Management Of Gastrointestinal Perforation Following Blunt Trauma Abdomen :-RIMS Ranchi

Background: Blunt trauma to the abdomen leading to bowel injury is one of the major causes of death in the society. The most important problem associated with gastrointestinal perforation following blunt abdominal trauma is that they frequently remain undetected or are diagnosed too late despite advances in medical imaging. Objective: To evaluate gastrointestinal perforation following blunt abdominal trauma, their anatomical distribution, diagnosis, management, and outcome. Materials and Methods: The study was a prospective observational study conducted at the Department of General Surgery, RIMS RANCHI, from June 2017 to August 2018 on 64 patients undergoing surgery for gastrointestinal perforation following blunt abdominal trauma. The study variables included sociodemographic data, radiological findings, perforation-surgery interval, intraoperative findings, and surgical procedure performed. Postoperative outcomes in terms of recovery, postoperative complications, and mortality were studied. Results: Of 64 patients, 60 were male and only 4 were female subjects. The incidence was more in the young age group (maximum in 21–30 years age group) with road traffic accident being the most common causative factor. Free gas under diaphragm in chest X-ray was found in 42 (65.62%) patients, while remaining of them was diagnosed by USG abdomen (18 patients) and in CT abdomen (4 patients). Jejunum was the most common site of perforation followed by ileum. Among the surgical procedures, simple closure with peritoneal lavage was the most commonly performed surgery. Postoperative complications were seen in 22 (34.38%) patients, with chest infection being the most common. Five(7.81%) patients died in the postoperative period with a higher mortality rate in patients with delayed admission in hospital and increasing age (> 50 years). Conclusion: Posttraumatic gastrointestinal perforation most commonly involves the small intestine and can usually be managed by simple closure. Early surgery is associated with a good recovery. Risk of mortality increases with age > 50 years and delay in admission in hospital.