Pattern and early treatment outcome of abdominal injuries at Muhimbili national hospital Dar es salaam, Tanzania.

Abstract

Background: Abdominal trauma is among the leading causes of morbidity and mortality in all age groups in the world. However, identifying serious intra-abdominal pathology due to trauma can be a challenge. Many injuries may not manifest during the initial assessment and treatment period. Mechanisms of injury often result in other associated injuries that may divert the physician's attention from potentially lifethreatening intra-abdominal pathology. There is an increase in reports about Motor Traffic Accidents from every corner of our country. These accidents have led to a surge in the number of patients presenting to health care centers including Muhimbili National Hospital with abdominal trauma. Currently there are no published data on pattern of abdominal injury and our surgical department has no guidelines for management of trauma patients. A study aiming to determine the Pattern and Early Treatment Outcome of patients with Abdominal Injury was conducted at Muhimbili National Hospital. Methodology: A descriptive, prospective, hospital-based study involving observation of patients from admission to final outcome of management at discharge or death was carried out. Consecutive admissions of 92 patients with abdominal injuries attended to at the department of surgery Muhimbili National Hospital were enrolled in the study. The study was conducted from April to December 2011. The data were analyzed using SPSS software. Results: Ninety two patients were enrolled into the study. The male to female ratio was 7.4:1. Sixty two patients (67.4%) were in the age group of 21-40years. Fifty one patients (55.4%) sustained abdominal injuries following motor traffic accidents. Sixty patients had blunt injury, 32 patients had penetrating injuries. Associated injuries were found in 36.9% of patients. All the patients underwent laparotomy. The spleen was found to be the most commonly injured organ in blunt trauma constituting 33.3% of patients with blunt abdominal injuries while bowel was found to be the commonest injured intraabdominal organs occurring in 37% of all cases. Negative and non therapeutic laparotomies constituted 21% of all cases. There were 3 patients with complications and7 deaths. The mean length of hospital stay was 5.03 days. None of the patients underwent a re-laparotomy. Conclusions: Blunt trauma was the commonest type of abdominal injury and the spleen was found to be the most common organ injured among patients with blunt trauma. Laparotomy was carried out in all patients with abdominal injuries, no conservative treatment was employed. FAST results were found not to be reliable to most patients with abdominal injuries. The rate of negative and non therapeutical laparotomy was high. In abdominal trauma patients the rate of post operative complications was low. Recommendations: Protocol for management of patients with abdominal injuries should be made and be available for guiding surgeons on management of patients with abdominal injuries. Utilization of other investigative tools such as contrast CT scan is necessary to reduce the rate of negative and non therapeutic laparotomies. Selective conservative management should be used in patients with minor abdominal injuries.