Abdominal Injury. Pathogeniesis and Outcome of the Treatment
Abdominal injuries seem to appear rather not frequently. In a presented material their prevalence does not exeed 0.3% of all patients. In spite of that they are significant problem of surgical wards on duty for in many cases surgical intervention is necessary.
The aim of the study was to assess the extent of required surgical treatment and the results of injury management.
Material and methods. 95 patients with abdominal injury were treated in our clinic between years 1996 and 2006. There were 29 women (30.5%) and 66 males (69.5%) in this group at the age ranging from 17 to 91 years /mean-44 years/. The reasons of the injury were as follow: traffic accidents in 33 patients (34.7%), sudden collapse and the fall from the height in 25 patients (26.3%) and the assault in the rest 32 patients (33.7%). Blunt abdominal trauma was diagnosed in 69 patients (72.6%) while penetrating one in 26 persons (27,4%). Isolated injury to abdominal cavity concerned 35 cases (36,8%) and in the rest 60 cases (63,2%) were poly-trauma patients. Abdominal trauma was accompanied most frequently by chest trauma (34 cases-35.8%), then by head injury (32 cases - 33.7%) and bone fracture (29cases -30.5%). In 24cases (25.3%) all the mentioned injuries appeared simultaneously. Diagnosis was based on physical evaluation and ultrasound examination. In selected cases computed tomography was done. As the result of performed evaluation the diagnosis was made and 53 patients (55.8%) were operated. In 18 patients splenectomy was performed because of its rupture, the following 14 patients required suture of the intestine, 13 patients required drainage of intraperitoneal haematomas and ruptured mesocolon. 8 patients had injury to the liver and kidney. 42 patients (44.2%) were treated conservatively.
Results. All of the operated patients survived and were discharged home. There were 8 deaths (8.4%) in the group treated conservatively. Six of them appeared just after the admission to the clinic or in the emergency room and two of them in the fist several days of patients stay. The reason of all the deaths was profound posttraumatic shock due to multi-organ injury.
Conclusions. 1. Intraperitoneal hemorrhage and peritonitis due to gastrointestinal tract injury are the most frequent indications for surgery in patients with abdominal trauma. 2. The main reasons for unsuccessful treatment of isolated abdominal injuries are multi-organ injury and postraumatic shock.