Motor vehicle accidents account for most of the cases of blunt injury abdomen. Blunt injury abdomen is most commonly caused by road traffic accidents. The rapid increase in number of motor vehicles and its aftermath has caused rapid increase in number of victims of blunt abdominal trauma. Motor vehicle accidents account for 75%-80% of blunt abdominal trauma.
Aim: The aim of the study is to evaluate the incidence of blunt injury abdomen, clinical presentation, findings of laprotomy, study the mode of treatment, mortality, and morbidity.
Methodology: This is a prospective study of 50 cases of blunt injury abdomen conducted in Government General Hospital, Guntur. From November 2015 to October 2017.
Results: Males (92%) outnumbered females (8%). The most common age group affected is 21-30 yrs, which forms the young and reproductive group. Road traffic accidents form the most common mode of injury accounting up to 86%. Majority of our study population (84%) presented with pain abdomen followed by features of peritonitis (56%). The latent period in our study was less than 12hrs in 64% of patients. Haemoglobin and hematocrit values become handy in blunt injury abdomen patients, X-ray erect abdomen and chest X-ray forms important investigation tools. Ultra sonography (FAST) has picked up solid organ injury in 68% of cases. Four quadrant aspiration is a simple and non specific diagnostic tool. CECT abdomen was performed in 70% of study population and had pivotal role in deciding operative versus conservative management in hemodynamically stable cases. The most common injured organ is spleen followed by liver and small intestine in descending order. For splenic injury most common surgery performed was splenectomy in 11 patients followed by 6 patients. Liver injury was managed with hepatorraphy in 8% cases followed gel foam application in 2% case. Next most common organ was small intestine, jejunum involved in 5 cases followed by ileum in 4 cases. Isolated mesenteric tear was seen in 2 cases, mesentery injury associated with other organs was seen 6 cases. Jejunal and ileum has perforations and closure of perforation was done 5 cases, resection anastomosis was done in 2 cases. Mesenteric injury is most commonly associated with splenic injury it was seen in 6% of cases. Mesenteric rent closure is the most treatment offered 12% of cases. Large intestine injury was seen in 8% cases colostomy was the treatment in half of the cases. Duodenal injury is associated with pancreatic injury in single case. Pancreatic injury was seen in 5 cases. 3 patients were died with pancreatic injury making pancreatic injury management as most challenging. Laparotomy drainage procedure treatment offered in 4 cases of pancreatic injury.
Conclusion: Blunt injury abdomen with solid organ injury forms considerable load of patients in our society. Road traffic accidents form the most common mode of injury. So efforts should be made to bring road traffic regulations into strict action and traffic norms regulated. CECT forms the core investigation of choice in dealing with blunt injury abdomen patients, and becomes more important in deciding operative versus conservative management. Early diagnosis and repeated clinical examination and use of appropriate investigation form the key in managing blunt injury abdomen patients.