Blunt injury abdomen and their impact on Abdominal viscerae

Kevin Joseph, J (2012) Blunt injury abdomen and their impact on Abdominal viscerae. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: The care of the trauma patient is demanding and requires speed and efficiency. Evaluating patients who had sustained blunt abdominal trauma remains one of the most challenging and resource intensive aspects of acute trauma care. Blunt abdominal trauma is a leading cause of mortality and morbidity among all age groups . Identification of serious intra abdominal pathology is often challenging .Many injuries do not manifest during the initial assessment and treatment period. Missed intra abdominal injuries and concealed hemorrhage are the cause of increased mortality and morbidity especially in patients who survive the initial phase after an injury. AIM OF THE STUDY: 1. To study the effect of blunt injury abdomen and their impact on abdominal viscerae. 2. To Study regarding the pattern of distribution as age, sex and organ involvement. 3. To evaluate various associated injuires in blunt injury abdomen. 4. To focus on clinical signs & prioritize them as the prime tool in early diagnosis. 5. To Correlate the findings of abdominal sonography in trauma with laparotomy findings. 6. To analyze mortality with regarding to individual visceral injury. MATERIALS AND METHODS: Thirty Four cases of blunt abdominal trauma admitted in all surgical units at Tirunelveli Medical College Hospital, Tirunelveli during the period of December 2010 to November 2011 were taken for this study. The cases were selected in such a way that only those patients with definitive history and clinical findings suggestive of injury to Viscerae which were later confirmed by investigations, laparotomy and autopsy. Detailed history regarding the mode and nature of injury were taken, The clinical features were studies in details with special note to any associated injuries like head injury, chest injury and fracture limbs. Basic investigations viz. blood Hb, blood urea, blood sugar, serum creatinine and blood grouping were done in all cases. Plain X-ray of the abdomen in erect posture was taken in most of the cases expect in those who were admitted in a critically ill condition. Radiographs of other parts were also taken to find out associated injuries. Under aseptic precaution using sterile 18 G needle peritoneal tapping done in all the four quadrants, in all patients with the history of blunt abdominal trauma. At laparotomy a systematic approach with examination of all intra abdominal organs were made. After surgery the patients were continued on nasogastric, aspiration, antibiotics. Postoperative complications were specifically looked for, if present were treated appropriately. Inclusion Criteria’s: 1. Age limit >12 yrs. 2. All patients with head injury. 3. All patients with fractures. Exclusion Criteria: Patients below 12 yrs of age. CONCLUSION: 1. The most commonly injured organ is spleen in blunt abdominal trauma which is similar to other studies. 2. RTA accounted for majority of cases of blunt injury abdomen which is around 64.70%. 3. Similar to many large series males are more often affected in blunt abdominal injuries than females and middle aged persons are more often affected than extremes of age. 4. Commonest associated injuries occurred in our study was chest injury in eight cases. 5. FAST is rapid cheap noninvasive procedure used for screening in the emergency ward itself while the patient is resuscitated. 6. Biochemical investigations are not of much help. The investigations only complimentary to clinical diagnosis. 7. In the unstable trauma patient, a positive FAST eliminates the need for further tests and indicates the necessity for abdominal exploration the emergency ward itself while the patient is resuscitated. 8. Diagnostic paracentesis is a rapid, bedside tool for diagnosis immediately at the bedside arrival of the patient. 9. Thorough initial clinical evaluation, repeated clinical examinations monitoring vital signs are essential in minimizing the chance of missing life threatening intra abdominal injuries. 10. The mortality in this study is related to severity of injuries. Severe the grading of injury more is the mortality.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Blunt injury abdomen ; impact ; Abdominal viscerae.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 09 Jun 2018 17:28
Last Modified: 13 Sep 2018 11:45

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