A study on initial outcome of selective non-operative management in penetrating abdominal injury in a tertiary care hospital in Bangladesh

Abstract

Objective: The aim of this study was to assess the initial outcome of non-operative, conservative management in selective penetrating abdominal injury in a tertiary care hospital. Material and Methods: This was a cross sectional study done on purposively selected 36 patients with penetrating abdominal injuries of all ages admitted within 6 hours of the incident. All patients confirmed peritoneal breach and standard algorithm of management was followed. Closed monitoring was ensured with repeated investigations at regular intervals. Outcome parameters included surgical site infection (SSI), fever, hypothermia, wound dehiscence, fecal fistula, length of stay, pulmonary complication and death. Results: A total of 36 patients with a mean age of 30 years (SD= 6.7), consisting all males, mostly (58%) from rural areas and 73% from low socioeconomic condition. Site of injury was noted in the epigastrium (42%) and right iliac region (22%). Among them, 33 (92%) patients were successfully managed with non-operative management and 3 (8%) patients needed laparotomy. Routine imaging and clinical observation could detect hollow viscus injury within 36 hours in 3 patients. Hospital stay was significantly lower (< 7 days) in conservative management. Conclusion: Clinical examination alone and/or together with different diagnostic methods could reduce the number of negative laparotomies and associated morbidities. Single surgeon must closely monitor a patient of penetrating abdominal injury and take vital decisions from the time of admission until discharge.

Rare penetrating abdominal injury caused by falling from height: Miraculously good prognosis

“…It is worth noting that penetrating trauma of the abdominal cavity is caused by external force, it often causes muscle and fascia injury and dysfunction, and then abdominal hernia occurs ( 14 ), although it is extremely rare, it should also be noted that this rare of late complications. Besides, non-surgical conservative management is not unwise for patients with penetrating abdominal trauma, provided that there is no major organ damage and risk of infection or hemorrhagic shock, whereas the presence of peritonitis and the need for resection of abdominal organ damage are indications for emergency surgery (exploratory laparotomy) when hemodynamic instability ( 15 , 16 ). Whether antibiotics should be used prophylactically before or after surgery is still controversial for patients with penetrating abdominal trauma, the benefit or harm of prophylactic use of antibiotics in reducing complications such as sepsis, intra-abdominal abscess, and wound infection needs to be considered by clinicians which based on clinical and evidence-based medical evidence ( 17 ).…”

Surgical Site Infections in Gastroenterological Surgery

“…Furthermore, SSIs are still the second most frequent healthcare-associated infection in Europe and the United States (2). In the United States, recent data show that SSI accounts for over two million nosocomial infections in patients who have been hospitalized (3). SSIs significantly increase the postoperative length of hospital stay by approximately 7-10 days, increase the hospital expenses, and carry a 2-11-fold higher risk of death compared with patients without SSIs, regardless of improved surgical practice, surveillance, and infection-control techniques (4)(5)(6).…”

Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

“…PAI had been managed conservatively until the early 1900s. However, laparotomy became the standard practice with evidence of a better chance of survival than conservative management ( 6 ).…”