William Premalatha Sharon Rose1, Ravikumar Sumathi2, Dhanasekaran Uma3
Trauma is a major health problem in all countries and it unfortunately forms 60-70% of all emergency admissions to any hospital. Trauma patients need the most important care since these are the patients who can be salvaged to the maximum. Traumatic injuries remain the leading cause of death among patients aged 12–45 years and continue to account for substantial morbidity in this population. Hollow viscus injury following blunt abdominal trauma is an infrequent diagnosis. The incidence of hollow viscus injuries following abdominal trauma varies from 2 to 15%. Thus, we performed the present study to review our experience with hollow viscus injury following abdominal trauma in a tertiary care centre. Mahatma Gandhi Memorial Government Hospital, Trichy, attached to KAPV Government Medical College is one of the tertiary centre for trauma in Tamilnadu in which majority of patients admitted to surgical triage ward are due to trauma.
Objectives-
Complete systemic examination of all trauma patients admitted to triage ward.
Identifying patients having or suspected to have abdominal injury.
Appropriate investigations for those patients.
To analyse mechanism of injury, organs involved and accompanying injuries in traumatic hollow viscus injuries.
To analyse the different surgical procedures and finally the post-operative outcome.
MATERIALS AND METHODS
The study population are those patients admitted in surgical triage ward in MGMGH attached to KAPV Medical College, Tiruchirapalli with hollow viscus injuries. It is a prospective non-randomised descriptive study. Duration of study – January 2016 to December 2016.
RESULTS
There is a wide range in presentation of patients- the youngest patient being 16 years and oldest patient being 65 years of age. The commonest mode of injury in our study is the blunt abdominal trauma as compared to penetrating abdominal trauma (77.08% Vs. 22.92%). The major cause of both blunt and penetrating trauma (>90%) is Road traffic accident (RTA) followed by accidental fall. The most common site of hollow viscus perforation in our study was ileum (35.41%) followed by combined injury of ileum and mesentery (18.75%). Respiratory infection (16.67%) is the most common complication followed by wound infection (12.5%) and the leak rate was the least complication in our study (2.08%). Mortality is less in patients who were referred early to our hospital i.e. within two days as compared to those patients referred late (21.05% Vs. 50%).
CONCLUSION
The commonest cause of death is associated polytrauma, followed by septicaemia owing to delayed referral to our hospital due to the subtle clinical signs seen in these patients or due to misdiagnosis, severe unstable haemodynamic status at the time of presentation leading to delay in surgery for correcting the haemodynamic status. To reduce the mortality, the recent concept of damage control surgery has to be stressed strongly whose feasibility and the effectiveness in our setup has to be studied further. So, we conclude that with early diagnosis, timely reference, early surgical intervention and intensive post-operative care we can definitely save the life of these trauma patients with these relatively rare injuries.
