Study of Blunt Traumatic Abdominal Solid Organ Injuries with Special Reference to Non-operative Management

Abstract

With increasing number of motor vehicles, the incidence of Blunt Trauma Abdomen (BTA) is on the rise. It has been posing severe threat to mobile population of society. With paucity of specialized trauma centers at primary and secondary level hospitals, BTA is either missed or delayed or is over enthusiastically treated by operative intervention in all cases, thereby increasing morbidity and mortality. The aim is to evaluate the criteria for Operative or Non-Operative Management (NOM) and to review Conservative Line of Management. This is a prospective hospital based study, conducted at Department of General Surgery, SMS Medical College Hospital, Jaipur (Rajasthan) from 2010 to 2012. A total of 100 patients were studied. Hemodynamically unstable and hollow viscous injury patients were excluded from study. After thorough clinical examination, patients were subjected to Focused Abdominal Trauma Sonography (FAST) and CECT, a decision of conservative or operative management was taken. The results show that 75% patients of BTA were of the age group of 21–40 years, of these, 83% patients were males. 90% patients presented with pain abdomen and 56% with distension. FAST and CECT revealed 51% had spleen, 44% liver, 14% kidney and 4% pancreas injury. 61% patients were treated by NOM without any mortality whatsoever. Only five patients had respiratory and intra-abdominal infection. Out of 39% patients of operative group, 33.33% developed wound infection, 12.8% had respiratory infection followed by 2.56% abdominal infection and dehiscence each. Total 14% patient died in this study, of these 6% died at initial resuscitation, 6% died post operatively due to massive abdominal trauma and 2% died due to associated head injury. NOM had a better outcome in BTA patients if properly and repeatedly evaluated by clinical examination, FAST and CECT with no mortality in the series.

Keywords: Blunt Abdominal Trauma, Non-Operative Management, Focused Abdominal Sonography for Trauma, Road Traffic Accident