Evaluation of the outcome of non-operative management in blunt abdominal solid organ injury

Abstract

INTRODUCTIONBlunt injury to abdomen is one of the most common injuries caused by road traffic accidents. It can also result from fall from height, assault with blunt objects, industrial mishaps, sport injuries, bomb blast etc. The rapid deceleration cause the shearing force to tear tissues at interfaces between tissues that are relatively fixed compared to surrounding structures or crush the tissues between external force and vertebral column or rapidly raise the intra-abdominal pressure from external compression causing rupture of hollow organs. The advent of newer imaging techniques with high resolution Computerised Tomography (CT) scanners has enabled the clinicians to exactly diagnose the extent of the intra-abdominal injuries. These injuries are commonly managed by surgery, but the shift to selective non operative management (NOM) of blunt injuries to abdominal solid organs is one of the most notable trends in the care of trauma. The increasing use of non-operative management is based on low failure rates reported in most of the retrospective studies.2 Preservation of the spleen was initially applied in paediatric trauma and later in adults with success rate of 90-95% in children and only 70-80% in adults. Non ABSTRACT Background: Blunt injury to abdomen is one of the most common injuries caused by road traffic accidents. The advent of newer imaging techniques with high resolution Computerised Tomography (CT) scanners has enabled the clinicians to exactly diagnose the extent of the intra-abdominal injuries. These injuries are commonly managed by surgery, but the shift to selective non operative management (NOM) of blunt injuries to abdominal solid organs is one of the most notable trends in the care of trauma. Methods:The present study is a prospective one to evaluate the outcome of non-operative management of blunt trauma abdomen conducted at Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai from the month of April 2011 to September 2013. Results: Out of 50 cases, the most common organ to be injured was the liver (32 cases) and of which 27 cases were managed by non-operative method and it is statistically significant (p=0.008). Of the 50 patients, 15 patients got converted. 8 patients (16%) were converted due to fall in Hb, 6 patients (12%) converted due to fall in Hb and hypotension, and one patient (2%) was converted due to persistent fever and features of peritonitis. 35 patients were managed conservatively. 12 out of 15 patients (80%) who underwent laparotomy developed complications, in comparison only 5 out of 35 patients (15%) who were treated conservatively had complication. Conclusions: In our study, non-operative management was successful in 70% of the patients with good outcome.

A prospective observational study of outcome of conservative management in blunt abdominal trauma

“…Blunt injury of abdomen as one of the most common injuries caused by road traffic accidents has been reported by many studies. [10] John S et al [9] also reported most common mode of injury was due to Road traffic accidents in their study from Chennai.…”

“…Mortality was also higher in the converted group in study done in Oman by Raza M. [29] . John S et al [9] reported that mortality was also higher in the operative group. Malhotra et al [31] and Schroeppel and Croce [32] reported that non-operative management significantly improved outcomes over operative managements in terms of decreased abdominal infections, decreased transfusions and decreased lengths of stay.…”