Comparative study of conservative and operative management of solid organ injury in blunt abdominal trauma

Vimal Raj, S (2015) Comparative study of conservative and operative management of solid organ injury in blunt abdominal trauma. Masters thesis, Coimbatore Medical Collegel, Coimbatore.

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Abstract

Summarizing the findings of the study, details furnished here are in accordance with the renounced statistics. This is a prospective study of 48 cases of blunt abdominal trauma conducted in CMCH from August 2013- August 2014. Males (83%) outnumbered Females (17%). The most common age group affected is of 21-30 years which forms the young and reproductive group. Road traffic accident forms the most common mode of injury (56.2%). Majority of our study population (90%) presented with pain abdomen followed by abdominal distention (56%). The latent period in our study was < 18 hours in 90% of cases. Hemoglobin and hematocrit value becomes handy in treating BIA injury. X ray erect abdomen and chest X ray forms important investigational tools. Ultra sonography (FAST) has picked up solid organ injury or collection in 90-95% of cases. So it becomes an important tool in emergency set up, more so in hemodynamically unstable patients. Four quadrant aspiration is a simple and non specific for diagnosis. DPL was done in small number of patients since facility of high resolution ultrasonography (FAST) was available in our institution. CECT abdomen was performed in 75% of study population and had pivotal role in deciding operative or conservative management in hemodynamically stable patients. The most common injured organ in the present study is spleen followed by liver, kidney, and pancreas in the decreasing order. For splenic injury, most common surgery performed was Splenectomy in 7 patients followed by splenorraphy in 2 patients. Rest was all managed conservatively. Liver injuries were managed conservatively most of the times and hepatorraphy was done in 5cases. Retroperitoneal hematoma was seen in a small proportion of patients associated with renal injuries and were treated conservatively. Multiple intra-abdominal organs were involved in our study accounting for 25%. Associated extra abdominal injuries like head, thoracic and orthopedic injuries were found in 30 cases in the present study and influenced the morbidity and mortality of the patients. Patients with stable vitals can be managed conservatively with serial monitoring of vitals and repeat ultrasonogram. Post-operative wound infections and respiratory complications were responsible for majority of long hospital stay in ours study. The present study showed a mortality of 14.6%. CONCLUSIONS: Blunt injury abdomen with solid organ injury forms considerable load of patients in our surgical ward admissions. Most common age group involved is 21-30 years. Predominantly males are affected in large proportions. Road traffic accident forms the most common mode of injury. So efforts should be made to bring road traffic regulations into strict action and traffic norms regulated. Well established trauma care centres should be established at every Taluk hospital. Measures for early transport of the patients from the accident site to the trauma centres should be undertaken. Significant number of cases will have associated injuries with blunt injury abdomen like head injury, thoracic injury, extremity fractures. Clinical presentation is varied, sometimes confusing. Blunt injury abdomen is usually less obvious. Hence, repeated examination by multi-specialty personnel in a specialized trauma centre is required. Erect abdomen X ray is a useful investigation to identify associated hollow viscus injury. Falling titres in serial hematocrit value indicates ongoing bleeding. With the advent of high resolution ultrasonography (FAST), DPL and four quadrant aspiration blood investigations are becoming less opted. CECT forms the core investigation of choice in dealing with blunt injury abdomen patients, and becomes more important in deciding operative versus conservative management. Early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in managing Blunt abdominal injuries. Conservative management of liver and splenic injuries can be done in patients with stable vitals and grade 1 and grade 2 splenic and liver injuries.

Item Type: Thesis (Masters)
Uncontrolled Keywords: conservative ; operative management ; solid organ injury ; blunt abdominal trauma ; Comparative study.
Subjects: MEDICAL > General Surgery
Depositing User: Kambaraman B
Date Deposited: 03 Oct 2018 03:59
Last Modified: 03 Oct 2018 03:59
URI: http://repository-tnmgrmu.ac.in/id/eprint/9645

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