scholarly journals Non-Operative Management of Blunt Abdominal and Retroperitoneal Solid Organs Trauma, with Retroperitoneal Hemorrhage – Indications, Methodology and Necessity

2021 ◽  
Vol 10 (3) ◽  
pp. 540-548
Author(s):  
V. V. Aleksandrov ◽  
S. S. Maskin ◽  
N. K. Yermolayeva ◽  
V. V. Matyukhin
Keyword(s):  
Blunt Trauma ◽  
Treatment Option ◽  
Abdominal Cavity ◽  
Operative Management ◽  
Retroperitoneal Space ◽  
Retroperitoneal Hemorrhage ◽  
Actual Problem ◽  
Wide Range ◽  
Non Operative Management

Introduction. The article is devoted to an actual problem — blunt trauma of the abdomen and organs of the retro­peritoneal space.Aim of study. Specify the indications for non­operative management of patients with blunt trauma of the solid organs of the abdominal cavity, retroperitoneal space, with retroperitoneal hemorrhage and measures for this treatment option.Material and methods. The analysis of literature sources of Russian and foreign authors is carried out and the indications, methods and necessity of non­operative management of patients with blunt trauma of solid organs of the abdominal cavity and retroperitoneal space, retroperitoneal hemorrhages are substantiated.Conclusion. Non­operative management of patients with blunt trauma of solid organs of the abdominal cavity and retroperitoneal space, retroperitoneal hemorrhages is possible only in large specialized centers with a wide range of diagnostic and therapeutic capabilities.

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 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 Damage control surgery for splenic trauma: "preserve an organ - preserve a life"

2021 ◽  
Vol 52 (2) ◽  
pp. e4084794
Author(s):  
Carlos Serna ◽  
José Julian Serna ◽  
Yaset Caicedo ◽  
Natalia Padilla ◽  
Linda M Gallego ◽  
...  
Keyword(s):  
Damage Control ◽  
Abdominal Cavity ◽  
Damage Control Surgery ◽  
Operative Management ◽  
Splenic Trauma ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Arterial Bleeding ◽  
Non Operative Management ◽  
Injured Patients

The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.

scholarly journals Splenic artery embolisation in the non-operative management of blunt splenic trauma in adults

2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Richard J. Cormack ◽  
Mollie C.M. Ferris ◽  
Jason K. Wong ◽  
Stefan Przybojewski
Keyword(s):  
Blunt Trauma ◽  
Vascular Injury ◽  
Splenic Artery ◽  
Splenic Injury ◽  
Operative Management ◽  
Trauma Centre ◽  
Splenic Trauma ◽  
Non Operative Management ◽  
Splenic Salvage ◽  
Salvage Rate

Background: The purpose of this study was to evaluate the splenic salvage rate with angioembolisation in the non-operative management (NOM) of blunt splenic injury.Methods: We conducted a retrospective analysis of patients presenting to our Level I trauma centre with computed tomography (CT)-confirmed splenic injury following blunt trauma and in whom angioembolisation was utilised in the algorithm of NOM. Data review included CT and angiography findings, embolisation technique and patient outcomes.Results: Between January 2005 and April 2010, 60 patients with splenic injury following blunt trauma underwent NOM, which included splenic artery embolisation (SAE). All patients included in the study required a preadmission. CT scan was used to document the American Association for the Surgery of Trauma (AAST) grade of splenic injury. The average injury grade was 3.0. The non-operative splenic salvage rate following SAE was 96.7% with statistically similar salvage rates achieved for grades II to IV injuries. The quantity of haemoperitoneum and the presence of a splenic vascular injury did not significantly affect the splenic salvage rate. The overall complication rate was 27%, of which 15% were minor and 13% were major.Conclusion: SAE is a safe and effective treatment strategy in the NOM of blunt splenic injury. The quantity of haemoperitoneum, the presence of vascular injury and embolisation technique did not significantly affect the splenic salvage rate.

scholarly journals A comparison of case series comparing Non Operative Management vs Operative Management of splenic injury after blunt trauma.

2014 ◽  
Vol 20 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Roberto Cirocchi ◽  
Alessia Corsi ◽  
Elisa Castellani ◽  
Francesco Barberini ◽  
Claudio Renzi ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Splenic Injury ◽  
Case Series ◽  
Operative Management ◽  
Non Operative Management

scholarly journals Parameters for therapeutic laparotomy in blunt trauma abdomen

2018 ◽  
Vol 6 (1) ◽  
pp. 159
Author(s):  
Younis Ahmad ◽  
Arshid Iqbal Qadri ◽  
Iqtibas Ahmad Ganie ◽  
Muqtasid Rashid ◽  
Gowhar Aziz Bhat
Keyword(s):  
Blunt Trauma ◽  
Scoring System ◽  
Clinical Laboratory ◽  
Recursive Partitioning ◽  
Operative Management ◽  
Rapid Identification ◽  
Large Sample Size ◽  
Radiological Parameters ◽  
Life Threatening ◽  
Non Operative Management

Background: The rapid identification of potentially life threatening intra-abdominal injury is critical for patients who sustain blunt abdominal trauma. There has been a shift from operative to non-operative management (NOM) in hemodynamically stable blunt trauma abdomen patients. The aim of present study was to determine the certain clinical and radiological parameters for therapeutic laparotomy (TL) in blunt trauma abdomen in adult patients.Methods: A prospective observational study was conducted on victims of blunt trauma who presented to our level II Emergency Department from May 2012 to June 2014. Their clinical, laboratory and radiological parameters were collected, evaluated and analyzed. A previously developed ultrasound scoring system was applied to FAST findings. Patients were followed to determine if they underwent TL or NOM.Results: A total of 7750 polytrauma patients with suspected blunt trauma abdomen underwent FAST. 338 (4.36%) patients had a positive FAST, out of which 144 were included, 93 (64.58%) patients were selected for NOM, and 51 (35.4%) patients underwent TL. NOM was successful in 76 (81.73%) patients, whereas 17 (18.27%) failed NOM and were operated. Using recursive partitioning analysis, the most important predictor for a TL, was whether the patient has an ED SBP of ≤90mmHg while other parameters include, ED pulse rate >110/min; total fast score >3; large amount of hemoperitoneum; presence of abdominal guarding, pallor and polytrauma.Conclusions: There are certain immediately available clinical, and radiological parameters, which if validated by a prospective, large sample size study could help in deriving a decision rule or even a scoring system that would determine the need for therapeutic laparotomy in blunt trauma abdomen patients.

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