Abdominal trauma and infection

Boediono Soehendro,surgeon The Central Hospital of Indonesian Army Jakarta

Background
Trauma as the leading cause of death in those aged 1-44 years Abdominal trauma was the cause of the death that could be prevented The cause of the biggest abdominal trauma was the traffic accident Blunt and penetrating injury patterns Clinical sign about intraperitoneal,retroperitoneal and pelvic injuries

Blunt abdominal trauma

Great mortality due to delayed diagnosis and associated injuries Spleen(40-55%),liver(35-45%),small bowel(5-10%),retroperitoneal hematoma 15% Compression forces: solid & fixed organ ,hollow organs rupture Deceleration forces: relative fixed & free organ

Penetrating abdominal trauma

Caused by gunshot wounds and stab wounds Liver(40%),small bowel(30%), diafragma(20%) and colon(15%) Gsw : small bowel(50%), colon(40%),liver(30%),vascular structures(25%) Suicide and homicide consistently in the top 15 causes of death (USA)

Complications
Intra abdominal hemorrhage Intra abdominal infection Sepsis and death can occur Delayed rupture or hemorrhage from solid organs

Specific physical examination finding before surgical intervention(laparotomy) Evidence of shock without obvious external blood loss Evidence of peritonitis Altered levels of consciousness

Intraoperative details
Essential components to the trauma laparotomy include control of bleeding, identification of injuries,control of contamination, and reconstruction (if possible) Small bowel ruptured : control contamination is high priority Colon ruptured : depends on the extend of the defect, the amount of contamination,and the stability of the patient

Hollow viscus organ rupture

.in the unstable patient,a damage control procedure may be performed,with control of contamination and resection of devitalized segments without anastomosis.The patient returns to the operating room within 24-48 hours for reexploration.

Penetrating abdominal trauma in Army Hospital (2006-2007)

No Organ 1 Stomach 2 Ileum 3 4 Colon Omentum Treatment Closure+drain Closure+drain Colostomy Stop bleeding Number 1 2 2 2

All cases are performed laparotomy No surgical side infection after surgery intervention

Blunt Abdominal trauma in Army Hospital (2006-2007)

No Organ Action Amount Death

1 2 3 4 5 6 7 8 9

Colon Liver Ileum Stomach Yeyunum Omentum Spleen Anorectal

Minimal bleeding

Colostomi Tamponade

3 5 2 1 1

Closure+drain 5 Closure+drain 4 Closure+drain 3 Stop bleeding 3 Spleenectomi 2 Colostomi Concervatif 1 6

Data in Army Hospital

Indication for emergent laparotomy in stomach,yeyunum,and colon perforations is diffuse peritonitis Indication for laparotomy in rupture liver,spleen and omentum is intra abdominal hemorrhage

Data infections in Army Hospital

15 cases are peritonitis before laparotomy explorations 8 cases infection on the incision wound after laparotomy 4 cases are diffuse peritonitis after laparotomy and dead cause by sepsis

Data in Army Hospital

Abdominal trauma : - Caused of death are intra abdominal sepsis and multiple trauma - The trauma cases are stomach perforated(1),ileum perforated(2), yeyunum perforated(1)

Trauma colon
There were 5 cases of the trauma colon, that is 3 blunt traumas and 2 stick traumas All the cases were carried out with colostomy 3 cases experienced the infection of the operation wound None experienced the injured infection intra abdominal

Trauma gaster
There were 5 cases of the stomach trauma, that is 4 blunt traumas and 1 stick trauma 2 cases that experienced the infection of the operation wound 1 case that experienced the infection of intra abdominal

Intra abdominal sepsis

Happened diffused peritonitis in the abdominal trauma with the perforation hollow viscus the organ before the operation The infection intra abdominal post laparotomy happened in 4 cases In the sharp trauma did not have the infection of the operation wound or peritonitis post the operation

Discussion
All that experienced the infection was the blunt trauma of abdomen All that experienced the infection of the operation wound, the infection intra abdominal, and sepsis were that the perforation hollow viscus The emergency operation of laparotomy in the all case of blunt trauma abdominal was done more than 10 occurrence hours of the trauma