Blunt Trauma Abdomen-Spectrum of Injuries and their Management in a Peripheral Hospital

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Blunt Trauma Abdomen-Spectrum of Injuries and their Management in a Peripheral Hospital

   

Gurmeet Singh Sarla1* and Aparna Jaieel2

1,2Military hospital khadki India Pin 411020

*Corresponding author: Sarla GS, Military Hospital Khadki India.

Citation: Sarla GS, (2023). Blunt Trauma Abdomen – spectrum of injuries and their management in a peripheral hospital. Genesis J Surg Med. 2(2):1-7.

Received: November 14, 2023 | Published: December 27, 2023.

Copyright© 2023 genesis pub by Sarla GS, et al.  CC BY-NC-ND 4.0 DEED. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0  International License. This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.

Abstract

Blunt trauma abdomen can present in a very subtle way with missed internal injuries unless specifically looked for. Solid organ injuries, mesentery and hollow viscus are the commonly injured. The management can be surgical or non-operative depending upon the severity and hemodynamic stability of the patient. The three cases are an example of the varied presentation of blunt abdominal trauma and its management.

Keywords

Blunt Trauma Abdomen; Abdominal injuries; Clinical Suspicion

Introduction

Motor vehicle accidents are responsible for 75 to 80 % of blunt abdominal trauma along with falls [1]. Unlike penetrating abdominal trauma, blunt trauma abdomen is not obvious and likely to be missed unless specifically looked for. The management of blunt abdominal trauma is progressively increasing due to advances in diagnostics, despite this the morbidity and mortality remains at large [2]. Due to the inadequate treatment of the abdominal injuries, most of the cases are fatal [2,3]. Here we present 3 cases of blunt trauma abdomen spectrum managed at a peripheral hospital with no CT scan facilities which brings out the role of clinical suspicion, repeated evaluation, and team work.

Case 1

49-year male, presented with history of fall from bicycle while returning from work. He was given first aid and referred to our Centre for further management. On enquiry, patient gave history of fall from bicycle following which he developed pain all over the abdomen and distension. He gave no history of vomiting/ bladder complaints/ any other injuries. Clinical examination revealed tachycardia with normal blood pressure. As per protocol, after securing IV access and ensuring hemodynamic stability, he underwent Ultrasound of Abdomen which revealed hemoperitoneum. Chest X-Ray and X-Ray abdomen  were within normal limits. In view of Sonological and X-Ray findings and hemodynamic stability, he was shifted for CECT Abdomen (done outside as the Centre did not have a CT scan facility). CECT abdomen revealed hemoperitoneum with mesentery as the probable source. The patient was taken up for Emergency Exploratory laparotomy which revealed a tear in the mesentery [Figure 1] and approximately 1 L hemoperitoneum [Figure 2]. The mesenteric tear was repaired with absorbable sutures and abdomen closed over drain after thorough lavage. The post op period was uneventful and the patient was discharged on Postoperative day 11 after suture removal. He was reviewed after 1 month and remained asymptomatic.

Figure 1: Mesenteric tear.

Case 2

46-year male, no known comorbidities, presented to the A & E department with complaints of retention of urine since morning. He was a security guard by profession and gave history of falling off his bed. On clinical examination, he was hemodynamically stable with suprapubic dullness to percussion and no bony injury. He was managed with catheterization and advised surgical consultation on OPD basis. The catheterization was smooth. He, however, had hematuria post catheterization which resolved with bladder wash. The patient reported to A & E again in the evening with suprapubic discomfort. Clinical examination revealed lower abdominal guarding and tenderness. Per urethral catheter was in situ with no gross hematuria. Ultrasound revealed no significant findings. Chest X-Ray done in view of diffuse tenderness and guarding showed gas under diaphragm [Figure 3]. Based on clinical and radiological findings, exploratory laparotomy with provisional diagnosis of hollow viscus perforation was offered.