Diagnosis peritoneal lavage in the evaluation of abdominal trauma using the dipstick

Githaiga, Joseph; Adwok, John

doi:10.4314/eamj.v79i9.9116

Cited by 7 publications

(11 citation statements)

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“…Splenorrhaphy appears a better alternative. However, its success depends on operator experience and most African surgeons are unlikely to have at their disposal the technical material, like fibrin glue or dexon mesh, which makes splenorrhaphy more successful [27,28]. In the present study, more than 80% of patients were treated operatively and the majority of patients underwent splenectomy.…”

Section: Discussionmentioning

confidence: 75%

Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience

et al. 2012

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BackgroundSplenic injuries constitute a continuing diagnostic and therapeutic challenge to the trauma or general surgeons practicing in developing countries where sophisticated imaging facilities are either not available or exorbitantly expensive. The purpose of this review was to describe our own experience in the management of the splenic injuries outlining the aetiological spectrum, injury characteristics and treatment outcome of splenic injuries in our local environment and to identify predictors of outcome among these patients.MethodsA prospective descriptive study of splenic injury patients was carried out at Bugando Medical Centre in Northwestern Tanzania between March 2009 and February 2011. Statistical data analysis was done using SPSS software version 17.0.ResultsA total of 118 patients were studied. The male to female ratio was 6.4:1. Their ages ranged from 8 to 74 years with a median age of 22 years. The modal age group was 21-30 years. The majority of patients (89.8%) had blunt trauma and road traffic accidents (63.6%) were the most frequent cause of injuries. Most patients sustained grade III (39.0%) and IV (38.1%) splenic injuries. Majority of patients (86.4%) were treated operatively with splenectomy (97.1%) being the most frequently performed procedure. Postoperative complications were recorded in 30.5% of cases. The overall length of hospital stay (LOS) ranged from 1 day to 120 days with a median of 18 days. Mortality rate was 19.5%. Patients who had severe trauma (Kampala Trauma Score II ≤ 6) and those with associated injuries stayed longer in the hospital (P < 0.001), whereas age of the patient, associated injuries, trauma scores (KTS II), grade of splenic injuries, admission systolic blood pressure ≤ 90 mmHg, estimated blood loss > 2000 mls, HIV infection with CD4 ≤ 200 cells/μl and presence of postoperative complications were significantly associated with mortality (P < 0.001).ConclusionTrauma resulting from road traffic accidents (RTAs) remains the most common cause of splenic injuries in our setting. Most of the splenic injuries were Grade III & IV and splenectomy was performed in majority of the cases. Non-operative management can be adopted in patients with blunt isolated and low grade splenic injuries but operative management is still indispensable in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of splenic injuries in our centre.

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Section: Discussionmentioning

confidence: 75%

Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience

et al. 2012

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“…Controversies remain on abdominal injuries management with resultant inadequate preparation of surgeons in their management (4). With the introduction of selective management of abdominal injuries in 1960 by Shaftan, the rates of negative laparotomy have progressively decreased (2). This study establishes a 10% decrease from the 26% found by Kibosia in 1990.…”

Section: Introductionmentioning

confidence: 75%

“…The type of injury determines the likely contents of the abdomen to be hurt (7,8) but this is not a fast and hard rule. Patients with no overt physical findings can have significant intra-abdominal injury while others with penetrating injuries can have negative laparotomy (2).…”

Section: Introductionmentioning

confidence: 99%

Pattern and outcome of abdominal injuries at Kenyatta National Hospital, Nairobi

2006

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depended on severity of injury. Modes of management varied between attending surgical firms. There was a 20% change in the mode of management and a 16.1% rate of negative laparotomy. Penetrating injuries had a better interventional outcome. Penetrating abdominal injuries had higher rates of complications while the blunt injuries had higher rates of mortality. Overall, both the complication and mortality rates were 12.5%. Correlates of mortality included delay before surgery, associated injuries, need for blood transfusion, admission to intensive care unit and duration prior to admission. Abdominal injury patients stayed an average of 6.4 days with the blunt injuries with complications staying close to twice as much as their penetrating counterparts. Conclusion: Abdominal injuries are a predominantly male disease with the majority in the third decade of life. As opposed to previous studies, gunshot wounds are now a significant cause of abdominal injuries in Kenyatta National Hospital (KNH). The rate-of negative laparotomies has come down by 10% over the past 15 years. The outcome of management depends on the severity and type of injury sustained.

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“…5 Another two studies conducted in Kenyatta National Hospital showed a still higher male to female ratio of 11.5:1 and 12.7:1 respectively. 6,7 In our study, the high incidence among males was probably due to associated risk factors which includes habits like smoking and alcohol intake.…”

Section: Discussionmentioning

confidence: 94%

Gastrointestinal perforations: a tertiary care center experience

2017

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Background: In spite of the advances in surgical techniques and antimicrobial molecules, gastrointestinal perforations still remain highly fatal. Delay in diagnosis as well as referral is often attributed to be the cause behind the high mortality caused by this condition. The aim of the study was to elucidate the etiological factors of gastro intestinal perforation as well as postoperative outcome among patients undergoing treatment at a tertiary care centre.Methods: This was a Descriptive study of patients admitted with gastro intestinal perforation in the General Surgical wards of Government Medical College, Trivandrum from March 2014 to February 2015. The demographic, clinical, operative and post-operative findings were entered into a structured performa and analyzed statistically.Results: Atraumatic perforation was found to predominate over traumatic perforations. Most of the atraumatic perforations belong to the age groups between 21 and 30. Also, there is a high male predominance among these patients. Proximal gastrointestinal tract injuries predominate much more than distal ones. Increased morbidity is seen if there are associated co morbidities and risk factors including smoking and alcohol abuse. Mortality rate is highest in traumatic injuries involving colon and rectums.Conclusions: Mortality due to perforation peritonitis is still a challenge to the surgeon and burden to the society. Early diagnosis and treatment will positively alter the outcome of a gastrointestinal perforation and can be ensured only by timely arrival of the patients to hospital and subsequently by early intervention. This in turn depends mostly on strengthening the primary care and referral services.

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Diagnosis peritoneal lavage in the evaluation of abdominal trauma using the dipstick

Cited by 7 publications

References 0 publications

Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience

Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience

Pattern and outcome of abdominal injuries at Kenyatta National Hospital, Nairobi

Gastrointestinal perforations: a tertiary care center experience

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