Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome

Abstract

Abdominal injury as a result of both blunt and penetrating trauma has an appreciable mortality rate from hemorrhage and sepsis. In this article, we present our experience with the management of abdominal trauma in Durban and investigate factors that influence outcome. We performed a prospective study of patients with abdominal trauma in one surgical ward at King Edward VIII Hospital in Durban over a period of 7 years, from 1998 through 2004. Demographic details, cause of injury, delay before surgery, clinical presentation, findings at surgery, management and outcome were documented. There were 488 patients with abdominal trauma with a mean age of 29.2 ± 10.7 years. There were 440 penetrating injuries (240 firearm wounds; 200 stab wounds) and 48 blunt injuries. The mean delay before surgery was 11.7 ± 16.4 hours, and 55 patients (11%) presented in shock. Four hundred and forty patients underwent laparotomy, and 48 were managed nonoperatively. The Injury Severity Score was 11.1 ± 6.7, and the New Injury Severity Score was 17.1 ± 11.1. One hundred and thirty-seven patients (28%) were admitted to the intensive care unit (ICU), with a mean ICU stay of 3.6 ± 5.5 days. One hundred and thirty-two patients developed complications (28%), and 52 (11%) died. Shock, acidosis, increased transfusion requirements, number of organs injured, and injury severity were all associated with higher mortality. Delay before surgery had no influence on outcome. Hospital stay was 9.2 ± 10.8 days. The majority of abdominal injuries in our environment are due to firearms. Physiological instability, mechanism of injury, severity of injury, and the number of organs injured influence outcome.

Blunt abdominal trauma and organ damage and its prognosis

“…5 The most common mechanism of blunt abdominal trauma evaluated in most studies and the present study were a car crash. 2,3,7,9,19,[22][23][24] In this study from 332 patients with blunt abdominal trauma, 290 cases (83.7%) had not any damage to any organ. Spleen and liver were equally the most injured organs.…”

“…In similar studies, blunt abdominal trauma was reported to be more common in men. 1,4,7,9 This is probably due to the outdoor activity of men.…”

“…3 Trauma frequently affects young people. 9 Most patients with blunt abdominal trauma are in the third decade of their life. 7 Blunt abdominal trauma is more common in men than women.…”

The conservative management of abdominal injuries

“…The liver, followed by the spleen are the most commonly injured abdominal organs in blunt abdominal injuries. In these injuries, shock, acidosis, transfusion requirement, presence of multiple organ injury, delay in treatment, presence of co-morbid diseases and high trauma sco-res are factors increasing mortality (3)(4)(5). Although there are studies reporting mortality rate as high as 25.8% (64 deaths in 248 trauma patients) for abdominal injuries, in general the mortality is 10% (3-5, 9).…”

Abdominal stab wound in A Pregnant woman resulting in Evisceration, Uterine Perforation and Fetal Chest Injury: A Case Report and Literature Review

“…These can be non-penetrating or penetrating when they pass through the peritoneal cavity. The epidemiology differ greatly by geographic region; however, all studies agree on the higher incidence of blunt abdominal trauma in the civilian population compared to penetrating lesions, which can account for approximately 10 to 30% of abdominal traumatic injuries [7,8]. Penetrating lesions can be stabbed or gunshot in up to 15% of the series [7].…”