Abdominal trauma in urban Papua New Guinea

BACKGROUND: Trauma is the commonest cause of surgical admission in Papua New Guinea, accounting for around 30% of cases in Port Moresby and over 40% in the highlands. The abdomen is traumatized in about 10-15% of trauma cases. In malarial endemic areas the enlarged spleen is particularly prone to rupture although earlier studies showed that this injury can often be managed conservatively. AIM: To determine the pattern and outcome of abdominal injury in the two largest cities, Port Moresby and Lae, in the 1990s. METHODS: A retrospective study of 213 adult admissions for abdominal trauma in Port Moresby and a prospective study of 98 adult abdominal trauma patients in Lae. In both centres malaria is endemic. Statistical analysis where appropriate was made using the chi2 test. RESULTS: Abdominal trauma was more likely to affect men outside the home and women in the home. Assault was responsible for 72% of cases of abdominal trauma. Women were assaulted by their husbands in two-thirds of cases. The spleen was the most likely organ to be injured, particularly in blunt trauma. Road traffic accidents caused only 10% of admissions with abdominal trauma. Most patients were admitted with a single injury. Splenic injury was managed nonoperatively in over 60% of cases. The negative laparotomy rate was 7% in Port Moresby and 20% in Lae, but negative laparotomy did not cause any deaths or extra morbidity. 17 patients (5.5%) died, the highest case fatality rate being 29% in a group of 31 patients with an injury severity score of 25 or greater. CONCLUSION: The pattern of abdominal trauma reflects the culture of Papua New Guinea and the different spectrum of risks to men and women. Once patients reach hospital they tend to do reasonably well although there is room for improvement, particularly with early assessment of the extent of the injury. The enlarged spleen is prone to injury and in those cases requiring laparotomy it is difficult to conserve. Many cases of ruptured spleen can be treated nonoperatively.