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KMID : 0376419770010000085
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Chonbuk University Medical Journal
1977 Volume.1 No. 0 p.85 ~ p.91
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Clinical Study of Blunt Abdominal Trauma.
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Abstract
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This records of 94 patients with blunt abdominal trauma admitted to Jeonbug National University Hospital from April, 1971 to March, 1976 have been reviewed.
At first, some of the patients presented with no specific complaint or signs of injury, blunt abdominal injury was usually diagnosed preoperatively using conventional methods including history, physical examination, routine laboratory tests and X-ray studies.
Abdominal paracentesis had on 69.5% accuracy.
Mortality and morbidity continue to be significant in blunt abdominal trauma.
Therefore a high index of suspicion and an adequate, observation period are mandatory for proper care of patients subjected to blunt trauma.
The results are as follows.
1) The sex distribution was 74 males (78.7% ) and 20 females (21.3 %) with ratio of 3.7:1, and the age distribution revealed a high incidence in 3rd and 4th decades (51. 1 %) .
2) The seasonal distribution showed the highest incidence in summer involving 32 cases (35.1%).
3) The causes of blunt abdominal trauma were violence(51.1 %) , traffic accidents(29.8 %) and falling(19.9%).
4) The clinical manifestations were abdominal pain(95.7%), tenderness (92. 6% ), rebound tenderness (82.9 %) , rigidity (63. 8 %) , diminished peristalsis (61.7 %) and abdominal distention (61. 7 %) in order of frequency.
5) Preoperative leukocytosis was noticed in 81.1% of the cases. Abdominal paracentesis was valuable in diagnosis of blunt abdominal trauma and 41 cases (69.5% ) of 59 cases had a positive findings. Free air was present in 72.7% of hollow viscus pserforation.
6) As to the organs injured and the frequency of involvement, the small bowel was most frequently injured (37.8 %) , follewed by retroperitoneal hematoma(13.5 %) , splenic rupture (12.2%), urinary bladder rupture (12.2 %) , liver (7.3% ) , large intestine (4.9 %) and stomach (4.9%).
7) 53 cases (73. 6%) had single organ involvement, 11 cases (15.3% ) two organ involvement and 8 cases (11.1% ) had more than two organ involvement.
8) The frequently associated extraabdominal injuries were chest injuries (7, 4 %) , urethral injuries(5.3%) and pelvic bone fracture(3.1%) in order of frequency.
9) Simple closure was performed in most cases of injuries of the small bowel, the stomach and the urinary bladder. In the injuries of large intestine, primary closure with colostomy or primary closure with drainage was done. In the injuries of the kidney, nephrectomy was performed in 3 cases and conservative treatment in one case. Simple closure and drainage was done in most cases of liver injuries. Splenectomy was performed in all cases of splenic injuries.
10) Incidence of postoperative complication was 43.1% (31cases) , and the major complications were wound infection (19.4 %) and pulmonary complication (13.9 %) .
11) The mortality rate was 8.5%, and the main causes of death were hypovolemic shock(4 cases) and renal shutdown(2 cases).
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