A profile of abdominal visceral injuries: An analytical study of 44 cases

Balamurugan, K (2006) A profile of abdominal visceral injuries: An analytical study of 44 cases. Masters thesis, Coimbatore Medical College, Coimbatore.

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Abstract

INTRODUCTION: Major trauma due to motor vehicle accidents, industrial accidents and Civilian violence is the commonest cause of Mortality and Morbidity in young adults. Blunt abdominal trauma is usually associated with multisystem injury which may include head, thoracic or limb injury. In penetrating trauma the most common findings are major intra-abdominal vascular trauma leading to hypovolemic shock or septic complications following disruption of solid organs and injury to the bowel. Both blunt and penetrating injury may cause damage to solid and hollow viscera within the peritoneal cavity or to the blood vessels within the mesentery or retroperitoneal tissues. AIMS AND OBJECTIVES: 1. The aims of this study are, to study the pattern of injury to the abdominal viscera in civilian accidents during a particular period of time i.e., from 2003-2006. 2. To study the incidence and prevalence of the various organ injuries during the same period of time. 3. To study the modalities of diagnosis and treatment for the same. 4. To grade and classify severity of various abdominal organs according to injury severity score. 5. To evaluate, simple, cost effective, and easy to perform bedside tests in the diagnosis of serious life threatening internal organ injuries and statistically evaluate them. 6. This work reviews the mechanism of abdominal trauma, the recognitions of important diagnostic features of significant injury and the optimal management of selected injuries to individual organs. 7. Important principles in the management of these complex injuries are reviewed. 8. Application of sound surgical principles to the management of abdominal trauma should decrease the incidence of unnecessary deaths when major lesions remain undiagnosed or untreated. 9. Appropriate immediate resuscitation, diagnosis and management should also reduce the incidence of post injury septicemia, pulmonary insufficiency, renal failure and malnutrition. MATERIALS AND METHODS: A series of 44 patients with injuries of the abdominal viscera who were admitted to the trauma ward of Coimbatore Medical College Hospital with abdominal guarding, rigidity or penetrating injuries during 2004 - 2006 were studied. Of these patients, 26 patients were admitted for blunt injury and remaining 18 cases were of penetrating abdominal injuries. All these patients were worked up diagnostically and therapeutically as emergency measure. Surgical management was on as emergency basis for indicated patients. 8 patients were managed conservatively and discharged. All the patients were worked up as follows-Blood grouping and cross matching, basic investigations, chest and abdominal radiography ; Abdominal paracentesis, USG, CT abdomen and appropriate surgical management were done as indicated. The Definitive surgical management was based on per -operative findings during surgery and planned accordingly. RESULTS: IN 18 CASES OF PENETRATING INJURY: Liver 3, Spleen* 3, Kidney 1, Stomach** 1, Small intestine*** 10, Colon 2, Rectum 1, * Colon also involved in 1 patient. ** Liver also involved in 1 patient. *** Colon also involved in 1 patient. Considering the entry wounds of penetrating injury and hemodynamic instability, 10 patients were taken for ultrasonogram. Solid organ injury were detected in 7 patients out of which 3 were splenic injuries, 3 liver injuries, 1 renal injury. All 18 were taken for laparotomy. One patient died in Post -Operative period, who had both splenic and colon injuries. IN 26 CASES OF BLUNT INJURY: Liver 6, Spleen* 8, Small intestine 6, Pancreas** 1, Renal *** 3, Retroperitoneal 3, Duodenum 1, Colon 2. * Small intestine perforation with 1 case. ** Retroperitoneal hematoma also present in this case. *** Retroperitoneal hematoma also present in 2 cases. All the 26 patients were taken for plain X- ray abdomen. Air under the Diaphragm was seen in 5 out of 9 bowel injury cases. Abdominal paracentesis done in 18 hemodynamically unstable Patients revealing hemoperitoneum in 10 cases which is 55 % sensitivity. All 18 cases were taken for laparotomy had intraoperative findings Corroborating clinical suspicion. USG was done in all 26 cases of blunt injury, showed splenic injury in 8 patients, liver injury in 6 patients and renal injury in 6 patients. The above findings were confirmed by either laparotomy or CT - Abdomen. CT abdomen done in 10 cases, 1 case of pancreatic Injury, 2 cases of retroperitoneal hematoma and confirmed the findings of USG in remaining cases. CONCLUSION: 1) The pattern and incidence of abdominal and visceral injuries in this geographic area was studied. 2) In this study, the commonest visceral organ injury was small intestine (16 cases) followed by spleen (11 cases). 3) In blunt abdominal injury the commonest organ injured was spleen (8 cases) and in penetrating abdominal injury the commonest organ injured was small intestine(10 cases). 4) Emergency USG at the bed side is desirable and useful especially in blunt trauma, to plan for management in order to avoid Negative Laparotomy. 5) CT-scan was particularly useful to detect injury of pancreas and retroperitoneal injuries.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Abdominal Visceral Injuries, Profile, Analytical study, 44 cases.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 08 Jun 2018 15:52
Last Modified: 23 Mar 2020 07:45
URI: http://repository-tnmgrmu.ac.in/id/eprint/8289

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