Penetrating Abdominal Injuries: Pattern and Outcome of Management in Khartoum

Maha Yassin Omer, Aamir Abdullahi Hamza, Mohammed Toum Musa

Department of Surgery, College of Medicine & Health Sciences, Bahri University, Khartoum, Sudan.
Department of Surgery, Faculty of Medicine, Al Neelain University, Khartoum, Sudan.
Department of Surgery, Faculty of Medicine, Khartoum University, Khartoum, Sudan.

DOI: 10.4236/ijcm.2014.51004                

Abstract

Background: The pattern and presentation of penetrating abdominal trauma vary according to places and the structure of the present health system. As well controversies in management exist ranging from mandatory exploration to selective non-operative management. Objectives: To determine the pattern of penetrating abdominal trauma, current management practiced and outcome in Khartoum. Patients and Methods: The study was prospective, descriptive and hospital-based. It was carried out at the main three hospitals in Khartoum State. It was conducted over a period of one year from 2012 Mar to 2013 Mar. All patients who presented penetrating injury to their abdomen were included. Results: The study included 85 patients with a mean age of 28 years (SD ± 10). The male to female ratio was 11:1. Most of the patients (89.4%) were in the first four decades of their life. Twenty-three patients (27.1%) presented shock. Stab wound is the commonest mode of trauma seen in 83.5% of our patients. The majority of our patients were managed by exploratory laparotomy (81.2%), however 16 (18.8%) underwent conservative measures. Of the operated group, solid organ injuries were found in 22.9%, yet hollow viscous injuries were reported in 86.9% of the patients. Registrars operated on 78.26% of the patients. The rate of negative laparotomy of this study was 8.7%. Complications and mortality were encountered in 25.9% and 4.7% respectively. The mean hospital stay was 8.47 days (SD ± 10.6). Conclusion: This study demonstrates no difference in the pattern of intra-abdominal injuries. The rate of operative treatment is acceptable, but more laparotomies can be avoided if the haemodynamic stable patients without features of peritonitis were given a period of observation. The overall outcome was satisfactory.

Keywords

Mandatory Laparotomy; Mortality; Non-Operative Management; Penetrating Abdominal Injuries

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. Aldemir, I. Tacyildiz and S. Girgin, “Predicting Factors for Mortality in the Penetrating Abdominal Trauma,” Acta Chirurgica Belgica, Vol. 104, No. 4, 2004, pp. 429-434.
[2]	D. Demetriades and G. Velmahos, “Technology-Driven Triage of Abdominal Trauma: The Emerging Era of Nonoperative Management,” Annual Review of Medicine, Vol. 54, 2003, pp. 1-15. http://dx.doi.org/10.1146/annurev.med.54.101601.152512
[3]	M. Saghafinia, N. Nafissi, M. R. Motamedi, M. H. Motamedi, M. Hashemzade, Z. Hayati and F. Panahi, “Assessment and Outcome of 496 Penetrating Gastrointestinal Warfare Injuries,” Journal of Royal Army Medical Corps, Vol. 156, No. 1, 2010, pp. 25-27. http://dx.doi.org/10.1136/jramc-156-01-05
[4]	H. D. Siddig and M. E. Ahmed, “Management of Abdominal Trauma in Khartoum Teaching Hospital,” Khartoum Medical Journal, Vol. 1, No. 3, 2008, pp. 112-115.
[5]	M. A. Gad, Aly Saber, Shereif Farrag, M. E. Shams and G. M. Ellabban, “Incidence, Patterns, and Factors Predicting Mortality of Abdominal Injuries in Trauma Patients,” North American Journal of Medical Sciences, Vol. 4, No. 3, 2012, pp. 129-134. http://dx.doi.org/10.4103/1947-2714.93889
[6]	P . Musau, P. G. Jani and F. A. Owillah, “Pattern and Outcome of Abdominal Injuries at Kenyatta National Hospital,” Nairobi, East African Medical Journal, Vol. 83, No. 1, 2006, pp. 37-42. http://dx.doi.org/10.4314/eamj.v83i1.9359
[7]	M. Asuquo, M. Umoh, V. Nwagbara, G. Ugare, C. Agbor and E. Japhet, “Penetrating Abdominal Trauma: Experience in a Teaching Hospital, Calabar, Southern Nigeria,” International Journal of Clinical Medicine, Vol. 3, No. 5, 2012, pp. 426-430. http://dx.doi.org/10.4236/ijcm.2012.35079
[8]	M. N. Mnguni, D. J. J. Muckart and T. E. Madiba, “Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome,” International Surgery, Vol. 97, No. 2, 2012, pp. 161-168. http://dx.doi.org/10.9738/CC84.1
[9]	G. Ruhinda, P. Kyamanywa, D. Kitya and F. Bajunirwe, “Abdominal Injuries at Mbarara Regional Referral Hospital, Uganda,” East and Central Africa Journal of Surgery, Vol. 13, No. 2, 2008, pp. 29-36.
[10]	B. I. Monzon-Torres and M. Ortega-Gonzalez, “Penetrating Abdominal Trauma,” SAJS, Vol. 42, No. 1, 2004, pp. 11-13.
[11]	A. Salim and G. C. Velmahos, “When to Operate on Abdominal Gunshot Wounds,” Scandinavian Journal of Surgery, Vol. 91, No. 1, 2002, pp. 62-66.
[12]	H. P. Navsaria, J. U. Berli, S. Edu and A. J. Nicol, “Nonoperative Management of Abdominal Stab Wounds: An Analysis of 186 Patients,” SAJS, Vol. 45, No. 4, 2007, pp. 128-132.
[13]	M. Ohene-Yeboah, J. C. B. Dakubo, F. Boakye1 and S. B. Naeeder, “Penetrating Abdominal Injuries in Adults Seen at Two Teaching Hospitals in Ghana,” Ghana Medical Journal, Vol. 44, No. 3, 2010, pp. 103-108.
[14]	A. Gaudeuille, A. Doui Doumgba, J. Ndémanga Kamoune, E. Sacko and N. M. Nali, “Abdominal Trauma in Bangui (Central Africa): Epidemiologic and Anatomical Aspects,” Le Mali Médical, Vol. 22, No. 2, 2007, pp. 19-22.
[15]	J. G. Parreira, S. Rasslan and E. M. Utiyama, “Controversies in the Management of Asymptomatic Patients Sustaining Penetrating Thoracoabdominal Wounds,” Clinics, Vol. 63, No. 5, 2008, pp. 695-700. http://dx.doi.org/10.1590/S1807-59322008000500020
[16]	D. Demetriades, P. Hadjizacharia, C. Constantinou, C. Brown, K. Inaba, P. Rhee and A. Salim, “Selective Nonoperative Management of Penetrating Abdominal Solid Organ Injuries,” Annals of Surgery, Vol. 244, No. 4, 2006, pp. 620-628.
[17]	J. J. Como, F. Bokhari, W. C. Chiu, T. M. Duane, M. R. Holevar, M. A. Tandoh, R. R. Ivatury and T. M. Scalea, “Practice Management Guidelines for Selective Nonoperative Management of Penetrating Abdominal Trauma,” Journal of Trauma, Vol. 68, No. 3, 2010 pp. 721-733.
[18]	A. C. Beekley, L. H. Blackbourne, J. A. Sebesta, N. McMullin, P. S. Mullenix and C. J. B. Holcomb, “Selective Nonoperative Management of Penetrating Torso Injury from Combat Fragmentation Wounds,” The Journal of Trauma Injury, Infection, and Critical Care, Vol. 64, No. 2, pp. 108-117. http://dx.doi.org/10.1097/TA.0b013e31816093d0
[19]	A. E. Dongo, E. B. Kesieme, D. O. Irabor and J. K. Ladipo, “A Review of Posttraumatic Bowel Injuries in Ibadan,” ISRN Surgery, Vol. 2011, 2011, Article ID: 478042. http://dx.doi.org/10.5402/2011/478042
[20]	M. Uludag, G. Yetkn, B. Çitgez, F. Yener, I. Akgün and A. Çoban, “Effects of Additional Intraabdominal Organ Injuries in Patients with Penetrating Small Bowel Trauma on Morbidity and Mortality,” Turkish Journal of Traua & Emergency Surgery, Vol. 15, No. 1, 2009, pp. 45-51.
[21]	M. Bala, S. A. Gazalla, M. Faroja, A. I. Bloom, G. Zamir, A. I. Rivkind and G. Almogy, “Complications of High Grade Liver Injuries: Management and Outcomewith Focus on Bile Leaks,” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol. 20, No. 20, 2012, pp. 1-7. http://dx.doi.org/10.1186/1757-7241-20-20
[22]	S. Pandey, A. Niranjan, S. Mishra, T. Agrawal, B. M. Singhal, A. Prakash and P. C. Attri, “Retrospective Analysis of Duodenal Injuries: A Comprehensive Overview,” The Saudi Journal of Gastroenterology, Vol. 17, No. 2, 2011, pp. 142-144. http://dx.doi.org/10.4103/1319-3767.77247
[23]	A. P. Düzgün, M. M. Özmen, B. Saylam and F. Cofikun, “Factors Influencing Mortality in Traumatic Ruptures of Diaphragm,” Turkish Journal of Trauma & Emergency Surgery, Vol. 14, No. 2, 2008, pp. 132-138.
[24]	E. S. Hirano, V. G. Silva, J. B. Bortoto, R. H. de Oliveira Barros, N. M. G. Caserta and G. P. Fraga, “Plain Chest Radiographs for the Diagnosis of Post-Traumatic Diaphragmatic Hernia,” Revista do Colégio Brasileiro de Cirurgiões, Vol. 39, No. 4, 2012, pp. 280-285. http://dx.doi.org/10.1590/S0100-69912012000400007