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Gastrointestinal perforation following blunt trauma abdomen: a study of 78 cases

Prahlad Ram Bajiya, Sanchit Jain, Laxmi Narayan Meena.

Abstract
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, SMS Medical College and Hospital, Jaipur, from April 2012 to October 2013 on 78 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 78 patients, 76 were male and only 2 were female subjects. The incidence was more in the young age group (maximum in 2130 years age group) with road traffic accident being the most common causative factor. Free gas under diaphragm in chest X-ray was found in 51 (65.4%) patients, while remaining of them was diagnosed by USG abdomen (20 patients) and in CT abdomen (7 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 38 (48.7%) patients, with chest infection being the most common. Ten (12.8%) 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.

Key words: Blunt trauma, gastrointestinal perforation, morbidity, mortality



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