The Evaluation, Management and Outcome about an Experience with Sharp Force Abdominal Injury

<p><strong>Background and Objective:</strong> Sharp force injuries (SFI), inflicted by cutting or stabbing, result in variable outcome depending upon the nature and site of the injury. This study evaluated the cases of SFIs and their outcome with reference to the time of presentation, demographic data, wounded organs, and surgical procedure performed.<br /><strong>Methods:</strong> This retrospective study analyzed the clinical data of 20 patients who presented with sharp force injury (knife stabbing and penetrating abdominal trauma) and were admitted between April 2015 and November 2016. The management and outcome of patients were recorded.<br /><strong>Results:</strong> All patients in this study were male and aged between 21 and 30 years. Knife stabbing was the only mechanism of injury in all cases. Colon (50%) was the commonest organ injured followed by intestine (40%) and liver (30%). Mortality rate was 10%. There were two cases with negative laparotomy (10%). Wound sepsis (10%) was the commonest complication.<br /><strong>Conclusions: </strong>SFI involving abdominal area are managed either conservatively or with primary repair and laparotomy to save internal organs. Early presentation and prompt management leads to reduced chances of complications and mortality.</p>

Laparotomy Due to War-Related Penetrating Abdominal Trauma in Civilians: Experience From Syria 2011-2017

ABSTRACT Objectives: Penetrating abdominal trauma is one of the injuries that could affect civilians in wartime. This retrospective study investigates the commonly injured abdominal organs, and the impact of multiple injured organs on mortality. Methods: We reviewed the operating room (OR) logs of patients who presented to the surgical emergency department (SED) at Al-Mouwasat University Hospital with war-related abdominal penetrating trauma requiring exploratory laparotomy between April 1, 2011 and December 31, 2017. Results: Of 7826 patients with traumatic injuries, 898 patients (11.5%) required exploratory laparotomy. Of all patients who had an exploratory laparotomy (n = 898), 58 patients (6.5%) died in the perioperative period. Regarding complete laparotomies (n = 873 patients), small intestines, large intestines, and liver were the most commonly affected organs (36.4%, 33%, 22.9%, respectively). A total of 92 patients (10.2%) had negative laparotomy in which all the abdominal organs were not injured. The perioperative mortality rate (POMR) increased when more organs/organ systems were injured per patient reaching a peak at 3 organs/organ systems injuries with a POMR of 8.3%. POMR was highest in patients with musculoskeletal injuries (18.2%), followed by vascular injuries (11.8%), and liver injuries (7%). Conclusions: The management of civilians’ abdominal injuries remains a challenge for general and trauma surgeons, especially the civilian trauma team. The number and type of injured organs and their correlation with mortality should be considered during surgical management of penetrating abdominal injuries.

Comparison of performance statistics of CT scan and ultrasonography in complicated appendicitis: experience in a tertiary care centre

Background: This study is conducted from November 2018 to November 2019 in this institute, where comparison of performance statistics is done between CT scan and Ultrasonography in patients with complicated appendicitis scheduled for conservative management, elective or emergency surgery. Aim of the study was to evaluate and compare the performance statistics of CT scan and Ultrasonography in complicated appendicitis.Methods: The CT scan or USG findings of 87 patients were reviewed. The patients were divided into two groups i.e. CT scan group (group-1/18 patients), USG group (group-2/69 patients). Satistical analysis Student”s t-test, Fischer”s test, p-value, k-value.Results: Clinical signs, CT findings, USG findings, complications at surgery and histological examinations were noted. 2, 3, 13, patients presenting with CT features and 5, 13, 51 patients presenting with USG features of appendicular perforation, peri-appendicular abscess, inflammatory appendicular mass respectively. No clinical signs showed a significant association with the presence of appendicular perforation, peri-appendicular abscess, inflammatory appendicular mass or the complication encountered at surgery.Conclusions: In this study, by comparing CT scan group and USG group in complicated acute appendicitis, CT scan can change the plan of management in doubtful cases, decrease length of hospital stay and expenses, reduce the complication rate and negative laparotomy rate, and reduce the episodes of conversion to open surgery.

Diagnostic Laparoscopy Reduces the Rate of Negative Laparotomy in Trauma Patients

Background: The last century has witnessed immense evolvement of management of patients with abdominal trauma. Moreover the recent trend has shifted to selective operative management rather than exploratory laparotomy in trauma patients with suspected intraabdominal injuries and is considered more rational as well. Diagnostic laparoscopy is highly sensitive in detecting intra-abdominal injury with subsequent reduction in the rate of negative laparotomy and procedure related morbidity. Objective: The study was carried out to find the role of diagnostic laparoscopy in abdominal trauma. Methods: An observational study was carried out in the casualty block of Dhaka Medical College Hospital from 1st June 2015 to 30th March 2016. A total of 50 successive patients were assigned in this study. All of them were admitted with abdominal trauma and underwent diagnostic laparoscopy during the period of 10 months. The study was designed to find out whether laparoscopy can help in identifying intra-abdominal injuries with consequent avoidance of unnecessary operative explorations. Results: Intra-abdominal injuries other than GIT perforation were diagnosed by laparoscopy with 100% accuracy but in case of bowel injury the diagnostic accuracy was 80%. Conclusion: Diagnostic laparoscopy is the procedure of choice in doubtful intra-abdominal injuries with impressive accuracy except for bowel injury. Subsequently it reduced the need for negative laparotomies with their procedure related adverse effects. Journal of Surgical Sciences (2018) Vol. 22 (1): 47-51

Penetrating abdominal injuries in an emerging semiurban teaching hospital

Objective: There has been a worldwide rise in the prevalence of penetrating abdominal injury (PAI), and there are both inter-country and intra-country variations in frequencies. This study evaluates the mechanisms and pattern of penetrating abdominal injuries and the treatment outcome in our center. Methods: This descriptive study of adult patients managed for PAI was conducted at the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti from January 2015 to December 2018. Data were prospectively collected and analyzed by using descriptive statistics from Statistical Package for Social Sciences (SPSS) version 20.0. Results: There were 96 patients managed for abdominal injuries during the study period. Forty-six (47.9%) of them had PAI, while 50 (52.1%) others sustained blunt trauma. Patients ages ranged from 17-72 years (mean = 34.2±10.8 years; median = 34 years). Majority, 42 (91.3%), were males, while 4 (8.7%) were females (M: F=11:1). The most afflicted age group was in the 4th decade. Majority of the injuries were due to gunshot (60.9%) followed by stab (26.1%), unsafe abortion (6.5%), road traffic injury (4.3%) and fall (2.2%). Gastrointestinal injuries were the most common with small bowel perforations predominating. Solid organ injuries were only seen in 3 (7.9%) patients. Eight (17.4%) had associated extra-abdominal injuries. Thirty-eight (82.6%) patients required exploratory laparotomy, while 8 (17.4%) were managed non-operatively. The negative laparotomy rate was 2.6%. Seven (15.2%) patients developed complications which were mostly wound infection (10.8%). The duration of hospital stay was 1-58 days (mean 12.7±10.5). Three patients (6.5%) with gunshot injuries died. Conclusion: Gunshot wounds were the major variant of PAI, and the highest cause of mortality from it. Gut injuries were most common, and exploratory laparotomy remains the main-stay of treatment, while non-operative management is practicable in carefully selected cases.

Trauma Audit for Intra-Abdominal Injury in Hospital Pulau Pinang

Introduction: Intra-abdominal injury is one of the leading causes of morbidity and mortality in all age groups in the world. Our aim is to review the demography, incidence rates and prevalence of intra-abdominal injury in Hospital Pulau Pinang in a tertiary hospital in Northern region of Malaysia. Materials and Methods: We retrospectively reviewed medical records of patients diagnosed with intra-abdominal injury from January 2016 until December 2017 using an in-house electronic database. Traumatic renal injury was excluded. Diagnosis was confirmed via contrast-enhanced CT scan or exploratory laparotomy. Results: A total of 82 patients were diagnosed with intraabdominal injury over a period of 2 years. There is a male (75.61%) and of Chinese ethnicity (43.90%) predominance. Median age at presentation was 20 years old. The oldest patient was 94 years old and the youngest patient was 9 months old. Commonest etiology was motor vehicle accident (78.04%) followed by traumatic fall (12.19%). The commonest injury was splenic injury (50%) followed by liver injury (39.28%). The majority of patient (59.52%) was treated non-surgically, in which a grade 2 splenic injury patient underwent operation after failing a non-operative management. There were only 2 mortalities among the 34 patients in the operative group. There is a higher incidence among Chinese ethnicity due to skewed distribution of Chinese population in our studied area in relation to total Chinese population in Malaysia. We showed a reduction in negative laparotomy in stable patients with suspected intra-abdominal injury with the utilization of a CT scan. Decision for non-operative management should be tailored to individualized approach accompanied by serial assessment for optimal care. Conclusion: Blunt trauma was the most common type of intra-abdominal injury and the spleen was found to be the most common organ injured.

External validation of Tzanakis scoring system in acute appendicitis in a rural hospital

Background: Acute appendicitis is one of the most common cause of acute abdomen surgery. Several scoring systems have been adopted by physicians to aid in the diagnosis and decrease the negative appendicectomy rate. Tzanakis scoring system is one such score. Objective of present study was the validation of this scoring system in our population and compare its accuracy with histopathological examination (HPE).Methods: A retrospective study was carried out at the Department of Surgery at Mohammad Afzal Beigh Memorial Hospital Anantnag India. Tzanakis score was calculated in 288 patients who underwent appendicectomy from September 2016-2018 and HPE results were analysed.Results: 276 patients were eligible for the study. The sensitivity and specificity of Tzanakis score in diagnosing appendicitis was 90.66% and 73.68% respectively. The overall diagnostic accuracy was 86.23% with positive predictive value of 97.89% and negative predictive value of 36.84%.Conclusions: Tzanakis scoring system is an accurate modality in establishing the diagnosis of acute appendicitis and preventing a negative laparotomy.

Is laparoscopy still of value in managing the patient with abdominal trauma?

Introduction Stabbings are an increasing international problem and the UK is not exempt. Although the incidence and costs of negative laparotomy are well known, and laparoscopy has been available for over 100 years, it is only in the last three decades that has seen its effective utilization in trauma both as a diagnostic and therapeutic modality. Methods A retrospective two-year study of all patients undergoing laparoscopy for suspicion of diaphragmatic injury or breach of the peritoneum who were haemodynamically stable from non-ballistic penetrating torso trauma at St Mary’s Hospital (Imperial Healthcare Trust). Results Three groups of patients were identified: diagnostic laparoscopy without injury (n = 31), laparoscopy with injury ± laparoscopic treatment (n = 41) and diagnostic laparoscopy converted to laparotomy (n = 10). The patients who had laparoscopic intervention had a shorter hospital stay (2 vs. 5 days, p = 0.004), decreased intensive treatment unit admission (p = 0.007) and decreased intensive treatment unit stay (p = 0.007) compared to those who had conversion to laparotomy. Conclusion Trauma laparoscopy is a useful modality in managing selected trauma patient with suspected intra-abdominal injuries and can avoid unnecessary laparotomy. It is associated with a shorter hospital stay.