Peroperative profile and procedures done at laparotomy in abdominal injuries due to polytrauma- our 3 years experience

Background: 25% of all abdominal trauma require abdominal exploration (Townsend, 2008; Hemmila, 2008; Dipak, 2016).7-10 % of all polytrauma deaths occur due to abdominal injuries (Fabion et al., 2002; Karamercan et al., 2008). Early detection and optimal procedure would reduce the morbidity and preventable mortality. Delay in diagnosis may be dangerous to the patient and can lead to the mortality and morbidity (Rishikant et al., 2015). Aim: To study the profile of various abdominal organ injuries found at laparotomy in polytrauma and various surgical procedures undertaken and outcome of the surgery. Materials and Methods: It is a retrospective observational study conducted for three years from 1st January 2014 to 31st December 2017 at Institute of Orthopedic Research and Accident Surgery, Madurai, at Devadoss multispecialty hospital, a private tertiary teaching polytrauma institute at Madurai, South Tamil Nadu, India. Patients who left the hospital against medical advice, those aged below 12 years and injuries treated conservatively by non-operative management (NOM) were excluded in this study. Analysis is based on the intra-operative findings such as pattern of abdominal organ injury, grade of injury due to different modes of injury, various surgical procedures undertaken, hospital stay and outcome recorded in the case sheet were analyzed by statistical methods. Results: In the span of 3 years of study, 48 patients had abdominal injuries due to polytrauma.17 haemodynamically stable patients with radiological signs of solid abdominal visceral injury were treated by non-operative management(NOM) were excluded from the study. Remaining 31 patients underwent laparotomy. The cause of injury was blunt trauma in 26 cases and penetrating injury in 5 cases. Common solid organ of injury was spleen and hollow visceral injury was small bowel. Multiple organ injuries are more common than isolated organ injury. Indications for solid organ injury were mainly for control of bleeding and for high grades of injuries as per standard protocol. All hollow visceral injury of all grades needed laparotomy. They required either resection and anastomosis or diversion. Hospital stay depended on associated injuries requiring surgery and co-morbid illness. Conclusion: Early diagnosis and treatment are of important factors determining the overall outcome. An associated injury often determines the survival. Multiple organ injury is more common than isolated injuries. No part of the abdomen is immune to trauma. All hollow visceral injuries needs laparotomy. Role of laparotomy is to control and arrest ongoing bleed and to manage peritonitis due to bowel perforations. Although early diagnosis of intestinal injuries is difficult, it is very important to recognize them since they have tremendous infectious potential. Surgical procedures have to be tailored as per intra-operative findings, general condition of patients and facilities available at the centre to reduce the morbidity and mortality.