Blunt trauma to abdominal solid organs: an experience of non-operative management at a rural hospital in Zambia

Abstract

Introduction although non-operative management of patients with blunt trauma to abdominal solid organs has become standard care, the role of peripheral hospitals remains poorly defined. This study reviews treatment and outcomes in patients with liver and spleen injuries at a regional hospital over a 10-year period. Methods a retrospective review of prospectively collected data was performed and supplemented by case notes retrieval. All patients with solid visceral injuries managed between 2009 and 2019 at a rural surgical hospital in Zambia were included. On admission, the patients were offered either urgent laparotomy or non-operative management (NOM) depending on their haemodynamic status. Continuous variables were expressed as median and mean ± standard deviation; categorical data were expressed as percentages. Statistical evaluation of data was performed by two-sample t-test. Statistical significance was assigned at p<0.05. Results fourty-three patients were included. The majority of victims sustained isolated spleen or liver injury. Twenty-three patients were urgently operated due to haemodynamic instability. Splenectomy performed in 17 patients, liver laceration sutured in 5 patients. One patient underwent concomitant splenectomy and liver repair. Conservative management was attempted in 20 (47%) patients and was successful in 18 (42%). In two patients NOM failed and splenectomy was performed urgently. Two patients died postoperatively. There were no deaths in NOM group. Conclusion NOM of patients with injury to solid abdominal organs could be safely initiated in rural hospitals provided there is uninterrupted monitoring of patients' condition, well-trained staff and unrestricted access to the operating theatre (OT).

Hazard Ratio of 90-Day Mortality in ICU Patients with Abdominal Injuries Compared with Head Injuries

“…[32][33][34] Moreover, involvement of multiple organs in intra-abdominal injuries and the presence of associated extra-abdominal injuries in addition to abdominal injuries result in severe injuries and subsequently influence the patients' outcomes. [35][36][37] This evidence indicates the need for a coordinated trauma care system and properly trained personnel to take care of abdominal injuries in trauma patients. A team approach is essential for successful management of the injured patient.…”

Conservative management of multi-trauma induced peritonitis: Experience, outcomes, and indications

“…Their conditions may deteriorate if an inappropriate exploratory laparotomy is performed, causing serious physiological dysfunction, even death[ 4 ]. The recent study retrospectively reviewed 43 cases of blunt trauma to abdominal solid organs and found 20 (47%) cases attempted conservative management with successful rate of 90% (18 out of 20 cases)[ 5 ]. We aim to review the outcomes of conservative management of traumatic peritonitis and explore the indications for managing it conservatively.…”