DOI: http://dx.doi.org/10.18203/2349-2902.isj20183721

A study of role of non-operative management in blunt abdominal trauma with solid organ injury

Atish N. Bansod, Rohan Umalkar, Ambrish T. Shyamkuwar, Amar Singade, Priyanka Tayade, Neha Awachar

Abstract


Background: The present study of role of non-operative management in blunt abdominal trauma with solid organ injury was done to assess the feasibility and safety of non-operative management in hemodynamically stable patients and identify the causes, predictive factors to delineate the rate of non-operative management failure.

Methods: A longitudinal observational study was carried out from September 2013 to November 2015. All cases of blunt trauma abdomen with ultrasonological e/o solid organ injury and were hemodynamically stable were included in study.

Results: Total 138 cases presented with a history of blunt trauma abdomen of which 56 cases had ultrasonological evidence of solid organ injury. 8 cases were excluded as 6 of these were hemodynamically unstable at presentation while 1 had bowel perforation and another had severe head injury all requiring operative management. Maximum cases were of age group 21-30 years (41.66%) and 31-40 years (31.25%). 42 (87.5%) cases were male and 6 (12.5%) cases of 48 were females.  28 (66.67%) cases presented as Road Traffic Accident. 28 (66.67%) cases had abdominal pain as the commonest symptom while tenderness in 38 (79.17%) cases and tachycardia in 30 (75%) cases was the predominant sign. Most injuries were seen in spleen 23 (47.92%) cases f/b Liver with 14 (29.12%). Conservative management was successful in 40 (83.33%) cases and failed in 8 (16.67%) cases. Mortality of the study was 1 (2.08%) case.

Conclusions: Non-operative strategy is a successful approach in patients who are hemodynamically stable and authors strongly recommend it.


Keywords


Blunt trauma abdomen, Hemodynamically stable, Non-operative management

Full Text:

PDF

References


Paden M, McGee K, Krug E. Injury: a leading cause of the global burden of disease. Geneva, Switzerland: World Health Organization; 2000. Available at:

http://www.who.int/iris/handle/10665/42624

Moore FA, Davis JW, Moore EE, Cocanour CS, West MA, McIntyre RC. Western Trauma Association (WTA) critical decisions in trauma: management of adult blunt splenic trauma. J Trauma. 2008;65:1007-11.

Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: spleen, liver, kidney. J Trauma. 1989;29:1664-6.

Norrman G, Tingstedt B, Ekelund M, Andersson R. Non-operative management of blunt liver trauma: feasible and safe also in centres with a low trauma incidence. HPB. 2009;11:50-6.

Fazili A, Nazir S. Clinical profile and operative management of blunt abdominal Trauma (BAT): a retrospective one year experience at SMHS Hospital, Kashmir India. JK Practitioner. 2001;8(4):219-21.

Ong CL, Png DJ, Chan ST. Abdominal trauma-a review. Singapore Med J. 1994 Jun;35(3):269-70.

Legome EL, Geibel J. Blunt abdominal trauma: practice essentials, pathophysiology, etiology. Medscape reference: drugs and diseases; 2010. Available at:

http://emedicine.medscape.com/article/1980980-overview#a6

Peitzman AB, Heil B, Rivera L. Blunt splenic injury in adults: multi-institutional study of the eastern association for the surgery of trauma. J Trauma. 2000;49(2):177-89.

Stein DM, Scalea TM. Nonoperative management of spleen and liver injuries. J Intensive Care Med. 2006;21:296-304.

Kozar RA, Moore FA, Moore EE, West M, Cocanour CS, Davis J et al. Western Trauma Association critical decisions in trauma: nonoperative management of adult blunt hepatic trauma. J Trauma Acute Care Surg. 2009;67(6):1144-9.

Li M, Yu WK, Wang XB, Ji W, Li JS, Li N. Non-operative management of isolated liver trauma. Hepatobiliary Pancreat Dis Int. 2014;13(5):545-50.

Bergen CT, Chan TN, Bodzin JH. Intravenous pyelogram results in association with renal pathology and therapy in trauma patients. J Trauma. 1987;27:515.

Santucci RA, Wessells H, Bartsch G, Descotes J, Heyns CF, McAninch JW, et al. Evaluation and management of renal injuries: consensus statement of the renal trauma subcommittee. BJU Int. 2004 May;93(7):937-54.

Lynch TH, Martinez-Pineiro L, Plas E, Serafetinides E, Turkeri L, Santucci RA, et al. European Association of Urology. Eur Urol. 2005;47(1):1-15.

Summerton DJ, Djakovic N, Kitrey ND, Kuehhas FE, Lumen N, Serafetinidis E, et al. Guidelines on Urological Trauma. © European Association of Urology 2015. Available at:

http://uroweb.org/guideline/urological-trauma.

Maarouf AM, Ahmed S, Salema B, Zaiton. Factors predicting the outcome of non-operative management of high-grade blunt renal trauma. African J Urol. 2015;21:44-51.

Wood JH, Partrick DA, Bruny JL, Sauaia A, Moulton SL. Operative vs nonoperative management of blunt pancreatic trauma in children. J Pediatr Surg. 2010;45:401Y406.

Paul MD, Mooney DP. The management of pancreatic injuries in children: operate or observe. J Pediatr Surg. 2011;46:1140Y1143.

Cuenca AG, Islam S. Pediatric pancreatic trauma: trending toward nonoperative management. Am Surg. 2012;78(11):1204-10.