Title: A Study of Safety and Outcome of Non Operative Management of Blunt Abdominal Trauma
Authors: Dr R.K Meher, Dr Dhirendranath Soren, Dr Dharbind Kumar Jha
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.42
Abstract
Blunt trauma continues to be the most common mechanism of injury to the abdomen. Now with the improvement in diagnostic & therapeutic intervention, modern treatment tilts more towards non-operative management of blunt trauma abdomen .This is a prospective study of 100 cases of blunt abdominal trauma, Managed in the Department of surgery S.C.B Medical college & hospital, Cuttack during the period from july 2010- 0ct 2012, with special emphasis on non operative management based on clinico radiological examination. In this study,Males out number female in the ratio of 4:1 and the age ranging from 4 years to 69 years. Majority of cases were victims in 2nd, 3rd and 4th decades taking a toll of 71.25% of cases. Road traffic accident being the commonest cause.
Abdominal pain, tenderness, rigidity, shock, pallor, absence of bowel sounds and distension were the common manifestations found in patients with blunt abdominal injuries.
USG abdomen was the important tool in unstable patients to detect hemoperitoneum (61.3%) and to decide the protocol in stable patients for conservative management. However it missed 9 patients with splenic injuries, 5 with liver injuries, 3 with kidney injuries. It is a poor tool to detect kidney, pancreas, bowel and mesenteric injuries.
CECT abdomen is the most important tool in grading the organ injuries and deciding conservative management. CT detected 37 splenic injuries of which 29 were managed conservatively. 21 liver injuries were detected of which 16 were managed conservatively &5 cases of kidney injury were detected all of which were managed conservatively.
66 patients with blunt abdominal injury were managed conservatively. Spleen is the most common organ injured that managed conservatively. Out of 37 splenic injuries 29 were managed conservatively. Other organs which were managed conservatively are liver (16), kidney (5), bladder (2), pancreas (1) and mesentery (2).
Only one patient in the conservative group developed pseudocyst of pancreas. Another patient developed clot retention. The hospital stay period in the conservative group was 9-12 days.
There was no mortality in the conservative group. The overall mortality was 4% all in the operative group. The mortality was due to associated organ and system injuries.
The advent of sophisticated imaging technologies and adjunctive minimally invasive techniques has somewhat lightened the trauma surgeon's operative burden. Despite that, more than ever, nothing surpasses the value of repeated clinical assessment by an experienced trauma surgeon, in guiding the ultimate therapeutic decisions. After all, the ultimate default pathway for severely injured trauma patients who failed non operative management is the operating theatre.
