Volume : 08, Issue : 12, December – 2021

Title:

11.CONSEQUENCES OF CONSERVATIVE MANAGEMENT OF BLUNT ABDOMINAL TRAUMA

Authors :

Dr. Sumaria Komal, Dr. Moneeba Tahir, Dr. Tayyba irfan

Abstract :

Background: To assess the feasibility of Non-operative management of Blunt abdominal trauma in a teaching hospital of Pakistan.
Methods: A prospective observational study was carried out over a period of 3 years including 52 cases of blunt abdominal trauma in a teaching hospital in Pakistan . Patient and trauma characteristics of the cases, different modalities of treatment and outcomes were evaluated. All the cases were divided in 3 groups: Operative group, Non-Operative Management and Non-Operative Failure group. Operative group and non-operative management group were compared using Fischer Exact Test for categorical variable and student’s “t” test for continuous variable.
Results: There were 36% of cases in operative group, 61% in nonoperative management group and 2% in non-operative management failure group. Non-operative management was successful in 97% of cases. Injury severity score, admission hematocrit and hemodynamic status were significantly different between non-operative management and Operative group. Non-operative management failure occurred in 1 case and was secondary to delayed hepatic hemorrhage.
Conclusion: Non-operative management of Blunt abdominal trauma can be attempted with high degree of success. Hemodynamic and clinical instability rather than severity of the organ injury is the predictor of failure in non-operative management. Spleen and bowel injury are the most common organ that usually land up in operative group because of hemodynamic instability in splenic injury and peritoneal contamination in bowel injury. Close surveillance in an intensive care unit is always desirable.

Cite This Article:

Please cite this article in press Sumaria Komal et al, Consequences Of Conservative Management Of Blunt Abdominal Trauma., Indo Am. J. P. Sci, 2021; 08(12).

Number of Downloads : 10

References:

1. Keller MS. Blunt injury to solid abdominal organs. Semin Pediatr Surg 2004;13:10611.
2. Leung E, Wong L, Taylor J. Non-operative management for blunt splenic trauma in children: An updated literature review. Surgical Practice 2007;11:29-35.
3. Yanar H, Ertekin C, Taviloglu K, et al: Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. J Trauma 2018;64:94348.
4. Thompson SR, Holland AJ. Current management of blunt splenic trauma in children. ANZ J Surg 2006;76:48-52.
5. American College of Surgeons: ATLS Advanced Trauma Life Support Program for Doctors. Chicago, IL, USA 7th edition. 2004.
6. AAST Injury Scaling and Scoring System. Trauma Tools – The American Association for the Surgery of Trauma .
7. Schwab CW. Selection of non-operative management candidates. World J Surg 2001;25:1389-92.
8. Knudson MM, Maull KI. Non-operative Management of solid organ injuries- Past, Present and Future. Surg Clin North Am 1999;79:1357-71.
9. Christmas AB, Wilson AK, Manning B, et al. Selective management of blunt hepatic injuries including nonoperative management is a safe and effective strategy. Surgery 2005;138:606-10.
10. McConnell DB, Trunkey DD. Non-operative management of abdominal trauma. Surg Clin North Am 1990;70:677-88.
11. Cadeddu M, Garnett A, Al-Anezi K, et al: Management of spleen injuries in the adult trauma population: a tenyear experience. Can J Surg 2006;49:386-90.
12. Meredith JW, Young JS, Bowling J, et al. Non-operative management of blunt hepatic trauma: the exception or the rule. J Trauma 1994;36:529-35.
13. Velmahos GC, Toutouzas K, Radin R, et al: High success with non-operative management of blunt hepatic trauma: the liver is a sturdy organ. Arch Surg 2003;138:475-80.
14. Kozar RA, Moore FA, Cothren CC, et al: Risk factors for hepatic morbidity following nonoperative management: multicenter study. Arch Surg 2006;141:451-8.
15. Huerta S, Bui T, Porral D, et al. Predictors of morbidity and mortality in patients with traumatic duodenal injuries. Am Surg 2005;71:763-67.