MANAGEMENT OF BLUNT ABDOMINAL TRAUMA IN A RESOURCE-LIMITED SETTING: EXPERIENCE FROM AL-GAMHORIA MODERN GENERAL HOSPITAL, ADEN, YEMEN

Abstract

Blunt abdominal trauma (BAT) is a frequent emergency in spite of improved recognition, diagnosis and managemand remaining a major health - threat causing significant morbidity and mortality, particularly in low- and middle-income countries and needs careful evaluation and management for better outcome, where the resources are limited and the impact of the financial burden is very important. Advances in imaging have supported the shift from routine laparotomy to selective non-operative management (SNOM), but evidence from resource-limited settings remains scarce. To study the mode of blunt abdominal injury, role of various investigations modalities (FAST, CT scan) to detect various organ injuries and their application alongside good clinical evaluation in guiding treatment decision with the aim of reducing unnecessary surgical intervention, to evaluate the management outcomes of blunt abdominal injury in BAT at Al-Gamhoria Modern General Hospital, Aden, Yemen. Retrospective descriptive and analytical study was based on 67 patients,present to Algamhoria Modern General Hospital. Aden. Yemen. all cases were managed with blunt abdoninal injury The study was done on retrieving the records from the medical records department between 2018-2023 Data included demographics, mechanism of injury, clinical presentation, imaging, management, complications, and mortality. Most of the patients in our study were male (91,04%) and aged <30 years (74.63%). Road traffic accidents were the leading cause (67.16%). Conservative management initially was applied in 52 (77.61), out of 67 patients of these 4 went on to require surgical intervention due to failuer of conservative treament; in total 48 (71.64%) patients were managed non- operatively and 19(28.36%) were managed surgically. NOM has been very successful with rate of (92,3%) and failure occurred in 4 (7.7%), spleen 11(16.41%) was the commonest organ injured, followed by Liver 8(11,94%), kidney injury in 7(10.45%),, and the most common surgery performed was splenectomy 9 ( 13,43% ), most common extra- abdominal injury was thoracic 8(11,94 %) as a ribs fracture, heamothorax and pneumothorax and orthopedec 7 (10,45%) were mainly pelvic fractures, Imaging significantly influenced management: conservative rates were higher with CT (81.3%), FAST (70%), and CT+FAST (86.7%) compared with no imaging (16.7%). mortelity rate was 2 (2,98%). complication 6 (8,96 %) surgical site infection most common were in 4 (5,97%). Selective non-operative management of BAT is safe and effective in hemodynamic stable patients without peritoneal sings, particularly when supported by imaging. CT remains the most valuable tool, while FAST is indispensable for unstable patients. Expanding imaging capacity is critical to improving trauma outcomes in resource-limited settings.