In blunt abdominal trauma common injuries include injuries to solid organs like liver, spleen, kidneys and pancreas; rupture of hollow viscus like small bowel, urinary bladder and colorectum; tear or avulsion of mesentery or pedicle of solid organ or retroperitoneal haemorrhage. Spleen and liver are the most commonly injured organs in blunt trauma abdomen [1]. Blunt abdominal trauma commonly results from either a compression force or a deceleration injury. It has greater mortality than penetrating trauma as there is often injury to multiple organ systems [2]. Clinical examination can be unreliable and clinical manifestations may be delayed for hours or days. The accuracy of diagnosis increases if patient is re-evaluated repeatedly at frequent intervals [3].

In India 75-80% of Blunt trauma abdomen cases occurs due to road traffic accidents. It is followed by pedestrian accidents, abdominal blows, fall from heights and sports injuries [4]. This ever-expanding epidemic targeting the young and productive generations is likely to take a heavy burden on the quality of life and socio- economic growth of the region. The objective of our study was to determine the modes of blunt trauma abdomen and patterns of injury among the patients admitted to the department of general surgery at Indira Gandhi Medical College, Shimla, Himachal Pradesh.

It was a descriptive cross-sectional study that was conducted on the patients with blunt abdominal trauma in the department of General Surgery over a period of one year. The data was cleaned and entered using Microsoft excel spreadsheet and was analysed using SPSS version 16. The quantitative variables were expressed in mean and standard deviation whereas the qualitative variables were expressed in frequencies and proportions.

Table 1: Distribution of the Modes of Injury

Table 2: Organ Wise Distribution of Abdominal Injuries

A total of 400 patients of Blunt Abdominal Trauma were studied during this period fulfilling inclusion criteria. Patients who sustained Blunt Abdominal Trauma due to Road traffic accidents, fall from height, assault or any other mode of injury having abdominal tenderness, evidence of external injury mark and dangerous mode of injury were clinically examined as per ATLS guidelines. Patients were immediately resuscitated and investigated. Ultrasound FAST was done and patients having evidence of free fluid in abdomen were subjected to CECT abdomen.

A total of 400 patients of blunt trauma abdomen were studied during this period. Patients who sustained Blunt Abdominal Trauma due to Road traffic accidents, fall from height, assault or any other mode of injury having abdominal tenderness, evidence of external injury mark and dangerous mode of injury were clinically examined as per ATLS guidelines. Patients were immediately resuscitated and investigated. Ultrasound FAST was done and patients having evidence of free fluid in abdomen were subjected to CECT abdomen. 

Mean age of the patient was 37.13 years and out of 400 patients, 305 (76.25%) patients were males while rest were females. Out of 400 patients, 278 (69.50%) patients acquired injury due to fall, 113 (28.25%) patients acquired injury due to Road Side Accidents (RSA), 09 (2.25%) patients acquired injury due to assault and no patient sustained sports injury (Table 1).

It was found that among 43 USG FAST positive patients, 20 (46.51%) patients acquired splenic injuries (overall BTA of 5.00%), 17 (39.53%) patients acquired liver injuries (overall BTA of 4.25%), 10 (23.26%) patients acquired hollow viscus injuries (overall BTA of 2.50%), 06 (13.95%) patients acquired renal injuries (overall BTA of 1.50%) and 01 (2.33) patient acquired pancreatic injury (overall BTA of 0.25%) (Table 2).

In our study history of fall was responsible for blunt abdominal trauma in 69.50% of patients and injury due to Road Side Accidents (RSA) was found in 28.25% of patients. History of assault was found in 2.25% of patients and no patient was found with sports injury. Caren Dsouza et al. [5] in their study on epidemiological trends of trauma in tertiary care centre of Karnataka, observed that fall was the most common cause of injuries accounting for 60.78% followed by RTA 16.57%. Kalaiselvan et al. [6], also concluded in their study on epidemiology of injury in rural Pondicherry that fall was the most common cause of injury followed by road traffic accidents. Ghimire A et al. [7] reported falls from height as the commonest mode of injury in their study on epidemiology of injury among urban population of Kathmandu. Fall being the most common mode of injury in the present study is explained due to the hilly terrain of Himachal Pradesh, especially that of Shimla and the adjoining areas. A number of areas are in-accessible by roads and people have to climb on tortuous paths which make them vulnerable to falls. Numbers of areas are snow bound during the winters and this again renders them vulnerable to slips and falls. Farming in these areas is mainly terrace farming along the slopes which also predispose the local population to falls. An increase in falls amongst the workers can be attributed to ongoing construction of various infrastructural projects, dams, hydel power projects etc. 

The most common cause of abdominal injury in our study population was through falling followed by road side accidents. USG FAST is an effective diagnostic modality. Spleen was the most commonly injured abdominal organ among our study participants. Further analytical studies are required to determine the risk factors responsible for such type of abdominal injuries so that such injuries may be prevented to happen in future.

1. Visrutaratna, P. and W. Na-Chiangmai. "Computed tomography of blunt abdominal trauma in children." Singapore Medical Journal, vol. 49, no. 4, 1 Apr. 2008, pp. 352–358.

2. Ntundu, S.H. et al. "Patterns and outcomes of patients with abdominal trauma on operative management from northern Tanzania: A prospective single centre observational study." BMC Surgery, vol. 19, no. 1, Dec. 2019, pp. 1–10.

3. Lema, M.K. et al. "Pattern and outcome of chest injuries at Bugando Medical Centre in Northwestern Tanzania." Journal of Cardiothoracic Surgery, vol. 6, no. 1, Dec. 2011, pp. 1–7.

4. Reddy, N.B. et al. "An epidemiological study on pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents of Bangalore: Autopsy-based study." Journal of Emergencies, Trauma and Shock, vol. 7, no. 2, Apr. 2014, pp. 116–120.

5. Dsouza, C. et al. "Epidemiological trends of trauma in tertiary care Centre in Dakshina Kannada district of Karnataka, India." Journal of Clinical and Diagnostic Research (JCDR), vol. 8, no. 3, Mar. 2014, pp. 66–68.

6. Kalaiselvana, G. et al. "Epidemiology of injury in rural Pondicherry, India." Journal of Injury and Violence Research, vol. 3, no. 1, 2011, pp. 61–66.

7. Ghimire, A. et al. "An epidemiological study of injury among urban population." Kathmandu University Medical Journal, vol. 7, no. 4, 2010, pp. 402–407.