Inadequacy in Diagnosis of Blunt Trauma Abdomen - Can Anaesthesiologist Be Baffled by Catastrophic Intraoperative Findings?

Abstract

ABSTRACT:The magnitude of injury inflicted by Blunt trauma abdomen has varied manifestations ranging from minor single-system injury to devastating, multi-system injury .Blunt trauma abdomen alone or in association with polytrauma is a frequent presentation in the emergency department. High index of suspicion and clinical acumen is required during evaluation of blunt abdominal injuries because physical signs and symptoms indicating presence of visceral lesions may poorly correlate with clinical presentation. Diagnostic peritoneal tapping is considered safe initial option with high accuracy but carries possibility of significant false positive and false negative result. Ultrasonography (FAST) has its own limitations; although CT findings can be conclusive it involves time for analysis and the patient should be cooperative. Blunt trauma abdomen may present with life threatening internal haemorrhage due to visceral or vascular injuries prompting emergency surgical intervention at odd hours with limited investigations and resources, Pre anaesthetic optimization by maintenance of adequate tissue oxygenation with optimal blood volume replacement and judicious use of inotropes, determine outcome of such emergency procedures. Careful selection of anaesthetic techniques and drugs particularly the inducing agents can be life-saving. Agility of the attending anesthesiologist to handle unforeseen intra operative critical events plays a pivotal role in overall outcome. We are discussing Anaesthetic management of a 23 year old victim of road traffic accident, who sustained blunt trauma abdomen about 24 hrs. Back, was conscious, oriented and ambulatory till the time of shifting to the operating theatre but on exploration sudden gush of blood from a preoperatively undetected 7 cms long tear of the sub diaphragmatic part of IVC, and lacerated liver almost exsanguinated the patient.