scholarly journals Non operative management of a patient with splenic trauma with angioembolisation after delayed presentation

2019 ◽  
Vol 6 (9) ◽  
pp. 3412
Author(s):  
Deepak Paul ◽  
Thomas K. Thomas ◽  
Dayananda Babu ◽  
Rajan Janardhanan ◽  
Ribin Christhudas
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Operative Management ◽  
Organ Injury ◽  
Splenic Trauma ◽  
Solid Organ ◽  
Delayed Presentation ◽  
Mortality And Morbidity ◽  
Common Causes ◽  
Non Operative Management

Road traffic accidents are one of the most common causes of death in India. Those involved in RTA’s frequently suffer from solid organ injury, spleen being the second most common organ involved. Splenic injuries are associated with great deal of mortality and morbidity. Splenic injuries were classically treated with splenectomy but there has been a paradigm shift to non-operative management in recent times leading to splenic salvage and preservation of function of the spleen. This report is about a lady who was managed successfully with angioembolization in spite of the fact that the patient presented late after RTA. 

scholarly journals Management of blunt trauma abdomen in a tertiary care teaching hospital: a surgical audit

2018 ◽  
Vol 5 (6) ◽  
pp. 2177
Author(s):  
Shashikumar H. B. ◽  
Madhu B. S. ◽  
Ajo Sebastian
Keyword(s):  
Blunt Trauma ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Tertiary Care ◽  
Operative Management ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Surgical Audit ◽  
Non Operative Management

Background: Blunt abdominal trauma is a common scenario in Emergency department and the common cause being road traffic accidents. With this study we present our experience with blunt trauma of abdominal solid organ injuries over a period of 12 months.Methods: A retrospective study was conducted among 45 blunt trauma of abdominal solid organ injuries who presented to the emergency room of Department of General Surgery of Mysore Medical College and Research Institute, Mysore from 1st January 17 to 31st December 2017.All date were retrieved from medical records and statistical analysis was performed using Epi info version 7.Results: Mean age of study population was 31.46 years. 78.2% of the patients were males. Thirty-three (73.3%) patients undergone non-operative management. Splenic injury was reported as the most common abdominal solid organ injury followed by liver.Conclusions: With the advent of newer investigative modalities like contrast enhanced computed tomography (CECT) abdomen, more and more cases of blunt trauma abdominal solid organ injury can be managed non-operatively with effective ICU care. High-grade injuries do not preclude non-operative management.

scholarly journals Solid organ injury in blunt trauma abdomen: an etiological evaluation and success rate of non-operative management

2018 ◽  
Vol 5 (4) ◽  
pp. 1350
Author(s):  
Ramachandra M. L. ◽  
Krishna S. R.
Keyword(s):  
Blunt Trauma ◽  
Surgical Management ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Operative Management ◽  
Abdominal Injury ◽  
Organ Injury ◽  
Free Fluid ◽  
Road Traffic Accidents ◽  
Non Operative Management

Background: Trauma remains the most common cause of death for all individuals between the ages of 1 and 44 years. 10% of these fatalities are attributable to abdominal injury. The Indian fatality rates for trauma are 20 times that for developed countries. The management of patients with blunt abdominal injury has evolved greatly over the last few decades from complete surgical management historically to present non operative management in most of the cases. In view of increasing number of road traffic accidents, rampant increase in construction work, accidental fall from height, this study is conducted to look into the causes of such incidents and also to strengthen the already established rules of non operative management in cases of blunt trauma abdomen.Methods: This is a prospective study of 53 patients who presented to K. R. Hospital, Mysuru, Karnataka, for management of blunt trauma abdomen over the period of January 2016 to June 2017. Unstable patients with initial resuscitation underwent Focused Assessment Sonography for Trauma. Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen. Organ injuries were scaled according to the American Association for the Surgery of Trauma and these patients were managed conservatively after ruling out hollow viscus perforation.Results: Majority of the patients belonged to male sex (85%) and of the age group 21-40 years constituting 58.3% of patients. Road traffic accident was the most common mode of injury which included 35 patients (66%). A total of 19 cases had splenic injury out of which 13 (68.5%) underwent non operative management and 6 (31%) underwent emergency Splenectomy. liver injury was present in 15 patients and all were managed conservatively. In total non operative management was done in 73.5% of cases and surgical management was done in 26.5% of cases.Conclusions: The presence of free fluid with organ injury always does not mandate laparotomy. Patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in non operative management of blunt trauma abdomen. RTA being the most common mode of injury, adequate measures should be taken to prevent road traffic accidents by strict action and traffic norms and citizen education.

scholarly journals A prospective and retrospective study on conservative management of hepatic and splenic injury following blunt abdominal trauma

2020 ◽  
Vol 7 (6) ◽  
pp. 1930
Author(s):  
Induchoodan Ponnamma Pillai Sukumaran Nair ◽  
Rajesh P. S.
Keyword(s):  
Abdominal Trauma ◽  
Conservative Management ◽  
Blunt Abdominal Trauma ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Road Traffic ◽  
Operative Management ◽  
Splenic Trauma ◽  
Solid Organ ◽  
Non Operative Management

Background: worldwide road traffic accidents accounts as the leading cause of death of young people. For a very long time most of the intra-abdominal injuries following blunt abdominal trauma were managed operatively. Conservative management is becoming more acceptable and effective management option for blunt abdominal trauma during the last few decades.Methods: This study was conducted in Government Medical College, Kottayam during September 2007 to December 2008. All conservatively managed blunt abdominal trauma patients during the study period were included in the study.Results: Out of 22 patients, 4 patients failed conservative management. Success rate was 81%. Most commonly injured solid organ in the study group was liver (77%). Maximum cases were of age group 10 to 20 (31.81%) years. 81% of patients were males. Motor vehicle accident was the most common cause of trauma (77%). Mean stay in intensive care unit was 4.2 days and mean hospital stay was 15.7 days. Mean systolic blood pressure was 110 mmHg ranging from 70 to 130 mmHg. 50% of patients had moderate hemoperitoneum and non-had massive hemoperitoneum.Conclusions: Non operative management is safe and effective approach in blunt spleen and liver injuries. Non operative management should be treatment of choice for all hemodynamically stable patients with blunt liver and splenic trauma.

scholarly journals 90 Penetrating Abdominal Trauma: Comperative Study Between Operative and Conservative Management

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Shalaby ◽  
M Ibrahim ◽  
T El Faioumy ◽  
M Elmessiry
Keyword(s):  
Abdominal Trauma ◽  
Operative Management ◽  
The Other ◽  
University Hospital ◽  
Organ Injury ◽  
Low Grade ◽  
Trauma Patients ◽  
Solid Organ ◽  
Penetrating Abdominal Trauma ◽  
Non Operative Management

Abstract Aim to Assess the feasibility and safety of selective non-operative management in penetrating abdominal injuries and to identify a protocol for selection of patient’s candidates for non-operative management. Method In this comparative study 40 abdominal stab victims (admitted to Emergency Department of Alexandria Main University Hospital) were selected during 6 months period where 20 patients were suitable for non-operative management according to strict selection criteria whereas the other 20 patients were operated according to clinical and/or radiological indications or on basis of department protocol, the results were compared in view of final outcome. Results In our study, 15 patients were assigned for operative management according to selected clinical and/or radiological indications only 3 of them (20%) had non-therapeutic laparotomies, On the other hand, five patients were explored on basis of department protocol in violation of our indications for exploration; four of them (80%) were non-therapeutic. So, the rate of non-therapeutic laparotomies was significantly higher when done mandatory without selected clinical and radiological indications. Conclusions Assessment of vital signs together with abdominal examination are the most important and dependable tools in decision making in penetrating abdominal trauma patients. Patients with shock on admission (but responding to resuscitation), proved low grade solid organ injury (by CT), and proved intraperitoneal collection (by US or CT) could be managed conservatively regarding that they remain vitally and clinically stable. If failure of conservation occurs, it is usually during the 1st 24 hours after admission.

Selective non-operative management of solid organ injury following abdominal gunshot wounds

Injury ◽  
2007 ◽  
Vol 38 (9) ◽  
pp. 1084-1090 ◽  
Author(s):  
Joseph DuBose ◽  
Kenji Inaba ◽  
Pedro G.R. Teixeira ◽  
Antonio Pepe ◽  
Michael B. Dunham ◽  
...  
Keyword(s):  
Gunshot Wounds ◽  
Operative Management ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Non Operative Management ◽  
Abdominal Gunshot Wounds

scholarly journals Renal trauma: a 5-year retrospective review in single institution

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Syarif ◽  
Achmad M. Palinrungi ◽  
Khoirul Kholis ◽  
Muhammad Asykar Palinrungi ◽  
Syakri Syahrir ◽  
...  
Keyword(s):  
Operative Management ◽  
Organ Injury ◽  
Renal Trauma ◽  
Solid Organ ◽  
Mechanism Of Injury ◽  
Current Management ◽  
Injury Management ◽  
Icd 10 ◽  
Non Operative Management ◽  
Overall Mortality

Abstract Background Renal trauma occurs in up to 5% of all trauma cases and accounts for 24% of abdominal solid organ injuries. Renal trauma management has evolved over the past decades, and current management is transitioning toward more conservative approaches for the majority of hemodynamically stable patients. The objective of this study was to analyze the mechanism of injury, management, and outcome in renal trauma. Methods Patients diagnosed with renal trauma in Makassar, Indonesia, from January 2014 to December 2018 were identified retrospectively by the ICD-10 code. Data were collected from medical records. Imaging was classified by radiologists. Variables analyzed included age, sex, mechanism of injury, degree of renal trauma, related organ injury, management, and outcome. Results Out of the 68 patients identified, the average age was 23.9 ± 0.6 years, and most were male (83.8%). Blunt trauma accounted for 89.7% of all cases. The most common renal injuries were grade IV (42.6%), and 14% of the cases had no hematuria. Most patients were treated with non-operative management (NOM). Nephrectomy was performed in 16.2% of cases, and 5.9% of cases underwent renorrhaphy. It was found that 58.8% of cases had isolated renal trauma, and the overall mortality rate (2.9%) was due to related injuries. Conclusions The majority of blunt and penetrating renal trauma cases that are hemodynamically stable have a good outcome when treated with NOM. The presence of injury in other important organs both intra- and extra-abdominally aggravates the patient’s condition and affects the prognosis.

scholarly journals Studying the clinical profile of blunt hepatic trauma

2021 ◽  
Vol 8 (3) ◽  
pp. 869
Author(s):  
Vijay Pal ◽  
Bhavinder Kumar Arora ◽  
Rohit Singh ◽  
Gourav Mittal ◽  
Monika Shekhawat ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Conservative Management ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Operative Management ◽  
Significant Shift ◽  
Solid Organ ◽  
Hepatic Trauma ◽  
Blunt Hepatic Injury ◽  
Surgery Department

Background: The liver is the largest intra-abdominal organ and is considered to be the second commonest organ to be injured in blunt abdominal trauma. Blunt hepatic injuries due to road traffic accidents are the sixth leading cause for death in India. Approximately 15-20% of abdominal injury presents as hepatic trauma and is liable for 50% of death resulting from abdominal trauma. The mortality rate is higher with blunt hepatic trauma than penetrating injuries. The advent of improved and expeditious imaging technologies amid advances in critical-care monitoring, prompted a significant shift towards conservative management of solid-organ abdominal injuries.Methods: The study was conducted over 96 patients in General Surgery Department, PGIMS, Rohtak with a history of blunt hepatic injury. The study duration was from 16th May 2018 till 1st June 2020. The aim of the study was to evaluate the pattern of blunt hepatic trauma and the patterns with which they presented in the emergency department.Results: In this study, 98.96% of the patients were managed conservatively whereas only 1.04% of patients needed surgical intervention. Conservative approach was possible because of strict patient monitoring, availability of experienced surgeons and radiologists, good intensive care unit care.Conclusions: The study concluded that conservative management of the patient is better than operative management and can be done in the patients who are hemodynamically stable. Most of the patients settle after 48 hours if managed conservatively.  

scholarly journals Modalities in the management of splenic trauma

2020 ◽  
Vol 7 (9) ◽  
pp. 2940
Author(s):  
Swetha B. M. ◽  
Santosh Raja Erabati ◽  
V. V. Harika Majji
Keyword(s):  
Conservative Management ◽  
Road Traffic ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Splenic Trauma ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Hemodynamic Status ◽  
Fall From Height ◽  
Non Operative Management

Background: The aim of the study to study the modalities in the management of splenic trauma. Factors affecting non operative management in order to improve the outcome of conservative management, and the factors responsible for conversion to operative management.Methods: 30 patients were admitted in the Department of Surgery, NRI Institute of Medical Sciences, Visakhapatnam, satisfying the inclusion criteria between 01 June 2016 to 31 August 2018.Results: A cross-sectional type of study was performed. Among the 30 patients, 21 were male and 9 were female. It was seen that in 80% of patients the mode of injury was road traffic accident. Human assault, animal attack and fall from height contributed to 6.66% each. The most common reason for conversion to operative management was fragile hemodynamic status of the patient. 20% of the cases were grade I, 40% grade II, 26.66% grade III, 6.66% each of grade IV and grade V, all cases of grade IV and grade V were managed operatively. In this study 60% of the cases could be managed conservatively, 1 case (3.33%) splenorraphy was done. 33.3% (1/3rd) patients required splenectomy, and 1 (3.33%) patient expired who presented late and with hemodynamic instability, belonged to grade V splenic injury.Conclusions: Conservative management has replaced splenectomy as the most common method of splenic trauma management in patients with stable hemodynamic status. Higher grades of splenic injuries have been managed conservatively. As a result, 60% of all blunt splenic injuries can be managed non-operatively with a success rate of 98%. Operative management associated with stringent intensive care unit (ICU), transfusions are restricted to higher grades of splenic injuries.

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