Trauma is a major public health problem worldwide leading to morbidity and mortality. Approximately one third of trauma patients have abdominal trauma [1]. Trauma is reported to be the leading cause of death, hospitalization and long-term disabilities in first four decades of life [2]. 

The small and large bowel is commonly affected in penetrating trauma. However, they are less frequently affected than solid organs like the spleen and the liver in blunt trauma. Diagnostic modalities evolved in diagnosis of abdominal injuries include diagnostic peritoneal Lavage, Focused Abdominal Sonography for Trauma (FAST) and computerized tomographic scan which was introduced in 1981 [3]. Now, MRI is also being used. Advanced imaging techniques like spiral CT scan and MRI has made early detection of blunt abdominal injuries. The first step in management of blunt trauma abdomen is resuscitation. The aim of resuscitation is to correct and maintain oxygenation and tissue perfusion. The surgical approach involves control of haemorrhage, limitation of contamination and restoration of continuity. The concept of damage control is based on the realization that patients with hypothermia, acidosis and coagulopathy are in metabolic exhaustion and have a high risk of death [4]. The final objective of surgical intervention remains unaltered, but the emphasis on timing has changed in damage control. Surgical techniques are performed to minimize the metabolic insult rather than merely restoring anatomical continuity [5]. The objective of this study was to determinine the management modalities, complications and mortality in blunt trauma abdomen among the patients admitted in the department of General Surgery in Indira Gandhi Medical College, Shimla, Himachal Pradesh.

It was a descriptive cross-sectional study that was conducted on the patients with blunt abdominal trauma in the department of General Surgery over a period of one year. The data was cleaned and entered using Microsoft excel spreadsheet and was analysed using SPSS version 16. The quantitative variables were expressed in mean and standard deviation whereas the qualitative variables were expressed in frequencies and proportions.

A total of 400 patients of Blunt Abdominal Trauma were studied during this period fulfilling inclusion criteria. Patients who sustained Blunt Abdominal Trauma due to Road traffic accidents, fall from height, assault or any other mode of injury having abdominal tenderness, evidence of external injury mark and dangerous mode of injury were clinically examined as per ATLS guidelines. Patients were immediately resuscitated and investigated. Ultrasound FAST was done and patients having evidence of free fluid in abdomen were subjected to CECT abdomen.

Mean age of the patient was 37.13 years and out of 400 patients, 305 (76.25 %) patients were males while rest were females.

In our study among 43 FAST positive patients of Blunt Trauma Abdomen none of the patients presented with isolated Grade-I injury of any solid organ. Average hospital stay in Grade-II solid organ injury was 5.92 days, Grade-III 6.18 days, Grade-IV 7.22 days, Grade-V 7.67 days. Patients with Hollow Viscus injuries had average hospital stay of 9.4 days and 1 patient had Mesenteric tear and hospital stay was 6 days (Table 1).

Table 1: Average Duration of Stay in Hospital Based on the Grade of Injury

In our study of 400 patients, associated injuries with blunt abdominal trauma were also found. Head injuries were found in 45 (11.25 %) patients, spine injuries were present in 32 (8.00%) patients, chest injuries were present in 16 (4.00%) patients and pelvic injuries were present in 2 (0.50%) patients (Table 2).

Table 2: Injuries Associated with Blunt Trauma Abdomen

In our study the patients were subjected to USG FAST and positive patients were then subjected to CECT abdomen to find the organs injured and nature of injuries and grading of injuries. In our study out of 400 patients, 17 patients of liver injuries had grade I-V injuries did not require operative intervention and none of the patients developed complications. In two studies by Croce et al. and Brasel et al., approximately 70-90% of all patients of blunt hepatic trauma were haemodynamically stable [16,7].

In our study on 400 patients, 20 patients had splenic injury. None of the patients needed intervention in the form of splenectomy, splenorraphy or damage control surgery or Trans-Arterial Embolization (TAE). No patient had developed complications in the form of re-bleed, infection or any complications directly attributable to trauma. In several studies by Cogbill et al. [8], Powell et al. [19], Davis et al. [10], Hann et al. [11] and Konstantakos et al. [12], management of blunt splenic injury has undergone significant evolution over the past two decades from operative to conservative management. Conservative management of splenic injury was started in children and later it was tried on adult patients. 

In our study Grade - I pancreatic injury was found in only 1 (2.33%) patient and no patient was found with grade II, III, IV and V pancreatic injuries. In several studies by Heitsch [13], Wisner [14], Cogbill [15] and Vasquez et al., [16], pancreatic injury is relatively uncommon, occurring in 0.2-2 % of all trauma patients and 3-12 % of patients with abdominal injury. 

In our study associated injuries with blunt abdominal trauma were also found. Head injuries were found in 45 (11.25%) patients, spine injuries were present in 32 (8%) patients, chest injuries were present in 16 (4%) patients and pelvis injuries were present in 2 (0.5%) patients. Nahum AM studied that there is 10 % incidence of spinal injuries in BTA [17]. Our study also corroborates with this study.

Patients with history of blunt trauma to abdomen should be thoroughly assessed clinically and resuscitation should be started immediately. USG FAST is quite sensitive to screen for presence of free fluid in abdomen. Haemodynamic instability, persistent peritonism and hollow viscus perforation are indications for surgical intervention. Retroperitoneal haematoma/injuries can be missed on clinical and sonological assessment. They are revealed on CECT abdomen. Most of blunt trauma abdomen patients can be managed on conservative line with intensive monitoring and appropriate treatment. However, almost every patient with hollow viscus perforation needs exploratory laparotomy.

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