Raghu Rachha1, Santhosh Babu CH2, D. Devender3
Penetrating trauma forms an important component of surgical emergencies. The importance of this category becomes further apparent when one realises that most of such trauma victims are essentially healthy people and in the prime of their life. Over the past century, great advances were made in the management of such wounds. The operative management replaced the expectant therapy and reduced mortality rates. So this study is being done to evaluate the various indications for early mandatory laparotomy in penetrating abdominal injuries.
AIM
Aim of the study is to study various modes of injuries of penetrating injuries of abdomen, clinical presentation and their management.
MATERIALS AND METHODS
The study includes 60 cases of penetrating injury to abdomen admitted to our hospital during the period August 2013 to August 2015. After initial resuscitation and achieving haemodynamic stability, all patients were subjected to careful clinical examination. Depending on the clinical findings decision for further investigations such as local wound exploration, X-ray abdomen and ultrasound abdomen taken. The resuscitation begins in the causality and based on the vitals, patients were submitted to immediate laparotomy or shifted to T.M.T ward for further evaluation. The decision for operative or nonoperative depends on the clinical examination and results of diagnostic tests. They were subsequently investigated and managed according to the standard protocol.
RESULTS
81.67% of cases of penetrating abdominal trauma underwent exploratory laparotomy. Laparotomy was therapeutic in 79.59% of cases. Commonest organ injured in the descending order of frequency: Small bowel, liver, stomach, mesentery, large bowel, spleen, gall bladder and diaphragm. Average duration of hospital stay was 7 days. Mortality rate was 3.3%.
CONCLUSION
Penetrating abdominal trauma is one of the surgical emergencies. Majority of patients who present with evisceration after penetrating wound require a laparotomy. This is true regardless of what has eviscerated or the presence of other clinical indications to operate. Evisceration continues to prompt operative intervention. Small bowel and liver are the commonest organs injured in the present study. Stomach is the next common organ injured in the present study. It can also be managed by simple suturing. Wound infection and intra-abdominal sepsis was the frequent postoperative complication in the present study.
