Balaji, S (2010) A Comprehensive study on Abdomino-Pelvic Hollow Viscus Injuries. Masters thesis, Chengalpattu Medical College, Chengalpattu.
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Abstract
INTRODUCTION: TRAUMA has been regarded as the number one killer in the world. As the world today moves into an era of ‘Living life in the fast lane’, there is an increased level of recklessness, carelessness and vice thereby making ‘TRAUMA’ the leading cause for mortality universally .In civilian life, trauma has always been a serious affliction to the increasingly mobile society. Abdominal injuries are mostly due to blunt trauma. Penetrating injuries are also seen with increasing frequency in hospital emergency departments, particularly in urban areas. Solid viscera are more commonly affected in trauma and have attracted greater clinical attention and analytical interventional studies. But, abdominal hollow viscus injuries are no less common, and is equally life threatening with the possibility of exsanguinating bleeding compounded by perforation peritonitis. In India there is an appreciable fall in ulcerative and infective perforations due to increasing availability of newer medical facilities. There is still one type of hollow visceral affliction which seems to be increasing, the one related to TRAUMA (both accidental and non accidental). Despite remarkable developments and newer technologies like USG, CT scan and MRI ; good common sense, clear clinical history taking, skilful clinical examination acumen, simple radiographs, bedside investigations and a clear protocol can help in a reasonably accurate diagnosis in a remarkably high number of patients with hollow visceral injuries/perforations. The pattern of injuries is protean and virtually any intra abdominal viscera can be involved ranging in spectrum from a serosal laceration, minor tear to complete transection of the bowel and associated organ rupture. In developing into a good surgeon, the ability to tackle trauma cases, particularly those related to abdominal hollow visceral perforations/injuries is an important yardstick for effectiveness and good surgical skill. OBJECTIVES: 1. Describe the patterns of traumatic hollow viscus injuries. 2. Identify the organ(s) prone in specific forms of injury. 3. Attempt to link the morbidity and mortality to the delay in diagnosis and surgery. 4. Detail on the deceptive presentations in blunt injury abdomen. 5. Produce a protocol for the management of hollow viscus injury following penetrating and blunt injuries to the abdomen. MATERIAL AND METHODS: The cases have been selected from patients seeking surgical attention at Chengalpattu Medical College Hospital between July 2007 and October 2009. All suspected cases were followed up from the beginning of admission till their eventful discharge/death. All relevant information and details were gathered from the case sheets and hospital records and from interviews. To streamline the collection of information, all details were entered in customised proformas. The entries were tabulated under different categories and further indexed to facilitate comparison between comparable groups/subgroups. All cases were run through simple baseline blood and urine analysis. Skiagrams of abdomen and chest were essential part of the investigative workout. Clinical information at the time of admission especially hemodynamic parameters and salient abdominal findings were duly recorded. Cases were assigned into different graded categories depending on the time lag from the time of symptoms, of presentation to the time of surgery. Intra- operative findings were compared with the provisional diagnoses. The site and the size of the perforations, the amount of peritoneal soiling, associated intra- abdominal pathologies, the nature of operation performed and other relevant general factors have been tabulated. Postoperative events were recorded and all complications that arose were noted and but since no autopsy was ever performed; only the probable cause leading to or immediately responsible for death could be conjectured. In cases of traumatic hollow viscus injuries, relevant history was elicited to determine the nature of violence/traumatic force, its extent, the weapon used (if any), time of the incident, time of presentation, time of surgery, any time expended in initial resuscitation or revival, the condition of the patient at presentation and any other major injuries were also carefully noted. CONCLUSIONS: From the study and analysis of the patterns of presentation and clinical outcome in cases of traumatic hollow viscus injuries, it can be concluded that: 1. In a referral hospital like Chengalpattu Medical College with trauma care, dealing with intra- abdominal emergencies consequent to trauma forms an important part of surgical management and training. 2. The clinical presentation may vary from a deceptively normal appearance to those in a collapsed and moribund state and the pattern of injury can be complicated by the association with other clinical organs like liver, spleen, kidney, pancreas, etc. 3. While dealing with intra-abdominal hollow viscus emergencies associated with multi-system involvement, the surgeons should prioritize the management of immediately life threatening injuries over those of low ominous significance. 4. Though penetrating abdominal injuries are more commonly associated with HVI than blunt injuries(as per the international studies-4:6),in our study, it was found that blunt injuries were the leading cause for HVI (5.4:4.6). The probable explanation for this could be the increased incidence of gunshot injuries in the international studies as causes for penetrating injuries leading to HVI. Stab injuries, which was commoner in our study, have only 20% chance of causing HVI, as compared to gunshot injuries which has 80-90% chance of causing HVI. 5. There is an increased incidence of complication and mortality when: a. There is an inordinate delay in presentation. b. There has been inadequate pre-operative resuscitation measures. c. There are other unrelated risk factors for surgery. d. There is precious loss of time in deciding on the need and nature of surgical intervention. e. The surgical procedure undertaken is unduly prolonged and complicated. f. The injury involves distal segments of the intestines with considerable peritoneal spillage of bowel content. g. Since most of the cases were medico-legal, the surgeon is biased towards an active surgical intervention without equivocating, so as not to miss even a minor injury or a masquerading major injury. h. The proper management of traumatic hollow viscous injuries requires the application of good clinical acumen, quick decisions, technique and adequate post- operative back- up facilities and care.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Abdomino-Pelvic Hollow Viscus Injuries ; Comprehensive study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 07 Jun 2018 04:03 |
| Last Modified: | 08 Jun 2018 01:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8283 |
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