No need for surgery? Patterns and outcomes of blunt abdominal trauma

Abstract

IntroductionThe management of a patient suffering from blunt abdominal trauma (BAT) remains a challenge for the emergency physician. Within the last few years, the standard therapy for hemodynamically stable patients with BAT has transitioned to a non-operative approach. The purpose of this study is to evaluate the outcome of patients with BAT and to determine the reasons for failure of non-operative management (NOM).Materials and methodsAnalysis of 176 consecutive patients treated for BAT was conducted in a German level 1 trauma center from 2004 to 2011. Abdominal injuries were classified according to the American Association for the Surgery of Trauma (AAST). Patients included were demonstrated to have objective abdominal trauma with either free fluid on focused assessment with sonography for trauma (FAST) or computed tomography (CT), or proven organ injury.ResultsPatients, 142 of 176 (80.7%), with BAT were initially managed non-operatively, with a success rate of 90%. The rates of NOM success were higher among those with less severe injuries; 100% with Abbreviated Injury Scale (AIS) of 1. In total, 125 patients (71.0%) were managed non-operatively, and 51 (29.0%) required surgical intervention. NOM failure occurred in 9.2% of the patients, the most common reason being initially undiagnosed intestinal perforation (46.2%). Positive correlation was identified (r = 0.512; p < 0.001) between the ISS (injury severity score) and the NACA (National Advisory Committee of Aeronautics) score. The delay in operation in NOM failure was 6 h in patients with underlying hepatic or splenic rupture and 34 h with intestinal perforation. The overall mortality of 5.1% was attributed especially to old age (p = 0.016), high severity of injury (p < 0.001), and greater need for blood transfusion (p < 0.001).ConclusionNOM was successful for the vast majority of blunt abdominal trauma patients, especially those with less severe injuries. NOM failure and operative delay were most commonly due to occult hollow viscus injury (HVI), the detection of which was achieved by close clinical observation and abdominal ultrasound in conjunction with monitoring for rising markers of infection and by multidetector computed tomography (MDCT) if additionally indicated. Based on this concept, the delay in operation in patients with NOM failure was short. This study underscores the feasibility and benefit of NOM in BAT.

Lessons learned from blunt trauma abdomen: Surgical experience in level I trauma centre

“…In our study, the initial nonoperative treatment rate was 58.44%, with an approximate success rate of 90%, a finding which is higher as compared with other reported series (32). We accept that the complication rate of 16.88% and the surgical intervention rate of 37% in our study was higher but comparable with the other reported studies where the reported rate was 10 to 27% (33,34). The learning curve of the treating trauma team as well as the supporting paramedical staff was one of the predominant contributory factors.…”

Transhepatic glue injection for hepatic pseudoaneurysm and arteriohepatic venous fistula after the failure of transarterial embolization

“…4,5,8,10,11 Currently, primary surgery is only necessary to treat severe hepatic injury cases associated with hemodynamic instability. 10,11,23,24 Our patient presented with a grade V liver injury. Although the patient's hemodynamics were initially unstable, the patient responded to fluid resuscitation, enabling hemostatic treatment by interventional radiology.…”

Missed abdominal injury: why and how to deal? A retrospective interventional study

“…The fatality depends on the delay in emergency laparotomy and advanced age. 17,18 So, the success of operating management in NOM patients going for surgery and primary operating management depends on the perfect timing of surgery. Young people tolerate delay better then elderly, single organ better than multiple and small surface of bleed than larger.…”

“…Young people tolerate delay better then elderly, single organ better than multiple and small surface of bleed than larger. 16,17,18 . There were 20 of 72(27.7%) patient, who required operative management, without thinking of failure but to save life.…”