Posted by Shefali Oza as told to her by Dr. Jhapat Bahadur Thapa, MBBS
A 12-year old boy from an area two hours walking distance from the Nyaya Health clinic was brought in after an abdominal injury. While looking after a grazing bull, the bull became aggressive and injured the boy’s lower abdomen. He arrived at our clinic at 6pm after being carried on a stretcher by his relatives.
During our initial observations, we found a 3 centimeter open wound in the lower abdomen (left iliac fossa) and the lining of the abdominal cavity was protruding through the wound. His vital signs were stable. We established intravenous access and quickly used the ultrasound to scan for free intraperitoneal fluid, which is an important indicator of dangerous abdominal trauma including hemorrhaging. The scan was negative. The ultrasound machine allowed us to check for this free fluid without requiring an on-site radiologist, since a trained physician can scan and interpret the results of the ultrasound image.
We then proceeded to close the wound. First, we gave the boy local anesthesia. We then extended the wound margins in order to have better access to the fascia, a strong connective tissue found throughout the body to support and protect the surrounding organs, muscles, and other body parts. We then closed this fascial layer, the overlying subcutaneous layer, and finally the skin.
Closing the open adominal wound with stitches.
The boy was admitted for overnight observation and received maintenance intravenous fluids as well as ceftriaxone and metronidazole, which are two antibiotics that, when given together, provide a simple and cost-effective treatment against abdominal infection. The following day the patient passed urine and had good bowel movements. He was also started on oral fluids.
On the 3rd day after his injury, the boy was discharged with oral antibiotics and his family was advised on wound care and to return for a follow-up visit. We were pleased that we were able to treat this child for an injury that was dangerous, particularly if left untreated.
The patient after his wound was closed and dressed by the Nyaya Health staff.
