Non operative management of blunt abdominal trauma

Non operative management of blunt abdominal trauma

• 1.
  Issue 1 Non OperativeManagement of Blunt Abdominal Trauma BY Prof. Hesham Amer Prof. of General Surgery Cairo University
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  • Liver andspleen: 75% of injuries in blunt trauma. • Bleeding frequently stops:67% non therapeutic laparotomy after D.P.L. • Routine laparotomy in mild cases Morbidity ⇨ untoward splenectomy Mortality-⇨ Liver injures in less experienced hands. Rationale Blunt trauma
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  Pre-requisites • Hemodynamically stable(less than 2 units of red blood cells in hepatic injury). • Hellical C.T. with I.V. contrast. • Close clinical observation (Neurologically intact patient). • Serial hematocrit studies. • Angiographic services is valuable. Blunt trauma
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  Why C.T. I Diagnosis of holloworgan injury. II Grading injuries : Liver Spleen Suggest angiographic intervention III
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  Liver G.II: *S.C hematoma 10-50% * Laceration 1-3 cm length <10 cm Injury scale G.I: *S.C. hematoma <10% *Laceration: depth <1cm Spleen G.I: *S.C. hematoma <10% *Laceration: depth <1cm G.II: *S.C hematoma 10-50 % * Laceration 1-3 cm Blunt trauma
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  Liver G.IV: parenchymal disruption 25-75% of a lobe Injury scale G.III: *S.C. hematoma >50% or parenchymal. *Laceration: depth >3cm Spleen G.III: *S.C. hematoma >50% or parenchymal >5 cm or expanding G.IV: * Laceration involving segemental or hilar vessels major devascularization Blunt trauma
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  Liver G.VI: Liver avulsion Injury scale G.V: Parenchymal disruption>75 % . *Juxta hepatic venous injury Spleen G.V: Shattered spleen. hilar vessels major devascularization Blunt trauma
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  Follow up Clinicalobservations 1. Increasing distension 2.Increasing peritonism (not initial). 3.Shock index : HR/ syst BP if > 0.9 suggests a decompensated stage ⇨ invasive monitoring Blunt trauma
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  Details of Management Repeat imaging Bedrest 3- 5 days ICU or regular wards angiography Vigorous physical activities 3-6 m Blunt trauma
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  Concerns on adaptingnon operative treatment IV- Increased transfusio n needs I - Missed hollow organ injury 2-3 % II- Decompensat ion: Sudden or gradual III – Infective complications : •Blood •Bile •Devitalized liver Blunt trauma
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  Results of prospectivestudies Liver 67% in adults & 80% in pediatrics Spleen 50-60% meet criteria >95 % 85%
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  Results of prospectivestudies Non operative Intra-abdominal complications : More operative Liver related complications : Less Mortality of liver injures : Less Need for blood : Not greater Blunt trauma