidence of various organs injured in blunt abdominal injuries. 6. To compare the incidence of solid organ injury with others. 7. To compare conservative and interventional approach. 8. To find the effects of time interval between injury and intervention in the outcome. 9. To analyse various investigation modalities. 10. To analyse associated injuries. 11. To compare the results with other existing studies. MATERIALS AND METHODS: The study was conducted in Government Chengalpattu Medical College Hospital, Chengalpattu for a period of 2 yrs and 6 months. The study comprises of patients who sustained blunt abdominal injury who were admitted and managed in our hospital. All patients were received in the casualty department by the casualty medical officer and the duty general surgeon was called to attend the patients. All the cases were registered as medico legal cases. After primary survey of these patients, brief history and complete physical assessment all the basic investigations were done. Skiagrams were taken routinely. Ultra sonogram (F.A.S.T SCAN) was done for all cases and CT scan was done for selected cases. Peritoneal tapping was done for all cases and Diagnostic peritoneal Lavage was done for few cases of clinically equivocal abdomen. Based on the clinical finding and investigations cases were managed. At laparotomy, a systematic approach with examination of all intra abdominal organs were made. After surgery patients were managed with Nasogastric tube, IV fluids and antibiotics. Post operative complications were specifically looked for. CONCLUSION: 1. Hepatosplenic injuries are more common in our study accounting for nearly sixty percentage of total injuries in blunt abdominal injury. 2. High index of suspicion is necessary to rule out abdominal injury especially in a polytrauma patient. 3. Repeated clinical examination by same surgeon and periodic monitoring is necessary for early recognition of intra abdominal injury. 4. Commonest between 30 to 39 years of age. 5. Only 53.8 percent of patients with blunt injuries have external injuries over the abdomen. 6. About 32.75 percent of patients have associated other injuries. 7. Prompt resuscitation with simple investigations such as X-ray abdomen erect, chest X-ray, Peritoneal Aspiration / lavage are significant to decide the organ injury. 8. Ultra sound is an useful adjuvant in solid organ injury. 9. Spleen is the commonest organ involved in Blunt Injury accounting for 35.84 Percentage of total injuries. 10. Vascular injuries are rare. 11. Associated injuries to other systems needs prompt intervention. 12. Mortality and morbidity are high if the time interval between injury and surgery is prolonged. 13. Abdominal injuries cause very high incidence of mortality and morbidity if not recognized and intervened at the earliest.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Visceral Injuries ; Blunt Abdominal Injury ; Analysis.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 07 Jun 2018 03:38
Last Modified: 08 Jun 2018 01:04
URI: http://repository-tnmgrmu.ac.in/id/eprint/8280

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