XXXX in urban Papua New Guinea.

@entity1 @entity1661 @entity311 @entity3511 @entity204 @entity130
BACKGROUND: @entity130 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 @entity130 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 @entity3511 in the two largest cities, Port Moresby and Lae, in the 1990s. METHODS: A retrospective study of 213 adult admissions for @entity1661 in Port Moresby and a prospective study of 98 adult @entity1661 @entity1 in Lae. In both centres @entity311 is endemic. Statistical analysis where appropriate was made using the chi2 test. RESULTS: @entity1661 was more likely to affect @entity1 outside the home and @entity1 in the home. Assault was responsible for 72% of cases of @entity1661 . @entity1 were assaulted by their husbands in two-thirds of cases. The spleen was the most likely organ to be injured, particularly in @entity130 . Road traffic accidents caused only 10% of admissions with @entity1661 . Most @entity1 were admitted with a single injury. @entity130 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 @entity204 or extra morbidity. 17 @entity1 (5.5%) died, the highest case fatality rate being 29% in a group of 31 @entity1 with an injury severity score of 25 or greater. CONCLUSION: The pattern of @entity1661 reflects the culture of Papua New Guinea and the different spectrum of risks to @entity1 and @entity1 . Once @entity1 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.
