Hallow viscus perforations blunt abdominal trauma

SUMMARYAim: The aim of this study is to investigate the demographics, diagnostic methods, operation timing, applied surgical methods of the patients who were admitted to the emergency service with blunt hollow viscus perforation (BHVP) to Department of General Surgery, Faculty of Medicine, University of Inonu between 2003-2007.Patients and method: The medical records of 104 patients who were operated on because of blunt abdominal trauma in Department of General Surgery between 01/01/2003-31/09/2007 were retrospectively analysed.Results: One hundred and fourteen (52.3%) of 218 patients who were hospitalised in Department of General General Surgery for blunt abdominal trauma were followed conservatively. Of 104 patients (47.7%) who were operated on, solid organ injury and hollow viscus perforation were found to be 45.2% and 41.3% of the cases respectively. Negative laparotomi rate was 14.5%. The highest incidence of isolated perforations belonged to small intestine with a rate of 40.5% while stomach perforation was the least observed (2.35%). The mean white blood cell count of the patients with BHVP was 17310 /mL. All the patients had generalised tenderness and muscular rigidity in their abdominal physical examination. Abdominal ultrasonography was performed in 92.8% of the patients and revealed intraperitoneal free fluid, solid organ injury or both in 77.5%. The most common cause of BHVP was found to be motor vehicle accidents including pedesterians. The mean time from admission of the patient to emergency room to laparotomy was 107 (30-240) minutes.Conclusions: The decision of laparotomy can be directly given in an alert, hemodinamically stable trauma patient with BHVP according to the initial abdominal physical examination or an examination performed after a short interval in the presence of generalised tenderness and guarding. Leukocytosis which is accepted as non-specific for trauma patient can be significant in BHVP with clinical suspicion and concomitant findings. Free intraperitoneal fluid without solid organ injury in abdominal ultrasonography is a significant finding for diagnosis of BHVP and decision of laparotomy. The short interval between admission of the patient with BHVP to the emergency room and laparotomy decreases the rate of postoperative mortality and morbidity.Key words: Blunt abdominal trauma; diagnosis; laparotomy; perforation.