Non-operative management for abdominal solidorgan injuries: A literature review

Kanlerd, Amonpon; Auksornchart, Karikarn; Boonyasatid, Piyapong

doi:10.1016/j.cjtee.2021.09.006

Cited by 10 publications

(11 citation statements)

References 64 publications

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“…The management of solid injuries is predominantly nonoperative in hemodynamically stable patients, and angioembolization is a useful adjunct to solid organ preservation [6]. The success rates of nonoperative management have been reported to be approximately 86% in splenic trauma [4], 97% in hepatic trauma [7], and 92% in renal trauma [8].…”

Section: Discussionmentioning

confidence: 99%

Successful nonoperative management of a simultaneous high-grade splenic injury and devascularized kidney in Australia: a case report

Nguyen,

Hsu

2023

J Trauma Inj

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Severe blunt injuries to isolated solid abdominal viscera have been previously managed nonoperatively; however, management algorithms for simultaneous visceral injuries are less well defined. We report a polytrauma case of a 33-year-old man involved in a motorbike collision who presented with left-sided chest and abdominal pain. Initial imaging demonstrated multiple solid organ injuries with American Association for the Surgery of Trauma (AAST) grade V splenic injury and complete devascularization of the left kidney. The patient underwent urgent angioembolic coiling of the distal splenic artery with successful nonoperative management of simultaneous grade V solid organ injuries.

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Section: Discussionmentioning

confidence: 99%

Successful nonoperative management of a simultaneous high-grade splenic injury and devascularized kidney in Australia: a case report

Nguyen,

Hsu

2023

J Trauma Inj

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“…Low grades of solid organ injury (I-III) as a dictum are managed with NOM. High-grade damage, extensive hemoperitoneum, active bleeding symptoms on CT scan, older patient age, and multiple solid organ injury are all risk factors for NOM failure [ 8 , 9 ]. The present case suffered Grade V injuries (shattered spleen and left kidney) and was successfully managed with NOM.…”

Section: Discussionmentioning

confidence: 99%

Successful non-operative management of multiple intra-abdominal solid organ injury after blunt abdominal trauma: a case report

Mahawar¹,

Shinde²,

Jogdand³

2022

Pan Afr Med J

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Injuries to the solid abdominal viscera are common after blunt trauma. The success of non-operative management of these injuries has led to recent extensions of this approach to managing higher-grade, more complicated injuries that are typically treated operatively. We reported a 19-year-old male who presented with abdominal pain and gross hematuria during the late hours due to a motor vehicle accident. Abdominal computed tomography scan revealed moderate hemoperitoneum, extensively devascularized spleen with laceration extending into the hilum, multiple tears in the left kidney extended to the hilum, and large perinephric hematoma suggestive of Grade V injuries (shattered spleen and left kidney). We managed the patient non-operatively until he improved and became ready for discharge from the hospital in stable good health status. In conclusion, this case brings to light a unique instance where severe grade multiple solid organ injury was successfully managed with a conservative approach.

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“…It is suggested to have follow-up imaging, especially in patients at higher risks for biliary complications, such as high-grade injury, central hepatic injury and post main hepatic artery embolization, as well as in patients with the onset of non-specific abdominal complaint, developing jaundice or abruptly elevated liver enzymes [ 7 , 27 ].…”

Section: Computed Tomography (Ct)mentioning

confidence: 99%

“…Thus, it is suggested to repeat the 48 h CT scan in patients with a high-grade renal injury (grades IV-V) and in patients who have signs and symptoms of complications such as high-grade fever, persistent/worsening back pain, ongoing blood loss, intermittent gross hematuria, hypertension and abdominal distension after 48 h of admission ( Figure 7 ) [ 7 ]. Furthermore, consider that in patients with large perinephric hematoma and deep parenchymal injury, a collecting system injury may be obscured [ 7 ], and so it is prudent to re-image these patients, including in the CT protocol late-phase acquisitions ( Figure 7 ).…”

Section: Computed Tomography (Ct)mentioning

confidence: 99%

“…Computed Tomography (CT) represents the “gold standard” imaging technique in the first-line evaluation of polytraumatized patients [ 1 , 2 , 3 ], as it ensures high diagnostic accuracy, rapid execution time, and hospital availability; however, once the diagnosis is made and the patient is stable, a series of possibilities open up regarding the best diagnostic imaging tool to choose for monitoring the diagnosed lesions or detecting complications, depending on the involved anatomical structures, the grade of each injury, and the availability and expertise of each imaging method [ 4 , 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

et al. 2023

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In the transition from the operative to the conservative approach for the polytraumatized patients who undergo blunt trauma, diagnostic imaging has assumed a pivotal role, currently offering various opportunities, particularly in the follow-up of these patients. The choice of the most suitable imaging method in this setting mainly depends on the injury complications we are looking for, the patient conditions (mobilization, cooperation, medications, allergies and age), the biological invasiveness, and the availability of each imaging method. Computed Tomography (CT) represents the “standard” imaging technique in the polytraumatized patient due to the high diagnostic performance when a correct imaging protocol is adopted, despite suffering from invasiveness due to radiation dose and intravenous contrast agent administration. Ultrasound (US) is a readily available technology, cheap, bedside performable and integrable with intravenous contrast agent (Contrast enhanced US—CEUS) to enhance the diagnostic performance, but it may suffer particularly from limited panoramicity and operator dependance. Magnetic Resonance (MR), until now, has been adopted in specific contexts, such as biliopancreatic injuries, but in recent experiences, it showed a great potential in the follow-up of polytraumatized patients; however, its availability may be limited in some context, and there are specific contraindications, such as as claustrophobia and the presence non-MR compatible devices. In this article, the role of each imaging method in the body-imaging follow-up of adult polytraumatized patients will be reviewed, enhancing the value of integrated imaging, as shown in several cases from our experience.

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Non-operative management for abdominal solidorgan injuries: A literature review

Cited by 10 publications

References 64 publications

Successful nonoperative management of a simultaneous high-grade splenic injury and devascularized kidney in Australia: a case report

Successful nonoperative management of a simultaneous high-grade splenic injury and devascularized kidney in Australia: a case report

Successful non-operative management of multiple intra-abdominal solid organ injury after blunt abdominal trauma: a case report

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

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