Md Sumon Rahman1, Kamrul Hasan2, Hasal Ul Banna1, Akm Maruf Raza3, Tarafder Habibullah4. 1. Department of Surgery, Jahurul Islam Medical College and Hospital, Kishoregonj, Bangladesh. 2. Department of Surgery, Cumilla General Hospital, Cumilla, Bangladesh. 3. Department of Pathology, Jahurul Islam Medical College and Hospital, Kishoregonji, Bangladesh. 4. Department of Surgery, Enam Medical College Hospital, Savar, Dhaka, Bangladesh.
Abstract
OBJECTIVES: 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.
OBJECTIVES: 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.
Authors: S N Zafar; S Nabeel Zafar; A Rushing; E R Haut; M T Kisat; C V Villegas; A Chi; K Stevens; D T Efron; H Zafar; A H Haider Journal: Br J Surg Date: 2012-01 Impact factor: 6.939
Authors: John J Como; Faran Bokhari; William C Chiu; Therese M Duane; Michele R Holevar; Margaret A Tandoh; Rao R Ivatury; Thomas M Scalea Journal: J Trauma Date: 2010-03