Consultant Kailash Hospital Greater Noida Ex Consultant Yashoda hospital Delhi NCR

Postoperative outcome of penetrating injuries of chest and abdomen: Our experience Dr A P S Bedi, Dr R K Sisodia, Dr R P Singh, The objective of this study was to evaluate the post operative outcome of penetrating injuries of chest and abdomen admitted at Kailash Hospital Limited at Greater Noida, Gautambudh Nagar, Uttar Pradesh, from January, 2014 to June, 2015. Only penetrating injuries were considered. Penetrating injuries to the chest and abdomen were considered; pure limb injuries were excluded from the study. Patients, who were critical and could not tolerate any kind of intervention, were excluded. This study was carried out retrospectively, evaluating data from 01/01/14 to 30/06/15. A total of thirty cases were operated, of penetrating injuries of abdomen and chest. Male patients were twenty nine in number and only one female with penetrating injury to chest was operated. Average age was 31 years (range 17 years to 46 years). Hospital stay was from 2 days to 22 days with mean of 7.4 days. Follow up period, including the telephone queries is from 1 to 18 months with a mean of 8.4 months. Overall mortality rate was zero for follow up of 8.4 months. One patient has a pending ileostomy closure. Bullet could not be retrieved in two cases. One bullet was impacted in pulmonary parenchyma and could not be retrieved. Another patient had impacted bullet in body of second lumbar vertebra and surgical decision was taken by neurosurgeon for not to retrieve it, in view of associated operative morbidity Injury Charting Injury Number of cases
Haemothorax 8 (16%)
Haemoperitoneum 17(34%)
Liver Injury 5(10%)
Diaphragmatic injury 2(4%)
Stomach perforation 1(2%)
Duodenal Perforation 1(2%)
Small Intestine Perforation 7(14%)
Colonic Injury 5(10%)
Spleen Injury 3(6%)
Bladder Injury 1(2%)

Procedure Charting Chest tube (8), Laparotomy (13), Splenectomy (2), Resection Anastomosis (5), Ileostomy (3), Laparoscopy (4), Thoracoscopy (2). Discussion Incidence of penetrating injuries to chest and abdomen in Greater Noida, Gautambudh Nagar, is very high.Majority of penetrating injuries to the chest can be managed by chest tube insertion.This form of management is effective when there is no underlying major vessel or cardiac injury. Pulmonary contusions usually resolve over period of time. CT scan is helpful in delineating the extent of injuries and to evaluate the mediastenum. In our experience we used thoracoscopy for retrieving bullets from pleural cavity .CT scan have low sensitivity in diagnosing penetrating injuries to the diaphragm. These cases have higher sensitivity to be diagnosed on laparoscopy. Evisceration, peritonitis or hemodynamically unstable patients are indications for laparotomy. Laparoscopy is offered to hemodynamically stable patients, only. It is known that late presentation to the hospital, requirement of multiple blood transfusions and colonic injuries are poor prognostic predictors, in penetrating injuries. All the cases which we operated were within 6 hrs of admission to hospital. Five colonic perforations were also repaired. Laparoscopy was done in four cases, all were hemodynamically stable. One patient underwent serosal repair laparoscopically. In our audit of 30 postoperative patients in penetrating injury to chest and abdomen, with follow up of 8.4 months, we report zero mortality rate. We at our centre during this period (1/1/14to 30/6/15) had four penetrating injuries to chest and abdomen which could not reach operation theatre, secondary to possible vital structure injuries. Acknowledgements Special thanks to the Department of Anaesthesia and Critical care including Dr Verma, Dr Maithani, Dr Amar, Dr Kaur, Dr Neha and ICU Staff