Selective Non-Operative Management of Ballistic Abdominal Solid Organ Injury in the Deployed Military Setting

Abstract

This article describes the non-operative management of five patients with ballistic abdominal solid organ injuries in a role 2E medical treatment facility. The selective non-operative management of ballistic abdominal solid organ injury is an accepted management strategy in high-volume civilian trauma centres, and appears to be equally safe and effective in the deployed military setting.

Liver Trauma - Operative Management

“…This has been brought about in conjunction with the wider availability of axial imaging and endovascular techniques aiding diagnosis and haemorrhage control in stable patients ( Figure 1 and 2) [8,9]. Battlefield liver trauma is still almost always managed operatively [10,11], although SNOM of battlefield liver injury has also been reported recently [12][13][14], but has yet to become accepted practice.…”

Military treatment of splenic injury in the era of non-operative management

“…Five cases of successful SNOM of ballistic abdominal solid organ injuries in local national patients have been reported, though none had splenic injury and follow-up was limited; it was concluded that this method was suitable for carefully selected patients 24. This was also the conclusion of the Academic Department of Military Surgery and Trauma Torso Trauma Working Group which produced guidelines on this topic after examination of the published evidence, much of it civilian, and discussion of personnel deployed 25…”

The principles of non-operative management of penetrating abdominal injury

“…Many of these patients had associated renal, diaphragmatic, or pulmonary injuries (Navsaria et al., 2009; Omoshoro-Jones et al., 2005). The combination of right renal and hepatic injury, sometimes also associated with diaphragmatic and pulmonary injury, is recognised as a distinct entity which, despite its complexity, may be amenable to non-operative management (Renz and Feliciano, 1994; Velmahos et al., 1998; Wood et al., 2010). This is in contrast to left-sided injuries, which are probably more commonly associated with hollow viscus injuries.…”