Blunt abdominal trauma: watch and wait

Abstract

Purpose This review examines recent advancements in nonoperative management (NOM) of hemodynamically stable blunt abdominal trauma, focusing on expanding patient selection for observation-first strategies, particularly for high-grade solid organ injuries. Recent Findings Advances include a more deliberate nonoperative approach, allowing for broader patient inclusion in diagnostic and interventional angiography. Strict clinical monitoring and appropriate follow-up strategies are crucial to identify early signs of clinical progression and complications. Repeated contrast-enhanced CT (CECT) scan can be used for close observation of high-risk injuries, while the repetition of CECTs may be avoided for lower-risk cases, such as specific high-grade kidney injuries. The role of contrast-enhanced ultrasound (CEUS) in detecting sequelae of nonoperative approaches is still debated and has lot of potential, with ongoing trials exploring possible advantages. Summary Multidisciplinary trauma teams play a crucial role in nonoperative management, particularly for high-grade injuries. A careful selection of patients is essential to minimize failure rates. Complications of nonoperative and angiographic approaches should be managed according to local expertise.

Editorial: Acute trauma management in a changing environment

“…Surgical damage control is now used in conjunction with damage control resuscitation to restore physiology and prevent further collapse. Chung and Scalea critically review this concept and highlight potential risks when being overused, in particular along with damage control laparotomy [9]; subsequently, Cioffi et al provide current evidence and guidance for the nonoperative management of blunt abdominal trauma in hemodynamically stable patients [10]. In mangled extremities where integrity and viability are in danger, the decision of primary amputation versus limb salvage becomes critical.…”