รูปแบบการบาดเจ็บช่องท้องชนิดไม่มีแผลทะลุและปัจจัยที่ทำนายการรักษาด้วยวิธีผ่าตัดโดยใช้เอกซเรย์คอมพิวเตอร์ ในโรงพยาบาลพระนครศรีอยุธยา

Orawan Jullapanont

Authors

Orawan Jullapanont Phra Nakhon Si Ayutthaya Hospital

Keywords:

blunt abdominal injuries, computed tomography, operative management, non-operative management

Abstract

Objectives : To describe the pattern of blunt abdominal injuries and the predictors of operative treatment by using computed tomography (CT) in patients presented to Phra Nakhon Si Ayutthaya Hospital.

Methods : A retrospective cohort study was performed. Patients who were hemodynamically stable, with high clinical suspicion of intra-abdominal injuries and underwent CT whole abdomen from October 1^st, 2018 to October 31^st, 2021 were enrolled. Medical records were reviewed. The whole abdomen CT images were analyzed by one radiologist. Descriptive analysis was used for reporting pattern of blunt abdominal injuries. The predictors of operative treatment versus successful observation were analyzed by Chi-square test and Fisher’s exact test.

Results : Male was common than female (3.4:1). An average age was 35.2 years (S.D.=17.4). The majority age group was 15-45 years found 60.6%. Rode traffic accent was the most common cause of injury found 84.7%. The most common CT findings was hemoperitoneum, which was seen 73.8%. Liver was the commonest organ injury found 34.4%, followed by kidney and spleen found 14.8% and 14.2%, respectively. Bowel and mesenteric injury found 11.5%. Adrenal, pancreas and urinary bladder were injured in fewer patients. The majority of definitive management was observation found 78.7%. The rate of operative treatment was associated with severe splenic injury (AAST grade IV-V), bowel and mesenteric injury, intraperitoneal bladder rupture, large hemoperitoneum, retroperitoneal hemorrhage and pneumoperitoneum (P-value < 0.05). Only 10.4% were found normal.

Conclusion : Computed tomography is main modality for evaluation of blunt abdominal injuries, it can explain details of injury, severity, predict prognosis and treatment. The rate of operative treatment was associated with severe splenic injury (AAST grade IV-V), bowel and mesenteric injury, intraperitoneal bladder rupture, large hemoperitoneum, retroperitoneal hemorrhage and pneumoperitoneum.

Keywords : blunt abdominal injuries, computed tomography, operative management, non-operative management

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