Nonoperative management of solid abdominal organ injuries: From past to present

Abstract

Background and aims: today, a significant proportion of solid abdominal organ injuries, whether caused by penetrating or blunt trauma, are managed nonoperatively. However, the controversy over operative versus nonoperative management started more than a hundred years ago. the aim of this review is to highlight some of the key past observations and summarize the current knowledge and guidelines in the management of solid abdominal organ injuries. Materials and Methods: a non-systematic search through historical articles and references on the management practices of abdominal injuries was conducted utilizing early printed volumes of major surgical and medical journals from the late 19th century onwards. Results: until the late 19th century, the standard treatment of penetrating abdominal injuries was nonoperative. the first article advocating formal laparotomy for abdominal gunshot wounds was published in 1881 by sims. after World War i, the policy of mandatory laparotomy became standard practice for penetrating abdominal trauma. during the latter half of the 20th century, the concept of selective nonoperative management, initially for anterior abdominal stab wounds and later also gunshot wounds, was adopted by major trauma centers in south africa, the united states, and little later in europe. in blunt solid abdominal organ injuries, the evolution from surgery to nonoperative management in hemodynamically stable patients aided by the development of modern imaging techniques was rapid from 1980s onwards. Conclusion: With the help of modern imaging techniques and adjunctive radiological and endoscopic interventions, a major shift from mandatory to selective surgical approach to solid abdominal organ injuries has occurred during the last 30-50 years.

Surgical management of traumatic pancreatic injuries and their consequences.

“…3 The current literature shows clear tendency toward utilization of NOM of pancreatic trauma. 5,10,15,23 In the same line, we successfully implemented NOM in 9 patients (28%) with evidence of pancreatic injuries not involving the pancreatic duct. However, 2 patients developed pancreatic-trauma related consequences after initial discharge.…”

“…5 Pancreatic trauma might trigger several consequences including pancreatic leaks, abscesses, pseudocysts, pancreatitis and pancreatic necrosis. [6][7][8][9][10] The risk of complications and mortality should be considered with extensive parenchymal and ductal injuries as well as when the diagnosis is delayed. 11,12 Evaluation of the extent of pancreatic injury by various imaging techniques in the setting of abdominal trauma might be demanding.…”

“…5 During surgical management, location of injury decisively determines the optimal surgical intervention that can be applied on individual basis. 3,10 Studies from Egyptian trauma centers have not adequately highlighted the subject of pancreatic trauma. Therefore, we will address for the first time traumatic pancreatic injuries with regard to types, grades, management strategies and clinical outcome at the emergency and trauma unit, Department of Surgery, Sohag University Hospital.…”

Is early chemical thromboprophylaxis in patients with solid organ injury a solid decision?

“…The advent of ultrasonography and computed tomography allowed clinicians to accurately evaluate solid organ injuries without the need for surgical exploration. (9) There are often overlapping priorities in the management of patients with solid organ injuries. While hemostasis at the injury site takes precedence over other management considerations, these patients are at risk of venous thromboembolic events (deep vein thrombosis and/or pulmonary embolism), especially when they meet all elements of the Virchow triad (hypercoagulability, stasis, endothelial injury) (10).…”

Nonoperative management of splenic injury in closely monitored patients with reduced consciousness is safe and feasible

“…The spleen is the most frequently injured intra-abdominal organ [1, 2]. Treatment of blunt splenic injury has undergone an extensive change over the past decades [3–5]. Currently, selective nonoperative management (NOM) is the preferred treatment and is used in up to 70% of patients [6–9].…”