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Penetrating abdominal injury in tertiary hospital: our experience

Author: 
Paramjeet Sangwan, Rajkumar, P.N., Abdul Quadar, Yaam Kumar, C. and Vivek, K.,
Subject Area: 
Health Sciences
Abstract: 

Penetrating Abdominal trauma is increasing because of the increase of violence in our fellowship. A number of patients with penetrating abdominal trauma have normal vital signs and negative abdominal examination when referred to trauma centres. A great heap of contention exists between authorities about screening these patients for emergency laparotomy. The optimal management of hemodynamically stable asymptomatic patients remains controversial. The goal is to identify and treat injuries in a cost efficient way. Common evaluation strategies are Local Wound Exploration (LWE), Diagnostic Peritoneal Lavage (DPL), Serial Clinical Assessments, and Computed Tomography (CT) imaging. Reaching a decision to operate on a patient with penetrating injury abdomen is a challenge. The Objective of this study was to analyze the pattern of penetrating abdominal trauma, current management practiced and outcome. Patients and Methods: Eighty (80) patients who were admitted to the Department of General Surgery, Bowring and Lady Curzon Hospital between March 2010 and August 2015 with abdominal stab wounds were included in prospective study. Results: A total of 80 patients with penetrating abdominal trauma were assessed with a mean age of 29 yrs. The male to female ratio was 25.7:1. Most of the patients (89.4%) were in the Second to fourth decades of their liveliness. Twenty-Five patients (31.25%) presented with shock. The homicidal Stab wound is the commonest mode of injury seen in our patients. All of our patients were managed by exploratory laparotomy. Hollow viscus injuries were reported in 81.25% and Solid organ injuries was found in 20% of the patients. The rate of negative laparotomy of this study was 7.2%. Complications and mortality were encountered in 31.25% and 2.5% respectively. The mean hospital stay was 9 days. Conclusion: The study shows no difference in the pattern of intra-abdominal injuries regardless of the means of penetrating abdominal injury. The rate of operative treatment is satisfactory, but laparotomies can be avoided in hemodynamically stable patients without peritonitis provided more sensitive investigations are available which can identify early/minor injuries. There is a need to identify new imaging modality/ procedure which helps to determine the management scheme. Till date many investigations / procedures have been proposed, but none have withstood the test of time. The overall outcome was acceptable and comparable to other studies.

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