ORIGINAL RESEARCH

Section: Forensic Medicine

[Link]

Assessment of the Forensic Autopsies due to Blunt Injury Abdomen

among the Patients Admitted to the Hospital - A Retrospective Study
M. Sugatha1, Kranthi Kumar2

It is a major contributor to global mortality and morbidity

ABSTRACT with a notable difference between Low Income Countries
Introduction: Blunt injury in the abdomen is seen more (LIC) and High to Moderate Income Countries (HMIC).
commonly because of rapid industrialization and increased The modality of trauma differs globally however the most
number of vehicles ultimately leading to more number notable cause is pedestrian vs. vehicle and road traffic
of accidents. It can occur as a result of fall from height, collision respectively. It is imperative that patients who have
assault with blunt objects, sports injuries, and bomb blasts. sustained a traumatic injury are managed in an appropriate
In majority of the cases, blunt injury was the cause of death.
and timely manner.5
In criminal violence, blunt injuries lead to death and more of
Abdominal injury is a significant cause of morbidity and
forensic importance. The aim of the present study was to make
a pattern of blunt abdominal injuries, which were fatal and
mortality; expedient diagnosis and treatment of intra-
resulted in death. abdominal injuries are essential to prevent morbidity and
Material and methods: A total of 160 cases of deaths from death. In this era of modern technology, the rate of road
blunt abdominal trauma from 1st July 2011 to 30th June 2013 accidents has increased rapidly due to high speed engines
were included in the study. Demographic details about age, in automobiles. The reason of these injuries is due to the
gender, occupation brief facts of the cases collected from the evolution of mass production of automobiles which leads to
inquest report were entered. Patterns of death and types of the creation of explosive compounds capable of producing
injuries were studied and the data was collected through a pre- sufficient compression forces resulting into the highest
designed format. impact on human body leading to severe bleeding from the
Results: The most common age group affected with blunt major organs.6
abdominal injuries was 20-40 years followed by above 40
The other causes include assaults, industrial accidents and
years and below 20 years. The main cause of injury was found
falls from height. Mortality rates are quite higher among
to be due to road accidents. The most common organ involved
in blunt injury of abdomen was liver followed by intestine patients with blunt abdominal trauma than in those with
and spleen. The mechanism of death was found to be due to penetrating wounds, because of the lack of early diagnostic
hemorrhage. facilities and optimal management. Consequently, it becomes
Conclusion: Injury to abdomen is considered to be the most dangerous because it is difficult to assess pathologies in
common reason for morbidity and mortality among the poly-trauma victims.7
general population. From the previous literature, a study done by Naghavi et
al stated that trauma leads to more deaths than HIV/AIDS,
Keywords: Blunt Injury Abdomen, Death, Inquest, Spleen
tuberculosis and malaria combined, even when intentional
self-harm is not considered. An estimated 1.5 million people
died in traffic collisions and road related accidents during
INTRODUCTION 2013 and when Years Life Lost (YLL) was calculated
Trauma or injury has been defined as damage to the body according to 15% increase since 1990, and death by trauma
caused by an exchange with environmental energy that is has moved up the ranking scale from 9th to 5th place globally.
beyond the body’s resilience.1 It is the most common cause The most common causes of death in Road Traffic Accidents
of death for all individuals between the ages of 1 and 44
years. Globally, injury is the seventh leading cause of death, Associate Professor, Department of Forensic Medicine, Osmania
1

with 5.8 million deaths attributable to trauma. According to Medical College, Hyderabad, 2Ex- Postgraduate Student,
the World Health Organisation by the year 2020, trauma will Department of Forensic Medicine, Osmania Medical College,
become the first or second leading cause of death over all Hyderabad. India
ages.2 Corresponding author: M. Sugatha, Associate Professor,
Abdominal trauma has been traditionally classified as Department of Forensic Medicine, Osmania Medical College,
either blunt or penetrating. Penetrating abdominal trauma Hyderabad. India
can usually be diagnosed easily and reliably, whereas blunt
abdominal trauma is often missed because clinical signs are How to cite this article: M. Sugatha, Kranthi Kumar. Assessment
less obvious. Blunt abdominal injuries predominate in rural of the Forensic Autopsies due to Blunt Injury Abdomen among
areas, while penetrating ones are more frequent in urban the Patients Admitted to the Hospital - A Retrospective Study.
International Journal of Contemporary Medical Research
settings. Penetrating abdominal trauma is often subdivided
2019;6(4):D4-D7.
into stab wounds and gunshot wounds, which require
different methods of treatment.3,4 DOI: [Link]

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International Journal of Contemporary Medical Research
Volume 6 | Issue 4 | April 2019 | ICV: 98.46 | ISSN (Online): 2393-915X; (Print): 2454-7379
Sugatha, et al. Forensic Autopsies due to Blunt Injury Abdomen

Section: Forensic Medicine

(RTAs) were attributed to accidents that takes place among 100
pedestrians which are struck by a vehicle (n=36%), motor 90
vehicle road injuries (n=33%) and motorcycle accidents 80
(n=17%).8 70
In contrast to penetrating injury, the decision to perform 60
laparotomy for blunt abdominal trauma is more complex 50
and difficult, because of structural injury being less obvious 40
and associated other injuries may necessitate more urgent
30
action. When laparotomy is performed, the surgeon should
20
keep a careful record of the injuries, which he observes, for
10
many of these are due to criminal violence and such cases
0
are important from forensic point of view. It may be difficult Below 20 years 20-40 years Above 40 years
to interpret the anatomic abnormalities to understand the
mechanism of death, and may require a lengthy explanation.9 Graph-1: Shows the distribution of age group among the study
subjects
Hence, the aim of the present study was to analyse the deaths
due to blunt injury abdomen, brought to the mortuary which
was both dead on arrival and dead after hospitalisation
and also to identify the commonest complications leading
to death in abdominal trauma with the mechanism
involved.
MATERIAL AND METHODS Male
The present study was a retrospective which was conducted Female
from 1st July 2011 to 30th June 2013 among patients admitted
in an Osmania General, Hospital. Total 160 patients were
admitted with the blunt abdominal trauma in two years.
Clinical history like time of admission, and deaths and other
relevant data was collected from the hospital case sheets and
death summaries. Detailed description was also taken for Graph-2: Shows the distribution of gender among the study
pattern, nature of injuries, complications, cause of death and subjects
mechanism of death from a detailed follow-up and study of
the autopsy cases and reports. % of organ involved
The deaths analyzed in this study were those whose cause % of cases involved
directly involved AT. Also, cases with trauma in other body 40%
35% 34%
regions were included such as the head, limbs and thorax,
as long as associated with AT in the mechanism of death. 30%
Cases presented with technical problems in the completion 25%
20%
of the reports, the duplicates, and the cases with types of 20%
16%
trauma could not be precisely defined, and those in which the 15%
death was due to trauma occurring exclusively in other body 10% 8% 8%
6% 6%
regions other than the abdomen were completely excluded 5% 2%
from the study. 0% 0%
0%
STATISTICAL ANALYSIS
The data was entered in the Microsoft excel sheet and the
Graph-3: Shows the common organ involved in blunt injury of
statistical analysis was done by using SPSS software version
abdomen
21. Descriptive statistics was performed using frequency and
percentages which was presented in the form of tables and
graphs. abdomen. It was found that liver (34%) was most common
organ followed by intestine (20%) and spleen (16%). Table
RESULTS no. 1 shows the associated injuries of abdomen and was
In the present study, the most common age group affected found that head injury (35%) was most commonly involved
with blunt abdominal injuries was in the age group of 20-40 with chest (32.5%) followed by pelvis (10.6%) and spine
years and there were only 24 cases below 20 years followed injuries (10%). Also, there were cases that died due to the
by 42 cases above 40 years (Graph-1). Graph no. 2 depicts involvement of multiple injuries (11.8%).
distribution of gender; it was found that out of 160 cases, Table no.2 shows the mechanism due to which the patient’s
72.5% were males and 27.5% were females. Graph no. death takes place. Around 66.5% death occurs due to
3 depicts the percentage of organ involved in blunt injury haemorrhage followed by infection (27.5%) and neurogenic

International Journal of Contemporary Medical Research D5

ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 98.46 | Volume 6 | Issue 4 | April 2019
 Sugatha, et al. Forensic Autopsies due to Blunt Injury Abdomen
Section: Forensic Medicine

Associated injuries No. of cases Percentage

Head injury 56 35%
Chest injury 52 32.5%
Pelvis 17 10.6%
Spine injury 16 10%
Multiple injuries 19 11.8%
Total 160 100%
Table-1: Shows the injuries of abdomen associated with head injury and chest injury

S. No. Type of mechanism Male Female Total Percentage

1. Shock Neurogenic (or) Visceral 08 02 10 6.25%
2. Hemorrhage 78 28 106 66.25%
3. Infection 26 18 44 27.5%
4. Total 112 48 160 100%
Table-2: Shows the mechanism of death among the study subjects

Period of survival Male Female Total Percentage

0 – 1 hour 56 18 74 46.25%
1 – 6 hours 24 14 38 23.75%
6 – 12 hours 14 8 22 13.75%
12 – 24 hours 8 3 11 6.85%
1 – 2 days 6 4 10 6.25%
2 – 7 days 2 1 3 1.8%
1 – 2 weeks 1 0 1 1.6%
More than 1 month 1 0 1 0.6%
Total 112 48 50 100%
Table-3: Shows the period of survival among the study subjects

shock (6.25%). Table no. 3 shows the period of survival damaged organs in cases of penetrating AT necropsied was
among the cases and it was found that maximum number liver, followed by the intestines both in gunshot and stabbing
(46.25%) of cases died within the time period of 0-1 hour victims. Although there are regional variations, the reverse is
followed by 1-6 hour. Least number of cases died after 1-2 epidemiologically observed, with intestines more damaged
(1.6%) weeks and 2-7 days (1.8%). than the liver in this type of trauma.13
DISCUSSION Also, 4478 patients operated on due to penetrating AT
indicated that the intestines (duodenum, jejunum, ileum and
Due to rapid development of cities and development and
colon) were the most commonly affected abdominal organs,
construction of new factories, the incidence of cases of blunt
followed by the liver, stomach and kidneys. The same finding
abdominal trauma has increased. Injuries in blunt abdominal
was observed in a study done by Florianópolis et al. Liver
trauma have a wide variety of spectrum. It can range from
lesions by penetrating AT show higher mortality rates than
no any organ injury to multi-organ injury. In some cases,
intestinal lesions, reaching 22% in gunshot wound cases and
there may be associated head or chest or any other injuries,
8% in stabbing ones, which explains their high prevalence in
in such circumstances it is difficult to perform abdominal
examination. So, each poly-trauma patient has to be IML-BH penetrating necropsies.13
thoroughly investigated in addition to clinical examination. Although the liver was the most commonly injured abdominal
In the present study, 70% cases were males and 30% were organ in penetrating AT in the present study, there were
females and this increased incidence of trauma in male is predominantly more lesions in the intestines, stomach and
attributed to their work outside house, frequent travelling, large abdominal vessels of individuals who were victims of
more social activities and influence of alcohol sometimes. penetrating trauma compared with victims of blunt trauma.
This finding is in concordance with studies conducted by It is noteworthy that isolated hepatic lesions due to gunshots
Kamawat JL, Panchal HA and Aziz A. In the present study, are not common, these being usually associated with other
blunt abdominal trauma due to road traffic accidents were lesions, particularly the right lung, diaphragm, right kidney
seen in 68% (most common), assault in 17%, fall down in and small intestine. Early deaths take place due to severe
12%, hit by animals in 2% and by blunt object in 1%.10,11,12 blood loss from the head, respiratory system, and abdominal
The major concern for surgeon is control of haemorrhage organs but these deaths are largely treatable and therefore
in blunt trauma but how it can be best done with safety and possibly preventable. Furthermore, the late death occurs
less morbidity, depends on grade, severity and site of injury. due to infection and multi organ failure. Decreasing these
In a study done by Bordoni PHC et al revealed that the most numbers of injury-related deaths during each period depends

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International Journal of Contemporary Medical Research
Volume 6 | Issue 4 | April 2019 | ICV: 98.46 | ISSN (Online): 2393-915X; (Print): 2454-7379
Sugatha, et al. Forensic Autopsies due to Blunt Injury Abdomen

Section: Forensic Medicine

upon the expedient and optimal medical care. 11. Kumawat JL, Mathur PN, Mathur K, Mehta FS. A
In order to minimize mortality in cases of abdominal retrospective study of blunt trauma abdomen. J Evol
trauma, risk factors for mortality need to be systematically Med Dent Sci. 2015;4:10263-9.
identified and studied. In recent years, studies have identified 12. Panchal HA, Ramanuj AM. The study of abdominal
trauma. Int Surg J. 2016; 3:1395.
a number of such risk factors, including sex, the length of
13. Aziz A, Bota R, Ahmed M. Frequency and Pattern
the interval between abdominal injury and surgery, shock at
of Intra-abdominal Injuries in Patients with Blunt
the time of admission, and cranial injury. Injuries in blunt Abdominal Trauma. J Trauma Treat. 2014; 3:196.
abdominal trauma have a wide variety of spectrum. It can 14. Bordoni PHC et al. Deaths from abdominal trauma:
range from no any organ injury to multi-organ injury. In analysis of 1888 forensic autopsies. Rev Col Bras Cir.
some cases, there may be associated head or chest or any 2017; 44:582-595.
other injuries, in such circumstances it is difficult to perform 15. Smith J, Caldwell E, D'Amours S, Jalaludin B, Sugrue
abdominal examination. So, each poly-trauma patient M. Abdominal trauma: a disease in evolution. ANZ J
has to be thoroughly investigated in addition to clinical Surg. 2005; 75:790-4.
examination.14,15 16. Majid S, Gholamreza F, Mahmoud YM. New scoring
system for intra-abdominal injury diagnosis after blunt
CONCLUSION trauma. Chin J Traumatol. 2014; 17:19-24.
Majority of the victims were males. The age group of 20-
30 years accounts for total deaths due to blunt trauma of Source of Support: Nil; Conflict of Interest: None
abdomen. The most frequently noted cause of blunt injury
Submitted: 18-03-2019; Accepted: 09-04-2019; Published: 30-04-2019
abdomen was road traffic accidents followed by falls. The
incidence of death was high within 1-6 hours after sustaining
trauma. The liver was commonly injured organ followed by
intestine and spleen. The mechanism involved was found to
be haemorrhage due to which most of the death occurs.
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ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 98.46 | Volume 6 | Issue 4 | April 2019