R. R. Chakraborty1, A. A. Maruf1, T. Benzir1, R. R. Chakraborty1 1Chittagong Medical College Hospital,Department Of Casualty,Chittagong, Bangladesh
Introduction:
Trauma is the leading cause of death in the active people under the age 45 years. There is definite protocol for conservative management of Blunt Abdominal Trauma (BAT) but much lower threshold for exploratory laparotomy in Penetrating Abdominal Trauma (PAT). Though some specific presenting features and investigation findings are crucial in decision making, still the rate of Non Therapeutic Laparotomy (NTL) varies center to center from 12% – 40% in both blunt and penetrating abdominal trauma.
Methods:
A prospective study was conducted from July 2017 to June 2018 to evaluate the characteristics of cases that lead to NTL. The study was conducted in casualty department of a tertiary level hospital in Bangladesh. All patients with abdominal injury underwent exploratory laparotomy were included in this study. Only those cases which were found NTL were analyzed to see the presenting features that lead to exploratory laparotomy.
Results:
During the study period 114 patients with abdominal trauma underwent exploratory laparotomy of which 42(36.8%) for blunt injury and 72(63.2%) for penetrating injury. Total NTL cases were 38 (33.33%). Analysis of NTL cases reveals that NTL for BAT were 8 (21.1%) and NTL in case of PAT were 30(78.9%). Indications for laparotomy in NTL cases of BAT were peritonitis 6(15.8%), Hemodynamic instability 4(10.5%), abdominal distension with significant peritoneal collection 8(21.1%)and average peritoneal collection was 2075 ml. Indications for laparotomy of NTL in PAT were peritonitis 20(52.6%), Evisceration of gut and omentum 8(21.1%), Hemodynamic instability 12(31.6%), dangerous mechanism of injury 6(15.8%), abdominal distension with significant peritoneal collection 14(36.8%) and average peritoneal collection was 226ml.
Conclusion:
In this study we found a high rate of NTL where we made the decision of exploratory laparotomy in abdominal trauma cases based on certain clinical features, abdominal Ultrasonography and in some cases on abdominal CT-Scan. More over higher rate of NTL in penetrating Abdominal trauma was due to very low threshold for exploratory laparotomy in these cases due to protocol obligation and medico-legal issue. So it seems that traditional way of decision making for exploratory laparotomy should be challenged and much scope to think in this issue.