IAJPS 2020, 07 (08), 33-38 Haq Nawaz et al ISSN 2349-7750

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CODEN [USA]: IAJPBB ISSN: 2349-7750

INDO AMERICAN JOURNAL OF

PHARMACEUTICAL SCIENCES
SJIF Impact Factor: 7.187
http://doi.org/10.5281/zenodo.3970628

Available online at: http://www.iajps.com Research Article

INCIDENCE OF ABDOMINAL TRAUMA IN A TERTIARY

CARE HOSPITAL
1Dr
Haq Nawaz, 2Dr Muhammad Adeel Iqbal, 3Dr Mehak Javed
1
Sheikh Zayed Medical College, Rahim Yar Khan
2
Faisalabad Medical University, Faisalabad
3
Faisalabad Medical University, Faisalabad
Article Received: June 2020 Accepted: July 2020 Published: August 2020
Abstract:
Objective: There has been a global increase in the incidence of abdominal trauma in surgical patients. We
conducted this study to evaluate the pattern of abdominal injuries, patient characteristics and the management
outcome in our setting.
Methods: It was a descriptive (combined retrospective and prospective) study of all patients with abdominal
trauma admitted and managed at the Emergency department of Sheikh Zayed Hospital, Rahim Yar Khan for one-
year duration from March 2019 to March 2020. Data on socio-demographics, clinical profile, investigations,
treatments and outcome were entered into a spread sheet and analyzed using SPSS version 20.0.
Results: A total of 2728 trauma patients presented during the study period. Of these, 68 (2.5%) suffered from
abdominal injuries. Their ages ranged from 6 to 72 years (mean 30.3±13.2). Fifty-nine (86.8%) were males
while 9 (13.2%) were females (M: F ratio = 6.6:1). Forty-nine (72.1%) sustained blunt trauma while 19 (27.9%)
had penetrating injuries. Road traffic incident (RTI) (n=41; 60.3%) was the most common source of trauma,
followed by assault: gunshot (n=9; 13.2%), and stab (n=7; 10.3%). Spleen (n=23; 33.8%) was the most common
solid organ injured followed by the liver (n=7; 10.3%) while small bowel (n=8; 11.8%) was the most common
hollow viscous injured. Forty-seven (69.1%) required operative intervention. Post-operative complication rate
was 17% with wound infection (12.5%) predominating. The mortality rate was 4 (5.9%).
Conclusion: RTI and assault are major causes of abdominal injury. Measures to reduce RTI, youth restiveness
and criminal activities will stem the tide.
Keywords: Abdominal trauma, Semi-urban tertiary institution, Treatment outcome
Corresponding author:
Dr. Haq Nawaz, QR code
Sheikh Zayed Medical College, Rahim Yar Khan

Please cite this article in press Haq Nawaz et al, Incidence Of Abdominal Trauma In A Tertiary Care
Hospital., Indo Am. J. P. Sci, 2020; 07(08).

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INTRODUCTION: METHODS:
Abdominal trauma has been described as a disease It was a descriptive (combined retrospective and
in evolution and has been described as an important prospective) study of all patients with abdominal
cause of morbidity and mortality among trauma trauma admitted and managed at the Emergency
patients. About a third of patients with injuries department of Sheikh Zayed Hospital, Rahim Yar
worldwide have abdominal trauma, which is a Khan for one-year duration from March 2019 to
significant part of the tragic loss of life. According March 2020. During the prospective period, all
to the World Health Organization (WHO), trauma patients who came for emergency treatment with
will be the first or second leading cause of life abdominal trauma entered the datasheet for the
productivity in both developed and developing study. Required information: patient socio-
countries by 2020. demographic, complaints, time of arrival at the
emergency room, type and mechanism of injury,
There are regional and global differences in the results of clinical trials, results of appropriate
incidence of abdominal trauma and etiological radiological examinations (chest X-ray and
factors associated with abdominal injury ultrasound of the abdomen) and laboratory tests.
worldwide. These factors include civil and political All patients under abdominal examinations before
violence, robbery attacks, increased car accidents, leaving the emergency room to be admitted to the
riots and global terrorism, but are not limited to ward or operating room.
them. Abdominal trauma can also occur in
recreational activities such as contact sports, and Patients were sufficiently revitalized and executed
internal events such as workplaces and falls from a by the executive council, who on the basis of his
height. Health problems caused by car accidents decision to continue the operation or, among other
may not be a part of the case, especially in things, his hemodynamic state, mechanism and
developing countries where those who are focused degree of injury in patients. Requirements for mass
on productive life are often involved. blood transfusions and intraoperative results (those
performed) have been recorded. Complications
Abdominal trauma is usually classified as blunt or related to patient management have also been
penetrating. Blunt injuries can be the result of car reported. The resources obtained from this study
accidents, war injuries, ill-treatment, high-altitude were morbidity and mortality.
falls, sports accidents, martial arts, athletics and
mountaineers, penetrating types often during The generated data was entered into a spreadsheet
stabbings, arrows and spears, firearms and and analyzed using the Statistical Social Sciences
secondary gun injuries. (SPSS) version 20.0 package. (IBM internal).

Diagnosis of abdominal penetrance injury is RESULTS:

usually easy and reliable, but blunt abdominal A total of 2,728 patients with injuries were treated
trauma is a real problem even for experienced over a one-year period 68 (2,5%) patients with
general surgeons and trauma, some injuries may abdominal injuries (43 (63.2%) in the retrospective
not occur during the initial assessment and period and 25 (36.8%) well taken into account
treatment period. This situation is deteriorating in during the prospective period. Age ranges from 6 to
an environment with limited resources, such as 72 years (average 30.3 to 13.2). Fifty-nine (86.8%)
ours, where advanced diagnostic weapons such as are men and 9 (13.2%) male and female: ratio of
trauma-oriented ultrasound (FAST), computed women to 6.6:1. The age distribution of patients is
tomography (CT) and laparoscopy are not available shown in Figure 1. The most affected age group are
in many centers. 21-30 years and 31-40 years. 2 patients over 70
years of age were diagnosed with house collapses
Over the years, blunt and penetrating injuries from and blunt spinal cord injury, respectively.
routine operational management have been the shift
of the paradigm to selective inoperable damage Forty-nine patients (72.1%) suffered a serious
management (SNOM). The current purpose of injury and 19 (27.9%) had stabbing wounds. The
penetration of the injury is that when all patients injury mechanisms are set out in Table 1. Most
are required a routine laparotomy, it differs from injuries (60.3%) traffic incidents (ITI). The trauma
the "need to scan all people with a hole in the caused by the blunt object was the lowest (2.9%).
abdomen". We do this work around us to know the Iatrogenic injuries caused by dangerous abortion
abdominal injury, assess the pattern of abdominal practices account for 15.8% of penetrating injuries.
injuries, the characteristics of the patient and the
result of treatment.

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Table 1. Mechanisms of injuries

A etiology No. Percent
RTI 41 60.3
Gunshot 9 13.2
Stab 7 10.3
Fall 6 8.8
Criminal abortion 3 4.4
Hit by blunt object 2 2.9

Table 2. Intraabdominal visceral injuries

Organs No. Percent

Solid organs

Spleen 23 33.8

Liver 7 10.3

Pancreas 3 4.4

Kidney 2 2.9

Hollow viscera

Stomach 1 1.5

Small bowel 8 11.8

Large bowel 4 5.9

Rectum 3 4.4

Urinary bladder 1 1.5

Other structures

Mesentery 4 5.9

Greater omentum 1 1.5

Retroperitoneal haematoma 2 2.9

Multiple abdominal viscera 9 13.2

The visceral injury formula is defined in Table 2. Spleen (33.8%) was the most common solid organ in the small
intestine (11.8%), the most common in this study.
Other accompanying non-defect changes experienced by patients are shown in Table 3.
Table 3. Associated extra abdominal injuries with BAT
Associated injuries No. Percent
Thoracic* 13 26.5
Head 7 14.3
Extremities (long bones fractures) 5 10.2
Pelvic fracture 3 6.1
Spinal injury 1 2.0
Multiple 5 10.2
Chest (26.5%) was the most affected area of the body with varying degrees of injury. Five patients (10.2%) had
a lot of injuries. Patients had non-surgical and surgical treatment as shown in Table 4. A total of 47 patients
(69.1%) require surgery. More patients (32.7%) in the blunt group compared to the penetrating group (26.3%).

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Table 5 demonstrates various surgical procedures performed in patients. Splenectomy was the most common
operation.

Eight patients (17%) mainly from postoperative complications (12.5%) with wound infection. The hospital stay
lasts from 2 to 32 days (on average 11.4-6.0), and patients with non-smoker injuries have had longer stays at the
entrance. Four patients died with a mortality rate of 5.9%. Patients were monitored for an average of 14 months
and no delays were reported.

Table 4. Mode of treatment

Treatment No. Percent

Blunt
Non-operative 16 23.5
Operative 33 48.5
Penetrating
Non-operative 5 7.4
Operative 14 20.6
Total 68 100

Table 5. Surgical procedures performed

Operative procedures No. Percent
Splenectomy 18 38.3
Hepatorrhaphy 4 8.5
Nephrectomy 1 2.1
Closure of bowel perforation 6 12.8
Bowel resection with primary anastomosis 5 10.6
Repair of rectal injury with diverting loop colostomy 3 6.4
Repair of urinary bladder tear 1 2.1
Laparotomy and drainage of haemoperitoneum only* 9 19.2

DISCUSSION: blunt injuries. However, more penetrating injuries

Worldwide, there has been an increase in the contrast with several other recorded reports. The
incidence of abdominal injuries in significant dominance of blunt injuries can be attributed to the
morbidity and mortality. The number of crimes high rate of car and motorcycle accidents, as many
may increase in our environment due to increased unemployed young people are now resorting to
urbanisation rates, civil and political unrest and an using motorcycles for commercial purposes.
increase in crime rates, including armed robberies
and road accidents. Younger age groups are the Most are road accidents (n-41; 60.3%) blunt injury
most vulnerable groups because they are riskier and and subsequent high falls (n-6, 8.8%). Similar
mobile. Mean age 30.3 years in the third and fourth results have been reported in various national and
years (41, 60.3%) was most affected in our study. international studies. Poor road infrastructure (no
This is contrary to the findings of other authors damaged roads, pedestrian crossings and road
around the world. This will therefore lead to signs), poor driving habits, congestion, lack of
significant economic losses for the family, society compliance with standard safety measures and a
and the nation as a whole. Men (86.8%) were more lack of adequate regulatory control by road law
likely to be affected in this study and are consistent enforcement authorities are responsible for the
with observations from previous studies. This male increase in accidents. Shooting (13.2%) followed
domination may not be alien to the increased by a stab wound (10.3%) it was the most common
involvement of outdoor activities, crime and cause of penetrating abdominal trauma, attack and
violence. everything happened in men. Penetrating changes
only (n-3, 4.4%) were the result of a criminal
Most blunt abdominal injuries (72.1%) 27.9% of abortion observed in women in this study. Unsafe
patients treated for abdominal trauma. This is more abortion remains an important health problem in
similar to the work of other employees who report our environment. Most abortions are performed

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secretly by many unskilled and inexperienced Postoperative complications were reported as eight
health care professionals, and even charlatans, as a (17%) Patients. In six (12.8%) patients, superficial
result of intra-abortion injuries. infections developed in the surgical area, 1 (2.1%)
endovascular coagulation occurred in patients with
In our study, the spleen was the most common liver injuries and 1 (2.1%) had a pelvic abscess.
solid organ, followed by the liver. Similar results of Infection with the surgical area has also been
dominance of spleen lesions have been reported by reported as the most common postoperative
other authors. The most affected gastrointestinal complications in studies conducted elsewhere. Four
segment was 17 (25.1%) patients, large, small deaths (5.9%) were recorded and all were blunt
intestine penetrating abdominal trauma. The injuries. One of them was an elderly man with
susceptibility of the small intestine to the lesions is chronic liver disease, while the rest suffered
the result of a large area occupied in the abdomen multiple injuries. There was no mortality in people
and the fact that they are protected only by the wall with penetrating injuries, as most of them had no
of the anterior snow. Other parts of the digestive ablution injuries. The presence of related changes
tract, such as the stomach, duodenum and pancreas, is a factor in the increase in mortality. This
are fairly well protected by the skeleton or position mortality rate was comparable to some reported by
compared to other structures. Similarly, the urinary the authors. In other studies, higher mortality rates
bag is protected by an empty pelvic bone. were reported between 10% and 17.9%. However,
we are aware that mortality will be a function of
Patients with abdominal injuries may experience how complex injuries are among other factors.
other associated non-deep injuries that may affect
their treatment and the outcome of this treatment. CONCLUSION:
In this study, 13 (26.5%) patients were found to be The incidence of abdominal trauma is increasing
associated with chest injuries. It is also similar to globally and it is a cause of considerable morbidity
other authors who report that chest trauma is most and mortality among trauma patients. In our
commonly associated with injury in their studies. setting, blunt abdominal trauma is mostly
This is due to the proximity of the abdomen, and secondary to road traffic crashes while penetrating
some injuries to the solid organs can be associated injuries were due to stab and gunshot and the
with fractures of the ribs. However, Chalya and pattern of injuries is not different from those
others reported that head injuries were the most reported in other studies. Various preventive
common injury. The presence of related injuries measures to reduce RTA will lead to a reduction in
has been shown to be significantly linked to the incidence of abdominal trauma. Concerted
increased hospital stay and mortality. Our results efforts should be made by government at all levels
were similar because patients with abdominal at providing gainful employment for the teeming
injuries were hospitalized for a long time and three unemployed youths in order to reduce their
of the four deaths were injured. Therefore, early restiveness and criminal activities.
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