A COMPREHENSIVE STUDY OF PATHOPHYSIOLOGY AND MANAGEMENT OF BLUNT ABDOMINAL TRAUMA

This prospective study based on the analysis of 60 consecutive cases of blunt abdominal trauma admitted to Department of Surgery M.K.C.G. Medical College hospital, Berhampur, Odisha, during the study period of JULY 2012-JULY 2014. Each patient was examined thoroughly, after taking a detailed history and Cases were admitted on emergency basis and possible immediate investigations were done. The diagnosis was made with history, clinical features and X-ray chest PA view and/or X-ray abdomen erect posture with/without ultrasound abdomen computed tomography of abdomen and pelvis to support the diagnosis. AIMS AND OBJECTIVES: To determine the incidence, Patho-Physiology and Management of various abdominal organs injuries caused by blunt force. RESULTS: Among 60 cases of blunt abdominal injury, maximum number of cases belongs to the age group 21-30 yrs. Males were the predominant victims with ratio 7.5:1. It was found that road traffic accidents by heavy vehicle like bus; car and truck were responsible for 71.66% of blunt abdominal injuries. Among 60 cases of blunt injury, the incidence of the involvement of jejunum, spleen, liver and stomach were 30%, 25%, 15%, 8.33% cases respectively. Exploratory Laparotomy was done in 48 cases and 12 cases were managed conservatively to change the fate of these patients. The procedures adopted in the management were splenectomy, hepatorrhaphy, omental patch closure (either Grahams or modified Grahams technique according to the surgeon's preference), simple closure, resection anastomosis, iliostomy or colostomy etc according to the surgical pathology and general condition of the patient. Mortality rate in this study is 11.66% (n=7) and immediate cause of death was shock and haemorrhage and in those cases where death was delayed, cause of death was septicaemia. CONLUSION: Road Traffic Accidents is the major cause and small intestine is more frequently involved abdominal organ. Early diagnosis and treatment of blunt abdominal trauma carries better prognosis. The mortality is more in patients with other associated injuries especially head injuries and in patients who were admitted delayed in the hospital. Evaluation of other associated injury should be mandatory in all blunt abdominal trauma cases.