PENETRAT ING ABDOMINAL TRAUMA

A PROSPECTIVE STUDY

Abstract

Objectives: 1) To assess the effect of time, nature of injury
and surgical procedure on the prognosis of patients presented with penetrating abdominal trauma 2) To
formulate the recommendations for the management of penetrating abdominal trauma. Design:
Prospective. Setting: Surgical Department of Jinnah Hospital, Allama Iqbal Medical College, Lahore.
Period: November 2000 to May 2002. Patients & Methods: Sixty consecutive cases of penetrating
abdominal trauma presented to surgical emergency were included in this study. Patients having chronic
illness or associated injuries like head injury, chest injury, limb injury etc were excluded from the study.
Proper history, thorough physical examination and necessary investigations were carried out. After initial
resuscitation, exploratory laparotomy was performed in all cases of firearm abdomen. For stab abdomen,
the indications for laparotomy included hypotension despite enthusiastic resuscitation, gas under diaphragm
on plain x-ray abdomen, evisceration, omental protrusion or peritonitis. The pre and per-operative findings
and surgical procedures were recorded. Results: Fifty five patients (91-67%) were male and five (8.33%)
were female. Average age of the patients was 32.2 years. Twenty eight (46.67%) patients reached the hospital
within three hours of the injury. Twenty two (36.6%) reached within 3-6 hours and ten patients (16.66%)
reached hospital more than six hours after injury. Out of sixty patients forty three (71.67%) were firearm,
fifteen patients (25%) were of stab wound and two patients (3.33%) were of road traffic accident. In 19
patients two or more organ system were damaged. Type of procedures performed included primary repair,
right hemicolectomy, primary repair with diverting colostomy, resection and end to end anastomosis,
Hartmann’s procedure, Hepatorrhaphy, splenectomy, distal pancreatectomy, nephrectomy and repair of
Kidney. Ten patients died. Post-operative complications included wound infection (24%), chest
infection(13.34%), wound dehiscence (10.67%), fecal fistula (6.67%), burst abdomen(5.34%), subphrenic
abscess(2.67%) and transient renal failure (1.34%). Most of the patients who arrived early in the hospital and
treated promptly had less morbidity and mortality. Conclusions: Mandatory exploratory laparotomy for all
gunshot and for the stab wounds penetrating the peritoneal cavity proves to be safe and prudent policy.