Title: A Clinical Study of Blunt Injury Abdomen and Its Management at MNR Hospital Sangareddy, Telangana

Authors: Dr T.Rudra Prasad Reddy, Dr Lakshmi Dharanidhar Reddy Vangala, Dr Srinu Naik Angoth

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.157

Abstract

Trauma, or injury, is defined as cellular disruption caused by an exchange with environmental energy that is beyond the body's resilience. The abdomen is frequently injured after both blunt and penetrating trauma. Trauma is the leading cause of death between the ages of 1 and 44 years. In all age groups, it is surpassed only by cancer and atherosclerosis in mortality. The evaluation and treatment of abdominal injuries are critical components in the management of severely injured trauma patients. Because missed intra-abdominal injuries are a frequent cause of preventable trauma related deaths, a high index of suspicion is warranted.

Multiple factors, including the mechanism of injury, the body region injured, the patient's hemodynamic and neurologic status, associated injuries, and institutional resources influence the diagnostic approach and the outcome of abdominal injuries. Motor vehicle accidents account for 75 to 80% of blunt abdominal trauma. Approximately 25% of all trauma victims will require abdominal exploration. Blunt injury of abdomen is also a result of fall from height, assault with blunt objects, industrial mishaps, sport injuries. Blunt abdominal trauma is usually not obvious. Hence often missed, unless, repeatedly looked for. The knowledge in the management of blunt abdominal trauma has progressively increased.

Non operative management (NOM) for blunt abdominal trauma was found to be highly successful and safe. Management by NOM depends on clinical and hemodynamic stability of the patient, after definitive indications for laparotomy are excluded. A patient under NOM should be admitted to ICU for at least 48-72 hours for close monitoring of vital signs and repeated clinical examinations. NOM to be terminated if patient develops hemo-dynamic instability and appearance of newperitoneal signs due to delayed hollow viscous or missed injuries.44

In view of increasing number of vehicles and consequently road traffic accidents, this dissertation has been chosen to study the cases of blunt abdominal trauma with reference to the patients presenting at MNR medical college & hospital, Sangareddy.

References

  1. Charles Brunicardi, Dana. K.Anderson, Timothy. R.Billas, John Hunter, Jeffery B. Matthews. Schwartz's Principles of Surgery 9th edition p135-197.
  2. Courtney M Townsend JR MD, R Daniel Beauchamp MD, B..Markevers MD Kenneth L Mattox MD: Sabiston Textbook of Surgery19th edition: vol 1: 2012: p430-471.
  3. Norman S Williams, Christopher J.K. Bulstrode, P Ronan O Connell, Bailey and Love’s Short Practice of surgery 26th edition 2013:3:29 p300-364.
  4. Alfred Cuschieri, Pierce Grace, AraDarzi, Neil Borley, David Rowley Clinical surgery 2nd edition Black well Publishers p210-254.
  5. Uri Kaplan, Oshama A Hatoum, Alexander Chulsky, HussamMenzal. Two weeks delayed bleeding in blunt liver injury: case report and review of the literature World Journal of Emergency Surgery 2011, 6:14 do 10.1186/1749-7922-6-14.
  6. Adam Wallis, Michael D Kelly and Lyn Jones. Angiography and embolisation for solid abdominal organ injury in adults - a current perspective World Journal of Emergency Surgery 2010, 5:18 doi:10.1186/1749-7922-5-18.
  7. Lee BC, Ormsby EL, McGahan  JP, Melendres  GM, Richards JR. The utility of sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy Am J Roentgenol 2007;188(2):415-21.
  8. George A Giannopoulos, Iraklis E Katsoulis, and Michalis K Digalakis , Panayotis A Patsaouras, Non-operative management of blunt abdominal trauma. Is it safe and feasible in a district general hospital. Scand J Trauma ResuscEmerg Med. 2009; 17: 22.
  9. Vanessa M Banz, Muhammad U Butt, Heinz Zimmermann, Victor Jeger and Aristomenis K Exadaktylos Free abdominal fluid without obvious solid organ injury upon CT imaging Journal of Trauma Management & Outcomes 2009,:10doi:10.1186/ 1752-2897-3.
  10. E. Dongo, E. B. Kesieme, D. O. Irabor, and J. K. Ladipo. A Review of Posttraumatic Bowel Injuries ISRN Surgery Volume 2011 (2011), Article ID 478042, doi:10.5402/2011/478042.
  11. Cusheri A, Giles G. R., Moosa A. R: Essential Surgical Practice; Butterworth International Ed. 1998: p263-304.
  12. John E. Skandalakis, Gene L. Colborn, Thomas A. Weidman, Roger S. Foster, Jr Andrew N. Skandalakis' Surgical Anatomy p78-118.
  13. A.G. Decker, D.J. duPlessis, Lee McGregors Surgical anatomy 12th edition p78- 113.
  14. Hamilton Bailey’s Emergency surgery: 13th edition: 2000: p446-471.
  15. Feliciano DV. Diagnostic modalities in abdominal trauma. Peritoneal lavage, ultrasonography, computed tomography scanning, and arteriography. SurgClin North Am 1991; 72: 241-56
  16. Surgery of the liver and biliary tract: L.H. Blumgart: vol 1: 3rd edition: 2000: 1277- 1318p.
  17. Diagnosis and management of blunt small bowel injury: a survey of the membership of the American Association for the Surgery of Trauma. 2000 Mar: 48 (3): 402-7.
  18. Donald D. Trunkey, Tom Shires, Robert McClelland; Management of Liver Trauma in 811 consecutive patients. Ann Surg. May 1974: vol 179: No 5; p722-728.

Corresponding Author

Dr Lakshmi Dharanidhar Reddy Vangala

Dept of Surgery, MNR Medical College and Hospital, Fasalwadi, Sangareddy, Telangana Pin: 502001

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Ph: +919030504585