Jose Kuruvilla1 , Sunil M.2
BACKGROUND Blunt injuries of abdomen are very common emergencies encountered in general surgical practice. Conservative management is preferred in all such cases except those with injury to solid organs in the abdomen and hence accurate Radiodiagnosis with CT scan is ideal when performed accurately and in time. In cases of haemoperitoneum, the active extravasations and their rate of bleeding are more useful in the management than merely report of volume of free blood in the abdomen. We wanted to study the efficacy of computed tomography (CT) scan of abdomen as a diagnostic tool for accurate diagnosis of blunt injuries to abdomen. METHODS 77 patients presenting with blunt injuries abdomen from Al Azhar Medical College and Hospital, between March 2018 and May 2020 were included in the study. Patients with a normal CT scan not requiring admission or those who were discharged after a short, stay not more than 3 days without any further investigation were excluded. Protocol consisting of portal venous phase images of the abdomen and pelvis, were acquired 65 - 80 seconds after the beginning of intravenous contrast material administration. In few cases, longer delay time was used- up to 75 to 80 seconds for CT imaging. Findings like haemoperitoneum, contrast blush consistent with active extravasations of blood, Laceration (linear shaped hypodense areas), haematomas (oval or round shaped areas), contusions (vague ill-defined hypodense areas that are less well perfused), pneumoperitoneum, devascularization of organs or parts of organs and subcapsular haematomas were recorded. RESULTS Among the 77 patients with blunt injuries to abdomen included in the present study, there were 49 (66.23%) male patients and 28 (36.36%) female patients with a male to female sex ratio of 2.38:1. The youngest patient was aged 7 years and the eldest patient was aged 53 years with a mean age of 43.15 ± 3.45 years. Out of 77 patients, 55 (71.42%) patients were treated conservatively and the remaining 22 (28.57%) were surgically explored for treatment. An overall sensitivity of diagnosing injuries to solid organs was 97% and specificity was 98%. The positive predictive value was 81% and negative predictive value was 98%. In case of bowel injuries, the sensitivity and specificity were calculated and found that they were 96% and 97% respectively. CONCLUSIONS Majority of the patients with blunt injuries to abdomen can be successfully managed conservatively. Only 28.57% of the patients in the present study required surgical intervention, which was for Grade IV / V Splenic injuries, hepatic injury with active contrast extravasations and bowel injuries.
