Studying the clinical profile of blunt hepatic trauma

Background: The liver is the largest intra-abdominal organ and is considered to be the second commonest organ to be injured in blunt abdominal trauma. Blunt hepatic injuries due to road traffic accidents are the sixth leading cause for death in India. Approximately 15-20% of abdominal injury presents as hepatic trauma and is liable for 50% of death resulting from abdominal trauma. The mortality rate is higher with blunt hepatic trauma than penetrating injuries. The advent of improved and expeditious imaging technologies amid advances in critical-care monitoring, prompted a significant shift towards conservative management of solid-organ abdominal injuries.Methods: The study was conducted over 96 patients in General Surgery Department, PGIMS, Rohtak with a history of blunt hepatic injury. The study duration was from 16th May 2018 till 1st June 2020. The aim of the study was to evaluate the pattern of blunt hepatic trauma and the patterns with which they presented in the emergency department.Results: In this study, 98.96% of the patients were managed conservatively whereas only 1.04% of patients needed surgical intervention. Conservative approach was possible because of strict patient monitoring, availability of experienced surgeons and radiologists, good intensive care unit care.Conclusions: The study concluded that conservative management of the patient is better than operative management and can be done in the patients who are hemodynamically stable. Most of the patients settle after 48 hours if managed conservatively.

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A prospective and retrospective study on conservative management of hepatic and splenic injury following blunt abdominal trauma

International Surgery Journal ◽

10.18203/2349-2902.isj20202061 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1930

Author(s):

Induchoodan Ponnamma Pillai Sukumaran Nair ◽

Rajesh P. S.

Keyword(s):

Abdominal Trauma ◽

Conservative Management ◽

Blunt Abdominal Trauma ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Road Traffic ◽

Operative Management ◽

Splenic Trauma ◽

Solid Organ ◽

Non Operative Management

Background: worldwide road traffic accidents accounts as the leading cause of death of young people. For a very long time most of the intra-abdominal injuries following blunt abdominal trauma were managed operatively. Conservative management is becoming more acceptable and effective management option for blunt abdominal trauma during the last few decades.Methods: This study was conducted in Government Medical College, Kottayam during September 2007 to December 2008. All conservatively managed blunt abdominal trauma patients during the study period were included in the study.Results: Out of 22 patients, 4 patients failed conservative management. Success rate was 81%. Most commonly injured solid organ in the study group was liver (77%). Maximum cases were of age group 10 to 20 (31.81%) years. 81% of patients were males. Motor vehicle accident was the most common cause of trauma (77%). Mean stay in intensive care unit was 4.2 days and mean hospital stay was 15.7 days. Mean systolic blood pressure was 110 mmHg ranging from 70 to 130 mmHg. 50% of patients had moderate hemoperitoneum and non-had massive hemoperitoneum.Conclusions: Non operative management is safe and effective approach in blunt spleen and liver injuries. Non operative management should be treatment of choice for all hemodynamically stable patients with blunt liver and splenic trauma.

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SPECTRUM AND OUTCOME OF BLUNT ABDOMINAL TRAUMA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i1.876 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Mahesh Kumar Sharma ◽

Dr. Arun Bhargava

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Traffic Accident ◽

Traffic Accidents ◽

Splenic Injury ◽

Road Traffic ◽

Age Groups ◽

Operative Management ◽

Fall From Height ◽

Type Of Injury

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. So we evaluate the spectrum and outcome of blunt trauma. Methods: Hospital based prospective study conducted on 100 patients at department of general surgery. Results: Distribution according to type of injury consisted of maximum cases, 84 (84%) of road traffic accidents, 11% cases were of fall from height. Conclusions: Males were pre-dominantly affected. Road traffic accident was the most common cause of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt abdominal trauma, Liver injury, Perforation, Splenic injury

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Management of blunt trauma abdomen in a tertiary care teaching hospital: a surgical audit

International Surgery Journal ◽

10.18203/2349-2902.isj20182217 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2177

Author(s):

Shashikumar H. B. ◽

Madhu B. S. ◽

Ajo Sebastian

Keyword(s):

Blunt Trauma ◽

Traffic Accidents ◽

Road Traffic ◽

Tertiary Care ◽

Operative Management ◽

Organ Injury ◽

Solid Organ ◽

Solid Organ Injury ◽

Surgical Audit ◽

Non Operative Management

Background: Blunt abdominal trauma is a common scenario in Emergency department and the common cause being road traffic accidents. With this study we present our experience with blunt trauma of abdominal solid organ injuries over a period of 12 months.Methods: A retrospective study was conducted among 45 blunt trauma of abdominal solid organ injuries who presented to the emergency room of Department of General Surgery of Mysore Medical College and Research Institute, Mysore from 1st January 17 to 31st December 2017.All date were retrieved from medical records and statistical analysis was performed using Epi info version 7.Results: Mean age of study population was 31.46 years. 78.2% of the patients were males. Thirty-three (73.3%) patients undergone non-operative management. Splenic injury was reported as the most common abdominal solid organ injury followed by liver.Conclusions: With the advent of newer investigative modalities like contrast enhanced computed tomography (CECT) abdomen, more and more cases of blunt trauma abdominal solid organ injury can be managed non-operatively with effective ICU care. High-grade injuries do not preclude non-operative management.

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SPECTRUM OF BLUNT ABDOMINAL TRAUMA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i8.1331 ◽

2020 ◽

Vol 4 (8) ◽

Author(s):

Ajay Pal ◽

Indira . ◽

L. K. Kapil

Keyword(s):

Liver Injury ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Traffic Accidents ◽

Splenic Injury ◽

Road Traffic ◽

Age Groups ◽

Operative Management ◽

Initial Assessment ◽

Cross Sectional

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. Many injuries may not manifest during the initial assessment and treatment period. Methods: Hospital based cross-sectional study conducted at Trauma center and P.B.M Hospital, Bikaner Results: Distribution according to type of injury consisted of maximum cases, 86% of road traffic accidents 74 of which were male and 12 female. 10% cases were of fall from height, 6 were male and 4 female .Assault cases were 4%. Case distribution according to organ involved consisted of 54.00% cases of liver injury,18.00% cases were of splenic injury, 23.00% patients had ilial injury, Pancreatic injury occurred in 2patient. Conclusions: Males were pre-dominantly affected. Road traffic accident was the most common cause of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt abdominal trauma, Liver injury, Perforation, Splenic injury

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Presentation and Management of Hepatic Injury due to Blunt Trauma in Patients Attending in Casualty Block of DMCH - A Study of 50 Cases

Journal of Dhaka Medical College ◽

10.3329/jdmc.v27i1.38947 ◽

2018 ◽

Vol 27 (1) ◽

pp. 57-61

Author(s):

Mohammad Mahfuzur Rahman Chowdhury ◽

SM Amjad Hossain ◽

Salma Sultana ◽

Rifat Zaman ◽

Md Alauddin ◽

...

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Traffic Accidents ◽

Hepatic Injury ◽

Road Traffic ◽

Operative Management ◽

College Hospital ◽

Medical College ◽

History Of ◽

Non Operative Management

Objective: To diagnose the cases of hepatic injury due to blunt abdominal trauma in a shortest possible time and find out the way of efficient and planned management of hepatic injury in our present setting. Materials and methods: This study was done in the casualty department of Dhaka Medical College Hospital and 50 patients of hepatic injury following blunt abdominal trauma were selected over a period of January 2010 to December 2010. All 50 patients were admitted within 24 hours of incidence. The patients were diagnosed clinically by history and physical examination and relevant investigations. Immediately after admission patients were resuscitated by clearance of airway, maintenance of respiration, arrest of external bleeding and maintenance of normal circulation (ATLS Protocol). After resuscitation further management was planned depending upon the condition of the patient. Clinical presentation, overall management and outcome were evaluated by the available resources of casualty ward of DMCH. Results: Most patients were male (88%) and 68% of patients were belonged to age group of 21 to 40 years. Most of the patients (90%) were injured as a result of road traffic accidents. All patients had a history of trauma and most of them presented with abdominal pain, tenderness muscular rigidity of abdomen and shock (38%). Only 13 (26%) patients had isolated hepatic injury. Rest of the patients had associated other organ injuries. Majority patients (46%) had Grade-I hepatic injury. Out of 50 patients, 46 were operated and most of them had other intra abdominal organ injuries and 4 patients were given non-operative management. Suture hepatorrhaphy was done in 38 (76%) cases. Most common post operative complications were pulmonary in origin (24%) and three patients were died in this series. Conclusion: Simple technique of hemostasis such as suture hepatorrhaphy is sufficient in most cases with adequate drainage and non operative management can be tried based on haemodynamic stability. J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 57-61

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Presentation and Management of Hepatic Injury due to Blunt Trauma in Patients Attending in Casualty Block of dmch- a Study of 50 cases

Journal of Dhaka Medical College ◽

10.3329/jdmc.v25i2.33981 ◽

2017 ◽

Vol 25 (2) ◽

pp. 133-137

Author(s):

Mohammad Mahfuzur Rahman Chowdhury ◽

SM Amjad Hossain ◽

Salma Sultana ◽

Rifat Zaman ◽

Md Alauddin ◽

...

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Traffic Accidents ◽

Hepatic Injury ◽

Road Traffic ◽

Operative Management ◽

College Hospital ◽

Medical College ◽

History Of ◽

Non Operative Management

Objective: To diagnose the cases of hepatic injury due to blunt abdominal trauma in a shortest possible time and find out the way of efficient and planned management of hepatic injury in our present setting.Materials and methods: This study was done in the casualty department of Dhaka Medical College Hospital and 50 patients of hepatic injury following blunt abdominal trauma were selected over a period of January 2010 to December 2010. All 50 patients were admitted within 24 hours of incidence. The patients were diagnosed clinically by history and physical examination and relevant investigations. Immediately after admission patients were resuscitated by clearance of airway, maintenance of respiration, arrest of external bleeding and maintenance of normal circulation (ATLS Protocol). After resuscitation further management was planned depending upon the condition of the patient. Clinical presentation, overall management and outcome were evaluated by the available resources of casualty ward of DMCH.Results: Most patients were male (88%) and 68% of patients were belonged to age group of 21 to 40 years. Most of the patients (90%) were injured as a result of road traffic accidents. All patients had a history of trauma and most of them presented with abdominal pain, tenderness muscular rigidity of abdomen and shock (38%). Only 13 (26%) patients had isolated hepatic injury. Rest of the patients had associated other organ injuries. Majority patients (46%) had Grade-I hepatic injury. Out of 50 patients, 46 were operated and most of them had other intra abdominal organ injuries and 4 patients were given non-operative management. Suture hepatorrhaphy was done in 38 (76%) cases. Most common post operative complications were pulmonary in origin (24%) and three patients were died in this series.Conclusion: Simple technique of hemostasis such as suture hepatorrhaphy is sufficient in most cases with adequate drainage and non operative management can be tried based on haemodynamic stability.J Dhaka Medical College, Vol. 25, No.2, October, 2016, Page 133-137

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ANALYSIS OF BLUNT ABDOMINAL TRAUMA CASES AT TERTIARY CARE HOSPITAL BIKANER (RAJASTHAN)

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i6.1973 ◽

2021 ◽

Vol 5 (6) ◽

Author(s):

Deepak Singh Panwar ◽

Ashok Kumar

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Traffic Accidents ◽

Road Traffic ◽

Tertiary Care ◽

Operative Management ◽

Care Hospital ◽

Young Males ◽

Medical College ◽

Blunt Abdominal Injury

Background: In view of increasing number of vehicles and consequently road traffic accidents, this dissertation has been chosen to study the cases of blunt abdominal trauma with reference to the patients presenting at P.B.M. hospital, attached to S.P. Medical College, Bikaner. Methods: Prospective hospital-based study was conducted on all the patients of blunt abdominal injury admitted in the department of surgery, S.P. Medical College and P.B.M. Hospital, Bikaner. Results: Majority of the patients presented with abdominal pain (86%) and abdominal tenderness (81%). Conclusion: We concluded that young Males are predominantly affected. Road traffic accident forms the most common mode of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt trauma, Age, Sex

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Non operative management of a patient with splenic trauma with angioembolisation after delayed presentation

International Surgery Journal ◽

10.18203/2349-2902.isj20194089 ◽

2019 ◽

Vol 6 (9) ◽

pp. 3412

Author(s):

Deepak Paul ◽

Thomas K. Thomas ◽

Dayananda Babu ◽

Rajan Janardhanan ◽

Ribin Christhudas

Keyword(s):

Traffic Accidents ◽

Road Traffic ◽

Operative Management ◽

Organ Injury ◽

Splenic Trauma ◽

Solid Organ ◽

Delayed Presentation ◽

Mortality And Morbidity ◽

Common Causes ◽

Non Operative Management

Road traffic accidents are one of the most common causes of death in India. Those involved in RTA’s frequently suffer from solid organ injury, spleen being the second most common organ involved. Splenic injuries are associated with great deal of mortality and morbidity. Splenic injuries were classically treated with splenectomy but there has been a paradigm shift to non-operative management in recent times leading to splenic salvage and preservation of function of the spleen. This report is about a lady who was managed successfully with angioembolization in spite of the fact that the patient presented late after RTA.

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Hepatic Trauma Interventions

Seminars in Interventional Radiology ◽

10.1055/s-0041-1724014 ◽

2021 ◽

Vol 38 (01) ◽

pp. 096-0104

Author(s):

Akshita S. Pillai ◽

Girish Kumar ◽

Anil K. Pillai

Keyword(s):

Liver Injury ◽

Cause Of Death ◽

Abdominal Trauma ◽

Penetrating Trauma ◽

Liver Trauma ◽

Solid Organ ◽

Hepatic Trauma ◽

Blunt Abdominal Injury ◽

Large Size ◽

Uncontrolled Bleeding

AbstractThe liver is the second most commonly involved solid organ (after spleen) to be injured in blunt abdominal trauma, but liver injury is the most common cause of death in such trauma. In patients with significant blunt abdominal injury, the liver is involved approximately 35 to 45% of the time. Its large size also makes it a vulnerable organ, commonly injured in penetrating trauma. Other than its position and size, the liver is surrounded by fragile parenchyma and its location under the diaphragm makes it vulnerable to shear forces during deceleration injuries. The liver is also a vascular organ made of large, thin-walled vessels with high blood flow. In severe hepatic trauma, hemorrhage is a common complication and uncontrolled bleeding is usually fatal. In fact, in patients with severe abdominal trauma, liver injury is the primary cause of death. This article reviews the clinical presentation of patients with liver injury, the grading system for such injuries that is most frequently used, and management of the patient with liver trauma.

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Solid organ injury in blunt trauma abdomen: an etiological evaluation and success rate of non-operative management

International Surgery Journal ◽

10.18203/2349-2902.isj20181108 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1350

Author(s):

Ramachandra M. L. ◽

Krishna S. R.

Keyword(s):

Blunt Trauma ◽

Surgical Management ◽

Traffic Accidents ◽

Road Traffic ◽

Operative Management ◽

Abdominal Injury ◽

Organ Injury ◽

Free Fluid ◽

Road Traffic Accidents ◽

Non Operative Management

Background: Trauma remains the most common cause of death for all individuals between the ages of 1 and 44 years. 10% of these fatalities are attributable to abdominal injury. The Indian fatality rates for trauma are 20 times that for developed countries. The management of patients with blunt abdominal injury has evolved greatly over the last few decades from complete surgical management historically to present non operative management in most of the cases. In view of increasing number of road traffic accidents, rampant increase in construction work, accidental fall from height, this study is conducted to look into the causes of such incidents and also to strengthen the already established rules of non operative management in cases of blunt trauma abdomen.Methods: This is a prospective study of 53 patients who presented to K. R. Hospital, Mysuru, Karnataka, for management of blunt trauma abdomen over the period of January 2016 to June 2017. Unstable patients with initial resuscitation underwent Focused Assessment Sonography for Trauma. Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen. Organ injuries were scaled according to the American Association for the Surgery of Trauma and these patients were managed conservatively after ruling out hollow viscus perforation.Results: Majority of the patients belonged to male sex (85%) and of the age group 21-40 years constituting 58.3% of patients. Road traffic accident was the most common mode of injury which included 35 patients (66%). A total of 19 cases had splenic injury out of which 13 (68.5%) underwent non operative management and 6 (31%) underwent emergency Splenectomy. liver injury was present in 15 patients and all were managed conservatively. In total non operative management was done in 73.5% of cases and surgical management was done in 26.5% of cases.Conclusions: The presence of free fluid with organ injury always does not mandate laparotomy. Patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in non operative management of blunt trauma abdomen. RTA being the most common mode of injury, adequate measures should be taken to prevent road traffic accidents by strict action and traffic norms and citizen education.

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