Early Post-Operative Complications Following Exploratory Laparotomy in Patients with Abdominal Trauma

Laparotomy in patients who have sustained abdominal trauma is a common surgery performed in order to evaluate and treat any intra-abdominal damage [1]. Reasons for performing this procedure usually include either blunt or penetrating trauma if the clinician suspects damage to an organ or presence of intraperitoneal bleeding or peritonitis [2]. This surgery requires the clinician to make an incision in the abdomen to examine internal organs, which may be the liver, spleen, bowel, and blood vessels [3]. While the choice to conduct a laparotomy is made based on clinical presentation, hemodynamic instability, and diagnostic tools like FAST and CT scans, the need for this procedure can sometimes be urgent [4].

 Early complications after surgery are very common in exploratory laparotomy and significantly impact the patient’s recovery process. Wound infection is one of the most common complications, developing due to trauma or during the procedure, manifesting itself through signs such as redness, discharge, and poor healing [5]. Bile leakage is another major complication, especially if there is damage to the liver and biliary system, when bile leaks into the abdominal cavity and causes inflammation and infection [6]. Another severe complication associated with this procedure is wound dehiscence, also known as “burst abdomen,” when the surgical wound splits open partly or entirely because of poor wound healing, infection, or increased pressure in the abdomen [7].

 Septicemia is a critical and potentially lethal complication which may develop secondary to poorly controlled infection, especially if the source of infection is intra-abdominal or associated with wounds [8]. Should it progress untreated, it could lead to systemic inflammatory reaction syndrome, organ dysfunction, and increased risk of mortality [9]. The following predisposing factors increase the possibility of developing such complications: delayed presentation, severity of the injury, malnutrition, and postoperative care deficiency [10].

 The justification behind carrying out this research in Khyber Pakhtunkhwa is the high prevalence rate of abdominal injuries, mainly attributed to road traffic injuries, interpersonal assaults, and lack of safety precautions in the region.

 Objective

This research will be undertaken with the aim of determining the causes of postoperative complications and reducing the mortality and morbidity rate associated with exploratory laparotomy for abdominal injuries. The purpose of this study is to find out the incidence rate of early postoperative complications associated with exploratory laparotomy.

This descriptive study was carried out in the General Surgery Department of MTI LRH over a duration from 20th July 2025 to 20th November 2025. The ethical approval certificate number was Ref No. 229/LRH/MTI dated 02/06/2025. The sample size was calculated as 76 by using WHO sample size calculator, taking expected frequency of bile leak as 5.2%,11 margin of error 5% and confidence level 95%.

 Inclusion criteria: Patients of age 25–70 years of either gender and presenting with abdominal trauma as defined above were included in the study.

 Exclusion criteria: Patients having pre-existing chronic abdominal conditions, pregnancy, or immunocompromised status were excluded from the study.

 Before starting data collection, informed written consent was taken from all patients after explaining purpose, benefits and possible risks of study. Demographic variables including age and gender were recorded for each patient. Patients having abdominal trauma were identified on clinical evaluation, where blunt trauma was considered when abdominal tenderness, pain (VAS>3), and hematuria were present, while penetrating trauma was considered when entry or exit wound, pain (VAS>3), and tenderness were present. Exploratory laparotomy was carried out as opening of abdominal cavity through midline incision for direct visualisation and management of intra-abdominal organs.

 Patients were then followed up for 30 days after procedure for occurrence of early post-operative complications. Early post-operative complications were assessed during follow-up period. Wound infection was taken when there was redness, pain (VAS>3), warmth and purulent discharge at wound site on clinical examination. Bile leak was considered when ultrasound showed anechoic or hypoechoic fluid collection in subhepatic or perihepatic region in patients having abdominal pain (VAS>3), fever and jaundice. Dehiscence of wound was described as partial or complete tearing apart of the surgical wound. Paralytic ileus was described as showing uniform dilatation of both small and large bowel loops on radiology in patients who presented with distended abdomen and nausea/vomiting. Sepsis was described as finding of growth of either bacterium or fungus in one or more blood cultures from patients who had at least two of the following: respiratory rate >22/min, altered sensorium, or blood pressure <100 mm Hg.

 Data was analysed using SPSS version 25. Numerical variable like age was presented as mean ± standard deviation or median with interquartile range. Categorical variables including gender, early post-operative complications, clinical presentations and residence area were presented as frequencies and percentages. Stratification of early post-operative complications was done with respect to age, gender, clinical presentations and residence area to assess effect modifiers. Post-stratification Chi-square test or Fisher’s exact test was applied and p-value <0.05 was considered statistically significant.

 

The results show that infection of wounds is the most common complication, being experienced by 29 patients (38.2%), followed by septicemia with 11 patients (14.5%), wound dehiscence for 8 patients (10.5%), and paralytic ileus for 6 patients (7.9%), with the least common complication being bile leak for only 3 patients (3.9%). The high prevalence rate of infection might be associated with poor handling of tissues and delayed presentation due to the presence of bacteria and contaminants that would hinder the healing process. The increased number of patients with septicemia could result from systemic inflammation and the transfer of bacteria from the gut wall. Furthermore, there was a significant higher number of patients with wound infection from the rural community (22 patients, 47.8%) compared to the urban community (7 patients, 23.3%). Such an observation could arise from poor sanitation, delayed presentation, and lack of facilities for wound treatment in the rural areas. Bile leakage and paralytic ileus showed a significant relationship with the development of pain, implying that pain is an important factor that could denote internal injury to the bowel and biliary ducts.

 The findings of present study showed wound infection as most common complication 29 (38.2%), which is comparable with Bhatti AA et al. 12 reporting 24% and Bansal AR et al. 13 showing wound complications 33%, though slightly higher in current data, possibly due to trauma-related contamination and delayed intervention. Similar trend also observed by Amrit P et al. 14 with wound complications 33% and Chauhan S et al. 15 with 11.4%, however lower rates in some studies may be due to better perioperative care and early management. Septicaemia 11 (14.5%) in present findings is higher than Chauhan S et al. 16 reporting 8% and Chaudhary SH et al. 17 showing 5.6%, which may be explained by severity of abdominal trauma and higher risk of systemic infection in such patients.

Wound dehiscence 8 (10.5%) is nearly similar to Bhatti AA et al. 12 (10.67%) and Iqbal S et al. 18 (10.1%), suggesting consistent pattern related to poor wound healing, infection and increased intra-abdominal pressure. Paralytic ileus 6 (7.9%) is lower than Amrit P et al. 14 and Bansal AR et al. 13 (26%), possibly due to variation in patient selection and early mobilisation practices. Bile leak 3 (3.9%) remained least common, which is expected finding due to limited hepatobiliary injuries, also supported indirectly by trauma distribution described in Pooria A et al. 19

 Higher wound infection in rural population 22 (47.8%) is in line with general observations of increased complications in resource-limited settings, although not directly quantified in most studies, but Hatewar A et al. 20 suggested influence of socio-demographic factors on outcomes. Lack of significant association with age and gender is consistent with Iqbal S et al. 18 where no demographic impact was noted, possibly indicating that surgical and injury-related factors play more dominant role than baseline characteristics. Overall, complication burden observed is comparable with multiple emergency laparotomy studies such as Murtaza B et al. 21 (33.7%) and Chauhan S et al. 15 (36.57%), though slightly higher rates in present findings may be due to trauma-specific pathology and late presentation.

Limitations

The limitation of this study is that it was done on a single-center basis. This can be seen as a factor that affects the ability to generalize from the results. Another limitation that could affect the strength of the research is that a smaller sample size was used in the experiment. Non-probability sampling increases the chances of having a bias in the study.

Conclusions of our study show that early complications following exploratory laparotomy for abdominal trauma are prevalent, with the majority of patients developing wound infections as the leading complication. Septicaemia, wound dehiscence, and paralytic ileus were other complications encountered by the subjects in our study group. Being from rural settings and having specific clinical presentations were linked with the development of complications.

 Disclaimer: None

Acknowledgement: The author thankful to the department medical staff for their support, as proper documentation and organised patient data handling helped in completion of this study.

Conflict of Interest: It is stated that no conflicts of interest was present in this study.

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