DEVELOPING TRAUMA IN DEVELOPING NATIONS: A BLUNT ABDOMINAL TRAUMA IN KIBOGORA, RWANDA

Objectives: A 37 year old male with an unknown past medical history presents after a motorcycle collision (MCC) with blunt abdominal trauma. He initially presented to a traditional healer and then to an outside hospital (OSH). He was transferred to Kibogora Mission Hospital for worsening abdominal pain. On arrival, he was hemodynamically stable with tenderness in the left lower quadrant (LLQ) without peritonitis. Labs were notable for a white blood cell count of 6, hemoglobin/hematocrit 16/51, and an OSH chest X-ray (CXR) was negative for a pneumothorax. Fast exam was positive for free fluid in pelvis. It was decided to take the patient to OR for an exploratory laparotomy.

A midline incision was made to open the abdomen. Upon entering, no frank stool or blood was visualized. When running the bowel, a bucket handle injury was noted in the jejunum. A small bowel resection was performed, and repaired by a small bowel- small bowel hand sewn anastomosis. A fascial defect was noticed in the LLQ with areas of necrosis, which were then resected. Healthy fascia was approximated and closed. The superficial wound above the fascia was packed and left open. Post operatively, the patient was admitted to the intensive care unit (ICU) and started on Ceftriaxone, Flagyl, maintenance fluids, and kept nothing per oral (NPO) with a nasogastric tube in place. The patient became hypoxic on post operation day one and required 10 liters of oxygen sating 92-94% and was tachycardia to the 140s. Patient was found expired shortly after and time of death was called.

Many nations around the world operate with far less resources than what are available in the United States. This particular hospital had resources for labs during all hours, as well as a scope tower and ultrasound only available during the day in specific hospital rooms. In the ICU, vitals were checked twice daily and not recorded. Pulse oximetry was the only continuous monitor available. There were two ventilators and suctions machines which remained in the operating rooms. Increasing resource availability should be a goal for existing United States hospitals as items we considered old or broken would go a long way.

Methods:

Results:

Conclusion: