Structure of abdominal injury and its consequences
Introduction. Mechanical injuries are a leading cause of disability and premature death among the working-age population in most countries worldwide. Injuries to the abdominal and retroperitoneal organs (abdominal trauma) significantly aggravate the course of trauma and are a frequent cause of death. The aim of the study was to analyse the structure and outcome of the treatment of abdominal trauma victims. Materials and methods. On the basis of the polytrauma department of the municipal non-profit enterprise «Municipal clinical hospital of emergency and urgent medical care named after A. I. Meshchaninov» of Kharkiv City Council councilаnalysis damage structure and the results of treatment of 240 patients with abdominal trauma were carried out, the main causes of lethal outcomes were determined. Results. Most of the patients with abdominal trauma were male (78,7%), and they were young (18 to 44 years old) (72,5 %). The cause of injury in 95 (39.6 %) victims was road traffic accident, in 58 (24.2 %) – catatrauma; in 65 (27.1 %) – domestic injury. In the abdominal cavity, parenchymatous organs (spleen and/or liver) were injured most frequently, identified in 66.7 % of victims. In 26.3 % of patients revealed damage to the small or large intestine, in some cases, trauma to the stomach and gallbladder was detected. In 37 (15.4 %), mesenteric injury was detected, and in 32 (13.3 %), omental injury was detected. Among retroperitoneal organs the renal trauma was frequent – 46 (19.2 %), pancreatic and urinary bladder injuries were revealed in 27 (11.2%) and in 13 (5.4%) cases, retroperitoneal haematoma was revealed in 63 (26.7 % ) victims. In 178 (74.2 %) victims a combined trauma was diagnosed: thoracic in 129 (53.8%) cases, skeletal in 96 (40 %), craniocerebral in 84 (35 %). Combined injuries of one anatomofunctional region were diagnosed in 80 (33.3 %), two in 67 (27.9 %), and three in 31 (12.9 %) victims. During in-hospital treatment, 34 (14.2 %) victims died, of which 12 (35 %) during the first week after injury. The duration of inpatient treatment for the victims who were discharged was 15.0 [12.0; 25.0] beds/day. The causes of mortality and prolonged hospitalization (more than 14 days) in most cases were cardiovascular, respiratory, purulent-septic and renal complications. Conclusion. Abdominal parenchymal injuries predominate in the structure of abdominal trauma, occurring in 66.7 % of victims. Combined (thoracic, skeletal and/or craniocerebral) trauma occurs in 74.2 % of victims. The fatality rate for isolated abdominal trauma was 4.8 %, with a significant increase in cases of combined trauma, up to 41.9 % for combined thoracic, skeletal and craniocerebral trauma.
Global Plan for the Decade of Action for Road Safety 2011–2020. World Health Organization. Available on: http://www.who.int/roadsafety/ decade_of_action/plan/plan_english.pdf
Paniker J., Graham S. M., Harrison J. W. Global trauma: The great divide. SICOT J. 2015; 1: 19. https://doi.org/10.1051/sicotj/2015019
Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2016. Geneva, World Health Organization; 2018
Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1204–22
Alqarafi A. M., Alhazmi A. M., Alawfi A. M., Alruhaili EMS, Alebrahaimi F. A., Sebeih SH. The patterns of abdominal trauma and factors associated with ICU admission following abdominal trauma in a major trauma center in Medina. AMJ 2019; 12 (3): 71–80. http s://doi.org/10.21767/AMJ.2018.3554
van Gool MH, Giannakopoulos GF, Geeraedts LM, Jr, de Lange-de KES, Zuidema WP. Complications after laparotomy for trauma: a retrospective analysis in a level I trauma centre. Langenbecks Arch Surg. 2015; 400 (1): 83–90
Agadzhanjan V. V., Kravcov S. A., Shatalin A. V., Levchenko T. V. Gospital’naja letal'nost' pri politravme i osnovnye napravlenija ee snizhenija. Politravma. 2015, 1: 6–15
Hadzhibaev A. M., Sultanov P. K. Abdominal'nye krovotechenija pri katatravme. Vestnik hirurgii. 2016; 175 (2) :43–48
Hietbrink F., Smeeing D., Karhof S., Jonkers H.F., Houwert M., van Wessem K. et al. Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization. World J Emerg Surg. 2019 Aug 14; 14: 40. https://doi.org/10.1186/s13017-019-0257-y
Zaruc'kij JaL, Kovalenko V. M., Laksha A. M., Savka І. S., Klіshevich B. A. Analіz letal'nostі sered postrazhdalih іz zakritoju poєdnanoju abdomіnal'noju travmoju z ushkodzhennjam selezіnki. Problemi vіjs'kovoї ohoroni zdorov'ja. 2013; 38 (1): 108–114. Rezhim dostupu: http://nbuv.gov.ua/UJRN/prvozd_2013_38%281%29__19
Gur'єv S. O., Chundak S. S., Sacik S. P. Analіz prichin letal'nostі u postrazhdalih z abdomіnal'noju travmoju vnaslіdok DTP. Problemi vіjs'kovoї ohoroni zdorov'ja. 2013; 38 (2): 35–41. – Rezhim dostupu: http://nbuv.gov.ua/UJRN/prvozd_2013_38%282%29__8
Harvin J. A., Maxim T., Inaba K., Martinez-Aguilar M. A., King D. R., Choudhry A. J. et al. Mortality after emergent trauma laparotomy: a multicenter, retrospective study. J Trauma Acute Care Surg. 2017; 83 (3): 464–468
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