A. Ravi Kamal Kumar1, S. V. P. L. Chandrakumar2, A. Vijayalaxmi3, B. Anja Naik4, K. Y. N. Bharat5, Jaheer Abbas6
Penetrating injuries to the abdomen form an important chunk of surgical problems confronting the trauma surgeon. These injuries usually affect young healthy individuals in the society. Previously all abdominal penetrating injuries used to be subjected to laparotomy. But it was found that there were more number of negative (non-therapeutic) laparotomies if this principle is followed. Shaftan in 1960 questioned the rationale of mandatory laparotomy in all cases of penetrating abdominal injuries, hence the laparotomy rates have fallen since then and a more selective approach is now followed depending on the clinical examination and investigations. A clinical study was conducted at Govt. General Hospital to study the modes of injury, epidemiology, evaluate the indications for emergency laparotomy in these cases and also to study the mortality and morbidity of abdominal penetrating injuries. 41 cases of penetrating injuries of abdomen were admitted in the emergency department in a 2 year period at Govt. General Hospital. These cases after initial resuscitation were subjected to clinical examination followed by Local wound exploration, U/S of abdomen, CT scan of abdomen. The indications for immediate laparotomy were evisceration of bowel and/ or omentum, hemodynamic instability, hemoperitoneum. The remaining cases were kept under observation with serial abdominal and physical examinations and other investigations as necessary. They were taken up for laparotomy as and when necessary depending on the physical examination. Penetrating injury abdomen is most common in young males in the age group of 20-30 years. Abdominal stab injuries mostly homicidal are common in this parts of India. Local wound exploration under local anaesthesia can be used as an initial triage tool in the emergency department. But peritoneal penetration as such is a poor indicator of significant organ injury. Serial physical and abdominal examinations form an important tool which can tell the surgeon the need for laparotomy which is coupled with other investigations like U/S and CT scan. Small bowel and liver are the most common organs involved. Wound infections are the commonest postoperative complications. Mortality is zero in this study as all cases are due to low velocity stabs. No gun shot injuries were reported in this study hence zero mortality.
