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J Korean Surg Soc. 1997 Oct;53(4):492-499. Korean. Original Article.
Kim KH , Lee HI , Ryu SK , Sung CK .
Department of Surgery, Dong Kang General Hospital, Ulsan, Korea.
Abstract

Traumatic hemoperitoneum can still induce high mortality and morbidity rates, despite current method of intensive management. This study was performed to identify the independent prognostic factors in patients with traumatic hemoperitoneum. Two hundred thirty-six patients who underwent emergency operations because of traumatic hemoperitoneum at the Department of Surgery, Dong Kang General Hospital, Ulsan, from January 1986 to June 1994, were entered into this retrospective study. One hundred eighty-six patients were male, and fifty were female. The median age of the patients was 34 years (2 to 77 years). The modes of trauma were 131 motor-vehicle accidents, 43 fall down injuries, 30 stab injuries, 23 assaults, and 9 others . The common sites of injury were lthe iver and the spleen, followed by the mesentery, the stomach, the small bowels, the large bowels, the pancreas, the kidney, the diaphragm, and the retroperitoneum in order of frequency. Prognostic variables were identified from the perioperative parameters by using a univariate analysis(student t- test, chi-square test), and independent prognostic factors were determined by a multivariate stepwise logistic regression analysis, using the SPSS Win. Ver.5.0 PC package program. Statistical significance was present for p < 0.05. The overall postoperative morbidity and mortality rates were 34.3% and 19%, respectively. By using univariate analysis, the amount of bleeding, transfusion, and the immediate post-operative blood pressure were identified as significant prognostic factors for morbidity. Also age over 50, accompanying brain injury, time interval (less than 3 hrs), the systolic blood pressure on arrival (less than 100 mmHg), trauma score (less than 10), grade of liver injury (greater than IV), great vascular injury, total amount of resuscitative fluid (more than 4,000cc), the total amount of transfusion (more than 10 units), and the immediate postoperative systolic blood pressure (less than 100 mmHg) were identified as significant factors for mortality. Multivariate analysis demonstrated the following important independent prognostic factors : the total amount of transfusion for morbidity and mortality, and the post-operative blood pressure and trauma score for mortality. Our results suggest that early massive resuscitation, early operation to minimize the total amount of blood loss, and intensive immediate postoperative care to maintain blood pressure, are of utmost importance in multiple trauma patients with hemoperitoneum.

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